◄UNIT 3 LEARNERS WITH DEAF-BLINDNESSUNIT 5 LEARNERS WITH SPECIFIC LEARNING DIFFICULTIES►

UNIT4 LEARNERS WITH PHYSICAL DISABILITIES AND OTHER HEALTH IMPAIREMENTS

  • UNIT4 LEARNERS WITH PHYSICAL DISABILITIES AND OTHER HEALTH IMPAIREMENTS

    Key Unit Competence: Apply suitable teaching methods, techniques
    and strategies to address the needs of learners
    with Physical Disabilities and Other Health
    Impairments
    INTRODUCTORY ACTIVITY
    Shumbusho is an amazing young boy who has exceeded most of the expectations
    of those who made assumptions based on his “labels” and therefore had lowered
    expectation for him. Fortunately, he did no live down to their expectations.
    Shumbusho has Duchenne Muscular Dystrophy, a form of Muscular Dystrophy
    which is genetically inherited disorders characterized by progressive muscle
    weakness and degeneration of skeletal muscles which control movement. At age
    two, Shumbusho was still unable to walk. At age six, Shumbusho had difficulty
    rising from a sitting or lying position. At primary school, he could not run the same
    distance as his peers, he would fall frequently and had unusual fatigue. By age 12,
    Shumbusho was using a wheelchair because his muscles in the shoulders, arms, back
    and legs were very weak. Shumbusho was a very bright learner despite his physical
    conditions. He has been blessed by many wonderful headteachers, teachers, aids
    and therapists who gave so much of themselves for his benefits. I hope that they
    will someday realize the impact that each one of them has had, individually and
    collectively on Shumbusho and through him on the community as a whole. Because
    of muscles weakness, Shumbusho had to be given an extra time to complete his
    assignments and homework. The school infrastructures were designed to facilitate
    Shumbusho’s movement. The school sometimes invite a physiotherapy who
    worked to help Shumbusho with his muscles strengths. Shumbusho had to be given
    adapted activities in Physical Education and Sport and in mathematics. Teachers
    were always happy to provide remedial teaching any time Shumbusho would miss
    the class. Due to the support he received Shumbusho passed the national exams
    successfully and was admitted to the best secondary school in Rwanda. Shumbusho
    is an inspiration, and a wonderful example of what can be a child with disabilities if
    provided with appropriate support and services.
    1. Discuss what characterized Shumbusho as a young boy who wanted to
    excel academically?
    2. Many people came in to help Shumbusho reach his potentials, who

    were these people?

    4.1. Definition of Physical Disabilities and other Health
    Impairments
    ACTIVITY 4.1
    1. You have probably met persons with Physical Disabilities. What
    do you understand by Physical Disabilities?
    2. You certainly know people who have chronic Health Impairments.

    How would you explain the term” Health Impairment”?

    4.1.1. Definition of Physical Disability
    A Physical Disability is the long-term loss or impairment of part of the body’s
    physical function. It can involve difficulties with walking and mobility, sitting
    and standing, use of your hands and arms, sight, hearing, speech, breathing,
    bladder control, muscle control, sleeping, fits and seizures or chronic tiredness.
    4.1.2. Definition of Health Impairments
    Health Impairment means having limited strength, vitality or alertness including
    a heightened alertness to environmental stimulus, that results in limited
    alertness with respect to the education environment that is due to chronic or
    acute health problems such as asthma, Epilepsy etc, and that adversely affects
    a child’s educational performance.
    SELF-ASSESSMENT 4.1
    1. Physical Disabilitycan involve difficulties with many aspects of
    life. What do you think are areas that are affected by the Physical
    Disability?

    2. What Health Impairment means to you?

    4.2. Categories of Physical Disability and Health Impairment
    ACTIVITY 4.2
    1. Discuss different physical and health problems you may have
    noticed among persons in your community?
    Physical Disability and Health Impairment can be categories into three broad
    categories:
    1. Musculo skeletal or Orthopaedic impairment
    2. Neuro Musculo Disability
    3. Chronic Health Impairment
    1. Musculo skeletal impairment or orthopaedic impairment
    It is defined as the inability to carry out distinctive activities associated with
    movements of the body parts due to muscular or bony deformities, diseases or
    degeneration. The disabilities grouped under musculo skeletal disability are:
    • Loss or Deformity of Limbs or amputation
    • Osteogensis Imperfecta or brittle bones
    • Muscular Dystrophy
    2. Neuro Musculo Disability
    It is defined as the inability to perform controlled movements of affected body
    parts due to diseases, degeneration or disorder of the nervous system. The
    categories are:
    • Cerebral Palsy
    • Spina Bifida
    • Poliomyelitis
    • Multiple Sclerosis
    • Poliomyelitis
    3. Chronic Health Impairment
    Chronic Health Impairments limit strength, vitality or alertness and may
    adversely affect the learner’ educational development. Learners with chronic
    Health Impairment are extremely limited in their activities and require
    intensive medical and educational help. The side effects of medications can
    have a significant impact on memory, attention, strength, endurance and energy
    levels.
    Some of the chronic health problems include:
    • Asthma
    • Cancer
    • HIV and AIDS
    • Heart condition
    • Rheumatic fever
    • Tuberculosis

    • Leukemia

    SELF-ASSESSMENT 4.2
    1. What is the difference between Musculo skeletal impairment and
    Neuro Musculo Disability? Give three example of each category
    2. What do you understand by Chronic Health Impairment? give
    three example of Health problem.
    3. What Health Impairment means to you?
    4.3. Causes of Physical Disability and other Health Impairment
    ACTIVITY 4.3
    1. Discuss different physical and health problems you may have
    noticed among persons in your community?
    The etiology or cause of physical and health disabilities varies greatly
    according to specific diseases or disorder. Some of the most common etiologies
    resulting in physical and health disabilities are genetic and chromosomal
    defects, teratogenic causes, prematurity and complications of pregnancy and
    acquired causes. On the other hand, the exact cause of some physical and health
    disabilities are unknown.
    4.3.1. Chromosomal and Genetic causes
    Among the most common causes of physical and health disabilities are hereditary
    conditions resulting from defects in one or both parent’s chromosomes or
    genes. Several genetic defects are believed to contribute to a range of physical
    and health disabilities such as muscular dystrophy.
    4.3.2. Teratogenic causes
    Many physical and health disabilities are caused by teratogenic agents that affect
    the developing fetus. Teratogens are outside causes, such as infections, drugs,
    chemicals or environmental agents, that can produce fetal abnormalities. The
    fetus is also at risk of developing physical and health disabilities when exposed
    to certain drugs, chemicals or environmental agents. Maternal abuse of alcohol,
    for example, has been linked to a range of physical, cognitive, and behavioral
    abnormalities that can result in lifelong damage. Serious fetal abnormalities
    can also occur as a result of prescription medications taken for maternal illness

    or disease (for example, certain antibiotics and seizure medications).

    4.3.3. Prematurity and complications of pregnancy
    Infants are usually born at approximately 40 weeks of gestation. An infant
    born before 37 weeks is considered premature. Infants who are premature
    and born with very low birth weights (less than 1.5 Kg) are at risk of having
    disabilities. The infant can develop neurological problems resulting in cerebral
    palsy, epilepsy etc.
    In some instances, babies that are born on time and with average weight
    encounter complications during the perinatal period. The most common
    cause of brain injury during the perinatal period is asphyxia – A decrease of
    oxygen in the blood. Among infants who survive an episode of asphyxia, several
    disabilities may occur such as cerebral palsy, epilepsy etc.
    4.3.4. Acquired causes
    Many physical and health disabilities are acquired after birth by infants,
    children and adults. These acquired causes include trauma, environment toxins
    and disease. For examples falls, accident are causes of amputation and other

    traumatic brain injury.

    SELF-ASSESSMENT 4.3
    1. With clear examples, explain how teratogenic agents can cause
    physical and health disability?
    2. What is asphyxia and how it is a leading cause of Physical
    Disability?
    4.4. Characteristics of Physical Disability and other Health
    Impairment
    ACTIVITY 4.4
    1. What are indicators of a person with amputation and
    poliomyelitis?
    The specific characteristics of an individual who has a physical or health
    disability will depend on the specific disease, its severity, and individual factors.
    Two individuals with identical diagnoses may be quite different in terms of
    their capabilities. Also, it is important to remember that students who have
    severe physical disabilities (even individuals who are unable to walk, talk or
    feed themselves) may have normal or gifted intelligence. No one should judge a
    person’s intellectual ability based on physical appearance.
    Let us discuss however on characteristics of the most commonly found Physical
    Disability in the school age population.
    4.4.1 Learners with amputation
    An amputation is the removal of a
    body extremity, most often referring    
    to the loss of an arm, leg, fingers, or
    toe. The removal is often done through
    surgery in response to a trauma,
    disease or infection. In addition
    to removing diseased tissues, the
    amputation of limb may also relieve
    pain. A congenital amputation occurs
    at birth and is the term used when

    someone is born without a limb.


    Students with amputation

    4.4.2 Learners with Muscular Dystrophy
    Muscular Dystrophy is a genetic(inherited) condition that gradually causes the
    muscles to weaken. It often affects a particular group of muscles, before moving
    on to the other muscles. If muscular dystrophy begins to affect the heart or the
    muscles used for breathing, it becomes life- threatening.
    A child with muscular Dystrophy may display the following observable
    characteristics:
    • Tendency to tire quickly
    • Postural changes due
    to progressive muscle
    weakness
    • Waddling gait with legs far
    apart
    • Walking on tip toes
    • Tendency to lose fine

    manual dexterity


    Equinovarus deformity

    • Trouble walking and maintaining balance
    • Poor posture with a protruding abdomen and a sway back
    • Equinovarus deformity of the feet
    • Increasing difficulty in rising from the floor

    • Lack of motivation because of limitation


    Difficulty in rising from the floor


    Posture change

    4.4.3. Learners with Cerebral Palsy
    Cerebral means” concerning the brain” and palsy means “paralyses or the
    inability to move. Therefore, cerebral palsy is a disorder of the brain that occurs
    as a result of brain damage or lack of development in the part of the brain
    controlling movement and posture.
    The following are key signs that you may notice in children with Cerebral Palsy:
    • Abnormal perception and
    sensation
    • Delayed or lack of speech
    control
    • Different walking patterns
    • Difficulty with gross and fine
    motor skills
    • Involuntary movement and
    lack of coordination

    Learners with Cerebral Palsy
    • Lack of muscle control, muscle tightness or spasm
    • Poor posture and spastic movements
    4.4.4. Learners with Epilepsy
    Epilepsy is currently defined as a tendency to have recurrent seizures (sometimes
    called fits). A seizure is caused by a sudden burst of excess electrical activity
    in the brain, caving a temporary disruption in the normal message passing
    between brain cells. The disruption results in the brain’s message becoming
    halted or mixed up.
    Learners who are epileptic display the following behaviours during a seizure
    attach:
    • Confusion and difficulty walking
    • Loss of consciousness
    • Convulsion
    • Drooling

    • Eyelid fluttering and rolling up

    • Falling down, staring and stiffening
    After the convulsions, you may observe the
    following:
    • Difficulty talking
    • Sleeping
    • Exhaustion
    • Thirst
    • Weakness

    • Urge to urinate/ defecate

    A girl after convulsions

    4.4.5. Learners with Spina Bifida
    Spina bifida is a birth defect that involves the incomplete development of the
    spinal cord or its coverings. The term Spina bifida comes from Latin and literally
    means split or open spine. Spina bifida occurs at the end of the first month
    of pregnancy when the two sides of the embryo’s spine fail to join together,
    leaving an open area. In some cases, the spinal cord or other membranes may
    push through this opening in the back. The condition is usually detected before
    a baby is born and treated right away. The symptoms of spina bifida vary from
    person to person, depending on the type and level of involvement. However,
    learners with Spina Bifida may have the following characteristics:
    • Closed neural tube
    defects
    • Have problems with
    bowel and bladder
    control
    • Fluid-filled sac visible
    on the back protruding
    from the spinal canal
    • Spinal cord tissue is
    usually exposed

    • Muscle weakness


    Fluid -filled sac on the bac

    • Paralysis
    • Incontinence
    • Poor short term memory
    • Easily distracted
    • Poor attention
    4.4.6. Learners with Poliomyelitis
    Poliomyelitis (Polio) is a highly infections viral disease, which mainly affects
    young children. The virus is transmitted through contaminated food and water,
    and multiplies in the intestine from where it can invade the nervous system.
    Many infected people have no symptoms, but do excrete the virus in their
    faeces, hence transmitting infection to others.

    Characteristics of polio include:

    • Degeneration of
    muscles and bones
    • Permanent paralysis
    • Stunted growth of the

    affected limb

    Learners with polio
    4.4.7. Learners with Asthma
    Asthma is the most common pulmonary disease of chilhood and is on the
    increase. Children who have asthma breathe normally until they come in
    contact with a substace or situation that triggers an asthma attach such as
    pollen, air pollution, a respiratory infection or exercise. When an asthma attach
    is triggered , the learner has the following chracateristics:
    • Wheezing
    • Frequent coughing
    • Shortness of breath
    • Labored breathing
    • Chest tightness, apin or presuure
    • Feeling very tired or weak after exercising
    • Trouble sleeping
    4.4.8. Learners with infectious diseases
    Several infectious diseases fall under the heading of other health impairements.
    Some infectious diseases are readily transmittable( such as tuberculosis),
    others may pose no threat in the school environment( such as AIDS).
    Learners with HIV and AIDS: A great number of children around the world
    are infected by the HIV every year. UNICEF, (2005) reported that at the end of
    2017, about 2.6 million children lived with HIV in the world. AIDS stands for
    Acquired Immunodeficiency Syndrome. It is a desease that prevent the body
    from fighting infections. The Human Immunodeficiency Virus, which is known
    as HIV, infects and damages parts of the body’s defenses againest infections.
    HIV can be transmitted through direct contact with blood or other body fluids.
    Children commonly contract HIV during fetal development in the mother’s
    uterus, at the time of birth, or during breastfeeding. Not all infant born to HIV
    positive mothers will have the HIV infection. However, the most common way
    children contract HIV is through mother- to baby transmission.Not all children
    with HIV will have symptoms, and those that do won’t have exactly the same
    ones. Symptoms can vary by age. Some of the more common are:
    • Being sick often with childhood illnesses such as an ear infection, a
    cold, an upset stomach, or diarrhea
    • Failure to reach the developmental milestones as the normal children
    SELF-ASSESSMENT 4.4
    1. You are asked to assist the group assessing children with
    disabilities. What would be the signs that would point to the fact
    that a child has:
    a. Muscular Dystrophy
    b. Cerebral Palsy

    c. Poliomyelitis

    4.5. Teaching and learning approaches for learners with
    Phyical Disabilities and other Health Impairements
    ACTIVITY 4.5
    1. How can you help a child with Cerebral Palsy?
    2. Environmental aspect is very important for learners with
    Physical Disabilities, how would ensure that environment is
    conducive for learners with PD to learn effectively?
    There are many teaching strategies you can use to ensure effective and
    productive learning environments and experiences for all students, including
    those with disabilities. Accessible Education is the process of designing courses
    and developing a teaching style to meet the needs of people who have a variety
    of backgrounds, abilities and learning styles. Just as there is no single way to
    teach, people learn in a variety of ways; using different instructional methods
    will help meet the needs of the greatest number of learners.
    Meeting the educational needs of students with Physical Disability and other
    Health Impairment requires several modifications or adaptations. These will
    be discussed under the five main headings:
     Attitude
    One of the first considerations in the effective teaching of individuals with
    physical difficulties is a positive attitude towards the learner’s potentials and
    limitations, understanding of his/her difficulties and the degree of educational
    limitation it causes. The following methods will help teachers to address the
    educational needs of learners with Physical Disabilities and other Health
    Impairments:
     The teacher sets up a buddy system in class so that other learners can assist the
    child with physical or Health Impairments
     Speak directly to the person, not to an accompanying support person
     If you are not sure what to do, ask, “Can I help?”
     Encourage students to tell you about any accessibility concerns
     Incorporate into lessons/ and or wall hanging, examples of role models who
    have Physical Disability
     If the learner has a seizure attack, ensure the following:
    • Remain calm to avoid emotional reactions from the learners
    • Never try to restrain the learner because nothing can be done to stop a
    seizure once it has begun
    • Do not interfere with the movement in any way
    • Talk to other teachers and learners to assure them that the condition
    is not contagious
    • Move the learner into horizontal position. Loosen his/ her collar, tilt
    his/ her head sideways for release of saliva and place something soft
    under the head
    • After the learner has get full consciousness, let him/ her rest
     Environmental arrangement
     Construction of ramps to all areas to enhance accessibility to all facilities
     Widening of the doors to enable movement of children on wheelchairs and
    those using crutches
     Avoid overcrowding the room so that there is ease in movement around.
     Ensure the door handles are easy to manage and are low
     Ensure the chairs, tables, beds and toilets are adapted to the learners’ heights
     Clear the area around the learner so that no injury from hard objects occurs
     Participation
     Be aware that students with upper-body weakness or paralysis may be unable
    to raise their hand. Make eye contact to include the student in classroom
    discussions
     Try to be considerate if the student with a Physical Disability is coming from
    a long distance place; it may take the student longer to reach the school/
    classroom
     Have students with communication difficulties (as is the case with cerebral
    palsy) use an alternative way of presentation in place of oral reporting
     If writing is difficult, let the learner use a tape recorder, where one is available
    or get a note taker
     If a visit or trip is planned to somewhere outside the school, plan well in
    advance to ensure that accessibility challenges on the journey and at the
    destination can be tackled.
     Plan activities at accessible locations so that all students can participate or,
    as a last resort, substitute an alternative activity with the same learning outcomes
     Consider alternative activities/exercises that can be used with less difficulty
    for the learner, but has the same or similar learning objectives
     Arrange for syllabus coverage for learners with Health Impairments since
    they may miss class when their conditions are exacerbated.
     Use appropriate learning, teaching aids and adapted physical education and
    sport equipment
     Refers the child (especially those with CP) for appropriate professional support
    like: Speech therapist, physiotherapist, occupational therapists, guidance
    and counselling specialist.
     Assistive devices and technology
     Provide assistive and compensatory devices such as wheelchairs, braces,
    calipers, special boots depending on the challenges to enable the child
    undertake school tasks
     Consider an assistive device as an extension of the person’s personal space
     Encourage learners who use crutches or other assistive devices to keep them
    within easy reach. Make a suitable space available in the classroom near the
    learners
     Assignment and tests
     Allow scheduled breaks during lectures, tests and exams
     Allow more time for the learner to finish his/her work.
     Provide different accommodations during exams. For example, provide
    separate venue, provide extend time for learners with Cerebral Palsy or
    Muscular Dystrophy, provide a scribe to those who are unable to write their
    answers.
     If appropriate, let the learner use computers during the exam (when the learner
    has been using it in the instruction)
     Where appropriate, give completely oral tests or completely written tests,
    whichever suits the learner’s needs
     Adapt some questions in exam without lowering the learning objectives. For
    example, the teacher may ask a question: Which is the capital of Rwanda?
    For a learner with severe cerebral palsy who is unable to talk or has difficulty
    in writing, the teacher may reformulate the question and ask: The capital of
    Rwanda is: a) Bujumbura, b) Kigali, c) Kampala
    SELF-ASSESSMENT 4.5
    1. Briefly explain which teaching strategies you would use to help

    learners with Physical Disabilities.

    SKILLS LAB
    1. Visit a school that accommodate learners with Physical
    Disabilities & OHI. Spend some hours in school. With reference
    to the following points, prepare three pages’ document to advise
    teachers and school in general how to effectively include learners
    with Physical Disabilities:
    • Categories of learners with Physical Disabilities
    • School environment (open space, facilities, playground)
    • Classroom environment (seating arrangement, teaching
    methodologies)
    • Attitude of teachers, peers and Learners with PD & OHI
    themselves
    END OF UNIT ASSESSMENT
    1. What are the strategies needed to be put in place to support
    learners with Physical and Health Impairments in school?
    2. What would you do if a learner has a seizure attack in your class?
    3. What are the common causes of Physical Disability?
    4. Discuss how Asthma and HIV and AIDS may impact on learners
    learning and development?
    5. How may you identify children with Muscular Dystrophy in your

    school?


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