Orthopedic Impairment

Definition
The Federal (IDEA) definition of orthopedic impairment means a severe orthopedic impairmen
that adversely affects a child’s educational performance. The term includes impairments
caused by a congenital anomaly, impairments caused by disease (e.g., poliomyelitis, bone
tuberculosis), and impairments from other causes (e.g., cerebral palsy, amputations, and
fractures or burns that cause contractures).
Causation
This disability category includes all orthopedic impairments, regardless of cause. Examples o
potential causes of orthopedic impairment include genetic abnormality, disease, injury, birth
trauma, amputation, burns, or other causes.
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Other causes of orthopedic impairments may include:
·        Spina bifida
·        Diabetes
·        Nervous system disorders
·        Traumatic spinal cord injury
·        Stroke
·        Muscular Dystrophy
·        Cerebral Palsy
Muscular-skeletal disorders
·        Rheumatoid arthritis
·        Respiratory Disorders
·        Endocrine-metabolic disorder
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Prevention
To prevent orthopedic impairments that result from preventable diseases, it is important to
focus on health education, nutrition and immunization. This includes relatively simple
procedures such as raising awareness of the importance of cleanliness, medical care, and
nutrition for the development of strong bones; monitoring births to avoid conditions resulting
from complicated births; and administering polio vaccinations to prevent polio and post-polio
syndrome.
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Characteristics
The U.S. Department of Education reports 5,971,495 students receiving special education
services in the 2003-2004 school years. Of that number, roughly 1.1%, or 68,188 students,
received special education services based on a classification of orthopedic impairments.
The IDEA category of orthopedic impairments contains a wide variety of disorders. These can
be divided into three main areas: neuromotor impairments, degenerative diseases, and
musculoskeletal disorders. The specific characteristics of an individual who has an orthopedi
impairment will depend on the specific disease and its severity, as well as additional individua
factors.
It is difficult, perhaps even impossible, to generalize about the characteristics of students with
orthopedic impairment. For example, a child with a spinal cord injury could have immobility
limited to one side of his or her body, just the arms or legs, or total paralysis. A child with
cerebral palsy may have movement but need a wheelchair because he or she has slow,
uncontrolled movements that make it difficult to walk.
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Many students with orthopedic impairments have no cognitive, learning, perceptual, language
or sensory issues. However, individuals with neuromotor impairments have a higher incidenc
of additional impairments, especially when there has been brain involvement. And there is a
close relationship between the two types:  for example, a child who is unable to move his legs
because of damage to the central nervous system (neuromotor impairment) may also develop
disorders in the bones and muscles of the legs (orthopedic impairment), especially if he  or sh
does not receive proper therapy and equipment
Some children with skeletal deformities have surgery. Others have to use various types of
braces, prosthetic, and orthotic devices before, after, or in place of surgery. Others may use
adapted wheelchairs. Many children identified with severe and multiple disabilities have an
orthopedic impairment that must be considered when assessing and establishing services.
The referral characteristics for the student with an orthopedic impairment fall more into the
area of physical characteristics. These may include paralysis, unsteady gait, poor muscle
control, loss of limb, etc. An orthopedic impairment may also impede speech production and
the expressive language of the child.
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Implementation of Educational Strategies
Typically, students with orthopedic impairments have a history of chronic disability diagnosed
by the medical community through routine care as infants and young children. In addition,
students who are permanently injured, involving muscles, joints or bones, usually are
diagnosed and receive rehabilitation services.
For most students with orthopedic impairments, the impact on learning is focused on
accommodations necessary for students to have access to academic instruction. Placement i
a key consideration for students with orthopedic impairments. The goal is inclusion in genera
education classes, but some students may need services from resource rooms, special
classes, schools, or residential facilities, as well as hospital or homebound programs.
As with most students with disabilities, the classroom accommodations for students with
orthopedic impairments will vary dependent on the individual needs of the student. Since man
students with orthopedic impairments have no cognitive impairments, the general educator
and special educator should collaborate to include the student in the general curriculum as
much as possible.
In order for the student to access the general curriculum, the student may require these
accommodations:
 Special seating arrangements to develop useful posture and movements
 Instruction focused on development of gross and fine motor skills
  Securing suitable augmentative communication and other assistive devices
 Awareness of medical condition and its affect on the student (such as getting tired quickly)
Because of the multi-faceted nature of orthopedic impairments, other specialists may be
involved in developing and implementing an appropriate educational program for the student.
Due to the various levels of severity of orthopedic impairment, multiple types of assistive
technology may be used. As with any student with a disability, the assistive technology would
need to address a need of the student to be able to access the educational curriculum. For
students with orthopedic impairments, these fall into two primary categories:
Devices to access information: These assistive technology devices focus on aiding the studen
to access the educational material. These devices include:
 speech recognition software
 screen reading software
 augmentative and alternative communication devices (such as communication boards)
 academic software packages for students with disabilities
Devices for positioning and mobility: These assistive technology devices focus on helping the
student participate in educational activities. These devices include:
 canes
 walkers
 crutches
 wheelchairs
 specialized exercise equipment
 specialized chairs, desks, and tables for proper posture development
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Effects on Adolescents
Accidents associated with drug and alcohol use are the leading cause of head injury and
orthopedic impairment among adolescents.
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Occupational therapy may assist teenagers with orthopedic impairments to be more active in
self-maintenance, academic and vocational
pursuits and play or leisure activities that occur in school environments.
Physical therapy is a related service provided to assist children and teenagers  with orthoped
impairments and enable them to travel independently within the school environment, manage
stairs, restrooms, and the cafeteria; participate in classroom activities; and maintain and
change positions in the classroom.
Independence and accessibility of buildings and services becomes even more significant to
teenagers with orthopedic impairment because it may be difficult for others to assist them
effectively.
Promoting social competence of students with orthopedic impairments. Is also essential  For
example: strategies and techniques to develop students' skills in developing peer
relationships, initiating and responding in social interactions, working cooperatively,
understanding expectations in various social situations, accepting responsibility for one's ow
behavior, and interacting constructively in a variety of group activities and social and
employment
Adolescents with orthopedic impairments also need support to transition to adult life roles. Fo
example, an understanding their legal rights and enhancing their ability to become self-
advocates are needed.
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Effects on Adults
The effects of orthopedic impairments on adult life roles include learning, daily living,
employment, and family life.
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Adults with lower limb orthopedic impairments may have difficulty in mobility. They may be
slow or fall frequently. Some may also continue to need mobility aids like wheelchairs,
crutches and calipers. Mobility aids require smooth surfaces, ramps etc. which may not be
readily available. Even after using mobility aids, adults may find it difficult to walk for long
distances and get tired easily.
Adults with upper limb and lower limb orthopedic impairment may continue to need assistanc
with self care. Work limitations continue to exist for some adults with orthopedic impairment.
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Current Trends
There are decreases in the rates of one of the common causes of orthopedic impairment, spin
bifida. Spina bifida is a disability that is present at birth. It occurs when there is damage to the
spinal cord and the column does not close completely, causing an impairment of lower body
movements and functions such as bladder/rectal troubles and even paralysis.
The recent decreases in the incidence of spina bifida reflect the success of a major public
health strategy, specifically, the implementation of campaigns to promote folic acid
supplementation for women of childbearing age. During the period from 1991 to 2003, the
incidence of spina bifida dropped from 24.9 to 18.9 per 100,000 live births All of the decrease
came after the U.S. Food and Drug Administration authorized the enrichment of cereals with
folic acid in 1996 and then made it mandatory in 1998. The decrease in the incidence of spina
bifida was larger and the economic benefit was greater than had been projected before
adoption of the policy.
To reduce further the rates of spina bifida and other neural tube defects, the Center for Diseas
Control is actively promoting the greater consumption of folic acid by women of childbearing
age (the agency estimates that 50 to 70 percent of these conditions are related to folic acid
deficiency).
http://www.ncbi.nlm.nih.gov/books/NBK11437/
Research overwhelmingly demonstrates that parent involvement in children's learning is
positively related to achievement.  Further, the research shows that the more intensively
parents are involved in their children's learning; the more beneficial are the achievement
effects. Efforts are needed to involve more parents in the education of their children with
orthopedic impairments and other disabilities, and to provide them with resources to assist
their children.
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