Orthopedic Impairment


The Federal (IDEA) definition of orthopedic impairment means a severe orthopedic impairment that adversely affects a child’s educational performance. The term includes impairments caused by a congenital anomaly, impairments caused by disease (e.g., poliomyelitis, bone tuberculosis), and impairments from other causes (e.g., cerebral palsy, amputations, and fractures or burns that cause contractures).


This disability category includes all orthopedic impairments, regardless of cause. Examples of potential causes of orthopedic impairment include genetic abnormality, disease, injury, birth trauma, amputation, burns, or other causes.


Other causes of orthopedic impairments may include:

·        Spina bifida

·        Diabetes

·        Nervous system disorders

·        Traumatic spinal cord injury

·        Stroke

·        Muscular Dystrophy

·        Cerebral Palsy
Muscular-skeletal disorders

·        Rheumatoid arthritis

·        Respiratory Disorders

·        Endocrine-metabolic disorder



To prevent orthopedic impairments that result from preventable diseases, it is important to focus on health education, nutrition and immunization. This includes relatively simple procedures such as raising awareness of the importance of cleanliness, medical care, and nutrition for the development of strong bones; monitoring births to avoid conditions resulting from complicated births; and administering polio vaccinations to prevent polio and post-polio syndrome.



The U.S. Department of Education reports 5,971,495 students receiving special education services in the 2003-2004 school years. Of that number, roughly 1.1%, or 68,188 students, received special education services based on a classification of orthopedic impairments.

The IDEA category of orthopedic impairments contains a wide variety of disorders. These can be divided into three main areas: neuromotor impairments, degenerative diseases, and musculoskeletal disorders. The specific characteristics of an individual who has an orthopedic impairment will depend on the specific disease and its severity, as well as additional individual factors.

It is difficult, perhaps even impossible, to generalize about the characteristics of students with orthopedic impairment. For example, a child with a spinal cord injury could have immobility limited to one side of his or her body, just the arms or legs, or total paralysis. A child with cerebral palsy may have movement but need a wheelchair because he or she has slow, uncontrolled movements that make it difficult to walk.


Many students with orthopedic impairments have no cognitive, learning, perceptual, language, or sensory issues. However, individuals with neuromotor impairments have a higher incidence of additional impairments, especially when there has been brain involvement. And there is a close relationship between the two types:  for example, a child who is unable to move his legs because of damage to the central nervous system (neuromotor impairment) may also develop disorders in the bones and muscles of the legs (orthopedic impairment), especially if he  or she does not receive proper therapy and equipment

Some children with skeletal deformities have surgery. Others have to use various types of braces, prosthetic, and orthotic devices before, after, or in place of surgery. Others may use adapted wheelchairs. Many children identified with severe and multiple disabilities have an orthopedic impairment that must be considered when assessing and establishing services.

The referral characteristics for the student with an orthopedic impairment fall more into the area of physical characteristics. These may include paralysis, unsteady gait, poor muscle control, loss of limb, etc. An orthopedic impairment may also impede speech production and the expressive language of the child.


Implementation of Educational Strategies

Typically, students with orthopedic impairments have a history of chronic disability diagnosed by the medical community through routine care as infants and young children. In addition, students who are permanently injured, involving muscles, joints or bones, usually are diagnosed and receive rehabilitation services.

For most students with orthopedic impairments, the impact on learning is focused on accommodations necessary for students to have access to academic instruction. Placement is a key consideration for students with orthopedic impairments. The goal is inclusion in general education classes, but some students may need services from resource rooms, special classes, schools, or residential facilities, as well as hospital or homebound programs.

As with most students with disabilities, the classroom accommodations for students with orthopedic impairments will vary dependent on the individual needs of the student. Since many students with orthopedic impairments have no cognitive impairments, the general educator and special educator should collaborate to include the student in the general curriculum as much as possible.

In order for the student to access the general curriculum, the student may require these accommodations:

  • Special seating arrangements to develop useful posture and movements
  • Instruction focused on development of gross and fine motor skills
  • Securing suitable augmentative communication and other assistive devices
  • Awareness of medical condition and its affect on the student (such as getting tired quickly)

Because of the multi-faceted nature of orthopedic impairments, other specialists may be involved in developing and implementing an appropriate educational program for the student.

Due to the various levels of severity of orthopedic impairment, multiple types of assistive technology may be used. As with any student with a disability, the assistive technology would need to address a need of the student to be able to access the educational curriculum. For students with orthopedic impairments, these fall into two primary categories:

Devices to access information: These assistive technology devices focus on aiding the student to access the educational material. These devices include:

  • speech recognition software
  • screen reading software
  • augmentative and alternative communication devices (such as communication boards)
  • academic software packages for students with disabilities

Devices for positioning and mobility: These assistive technology devices focus on helping the student participate in educational activities. These devices include:

  • canes
  • walkers
  • crutches
  • wheelchairs
  • specialized exercise equipment
  • specialized chairs, desks, and tables for proper posture development


Effects on Adolescents

Accidents associated with drug and alcohol use are the leading cause of head injury and orthopedic impairment among adolescents.


Occupational therapy may assist teenagers with orthopedic impairments to be more active in self-maintenance, academic and vocational

pursuits and play or leisure activities that occur in school environments.

Physical therapy is a related service provided to assist children and teenagers  with orthopedic impairments and enable them to travel independently within the school environment, manage stairs, restrooms, and the cafeteria; participate in classroom activities; and maintain and change positions in the classroom.

Independence and accessibility of buildings and services becomes even more significant to teenagers with orthopedic impairment because it may be difficult for others to assist them effectively.

Promoting social competence of students with orthopedic impairments. Is also essential  For example: strategies and techniques to develop students' skills in developing peer relationships, initiating and responding in social interactions, working cooperatively, understanding expectations in various social situations, accepting responsibility for one's own behavior, and interacting constructively in a variety of group activities and social and employment

Adolescents with orthopedic impairments also need support to transition to adult life roles. For example, an understanding their legal rights and enhancing their ability to become self-advocates are needed.


Effects on Adults

The effects of orthopedic impairments on adult life roles include learning, daily living, employment, and family life.


Adults with lower limb orthopedic impairments may have difficulty in mobility. They may be slow or fall frequently. Some may also continue to need mobility aids like wheelchairs, crutches and calipers. Mobility aids require smooth surfaces, ramps etc. which may not be readily available. Even after using mobility aids, adults may find it difficult to walk for long distances and get tired easily.

Adults with upper limb and lower limb orthopedic impairment may continue to need assistance with self care. Work limitations continue to exist for some adults with orthopedic impairment.


Current Trends

There are decreases in the rates of one of the common causes of orthopedic impairment, spina bifida. Spina bifida is a disability that is present at birth. It occurs when there is damage to the spinal cord and the column does not close completely, causing an impairment of lower body movements and functions such as bladder/rectal troubles and even paralysis.

The recent decreases in the incidence of spina bifida reflect the success of a major public health strategy, specifically, the implementation of campaigns to promote folic acid supplementation for women of childbearing age. During the period from 1991 to 2003, the incidence of spina bifida dropped from 24.9 to 18.9 per 100,000 live births All of the decrease came after the U.S. Food and Drug Administration authorized the enrichment of cereals with folic acid in 1996 and then made it mandatory in 1998. The decrease in the incidence of spina bifida was larger and the economic benefit was greater than had been projected before adoption of the policy.

To reduce further the rates of spina bifida and other neural tube defects, the Center for Disease Control is actively promoting the greater consumption of folic acid by women of childbearing age (the agency estimates that 50 to 70 percent of these conditions are related to folic acid deficiency).


Research overwhelmingly demonstrates that parent involvement in children's learning is positively related to achievement.  Further, the research shows that the more intensively parents are involved in their children's learning; the more beneficial are the achievement effects. Efforts are needed to involve more parents in the education of their children with orthopedic impairments and other disabilities, and to provide them with resources to assist their children.