1.5 Physical, Sensory, and Communication Disabilities

Other Health Impairment (OHI): Chronic and Acute Medical Conditions

Under federal IDEA regulations (34 CFR § 300.8(c)(9)), Other Health Impairment (OHI) is defined as having limited strength, vitality, or alertness (including a heightened alertness to environmental stimuli that results in limited alertness with respect to the educational environment) that is due to chronic or acute health problems, and adversely affects a child's educational performance.

Primary Health Conditions Served Under OHI

• Epilepsy / Seizure Disorders: Characterized by recurrent, unprovoked seizures caused by abnormal electrical discharge in the brain. Seizure types include Absence Seizures (Petit Mal) (brief 5–10 second lapses in awareness, staring spells often mistaken for day-dreaming) and Tonic-Clonic Seizures (Grand Mal) (loss of consciousness, muscle rigidity [tonic phase], followed by violent jerking [clonic phase]). Special educators follow the student's Seizure Action Plan (SAP): cushion the head, clear surrounding objects, turn the individual onto their side to maintain an open airway, time the seizure, do NOT place anything in the mouth, and dial 911 if a seizure lasts longer than 5 minutes or if a second seizure occurs immediately.
• Type 1 Diabetes Mellitus: An autoimmune condition where the pancreas produces no insulin. School teams manage two primary emergency states outlined in the student's Individualized Health Care Plan (IHCP):
  • Hypoglycemia (Low Blood Sugar < 70 mg/dL): Rapid onset; symptoms include shakiness, sweating, confusion, irritability, and dizziness. Treated immediately with 15 grams of fast-acting glucose (juice, glucose tabs).
  • Hyperglycemia (High Blood Sugar): Gradual onset; symptoms include extreme thirst, frequent urination, fatigue, and fruity breath odor. Treated with insulin administration and fluid hydration.
• Asthma: Chronic inflammatory airway disorder triggered by exercise, allergens, or stress. Accommodations include immediate access to quick-relief rescue inhalers (albuterol) and modified physical education.
• Sickle Cell Anemia: Genetic blood disorder causing red blood cells to become rigid and sickle-shaped, blocking blood flow. Causes painful vaso-occlusive crises, fatigue, and susceptibility to infection. Accommodations require frequent hydration, unrestricted restroom access, and temperature-controlled environments.

Orthopedic Impairments (OI) and Physical Positioning

Under 34 CFR § 300.8(c)(8), Orthopedic Impairment (OI) refers to severe orthopedic impairments that adversely affect educational performance. The category includes impairments caused by congenital anomaly, disease (e.g., poliomyelitis), or other causes (e.g., cerebral palsy, amputations, fractures/burns).

Primary Conditions Under Orthopedic Impairment

• Cerebral Palsy (CP): A group of non-progressive neurological disorders affecting body movement, posture, and muscle coordination caused by brain damage during prenatal, perinatal, or infant development. Major types:
  • Spastic CP (Most Common ~80%): Characterized by hypertonia (stiff, tight muscle tone), exaggerated reflexes, and scissoring gait.
  • Athetoid / Dyskinetic CP: Characterized by involuntary, slow writhing movements of hands, feet, arms, or legs, and fluctuating muscle tone.
  • Ataxic CP: Characterized by poor balance, lack of muscle coordination during voluntary movement, and unsteadiness.
• Spina Bifida: A neural tube defect where the spinal column fails to close completely during embryonic development. The most severe form, Myelomeningocele, involves protrusion of the spinal cord and meninges through the spinal defect. Key management considerations:
  • Hydrocephalus & VP Shunt Monitoring: Many children have a Ventriculoperitoneal (VP) shunt to drain excess cerebrospinal fluid. Teachers must monitor for signs of shunt failure (headache, vomiting, lethargy, irritability, swelling along the shunt tract).
  • Neurogenic Bladder / Bowel: Requires Clean Intermittent Catheterization (CIC) during the school day.
  • Latex Allergy Warning: Up to 70% of individuals with spina bifida develop severe, potentially life-threatening latex allergies. Classrooms must maintain strictly latex-free environments (no latex gloves, balloons, or rubber bands).
• Muscular Dystrophy (MD): Progressive genetic disorder causing muscle fiber degeneration. Duchenne MD is the most common form in children, characterized by progressive muscle weakness starting in early childhood (demonstrating Gowers' sign—using hands to "walk up" legs to stand), loss of ambulation by early adolescence, and eventual cardiac/respiratory involvement.

Physical Handling and Adaptive Positioning

Proper positioning prevents contractures, promotes skin integrity, enhances respiratory function, and optimizes head/eye control for instructional engagement:

• Positioning Equipment: Sidelyers, prone/supine standers, corner chairs, and adaptive wheelchair seating (maintaining proper 90-degree alignment at hips, knees, and ankles).
• Safe Transfers: Utilizing ergonomic lifting techniques, two-person transfers, or mechanical Hoyer lifts. Special educators follow Universal Precautions for all bodily fluid contact.

Sensory Impairments: Hearing, Vision, and Deaf-Blindness

Sensory impairments significantly alter how students receive and process environmental and instructional information.

1. Hearing Impairment and Deafness

• Types of Hearing Loss: Conductive (outer/middle ear obstruction; often medically treatable), Sensorineural (inner ear cochlear or auditory nerve damage; permanent), and Mixed.
• Communication Modalities: American Sign Language (ASL), Auditory-Verbal therapy, Cued Speech, and Total Communication (combining speech, signs, and visual aids).
• Assistive Technology: Hearing aids, Cochlear implants, and Personal FM/DM Systems (where the teacher wears a transmitter microphone that broadcasts directly to the student's receiver, optimizing signal-to-noise ratio).

2. Visual Impairment Including Blindness

• Definitions: Low Vision (visual acuity between 20/70 and 20/200 with correction) vs. Legal Blindness (visual acuity of 20/200 or less in the better eye with correction, or a visual field restricted to 20 degrees or less).
• Instructional Accommodations: Braille instruction (contracted and uncontracted), tactile graphics, large print materials, screen-reading software (e.g., JAWS), and screen magnification.
• Orientation and Mobility (O&M): Specialized instruction delivered by a certified O&M Specialist teaching students spatial awareness, cane travel skills, and independent navigation within school and community environments.

3. Deaf-Blindness

Concomitant hearing and visual impairments creating such severe communication and developmental needs that the student cannot be accommodated in special education programs solely for deaf or blind students. Supports include tactile sign language and trained interveners.

Speech or Language Impairment (SLI) and Assistive Technology

Under 34 CFR § 300.8(c)(11), Speech or Language Impairment (SLI) refers to a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child's educational performance.

Speech vs. Language Disorders

Special educators must distinguish between speech production disorders and language processing disorders:

• Speech Disorders: Impairment in the physical production of speech sounds:
  • Articulation / Phonological Disorders: Substitution, Omission, Distortion, Addition (SODA) of speech sounds past age-appropriate expectations.
  • Fluency Disorders: Interruptions in the flow, rhythm, and speed of speech (e.g., stuttering characterized by sound repetitions, prolongations, and silent blocks; cluttering).
  • Voice Disorders: Abnormal vocal pitch, loudness, resonance (hypernasality/hyponasality), or vocal quality (hoarseness, dysphonia).
• Language Disorders: Impairment in understanding or using spoken or written symbol systems:
  • Receptive Language Deficit: Difficulty understanding spoken vocabulary, comprehending complex grammar/sentences, or following multi-step verbal directions.
  • Expressive Language Deficit: Difficulty retrieving words, formulating sentences, using correct syntax/morphology, or organizing narrative output.
  • Pragmatic Language Deficit: Difficulty using language appropriately in social contexts.

Assistive Technology (AT) and Augmentative & Alternative Communication (AAC)

Under IDEA, school districts must evaluate a student's need for Assistive Technology devices and services:

• Low-Tech AT: Communication boards, Picture Exchange Communication System (PECS), slant boards, pencil grips, graphic organizers.
• Mid-Tech AT: Battery-operated single-message voice output devices (e.g., BIGmack switches), audio recorders.
• High-Tech AAC: Speech-Generating Devices (SGDs), dynamic display tablets with specialized communication software (e.g., TouchChat, Proloquo2Go), and eye-gaze tracking systems for students with severe physical limitations.