Physically challenged students.
The right to education of physically handicapped students are guaranteed by the US constitution. In fact, these group are one of the biggest population of children who are receiving special education services. The ways in which preschool, elementary and middle grade teachers can promote effective integration and learning among physically and medicallly handicapped students through parental involvement and positive peer interaction are presented. Teachers should also consider several modiifcations in classroom structure and daily routine to accomodate the needs of these special students.

Disabled students (Education)
Physically disabled children (Education)
Knight, Diane
Wadsworth, Donna
Pub Date:
Name: Childhood Education Publisher: Association for Childhood Education International Audience: Academic; Professional Format: Magazine/Journal Subject: Education; Family and marriage Copyright: COPYRIGHT 1993 Association for Childhood Education International ISSN: 0009-4056
Date: Summer, 1993 Source Volume: v69 Source Issue: n4
Accession Number:
Full Text:
Recent U.S. Department of Education figures indicate that approximately 147,000 students are being treated for physical disabilities, of which 41,000 are orthopedically handicapped, 43,000 are other health impaired and 63,000 are multiple-handicapped. Approximatly 17,000 students are technology-dependent and this number is expected to rise.

Until recently, students with severe health problems who needed continuous medical monitoring received their academic instruction in the isolated settings of residential facilities, hospitals and homes. Now, however, historic education laws have opened public school classroom doors to "medically fragile" or physically challenged students. These laws include Section 504 of the Vocational Rehabilitation Act of 1973 (PL 93-112), the Education for All Handicapped Children Act of 1975 (PL 94-142) and its 1986 Amendments (PL 99-457), and the Individuals with Disabilities Act of 1990 (PL 101-476).

The Council for Exceptional Children defines medically fragile students as requiring "specialized technological health care procedures for life support and/or health support during the school day. These students may or may not require special education" (Council for Exceptional Children, 1988, pp. 5-6). Students qualifying as "other health impaired" have "limited strength, vitality, or alertness, due to chronic or acute health problems, ... which adversely affects their educational performance" (Sirvis, 1988, p. 42). Physical disabilities may include a variety of neurological or musculo-skeletal impairments such as cerebral palsy, epilepsy, spina bifida, muscular dystrophy, arthritis or scoliosis. Severe, chronic illnesses include asthma, cystic fibrosis, diabetes, leukemia, sickle-cell anemia and hemophilia.

Physically challenged students are the fastest growing population of children receiving special education services. Advances in medical technology ensure declining mortality rates and improve the chances of preventing or curing many diseases and disorders. Recent U.S. Department of Education figures indicate that approximately 147,000 students are being treated for physical disabilities, of which 41,000 are orthopedically handicapped, 43,000 are other health impaired and 63,000 are multiple-handicapped (Hallahan & Kauffman, 1991). Approximately 17,000 students are technology-dependent and this number is expected to rise (Caldwell, Sirvis, Todaro & Accouloumre, 1991).

While school district central office personnel face the legal, financial and administrative issues associated with these students, regular classroom teachers and special education professionals must form a team to effectively serve this growing population. The following specific suggestions provide preschool, elementary and middle grade teachers with some immediate assistance necessary for the day-to-day, successful integration of students with physical and medical difficulties. The tips focus on parent involvement, peer interaction, environmental/training considerations and instructional adaptations.

Parent Involvement

Family members can provide key information about the student's abilities, interests, strengths and weaknesses. Parental insights complement information obtained from school sources and provide a general picture of the student's needs and capabilities (Bernheimer, Gallimore & Weisner, 1990). Teachers must acknowledge parents' anxiety, while channeling their concern into healthy, constructive contributions. Teachers can promote maximum parental involvement in the following ways:

* Medical History. Obtain the student's complete medical history, including names, addresses and telephone numbers of attending physicians. When possible, secure parental permission to contact physicians in a medical emergency or with questions. Make careful notes about the student's need for medication (dosage, frequency) and regularity of ongoing medical treatments (chemotherapy, radiation, dialysis, suctioning). Question parents about the student's physical limitations, stamina and endurance levels, as well as side effects of medication/treatment (appetite loss, lethargy, hair loss, mood swings). Educators should become familiar with danger signs, such as a specific localized pain in a student with sickle-cell anemia, seizure activity in a student with epilepsy or a severe cut or bruise on a student with hemophilia.

Parents must understand that school attendance increases the risk of exposure to diseases. Teachers should inform parents immediately about any potential health threats. Such notification is particularly important for students who have undergone cancer treatments or organ transplants, as they are more susceptible to contagion.

* Emergency Care Plans. Emergencies can result from medical equipment failure, natural disasters or physiological breakdown. Consult parents as to what person or agency should be notified in an emergency. As a general rule, inform local telephone and electric companies, fire and police departments, ambulance services, as well as the nearest hospital emergency room, about technology-dependent students. Avenues of emergency transportation in the community and alternate routes of transportation should be explored well in advance of any crisis. Trial runs might be conducted to ensure smooth operation during an emergency.

* Parent Participation. Parents of technology-dependent or other health impaired students and parents of non-health impaired students may have differing concerns. A harmonious balance needs to be established in attending to their concerns, beginning with the initial contact. Continuous communication between school and parents cannot be overemphasized.

Anxiety levels and potential stressful situations can be alleviated by being sensitive to parents' needs. Concentrate on the positive aspects of issues or situations, not on "problems." Encourage parental observation in the classroom at the time of first placement. Discourage overprotectiveness and encourage parents to allow their child to attempt new activities independently. Serve as a resource for parents, helping them to realize their assets and strengths through support groups, community involvement or as school volunteers.

Peer Interaction

The self-esteem of a physically challenged student has a critical effect on learning. To enhance self-image, the education team must be constantly mindful of ways to involve these students in classroom activities. Maximum socialization must be promoted to ensure a positive mainstreaming experience. In order to accomplish this objective, however, teachers must first be comfortable with their own understanding of physical disabilities and have parental support (American Cancer Society, 1980; Chekryn, Deegan & Reid, 1987). The following strategies may help foster positive peer interaction:

* Orientation to Equipment. When a physically disabled student initially joins the class, any unfamiliar equipment should be introduced to all students. Orthopedically handicapped students may use wheelchairs, walkers or braces. Technology-dependent students may require ventilators, suctioning machines and nebulizers. Such machines feature sounds, alarms, lights, cords, hoses and gauges that may prove frightening at first.

* Peer Socialization. Special care to promote "normalization" must be exercised. Peer acceptance will be strengthened by involving the disabled student in all daily activities (academic classes, art, music, physical education, cafeteria, playground, extracurricular events). Adapt situations to facilitate active participation and increase chances of success. For example, a student with a physical disability could hit the ball, but not run, during a baseball game.

Educators must be careful to avoid the appearance of giving "special privileges" to physically challenged students. If not handled appropriately, non-health impaired students may come to resent the frequent snacks given to a student with diabetes or the extra attention (therapy) paid to the student with cystic fibrosis.

* Classroom Management. Parents and the education team must jointly generate a consistent behavioral management program that will fit within preestablished classroom rules, while not compromising special health care needs. To further promote peer acceptance, this plan should be as similar as possible to that for other students. The teacher must be careful to feel "empathy" for the student, not "sympathy." Although it may be tempting to "give in" to the wishes of a student with a physical disability or life-threatening illness, such treatment will be detrimental. A mentor (another student or adult) can prevent possible behavioral problems by assisting the student with physical tasks or being available to talk, listen and understand.

Environmental/Training Considerations

Depending on health constraints, regular classroom placement of these students may be on a limited basis or for an extended period of time. Modifications in the structure and daily routine of the classroom may be necessary to accommodate students with physical disabilities. Some students can benefit from the use of specially constructed adaptive positioning equipment designed to foster social interaction, learning and independence. Other students will require continuous repositioning to relieve pressure points or to prevent the development of deformities (Sirvis, 1988). The following tips should be considered in regard to classroom environment and teacher training:

* Scheduling. Specialized equipment should be integrated in a manner that does not detract from the existing learning centers, equipment, furniture and routine of the classroom. Some physically disabled students may receive health care services at regularly scheduled times throughout the day, while others will require services as the situation demands. For technology-dependent students, such services (ventilating, breathing treatments, tube feeding) may conflict with the time allotted and/or required for instructional tasks. As much as possible, however, interruptions for medical intervention should be nondisruptive to peers and planned at times of minimal social interaction (rest times, individual study times).

One-to-one assistance may be periodically needed for missed instruction. For students with other health impairments experiencing a remission in health, the school team may need to work closely with the homebound teacher to ensure learning continuity.

* Spatial Requirements and Mobility. The school building must be accessible in its entirety to ensure maximum normalization. Students with orthopedic impairments need lowered shelves and hooks for easy storage and retrieval of instructional materials and personal belongings. Lowered water fountains and handrails in bathrooms facilitate the acquisition of personal hygiene and self-help skills. Lowered doorknobs and ramps allow the student to achieve independence in mobility.

Students who are technology-dependent have additional environmental restraints. Adequacy of electrical outlets and power sources, space for equipment and supplies, appropriate lighting and availability of water need to be considered. Whenever possible, students with physical disabilities should use the same types of desks as other students; this will foster uniformity and self-esteem.

It is prudent to maintain easy access to replacement equipment, should a breakdown/failure occur. Wheelchairs, braces and walkers may need repair on a moment's notice. In addition, manual backup for the power source (12 volt battery) and equipment for technology-dependent students (supplemental oxygen, resuscitator bag, suctioning catheter, extra trachea tubes) should be immediately available and may be stored in the regular classroom.

* Specialized Training. Team members and parents should stress the development of academic, language, motor and social skills; methods for fostering these skills can be the focus of inservices/workshops. In addition, general training sessions designed to disseminate information regarding types and usage of equipment, warning signs for pending crises, repositioning techniques, CPR and universal precautions/infection control will alleviate anxiety and promote collaboration.

Instructional Adaptations

The total development of physically disabled students depends upon professionals from a variety of disciplines sharing their expertise (Lowenthal, 1992; Taylor, Willits & Lieberman, 1990). The team must adapt instructional materials, methods and assessments, while providing direct instruction that is as close to grade level and/or age expectation as possible. Close adherence to approved curriculum guides and minimum standards should occur, while fostering problem-solving skills, creativity and individuality. The following strategies can help teachers adapt instructional materials:

* Support Service Assistance. Because of health constraints, many physically disabled students receive supplemental services from other educators and health care professionals. In many instances, it is both possible and desirable for the teacher to reinforce these learned skills in the regular classroom.

Activities promoting motor skill development (stamina and endurance, mobility, motor planning, range of motion) should be planned in conjunction with the physical therapist, occupational therapist and/or adaptive physical education teacher. Augmentative communication techniques (signing, communication boards, switches) may be necessary for students with vocal cord paralysis, disease-affected musculature, spinal muscular atrophy or tracheotomy installation. The services of a speech/language therapist may be required.

* Lesson Plan and IEP (Individualized Education Plan) Development. Regular classroom teachers should actively participate in IEP development if a student in their classroom also receives special education instruction. Such participation will allow teachers to develop lesson plans that reflect the student's strengths and weaknesses and to write specific objectives in behavioral terms, reflecting the student's needs and achievement expectations.

The special education teacher can be a valuable resource in designing and implementing specific behavioral and instructional interventions. Daily contact is recommended to ensure lesson continuity, skill reinforcement, task completion and mastery learning. Appendix A reflects simple adaptations, which may be necessary when teaching physically challenged students.


In the past, poor integration of the education system and the medical field made it difficult for physically challenged students to participate in regular classroom activities. Today's societal demands call for the pooling of knowledge from a variety of professionals to provide timely, cost-effective and time-efficient schooling.

The tips in this article are designed to raise the awareness level of educators and, at the same time, assist them in making the inclusion of physically challenged students a more pleasant, nonthreatening experience. Independence, normalcy and acceptance can be the positive outcome.


American Cancer Society. (1980). When you have a student with cancer. (80-(100m)-No. 2613-LE). New York: Author.

Bernheimer, L. P., Gallimore, R., & Weisner, T. S. (1990). Ecocultural theory as a context for the individual family service plan. Journal of Early Intervention, 14, 219-233.

Caldwell, T. H., Sirvis, B., Todaro, A., & Accouloumre, D. S. (1991). Special health care in the school. Reston, VA: Council for Exceptional Children.

Chekryn, J., Deegan, M., & Reid, J. (1987). Input on teachers when a child with cancer returns to school. Children's Health Care, 15, 161-165.

Council for Exceptional Children. (1988). Final report: CEC ad hoc committee on medically fragile. Reston, VA: Author.

Hallahan, D. P., & Kauffman, J. M. (1991). Exceptional children: Introduction to special education (5th ed.). Englewood Cliffs, NJ: Prentice Hall.

Lowenthal, B. (1992). Collaborative training in the education of early childhood educators. Teaching Exceptional Children, 24, 25-29.

Sirvis, B. (1988). Students with special health care needs. Teaching Exceptional Children, 20, 40-44.

Taylor, R. L., Willits, P., & Lieberman, N. (1990). Identification of preschool children with mild handicaps: The importance of cooperative efforts. Childhood Education, 67, 26-32.

Appendix A

Instructional Adaptations for Physically Challenged Children

1. Prevent paper and objects from slipping by using pads of paper, tape, clipboards, metal cookie sheets and magnets, photo album pages with sticky backings and plastic cover sheets, dycem (plastic) placed under paper and objects, or plastic photo cubes for displaying and storing materials.

2. Place a rubber strip on the back of a ruler or use a magnetic ruler to measure or draw lines.

3. Use calculators to perform computations.

4. Use felt tip pens and soft lead pencils that require less pressure. Improve grip on writing utensils by placing rubber bands, corrugated rubber or plastic tubing around the shaft. A golf practice ball or a sponge rubber ball may also be used.

5. Permit use of electronic typewriters, word processors or computers. Typing aids can include a pointer stick attached to a head- or mouthpiece to strike keys, a keyboard guard that prevents striking two keys at once, line spacers that hold written materials while typing and corrective typewriter ribbons that do not require the use of erasers.

6. Use lap desks or a table-top easel with cork that allows work to be attached with push pins.

7. Provide an "able table" that adapts to varying positions and angles and may be attached to a wheelchair or freely stood on a tray (elastic straps hold books/materials in place, while knobs adjust angles).

8. Write or type at tables/desks that adjust to wheelchair heights.

9. Provide two sets of books/workbooks--one for home and one for school use.

10. Tape assignments, lectures and activities that require extensive writing.

11. Allow a peer to carbon copy or photocopy class notes and provide written copies of board work.

12. Design worksheets/tests that allow students to answer in one of the following modes: one-word answers, lines placed through correct answers, magnetic letters moved on metal cookie sheets to indicate responses, wooden blocks placed on correct answers or containers with different categories in which answers can be dropped.

13. Use color-coded objects that are easy to handle and do not slip to indicate responses to polar questions: true/false, same/different, agree/disagree/don't know.

14. Select materials that are available on talking books or cassette tapes for students unable to hold books.

15. Use communication boards or charts with pictures, symbols, numbers or words to indicate responses.

16. Extend testing/assignment time and/or allow oral responses.

Diane Knight is Assistant Professor and Donna Wadsworth is Instructor, Special Education, Department fo Curriculum and Instruction, University of Southwestern Louisiana, Lafayette.
Gale Copyright:
Copyright 1993 Gale, Cengage Learning. All rights reserved.