SEMESTER IV

INCLUSIVE EDUCATION
 CHILDREN
WITH
ORTHOPAEDIC IMPAIRMENTS
DEFINITIONS
Orthopaedic impairments, in general, constitute as one of the
most common or more prevalent physical impairment in the
human beings.

Tver and Tver (1991) : “An orthopaedic impairment is an

impairment that interferes with the normal functioning of
bones, joints or muscles.”

Hunt and Marshal (2002) : “ Orthopaedic impairment

causing physical disability refers to a condition that
incapacitates the skeletal, muscular and/or neurological system
of the body to some degree.”
Orthopedic impairments can be classified as belonging to one of three
different categories: neuromotor impairments, degenerative diseases,
or musculoskeletal disorders (Heller & Swinehart-Jones, 2003).

Common examples of conditions according to each category include

the following:

Neuromotor Impairments: spina bifida, cerebral palsy, spinal cord

injuries.

Degenerative Diseases: muscular dystrophy, spinal muscular atrophy.

Musculoskeletal Disorders: club foot, missing/deformed limbs,

scoliosis.
FUNCTIONAL LIMITATIONS CAUSED BY ORTHOPAEDIC
IMPAIRMENT

Poor muscle control

Weakness and fatigue (lack of muscle strength, nerve enervation or pain, paresis)

Difficulty in working, talking, climbing steps, seeing, speaking, sensing or grasping (due to pain or
weakness)

Difficulty in reading things

Difficulty in doing complete or compound manipulations just as pushing or turning

Inability in using the limbs

Difficulty or total inability with regard to twisting motion

Difficulty in moving from one place to another

Inability in operating even well designed products directly without assistive devices (including mobility aids
like crutches, wheel chairs, communication aids like single switch based artificial voice etc)

Paralysis (total lack of muscular control in part or most of the body)

Interference with control like (a) problems in accuracy of motor programming and coordination (b)
uncontrolled and purposeless motion © tense and contracted muscles

Joint movement limitation (either mechanical or due to pain)

Difficulty faced in providing normal gait and usually have a jerky or totally uncoordinated gait
CAUSES OF ORTHOPAEDIC
IMPAIRMENTS
1. Genetic or hereditary causes :- Carried through genes & chromosomes. – malformed bodies, defective psyche structure
or diseases responsible for the development of orthopaedic or locomotor impairment at the later stage. Eg. Muscular
dystrophy (a group of hereditary diseases responsible for causing progressive muscular weakness, loss of muscular
control, contractions and difficulty in walking, breathing, reaching and use of hands involving strengths. Another one is
Marfan syndrome – resulting in development of poor muscles and curvature of spine. Achondroplasia (resulting in
development of straight upper back and curved lower back, osteogenesis imperfecta – brittle bones) are all examples.

2. Causes operative in the womb of the mother :-

Poor and defective physical and mental health of pregnant mothers, maternal malnourishment and subsequent nutritional
deficiencies, effect of chronic diseases, accidents and injuries caused to mothers and the children in the womb, effect of
hard drugs, intoxicating objects, poisoning, exposure to radioactive rays etc.

Prescribed hard drugs, poisonous substances & substances like cocaine, marijuana & other illicit drugs by the pregnant
mothers – called as maternal substance abuse – leads to congenital malformations leading to orthopaedic impairment

Inter-venous drugs may invite serious chemical damage to the developing foetus resulting in severe congenital
malformation

Alcohol consumption – Foetal Alcohol Syndrome (FAS)-brain damage, neurological anomalies of the face, heart failure.

Tobacco consumption & smoking

Active infection with Sexually Transmitted Diseases (STDs) & Acquired Immune Deficiency Syndrome ( AIDS).
3. Causes operative at the time of birth :-

Premature delivery

Hazards occurred during caesarian delivery

Chronic diseases , injuries in newborns.

4. Causes lying in the poverty & lower socio-economic conditions :- uncongenial

environment characterized by poor economic conditions, lower socio economic status
illiteracy, unhealthy living conditions, improper conducts damaging normal growth
and development. Too limited resources of parents may create lot of obstacles in
providing nutrition, medical care, housing and other facilities for adequate muscular
and neurological development and well being. Child marriages, child mothers,
premature babies – may lead to orthopaedic impairment.

5. Child abuse :- Children who are beaten, burned, sexually molested, starved , neglected
and brutalized by the elderly ones may result into permanent neurological damage,
facial disfigurement, skeletal deformity, muscular damage and sensory impairment.
6. Oxygen deprivation :- Anoxia may cause death of the brain cells, resulting into

the severe neurological & orthopaedic impairment conditions like cerebral palsy

and seizures etc.

7. Accidental & incidental factors :- Any mishappenings, bad incidents – slipping

in the bathroom, stumbling on the road, hit by a light object, burn, fatal accidents,

nature & man-made catastrophes & calamities may cause a big injury leading to

orthopaedic impairments.

8. Nutritional deficiency :- due to acute deficiencies

9. Effect of infection and diseases - The effect of infection & diseases –slight

carelessness or ignorance on the part of parents & concerned heath authorities-non-

introduction of polio drop etc.

CLASSIFICATION
 ORTHOPAEDIC IMPAIRMENTS

NEUROLOGICAL MUSCOSKELETAL
CONDITIONS
IMPAIRMENTS
Muscular dystrophy
Cerebral Palsy Poliomyelitis
Spina bifida Arthritis
Spinal cord injuries Osteogenesis imperfect
Osteomyelitis
Epilepsy Legg-calve-perthes disease
Head injuries Clubfoot
Multiple sclerosis Limb deficiences
1. ORTHOPAEDIC IMPAIRMENTS CAUSED BY
NEUROLOGICAL CONDITIONS
1. Cerebral palsy
Cerebral palsy is typically due to an injury to the developing brain
before or during birth. The term ‘cerebral’ signifies the presence
of a causative lesion & ‘palsy’ indicates the consequence of such
lesion.
Types of cerebral palsy
a. Spastic CP
 Most common type
 Have hyper tonic muscles
 Tense stiff and tight muscles
 Muscle contractions
b) Athetoid CP :-

 Involuntary uncoordinated & uncontrolled movements like grimacing

, writing, sharp jerks etc.

 20% of all cases of CP.

 Constant change in their muscle tone.

c) Ataxic CP :-

 1 to 10 % of all cases.

 Characterized by lack of coordination of voluntary muscles.

 Disturbed sense of depth & perception

 2. Spina bifida
Birth defect of the spinal column. Spina bifida is a general term
for congenital defect in the vertebrae that enclose the spinal cord.

Spina bifida may be classifies into 3 main types :-

(i) Occulta :-

* Mildest form

* Malformation of few vertebrae usually in the lower spine

* Leg numbness & mild loss of bladder control.

(ii) Meningocele :- Moderate form of spina bifida. Meninges that

surrounds the spinal cord bulges through an opening in the back

of the child at birth.

(iii) Meningomylocele :- Severe form of spina bifida. Here is a

sac like structure that contains spinal cord membranes, spinal

fluid and a portion of the spinal cord protrudes over the spinal

column. This condition carries high risk of function as the broken

area of the spinal cord possesses no skin to protect it.

3. Spinal cord injuries

Such situations usually happen if he is involved with some

accidents / incidents like motor cycle accidents, gunshot
wounds or fall or in some cases may be caused by chronic
diseases and infections.

4. Epilepsy ( seizure disorders )

This is a neurological condition of an individual when he is
subjects to a spontaneous abnormal discharge of electrical
impulses in certain brain cells, & the discharge spreads to
nearby cell causing a disturbance of movement, sensation,
behaviour & consciousness.
 Most common types of seizures :-

(i) Psychomotor seizure :-

 Last from two to five minutes.
 The child may be found to act out or do things with no purpose.
 Eg :- Walking around purposelessly, smacking his lips etc.

(ii) Petit mal seizure :-

 Loss of consciousness lasts for few seconds ( 10 to 20).
 Unusual behaviour like staring blankly, fluttering, blinking of
eyelids, rolling of the eyes, slightly moving his/her mouth or
dropping things in the hands, etc.
(iii) Grand mal seizures :-
 Known as tonic-clonic seizures.
 Falling on ground suddenly with a loud vocal cry
 Stiffening of his muscles accompanied with the loss of
consciousness.
 Violent shaking of the entire body on account of the
contraction & relaxation of the muscles.
 Saliva from the mouth , legs and arms may jerk, the bladder &
bowels may be emptied, tongue biting, laboured breathing and
blue to purple colouring of the skin may result.
5. Head injuries

Wide spectrum of acquired injury- brain stem injury, closed head

injury, cerebral haemorrhage, depressed skull fracture, injuries
caused by external by bullet , anoxia and post operative infections,
etc.

6. Multiple Sclerosis

Incurable progressive disease of the CNS that results into the

destruction of the insulating material covering nerve fibres. This
may be caused by difficulty in walking, talking, seeing, sensing,
grasping objects, poor muscle control, weakness, fatigue,
intolerance of heat and cold.
 CHARACTERISTICS
Poor muscle control
Weakness and fatigue
Difficulty in walking, talking, climbing steps. Seeing, speaking,
sensing or grasping.
Difficulty in reading things
Inability in using limbs
Joint movement limitation
Uncoordinated gait
Require physical assistance
Deformities
Paralysis
Jerky movements
Inaccurate coordination of limbs
2. ORTHOPAEDIC IMPAIRMENTS CAUSED BY
MUSCULOSKELETAL CONDITIONS
1. Muscular dystrophy
It is referred to a group of inherited diseases in which the
muscles of the body are subjected to the condition of progressive
atrophy. There are 3 types of muscular dystrophy –
(i) Pseudohypertrophic muscular dystrophy
 Also known as Duchenne muscular dystrophy
 Common in boys
 Child may experience difficulty in walking , running, climbing
or catching etc.
(ii) Facioscapulohumeral
 May occur in both girls & boys
 Causes weakness in arms, shoulders & facial muscles in
comparison to the legs.
 (iii) Juvenile dystrophy & limbgirdle dystrophy:-
 Least severe
 Motor impairment & disability
 Age of onset – 6 to 10 years

2. Poliomyelitis

Poliomyelitis is popularly known as polio. It is an acute communicable

diseases caused by a viral infection that can invade the nervous system.

3. Arthritis

Arthritis is defined as pain in and around the joints , usually reducing range
of motion & causing weakness. The type affecting the juveniles, is referred
to as juvenile rheumatoid arthritis. This disease may vary greatly & relatively
mild cases to the most severe cases.
4. Osteogenesis imperfecta

It is a hereditary disorder that goes in families because of

transmission to children by affected parents. Characterized by
improper bone formation & easy breaking.

5. Osteomyelitis

In this disorder there is a bacterial infection of the child’s bone

specially in the bones of the arms and the legs.

6. Legg- calve- perthes disease

It is a disorder in which a child suffers from the flattening of the

head of the femur or hipbone. It mostly occurs in boys during the
period 4 to 20 years.
7. Clubfoot

Clubfoot refers to the musculoskeletal condition of the

orthopaedic impairment in which one or both feet of a child

are turned at the wrong angle at the ankle.

8. Limb deficiencies ( amputation or congenital )

This may be present at birth or occur at any time later in life.

 MINOR CONDITIONS
1. Scoliosis – Abnormal , lateral curvature of the spine.

2. Bone cysts - Slow growing, bone destructive lesion located near one end of
the shaft of a bone.

3. Skeletal deformities – Affects upper and lower limbs

4. Congenital dislocation of the hip - It represents a defect in which the

upper part of the femur is displaced in the hip socket.

5. Arthrogryposis – Muscles of the limbs of an affect child are missing or

smaller & weaker than normal.

6. Marfan syndrome – muscles of the affected children are poorly developed

& their spine is curved.

7. Achondroplasia – It is a genetic disorder – straight upper black & curved

lower back.
PREVENTIVE MEASURES FOR
ORTHOPAEDIC IMPAIRMENT
CRITERIA FOR IDENTIFICATION OF STUDENT
AS HAVING ORTHOPEDIC IMPAIRMENT

The student may be identified as having orthopedic impairment if:

1. The student is diagnosed by a qualified medical practitioner as having an

orthopedic impairment

2. The impairment is severe; and

3. The impairment adversely affects the student's educational performance.

The term orthopedic impairment includes impairments caused by congenital

anomaly (e.g., clubfoot, absence of some member, etc.), impairments caused by

disease (e.g., poliomyelitis, bone tuberculosis, etc.), and impairments from other

causes (e.g., cerebral palsy, amputations, and fractures or burns that cause

contractures).
 SELF-HELP SKILLS
Self-help skills are a subset of a larger repertoire of daily living
skills, sometimes called activities of daily living (ADLs).

Specifically, the term “self-help” usually refers to the following

areas of independent behaviour:-

Eating/feeding and drinking: Skills may include holding and using

utensils properly, drinking without spilling, eating a variety of foods,
proper use of a napkin, table manners, and other mealtime routines.

Grooming: This area includes skills such as brushing hair, shaving,

and dressing (e.g., selecting clothing, putting clothes on and off without
assistance, and managing fasteners).
Personal hygiene: Skills include those such as bathing, brushing

teeth, washing hair etc

The service of occupational therapists are also needed for

encouraging participation of the impaired children in various

useful activities related to self-help , daily living, pre-vocational,

leisure time and perceptual skills. They provide instruction in the

use of assistive devices and assistive technology.

FUNCTIONAL SKILLS
Functional skills are those skills a student needs to live independently.

An important goal of special education is for children to gain as much

independence and autonomy as possible, whether their disability is
emotional, intellectual, physical, or a combination of two or more
(multiple) disabilities.

Skills are defined as functional as long as the outcome supports the

children's independence.

For some students, those skills may be learning to feed themselves.

For other children, it may be learning to use a bus and read a bus
schedule. We can separate the functional skills as:
 Life Skills

 Functional Academic Skills

 Community-Based Learning Skills

 Social Skills
THANK YOU …