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Traumatic Brain Injury

Speech and Language Impairment

SPEECH and LANGUAGE

IMPAIRMENT

Definition

·         There are many kinds of speech and language disorders that can affect children. In this fact sheet, we’ll talk about four major areas in which these impairments occur. These are the areas of:

o   Articulation | speech impairments where the child produces sounds incorrectly (e.g., lisp, difficulty articulating certain sounds, such as “l” or “r”);

o   Fluency | speech impairments where a child’s flow of speech is disrupted by sounds, syllables, and words that are repeated, prolonged, or avoided and where there may be silent blocks or inappropriate inhalation, exhalation, or phonation patterns;

o   Voice | speech impairments where the child’s voice has an abnormal quality to its pitch, resonance, or loudness; and

o   Language | language impairments where the child has problems expressing needs, ideas, or information, and/or in understanding what others say. (1)

·         Specific words in IDEA

o    “(11) Speech or language impairment means a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child’s educational performance.” [34 CFR §300.8(c)(11]

Characteristics

·         A child's communication is considered delayed when the child is noticeably behind  his or her peers in the acquisition of speech and/or language skills.  Speech disorders refer to difficulties producing speech sounds or problems with voice quality.  Characteristics may include:

o   interruption in the flow or rhythm of speech such as stuttering (known as dysfluency);

o   trouble forming sounds (called articulation or phonological disorders);

o   difficulties with the pitch, volume, or quality of the voice;

o   trouble using some speech sounds, such as saying "see" when they mean "ski."

·         A language disorder is an impairment in the ability to understand and/or use words in context, both verbally and nonverbally.  Characteristics include:

o   improper use of words and their meanings;

o   inability to express ideas;

o   inappropriate grammatical patterns;

o   reduced vocabulary and inability to follow directions 

Strategies

·         Patience, patience, patience

·         Accepting and accommodating an individual’s speech and individual instruction

·         Encourage the student to participate in classroom activities, giving her adequate time to speak.

·         Create an environment of acceptance and understanding in the classroom, and encourage peers to accept the student with speech impairment

·         Practice and maintain easy and effective communication skills:

o    model good listening skills,

o    facilitate participate of all students in discussion and activites

·         Speak to the student as you would with any other student.

·         Do not interrupt or try to complete her thoughts. Ask her to repeat her message when necessary; do not feign understanding.

·         When introducing new vocabulary, help the student practice difficult words. Dividing words into syllables and pronouncing each syllable will improve speech, reading and writing.

·         Using many different listening activities will also aid the student in comprehending and determining her own production of sounds.

·         Have the student answer “yes” or “no.”

Resources

Definitions

·         http://idea.ed.gov/explore/view/p/,root,regs,300,A,300%252E8,

·         http://nichcy.org/disability/specific/speechlanguage

Characteristics

·         http://www.ci.maryville.tn.us/mhs/MCSSped/speechlang.htm

Strategies

·         www.ataccess.org

·         www.asha.org

·         www.projectidealonline.org

·         http://www.brighthubeducation.com/special-education/

Christopher Baer, Laura Varela, Perrine Voisin 

Other Health Impairments

Hearing Impairment

Specific Learning Disability

Definition:  disorder in 1 or more of the basic psychological processes involved in understanding or in using language, spoken or written, which disorder may manifest itself in the imperfect ability to listen, think, speak, read, write, spell, or do mathematical calculations, including conditions such as perceptual disabilities, brain injury , minimal brain dysfunction, dyslexia, and developmental aphasia.  If the student does not achieve at the proper age and ability levels in one or more of several specific areas when provided with appropriate learning experiences age-appropriate instruction in one of more of the following areas:

·         Oral expression

·         Listening comprehension

·         Written expression

·         Basic reading skill

·         Reading fluency skills

·         Reading comprehension

·         Mathematics calculations

·         Mathematics reasoning

Does not make adequate progress to meet age or grade-level standards in one or more of the prior areas identified when utilizing the process of the child’s response to empirically based interventions; or a pattern of weaknesses and strengths that have been determined to exist in performance, achievement or both, relative to age, state-approved grade-level standards, or intellectual development, as determined by certified assessment professionals. Specific learning disabilities are considered a high-incidence disability.  The U.S. Department of Education reports that there are over 2.8 million students being served for specific learning disabilities and that’s approximately 47.4% of all children receiving special education.

Characteristics:

—  Intellectual

—  Academic

—  Reading

—  Writing and drawing

—  Arithmetic

—  Behavior

—  Communicative abilities

—  Physical

Teaching Strategies

Perceptual Difficulties

—  Do not present two pieces of information together that may be perceptually confusing.

—  Highlight important characteristics of new material

Students with Attention Difficulties

—  Maintain attention by breaking long tasks and presenting limited amounts of information.

—  Use prompts and cues to draw attention to important information. (like highlighting instructions)

Students with Memory Difficulties

—  Chunking- grouping of large strings of information into smaller or more manageable “chunks”.

—  Rehearsal or repetition, either oral or silent

—  Elaboration weaving of the material to be remembered into a meaningful content.

—  Categorization- being able to memorize information in categories. Ex. Animals

RESOURCES

—  www.interdys.org

Gives information about dyslexia, October is national dyslexia awareness month.

—  http://www.projectidealonline.org/specificLearningDisabilities.php

Gives helpful information, not for just one disability, but for several disabilities.

—  http://www.ldaamerica.org
Want to create opportunities for success for all children with learning disabilities.

—  http://www.ncld.org

Gives basic information and resources for schools.

Orthopedic Impairment

Orthopedic Impairment

Definition: Orthopedic impairment is defined as a severe orthopedic impairment that adversely affects a child's educational performance. The term includes impairments caused by congenital anomaly (e.g., clubfoot, absence of some member, etc.), impairments caused by disease (e.g., poliomyelitis, bone tuberculosis, etc.), and impairments from other causes (e.g., cerebral palsy, amputations, and fractures or burns that cause contractures).

Characteristics of Students who have Orthopedic Impairment:

·         Learning, perceptual, or sensory problems

·         May impede speech production

·         Impede expressive language of the child

Characteristics based on 3 Categories of Orthopedic Impairments:

Neuromotor Impairments: an abnormality of, or damage to, the brain, spinal cord, or nervous system that sends impulses to the muscles of the body. These impairments are acquired at or before birth, and often result in complex motor problems that can affect several body systems.

·         Limited limb movement

·         Loss of urinary control

·         Loss of proper alignment of spine

Two most common are Spina Bifida and Cerebral Palsy

1.      Spina Bifida: is a developmental defect of the spinal column. It may or may not affect intellectual functioning. Spina bifida occulta is a mild condition while spina bifida cystica is more serious.

·         Involves some paralysis

2.       Cerebral Palsy : refers to several nonprogressive disorders of voluntary movement or posture that are caused by malfunction of or damage to the developing brain that occurs before or during birth or within the first few years of life. Individuals with cerebral palsy have abnormal, involuntary, and/or uncoordinated motor movements.

The four most common types of cerebral palsy include:

·         Spastic (very tight muscles occurring in one or more muscle groups that result in stiff, uncoordinated movements)

·         Athetoid (movements are contorted, abnormal, and purposeless)

·         Ataxic (poor balance and equilibrium in addition to uncoordinated voluntary movement)

·         Mixed (any combination of the types)

Degenerative Diseases:  are composed of various diseases that affect motor development. The most common is muscular dystrophy.

·         Muscular dystrophy: group of inherited diseases characterized by progressive muscle weakness

Musculoskeletal Disorders: are composed of various conditions that can result in various levels of physical limitations

·         juvenile rheumatoid arthritis

·         limb deficiency

Teaching Tips

• 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 effect on the student (such as getting tired quickly)
• Educate everyone in the school community on a student’s disability
• Have parent/student/resource staff conferences to ensure classroom is accommodating for each child’s IEP

Due to the various levels of severity of orthopedic impairment, multiple types of assistive technology may be used

·         speech recognition software

·         screen reading software

·         augmentative and alternative communication devices (such as communication boards)

·         academic software packages for students with disabilities

Learning Tools

• Physical Therapists who work on gross motor skills (focusing on the legs, back, neck and torso)
• Occupational Therapists who work on fine motor skills (focusing on the arms and hands as well as daily living activities such as dressing and bathing)
• Speech-Language Pathologists who work with the student on problems with speech and language
• Adapted Physical Education Teachers, who are specially trained PE teachers who work along with the OT and PT to develop an exercise program to help students with disabilities
• Other Therapists (Massage Therapists, Music Therapists, etc.)

Additional Resources

·         Project Ideal: http://www.projectidealonline.org/orthopedicImpairments.php

·         Bright Hub Education: http://www.brighthubeducation.com

·         National Center on Accessible Instructional Materialshttp://aim.cast.org/learn/disabilityspecific/physical

United Cerebral Palsy: http://www.ucp.org/

Multiple Disability

October 16, 2012

“It should be noted however, that these students can also have average or even above-average intelligence”

Resources:   United Cerebral Palsy Association – www.ucp.org   Utah Center for Assistive Technology – ucat.usor.utah.gov   Assistiveware – www.assistiveware.com   Project Ideal - http://projectidealonline.org/multipleDisabilities.php   National Dissemination Center for Children with Disabilities http://nichcy.org/disability/specific/multiple

Multiple Disabilities

Encompasses a combination of conditions that may impact a student’s ability to learn and achieve success in an academic setting.  o   Students with severe disabilities are typically included under this terminology. o   This disability category includes those students with the most severe physical, cognitive, and communicative impairments.  o   The common connection isn’t that they have two or more co-existing impairments, but that they generally need extensive support across any number of skill areas.

Characteristics - Six Categories that impact their learning:

Intellectual functioning-  Most have severe impairments   Adaptive skills-  Especially self-care and social skills Programs should include self-care and self-advocacy components (essential for their inclusion in the community)

Motor development- Significant delays in fine and gross motor skills Physical Therapy w/ orthopedic supports to improve deficits in motor Sensory impairments- Hearing and visual impairments are common Having a clear understanding of their sensory impairments will

help develop appropriate instructional programs.

Health care needs- Medical procedures, medical aids, medications

Communication skills- Challenges requiring augmentative and alternative communication

Teaching Strategies:

Planning process: a multidisciplinary process (parents, teachers, physical therapist, assistive technology teachers, and any additional support staff).   Determining the students strengths and desires   Determine what Resources and support will be needed   Develop an IEP   Integrate students with multiple disabilities with other peers.  Part of the

learning process is social development. Peer tutoring – Must be reciprocal.  Student with MD should be able to provide something to the tutoring process, even if it is simply social behavior.   Assistive technology – is an effective tool for students with MD in overcoming functional and communicative limitations.   Augmentative and Alternative Communication –is any

instructional device, technique, or system that serves to support and bolster communication

GOAL: AAC devices allow students with MD to share countless emotional and social benefits that can come from a reciprocal interaction with another person.

 

Tangible and tactile symbol systems:

Choice boards

Object prompts & symbols

Physical modeling & prompting

Computer or microswitch technology