Definition of Otherwise Health Impaired
ERIC Digest #459.
Students with Physical Disabilities and Health Impairments. Revised.
Author: Venn, John
Used in the special education context, physical disability or orthopedic
impairment includes severe disabilities that adversely affect educational performance.
There is a diverse range of disabilities in this category including such conditions
as cerebral palsy, spina bifida, amputations or limb absences, and muscular dystrophy.
According to Connor, Scandary, and Tulloch (1988), "the physiological and
functional problems of this population are complex and diverse, and their handicaps
may be temporary, intermittent, chronic, progressive, or terminal" (p. 7).
HOW ARE PHYSICAL DISABILITIES AND HEALTH IMPAIRMENTS DEFINED?
The term special health impairment refers to a variety of health
problems that dictate the need for special medical or educational services.
Health impairments include convulsive disorders, cystic fibrosis, heart disease,
sickle cell disease, hemophilia, asthma, rheumatic fever, cancer, AIDS, or any
other chronic or acute health problem that limits strength, vitality, or alertness
and adversely affects the student's educational development.
Approximately 1.3% (58,328) of all students receiving special
education services are orthopedically impaired, while 1.2% (52,658) are counted
as other health impaired (Tenth Annual Report to Congress, 1988).
WHAT ARE SOME OF THE CHARACTERISTICS OF THESE POPULATIONS?Some students have no restrictions on what they can do and learn,
while others are extremely limited in their activities and require intensive medical
and educational help. A physical problem can hamper a student's mobility, coordination,
stamina, communication, or learning abilities to such an extent that educational
objectives are difficult to accomplish and special education intervention is required.
For example, children with cerebral palsy typically have deficits
in gross and fine motor development as well as speech and communication problems.
Some children have extremely debilitating physical conditions that result in
low intellectual functioning, serious limitations in activities, and multiple
primary handicaps. Others function in the average or gifted range intellectually
and participate full time in regular classes.
WHAT SPECIAL CONSIDERATIONS ARE NECESSARY IN ASSESSING STUDENTS
WITH PHYSICAL DISABILITIES OR HEALTH IMPAIRMENTS?Examiners must have a broad base of skills in order to measure
adequately the functional and cognitive abilities of students who are physically
disabled or health impaired. In addition to the areas traditionally evaluated
in the assessment of children with mild handicaps, measures should be included
in the areas of gross motor, fine motor, and daily living skills; perception;
recreation and leisure skills; augmentative communication; and sensory input.
Competent diagnosticians recognize their personal limitations and seek help from
therapists, educators, physicians, nurses, social workers, and others to gather
Since the assessment of a student who has physical or health
impairments is often time consuming and taxing to both the examiner and the
child, the team of professionals should meet before data are gathered to consider:
(a) the nature of the data base desired; (b) the potential use of the data;
(c) specific measurement techniques or modifications of traditional measures;
(d) who should present the items; (e) the method of data collection; (f) appropriate
response modes and/or equipment; (g) position(s) for testing; (h) stamina and
fatigue factors; (i) the order in which professionals will conduct the testing;
(j) implications of medications for test performance and for the best time of
day to test; (k) how data will be shared when evaluations are completed; and
(l) the nature of nontraditional measures that should be incorporated in the
assessment (e.g., evaluation of the child's milieu) (Reynolds & Clark, 1983).
Developing a comprehensive preassessment plan ensures that the information necessary
for establishing programs and setting priorities for intervention will be available
WHAT ARE THE KEY EDUCATIONAL CONSIDERATIONS?One of the main considerations is the use of the team approach
in developing and carrying out a child's educational program. The team generally
includes the parents, teachers, medical professionals, and health-related professionals
such as a physical therapist. Parents are critical members of the team and should
be involved in all educational decisions. Sirvis (1988) noted that the team should
design a program that meets the needs of the student in five basic goal areas:
"(a) physical independence, including mastery of daily living skills; (b)
self-awareness and social maturation; (c) communication; (d) academic growth;
and (e) life skills training" (p. 400). Interdisciplinary services such as
occupational and physical therapy and speech and language therapy are of prime
importance for youngsters who have physical disabilities.
Another important educational consideration is placement. Educational
services are provided in a variety of settings including regular classrooms,
resource rooms, special classes, and other, more restrictive settings including
hospital and homebound programs. Approximately 8% of students with orthopedic
impairments and 18% of students with health impairments are served in home and
hospital environments (Tenth Annual Report to Congress, 1988). Since educational
services may include extensive medical and health-related support, arrangements
often need to be made to provide these services in diverse educational settings.
The need for support services is often a vital consideration in fitting a program
to an individual student. Most common among the related services are transportation,
physical therapy, occupational therapy, diagnostic services, school health services,
counseling, and school social work services (Tenth Annual Report to Congress,
It is often necessary to modify and adapt the school environment
to make it accessible, safe, and less restrictive. Accessibility guidelines
are readily available, and when these guidelines are followed the environment
becomes easier for the child to manage independently. It is important that modifications
be no more restrictive than absolutely necessary so that the student's school
experiences can be as normal as possible. Many authorities stress the importance
of avoiding overprotection of students with physical or health impairments.
It is also important to permit students with disabilities to take risks just
as their able-bodied cohorts do.
Recent advances in technology have helped to make life more
nearly normal for students with physical disabilities. For example, students
with cerebral palsy can use computer terminals to aid in communication. Through
technology, even a person with the most severe handicaps can have greater control
over communication and daily living skills. Modifying the environment may mean
providing special adaptive equipment such as specially designed desks, positioning
devices, wedges, or standing tables. Adaptations also may include establishing
procedures for dealing with medical emergencies when students have serious medical
WHAT ARE SOME OF THE SPECIAL PROBLEMS IN WORKING WITH PRESCHOOL
CHILDREN WITH PHYSICAL DISABILITIES?
One area requiring
special attention is the handling and positioning of young children. Handling
refers to how a child is picked up, carried, held, and assisted. Positioning
refers to providing support for the child's body and arranging instructional
or play materials in special ways. Proper handling helps make the child more
comfortable and more receptive to instruction. Proper positioning allows the
child to perform and manipulate materials most efficiently (Fraser & Hensinger,
1983). Communication skills are often difficult for children who have physical
disabilities; therefore, preschool programs need to pay special attention to
ERIC Digest #459. ED314915 89
Students with Physical Disabilities and Health Impairments. Revised. Author:
ERIC Clearinghouse on Handicapped and Gifted Children, Reston, Va.
ACCESS ERIC 1-800-LET-ERIC