Chapter 7 Physical Disabilities and Health Problems

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Chapter 7Physical Disabilities and Health

Problems


Physical Disabilities and Health Impairments

• Physical impairments that relate to problems involving skeleton, joints, and muscles

• Health conditions related to limited strength, vitality, or alertness due to chronic or acute health problems


Cerebral PalsyCerebral Palsy

Cerebral refers to the brain.

Palsy refers to weakness, paralysis or lack of muscle control.


Physical Disabilities

• Cerebral palsy—neurological disorders resulting in lack of control of muscle movements: – Spasticity—the muscles are spastic. They do

not contract and flex as they should.– Hypotonicity—the muscles are floppy.– Athetosis—fluctuating or uneven muscle tone.– Ataxia—lack of motor coordination.– Mixed—combination of two or more.


Physical Disabilities (continued)

• Classifications based on body parts– Diplegia—all four extremities– Hemiplegia—one side of the body– Paraplegia—legs only– Quadripelgia—arms, legs, trunk, and head

control


Causes of Cerebral Palsy

Some of the causes of cerebral palsy include:

• blood type incompatibility between mother and infant

• premature birth • bacterial infection of the mother,

fetus or infant affecting the central nervous system

• loss of oxygen to the infant during birth

• physical injuries during or following birth

• lack of growth factors during intra-uterine development

• inability of placenta to provide the fetus with oxygen and necessary nutrients


What are the characteristics of cerebral palsy?

Cerebral palsy can be grouped into three main types which describe the disorders or movement and posture that may be experienced by a person.

These are called spasticity, athetosis and ataxia.


Cerebral Palsy

• Spasticity occurs when muscles are high in tone (tension) but weak in strength. A person experiencing spasticity may have difficulty moving their limbs and adopting stable posture.

• Athetosis refers to uncontrolled movements, which are often most noticeable when a person with this type of cerebral palsy commences movement. In addition, children with athetoid cerebral palsy often have very weak muscles or feel floppy when they are carried.

• Ataxia is characterized by unsteady, shaky movements or tremor. People with ataxic cerebral palsy and related disabilities have difficulty using muscles to achieve balance and coordinated movement. This is the least common type of cerebral palsy and related disabilities.


What part of the body is affected by cerebral palsy?

Specific words are used to describe the parts of the individual's body that are affected. DiplegiaBoth legs and both arms are affected, but the legs are significantly more affected than the arms. Children with diplegia usually have some clumsiness with their hand movements.

HemiplegiaThe leg and arm on one side of the body are affected.

QuadriplegiaBoth arms and legs are affected. The muscles of the trunk, face and mouth can also be affected.



• Spinal cord injuries– Spina bifida—imperfect development of the

spinal cord in utero• Hydrocephalus—build up of fluid on the brain• Incontinence—lack of control over bladder and

bowel movements


Spina Bifida

Spina Bifida means cleft spine, which is an incomplete closure in the spinal columnIn general, the three types of spina bifida (from mild to severe) are:

• Spina Bifida Occulta: There is an opening in one or more of the vertebrae (bones) of the spinal column without apparent damage to the spinal cord.

• Meningocele: The meninges, or protective covering around the spinal cord, has pushed out through the opening in the vertebrae in a sac called the "meningocele." However, the spinal cord remains intact. This form can be repaired with little or no damage to the nerve pathways.

• Myelomeningocele: This is the most severe form of spina bifida, in which a portion of the spinal cord itself protrudes through the back. In some cases, sacs are covered with skin; in others, tissue and nerves are exposed. Generally, people use the terms "spina bifida" and "myelomeningocele" interchangeably.


Effects of Spina Bifida

Depending on the severity and location of the defect, people who have spina bifida can experience a wide range of medical complications, including:

• Allergic reactions caused by prolonged exposure to latex • Bladder, bowel and kidney problems • Eye problems • Fractures • Hydrocephalus (excess fluid on the brain) • Learning disorders • Seizures • Skin problems • Tethered spinal cord • Weight gain


Children with Spina Bifida



• Muscular dystrophy—progressive weakening of the muscles– Duchenne’s disease—affects only boys;

weakness begins at hips and shoulders and moves to arms and legs.

• Hip dysplasia—hip moves in and out of socket.– Usually found in girls and treated with braces


MUSCULAR DYSTROPHIES:

• Duchenne Muscular Dystrophy (DMD)(Also known as Pseudohypertrophic)

• Becker Muscular Dystrophy (BMD) • Emery-Dreifuss Muscular Dystrophy (EDMD) • Limb-Girdle Muscular Dystrophy (LGMD) • Facioscapulohumeral Muscular Dystrophy (FSH or FSHD)

(Also known as Landouzy-Dejerine) • Myotonic Dystrophy (MMD)

(Also known as Steinert's Disease) • Oculopharyngeal Muscular Dystrophy (OPMD) • Distal Muscular Dystrophy (DD) (Miyoshi) • Congenital Muscular Dystrophy (CMD)


Duchenne Muscular Dystrophy (DMD)

• Definition - One of nine types of muscular dystrophy, a group of genetic, degenerative diseases primarily affecting voluntary muscles.

• Cause - An absence of dystrophin, a protein that helps keep muscle cells intact.

• Onset - Early childhood - about 2 to 6 years.

• Symptoms - Generalized weakness and muscle wasting first affecting the musclesof the hips, pelvic area, thighs and shoulders.

• Progression - DMD eventually affects all voluntary muscles, and the heart and breathing muscles. Survival is rare beyond the early 30s.



• Juvenile rheumatoid arthritis—painful inflammation around the joints– Children should be encouraged to move.– It often disappears by age 18.



• Program implications– Early intervention is key.– Professionals work together for consistency in

therapy.– Adaptive equipment may be necessary to

encourage movement and muscle strength.



• Adaptive equipment– Mobility devices—braces, walkers,

wheelchairs– Positioning devices—wedge mats, bolsters,

prone boards



• Adapting materials– Universal design approach

• Recognizing that a one-size-fits-all approach to education does not work

• Understanding the need to design curricula to meet the needs of all classroom learners

• Believing that all children who attend early education programs will be successful in their development and learning



– Manipulative materials• Wall displays• Velcro on blocks• Pegs on puzzle pieces

– Creative materials• Use large pencils, paintbrushes• Push pencils through a ball for an easier grip• Tape paper to easel or table to prevent sliding



– Self-help devices• Use Velcro instead of buttons.• Make utensils easier to grip for feeding.• Use suction cups for soap.



• Adaptations in the classroom– Wheelchair accommodation

• Widen aisles• Put materials up on shelves, not on the bottom• Bathroom accessibility

– Railings• Indoors and out, place railings to help children with

balance



– Floor coverings• Carpeting is best, if well stretched and securely

nailed down.• If no carpeting, provide nonskid crutches and

shoes

– Eye-level materials• Place objects at the children’s eye level for

independence.


Health Problems

• Some children are chronically ill and live every day with serious health problems.

• Many developmental disabilities involve significant health risks and problems.


Health Problems (continued)

• Asthma– This is the most common and the most

serious.– During an attack, a child cannot get a full

breath of air.– Lips and nails may turn blue.– If a child cannot get relief from medication,

emergency help needs to be called.


Asthma

• Asthma is one of the most common chronic diseases of childhood.

• An estimated 4 million children under 18 years old have had an asthma attack in the past 12 months, and many others have "hidden" or undiagnosed asthma.

• Asthma is the most common cause of school absenteeism due to chronic disease


WHAT IS ASTHMA?

• Asthma is an inflammatory condition of the bronchial airways. – This inflammation causes the normal function of the

airways to become excessive and over-reactive, thus producing increased mucus, mucosal swelling and muscle contraction.

– These changes produce airway obstruction, chest tightness, coughing and wheezing.

– If severe this can cause severe shortness of breath and low blood oxygen.

• Each individual suffers a different level of severity. – Virtually, all children with asthma, however, do enjoy

a reversal of symptoms until something triggers the next episode.


WHAT IS THE CAUSE OF ASTHMA?

• Inflammation of the airways is the common finding in all asthma patients.

• This inflammation is produced by allergy, viral respiratory infections, and airborne irritants among others.



• Cystic fibrosis– Children have excessive mucus, chronic

cough, progressive lung damage, and inability to absorb fats and proteins.

– They also tend to have frequent, foul smelling bowel movements and unusually salty perspiration.


Cystic Fibrosis• Cystic fibrosis (CF) is a chronic,

progressive condition that primarily affects the body's respiratory and digestive systems. It is due to a gene defect that causes the body to produce abnormally thick mucous.

• Approximately 30,000 children and young adults in the U.S. have CF. One in 31 Americans carries an abnormal copy of the CF gene but isn't sick with the disease. You must have two abnormal copies of the gene, one from your mother and one from your father, to have cystic fibrosis.

• In the early 1950s, children born with CF died early in childhood. Today, thanks to improved medical treatments, people with CF often live into their 30s and possibly beyond.


What Causes CF?

• CF occurs in children who have inherited two abnormal copies of a specific gene, one from each parent.

• A parent who does not have CF but has one normal copy of this gene and one abnormal copy is called a CF carrier. The normal copy dominates, so the parent shows no sign of CF. In some cases, carriers pass on their normal copy of the CF gene to their child. In other instances, they pass on their abnormal copy. A child who receives a normal copy from one parent and an abnormal copy from the other will be a CF carrier and won't have the disease. A child who receives an abnormal gene from both parents will develop CF.

• Males and females are equally likely to inherit CF.



• Hemophilia– This is found only found in males.– The blood does not clot normally, causing

serious internal bleeding.



• Leukemia– This is the most common type of childhood

cancer.– Chemotherapy is the most common

treatment.



• Sickle-cell anemia– Autosomal recessive disorder– Red blood cells are sickle in shape instead of

round, making it difficult for them to pass through the bloodstream.

– Overall fatigue is one of the chronic problems.– It is found only in African-American children.


Sickle Cell Anemia

• Sickle cell disease is an inherited blood disorder affecting red blood cells. Normal red blood cells contain hemoglobin A. People with sickle cell disease have red blood cells containing mostly hemoglobin S, an abnormal type of hemoglobin. These red blood cells become sickle-shaped (crescent-shaped), and have difficulty passing through small blood vessels.


Sickle Cell Disease

• Sickle cell disease is not spread like a cold and cannot be caught from another person.

• It is an inherited condition.

• Diagnosis of sickle cell disease can only be determined by a special blood test.

• Comprehensive care includes early diagnosis, preventive measures, treatment of complications, and ongoing patient education.

•

Many people with sickle cell disease live long and productive lives.



• Heart problems– Children with heart problems should be

encouraged to move.– Monitor their skin color for a blue tone.– Let the children tell you when they are too

tired to continue.



• Diabetes– The body does not produce or properly use

insulin. – Insulin is a hormone that is needed to convert

sugar, starches, and other food into energy needed for daily life.

– There are two types of diabetes—type 1 and type 2


Diabetes

• Type 1 diabetes is caused by an autoimmune disorder-a problem with the body's immune system.

• In a healthy body, specialized cells (called beta cells) in the pancreas make insulin. Insulin is a hormone that allows the body to use energy from food.

• In type 1 diabetes, the immune system mistakes beta cells for invaders and attacks them. When enough beta cells are destroyed, symptoms of diabetes appear.


Diabetes

• More common, and increasing • In type 2 diabetes, the beta cells still

produce insulin. • However, either the cells do not respond

properly to the insulin or the insulin produced naturally is not enough to meet the needs of the body.


Diabetes

• So insulin is usually still present in a person with type 2 diabetes, but it does not work as well as it should.

• Some people with type 2 can keep it under control by losing weight, changing their diet, and increasing their exercise. Others take one or more medications, including insulin.



– Hypoglycemia and hyperglycemia are the result

• Hypoglycemia is excessively low levels of sugar in the blood.

• Hyperglycemia is too much sugar in the blood.• When in doubt, give a form of sugar.

– Regulate food intake.– Monitor activity levels.– Watch for changes in behavior.



• Seizure disorders– Epilepsy is a form of seizure disorder.– Types of seizures:

• Febrile seizures, brought on by a fast rising fever• Generalized tonic-clonic seizures (grand-mal)

– Violent shaking and jerking

• Absence seizures (petit mal)– Momentary loss of consciousness– Often accused of daydreaming


Epilepsy and Seizure Disorders

• Epilepsy is a brain disorder in which clusters of nerve cells, or neurons, in the brain sometimes signal abnormally. In epilepsy, the normal pattern of neuronal activity becomes disturbed, causing strange sensations, emotions, and behavior or sometimes convulsions, muscle spasms, and loss of consciousness.

• Epilepsy is a disorder with many possible causes. Anything that disturbs the normal pattern of neuron activity - from illness to brain damage to abnormal brain development - can lead to seizures.


Epilepsy

• Epilepsy may develop because of an abnormality in brain wiring, an imbalance of nerve signaling chemicals called neurotransmitters, or some combination of these factors.

• Having a seizure does not necessarily mean that a person has epilepsy. Only when a person has had two or more seizures is he or she considered to have epilepsy. EEGs and brain scans are common diagnostic test for epilepsy.


Is there any treatment?

• Once epilepsy is diagnosed, it is important to begin treatment as soon as possible.

• For about 80 percent of those diagnosed with epilepsy, seizures can be controlled with modern medicines and surgical techniques


Types of Seizures

• Generalized seizures affect all or most of the brain.

• They include petit mal and grand mal seizures.


Petit Mal Seizures:

• Minimal or no movements (usually, except for "eye blinking") -- may appear like a blank stare

• Brief sudden loss of awareness or conscious activity -- may only last seconds

• Recurs many times • Occurs most often during childhood • Decreased learning (child often thought to be

day-dreaming)


Grand Mal Seizures

• Whole body, violent muscle contractions • Rigid and stiff • Affects a major portion of the body • Loss of consciousness • Breathing stops temporarily, then "sighing" • Incontinence of urine • Tongue or cheek biting • Confusion following the seizure • Weakness following the seizure (Todd's

paralysis)


Seizure Disorders

• Partial psychomotor seizures– Often appear like a tantrum– Child unaware of behavior– Become stereotypic for that child

– Medication is often prescribed.


Be aware of what to do during a seizure:

•Remain calm.

•Cushion child’s head.

•Remove sharp objects.

•Do not put anything in the child’s mouth.


Tourette Syndrome

• Tourette syndrome (TS) is a relatively common neurologic disorder characterized by sudden, brief movements or sounds called tics.

• Pediatric neurologist Leon Dure, MD, says, "The tics usually decrease in frequency when patients concentrate on mental or physical tasks and increase with boredom, excitement, fatigue, heat, and stress."



• AIDS– Caused by HIV– Attacks the healthy immune system, leaving a

person vulnerable to illness– Contracted through sexual contact, blood-to-

blood contact, and infected mother to baby



• Obesity– Not necessarily a disability, it can lead to poor

self-esteem and other health risks.– Child’s caloric intake exceeds caloric loss

through exercise.– Increase child’s movement and limit the intake

of empty calories through junk food.



• Undernourishment– Children consume too few calories, causing

low weight.– It can result from poor chewing and

swallowing.– Increase easy-to-swallow foods and consult

nutritionist for high-calorie, healthy food choices.


Health Problems and Classroom Practices

• Teachers should be informed of all health issues related to the child that may impact educational performance.

• Become educated on the illness, prevention, and care.


Health Problems and Classroom Practices (continued)

• Health records– These should be kept on all children and

should include:• Emergency telephone numbers• Names of doctors/dentists• Medications• Allergies• Immunizations



• Administering medications– This varies from state to state, but most

require the following:• Parent permission• Child’s name on the bottle with the dosage• Medication log to be on file• Locked area to keep medication



• Emergency considerations– Emergencies need to be planned for, even

though we hope they never occur.– Fire drills should be practiced monthly.– Parents should be contacted about plans for

their child in case of emergency.– Staff need a plan for classroom coverage.– Staff should have CPR and first aid training.



• Confidentiality– Similar to a doctor, a teacher needs to

maintain confidentiality about students.– Student files should not leave the building.– Students should not be discussed outside of

work.– Families need to know that they can trust the

teacher with this knowledge about their child.

Chapter 7 Physical Disabilities and Health Problems

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