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Review of DETA Criteria for Physical Impairment

education adjustment program Department of Education, Training and the Arts

Key Issues

The working party identified there was a need to: • align DETA definition and criteria with national and

international standards • clarify the relationship between diagnosed medical

conditions and impairment• describe the nature and extent of a physical impairment• clarify how the impairment is linked with activity

limitations/ participation restrictions in the school context• evaluate the effectiveness of the current verification form

for this category• identify when a review of verification is required


Definition of Physical Impairment

International DefinitionsVariety of definitions including physical/motor/motion/orthopaedicand disability/handicap/impairment.

Students with disabilities or impairments viewed in medical terms as organic disorders attributable to organic pathologies (e.g. in relation to sensory, motor or neurological defects). The educational need is considered to arise primarily from problems attributable to these disabilities.

Organisation for Economic Cooperation and Development (OECD) 2005


Definition of Physical ImpairmentNationally Variety of definitions including physical, disability, disorder, and

impairment – some include separate category of ABI. Definitions also related to funding.

Physical/diverse disability – “the presence of an impairment, which may have diverse effects within and among individuals, including effects on physical activities such as mobility. Included in this broad category is the subcategory Acquired brain injury which is used to describe multiple disabilities arising from damage to the brain acquired after birth. Note: Due to its low prevalence among children, acquired brain injury has not been reported separately in this bulletin.

Australian Institute of Health and Welfare 2005 Disabilities Updates: Children with disabilities


DETA Criteria for Physical Impairment pre 2005

• Significant physical impairmentand• Student requires regular specialised support

for access and participation in schooling. Source: Senate Employment, Workplace Relations and Education

References Committee report, Education of students with disabilities (2002), Appendix 5, pp.157-166 and ACT Student Disability Criteria (ACT Government), July 2003.


Criteria (until 12 November 2007)A Physical Impairment is a dysfunction of neurological and musculoskeletal systems which affects the

ability to move or coordinate and control movement when performing tasks. (A Physical Impairment may also affect the ability to use or feel certain parts of the body. Different) The body systems (may be) involved:

– musculoskeletal – involving the joints, limbs and associated muscles – neurological – involving the central or peripheral nervous systems (brain, spinal cord or

nerves).There are a wide range of conditions that may result in a Physical Impairment including cerebral

palsy, spina bifida, muscular dystrophy, arthritis, osteogenesis imperfecta, congenital malformations of the limbs, some acquired brain injury, some orthopaedic conditions.

A Physical Impairment may result from neurological damage, congenital malformation, genetic disorders, orthopaedic impairment , accidents resulting in brain injury, loss of limbs, severe burns.

There is a broad continuum of Physical Impairment and resulting implications for students. Some students may experience a mild impact on their access to, participation in, and outcomes from schooling, while others will experience a more significant impact. A Physical Impairment may be:

• present from birth (congenital) or acquired later (for example through an accident or illness) • progressive or non-progressive (this refers to whether or not the condition increases in extent or

severity over time).

The diagnosis of the body structure and function that is affected must be provided by medical specialist. Education Queensland recognises a diagnosis of a condition that affects these body systems and which may result in a Physical Impairment provided by a paediatrician, neurologist, orthopaedic surgeon, + rheumatologist and/or geneticist


Students functioning not to be accounted for existing diagnosis of IntelIectual Impairment, Autism Spectrum Disorder or Learning Difficulties

High incidence of combination of physical impairment with other impairments according to Australian Institute of Health and Welfare 2004 analysis of Australian Bureau of Statistics data (49% comorbidity in 2006 verifications)

No substantiated evidence provided in 2006 to exclude students with II, ASD or LD

Recommendation - No exclusion of students with these impairments but must have a musculoskeletal and/or neurological diagnosis and be able to demonstrate difficulties with movement

Criteria (until 12 November 2007)


The Impairment – dysfunction in body structure and function

Under the ICF - “Impairments are the problems in body function or structure

• Body structure - anatomical parts of the body– Structures of the nervous system e.g. spinal cord and related

structures Chapter 1– Structures related to movement e.g. structure of head and neck

region Chapter 7

• Body function - the physiological functions of body systems– Neuromusculoskeletal and movement-related functions Chapter 7


New Criteria (from November 12 2007) Criterion 1

Diagnosis of a Musculoskeletal and/or Neurological Condition (body structure)

which affects the ability to move or coordinate movement (body function)

• Musculoskeletal conditions - involving joints and muscles– e.g. Congenital or acquired physical malformations, joint

conditions, skin conditions where impact on joints and muscles, Neurofibromatosis where impact on joints and muscles

• Neurological conditions - involving brain, spinal cord or nerves– e.g. Cerebral Palsy, Muscular Dystrophy, Spinal Atrophy,

Spina Bifida, spinal tumours, Genetic Degenerative Diseases/Syndromes, Acquired neurological conditions including acquired brain injuries


Some musculoskeletal and/or neurological conditions may not affect the ability to move or coordinate movement e.g.

• Epilepsy• Acquired Brain Injury• Hydrocephalus• Mild Cerebral Palsies

Evidence needed to determine the nature and extent of the impairment in body function - Ability to move or coordinate movement


Additional information required in 2005

Section 3 information provided by the school1. Student’s difficulty with activities in their

education program2. Impact on access, participation and

educational outcomes + adjustments3. Disability specific needs to be identified

From 2006 all students verified are eligible for a profile to be submitted so information on adjustments is not required for verification

Physical Impairment - Activity Limitation/ Participation

Restriction in the school context


“The range and extent of activity limitation and participation restriction will vary with the extent of impairment as well as with environmental factors. Environmental adjustments and support needs are related to areas of activity limitation and participation restriction”

Australian Institute of Health and Welfare 2005 Disabilities Updates: Children with disabilities


New Criteria (from November 12 2007)

Criterion 2Information to be provided by the school on Activity

Limitations and Participation restrictions i.e. extent of the impairment (limitation in function) and the effect of the physical condition on the student’s functional performance (at the level of the individual) within the school setting (consideration of context of learning and environment)

How to record this information for a physical impairment?


Activity Limitations

Activity is described as the nature and extent of functioning at the level of the person. Activities may be limited in nature, duration and quality. (Physical Disability Council of Australia)

Activity is the execution of a task or action by an individual. Also described as “capacity”. ICF, 2001

Activity Limitations are the difficulties an individual may have in executing activities


Educational Impact2006 verification data collected70% of students verified demonstrated difficulties with Mobility

e.g mobility around classroom - transfers, hoists, assistance, equip mobility around school - walking, stairs, wheelchair

90% with Gross Motor difficultiesgross motor skills (age related) - GM programs, modified

HPE82% with Fine Motor difficulties

hand/arm function - writing FM programs, AT, assistance60% Self care difficulties

dressing, eating, toileting

50% Leisure often incorporated with Mobility and Gross Motor - swimming, sport, playground

35% Communication - assistive technology30% Social - assistance with peers


ICF’s nine domains of life• Learning and applying knowledge• General Tasks• Communication• Mobility• Self Care• Domestic Life• Interpersonal interactions and relationships• Major Life areas• Community, social and civic lifeAll 9 domains affected by a physical impairment

however 3 domains provide disability specific information required – Mobility, Communication, Self Care


Activity Limitations and Participation Restrictions

- Mobility, Self Care and Communication domains provide disability specific information for Physical Impairment

- Mobility (ICF) includes gross motor and fine motor but some conditions affect only one of these – separated Mobility to Gross mobility and Fine mobility

This information should be as recent as possible to accurately reflect student’s current functioning.


MobilityGross MobilityAbility to• Maintain positions –

sitting, standing• Change positions• Move indoors• Move outdoors• Move (other) –

run/hop/jump, use playground equipment, be involved in play/sports activities

Fine MobilityAbility to• Access and transport

materials• Manipulate environment

fittings and furniture• Manipulate materials• Produce written work• Other


Self Care

Ability to• Manage mealtime• Manage toileting• Manage hygiene• Manage clothing• Other

Communication

Ability to • Use physical structures to

speak• Use physical movement to

gesture• Use augmentative and

alternative communication• Other

Verification Form


Review of form - Key considerations

• How to provide information simply and easily – open boxes difficult to complete

• Difficulty with access to specialists (medical and educational)

• Need to scaffold best practice and consistency• Need to encourage communication between

schools and the AVT: PI• Need to link impairment to activity limitation and

participation restriction to assist schools to determine appropriate educational adjustments


PI Verification Form – Part B

Criteria 1 Diagnosis by Medical Specialist • Dysfunction of musculoskeletal and/or

neurological systems which affects the ability to move or coordinate movement diagnosed by - Paediatrician (79% in 2006), Neurologist (7%), Orthopaedic

Specialist (7%), Geneticist (6%), Rheumatologist (3%)

• Diagnosis by letter or signature on form with condition named. This diagnosis needs to be as current as possible.



Criterion 2 Activity LimitationsStudent’s ability to move within the school

settingQualifiers 0 = inability to move1 = partial ability to move2 = ability to moveCan include comments – how child performs movement ie

with equipment, assistance, physical or verbal cues etc



Criterion 2 Participation restrictions Student’s access to Foundation or Key Learning

areasQualifiersN/A = not applicable an option1 = 1 Learning area affected2 = 2 or more learning areas affected3 = All learning areas affectedCan specify area if only 1 or 2 learning areas affected e.g. HPE,

Home Economics


Students Needs

Optional tick boxes of assistance, equipment and programs

• Links the verification information to student’s IEP goals, school program and profile

Diagnosis + difficulty with movement (Activity Limitations) + curriculum access/participation

leads to decisions around how to best support students needs

Verification Reviews and Removal from Category


Verification Reviews• No mandatory review for most diagnoses

- a review of the diagnosis not necessary as many conditions do not change

• Reviews required for:– Perthes– Recent Acquired Brain Injury

• Review and date of review determined by the verifier

Removals from category


Contact Details

• [email protected]

• For PI Verification questions– Ph: 3240 9382

• For general Verification questions – Ph: 3240 9348 (Jeannie Grace)– Fax: 3240 9300EAP Verification Team

141 Merton RdWOOLOONGABBA Q 4102

PowerPoint

Documents

physical impairment

education of students

physical activities

orthopaedic impairment

education queensland

brain injury

body systems

neurological damage