Physical Disabilities:

Cerebral Palsy:

Cerebral Palsy is a disorder of movement and arises from damage to the developing brain which may occur before, during or shortly after birth. Common causes include blood group incompatibility, maternal infection, birth trauma (lack of oxygen), pre-mature/post-mature birth or a serious illness/accident. Physical impairment can range from mild to severe and related difficulties such as communication difficulties, learning difficulties, sensory impairment and epilepsy may also arise.

There are three main types of Cerebral Palsy:

1. Spasticity – characterised by the disordered control of movement
2. Athetoid - characterised by involuntary, jerky movements
3. Ataxia – characterised by balancing problems
Other terminology associated with Cerebral Palsy includes Hemiplegia (affects only one side of the body), Diplegia (affects all four limbs), Paraplegia (affects both legs) and Quadriplegia (affects all four limbs and trunk).

Educational Implications of Cerebral Palsy:
1. Mobility: Mobility will vary depending on the severity of the condition and will range from the use of a walking aid to use of a powered wheelchair. Mobility has huge implications for access to the school building and may require the installation of ramps, lifts, widened doorways and accessible bathrooms in a school
2. Seating: Seating posture and positioning will have implications for the type of desk and chair that the student uses throughout the school day. Ideally students should have access to a height adjustable desk which may be raised, lowered and tilted according to their needs
3. Fine & Gross Motor Skills: Handwriting and pencil grip/control may be affected and as a result the use of Assistive Technology may be employed. The student may therefore avail of a range of Reasonable Accommodations in the State Examinations. Completing physical tasks and activities will take the student considerably longer to achieve, so additional time must be given. The use of inclusive P.E. games should also be incorporated
4. Communication: Depending on communication difficulties experienced by the student, a range of Low Tech and High Tech Assistive Technologies may be used such as Picture Symbols, Big Mac and A.A.C. (Augmentative and Alternative Communication) devices
5. Learning Difficulties: Spatial and perceptual difficulties may arise due to limited exploration of the environment at an early age (e.g. unable to crawl independently). This will have an impact on learning, reading, writing and Mathematics in the student’s education
6. Fatigue: Students tend to tire more easily as more energy is required to complete activities. A balanced timetable in terms of subject selection and rest breaks would be encouraged
7. Personal Care: Depending on the severity of physical impairment, students may require the assistance of a Special Needs Assistant for feeding, dressing and toileting. SNA’s should have completed training in Manual Handling and Feeding before working with students who have complex physical needs
8. Emotional Well-being: In order that students do not develop a sense of “learned helplessness”, emphasis must be place on the students’ abilities, strengths and talents and their capacity to develop independent skills. As students may experience a sense of social isolation at school, emphasis must be placed on developing friendships with peers.

Spina Bifida:
Spina Bifida is a condition which arises when the spinal cord is exposed due to the separation of bones in the spinal column. Physical consequences are dependent on the lesion and damage that has been caused to the spinal cord. The cause of Spina Bifida is unclear but is attributed to environmental and genetic factors including a lack of Folic Acid in the diet. Paralysis and lack of sensation may range from minimal to complete loss and associated difficulties such as kidney/bladder damage, learning difficulties, eye defects and epilepsy may also arise. Hydrocephalus, which is an accumulation of fluid on the brain, may also exist and as a result students may require a shunt.

Educational Implications of Spina Bifida:
1. Mobility: Damage to the spinal cord may cause paralysis and lack of sensation to pain, temperature and touch. As a result, students are more susceptible to injury through fractures, knocks and burns. Pressure sores and stiffness may also arise and careful positioning of legs must be adhered to. Access to the school building may be enhanced through the installation of ramps, lifts, widened doorways and accessible bathrooms
2. Seating: Seating posture and positioning will have implications for the type of desk and chair that the student uses throughout the school day. Ideally students should have access to a height adjustable desk which may be raised, lowered and tilted according to their needs
3. Fine & Gross Motor Skills: Handwriting and pencil grip/control may be affected and as a result the use of Assistive Technology may be employed. The student may therefore avail of a range of Reasonable Accommodations in the State Examinations. Completing physical tasks and activities will take the student considerably longer to achieve, so additional time must be given. The use of inclusive P.E. games should also be incorporated
4. Learning Difficulties: Spatial and perceptual difficulties may arise due to limited exploration of the environment at an early age (e.g. unable to crawl independently). This will have an impact on learning, reading, writing and Mathematics in the student’s education. Students often demonstrate a considerable disparity between verbal performance and comprehension and are sometimes referred to as “fluent talkers” for this reason
5. Personal Care: Students will require the assistance of a Special Needs Assistant for toileting and the use of an accessible bathroom. SNA’s should have completed training in Manual Handling before working with students who have such physical needs. As students may be prone to kidney and bladder problems, they need to be encouraged to become independent in managing their personal hygiene. Attention should be paid to the risk of high temperatures which may indicate that the student has a urinary infection. Attention should also be paid to the risk of headaches, drowsiness and vomiting which may indicate that the student’s shunt is blocked
6. Emotional Well-being: In order that students do not develop a sense of “learned helplessness”, emphasis must be place on the students’ abilities, strengths and talents and their capacity to develop independent skills. As students may experience a sense of social isolation of school, emphasis must be placed on developing friendships with peers.

Muscular Dystrophy:
Muscular Dystrophy is a progressive, degenerative condition involving the breakdown of muscle fibre and gradual increasing muscle weakness. Muscular Dystrophy is primarily a hereditary condition which is carried through the female line and affects boys only. There are two main types of Muscular Dystrophy –Duchenne Muscular Dystrophy and Myotonic Muscular Dystrophy. Duchenne Muscular Dystrophy in particular is a progressive, life-limiting condition in which a significant change in the student’s abilities is seen over the years.

Educational Implications of Muscular Dystrophy:
1. Mobility: Muscular Dystrophy involves decreased levels of mobility. At approximately 8 – 10 years of age, a student will experience increased muscle weakness and the risk of falls will increase. As a result, the student will often become a wheelchair user at this point. Access to the school building will be enhanced through the installation of ramps, lifts, widened doorways and accessible bathrooms
2. Seating: Seating posture and positioning will have implications for the type of desk and chair that the student uses throughout the school day. Ideally students should have access to a height adjustable desk which may be raised, lowered and tilted according to their needs
3. Fine & Gross Motor Skills: As the student’s motor control becomes weaker, the need for specific Assistive Technologies (e.g. voice recognition software) will increase. The student may also avail of a range of Reasonable Accommodations in the State Examinations. Completing physical tasks and activities will take the student considerably longer to achieve, so additional time must be given. The use of inclusive P.E. games should also be incorporated
4. Learning Difficulties: Most students do not have associate intellectual difficulties but some may experience mild difficulties with reading, word comprehension and Mathematics. Memory skills may deteriorate with time which has implications for the subjects and school timetable selected for the student
5. Fatigue: Students tend to tire more easily and may experience frequent absences from school. A balanced timetable in terms of subject selection and rest breaks would be encouraged
6. Personal Care: Students will require the assistance of a Special Needs Assistance for toileting and the use of an accessible bathroom. SNA’s should have completed training in Manual Handling before working with students who have such physical needs. As a student’s level of dependency will increase, emphasis must be placed on maintaining the student’s personal dignity
7. Emotional Well-being: Students may experience feelings of frustration as they become increasingly dependent on others at a time when their peers are enjoying more freedom and independence. With increased awareness of the condition, students may need to avail of pastoral care and councelling

Physical Disability - Practical Interventions for Schools:
1. Access to Buildings – such as ramps, lifts, widened doors, accessible bathrooms, class layout, mobility between classes, fire evacuation plan
2. Specialised Equipment and Resources – such as height adjustable desks, slanted writing boards, triangular pencils, adapted scissors, book stands
3. Assistive Technology – such as adapted mice (roller ball, trackball, joystick, switch access, infrared), adapted keyboards, Big Mac, On-screen keyboards, A.A.C. communication devices, voice recognition software
4. Multi-disciplinary Teams – principal, class teacher, resource teacher, special needs assistant, parents, physiotherapist, occupational therapist, speech & language therapist, social worker, educational psychologist, nurse
5. Transition – additional support needed during transition from pre-school to primary school; primary school to post-primary school; post-primary school to third level/training
6. State Examinations – availability of Reasonable Accommodations at Junior Certificate and Leaving Certificate Level such as tape recorder, laptop, scribe, assistance of helper in practical subjects, use of separate centre and additional time
7. Support Services & Voluntary Bodies – Irish Wheelchair Association, Enable Ireland, Central Remedial Clinic, Health Service Executive, Muscular Dystrophy Ireland