Orthopedic Impairment

According to the federal Individuals With Disabilities Education Act (IDEA), an orthopedic impairment is defined as a bone-, joint-, or muscle-related disability that is so severe that it negatively affects a child’s educational performance.

The term includes impairments caused by a congenital anomaly (during/at birth), impairments caused by disease (e.g., poliomyelitis, bone tuberculosis), and impairments from other causes (e.g., cerebral palsy, amputations, and fractures or burns. IDEA Sec.300.8

Impairments are categorized as neuromuscular impairments or musculoskeletal disorders.

1. Neuromuscular impairment: impaired muscle function from damage to the nervous system (brain, spinal cord, nerves).

   • Spina Bifida (mild)-Spina bifida is a birth defect in which an area of the spinal column doesn’t form properly, leaving a section of the spinal cord and spinal nerves exposed through an opening in the back. Spina bifida occurs in 1 per 2,000 live births in the United States and is the most common central nervous system birth defect.

Two more severe types of Spina Bifida - meningocele (moderate), Myelomeningocele (MMC) (severe and may result in cognitive impairments)

1. • Cerebral Palsy: affects movement, balance, muscle tone; occurs in the area of the brain that controls muscle movement does not develop or is damaged. (Spastic CP has tight muscles causing stiffness, Athetoid CP: writhing movements; ataxic CP includes poor balance with uncoordinated movement; mixed CP-combines any two movement impairments)

   • Charcot-Marie-Tooth Disease- damages peripheral nerves responsible for relaying information between the central nervous system and the rest of the body.

   • Muscular Dystrophy: inherited disease where muscles progressively weaken.

   • Spinal Muscular Atrophy- SMA: attacks motor neurons in the spinal cord.Three types, I, II, and III determined by severity and age of onset.

2. Musculoskeletal Disorders: Conditions that affect muscles, bones, and joint. May be inherited or a result of injury.

• Club foot

• Limb deficiencies,

• Juvenile idiopathic arthritis

***Children with orthopedic impairment do not necessarily have any cognitive or learning disabilities.

Online Resources

Teaching Students With Orthopedic Impairment - BrightHub Education

National Association of Special Education Teachers: Orthopedic and Musculoskeletal Impairments (naset.org)

Orthopedic Impairments - Project IDEAL (projectidealonline.org)

Eligibility:

1. Medical report that identifies orthopedic disability and the limitations of the disability.

2. Information (e.g., observation and testing) to link the disability and the adverse effect it has on educational performance (academic, communication, independent functioning, social/emotional)

   • Testing and observations by a physical or occupational therapist is likely.

Clarifications under HAR:

• A medical diagnosis alone does not qualify a student for special education under IDEA or Ch. 60

• A student who has a disability but only needs a related service not special education would not be considered a student with a disability under IDEA or Ch. 60

Required Evidence of a Disability

• Identified orthopedic disability

  • Medical evidence that a severe orthopedic disability exists

  • Congenital anomaly or disabilities caused by disease or other causes are to be considered.

    • Examples: Poliomyelitis, Bone Tuberculosis, Cerebral palsy, Amputations, Fractures or burns.

• Adverse effect of the orthopedic disability on educational performance

  • Information to link the orthopedic disability and the adverse effect it has on educational performance.

  • All findings should lead to the conclusion that the student’s orthopedic disability is pervasive and affects educational performance in the PRESENT educational setting or natural environment is adversely affected.

• mobility training: learning how to use adaptive equipment, furniture, and devices

• writing and sensory supports: learning to use weighted or deep pressure equipment, grips, and holders

• communication training: learning how to use speech recognition software, AAC devices

• Therapy: speech, occupational, and physical.

• Ensure student can access and interact in educational environment

• Medical needs

• Instruction will be planned so student can participate as fully and independent as possible

Data Sources

• Medical report identifying orthopedic disability.

• Observation of behavior and performance in natural/educational environment.

• Medical and developmental history.

• Parent interview.

• Teacher reports/ review of student work.

• Multiple assessment approaches:

  • Standardized testing.

  • Dynamic assessment.

  • Rating scales.

  • Checklists.

  • Criterion -referenced tests.

  • Curriculum-based measures.

IDENTIFICATION - Orthopedic Impairments (weebly.com)

Eligibility Guidelines - OI

• Extended time to complete tasks

• Classroom clear of walkways, placing supplies within reach

• Using devices for mobility or improved access to learn and complete tasks

• Special seating

• Adaptive tools and technology (mobility, sensory needs, writing, communication, medical)

Documentation should use jargon free language.

Documentation must be from a variety of sources, identify the sources of information, and explain evidence. All findings should lead to the conclusion that the challenges the student is experiencing are associated with the disability and are occurring frequently and at a level of intensity that adversely affects performance in the current educational setting or natural environment.

Clearly state how ALL data leads to the conclusion of the orthopedic impairment adversely affecting the student’s performance in the educational setting or natural environment.

Medical information that provides evidence of an orthopedic disability and the limitations of such a disability.

***A diagnosis of an orthopedic disability alone DOES NOT qualify a student for special education under IDEA or Ch. 60. ***

What challenges or difficulties is the student facing because of their orthopedic impairment?

How is academic learning being affected?

Is communication being affected? Verbal, written or both?

Is independent functioning affected?