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FOUNDATIONS OF SPECIAL AND INCLUSIVE EDUCATION

Lesson 7: Types, Characteristics, and Identification of Learners with Difficulty
Walking and Moving
Learning Outcomes:
At the end of the chapter, the student is expected to be able to:
1. Characterize the different types of learners with difficulty walking and moving
2. Identify the types and causes of health impairments, physical disabilities, and
neurological conditions
3. Determine the accommodations/classroom adaptations of learners with difficulty
walking and moving

ENGAGE
LEARNERS WITH DIFFICULTY WALKING AND MOVING
The language that we use in describing learners could reflect and shape the way we
think about them. For instance, let us look at the difference between "child with disability" and
"disabled child." When we say "child with disability," this implies that the child has disability.
On the other hand, "disabled child" could imply that this child is disabled by the
circumstances, including people's attitudes and resources, rather than one's physical
disabilities (Fox, 2003). Table 9.1 shows handicapping terms we need to avoid and what to
use instead.
Table 9.1 Handicapping Words and What to Use Instead

Try to Avoid Use Instead

Handicapped child Disabled child
Suffers from a victim of Has the condition, has the impairment
Confined to a wheelchair Wheelchair-user
Wheelchair bound
Mentally handicapped Learning difficulty
Learning disabled
Crippled Disabled child
Spastic Has cerebral palsy

Physical disability is a label given to a vast range of difficulties that have to do with
physical functioning. It is a continuum wherein one end includes children with minor motor
problems; and at the other end, are children with very little control over their physical
functioning (Fox, 2003). Physical disability or orthopedic impairment could be caused by
congenital anomaly, including clubfoot; impairments caused by disease such as bone
tuberculosis; and impairments from other causes such as cerebral palsy, amputations, and
fractures or burns (Heward, 2017). Difficulties in doing the following could indicate that one is
physically disabled: moving around school; moving within the classroom; positioning within a
lesson; accessing the curriculum in terms of hand skills (Fox, 2003).
Other health impairments refer to conditions of having limited strength, vitality, or
alertness, which could limit one's participation in education. For example, when one has
heightened alertness toward environmental stimuli, it could limit one's alertness when it comes
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to the educational environment. This could be a chronic (i.e., long-lasting and most often
permanent condition that could result to special education) or acute (i.e., condition of limited
duration but nevertheless could produce severe debilitating symptoms) health problem (e.g.,
asthma, attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD),
diabetes, epilepsy, heart condition, among others, which negatively affects one's school
performance. Neuromotor impairment involves the central nervous system, which affects
one's ability to move, use, feel or control certain body parts (e.g., cerebral palsy) (Heward,
2017).
Typical and Atypical Development of Gross Motor (Physical) Skills
Gross motor (physical) skills are those which require whole body movement. These
involve the large muscles of the body, and are used to perform everyday functions, including
standing, walking, running, and sitting upright as well as eye-hand coordination skills. For us
to be able to tell whether a child's gross motor functions are developing typically, it is important
to take note of the gross motor developmental milestones identified below, which provide a
functional screening of developmental skills per age group (Kid Sense, n.d.). Failure to display
the given functions at the expected time could indicate problems in which mobility could be
affected, and wherein difficulty walking and moving could be experienced.
Table 9.2 Gross Motor Developmental Milestones
Age Developmental Milestones Possible Implications if Milestone
not Achieved
0-6 months • Rolls over front to back and • Poor muscle development for
back to front locomotion
• Sits with support and then • Delayed ability to play
independently independently
6-12 months • Crawls forward on belly • Delayed sensory development due
• Assumes a seated position to decreased ability to explore the
unaided environment
• Creeps on hands and knees • Poor muscle development
• Transitions into different • Delayed play skills
positions: sitting, all fours, lying
on tummy
• Pulls self to stand
• Walks while holding onto
furniture
• Takes 2-3 steps without support
• Rolls a ball in imitation of an
adult
18 months • Sits, crawls, walks • Delayed play skills
• Still has wide gait but • Difficulty interacting with the
walking/running is less clumsy environment due to delayed ability
to mobilize effectively
• Poor muscle development
2 years Walks smoothly and turns • Poor muscle development for
corners running and jumping
Begins running • Delayed ability to play
Can pull or carry a toy while independently and interact with the
walking environment
Climbs onto/down from • Decreased ability to interact
furniture without assistance socially
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Walks up and down steps with

support
Picks up toys from the floor
without falling over

3 years • Imitates standing on one foot • Decreased opportunities for social

• Imitates simple bilateral interaction
movement of limbs (e.g., arms • Poor development of body
up together) awareness and movement
• Climbs jungle gym and ladders planning skills
• Pedals a tricycle • Difficulties using playground
• Walks up/down stairs equipment
alternating feet • Difficulties or lack of confidence
• Jumps in place with two feet interacting with other children in
together active environments (e.g.,
• Able to walk on tip toes playgrounds)
• Catches using body
4 years • Stand on foot for up to 5 • Lack of confidence in movement-
seconds based activities
• Kicks ball forward • Difficulties using playground
• Throws a ball overarm equipment
• Catches a ball that has been • Difficulties or lack of confidence
bounced interacting with other children in
• Runs around obstacles active environments (e.g.,
• Able to walk on a line playgrounds)
• Able to hop on one foot
• Jumps over an object and lands
with both feet together
5 years • Able to walk upstairs while • May result in poor self-esteem
holding an object when comparing self to peers
• Walks backward toe-heel • Lack of confidence in movement-
• Jumps forward after based activities
demonstration • Difficulties participating in sporting
• Hands from a bar for at least 5 activities
seconds • Difficulties playing with moving toys
• Steps forward with leg on same such as bikes and scooters
side as throwing arm when
throwing a ball
• Catches a small ball using
hands only
6 years • Runs lightly on toes • Difficulty participating in sporting
• Able to walk on a balance beam activities
• Able to skip using a skipping • May result in poor self-esteem
rope when comparing self to peers
• Can cover 2 meters when • Lack of confidence in movement-
hopping based activities
• Demonstrates mature throwing
and catching patterns
• Mature (refined) jumping skills
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Types and Causes of Health Impairments, Physical Disabilities, and Neurological

Conditions
The following are the common types and causes of health impairments, physical
disabilities, and neurological conditions (Heward, 2017).
Epilepsy - Epilepsy or seizure disorder occurs when abnormal electrical discharges -
in the brain cause a disturbance of movement, sensation, behavior or consciousness.
Possible causes of epilepsy include cerebral palsy; infections of the brain or central
nervous system; metabolic disorders; lesion due to scar tissue from a head injury; high
fever; interruption in blood supply to the brain; shaken- baby syndrome, among others.
Among the conditions that can trigger seizures are fatigue, excitement, anger, surprise,
hyperventilation, hormonal changes, withdrawal from alcohol or drugs, and exposure
to certain patterns of light, sound, or touch.
Kinds of seizures:
a. Generalized tonic-clonic seizure or grand mal seizure
- the most common
- muscles become stiff
- one loses consciousness and falls to the floor
- violent shaking of the body while muscles contract and relax alternately
b. Absence seizure or petit mal
- less severe
- occurs more frequently
- involves a brief loss of consciousness, lasting from a few seconds to half a
minute or so
- stare blankly, flutter, or blink, grow pale, and drop whatever one is holding;
as if daydreaming or not listening.
- It is possible for one to be unaware of this seizure.
c. Complex partial seizure or psychomotor seizure
- manifests as a brief period of inappropriate or purposeless activity, for
instance, smacking one's lips, walking about aimlessly, or shouting.
d. Simple partial seizure
- sudden jerking motion while consciousness is retained
- may experience an aura or a warning sensation before the seizures occur.

Asthma - Asthma is a chronic lung disease. Its symptoms include wheezing, coughing,
and difficulty breathing. An asthma attack is usually caused by allergens, such as
pollen or certain foods; irritants, such as cigarette smoke; exercise; or emotional stress.

Cerebral Palsy - Cerebral palsy is a disorder of movement and posture. It is a

permanent condition that results from having a lesion in the brain or abnormality in
brain growth. Among the symptoms of cerebral palsy are disturbances in voluntary
motor functions such as paralysis, extreme weakness, and lack of coordination,
involuntary convulsions, and other motor disorders. An individual who has cerebral
palsy may lose control over one's arms, legs, or speech.
Depending on the location and extent of the brain damage, muscle tone and
movement in different body parts may be affected. The following terms are used to
describe the location of limb involvement: monoplegia, only one limb is affected;
hemiplegia, two limbs on same side of the body are involved; triplegia, three limbs
are affected; quadriplegia, all four limbs are involved and movement of the trunk may
also be impaired; paraplegia, only legs are impaired; diplegia, primarily involves the
legs, with less severe involvement of the arms; and double hemiplegia, primarily
involves the arms, with less severe involvement of the legs.
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Figure 9.1 Types of Cerebral Palsy

Spina Bifida - Spina bifida is the most common neural tube defect, which refers to
congenital malformations of the brain, spinal cord, or vertebrae. Here, the vertebrae
do not enclose the spinal cord. Thus, a portion of the spinal cord and nerves controlling
muscles and feeling in the lower part of the body fails to develop normally.

Muscular Dystrophy - Muscular dystrophy is a group of inherited diseases marked

by progressive atrophy or wasting away of the body's muscles. The most common and
severe type of which is the Duchenne muscular dystrophy, which affects only boys,
although about one-third of the cases are due to genetic mutation in families that have
no history of the disease. Among its symptoms are muscular weakness, which
manifests in difficulty running or climbing stairs; walking in unusual gait; protruding
stomach and hollow back; and having calf muscles that appear unusually large
because of fatty tissues replacing the degenerated muscles.

Figure 9.2 Types of Dystrophy

Spinal Cord Injuries - These are usually caused by lesions due to a penetrating injury,
stretching of the vertebral column, fracture of the vertebrae, or compression of the
spinal cord. Among the common causes of spinal cord injuries are motor vehicle
accidents, falls, acts of violence, and sports. Students who have spinal cord injuries
usually need the use of wheelchairs for mobility. Motorized wheelchairs are best for
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those with quadriplegia, while self-propelled wheelchairs are suggested for those with
paraplegia.
Classification of Physical Disabilities
Physical disabilities that could limit a person's ability to walk and move could include
physiological, functional, and/or mobility impairments. These can be categorized according to
whether they are fluctuating or intermittent, chronic, progressive or stable, visible or invisible.
In terms of pain experienced, some involve extreme pain, some less, while some do not
involve pain at all. The table below provides examples of classifications of physical disabilities
(Changing Paces, n.d.).

Table 9.3 Classification of Physical Disabilities

Examples of progressive conditions that get worse over time but can fluctuate:
➢ Multiple sclerosis – neurological deterioration
➢ Muscular dystrophy – muscular disorder
➢ Chronic arthritis – inflammation of the joints
Examples of non-progressive conditions that remain stable:
➢ Cerebral palsy – neurological condition
➢ Spina bifida – congenital malformation of the spinal cord
➢ Spinal cord injury – neurological damage resulting from trauma
Examples of disabilities that non-progressive but can fluctuate:
➢ Fibromyalgia – chronic pain condition
➢ Chronic fatigue syndrome – chronic fatigue condition

Etiology of Mobility Impairment

There are many types of mobility impairment that limit an individual's ability to walk and
move around, and the causes of which vary. Some of these conditions are resent at birth,
while some are due to illness or physical injury. Learners with quadriplegia have loss of
function in their arms, legs, and trunk, and often need the use of motorized wheelchairs.
Learners with paraplegia, on the other hand, have loss of function in their lower extremities
and lower trunk. These learners could use manual wheelchair and could fully move their arms
and hands (University of Illinois, n.d.).

Mobility impairments could also have other causes besides spinal cord damage. It
could be due to amputation, in which one or more limbs are removed because of trauma,
malignancies, or other conditions. It could also be due to arthritis, in which there is an
inflammation of body's joints, which causes pain, swelling, and difficulty with mobility. Back
disorder could cause difficulty on the student to perform actions such as sitting, standing,
walking, bending, or carrying objects. It could be due to degenerative disk disease, scoliosis,
or herniated disks. Students with cerebral palsy have damage to the brain that occurs before
or shortly after birth. Motor dysfunctions include difficulty walking, lack of muscle
coordination, spasms, as well as difficulty with speech. Neuromuscular disorders refer to a
wide range of conditions, including muscular dystrophy, multiple sclerosis, and ataxia that lead
to degeneration and atrophy of muscle or nerve tissues. Fibromyalgia is a condition of
rheumatism in "soft tissues" or muscles that cause constant muscular and ligament pain
(University of Illinois, n.d.).

Characteristics of Learners with Difficulty Walking and Moving

It is difficult to come up with a standard description of characteristics of learners with
difficulty walking and moving due to health impairments, physical disabilities, and neurological
conditions since their features and health conditions vary widely.
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The following table shows other characteristics of learners with difficulty walking and
moving.

Table 9.4 Characteristics of Learners with Difficulty Walking and Moving and
Suggested Accommodations/Classroom Adaptations

Characteristics of Learners with Suggested Accommodation/Classroom

Difficulty Walking and Moving Adaptations
Student has unique needs in terms of Create a physically accessible environment
physical space or has difficulty using that is not mobility-limited.
chairs/tables in the classroom or lab.
Student needs specialized transportation. Be flexible with their schedule. Students may
arrive late or have to leave before the class
is over due to adapted transportation
services.
Student is often physically unable to hold a Replace written exams or assignments with
pen and write for extended periods of time or an oral exam or presentation; use note
may experience challenges with input, takers; use assistive technology; use a
output, and information processing when scribe or speech-to- text software to record
working on assignments, tests, and/or answer on tests/exams; provide a room
exams. other than the classroom for exams if
required.
Student has difficulty finishing assignments Give extra time for tests/exams and perhaps
and/or tests in allotted time some components of coursework.
Student experiences fatigue and limited When speaking to a person who uses a
mobility when speaking to a person for a wheelchair for a long period of time, avoid
long period of time. the need for them to strain in order to look up
at you by sitting beside or leaning toward
them during the conversation, in order for
them to avoid experiencing fatigue and/or
pain.
Student requires extra time to obtain Make sure the student is always included
formats compatible with assistive with others when, forming groups
technology.
Student expends a great deal of energy to To reduce fatigue of students with physical
complete daily tasks. disability, it may be helpful to limit the
number of exams on a given day or week.
Extra time should be planned for oral reports
on occasion if the person has diction
problems. Perhaps suggest a reduced
course load.
Student experiences challenges with daily Ensure all off-site activities are accessible or
living activities and mobility. provide alternative assignment options.

Identifying Learners with Difficulty Walking and Moving

The following is a checklist that teachers can use in order to know a child’s functional
physical skills and understand the child’s physical needs in the classroom. Doing this would
allow the teachers to identify learners with difficulty walking and moving as well as let them
provide proper intervention to these learners.
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Table 9.5 Physical Skills Checklist for Teachers

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The formal screening and diagnosis of health impairments, physical disabilities, and
neurological problems is usually done by a doctor. The following table describes the methods
in which common methods used in order to screen or diagnose a child for such. While it is not
the teacher that does the diagnosis, it is important for them to be familiar with these as they
could be working with a multidisciplinary team in designing the Individualized Education Plan
(IEP) and in helping the learner.
Table 9.6 Screening for Health Impairments and Physical Disabilities

Condition Screening Method

Epilepsy Epilepsy is usually tested using electroencephalogram (EEG) (Epilepsy
Action, n.d.)
Asthma An Asthma and Allergies Symptom Test was made available by the
American College of Allergy, Asthma, & Immunology (n.d.). Among the
items are: "When I walk or do simple chores, I have trouble breathing or I
cough." and "When I perform heavier work, such as walking up hills and
stairs, or doing chores that involve lifting I have trouble breathing or I
cough." (refer to American College of Allergy, Asthma, & Immunology, n.d.,
for the full test).
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Cerebral It is important to diagnose cerebral palsy at an early age. The following can
Palsy be done: developmental monitoring, which involves tracking a child's growth
and development over time; developmental screening. wherein
developmental screening tests are conducted to identify specific
developmental delays in motor or movement; and developmental and
medical evaluations, where the goal is to diagnose, and the doctor rules out
other possible causes of the problem (Centers for Disease Control and
Prevention, n.d.)
Spina Bifida Spina bifida can be diagnosed prenatally (before birth) through blood tests,
ultrasound, amniocentesis (getting samples of fluid from amniotic sac
through a needle); or postnatally by a doctor using ultrasound (in early
infancy), magnetic resonance imaging (MRI), or computed tomography
(CT) scan to have a clear view of the spine and vertebrae. (My Child Without
Limits.org, n.d.)
Muscular A number of tests may be recommended for the diagnosis of muscular
Dystrophy dystrophy. These include enzyme tests (e.g., blood levels of creatinine
kinase (CK); electromyography; genetic testing; muscle biopsy, heart-
monitoring tests (eg, electrocardiography and echocardiogram); and lung-
monitoring tests (Mayo Clinic, n.d.a)
Spinal Cord The following procedures may be used to screen for spinal cord injuries: x-
Injuries rays, CT scan, and MRI (Mayo Clinic, n.d.b)