Neurological Disorder: Intervention

Physical and neurological disabilities are primarily medical and therapeutic conditions. Intervention stretches far beyond the academic and educational. An extensive team of professionals is needed to provide help, such as:

• Educators
•  Physicians
•  Occupational and physical therapists
• Speech and language pathologists
• Counselors

For educators it is the secondary difficulties that cause the most concern, such as:

• Academics
•  Communication
•   Mobility

MEDICAL INTERVENTION

• Surgery- For individuals with Cerebral Palsy and Spina Bifida, surgery can ease contractures (a permanent shortening of the muscles, tendons and ligaments), correct dislocations, repair joints. Also in the case of Spina Bifida surgery can drain spinal fluid from the protruding sac.
• Neurosurgery- For individuals with hydrocephalus, and other brain impairments.
• MRI/CT SCANS- Used to look at the brain and assess brain damage, and to investigate any area of the brain which is not functioning.

THERAPY

Therapies are most commonly associated with:

• Sensorimotor development
• Postural control
• Activities for daily living

• Environmental adaptation
• Augmentative communication

Occupational or physical therapy is determined by deficits such as:

•  Absence of robust righting (coming back to a sitting position)
• Inefficient sitting and standing posture
• Limited ability to perform sensorimotor tasks
• Inadequate physical fitness for daily living activities

EAs must always ensure proper postures and movement patterns for children with physical and motor disabilities. Areas of special concern are positioning (the correct seating for the individual) and carrying (the way the child is moved).

Individual positioning is prescribed for each child in order to facilitate:

• Normal muscle tone and symmetry
•  Provide stable and aligned posture
•  Inhibit primitive reflexes
• Facilitate normal movement patterns
•  Stabilize the head and trunk control
• Compensate for lack of sitting balance 

Speech and language therapy:

• used with children who have difficult or unintelligible speech. These students require augmentative communication devices that act as a substitute for speech

Augmentative Communication:

• Unaided- gestural communication (nodding, moving eyes, pointing etc.)
• Aided- depends on a device such as communication boards, mechanical or electrical devices and computers.

TECHNICAL AIDS

There are many technical aids available to assist an individual with a disability to have more control of events in their environment, offering individuals more independence than ever before.

Adaptive/Assistive Equipment- any device designed or modified to lead individuals with disabilities to independence. It could be anything from an adapted spoon to a computerized environmental control system. Within this broad category are prosthetic, orthotic and adaptive devices mainly used to assist children with physical and motor disabilities or sensory impairments

Prosthetic Devices- Used to replace lost functions and/or provide support.

• Artificial leg
•   Leg casts and braces
•  Ankle/foot equipment
• Crutches
•  Walkers
• Wheelchairs- self propelled, attendant operated, transit chairs, electronically controlled wheelchair can provide movement through voice-activated commands (it is programmed to respond to the owner’s voice and requires no muscle control)

 
 

Orthopedic Braces- used for the lower extremities for control and support (do not prevent contractures or develop walking skills).

Three main types of Orthopedic Braces: 

• Short leg braces- ankle joint
•  Long leg braces-knee to ankle
•     Hip braces- support for the hip

For children with Cerebral Palsy, braces are used for control. They help in ambulation, control involuntary movements and help prevent or correct deformities.

For children with Spina Bifida, braces are used mainly for support. Support braces weigh less than control braces.

 

Crutches- Used to help with balance and locomotion and to reduce weight on the lower extremities.

Walkers- Upright devices used to provide support and movement. Walkers can be modified to assist the individual. Supported standing forces weight bearing that is necessary for the normal formation of the hip joints.

Prosthetic equipment- may assist in therapeutic techniques for positioning and carrying. Positioning equipment and strategies allow children with motor problems to achieve postures and movement that might otherwise be impossible.

Hoyer lifts- used to assist in the transfer of an individual from a wheelchair. 

Adaptive boards, wedges and bolsters- used to give children the support they need when in a lying position.

Modified Chairs- Used for children who have difficulty sitting well/or for those who have abnormal hip and leg patterns.

Special Chairs- Aligns the body limbs and head; flexes the hips, knees and ankles; and brings the head and shoulders slightly forward.

Adapted Chairs- Corner chairs and bolster chairs (usually have removable trays)

Abduction block- something that the child’s legs can straddle (is often used to prevent the child from sliding to the floor. A footstool is used to ensure feet are not dangling (harmful to a child with a motor disorder).

Orthotic Devices are used to assist a limb’s action.

Special utensils: spoons, forks (some have Velcro straps) and dishes -used for a child with a movement dysfunction.

Adapted spoons may have a built up handle or swivel so that gravity can help the spoon and prevent spillage.

Specialized equipment in the classroom:

•   Page turners and book stands- assist in reading
• Magnetized pencils and equipment- helpful for writing/drawing
•   Specially adapted scissors- cutting

ADAPTIVE DEVICES

Voice activated computers- Students with a physical disability can use voice commands to enter information into a computer verbally. Some students may need peripherals to increase accessibility, such as:

• Alternative keyboard
• Touch screen
• Touch tablets
•  Optical pointers
•  Single switches
•  Trackball
•  Key guard
•  Head/mouth typing stick
•  Voice controlled devices

Microswitches:

• Pull switches/push switches,
•  Grasp switches
•  Wobble switches (activated by bending in any direction)
•  Pneumatic switches (activated by puffing or sucking on a straw)
• Sensor switches (activated by very small movements) can be set to activate under the control of any muscle in the body. They can be set to operate lights, appliances or a computer.

Click on these links to view the lasted in assistive technology.

http://www.bu.edu/today/2011/the-mind-reader/

http://www.hawking.org.uk/the-computer.html

EDUCATIONAL INTERVENTION

 Because of the progress in technology, assistive devices and team of trained educational professionals, students with neurological disorders are for the most part included in the general classroom.

However some students who have additional severe problems with perception, cognition or language may be placed in specialized classes. The amount of time the student is not included in the general classroom defines what the primary placement is:

General education placement:

• When a student is given instruction outside of the classroom for less than 21% of the time.

Resource room placement:

•  For students who are outside of the classroom from 21-60% of the time.

Separate class:

•  Where students spend more than 60% of the school day.

Separate school placement:

•  Where students spend more than 50% of the school day.

Home/hospital instruction:

•  Available for students who miss many days of school because of surgeries/medical appointments.

As with other students with exceptionalities, students with neurological disorders require accommodations, modifications, adaptations and a differentiated instructional approach which is geared to the individuals needs, and learning style. A team of educational/medical/therapeutic professionals, along with the students parents/student (if over 16) develop an I.E.P (individual education plan) geared to the educational well being of the student. The special educational resource teachers, teachers and educational assistants all implement the requirements set forth in the students I.E.P. Each students I.E.P. is as unique as the students themselves, and must be updated regularly in order for the student to be given the chance to reach their full potential. 

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Fetal Alcohol Syndrome Disorder: Intervention

Along with some of the interventions mentioned, students with FASD may need extensive behaviour management strategies and accommodations based on the individual's strengths, not chronological age. See the chart below for some accommodations:

 

 Diane Malbin- presenter on FASD Kidsability workshop