Orthopedic Impairment

Florida Definition

Orthopedic impairment means a severe skeletal, muscular, or neuromuscular impairment. The term includes impairments resulting from congenital anomalies (e.g. including but not limited to skeletal deformity or spina bifida), and impairments resulting from other causes (e.g., including but not limited to cerebral palsy or amputations). This definition is found in State Board of Education Rule 6A-6.030151, F.A.C.
http://www.fldoe.org/academics/exceptional-student-edu/ese-eligibility/orthopedic-impairment-oi.stml

General Overview

Early intervention and identification at birth or infancy or as soon as the disability occurs is critical. Early intervention can minimize the severity of the disability or prevent the development of additional disabling or medical conditions. In addition, the use of correct physical management procedures, adaptations, and devices can increase the acquisition of motor and self-care skills. The early development of adequate skills gives children a foundation for increasing their interaction with the environment, which in turn furthers the acquisition of cognitive, language, and social skills necessary for school success.

The U.S. Department of Education estimated that about 0.54 percent of all school-age children have physical or health disabilities (ranging from mild to severe). With the use of medication and the provision of an accessible setting and/or medical support teams, most students with physical or health impairments are able to function well in regular classes. Determining prevalence of figures is complicated by local variations in the classification of disabilities and the lack of a federal education category for children with physical disabilities (National Dissemination Center for Children with Disabilities Fact Sheet Number 12 (NICHCY) at http://www.parentcenterhub.org/nichcy-resources/).

Types of Orthopedic Impairments

Neuromotor impairments are disabilities resulting from damage to the central nervous system that impairs the brain’s control of muscle movement and the muscle receptor’s sensory feedback about speed, direction of movement, and body position (Educating Exceptional Children, Chapter 12; National Dissemination Center for Children with Disabilities Fact Sheet Number 12 (NICHCY) at http://www.parentcenterhub.org/nichcy-resources/).

• Cerebral palsy. A number of disabilities are caused by damage to the motor control centers of the brain. The damage affects muscle tone, which in turn interferes with voluntary movement and full control of the muscles, and delays gross and fine motor development. CP includes four major classifications: spastic, dyskinetic, ataxic, and mixed. In spastic cerebral palsy, muscle tone is abnormally high and increases during activity. Muscles and joints are tight or stiff, and movements are limited in the affected areas of the body. In dyskinetic cerebral palsy, tonal abnormalities involve the whole body. The individual’s muscle tone is changing constantly, often rigid while he or she is awake and decreased when asleep.
• Ataxic cerebral palsy is a condition in which voluntary movement involving balance is abnormal. Individuals with ataxic CP have difficulty controlling their hands and arms, and their gait is unsteady. Mixed cerebral palsy includes a combination of spastic, dyskinetic, and ataxic CP. The affected area can be (1) hemiplegic-just one side of the body (either left arm and left leg, or right arm and right leg); (2) diplegic-the whole body is involved, but the legs are more severely involved than the arms; and (3) quadriplegic-involvement is equally distributed throughout the body.
• Neural tube defects. This includes spina bifida (the separation of a portion of the backbone) and myelomenigocele (the protrusion from the spinal cord of a sac of fluids containing portions of the spinal cord).

Physical impairments include degenerative diseases, which affect the muscles and their supporting framework, the skeleton, and orthopedic and musculoskeletal disorders.

• Muscular dystrophy and spinal muscular atrophy (degenerative diseases). These are inherited disorders in which the muscles weaken and deteriorate. The most common form, Duchenne muscular dystrophy, occurs primarily but not exclusively in boys.
• Juvenile rheumatoid arthritis (Orthopedic and musculoskeletal disorders). Inflammation of the joints accompanied by fever and pain in the joints during acute periods. This begins at or before age 16 and causes swelling, stiffness, effusion, pain, and tenderness in the joints.
• Spinal curvatures (orthopedic and musculoskeletal disorders). Scoliosis is a form of spinal curvature in which the spine forms a “c” or an “s” when it is viewed from behind.
• Osteogenesis Imperfecta (orthopedic and musculoskeletal disorders). An inherited congenital fragility of the bones.
• Other types of orthopedic and musculoskeletal disorders include limb deficiencies, hip conditions and other musculoskeletal conditions.

Diagnostic Indicators

Most children with multiple and severe disabilities are identified at birth through early assessments (e.g., APGAR, Brazelton Neonatal Behavioral Assessment Scale). A physician or a team of specialists will make the diagnosis.

Characteristics



Primary

• Motor: Impaired physical functioning
  Examples include the need for special equipment including crutches, braces, custom splints, or a wheelchair are needed to perform in classroom activities; limited self-care skills
• Communication: Potential major communicative impairment
  Examples include difficulty expressing or understanding language; difficulty grasping reading; augmentative communication and alternative communication devices and procedures necessary for communication.

Secondary

• Cognitive: Impaired cognitive functioning
  Examples include short attention span, difficulty expressing or understanding language, difficulty grasping concepts such as reading and math.
• Sensory: Potential problems hearing and/or seeing
• Emotional and Social: Impaired emotional and social development and functioning