Inclusiveness

Course Description
• Development efforts need to include and benefit:
– people with various types of disabilities,
– people at risks of exclusion/discrimination and
marginalization,
• through provision of:
– Provision of quality education and training,
– creating equity, accessibility, employability,
– promoting prosperity,
– reducing poverty and enhancing peace, stability and
creating inclusive society
 Course description… cont’d
• This has not been the practice for people with
disabilities and vulnerable groups due to:
– unfavorable attitude,
– negligence,
– inaccessibility and
– exclusion from all development endeavors.
 Course description… cont’d
• people with disabilities are the most
disadvantaged minority in the world.
• They are about 15 percent of the global
population (about one billion people), and
17.6 million in Ethiopia.
 Course description… cont’d
• An exclusion practice of this large number of persons
with disabilities in Ethiopia is:
– an indicator of violating fundamental human rights
that undermines their potential/ability to contribute
to poverty reduction and economic growth.
• Exclusion practices of persons with disabilities
have a long history, affecting the life of
• people with disabilities and the society at large.
• In the past and even today people have been
discriminated due to their disabilities
 Course description… cont’d
• Inclusiveness promotes effective developments
through full participation of all members of a
population, people with disabilities and
vulnerabilities.
• Genuine inclusion of people with disabilities and
vulnerabilities allow of them to actively
participate in development processes and
eliminate dependence syndrome, leads to broader
benefits for families and communities, reduces
the impacts of poverty,
 Course description… cont’d
• Development can be achieved through
inclusiveness by creating equal access to
education, health care services, work and
employment, social protection and all
development center of human being.
Course objective and Expected Learning
outcomes
• Towards the completion of the course, the students will
be able to:
– Identify the needs and potentials of persons with disabilities
and vulnerabilities.
– Identify environmental and social barriers that hinder the
needs, potentials and full participations, in all aspects of life
of persons disabilities and vulnerabilities
– Demonstrate desirable inclusive attitude towards all persons
with disabilities and vulnerabilities in full participations
– Apply various assessment strategies for service provisions for
evidence-based planning and implementation to meet the
needs of persons with disabilities and vulnerabilities
Course objective and Expected Learning
outcomes
• Adapt environments and services according to the need and
potential of the persons with disabilities and vulnerabilities
• Utilize appropriate assistive technology and other support
mechanisms that address the needs of persons with disabilities
and vulnerabilities
• Respect and advocate for the right of persons with disabilities and
vulnerabilities
• Collaboratively work with special needs experts and significant
others for the life success of all persons with disabilities and
vulnerabilities in every endeavors and in all environments.
• Create and maintain successful inclusive environment for persons
with disabilities and vulnerabilities
• Promote the process of building inclusive society
 Chapter 1: Understanding Disabilities and
Vulnerabilities
• At the end of this chapter, the students will be able to:
• Define disability and vulnerability
• List different types of disabilities and vulnerabilities
• Explain brief causes of disability and vulnerability
• Describe the brief historical movements from
segregation to inclusion
• Describe the effect of attitude on the move towards
inclusion
• Discuss models of disability
 1.1 Definitions of Basic Terms (Impairment,
Disability and Handicap)
Impairment
• Impairment means a lack/abnormality of an
anatomic, physiological or psychological structure
or function or deviation on a person.
• It refers to any loss or abnormality of physiological,
psychological or anatomical structure or function.
• It is the absence of particular body part or organ.
• It could also a condition in which the body exists
but doesn‘t function.
Disability
• The term disability is ambiguous as there is no single agreement on the
concept (Mitra, 2006)
• It is not synonymous with AKAL-GUDATENGA (የአካል ጉዳተኛ) meaning
impairment.
• The full inclusion of people with impairments in society can be
inhibited by:
1. Attitudinal (societal barriers, such as stigma)
2. Physical barriers (environmental barriers, such as absence of stairs), and
3. Policy barriers (systemic barriers),
• Where all together can create a disabling effect and inhibit disability
inclusive development.
• They are disabling factors
• If these problems addressed, impairment may not lead to disability
Understanding disability using different
models
• Different approaches are used in
understanding disability and responding to it.
1. The moral and/or religious model: Disability as
an act of God
– is the oldest model of disability and is found in a
number of religious traditions;
– disability is regarded as a punishment from God for
a particular sin or sins that may have been
committed by the person with disability, by their
parents and/or ancestors.
Understanding disability: The moral
and/or religious model… cont’d
• Sometimes the moral and/or religious model of
disability perpetuates the myth of disability as
mysticism or some kind of metaphysical blessing.
• According to the mysticism perspective of
disability, the fact that one of the senses of a
person is impaired inevitably heightens the
functioning of other senses of that person, as well
as granting him or her ‘special abilities to perceive,
reflect, transcend, be spiritual’ (Olkin 1999:25–26)
Understanding disability: … cont’d
2. The medical model: Disability as a disease
• The medical model of disability is sometimes also referred to as
the ‘personal tragedy’ model.
• Disability is pathology (physiological, biological and intellectual).
• Disability means functional limitations due to physical, intellectual
or psychic impairment, health or psychic disorders on a person
(WHO,1996).
• The medical definition has given rise to the idea that people are
individual objects to be ―treated‖, ―changed" or ―improved"
and made more ―normal.
• The medical definition views the disabled person as needing to
―fit in ‖rather than thinking about how society itself should
change
Understanding disability: … cont’d

3. The social model: Disability as a socially constructed

phenomenon
• Inspired by the activism of the British disability
movement in the 1960s and the 1970s, the social model
of disability developed in reaction to the limitations of
the medical model of disability (D’Alessio 2011:44).
• According to the social model, it is society ‘which
disables people with impairments, and therefore any
meaningful solution must be directed at societal change
rather than individual adjustment and rehabilitation’
(Barnes, Mercer & Shakespeare 2010:163).
The social model: Disability as a socially
constructed phenomenon
• As Purtell (2013:26) observes, ‘[D]isabled people are
people who are “disabled” by the society they live in
and by the impact of society’s structures and attitudes’.
• ‘People with learning difficulties are ‘disabled people’
whose impairment is their learning difficulty: they are
disabled by the social reactions to it’ (Purtell, 2013:26).
• The social model is especially concerned with
addressing the ‘barriers to participation’ experienced
by PWDs as a result of various ableist social and
environmental factors in society (O’Connell, Finnerty &
Egan 2008:15).
The Social definition of disability:
• Disability is a highly varied and complex condition with
a range of implications for social identity and behavior.
• Disability largely depends on the context and is a
consequence of discrimination, prejudice and
exclusion.
• Emphasizes the shortcomings in the environment and
in many organized activities in society, for example on
information, communication and education, which
prevent persons with disabilities from participating on
equal terms.
Causes of disability
Genetic Causes
• Abnormalities in genes and genetic
inheritance can cause intellectual disability in
children.
– Down syndrome is the most common genetic
condition.
• Sometimes, diseases, illnesses, and over-
exposure to x-rays can cause a genetic
disorder.
Causes of disability
Environmental
• Poverty and malnutrition in pregnant mothers can cause a deficiency in vital
minerals and result in deformation issues in the unborn child.
• After birth, poverty and malnutrition can also cause poor development of vital
organs in the child, which can eventually lead to disability.
• The use of drugs, alcohol, tobacco, the exposure to certain toxic chemicals
and illnesses, toxoplasmosis,
• cytomegalovirus, rubella and syphilis by a pregnant mother can cause
intellectual disability to the child.
• Childhood diseases such as a whooping cough, measles, and chicken pox may
lead to meningitis and encephalitis. This can cause damage to the brain of the child.
• Toxic material such as lead and mercury can damage t he brain too.
• Unfortunate life events such as drowning, automobile accidents, falls and so on can
result in people losing their sight, hearing, limbs and other vital parts of their
body and cause disability.
Causes of disability
Unknown Causes
• The human body is a phenomenal thing.
Scientists have still not figured out what and
how some things in the body, cells, brain, and
genes come about.
• Humans have still not found all the answers
to all the defects in the human body
Inaccessible environments
• Sometimes society makes it difficult for people with some
impairment to function freely.
• When society develops infrastructure such as houses,
roads, parks and other public places without consideration
to people with impairment, they basically make it impossible
for them to take care of themselves.
– For example, if a school is built with a ramp in addition to stairs, it
makes it easy for people with wheelchairs to move about
freely. This way, their impairment is not made worse.
• Lack of education, support services, health and opportunities
for people with impairment can cause additional disability
to people with disabilities and even people with no disability
Some type of disabilities:
• Some nine major disabilities are listed and briefly discussed.
1.Visual impairment (VI)
• VI designates two sub- classifications: blindness and low
vision.
• Blindness, total or partial inability to see because of
disease or disorder of the eye, optic nerve, or brain.
• The term blindness typically refers to vision loss that is
not correctable with eyeglasses or contact lenses.
• Blindness may not mean a total absence of sight, however.
– Some people who are considered blind may be able to
perceive slowly moving lights or colors.
Low vision (LV)
• The term LV is used for moderately impaired
vision.
• People with LV may have a visual
impairment that affects only central vision
—the area directly in front of the eyes—or
peripheral vision—the area to either side of
and slightly behind the eyes.
2. Hearing Impairment
• Different definitions and terminologies may
be used in different countries for different
purpose.
• Pasonella and Carat from legal point of view,
define hearing impairment as a generic term
indicating a continuum of hearing loss from
mild to profound, which includes the sub-
classifications of the hard of hearing and deaf.
sub-classification
Hard of Hearing:
• "A hearing impairment, whether permanent
of fluctuating, which adversely affects a child's
educational performance but which is not
included under the definition of 'deaf'.“
• This term can also be used to describe
persons with enough hearing (usually with
hearing aids) as a primary modality of acquisition
of language and in communication with others.
sub-classification… cont’d
Deaf:
• Those who have difficulty understanding
speech, even with hearing aids but can
successfully communicate in sign language.
• Cultural definitions of deafness, on the
other hand, emphasize an individual‘s
various abilities, use of sign language, and
connections with the culturally deaf
community.
3. Specific learning disability
• Specific Learning Disability means a disorder in
one or more of the basic psychological processes
involved in understanding or in using language,
spoken or written, that may manifest itself in the
imperfect ability to listen, think, speak, read,
write, spell, or to do mathematical calculations.
• The term includes such conditions as perceptual
disabilities, brain injury, minimal brain dysfunction,
dyslexia, and developmental aphasia
Learning disabilities (LD) Vs learning
problems (LP)
• The term LD should not be confused with LP that are primarily the result of
visual, hearing, or motor disabilities; of intellectual disability; of emotional
disturbance; or of environmental, cultural, or economic disadvantage.
• Generally speaking, people with LD are of average or above average
intelligence.
• There often appears to be a gap between the individual‘s potential
and actual achievement.
• This is why learning disabilities are referred to as ―hidden disabilities:
the person looks perfectly ―normal‖ and seems to be a very bright and
intelligent person, yet may be unable to demonstrate the skill level expected
from someone of a similar age.
• A LD cannot be cured or fixed; it is a lifelong challenge.
• However, with appropriate support and intervention, people with LD can
achieve success in school, at work, in relationships, and in the community.
Types of Specific Learning Disabilities

• Auditory Processing Disorder (APD)

• Also known as Central Auditory Processing Disorder
• is a condition that adversely affects how sound that
travels unimpeded through the ear is processed or
interpreted by the brain.
• Individuals with APD do not recognize subtle differences
between sounds in words, even when the sounds are loud
and clear enough to be heard.
• They can also find it difficult to tell where sounds are
coming from, to make sense of the order of sounds, or to
block out competing background noises.
Types of Specific Learning Disabilities…
cont’d
Auditory Processing Disorder (APD)
A. Dyscalculia
– is a specific learning disability that affects a
person‘s ability to understand numbers and learn
math.
– Individuals with dyscalculia may also have poor
comprehension of math symbols, may struggle
with memorizing and organizing numbers, have
difficulty telling time, or have trouble with
counting.
Types of Specific Learning Disabilities…
cont’d
Auditory Processing Disorder (APD)
B. Dygraphia
 a specific learning disability that affects a person‘s
handwriting ability and fine motor skills.
 Problems may include illegible handwriting,
inconsistent spacing, poor spatial planning on
paper, poor spelling, and difficulty composing
writing as well as thinking and writing at the same
time.
Types of Specific Learning Disabilities…
cont’d
Auditory Processing Disorder (APD)
C. Dyslexia
– is a specific learning disability that affects reading and
related language-based processing skills.
– The severity can differ in each individual but can affect
reading fluency; decoding, reading comprehension,
recall, writing, spelling, and sometimes speech and
can exist along with other related disorders.
– Dyslexia is sometimes referred to as a Language-
Based Learning Disability.
Types of Specific Learning Disabilities…
cont’d
Auditory Processing Disorder (APD)
D. Language Processing Disorder (LPD)
– LPD is a specific type of Auditory Processing Disorder
(APD) in which there is difficulty attaching meaning to
sound groups that form words, sentences and stories.
– While an APD affects the interpretation of all sounds
coming into the brain, LPD relates only to the
processing of language.
– LPD can affect expressive language and/or receptive
language.
Types of Specific Learning Disabilities…
cont’d
Auditory Processing Disorder (APD)
E. Non-Verbal Learning Disabilities (NVLD)
– is a disorder which is usually characterized by a
significant discrepancy between higher verbal
skills and weaker motor, visual-spatial and social
skills.
– Typically, an individual with NVLD has trouble
interpreting nonverbal cues like facial expressions
or body language, and may have poor
coordination.
Types of Specific Learning Disabilities…
cont’d
Auditory Processing Disorder (APD)
F. Visual Perceptual/Visual Motor Deficit
– is a disorder that affects the understanding of
information that a person sees, or the ability to draw or
copy.
– A characteristic seen in people with learning disabilities
such as Dysgraphia or Non-verbal LD, it can result in
missing subtle differences in shapes or printed letters,
losing place frequently, struggles with cutting, holding
pencil too tightly, or poor eye/hand coordination.
4.Speech and Language Impairments
• Speech and language impairment means a
communication disorder such as stuttering, impaired
articulation, language impairment, or a voice
impairment that adversely affects a child‘s
educational performance.
• It is disorder that adversely affects the child's ability
to talk, understand, read, and write.
• This disability category can be divided into two
groups:
A. speech impairments and
B. language impairments
4.Speech and Language Impairments…
cont’d
A. Speech Impairments
• There are three basic types of speech impairments:
articulation disorders, fluency disorders, and voice
disorders.
A1. Articulation disorders
– Articulation disorders are errors in the production of speech
sounds that may be related to anatomical or physiological
limitations in the skeletal, muscular, or neuromuscular support
for speech production. These disorders include:
• Omissions: (bo for boat)
• Substitutions: (wabbit for rabbit)
• Distortions: (shlip for sip)
4.Speech and Language Impairments…
cont’d
A. Speech Impairments
A2. Fluency disorders
• are difficulties with the rhythm and timing of speech
characterized by hesitations, repetitions, or
prolongations of sounds, syllables, words, or phrases.
Common fluency disorders include:
– Stuttering: rapid-fire repetitions of consonant or vowel
sounds especially at the beginning of words, prolongations,
hesitations, interjections, and complete verbal blocks
– Cluttering: excessively fast and jerky speech
4.Speech and Language Impairments…
cont’d
A. Speech Impairments
A3. Voice disorders
– are problems with the quality or use of one's
voice resulting from disorders in the larynx.
– Voice disorders are characterized by abnormal
production and/or absences of vocal quality, pitch,
loudness, resonance, and/or duration.
4.Speech and Language Impairments…
cont’d
B. Language Impairments
– There are five basic areas of language impairments:
phonological disorders, morphological disorders, semantic
disorders, syntactical deficits, and pragmatic difficulties.
• Phonological disorders are defined as the abnormal
organization of the phonological system, or a significant deficit
in speech production or perception.
• A child with a phonological disorder may be described as hard
to understand or as not saying the sounds correctly.
• Apraxia of speech is a specific phonological disorder where the
child may want to speak but has difficulty planning what to say
and the motor movements to use.
4.Speech and Language Impairments…
cont’d
B. Language Impairments
• Morphological disorders are defined as difficulties with
morphological inflections (inflections on nouns, verbs,
and adjectives that signal different kinds of meanings).
• Semantic disorders are characterized by poor
vocabulary development, inappropriate use of word
meanings, and/or inability to comprehend word
meanings.
• Problems include restrictions in word meanings,
difficulty with multiple word meanings, excessive use
of nonspecific terms (e.g., thing and stuff), and
indefinite references (e.g., that and there).
4.Speech and Language Impairments…
cont’d
B. Language Impairments
• Syntactic deficits are characterized by difficulty in
acquiring the rules that govern word order and others
aspects of grammar such as subject-verb agreement.
• students with syntactic deficits produce shorter and less
elaborate sentences with fewer cohesive conjunctions
than their peers.
• Pragmatic difficulties are characterized as problems in
understanding and using language in different social
contexts. These students may lack an understanding of the
rules for making eye contact, respecting personal space,
requesting information, and introducing topic
5.Autism
• Autism is a developmental disability significantly
affecting verbal and nonverbal communication & social
interaction;
• is pervasive developmental disorder characterized is a
neurodevelopment disorder defined by impairments in
social and communication development, accompanied by
stereotyped patterns of behavior and interest such as:
– engaging in repetitive obsessive behaviors and activities and
stereotyped movements,
– resistance to environmental change or change in daily routines,
– unusual responses to sensory experiences.
• Communication deficiencies may leave a lasting mark of
social retardation on the child
5.Autism… cont’d
• Autism is generally evident before age three;
• A child who shows the characteristics of autism
after age 3 could be diagnosed as having autism
if the criteria above are satisfied.
• The term autism does not apply if the child‘s
educational performance is adversely affected
primarily because the child has an emotional
disturbance;
6. Emotional and Behavioral Disorders
• Is a condition exhibiting one or more of the following
characteristics over a long period of time and to a
marked degree that adversely affects educational
performance:
1. An inability to learn that cannot be explained by
intellectual, sensory, or health factors;
2. An inability to build or maintain satisfactory interpersonal
relationships with peers and teachers;
3. Inappropriate types of behavior or feelings under normal
circumstances;
4. A general pervasive mood of unhappiness or depression; or
5. A tendency to develop physical symptoms or fears
associated with personal or school problems.
 Classification of behavioral and emotional
disorders
• Conduct disorder: individuals may seek attention, are
disruptive and act out.
– The disorder is classified by type: overt (with violence or
tantrums) versus covert (with lying, stealing, and/or drug
use).
• Socialized aggression: individuals join subculture group
of peers who are openly disrespectful to their peers,
teachers, and parents. Common are delinquency and
dropping out of school.
• Early symptoms include stealing, running away from
home, habitual lying, cruelty to animals, and fire setting
 Classification of behavioral and emotional
disorders… cont’d
• Attention problems: attention deficit, being
easily destructible and having poor
concentration; being frequently impulsive and
not thinking the consequence of one’s actions.
• Anxiety/Withdrawn: These individuals are self-
conscious, reserved, and unsure of themselves.
They typically have low self-esteem and
withdraw from immediate activities.
• They are also anxious and frequently depressed
 Classification of behavioral and emotional
disorders… cont’d
• Psychotic behavior: more bizarre behavior,
hallucination, fantasy, talk in gibberish.
• Motor excess: hyperactive, cannot sit nor
listen to others nor keep attention focused.
 Classification of behavioral and emotional
disorders… cont’d
• Kauffman (1993) conclude that emotion or
behavioral disorders fall into two broad
classifications:
1. Externalizing Behavior: also called under controlled
disorder, include such problems disobedience,
disruptiveness, fighting, tempers tantrums,
irresponsibility, jealous, anger, attention seeking etc…
2. Internalizing Behavior: also known as over controlled
disorders, include such problems as anxiety, immaturity,
shyness, social withdrawal, feeling of inadequacy
(inferiority), guilt, depression and too much worries.
Causes of behavioral and emotional
disorders
There are many causes.
1. Biological- includes genetic disorders, brain damage, and
malnutrition, allergies, temperament and damage to the
central nervous system.
2. Family factors- include family interactions, family influence,
child abuse, neglect, and poor disciplinary practices at home.
3. Cultural factors- include some traditional and cultural
negative practices, for example watching violence and sexually
oriented movies and TV programs.
4. Environmental factors- include peer pressure, living in
impoverished areas, and schooling practices that are
unresponsive to individual needs
7.Intellectual Disability (ID)
• ID is a disability characterized by significant
limitations in both intellectual functioning
and in adaptive behavior, which covers many
everyday social and practical skills.
• This disability originates before the age of 18.
An individual is considered to have an
intellectual disability based on the following
three criteria:
7.Intellectual Disability… cont’d
• Sub average intellectual functioning: refers to
below-average general mental capacity in
learning, reasoning, problem solving, and so
on.
• One way to measure intellectual functioning is
using IQ test. Generally, an IQ test score of
around 70 or as high as 75 indicates a
limitation in intellectual functioning.
7.Intellectual Disability… cont’d
• Significant limitations exist in two or more adaptive skill areas:
It is the collection of conceptual, social, and practical skills that
are learned and performed by people in their everyday lives.
• Conceptual skills—language and literacy; money, time, and
number concepts; and self-direction.
• Social skills—interpersonal skills, social responsibility, self-
esteem, gullibility, innocence (i.e., suspicion), social problem
solving, and the ability to follow rules/obey laws and to avoid
being victimized.
• Practical skills—activities of daily living (personal care),
occupational skills, healthcare, travel/transportation,
schedules/routines, safety, use of money, use of the telephone.
Effects of intellectual disabilities
• intellectual disabilities affects academic learning,
the ability to adapt to home, school, and
community environments as presented under the
following sub-headings:
• General Cognition: People with intellectual
disabilities vary physically, emotionally, in
personality, disposition, and beliefs.
• Their apparent slowness in learning may be related
to the delayed rate of intellectual development
Effects of intellectual disabilities… cont’d

• Learning and Memory: The learning and

memory capabilities of people with intellectual
disabilities are significantly below average in
comparison to peers without disabilities.
• Children with intellectual disabilities may not
spontaneously use appropriate learning or
memory retention strategies and may have
difficulty in realizing the conditions or actions
that aid learning and memory.
Effects of intellectual disabilities… cont’d

• Attention: children must attend to the learning task

for the required length of time and control
distractions.
• Children with intellectual disabilities may have
difficulty distinguishing and attending to relevant
questions in both learning and social situations.
• The problem is not that the student will not pay
attention, but rather that the student does not
understand or does not filter the information to get
to the salient features
Effects of intellectual disabilities… cont’d

• Adaptive Skills: A child with intellectual

disabilities may have difficulty in both learning
and applying skills for a number of reasons,
including a higher level of distractibility,
inattentiveness, failure to read social cues, and
impulsive behavior
• the lack or underdevelopment of these skills
notably affects memory, rehearsal skills,
organizational ability, and being in control of the
process of learning
Effects of intellectual disabilities… cont’d

• Speech and Language: People with intellectual

disabilities may have delayed speech, language
comprehension and formulation difficulties
• Language problems are generally associated with delays
in language development rather than with a bizarre use
of language
• People with intellectual disabilities may show delayed
functioning on pragmatic aspects of language, such as
turn taking, selecting acceptable topics for conversation,
knowing when to speak knowing when to be silent, and
similar contextual skills
Effects of intellectual disabilities … cont’d

Motivation:
• People with intellectual disabilities (ID) are often described
as lacking motivation, or outer-directed behavior.
• Past experiences of failure and the anxiety generated by
those failures may make them appear to be fewer goals
directed and lacking in motivation. The result of failure is
often learned helplessness.
• The history of failure is likely to lead to dependence on
external sources of reinforcement or reward rather than
on internal sources of reward. They are less likely to self-
starters motivated by self-approval
Effects of intellectual disabilities… cont’d

• Academic Achievement: The cognitive difficulties

of children with mild to moderate intellectual
disabilities lead to persistent problems in academic
achievement unless intensive and extensive
supports are provided.
• Physical characteristics: Children with
intellectual disabilities with differing biological
etiologies, may exhibit coexisting problems, such as
physical, motor, orthopedic, visual and auditory
impairments, and health problems
Levels of support for individuals with
intellectual disabilities
• Levels of support range from intermittent
(just occasional or ―as needed‖ for
specific activities) to pervasive (continuous in
all realms of living).
Levels of support for individuals with
intellectual disabilities
Levels and areas of support for intellectual disabilities
level of Duration of Frequency of Setting of Amount of professional
support support support support assistance
Intermittent Only as Occasional or Usually only one or Occasional consultation or
needed infrequent two (e.g. 1–2 monitoring by professional
classes or activities)

Limited As needed, Regular, but Several settings, but Occasional or regular contact
but frequency not usually all with professionals
sometimes varies
continuing

Extensive Usually Regular, but Several settings, but Regular contact with
continuing frequency not usually all professionals at least once a
varies week

Pervasive May be Frequent Nearly all settings Continuous contact and

lifelong or continuous monitoring by professionals
8. Physical disability/Orthopedic
Impairment and Health impairment
• Many but not all, physical disabilities are
orthopedic impairments.
• The term orthopedic impairment generally refers
to conditions of muscular or skeletal system
and sometimes to physical disabling conditions of
the nervous system.
• Health impairment is a condition that requires
ongoing medical attention. It includes asthma,
heart defects, cancer, diabetes, hemophilia.
HIV/AIDS, etc
8. Physical disability/Orthopedic
Impairment and Health impairment
Classification and Characteristics
A. Mild physical disability:- these individuals are able
to walk without aids and may make normal
developmental progress.
B. Moderate physical disability:- individuals can walk
with braces and crutches and may have difficulty
with fine-motor skills and speech production.
C. Severe physical disability:-these are individuals
who are wheel-chair dependent and may need
special help to achieve regular development.
Classification and Characteristics

The physical disability could be broadly

classified in to two
• The neurological system (the brain ,spinal
cord & nerve) related problems.
• Musculo skeletal system ( the muscles,
bones and joints) are deficient due to
various causes.
I. Neurological system
• in conditions like cerebral palsy or a traumatic brain injury,
the brain either sends the wrong instructions or interprets
feedback incorrectly.
– the result is poorly coordinated movement.
• With the spinal cord injury or deformity, the path ways
between the brain and the muscles are interrupted, so
messages are transmitted but never received.
• The result is muscle paralysis and loss of sensation beyond
the point where the spinal cord or the nerve is damaged.
• individuals with this condition exhibit motor skill deficits
ranging from mild in coordination to paralysis of the
entire body.
I. Neurological system… cont’d
• Additional problems that can be associated with cerebral
palsy (CP) include:
– learning disabilities, intellectual disability, seizures, speech
impairments, eating problems, sensory impairments, and
joint and bone deformities such as spinal curvatures
and contractures (permanently fixed, tight muscles and
joints).
• Approximately 40 percent of those with CP have normal
intelligence; the remainders have from mild to severe
retardation.
• This is an extremely heterogeneous group having unique
abilities and needs.
I. Neurological system… cont’d
• Epilepsy:-is disorder that occurs when the brain cells are not
working properly and is often called a seizure disorder.
• Epilepsy is a condition that affects 1 to 2 percent of the
population. It is characterized by recurring seizures, which are
spontaneous abnormal discharge of electrical impulses of the
brain.
 Some persons with epilepsy have only a momentary loss of
attention (petit mal seizures); others fall to the floor and
then move uncontrollably.
 Fortunately, once epilepsy is diagnosed, it can usually be
controlled with medication and does not interfere with
performance in school.
• Most individuals with epilepsy have normal intelligence.
Spinal bifida and spinal cord injury

• Is a damage to the spinal cord which leads to

paralysis and loss of sensation in the
affected areas of the body.
• The spinal bifida is a birth defect of the
backbone (spinal column).
• The cause is unknown but it usually occurs in
the first twenty-six days of pregnancy.
II. Musculoskeletal system
Includes:
– the muscles and their supporting framework
and the skeleton.
– Progressive muscle weakness (muscular
dystrophy);
– Inflammation of the joints (arthritis), or
– Loss of various parts of the body (amputation)
II. Musculoskeletal system…cont’d
The list of the impairment and associated with
musculoskeletal malformation are the following:
A. Muscular dystrophy:-
– is an inherited condition occurring mainly in males, in
which the muscles weaken and deteriorate.
– The weakness usually appears around 3 to 4 years
of age and worsens progressively.
– By age 11 most victims can no longer walk.
– Death usually comes between the ages of 25 and
35 from respiratory failure or cardiac arrest.
II. Musculoskeletal system…cont’d

The list of the impairment and associated

with musculoskeletal malformation are the
following:
B. Arthritis:-
– is an inflammation of the joints.
– Symptoms include swollen and stiff joints, fever,
and pain in the joints during acute periods.
– Prolonged inflammation can lead joint deformities
that can eventually affect mobility.
II. Musculoskeletal system…cont’d

The list of the impairment and associated with

musculoskeletal malformation are the
following:
C. Amputation:-
– missing limbs because of congenital abnormalities
or injury or disease (malignant bone tumors in
the limbs).
– prosthetic devices (artificial hands, arms, or legs)
can be customized to replace limp functions and
increase independence in daily activities.
II. Musculoskeletal system…cont’d
Other muscle-skeletal disorders are:-
D. Marfan syndrome-
– is a genetic disorder in which the muscles are poorly
developed and the spine is curved.
– Individuals with marfan syndrome may have either
long, thin limbs, prominent shoulder blades, spinal
curvature, flat feet, or long fingers & thumbs.
– The heart and blood vessels are usually affected.
– The greatest danger is damage to aorta, which can lead to
heart failure. Individuals with marfan syndrome need to
avoid heavy exercise and lifting heavy objects.
II. Musculoskeletal system…cont’d
Other muscle-skeletal disorders are:-
E. Achondroplasis:
– is a genetic disorder that affects 1 in 10,000 births.
– Children with this disorder usually develop a normal
torso but have a straight upper back and a curved
lower back (sway back).
– These children are at risk of sudden death during
sleep from compression of the spinal cord interfering
with their breathing.
– The disability may be lessened through the use of the
back braces or by surgery.
Polio:-
• is viral disease that invade the brain and
cause severe paralysis of the total body
system.
• In its mild form results in partial paralysis.
• Post polio muscles that were previously
damaged weaken, and in some persons,
other muscles that were not previously
affected weaken as well.
Club foot
• is a major orthopedic problem affecting about 9,000 infants
each year. This term
• is used to describe various ankle or foot deformities, i.e
– Twisting inward (equino varus), the most severe form
– Sharply angled at the heel (calcanel vaigus), most common
– The front part of the foot turned inward.
• can be treated with physical therapy, and a cast on the foot
can solve the problem in most instances.
• In more severe cases, surgery is necessary. With early
treatment, most children can wear regular shoes and take
part in all school activities.
Cleft lip and cleft palate
• are openings in the lip or roof of the mouth,
respectively, that fail to close before birth,
the cause is unknown.
• Most cleft problems can be repaired
through surgery.
Health Impairments
• Any disease that interferes with learning
can make students eligible for special
services.
These disease caused problems are as follow:
1. Heart disease:
• heart value disorders;
• disorders of the blood vessels.
– heart implantation helps children to get cured.
Health Impairments…cont’d
2. Cystic fibrosis:-
• is a hereditary disease that affects the lungs
and pancreas.
• It leads to recurrent respiratory and digestive
problems including abnormal amounts of thick
mucus, sweet and saliva.
• The disease is so progressive and few who
have it survive beyond age 20.
Health Impairments…cont’d
3. Acquired immune deficiency syndrome (AIDS):
– caused by human immunodeficiency virus (HIV)
infection and transmitted primarily through exchange of
bodily fluids in transfusions or unprotected sex, and
by contaminated needles in addictive drug use.
4. Hemophilia:-
– is a hereditary disease in which the blood clots very slowly
or not all.
– The disorder is transmitted by sex-linked recessive gene
and nearly always occurs in males.
Health Impairments…cont’d
5. Asthma:
– is a chronic respiratory condition characterized by
repeared eplosde of breathing difficulties especially
while exhaling.
6. Diabetes:
– Developmental or hereditary disorder characterized by
inadequate secretion or use of insulin
7. Nephrosis & Nephritis
– Kidney disorders or diseases caused by infections,
poisoning, burns, accidents or other diseases
Health Impairments…cont’d
8. Sickle-cell anemia: Hereditary and chronic blood
disease (occurring primarly in African Americans)
characterized by red blood cells that are distored and
that do not circulate properly
9. Leukemia: Disease characterized by excessive
production of white blood Cells
10. Lead poisoning Disorder caused by ingesting
lead-based paint chips or other substances
containing lead
Health Impairments…cont’d
11. Rheumatic fever Disease characterized by painful
swelling and inflammation of the joints that can spread
to the hear and central nervous system.
12. Tuberculosis Infectious disease that commonly
affects the lungs and may affect other tissues of the
body.
13. Cancer Abnormal growth of cells that can affect any
organ system