PROFESSIONAL DIPLOMA IN

SPECIAL NEEDS EDUCATION (SNE)

A Training Programme By

UNILAG CONSULT

(UNIVERSITY OF LAGOS, AKOKA)

I
 SNE 121: EDUCATION OF THE PHYSICALLY AND HEALTH
IMPAIRED

Abiodun Afolabi, Ph.D

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or
transmitted in any form or by any means, electronic, mechanical, or photocopying, recording, or
otherwise, without prior permission of the copyright owner. Request for permission to reproduce any
portion of it should be directed to the Programme Coordinator, Professional Diploma Programme in
Special Needs Education (SNE), Unilag Consult, University of Lagos, Akoka

October 2021

II
 PREFACE

It is my pleasure to provide the Preface to the Module series in the Professional Diploma Programme in
Special Needs Education (SNE). This is one of the Modules that had been written by seasoned
practitioners and scholars in the field of Special Needs Education. This Module titled “Educationa of
the Physically and Health Impaired” is written in order to meet the scope and sequence requirements
of the course materials in Special Needs Education.

Special Needs Education is a broad discipline, with diverse areas such as Education of the Hearing
Impaired, Education of the Visually Impaired, Education of the Learning Disabled, Education of the
Intellectually and Developmentally Disabled, Education of the Speech Disordered, Education of the
Gifted and Talented, Education of the Physically and Health Challenged, among others.

This Module however introduces learners to the meaning and definitions of physical and health
impairments, the prevalence of physical and health impairments, cerebral palsy, challenges facing the
physically and health impaired persons, educational approaches and considerations for the physically
and health impaired persons, among other relevant topics. It was written in simple and clear language
which aids its better understanding.

While I am hopeful that this Module is going to be a good companion and additional reservoir of
knowledge in the field of Special Needs Education, the views expressed here however are those of the
Module writer.

Happy Reading!

Dr. Maruff Oladejo

Programme Coordinator,
Professional Diploma Programme in Special Needs Education (SNE),
Unilag Consult,
University of Lagos, Akoka

TABLE OF CONTENTS

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Programme Title Page ……………………………………………………………………………… i
Module Title Page ………………………………………………………………………………….. ii
Preface ………………………………………………………………………………………………. iii
Table of Contents ………………………………………………………………………………….. iv

Meaning and Definitions of Physical and Health Impairments 1 - 11

The Prevalence of Physical and Health Impairments 12 - 13

Cerebral Palsy 14 - 22

Challenges Facing the Physically and Health Impaired Persons 23- 27

Educational Approaches and Considerations for the Physically and Health Impaired 28 - 32

Resources for The Physically And Health Impaired Persons 33 - 39

Other Causes of Physical And Health Impairments 40 - 48

IV
 STUDY SESSION 1

MEANING AND DEFINITIONS OF PHYSICAL AND HEALTH

IMPAIRMENT
Introduction
Physical and health impairments are conditions that result into inability of some children not
to make the proper or best use of their arms or legs as the case may be, because, their bones,
nerves or muscles are involved. Most of the persons with these conditions have mobility
problems. Some cannot stand or walk unless they make use of assistive devices and walking
aids like crutches, walkers or canes and walking sticks. The persons with physical and health
impairments have physical and health related problems which can be conspicuous.

Learning Outcomes
When you have studied this session, you should be able to:
1.1) Explain the meaning and definition of physical and health impairment.
1.2) Give some observable signs of physical and health impairment.
1.3) Mention and explain the classification of physical and health impairment.
1.4) Explain the meaning of the physically and health impaired persons.
1.5) List some examples of conditions with physical and health impairments.

Physical impairment, Health impairment, Physically challenge

1.1 Meaning and Definitions of Physical and Health Impairment
Physical and health impairment is an umbrella term covering a variety of conditions which
limits the normal use of the body and or limbs. Kirk as far back as 1972 provided an acceptable
definition of children with physical and health impairment, by saying that ‘these children
comprise a heterogeneous group with varying disabilities each having a unique problem
which limits the effectiveness with which a child can cope with the academic, social and
emotional expectation of the school and community”. The impairment therefore may restrict
movement and or limit stamina.

Physical and health disability is sometimes used synonymously with physical and health
impairment and physical disability is broad and covers a range of disabilities and health
issues, including both congenital and acquired disabilities. Within that range are physical
disabilities or impairments that interfere with the child’s ability to attain the same

1
developmental milestones as his or her age-mates. The physical capacity to move, coordinate
actions, or perform physical activities is significantly limited, impaired, or delayed and is
exhibited by difficulties in one or more of the following areas: physical and motor tasks;
independent movement, performing basic life functions.

Physical and health disability varies according to the type and intensity of loss of mobility.
People with a physical disability have a loss that reduces the body’s motor skills. Motor skills
are based on a complex body structure, which includes the nervous system, spinal cord,
muscles, nerves, and joints. The disability affects one or more of these elements (e.g. muscular,
neurological, or skeletal systems) rather than a certain part of the body. There are a wide range
of problems grouped together under the term physical and health disability. They may be
directly linked to the disability or may be problems associated with some of the following
conditions: amputation, cerebral palsy (cerebral motor disorder), congenital conditions,
epilepsy, Friedreich’s ataxia, head injury, juvenile rheumatoid arthritis, multiple sclerosis,
muscular dystrophy, paraplegia/quadriplegia, scoliosis, or spina bifida, Some disabilities
involve the use of mobility devices such as prostheses, orthoses, a cane, a wheelchair, crutches,
or a walker.

From the foregoing, it then can be deduced that persons with physical impairment are
susceptible to a myriad of mobility-related problems in architectural designing of buildings
and infrastructure. Architectural designing include that of steps, staircases, heavy doors,
narrow lifts and high window levels among others. These restrict the movement of the
physically handicapped as well as their rehabilitation, employment, educational, vocational,
cultural and recreation opportunities (Olawale, 2000). As a matter of fact, there are some
neurological problems that are categorized as crippling, or a special health problem such as
aphasia –inability to produce speech due to brain damage. Hence, they are classified as non-
sensory physical impairment which may be classified as crippling and chronic health ailments.

1.2 Some Observable Signs of physical and health impairment

The observable signs which are easily noticed by any observant person are:

1. Slight limb or weakness of muscles especially at the joints (ankle, knee and so on);
2. Unsteady gait, swaying or involuntary movement of the limb;
3. Mild or severe paralysis of the limb or curves of the trunk and neck;
4. Absence or malformation of one or more limbs or parts of the body e.g. lips, nose,
fingers and so on;
5. Inability to relax muscles or control and coordinate gross and fine motor movement
such as required for grasping, throwing and catching of objects, writing and so on;

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6. Constant unexplainable falls; and
7. Drooling with lips drooping.

It should be emphasized that all these signs are never present in any one child, and not all
children who exhibit anyone or more of these signs are physically and health impaired.
Temporary illness may produce some of these signs, which will usually disappear as soon
as the child gets well. If the signs are permanent over a period of time, then the child would
be considered as being physically and health impaired depending on the severity and the
limitations, which condition imposed on the child’s activities.

1.3 Classification of Physical and health impairment

The conditions of physical and health impairment are classified under three major groups
namely: Neurologic impairments, Orthopaedic impairments and Other health
impairments.

1.3.1 Neurologic Impairment

These are a group of disorders that primarily relate to the Central Nervous System (CNS)
which comprised of the brain and spinal cord. It is widely believed that one of the most
common causes of physical disability in children is damaged to or deterioration of the
CNS. These are conditions which are caused by injury to or incomplete development of the
CNS. Damage to the brain may be so mild as to be undetectable as far as the child’s
functioning is concerned or so profound as to reduce the child control separate functions,
the damage or lack of development will result in various disabilities depending on the
affected part. Thus, neurologically impaired child may be paralyzed, unable to coordinate
body movement, have speech or perceptual problems. Examples of neurological
impairment are: anterior poliomyelitis, cerebral palsy, spina bifida, hydrocephalus, erb’s
palsy, multiple sclerosis, epilepsy, spinal cord injury, tourette syndrome, brain injury and
so on.

1.3.2 Orthopaedic Impairment

Orthopaedic Impairments (OI) are disabilities that have to do with bones and joints in the
body. Orthopaedic Impairments children are those children who suffer from such
impairments (defects, deformities and disturbances) of their muscle and skeletal and or
nervous system that may interfere with their normal functioning and adjustment to the
general and specific demands of their environment (particularly restricting the activities
related to locomotion or moving) and thus making them orthopaedic disabled to the extent

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of requiring special measures for their well being, adjustment and educational progress
(Mangal, 2015).

1.3.2.1 Functional Limitations Caused by Orthopaedic Impairment

Although, some of the observable signs highlighted above are common to all persons
physical and health impairments, but the following functional limitations are caused by
orthopaedic impairment:

- Poor muscle control.

- Weakness and fatigue (paresis, lack of muscles strength, nerve enervation, or pain).
- Difficulty in walking, talking, climbing steps, seeing, speaking, sensing or gasping
(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, wheelchairs, communication aids like single
switch based artificial voice, etc.).
- Paralysis (in which there will be total lack of muscular control).
- Interference with control like problems in accuracy of motor programming and
coordination, uncontrolled and purposeless motion and tense and contracted
muscles etc.
- Joint movement limitation (either mechanical or due to pain).
- Difficulty faced in providing normal gait and usually have a jerky or totally
uncoordinated gait.
- Difficulties and inabilities faced in motor functioning due to smallness of limbs,
missing limbs or abnormal (Mangal, 2015).

Examples of orthopaedic impairment are arthritis, scoliosis, talipes equinovaus, talipes

calcaneovalgus, amputation and so on.

1.3.3 Other Health impairment

The individual with Disabilities Education Act (IDEA) (2004) names several disorders in
other health impairments (OHI) official definition as “having limited strength, vitality

4
 or alertness, including a heightened alertness to environment stimuli, that results in
limited alertness with respect to the educational environment, that:

a. Is due to chronic or acute health problems such as asthma, attention deficit disorder
or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition,
haemophilia, lead poisoning, leukemia, nephritis (a kidney disorder), rheumatic
fever, sickle cell anaemia, and tourette syndrome; and
b. Adversely affects a child’s educational performance.

1.4 The Physically and Health Impaired Persons

Individuals with physical and health impairment are known as physically and health
impaired. The Physically and Health Impaired Persons (PHIP) are those who are crippled,
deformed or otherwise physically handicapped (exclusive of the visually, auditory and
other sensory handicapped) and those who have health problems which interfere with
normal functioning in a regular classroom. This category of people comprise
heterogeneous groups with varying disabilities, each with a unique problem, which limits
the effectiveness with which a child can cope with the academic, social and emotional
expectations of the school and community. In the past, classes for PHIP comprised
primarily children with mobility problems or problems of manual dexterity, but today
majority of children found in special classes and other programmes for physically impaired
have problems of coordination, perception and cognition (as well as mobility) resulting
from lack of proper development, of or injury to the central nervous system. Children with
physical disabilities are those whose non-sensory physical limitations or health problems
interfere with school attendance of learning to such an extent that special services, training
equipment, materials or facilities are required. The PHIP have variety of conditions which
limit the normal use of the body and or limbs.

Activity 1.1

Box 1.1
Why do you think physically and health impaired persons are categorized as
‘special’?

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In Study Session 1, you have learnt that:
1) Physical and health impairment is condition that limits the use of bones and muscles of the
sufferer.
2) There are some observable signs of physical and health impairment.
3) Physical and health impairments are categorized into neurological, orthopaedic and other
health impairments.
4) There are some functional limitations caused by orthopaedic impairment
5) Persons having physical and health impairment conditions are known as physically and
health impaired.

Self-Assessment Questions (SAQs) for Study Session 1

Now that you have completed this study session, you can assess how well you have achieve
its Learning Outcomes by answering the following questions.
SAQ 1.1 (tests Learning Outcomes 1.1)
What do you understand by Physical and health impairment?
SAQ 1.2 (tests Learning Outcomes 1.2)
Highlight observable signs being shown by persons with physical and health impairment
SAQ 1.3 (tests Learning Outcomes 1.3)
Mention and explain the three classifications of physical and health impairment.
SAQ 1.4 (tests Learning Outcomes 1.4)
Who are the physically and health impaired persons?
SAQ 1.5 (tests Learning Outcomes 1.5)
Mention some examples of conditions with physical and health impairment

References
Mangal, S.K. (2015): Children with cerebral palsy, pp 363-383, PHI Learning Private
Limited.
Olawale, S.G. (2000): Counselling exceptional children: A handbook for professionals and parents
working with exceptional children, Emolaj Press.
Further readings (If Any):

6
Afolabi, A. (2020): Physiotherapy for the physically impaired, Adeyoung Printing Press.

STUDY SESSION 2

PREVALENCE OF PHYSICAL AND HEALTH IMPAIRMENT

Introduction
The World Health organization (WHO) estimates that 7-10% of human beings have some
degree of impairment or disability. About 80% of these are said to live in developing countries
(Nigeria inclusive) and of these, it is estimated that less than 5% have access to rehabilitation
services.

Learning Outcomes
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When you have studied this session, you should be able to:
2.1) State the prevalence of physical and health impairment

: Physical impairment, Health impairment

2.1 Prevalence of Physical Impairment

Physical or health disabilities in children are low incidence disabilities according to Roosevelt
(2007). Prevalence of physical and health impairment in Nigeria is yet to be ascertained. In
America, of school age children, approximately 0.14% are classified as having a physical
disability and 0.59% are classified as having other health impairments. For physical disability,

- 3 children in 1000 are affected by cerebral palsy. According to the Centers for Disease
Control and Prevention (CDC) Trusted Source, it affects at least 1.5 to 4 out of every
1000 children worldwide.
- 1 in every 3,500 male births inherits Muscular Dystrophy.
- 1 in every 1,000 births develops spinal bifida.
- The last case of poliomyelitis (a viral infection that attacks the nerve cells in the spinal
cord that control muscle function) in the United States was reported in 1979, and it is
almost eradicated worldwide. A total of 748 confirmed cases in 2003 occurred in only
six countries (Roosevelt, 2007).
- According to Tenth Annual Report to Congress in America as at 1988, approximately
1.3% (58, 328) of all students receiving special education services are orthopedically
impaired, while 1.2% (52, 688) are counted as other health impaired.

2.2 Prevalence of Other Health Impairments

For other health impairments:

- Asthma is most common with 6.7 million children under 18 years being affected.
- Approximately 3 million Americans which constitute 1% have epilepsy.
- A startling 8% of African Americans have inherited sickle cell anaemia.
- Approximately 1.1 million Americans live with HIV/AIDS

- In Study Session 2, you have learnt that:

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Some fractions of the population of human beings are classified as having physical and other
health impairment.

Self-Assessment Questions (SAQs) for Study Session 2

Now that you have completed this study session, you can assess how well you have achieve
its Learning Outcomes by answering the following questions.

SAQ 2.1 (tests Learning Outcomes 2.1)

State the prevalence of physical and health impairment

References

Roosevelt, F.D (2007): Physical or health disabilities. In D.D. Smith (Ed): Introduction to special
education: making a difference, sixth edition. Boston.

Tenth Annual Report to Congress on the implementation of the Education of the handicapped
Act (1988). Washington D C,, U.S. Department of Health and Human Services, Office of Special
Education and Rehabilitative Services.

STUDY SESSION 3

CEREBRAL PALSY: DEFINITION/MEANING, CAUSES, AND

TYPES

Introduction
Cerebral palsy is used to describe a group of chronic conditions which affect body movements
and muscle coordination in persons affected with the disorder. It is one of the examples of
physical and health conditions. It is a disorder of movement and posture resulting from a
permanent damage or defect in the immature brain. Cerebral palsy causes damage to one or
more particular areas of the brain and usually occurs during fetal development or before,
during or shortly after birth, although the damage may be done during infancy.

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 Learning Outcomes
When you have studied this session, you should be able to:
3.1) Define and explain the meaning of cerebral palsy
3.2) Explain the causes of cerebral palsy
3.3) Explain the risk factors for cerebral palsy
3.4) Mention and explain the classifications of cerebral palsy based on the Gross Motor
Function Classification System
3.5) Describe the types of cerebral palsy according to the symptoms exhibited.
3.6) Describe the types of cerebral palsy according to the parts of the body affected

: Cerebral Palsy

3.1 Definitions/Meaning of Cerebral Palsy

The word “Cerebral” means having to do with the brain and “Palsy” means weakness or
problem with body movement and using the muscles (Stacy, 2021). Cerebral Palsy (CP) is a
group of disorder that affects a person’s disability to move and maintain balance and posture
(Stay, 2021). It refers to a group of disorders that affect muscle movement and coordination
many cases, visions, hearing or speech and sensation; changes in spine (such as scoliosis) or
joint problems (such as contractures) are also affected. CP is the most common cause of motor
disabilities in childhood. According to the Centers for Disease Control and Prevention (CDC)
Trusted Source, it affects at least 1.5 to 4 out of every 1000 children worldwide.

3.2 Causes of Cerebral Palsy

Abnormal brain development or injury to the developing brain (immature brain) can result or
cause CP. The brain damage usually occurs before birth (pre-natal), but it can also happen
during birth (peri-natal) or the first years of life (post-natal). Some of the possible causes
include:

1. Asphyxia neonatorum: This means a lack of oxygen to the brain during labour and
delivery.

10
 2. Gene mutations: This can result in abnormal brain development.
3. Severe jaundice in the infant.
4. Maternal infections: Such infections as German measles and herpes simplex of the
mother can affect the baby’s brain.
5. Brain infections: Infections of the brain such as encephalitis and meningitis can result
into brain damage of the infant.
6. Intercranial hemorrhage or bleeding in the brain.
7. Head injuries: This can be caused by car accident, a fall, or child abuse.

3.3 Risk Factors for CP

There are certain factors which put babies at an increased risk for CP. These include the
following:

- Premature birth.
- Low birth weight.
- Being a twin or triplet.
- A low Apgar Score – Apgar Score is used to assess the physical health of babies at birth.
- Breech birth: This occurs when the baby’s buttock or feet come out first during delivery.
- Rhesus incompability: Rhesus incompability means when a mother’s blood Rh type is
incompatible with her baby’s blood Rh type.
- Maternal exposure to toxic substances such as methyl mercury while the mother is
pregnant of the child.

3.4 Other problems associated with CP Children

CP children may have other problems such as:

1. Communication difficulties: They may speech and language disorders

2. Drooling.
3. Spinal deformity: They may suffer from or develop spinal deformity such as Scoliosis
(lateral curvature deviation), Lordosis (saddle back) and Kyphosis (Humpback or
round back}.
4. Osteoarthritis: This means inflammation of joints which affects the bones.
5. Contractures: This occurs when muscles get locked in painful positions.
6. Incontinence: This means inability to control the flow of urine or faeces.
7. Osteopenia: This is poor bone density that can make bones easily breakable.
8. Dental problems: They can have problems with their teeth.

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 3.5 Classification of CP
CP is classified according to the Gross Motor Function Classification System (GMFCS),
developed by the World Health Organization (WHO) and the Surveillance of Cerebral Palsy in
Europe. This is a universal standard for determining the physical capabilities of people with
CP.

The system focuses on:

- The ability to sit.

- The capability for movement and mobility.
- The charting independence.
- The use of adaptive technology.

Level 1 CP

This is characterized by being able to walk without limitations

Level 2 CP

A person with level 2 CP can walk long distances without limitations, but cannot run or jump.
They may need assistive devices such as leg and arm braces, when first learning to walk. They
also may need a wheelchair to get around outside of their home.

Level 3 CP

A person with Level 3 CP can sit with little support and stand without any support. They need
handheld assistive devices, such as a walker or cane, while walking indoors. They also need a
wheelchair to get around outside of the home.

Level 4 CP

A person with Level 4 CP can walk with the use of assistive devices. They are able to move
independently in a wheelchair, and they need some support when they are sitting.

Level 5 CP

A person with Level 5 CP needs support to maintain their head and neck position. They need
support to sit and stand, and may be able to control a motorized wheelchair.

3.6 Types of CP
Types of CP can be divided into two:

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 1. Those of the number of the limb affected or involved and
2. Those that have to do with the movement disorders and symptoms exhibited.

3.6.1 Types based on the number of limb affected.

These are types of according to the parts of the body affected.

a) Quadriplegia
In this type, all four limbs of the person are involved. This involves muscle movements
and weakness in both arms and both legs.
b) Diplegia
All four limbs are involved here too, but legs are more severely affected than the arms.
c) Hemiplegia
In this type, one side of the body is affected. It involves muscle movements and
weakness on one side of the body, but the arm is usually more involved than the leg.

Figure 1: One side of the body affected. Source

https://www.cerebralpalsyguide.com/cerebral-palsy/types/

d) Triplegia
Triplegia occurs when three limbs are affected. This may occur if both legs and one arm
cannot move freely.

Figure 2: Three limbs affected. Source: https://www.cerebralpalsyguide.com/cerebral-

palsy/types/

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 e) Monoplegia
Only one limb is affected in monoplegia, usually an arm.

Figure 3: One limb affected. Source:

https://www.cerebralpalsyguide.com/cerebral-palsy/types/

The location of movement problems is related to the location of a brain injury and can
determine which type of cerebral palsy a child has.

3.6.2 Types based on the symptoms exhibited:

a) Spastic CP
This is the common type and accounts for 77% of all cases. It is also referred to as
hypertonic CP. It is characterized by high muscle tone and exaggerated jerky
movements (spasticity). Spastic CP is caused by damage to the brain’s motor cortex
which controls voluntary movement; or damage to the pyramidal tracts which helps
relay signals to the muscles. Common symptoms of spastic CP include: abnormal
walking, awkward reflexes, contractures (permanently tightened muscles or joints),
stiffness in the muscles affected.

77% of all cases

Figure 4: Diagram showing brain’s motor cortex affected in spastic CP. Source:
https://www.cerebralpalsyguide.com/cerebral-palsy/types/

14
b) Athetoid CP
About 2.6% of children with the condition are diagnosed with athetoid CP. It is also
kmown as non-s[astic or dyskinetic CP. Athetoid CP is characterized by involuntary
writhing movement in the body and a combination of hypotonia (loosened muscles)
and hypertonia (stiffened muscles) which causes muscle tone to fluctuate. It is caused
by damage to the brain basal ganglia and/or cerebellum. Athetoid CP is considered
extrapyramidal because the extrapyramidal tracts in the brain regulate involuntary
reflexes and movement signaled by the basal ganglia and cerebellum. Common
symptoms of Athetoid CP include: feeding issues, floppiness in the limbs, problems
with posture, stiff or rigid body.

2.6% of all cases

Figure 5: Diagram showing basal ganglion and extrapyramidal tract affected in

Athetoid CP. Source: https://www.cerebralpalsyguide.com/cerebral-palsy/types/

c) Ataxic CP
Ataxic CP makes up about 2.4% of all CP cases. This type of CP causes ataxia and issues
with balance, coordination and voluntary movement. Ataxic CP is caused by damage to
the cerebellum, which is responsible for coordinating physical movement. Individuals
with ataxic CP often experience tremors and a reduction in muscle tone. Common
symptoms of ataxic CP include: poor coordination, problems with depth perception,
shakiness and tremors, speech difficulties, spreading feet apart when walking.

15
 2.4% of all cases

Figure 6: Diagram showing part of the brain affected in ataxic CP. Source:
https://www.cerebralpalsyguide.com/cerebral-palsy/types/

d) Hypotonic CP
This is also known as atonic CP and makes up to about 2.6% of all cases. It is a type
classified as low muscle tone that causes loss of strength and firmness, resulting in
floppy muscles. Instability and floppiness in muscles that characterizes this CP can
cause a child to miss developmental milestones such as crawling, standing, or walking.
Common symptoms of hypotonic CP include: flexible joints and ligaments, lack of neck
control, loose muscles and, poor balance and stability.

2.6% of all cases

Figure 7: Diagram showing the part of the brain affected in Hypotonic CP. Source:
https://www.cerebralpalsyguide.com/cerebral-palsy/types/

e) Mixed CP
Mixed CP results when damage to the developing brain is not confined to one location,
as it occurs in some cases. This may make the child to develop more than one type of
CP. About 15.4% of all cases are diagnosed as mixed type CP. The most common mixed
CP diagnosis is a combination of spastic and athetoid CP, since both are characterized
by issues of voluntary movement.

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 15.4% of all cases

Figure 8: Diagram showing parts of the brain that can be affected in Mixed CP. Source:
https://www.cerebralpalsyguide.com/cerebral-palsy/types/

In Study Session 3, you have learnt that:

Cerebral Palsy is not a disease but a condition in which an immature brain is damaged either
before birth, during birth or at childhood.
1) Causes of cerebral palsy and risk factors for cerebral palsy.
2) Both muscles and movement of the person can be affected.
3) The speech of the person can also be affected.
4) Cerebral palsy is classified based on Gross Motor Function Classification System.
5) The symptoms that a cerebral palsied person exhibit will depend on the part of the brain
damaged.
6) Cerebral Palsy can also be classified based on the part of the body (limb) affected.

Self-Assessment Questions (SAQs) for Study Session 3

Now that you have completed this study session, you can assess how well you have achieve
its Learning Outcomes by answering the following question
SAQ 3.1 (tests Learning Outcomes 3.1)

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 Define and explain the meaning of Cerebral Palsy
SAQ 3.2 (tests Learning Outcomes 3.2)
What are the causes of Cerebral Palsy?.
SAQ 3.3 (tests Learning Outcomes 3.3)
What are the risk factors for Cerebral Palsy?
SAQ 3.4 (tests Learning Outcomes 3.4)
Discuss the classification of Cerebral Palsy based on Gross Motor Function
Classification System
SAQ 3.5 (tests Learning Outcomes)
Describe the types of Cerebral Palsy according to the symptoms exhibited
SAQ 3.6 (tests Learning Outcomes)
Describe the types of Cerebral Palsy based on the number of limbs involved

STUDY SESSION 4

CHALLENGES FACING PHYSICALLY AND HEALTH IMPAIRED

PEOPLE

Introduction
People with disabilities face different things in the world owing to their disabilities. The
physically and health impaired persons are not left behind. This is because their disability they
suffer from is obvious at first meeting. People react negatively to them in the past by calling
them different derogatory names. Many of them are also confronted with different barriers
that range from architecture, to policy, attitude and programme. Employees of labour are not
left behind, as they are also confronted with different challenges.

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 Learning Outcomes
When you have studied this session, you should be able to:
4.1) Explain the challenges that persons with physical and health impairment face
4.2) Describe the physical barriers confronting the physically and health impaired person
4.3) Explain the attitudinal barriers that physically and health impaired person face
4.4) Explain the physical barriers confronting the physically and health impaired
4.5) Highlight and explain the policy barriers facing the physically and health impaired person
4.6) Explain the programme barriers confronting the physically and health impaired person
4.7) Explain the difficulties that employees with physically and health impairment at work face.

: Physically and Health Impaired Person

4.1 Challenges Facing Persons with Physical and Health Impairment

Nearly everyone faces hardships and difficulties at one time or another, but barriers can be
more frequent and have greater impact for people with disabilities. The World Health
Organization (WHO) describes barriers as being more than just physical obstacles. The
reactions of others have been and continue to be a major problem for individual with physical
and health problems and only compound the challenges they face because of their disabilities.
Many physical and health differences are obvious even at first meeting. As a consequence,
individual with these disabilities are forced often to deal with negative reactions of others.
WHO definition of barriers are “Factors in a person’s environment that, through their absence
and presence, limit functioning and create disability. These include aspects such as:

- A physical environment that is not accessible,

- Lack of relevant assistant technology (assistive, adaptive, and rehabilitative devices),
- Negative attitudes of people towards disability
- Services, systems and policies that are either non-existent or that hinder the
involvement of all people with a health condition in all areas of life.
- Often there are multiple barriers that can make it extremely difficult or even impossible
for people with disabilities to function. the most seven common barriers facing people
with physical and health disabilities are:

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 4.1.1 Attitudinal barriers
Attitudinal barriers are the most basic and contribute to other barriers. For example, some
people may not be aware that difficulties in getting to or into a place can limit a person
with a disability from participating in everyday life and common daily activities.

 Stereotyping: People sometimes stereotype those with disabilities, assuming their

quality of life is poor or that they are unhealthy because of their impairments.
 Stigma, prejudice, and discrimination: Within society, these attitudes may come
from people’s ideas related to disability – people may see disability as a personal
tragedy, as something that needs to be cured or prevented, as a punishment for
wrongdoing, or as an indication of the lack of ability to behave as expected in
society.

4.1.2 Physical barriers

Physical barriers are structural obstacles in natural or man-made environments that prevent or
block mobility (moving around in the environment) or access.

 These are steps and curbs that block a person with mobility impairment from entering a
building or using a sidewalk;
 Mammography equipment that requires a woman with mobility impairment to stand;
and
 Absence of a weight scale that accommodates wheelchairs or others who have difficulty
steeping up.

4.1.3 Policy barriers

Policy barriers are frequently related to a lack of awareness or enforcement of existing laws
and regulations that require programs and activities be accessible to people with physical
disabilities.

 Denying qualified individuals with disabilities the opportunity to participate in or

benefit from federally funded programs, services, or other benefits;
 Denying individuals with disabilities access to programs, services, benefits, or
opportunities to participate as a result of physical barriers.

4.1.4 Programme barriers

20
Programme barriers limit the effective delivery of a public health care program for people with
types of impairments.

 Inconvenient scheduling;
 Lack of accessible equipment (such as mammography screening equipment);
 Insufficient time set aside for medical examination and procedures;
 Little or no communication with patients or participants; and
 Provider’s attitudes, knowledge, and understanding of people with disabilities.

4.2 Employee with physical and health disability

Employees with disability are not likely to have all the listed disability features or affects at
work. Most people have just a few of those listed; one can only know by asking the person
directly. Employee with a physical disability may be affected at work. They may have
difficulties with:

 Accessing workstations, meeting rooms, bathrooms etc;

 Fatigue
 Manipulating objects, for example handwriting, handling files or using certain tools
 Using a standard computer keyboard or mouse
 Holding a telephone handset
 Traveling to and from work during ‘peak hour’
 Medication side effects

In Study Session 4, you have learnt that:

1) Persons with physical and health impairment are confronted with challenges.
2) Some of the challenges facing the physically and health impaired persons are
attitudinal, physical, policy, programme barriers.
3) Physical and health impaired employees are also faced with some difficulties.

Self-Assessment Questions (SAQs) for Study Session 4

Now that you have completed this study session, you can assess how well you have
achieve its Learning Outcomes by answering the following questions.

21
SAQ 4.1 (tests Learning Outcomes 4.1)
What are the challenges that confront persons with physical and health impairment?
SAQ 4.2 (tests Learning Outcomes 4.2)
Briefly describe the attitudinal barriers confronting the physically and health impaired
persons
SAQ 4.3 (tests Learning Outcomes 4.3)
State and explain the physical barriers that the physically and health impaired persons
face.
SAQ 4.4 (tests Learning Outcomes 4.4)
Highlight and explain the policy barriers facing the physically and health
impaired person
SAQ 4.5 (tests Learning Outcomes 4.5)
What are the programme barriers that the physically and health impaired person face

SAQ 4.6 (tests Learning Outcmes 4.6)

What are the difficulties that employees with physical and health impairment at work
face?
References

Smith, D.D. (2007): Introduction to Special Education: Making a difference, sixth

edition. Pearson Education Inc.

Oluokun, P.O. (2020): Capacity building and economic empowerment of learners

with physical and health impairment. In A.A Ufford & B.A. Adebiyi (Eds),
Special Needs Education: A viable tool for sustainable development goals in Nigeria. A
festschrift in honour of Dr. Theo Ajobiewe. Glory-Land Publishing
Comp.

22
 STUDY SESSION 5

EDUCATIONAL APPROACHES AND CONSIDERATIONS FOR

PHYSICALLY AND HEALTH IMPAIRED

Introduction
From the aforementioned, it has been established that, physically and health impaired
persons fall into categories of people referred to as ‘special’ and as a result special
educational programme that requires different curriculum and approaches are to be used
in educating them. Parts of this educational approaches include the use of different special
equipment and assistive technology devices like orthoses and prostheses; ambulatory
devices like crutches, walkers and walking sticks and the use of resource centers like the
gymnasium and physiotherapy laboratory for them when need arises. Another
consideration is to give these persons extra time during class sessions and examination
period. Some of them can even have to depend on writers to write their examination and
CA for them because of their peculiarity.

23
 Learning Outcomes
When you have studied this session, you should be able to:
5.1) State educational approaches for the physically and health impaired persons.
5.2) Explain various educational considerations for the physically and health impaired
persons.
5.3) Highlight suggested common modifications and adaptations for the education of the
physically and health impaired persons.

: Educational approaches, Physically and Health Impaired Persons

5.1. Educational considerations for the physically and health impaired persons.
The following are educational considerations for the physically and health impaired
persons:
1. One of the main considerations for the physically and health impaired is the use of
the team approach in developing and carrying out a child’s with physical and health
impairment educational programme. This team includes the parents, teachers,
medical and other health professionals, such as the physicians and the
physiotherapist. Parents in the team are critical members and they should be
involved in educational decisions. The team is expected to design a programme that
meets the needs of the student in five basic goal areas such as:
a) Physical interdependence: The student should be able to master daily living skills.
b) Self awareness and social maturation
c) Communication
d) Academic growth and,
e) Life skills training.

The design should include interdisciplinary services of occupational and physical therapy;
speech and language therapy as these are of prime importance.

2. Another important educational consideration for those children is placement. Many

educational services that can be provided in a variety of settings include: regular
classrooms, resource rooms, special classes, and other more restrictive settings

24
 including hospital and homebound progrmmes. Extensive medical and health
related support arrangements often need to be made in the educational placement in
order to provide these services in diverse educational settings. The need for support
services is often a vital consideration when fitting a programme to an individual
student. Most related services are transportation, physical therapy, occupational
therapy, diagnostic services, school health services, counseling and school social
work services.
3. Modification and adaptation of the school environment to make it accessible, safe
and less restrictive. Accessibility guidelines available can be made use of in order for
the environment to become easier for the child to manage independently.
4. Communication of the children with physical and health impairment can be aided
for example, students with CP can use computer terminals in communication.
Technology has advanced to the extent that a person with the most severe handicaps
can have greater control over communication and daily living skills.

5. Provision of special adaptive equipment. These are specially designed desks,

positioning devices, wedges, or standing tables. These can be made as part of
environment modification. Other devices and equipment for physically disabled
students are: speech-to-text software, magnification software, and eye gaze
communication device, alternative and modified keyboards, on-screen and touch
screen keyboards, specialized mice, text and screen reading
6. Adaptations may also include establishing procedures for dealing with medical
emergencies when students have serious medical problems.

7. There can be a need for variations of the general curriculum. This may be provided
to the students based on their on their unique needs, but most of them participate in
the general curriculum.
8. Teachers should especially be tuned to classroom situations that might endanger the
health of some students. An example of this would be the effect of chalk dust in
triggering an asthmatic attack.
9. Assistive technology (AT) devices can also help students participate in the general
education classroom and the general curriculum. We, as educators therefore, need
to find out which AT devices would be exceptional beneficial for specific students
and try to implement those into the curriculum or classroom.

5.2 Common Accommodations and adaptations

The following accommodations and classroom adaptations are a list of suggested

accommodations, but are not comprehensive or exhaustive, nor will all accommodations listed
be necessary in all cases. Other accommodations may be implemented based on the individual
needs of each student as recommended by Disability Services Office or other professionals.

25
Common Characteristics of a Commonly Suggested Accommodations/Classroom
Student with Physical Disabilities Adaptations

Has unique needs in terms of

physical space or has difficulty Physically accessible environment that is not
using chairs/tables in the mobility-limited can be created.
classroom/lab.

The schedule can be made flexible with students.

Student needs specialized
Students may arrive late or have to leave before the
transportation.
class is over due to adapted transportation services.

Written exams or assignments can be replaced with

Is often physically unable to hold a an oral exam or presentation.
pen and write for extended periods Can make use of note takers.
of time or may experience Can make use of assistive technology (e.g., computer,
challenges with input, output, and assistive software, mini recorder, etc.).
information processing when Can make use of a scribe or speech-to-text software to
working on assignments, tests, record answers on tests/exams.
and/or exams. A room other than the classroom for exams if
required can be provided (Gym or lab).

Student has difficulty finishing

Extra time for tests/exams and perhaps some
assignments and/or tests in allotted
components of coursework are given.
time.

When speaking to a person who uses a wheelchair for

a long period of time, avoid the need for them to
Experiences fatigue and limited
strain in order to look up at you by sitting beside or
mobility when speaking to a person
leaning toward them during the conversation, in
for a long period of time.
order for them to avoid experiencing fatigue and/or
pain.

Digital copies of texts are provided. (It is very

Requires extra time to obtain
important to provide students with a complete list of
formats compatible with assistive
reference documents as early as possible or prior to
technology.
the start of the semester).

Feels excluded during group

The person is always made sure to be included with
exercises or has difficulty moving
others when forming groups.
around the classroom.

Expends a great deal of energy to It may be helpful to limit the number of exams on a
complete daily tasks. given day or week in order to reduce fatigue of

26
Common Characteristics of a Commonly Suggested Accommodations/Classroom
Student with Physical Disabilities Adaptations

students with physical disability,. Extra time should

be planned for oral reports on occasion if the person
has diction problems.
A reduced course load can be suggested.

Ensure all off-site activities are accessible or provide

alternative assignment options.
Experiences challenges with daily Individuals with a motor disability sometimes use a
living activities and mobility. service animal, which is usually trained to respond to
unique commands. (It is preferable to ask permission
before you pet the service animal).

In Study Session 5, you have learnt that:

1) Persons with physical and health impairment can also be educated and that there are
specific educational considerations for them different from their able counterpart.
2) Different professionals can be involved in their educational considerations.
3) They are to be accommodated in their educational pursuits with classroom
adaptations.
4) Special adaptive equipment are being made use of in their educational considerations.

Self-Assessment Questions (SAQs) for Study Session 5

Now that you have completed this study session, you can assess how well you have achieve its
Learning Outcomes by answering the following questions:
SAQ 5.1 (tests Learning Outcomes 5.1)
State educational approaches for the education of the physically impaired persons.

SAQ 5.2 (tests Learning Outcomes 5.2)

What are various educational considerations for the physically and health impaired
persons?

SAQ 5.3 (tests Learning Outcomes 5.3)

27
 Highlight suggested modifications and adaptations for the education of the physical and
health impaired persons.

References
Duhaney, D. C., & Duhaney, l. M. G. (2000): Assistive technology: Meeting the needs of
learners with disabilities. International Journal of Instructional Media, 27(4), 393-401.

Rosenberg, M., Westling, D., & McLeskey, J. (2011). Special education for today's teachers: An
Introduction (2nd ed). Prentice Hal

STUDY SESSION 6

RESOURCES FOR THE EDUCATION OF THE PHYSICALLY AND

HEALTH IMPAIRED PERSONS

Introduction
Resources for the education of the physically and health impaired center on capital (fund) and
materials that are needed by this categories of persons. It is to be noted that, education of the
physically and health impaired persons is capital intensive, as most materials being used for
their education are expensive.

Learning Outcomes
When you have studied this session, you should be able to:
6.1) State the various sources of fund for the education of the physically and health
impaired persons.
6.2) Highlight the various basic provisions for the education of the physically and
health impaired persons.
6.3) Identify and explain various mechanical aids and assistive devices for care of the
children with cerebral palsy.
6.4) Define and explain the meaning of prostheses and orthoses.
28
6.5) Mention different examples of prostheses and orthoses.
6.6) Explain how to prescribe prosthetic devices to their client.
6.7) Highlight the functions and indications for orthotic devices.

: Educational Resources

6.1 Resources and fund for the education of the physically and health impaired persons
Capital and fund for the education of the physically impaired should be the prerogative of the
government. The bulk of the capital should come from the Federal government as all of them
are under its leadership, followed by the State government and last the Local government
which is at the grass root. Government should also be of assistance in providing various
materials needed by for their education. Although, the financial burden may be too much on
the government, assistance should be sought and given by the Non Governmental
Organizations (NGOs) and various individuals who GOD has blessed and well to doing the
society. Some of the materials they need are assistive technology devices.

6.2 Basic provisions for the education of physically and health impaired in general
The basic provisions of the education of physically and health impaired persons include:

1. Persons with physical disabilities that affect movement can use mobility aids, such as
wheelchairs, scooters, walkers, canes, crutches, prosthetic devices and orthotic devices,
to enhance their mobility.
2. Cognitive assistance including computer or electrical assistive devices can help person
function following brain injury.
3. Computer software and hardware, such as voice recognition programs, such as screen
readers, and screen enlargement applications, help person with mobility and sensory
impairments use computer technology.
4. In the classroom and elsewhere, assistive devices such as automatic page-turners, book
holders, and adapted pencil grips, allow person with disabilities to participate in
educational activities.
5. Barriers in community buildings, businesses, and workplaces can be removed or
modified to improve accessibility. Such modifications include ramps, automatic door
openers, grab bars, and wider doorways.
6. Lightweight, high performance wheelchairs have been designed for organized sports,
such as basketball, tennis, and racing.

29
 7. Adaptive switches make it possible for a child with limited motor skills to play with
toys and games.
8. Many types of devices help person with disabilities perform such tasks as cooking,
dressing and grooming. Kitchen implements are available and can be purchased with
large, cushioned grips to help person with weakness or arthritis in their hands.
Reaching devices to reach items on the shelves can also be acquired by them.
9. Mouth stick: This is a device that allows users to control input (whether that will be
moving their wheelchair or surfing the web) with a stick they manipulate with their
mouth.
10. Head wand: This is a device similar to a mouth stick, but users control input with their
head instead of their mouth.

6.3 Making use of assistive technology and mechanical aids for children with cerebral
pasly
The use of assistive technology and mechanical aids on the part of children with cerebral palsy
may help them in many ways to overcome their limitations and also correctly their movements
and postures to a certain extent. A few of those equipment and devices according to Mangal
(2015) are as follows:

1. Equipment helpful in positioning: These types of equipment help the child in providing
appropriate postures and positions while sitting, standing or walking. A few of them
are named as follows:
 Adaptive chair: These are special chairs used for positioning the child optimally so that
his feet, knees and hips are correctly aligned at 90 degree angles.
 Corner chair: These are chairs for providing support to the child in a sitting position.
 Floor sitter: This is a device for providing support to the child to sit on the floor.
 Stander: This is for supporting a child in a standing position, positioned at any angle
from horizontal to nearly vertical.
 Side lyer: This is helping the child to lie down safely on one side of the body.
 Standing frame or box: This is for supporting the standing children in a walking
position.
1. Equipment helpful in mobility: These pieces of equipment may provide help to children
with cerebral palsy in their mobility. A few of them can be named as follows:
 Crutches: These are ambulatory aids for walking.
 Walker: These are used for support in walking.
 Strollers or travel chairs: This is a type of wheeled chairs used to transport a child.
 Tricycles: These are three wheeled, pedaled vehicles adapted to accommodate
motor problems.

30
  Wheelchairs: These are chairs mounted on large wheels, for people with extreme
physical disabilities to move about.
 Adaptive switches: These enable children with limited movement ability to operate
electric, electronic and battery operated toys or devices.
2. Equipment helpful in communication: The children with cerebral palsy are usually
found to suffer from speech, language and other communication problems. For helping
them in this direction, the use of certain aids and equipment may prove quite useful.
Examples of such aids are communication boards, electronic devices and computers
equipped with voice synthesizer.
3. Equipment helpful in feeding: These pieces of equipment provide assistance in feeding
the children with cerebral palsy, including self-feeding. A few of them may be named as
follows:
 Cut out cups: These are helpful in monitoring liquid intake and making children
drink without over extending their necks.
 Cups with projecting rim: This is helpful in starting proper drinking.
4. Other adapted feeding utensils: Other utensils commonly used for the feeding purposes
like spoons, plates, bowls, etc. with custom made supports, handles or bends to meet
the unique handling of the children with cerebral palsy can be purchased or custom
designed as per the guidance of the therapists taking care of the children.

6.4 Other assistive technology devices: Prostheses and Orthoses

Prostheses and orthoses are part of assistive technology devices for the physically and
health impaired persons.

6.4.1 Prostheses

6.4.1.1. Definition and Meaning of Prostheses

Prostheses are substitutes for missing body parts for cosmetic and functioning purposes.
They are used as replacement for body parts that have been lost due to amputation or any
other means. They are referred to as artificial limbs. Prostheses involve the use of artificial
limbs to enhance the function and lifestyle of persons with limb loss. The prostheses must
be unique combination of appropriate materials, alignment, design, constructions to match
functional needs of the person. These needs are complex and vary for upper and lower
extremities. Lower limb prsotheses might address stability in standing, and walking, shock
absorption, energy storage and return, cosmetic appearance, and even extraordinary
functional needs associated with running, jumping, and other athletic activities. Upper
limb prostheses might address reaching and gasping, specific occupational challenges such
as hammering, painting, or weight lifting, and activities of daily living such as eating,

31
writing and dressing. Examples of prostheses are: cosmetic breast, articifical leg, artificial
arm/hand, artificial eyeball, gastric hands, dentures etc.

6.4.1.2. Prescription of prostheses

To prescribe prostheses, the prosthetic team must have adequate information about the
individual to be given the prescription. Such information is best obtained during a private
interview and such interview should include collecting information about the person’s age,
marital status, educational achievement, previous jobs, distance from house to place of
work, vocational training and desire to further education. All these will guide the choice of
prostheses to be prescribed to the person.

6.5 Orthoses

6.5.1. Definition and meaning of orthoses

An orthosis is an orthopaedic appliance used to support, align, prevent, or correct
deformities of a body part or improve the function of moveable parts of the body. An
orthosis is the addition of contraption to the body in order to improve its efficiency. It is
defined as any device attached/applied to the external surface of the body. Orthotics
involves precision and creativity in the design and fabrication of external braces (orthoses)
as part of a patient’s treatment process. The orthoses act to control weakened or deformed
regions of the body of a physically impaired person. Orthoses may be used on various
areas of the body including the upper and lower limbs, cranium, or spine. Common
orthotic interventions include spinal orthoses for scoliosis, HALOs used in life-threatening
neck injuries, and ankle foot orthoses used in the rehabilitation of children with cerebral
palsy (Georgia Tech, 2019). Other examples of orthoses are: caliper, toe raising apparatus,
cervical (neck) collar, back slab, knee cage and wheelchair etc.

6.5.2. Functions of orthoses

The functions of orthoses are:
1. To support the body segment;
2. To restrict or enforce motion;
3. To improve function of the body part.

6.5.3. Indications for orthoses

Indications for prescribing orthoses are:
a). To relive pain
b). To protect weak or healing musculoskeletal segment
c). To prevent/correct deformity
d). To improve function.

32
 In Study Session 6, you have learnt that:
1.) Resources for the education of the physically and health impaired persons involve
funding and providing materials by the all tiers of government.
2.) There are basic provisions for the education of the physically and health impaired
persons.
3.) There are materials and assistive technology devices to be used by the persons with
cerebral palsy.
4.) There are other examples of assistive technology devices such as prostheses and
orthoses used for the physically and health impaired persons.

Self-Assessment Questions (SAQs) for Study Session 6

Now that you have completed this study session, you can assess how well you have achieve its
Learning Outcomes by answering the following questions.
SAQ 6.1 (tests Learning Outcomes 6.1)
What are the various sources of fund for the education of the physically and health impaired
persons?

SAQ 6.2 (tests Learning Outcomes 6.2)

Highlight the basic provisions for the education of the physically and health impaired
Persons.

SAQ 6.3 (tests Learning Outcomes 6.3)

Mention various mechanical aids and assistive technology devices for the care of
persons with cerebral palsy.

SAQ 6.4 (tests Learning Outcomes 6.4)

Define and explain the meaning of prostheses and orthoses

SAQ 6.5 (tests Learning Outcomes 6.5)

Give various examples of prostheses and orthoses

SAQ 6.6 (tests Learning Outcomes 6.6)

Describe how you will prescribe prosthetic device to your client

33
SAQ 6.7 (tests Learning Outcomes 6.7)
Highlight various functions and indications for prescribing orthoses

References

Afolabi, A. (2020): Physiotherapy for the physically impaired. Adeyoung Printing Press.

Atipkui, F.N.B. (2016): Introduction to the education and training of learners with physical
and health impairment. In D.A Adediran & A.I. Ajobiewe (Eds): Foundation for special needs
education Vol. II A. Sped Study Series.

Oluokun, P.O. (2020): Assistive technology and independent mobility for learners with
movement hinderances (physical and health impairment/visual impairment). In B.A.
Adebiyi & F.O Azanor (Eds): Discrimination against people with disabilities (prohibition) acts:
Accessibility imperative and implementation strategies. A festschrift in honour of Dr (Mrs) Clara
Kikelomo Adeyemi. Glory-Land Publishing Company.

Mangal, S.K. (2015): Children with cerebral palsy, pp 363-383, PHI Learning Private
Limited.

34
 STUDY SESSION 7

OTHER CAUSES OF PHYSICAL AND HEALTH IMPAIRMENT

Introduction
There are many other conditions that result into physical and health impairment. This
session discusses some of those conditions like spina bifida, muscular dystrophy, arthritis,
anterior poliomyelitis, hemiplegia, amputation, epilepsy.

Learning Outcomes
When you have studied this session, you should be able to:
7.1) Define and explain spina bifida
7.2) Explain the causes and types of spina bifida
7.3) Define and explain the meaning of muscular dystrophy and forms of muscular dystrophy
7.4) Define and explain the meaning of arthritis and its causes
7.5) Define and explain the meaning of anterior poliomyelitis and its causes
7.6) Describe the clinical features of anterior poliomyelitis and its prevention
7.7) Define and explain the meaning of hemiplegia and its principal causes
7.8) Define and explain the meaning of amputation and forms of amputation
7.9) Explain the main reasons for amputation
7.10) Define and explain the meaning of epilepsy and its causes
7.11) Mention two categories of seizures

35
7.1 Spina bifida

7.1.1 Definition and meaning of spina bifida

Spina bifida literally means ‘split spine’. Spina bifida is a form of neural tube defect which
involves incomplete development of the brain, spinal cord, and/or their protective
coverings, which are caused by the failure of the foetus spine to close properly during the
first month of pregnancy. Spina bifida implies a failure of the enfolding of the nerve
elements within the spinal canal during early development of the embryo (Adams and
Hamblen, 1990). Spina bifida is a birth defect that involves the incomplete development of
the spinal cord or its coverings (Alexander, 2008). The nerve damage is permanent,
although the opening in the spine can be surgically repaired. The damage to the child’s
nerves may result in various degrees of paralysis in their lower limbs. In cases where there
sis no lesion present there is still the potential for the presence of improperly formed or
missing vertebrae, as well as nerve damage. Persons with spina bifida often experience a
form of learning disability in conjunction with physical and mobility disability. Many
persons with spina bifida use assistive devices including braces, crutches, or wheelchairs.

7.1.2 Causes of spina bifida

The causes of spina bifida are largely unknown (Alexander, 2008), although some evidence
suggests that genes and nutritional factor may play a role, but in most cases, there is no
familial connection.

7.1.3 Types of spina bifida

There are majorly two types of spina bifida: these are spina bifida occulta and spina bifida
manifesta.

7.1.3.1 Spina bifida occulta

This is the mildest form of spina bifida. Occulta means hidden. It is sometimes called
‘hidden’ spina bifida. With it, there is small gap in the spine, but no opening or sac on the
back. The spinal cord and the nerves usually are normal. Many times, spina bifida occulta
is not discovered until late childhood or adulthood. This type of spina bifida usually does
not cause any disability. They are relatively minor varieties in which the defect is not
obvious at the skin surface i.e failure of fusion of the vertebrae arches posteriorly.

7.1.3.2 Spina bifida manifesta

This include two types: meningocele and myelomeningocele

36
1. Meningocele: This involves the meninges covering the brain. If the meninges push
through the hole in the vertebrae, the sac is called a meningocele. With meningocele a
sac of fluid comes through an opening in the baby’s back. But, spinal cord is not in this
sac. There is usually little of no nerve damage. This type of spina bifida can cause minor
disabilities.

2. Myelomeningocele: Myelomeningocele is the most severe form of spina bifida. It occurs

when the meninges push through the hole in the back, and the spinal cord also pushes
through. With this condition, a sac of fluid comes through an opening in the baby’s
back. Part of the spinal cord and nerves are in the sac and are damaged. This type of
spina bifida causes moderate to severe disabilities, such as problems affecting how the
person goes to the bathroom, loss of feeling in the person’s legs or feet, and not being
able to move the legs. Most babies who are born with this type of spina bifida also have
hydrocephalus. A child with this typically has some paralysis and the degree of
paralysis largely depends on where the opening occurs in the spine.

7.2 Muscular dystrophy

7.2.1 Meaning of muscular dystrophy

Muscular dystrophy describes a group of genetic diseases which are characterized by
progressive weakness and degeneration of the person’s skeletal or voluntary muscles used
to control movement. In muscular dystrophy, abnormal genes (mutations) interfere with
the production of proteins needed for healthy muscles. Symptoms of the most common
variety begin in childhood, primarily in boys. Heart muscles, as well as some additional
involuntary muscles are affected by some form of muscular dystrophy. Some forms of
muscular dystrophy (MD) affect a person’s organs as well. Duchene is the form of MD that
affects children most commonly. Myotonic MD is the most common form of the disease
affecting adult populations. There are some of MD that appear in infancy or childhood,
while other forms may not appear until a person reaches middle age or older.

7.3 Arthritis

7.3.1 Definition and Meaning of arthritis

Arthritis is the inflammation of one or more joints, which result into pain, swelling,
stiffness, and limited movement. It is a group of conditions involving damage to the joints
of the body. Another name for arthritis is ‘joint inflammation’ but it is possible for
somebody to have joint inflammation for variety of reasons apart from arthritis, such as an
autoimmune disease, broken bone, general ‘wear and tear’ on joints and infection usually

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caused by bacteria or viruses. Often the inflammation goes away after the injury has
healed, the disease is treated, or the infection has been cleared.

7.3.2 Causes of arthritis

Arthritis results when there is breakdown of cartilage. Cartilage functions to protect the
joint, allowing for smooth movement, it absorbs shock when pressure is placed on the joint
when somebody walks. When cartilage breakdowns, the bones rub together, causing pain,
swelling (inflammation) and stiffness.

7.4 Anterior poliomyelitis

7.4.1 Definition and Meaning of anterior poliomyelitis

This is also known as infantile paralysis. Anterior poliomyelitis is an acute inflammation of
the anterior horns of the spinal grey matter giving rise to flaccid paralysis. It is a virus
infection of nerve cells in the anterior grey matter of the spinal cord, leading in many cases
to temporary or permanent paralysis of the muscles that they activate.

7.4.2 Causes of anterior poliomyelitis

It is caused by infection with a virus, of which at least three types have been identified. The
three polio virus types identified are a) Type 1, also known as Brunhide, b) Type 2, also
known as Lansing, and c) Type 3, also known as Leon.

7.4.3 Clinical Features of anterior poliomyelitis

For descriptive purposes, the disease is divided into five stages according to Adams and
Hamblen (1990):

a) Stage of incubation;
b) Stage of onset;
c) Stage of greatest paralysis;
d) Stage of recovery;
e) Stage of greatest paralysis.
- Stage of incubation
This is the interval between infection and onset of symptoms. No symptoms at all in
this stage and it can last for about 2 weeks.
- Stage of onset
Symptoms begin at this stage and the symptoms are like those of influenza, headache,
pains in the back and limbs and general malaise. It lasts for about 2 days.
- Stage of greatest paralysis

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 This is the stage that when it occurs, last about 2 months. Paralysis develops rapidly
and is usually within a few hours, thereafter remaining unchanged throughout this
change.
- Stage of recovery
This is the stage in which recovery of power occurs and continues for about 2 years.
There may be complete recovery and there may be none.
- Stage of residual paralysis
Muscles that did not recover in their powers after two years and still remain paralysed
or weak is permanent.

7.4.4 Prevention of anterior poliomyelitis

Anterior polio is preventable and its prevention is achievable by the use of oral vaccine. Oral
vaccine is given to children right from birth i.e. children are immunized against polio. This
vaccine is given to children four times at the following ages: at birth, at 6 weeks, at 10 weeks,
and at 14 weeks.

7.5 Hemiplegia (resulting from stroke/cerebrovascular accident)

7.5.1 Definition and meaning of hemiplegia

Hemiplegia is a spastic paralysis of the arm, the leg and sometimes of the face on the opposite
side of the brain lesion. The trunk muscles and diaphragm are not severely affected as a rule,
because they are bilaterally innervated from both sides of the brain.

7.5.2 Causes of hemiplegia

The principal causes of hemiplegia are:

- Hypertension i.e high blood pressure

- Stroke: This leading to hemiplegia is of two types:
Hemorrhagic stroke: This occurs as a result of internal bleeding into the brain substance
leading to embolism or thrombosis of one of the arteries in the brain.
Ischemic stroke: this is caused by a lack of blood flow to the b rain and account for
about 70% of all strokes.
- Tumors: these are of various kinds, or inflammatory conditions of the brain,
- Traumas. Injuries to the brain such as the ones that cause fractures of the skull can cause
hemiplegia.

Factors that can cause hemorrhage in the brain are:

- Arteriosclerosis: These are hardness and brittling of arterial wall,

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- High blood pressure: These may be associated with cerebral hemorrhage, which may be
so massive as to rupture into the ventricular system and cause death within minutes or
hours,
- Blood diseases such as pernicious anemia; and
- Aneurysm: This means abnormal dilatation of arteries.

7.6 Amputation

7.6.1 Definition and meaning of amputation

Amputation refers to the removal of the whole or part of an arm/hand or a leg/foot. It is
the process in which a body part is removed or severed from the body. It may result as a
form of medical intervention or as a surgical procedure, or it may occur during a traumatic
incident. In some situation, amputation may result from a congenital condition or disorder.
Congenital amputation may result from a congenital condition or disorder. Congenital
amputation is birth without limbs of without part of the limb or limbs. Amputation on an
extremity through surgical procedures is often a life saving method to relieve the mystery
of an intolerable pain.

7.6.2 Forms of amputations

There are congenital and acquired amputations. The exact cause of congenital amputation
is unknown and can result from a number of causes such as amniotic band syndrome.
Acquired amputations are amputation which happen later in life and can result from
cancer, trauma, severe infections and complications from diseases.

7.6.3 Reasons of acquired amputation

The main reasons for amputation are:

1. Peripheral Vascular Diseases e.g. atherosclerosis (hardening of arteries).

2. Trauma: This means injury especially as a result of road traffic accident and industrial
accident.
3. Malignancy: For example cancer. In an attempt to arrest the spread of cancer that
spread, amputation becomes necessary e. g. mastectomy.
4. Diabetes Mellitus (DM). This is as a result of unhealed wound.

7.7 Epilepsy

7.7.1 Definition and meaning of epilepsy

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Epilepsy is a seizure disorder in which the brain cells do not work properly in one or both
sides of brain, causing a range of seizures from tonic-clonic (momentary loss of
consciousness with muscle twitching) to myoclonic (abrupt jerking of muscles) and atonic
(sudden loss of muscle tone and loss of consciousness). According to the Epilepsy
Foundation of America, a seizure happens when a brief, strong surge of electrical activity
affects part or all of the brain Epilepsy Foundation of America, 2015). It is not contagious
and is not caused by mental illness or mental retardation. Sometimes severe seizure can
cause brain damage, because a person experiencing a seizure could fall and hit his head, or
be submerged while swimming, but most seizures do not seem to have a detrimental effect
on the brain. Persons with epilepsy may also be at higher risk of suicide due to associated
mood disorders or as a side effect of their medication (Meddie, 2019). Intractable epilepsy
from a young age can cause a child to fall behind in development, since seizures can cause
them to miss school, impairing their learning and Intelligent Quotient (IQ). Nonetheless, it
is documented that many persons with epilepsy can still lead healthy and socially active
lives, especially after educating themselves and the people around them about the facts,
misconceptions and stigma surrounding the disease (Meddie, 2019).

7.7.2 Causes of epilepsy

Epilepsy has many possible causes, from illness to brain damage to abnormal brain
development. Genetics may play a role. It can develop as a result of brain damage from
other disorders including brain tumors, alcoholism, Alzheimer’s disease, strokes, and heart
attacks. Epilepsy is also associated with a variety of developmental and metabolic
disorders. Other causes include head injury, prenatal injury, and poisoning.

7.7.3 Types of Seizures

There are many types of seizures. These are divided into two major categories:

1. Focal seizures: Symptoms here include unusual feelings or sensations that can take
many forms, such as sudden and unexplainable emotions, nausea, or hallucinations.
2. Generalized seizures: In this, symptoms may cause loss of consciousness, falls or
massive muscle spasms. Seizures themselves are not necessary epilepsy.

In Study Session 7, you have learnt that:

1). Spina bifida is a neural tube defect that can cause physical disability

41
2). Muscular dystrophy is a condition that causes progressive weakness and
degeneration of voluntary muscle leading to physical impairment
3). Arthritis results from breakdown of joint cartilage which can cause pains, swelling
and inability to move the joint well
4). Anterior poliomyelitis is a viral infection that damages the anterior horns of the
spinal grey matter of the spinal cord leading to paralysis of muscles
5). Hemiplegia is a spastic paralysis of muscles of one arm and leg and sometimes of the
face on the opposite side of the lesion in the brain causing disability
6). Amputation which means removal of the body parts can be congenital or acquired
7). Epilepsy is a seizure disorder, it is not contagious, it is not caused by a mental illness
or mental retardation and can lead to brain damage if the sufferer hit the head against a
hard surface
Self-Assessment Questions (SAQs) for Study Session 7
Now that you have completed this study session, you can assess how well you have
achieve its Learning Outcomes by answering the following questions.

SAQ 7.1 (tests Learning Outcomes 7.1)

Define and the meaning of spina bifida
SAQ 7.2 (tests Learning Outcomes 7.2)
What are the causes and types of spina bifida?
SAQ 7.3 (tests Learning Outcomes 7.3)
Define and explain the meaning of muscular dystrophy and its forms
SAQ 7.4 (tests Learning Outcomes 7.4)
Define and explain the meaning of arthritis and its causes
SAQ 7.5 (tests Learning Outcomes 7.5)
Define and explain the meaning of anterior poliomyelitis and its causes
SAQ 7.6 (tests Learning Outcomes 7.6)
Highlight and explain the clinical features of anterior poliomyelitis and its prevention
SAQ 7.7 (tests Learning Outcomes 7.7)
Define and explain the meaning of hemiplegia and its causes

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SAQ 7.8 (tests Learning Outcomes 7.8)
Define the meaning and forms of amputation
SAQ 7.9 (tests Learning Outcomes 7.9)
What are the main reasons for amputation?
SAQ 7.10 (tests Learning Outcomes 7.10)

Define and explain the meaning of epilepsy and its causes

SAQ 7.11 (tests Learning Outcomes 7.11)

Mention two categories of seizures

References

Adams, J.C. & Hamblem, D.L. (1990): Outline of orthopedics, eleventh edition; Churchill
Livingstone.

Afolabi, A. (2020): Physiotherapy for the physically impaired. Adeyoung Printing Press.

Alexander, M.A. (2008): Spina bifida: kids health for parents. Nermours Foundation.

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