9.4: Causes and Characteristics of Physical and Health Disabilities

Physical and health disabilities have many different causes and characteristics. Students with OIs often experience motor movement deficits that stem from damage to the central nervous system or loss of a limb. Students with OHIs may have contracted a virus or have another disease or disorder that impacts the operation of different organs. Students with TBIs may have different characteristics depending on the injury type, location, and severity (Smiley et al., 2022).

Orthopedic Impairments

Educators and clinicians working with students who have OIs are most likely to encounter cerebral palsy, spina bifida, and muscular dystrophy.

Cerebral Palsy

Cerebral palsy is a group of disorders that affect a person’s ability to move and maintain balance and posture. Cerebral palsy is the most common orthopedic impairment in children and is caused by abnormal brain development or damage to the developing brain that affects a person’s ability to control their muscles. The damage, which typically occurs before, during, or shortly after birth, does not progress over time.

The symptoms of cerebral palsy vary. A person with severe cerebral palsy might need to use special equipment to walk or might not be able to walk and need to use a wheelchair. Some people with cerebral palsy may also need an augmentative communication device to communicate with others. A person with mild cerebral palsy might not need any special equipment to walk. However, all people with cerebral palsy have problems with movement and posture. Many also have related conditions such as intellectual disability; seizures; problems with vision, hearing, or speech; changes in the spine (e.g., scoliosis); or joint problems (e.g., contractures).

Physicians classify cerebral palsy according to the main type of movement disorder and the location of the brain damage. This includes stiff muscles (i.e., spasticity), uncontrollable movements (i.e., dyskinesia), and poor balance and coordination (i.e., ataxia). There are four main types of cerebral palsy: spastic, dyskinetic, ataxic, and mixed cerebral palsy (CDC, 2022a).

Spina Bifida

Spina bifida, which affects the spine and is usually apparent at birth, is a type of neural tube defect. Spina bifida may occur anywhere along the spine if the neural tube does not close completely. When the neural tube does not close, the backbone that protects the spinal cord does not form and close as it should. This often results in damage to the spinal cord and nerves.

Spina bifida might cause physical and intellectual disabilities that range from mild to severe. The severity depends on the opening’s size and location in the spine and whether it affects part of the spinal cord and nerves. The three most common types of spina bifida are spina bifida occulta, meningocele, and myelomeningocele.

Spina bifida occulta occurs when an opening exists in one or more of the spinal column vertebrae but there is no damage to the spinal cord itself. Meningocele occurs when the membranes surrounding the spinal cord, called meninges, protrude through a hole in the vertebrae, causing the development of a meningocele sac. As with spina bifida occulta, the meningocele does not damage the spinal cord.

The most severe and commonly diagnosed type of spina bifida is myelomeningocele, in which the spinal cord itself protrudes through the back so that the nerves themselves are exposed. Depending on where this sac is located, various degrees of neurological problems may result. The higher the sac forms, the more serious the neurological problem. Spina bifida may be diagnosed during pregnancy or after the baby is born. However, spina bifida occulta might not be diagnosed until late childhood or adulthood or may never be diagnosed (CDC, 2022b).

Muscular Dystrophy

Muscular dystrophies are a group of muscle diseases caused by mutations in a person’s genes that result in muscle weakness and decreased mobility. There are different kinds of muscular dystrophy, each affecting specific muscle groups. Muscular dystrophy may be inherited, or a person may be the first in their family to have muscular dystrophy. There may be several different genetic types within each kind of muscular dystrophy, and people with the same kind of muscular dystrophy may experience different symptoms (CDC, 2022c).

Duchenne muscular dystrophy is the most prevalent kind of muscular dystrophy. Duchenne muscular dystrophy is usually inherited from the mother, who has a defective gene that regulates dystrophin, which is responsible for maintaining muscle fiber (Smiley et al., 2022). Duchenne muscular dystrophy usually affects the upper legs and upper arms first and may cause problems with the heart, lungs, throat, stomach, intestines, and spine (CDC, 2022c).

Other Health Impairments

Various health conditions may require special education or related services, including epilepsy, asthma, cystic fibrosis, and diabetes. Students with attention-deficit/hyperactivity disorder, discussed in Chapter 11, are also often provided services under this category.

Epilepsy

Epilepsy is a central nervous system disorder in which brain activity becomes abnormal, causing seizures or periods of unusual behavior, sensations, or loss of awareness. There are two types of seizures: focal seizures and generalized seizures.

Focal seizures result from abnormal activity in just one area of the brain. Generalized seizures involve all areas of the brain. There are two types of focal seizures: focal seizures without loss of consciousness and focal seizures with impaired awareness.

• Focal seizures without loss of consciousness. These seizures do not cause a loss of consciousness, but they may alter emotions or change how things look, smell, feel, taste, or sound. This type of seizure may also result in involuntary jerking of one body part (e.g., arm or leg) and spontaneous sensory symptoms such as tingling, dizziness, and flashing lights.
• Focal seizures with impaired awareness. These seizures involve a change or loss of consciousness or awareness. During a focal seizure with impaired awareness, a person may stare into space and not respond normally to their environment or perform repetitive movements such as hand rubbing, chewing, swallowing, or walking in circles.

There are six types of generalized seizures: absence seizures, tonic seizures, atonic seizures, clonic seizures, myoclonic seizures, and tonic–clonic seizures.

• Absence seizures. Absence seizures typically occur in children. They are characterized by staring into space with or without subtle body movements such as eye blinking and last between 5 and 10 seconds. These seizures may occur in clusters, happening as often as 100 times per day, and cause a brief loss of awareness.
• Tonic seizures. Tonic seizures cause stiff muscles and may affect consciousness. These seizures usually affect muscles in a person’s back, arms, and legs and may cause them to fall to the ground.
• Atonic seizures. Atonic seizures cause a loss of muscle control. Because this most often affects the legs, it often causes a person to suddenly collapse or fall down.
• Clonic seizures. Clonic seizures are associated with repeated or rhythmic jerking muscle movements. These seizures usually affect the neck, face, and arms.
• Myoclonic seizures. Myoclonic seizures usually appear as sudden, brief jerks or twitches and usually affect the upper body, arms, and legs.
• Tonic–clonic seizures. Tonic–clonic seizures are the most serious type of epileptic seizure. They can cause an abrupt loss of consciousness, body stiffening, twitching, and shaking (Mayo Clinic, 2022a).

When dealing with a student who is having a tonic–clonic seizure, remove all nearby furniture and objects, lay the individual down, and turn their head to the side to help prevent breathing problems. It is also a good idea to put a soft folded object (e.g., a towel or jacket) under the student’s head to prevent injuries. Do not put anything inside the student’s mouth (Smiley et al., 2022).

For many children, epilepsy is controlled with medication and does not impact their educational performance (CDC, 2022d). However, epilepsy may be associated with different risk factors such as intellectual disabilities, concussions, abnormal areas in the brain, and bleeding in the brain (Smiley et al., 2022).

Asthma

Asthma is a condition in which a person’s airways narrow and swell and may produce extra mucus. This can make breathing difficult and trigger coughing, wheezing, and shortness of breath. For some students, asthma is a minor health concern that is easily controlled with medication. For others, it may be a major health concern that interferes with daily activities and may lead to a life-threatening asthma attack. Children may experience one of two types of asthma: exercise-induced asthma or allergy-induced asthma triggered by airborne substances such as pollen, mold spores, cockroach waste, or pet dander (Mayo Clinic, 2022b).

Asthma, food allergies, and high risk of anaphylaxis (i.e., severe allergic reaction) frequently co-occur, and asthma increases the risk of fatal anaphylaxis. Therefore, students who have severe asthma may carry adrenaline or epinephrine kits that can be self-administered. Educators and clinicians working with students with severe asthma should also be familiar with administering these kits (Smiley et al., 2022).

Cystic Fibrosis

Cystic fibrosis is an inherited disorder that causes severe damage to different organs in the body. Cystic fibrosis affects the cells that produce mucus, sweat, and digestive juices. These secreted fluids are normally thin and slippery, but in people with cystic fibrosis, a defective gene causes the secretions to become sticky and thick. Instead of acting as lubricants, the secretions block tubes, ducts, and passageways, especially in the lungs and pancreas. Cystic fibrosis is a progressive disease that requires medication and physical therapy to thin and dislodge mucus from airways in the lungs (Mayo Clinic, 2022c; Smiley et al., 2022).

Diabetes

Diabetes refers to a group of diseases that affect how the body uses blood sugar (i.e., glucose). Glucose is an important energy source for the cells that make up muscles and other tissues within the body. It's also the brain's main source of fuel. The main cause of diabetes varies by type and leads to excess sugar in the blood, which may cause serious health complications such as nerve damage.

Chronic diabetes conditions include Type 1 diabetes and Type 2 diabetes. Type 1 diabetes is often diagnosed in children. Type 2 diabetes may develop at any age. Children may have a genetic predisposition to develop diabetes, and certain environmental risk factors, such as diet, may contribute to the disease’s development. The symptoms of diabetes include increased hunger, thirst, urination, and blurred vision. Both types of diabetes may be controlled with medication, diet, and exercise (Mayo Clinic, 2022d).

Traumatic Brain Injury

TBI usually results from a violent blow to the head or body. An object that goes through brain tissue may also cause TBI. Mild TBI may affect the brain’s cells temporarily. However, moderate to severe TBI may result in bruising, torn tissues, bleeding, and other physical damage to the brain. These injuries may result in long-term complications or death.

TBIs have different physical and psychological effects. For example, some signs or symptoms may appear immediately after the traumatic event, whereas others may appear days or weeks later. The signs and symptoms of mild TBI may include the following:

• Headache
• Nausea or vomiting
• Fatigue or drowsiness
• Problems with speech
• Dizziness or loss of balance
• Sensory problems, such as blurred vision, ringing in the ears, a bad taste in the mouth, or changes in the ability to smell
• Sensitivity to light or sound
• Cognitive, behavioral, or mental symptoms
• Loss of consciousness for a few seconds to a few minutes
• No loss of consciousness, but a state of being dazed, confused, or disoriented
• Memory or concentration problems
• Mood changes or mood swings
• Feeling depressed or anxious
• Difficulty sleeping
• Sleeping more than usual

Moderate to severe TBI may include any of the signs and symptoms of mild injury, as well as the following symptoms that may appear within the first hours to days after the head injury.

• Loss of consciousness from several minutes to hours
• Persistent headache or headache that worsens
• Repeated vomiting or nausea
• Convulsions or seizures
• Dilation of one or both pupils of the eyes
• Clear fluids draining from the nose or ears
• Inability to awaken from sleep
• Weakness or numbness in fingers and toes
• Loss of coordination
• Cognitive or mental symptoms
• Profound confusion
• Agitation, combativeness, or other unusual behavior
• Slurred speech
• Coma and other disorders of consciousness

Infants and young children with TBI might be unable to communicate headaches, sensory problems, or confusion. Educators and clinicians may observe the following behaviors in a child with TBI.

• Change in eating or nursing habits
• Unusual or easy irritability
• Persistent crying and inability to be consoled
• Change in ability to pay attention
• Change in sleep habits
• Seizures
• Sad or depressed mood
• Drowsiness
• Loss of interest in favorite toys or activities (Mayo Clinic, 2022e)

Students with TBI may also experience cognitive symptoms such as changes in attention, information processing, and memory that may affect educational performance. Students with TBI may also experience behavioral symptoms such as irritability, aggression, lack of self-control, and hyperactivity (Smiley et al., 2022).