Orthopedic Handicaps

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					Orthopedic Handicaps
Cerebral Palsy & Spinal Cord Injury




           Daniel Ewald
  Physical Disability vs. Orthopedic
             Impairment
• Physical disabilities
   – severe or multiple disabilities,
   – traumatic brain injury, and
   – other health impairments.
• Orthopedic impairment is simply more specific.
• From IDEA: Orthopedic impairment means a
  severe orthopedic impairment that adversely
  affects a child’s educational performance. The
  term includes impairments caused by congenital
  anomaly, impairments caused by disease, and
  impairments from other causes. (C.F.R. Sec.
  300.7(b)(7))
      Traits of Cerebral Palsy (CP)
• Cerebral = Brain injury
• Palsy = lack of muscular control
• An injury to the brain
  – The motor area, or muscular control, is damaged
     • Can happen in either left or right hemisphere or both
     • Different degrees depending on cause and time
• Maybe detectable at birth
• Must be diagnosed before age 6/3**
• Is not progressive
  – Symptoms may increase or decrease
• Usually have normal life span
     Symptoms of Cerebral Palsy
•   Difficulty with balance or walking
•   Involuntary movements
•   Sensory problems
•   May have seizures
•   Mental Retardation
    – 3% of all kids have mental retardation
    – 50-70% pr kids with cerebral palsy have mental
      retardation
• Stuttering/Vocal Impairments
    – Due to this, students maybe thought to have mental
      retardation since they are unable to communicate
      effectively.
              Cerebral Palsy Basics
• Anyone with CP has terms attached to their condition
  associated with when, type, and location(s) affected
    – When did it happen?
        • Prenatal – before birth
        • Perinatal – during birth
        • Postnatal – after birth
    – What Type is it?
        •   Spastic\Hypertonic – tightness prevents movement
        •   Athetoid – involuntary movement
        •   Ataxic – lack of coordination, balance, trouble walking
        •   Mixed – Can form any combination
    – Where is it mostly Located?

 •Monoplegia – one limb                   •Quadplegia – all limbs
 •Paraplegia – legs only                  •Diplegia – Legs affected more than
                                          arms
 •Hemiplegia – half the body
                                          •Double hemplegia – Arms affected
 •Triplegia – 3 limbs (usually legs and
                                          more than legs
 1 arm)
                       QUIZ!!!

  • Based on the terms on the past page,
    what is Daniel’s type of Cerebral Palsy?
        • Hints: Happened due to umbilical cord
     complications. Only one type. Two location terms.

Perinatal– Ataxic – Hemiplegia – Diplegia – Cerebral Palsy
              CP Statistics
• It’s estimated 2 to 3 people out of every
 1000 have cerebral palsy.
  – There are over 50,000 Canadians with CP.
• Usually overshadowed by other
  disabilities.
• In 97-98, about 1.2% of students had CP
                                Causes
• During pregnancy
   –   multiple births
   –   damaged placenta
   –   infections
   –   poor nutrition
   –   malformations of brain
• During labor:
   – premature delivery
   – abnormal positioning of the baby
   – lack of O2
• In early childhood:
   –   infection such as meningitis
   –   brain hemorrhages
   –   head injury
   –   lack of O2
   –   seizures
         Preventable causes

• Head injury
  – Accident, “shaken baby syndrome”
• Jaundice
• Meningitis
• Severe lead poisoning
• Rh incompatibility
• Ruebella (German measels)
       Spinal Cord Injury Quiz
  What       1

  would      2
                             1=Dead
   stop
                           2=Diaphragm
working if   3

   you       4               3=Hands
 suffered                    4=Chest
 a SCI at    5
                           5=Abdominal
  one of
    the      6               6=Legs
following                   7=Genitals
numbers?     7
       Spinal Cord Injury Terms
• Paraplegia – P – paralysis
    from the waist down
•   Quadriplegia – Q –
    paralysis from the
    shoulders down
• Complete – C – total loss
  below SCI
• Incomplete – I – partial
  control below SCI
• People have one
    underlined and one italic
                   Traits of SCI
• Depends on type of SCI
    – Numbness, tingling, loss of sensation, pain, or
      involuntary movement
• Total or partial paralysis occurs
    – Total – no sensory input or movement
    – Partial – some sensory input and movement
• Severity of injury and location on the spinal cord
    determines what will be affected and how
•   Possible to regain movement
    – Recovery occurs soon after injury till 2 years
    – Afterwards, very low chances
Secondary Medical Problems From SCI

 • Bladder and urinary tract infections
 • Lung infections
 • Skin break down
 • Pressure sores (bedcores, particularly on
   buttocks)
 • Blood clots
 • Osteoporosis
 • Cardiovascular disease
               What Causes SCI?
• An injury to the spinal cord
  – Spinal cord is a “rope” of nerve
    fibers
  – This rope is damaged in some way
      • Mild – can be fixed or small muscular
       loss
     • Severe – rope is severed
  SCI is also rarely caused by…
• Blood clots
• Abscesses
• Tumors
• Polio
• Spina bifida
• Friedrich's Ataxia (rare genetic disorder)
                         SCI Facts
• Incidence
    – between 183,000 and
      230,000 people have it now
    – 11,000 new cases each year
• SCI primarily affects young adults
    – 55% of SCI occurs from 16 – 30 yr old
• SCI effects all ethnicities pretty much equally,
    following percentages of the population closely
•   Cause
    – Almost half of cases caused by MVA
    – Falls, violence and sports contribute equally
     Emotional Impact of SCI

• When SCI occurs to students the effects
  are very traumatic
• Suicide rates are generally higher
  – As time goes on, chances lessen
• Students may face alienation from friends
  – Students can no longer participate as much
• Students may feel like they cannot do
 anything
   Cerebral Palsy & Spinal Cord Injury
             Common Traits
• Cerebral Palsy – an injury to the brain
• Spinal Cord Injury – an injury to the spine
• Both impede movement
  – Both have various degrees of affliction
• Widely shown on TV
  – Celebrities
  – Commercials
  – TV characters
     • Pelswick, the
       first main
       character who
       is handicapped
      Treatments for CP & SCI

• Physical Therapy
  – Practice day-to-day tasks
  – Try to (re)gain as much control as possible
• Surgery
  – Not widely used since medicine has not yet been able
    to fix nerve damage in the brain or spine
  – Can be used to lessen pain, or loosen muscles
• Stem Cells offer a viable cure for CP & SCI since
  nerve cells can be regrown
  – Tests in lab rats show nerve cells can be regrown
 Two Types of Technology used in
     the Class for CP and SCI
• Augmentative                • Assistive Technology
 (Alternative)                  – Physically involved but
 Communication                    cognitively able
  – Physically involved but     – Physically involved
    cognitively able              with unknown
  – Multiply involved with        cognitive abilities
    unknown cognitive           – Multiply involved with
    abilities                     unknown cognitive
  – Dispraxic, language           abilities
    delayed                     – Fine Motor difficulties
  – Pre-verbal or               – Developmentally
    emergent-verbal               delayed
    How to Use Technology and
Augmentative Communication Systems
• Technology and Augmentative Communication
    Systems can be very powerful, but they are useless in
    enabling children to realize their potential without
    appropriate training and a supportive environment.
•   Augmentative language or assistive technology system
    means: multiple systems.
•   Assessment and evaluation are on-going TEAM
    processes.
•   Vocabulary and Symbol selection are ongoing
    processes.
•   Augmentative communication is effectively taught in
    an environment comparable to foreign language
    immersion.
                      Continued
• Augmentative Communication and Assistive
    Technology is most effective if taught in an interactive
    and pragmatic format.
•   Partner training can play an important role in the
    success of communication and adaptations.
•   Classroom and home integration are crucial to
    success.
•   The art and science of augmentative communication
    and Assistive Technology is still a developing field.
•   Implementing augmentative communication and
    assistive technology consumes an enormous amount
    of time and energy from therapists, teachers, parents
    and the child.
            But it's worth it!

• Improves self-concept and self esteem
• Provides motivation
• Reduce frustration and behavior problems
• Increase participation in daily life
• Facilitates learning by making learning
  interactive instead of passive
• Changes expectations of others for child's
  potential
  Main Thing to Keep In Mind with
      Orthopedic Handicaps…
• MAKE THE ROOM HANDICAP ACCESSIBLE
  – Move the desks around
  – Make things lower
  – Allow extra time for student to get from point
    A to point B
  – If they have a powered wheelchair, seat them
    near an electrical outlet
• Make sure it is alright with the student to
 have others push him/her
   Let’s See How Handicap accessible
               Towson Is
• “All academic buildings have doors which meet
 A.D.A. criteria (lbs./pull).”
  – NOT all doors to academic buildings meet A.D.A.
    criteria.
• “attendant operated” elevators
• “Buildings with three levels or less may only
 have one accessible restroom.”
  – Students may need extra time to get to and from
    restrooms.
             Map handouts

• Map the route from your dorm or parking
  garage to your first class. Would you
  have to alter the route for a person with
  physical disabilities?
• Try this:
  – Get from the Towers to the Union Parking
    Garage!!!
  – Get into Newell Hall!!!
But Just Because They May
 Be In A Wheelchair, Does
  Not Mean They Cannot
          Succeed

				
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posted:4/12/2008
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