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It is an absence of or significant difference in a person’s body structure or function or mental functioning.

Centers for Disease Control and Prevention (CDC, 2017)



Structural Impairment

  • significant problems with an internal or external component of the body.

  • Examples- nerve damage that can result in multiple sclerosis, or a complete loss of a body component, as when a limb has been amputated.

Functional Impairment

  • include the complete or partial loss of function of a body part.

  • Examples- pain that doesn’t go away or joints that no longer move easily.

Physical and Chronic Health Impairments


19 May 2022
EDSP 202


  • define impairment, physical impairment, and chronic/ other health impairment;
  • determine the etiology and learner characteristics of the said impairment types ;
  • point out the instruction/ intervention strategies, assessment, and trends and issues for those children with physical and other health impairments; and
  • verbalize the utmost importance of learning these impairments.

  • Students with physical disabilities may either have orthopedic impairments or neuromotor impairments.

    • Orthopedic impairment- skeletal system-bones, joints, limbs, and associated muscles
    • Neuromotor impairment- central nervous system, affecting the ability to move, use, feel, or control certain parts of the body.

  • Though distinct and separate, orthopedic and neuromotor impairments may cause similar limitations in movement.

Heward (2012, in AASEP, n.d.)

Brief History: A Glance to These Impairments


  • People with physical/ health impairments didn't live long due to lack of sophisticated equipment to treat those.

  • Across cultures, individuals with impairments weren't valued and were viewed as incapable of contributing to group survival.

  • Infants die, and those who develop the injury/illness were ostracized from the group.

  • Primitive skulls were found with holes; people were trying to cure epilepsy through drilling a hole to let 'evil spirits out' (Temkin, 1971).

  • Religious influence in the Middle Ages brought humanitarian care:

    • "Children of God"- individuals with disabilities
    • Witches/ possessed by evil spirits- with seizure disorders

  • The 1800s- physicians and researchers showed an increased interest in physical disabilities and studied individuals with disabilities to find effective treatments.

  • The 1860s- Dr. William Little and cerebral palsy (pioneering efforts was previously called Little disease)

Characteristics of students with orthopedic impairments

Neuromotor impairments

are an abnormality of, or damage to, the brain, spinal cord, or nerves that send impulses to the muscles of the body (Gargiulio, 2019)

Degenerative diseases

Musculoskeletal disorders

diseases that affect motor movement (Gargiulio, 2019)

defects or diseases of the muscles or bones (Hallahan, Kauffman, & Pullen, 2019 )

IDEA's classification for physical impairments and other health impairment

Low-incidence disability

A special education category representative of students with disabilities that occur relatively infrequently.

Low-incidence disabilities include physical or health disabilities, such as traumatic brain injury, deaf-blindness, and multiple disabilities.

Due to experts' limited knowledge of suitable assessment methodologies, correct educational placements, curriculum selection, and usage of specialized strategies to satisfy learning and communication requirements, children with physical and health disabilities confront particular educational hurdles.


  • Causes of these diseases vary.
  • Physical and health disabilities are brought by genetic and chromosomal defects, teratogenic causes, prematurity, and pregnancy complications, as well as acquired causes.

  • Multiple etiologies- CP- preconception factors (maternal diagnosis of seizures/thyroid disease), prenatal (small for gestational age), perinatal factors (birth asphyxia), postnatal factors (respiratory distress syndroms/ infections) (MyIntyre et al., 2013)

  • teratogens- infections, drugs, chenicals, or environmental agents that can produce fatal abnormalities
  • acquired causes- trauma, child abuse, infections, environmental toxins, and disease
  • TBI- falls, accidents, child abuse; the impact depends on the cause and severity

Types of O.I.

Cerebral Palsy

  • Failure of a part of the brain to develop, blocked blood vessel, complications during labor, extreme prematurity, multiple births, STDs, poor nutrition, effects of anesthetics or analgesics
  • Early childhood: head injury, near drowning, poison ingestion, illness/infection, genetics

Presumed causes


  • It is a physical impairment that affects movement.
  • Four types:
    • spastic
    • atheotid/ dyskinetic
    • ataxic
    • any combination of those above

  • Test an infant's motor skills
  • Examine the mother's and infant's medical histories.
  • Test the infant's reflexes and early development of hand preference.
  • Look for signs of slow development, abnormal muscle tone, and unusual posture.

Types of O.I.

Cerebral Palsy

  • Failure of a part of the brain to develop, blocked blood vessel, complications during labor, extreme prematurity, multiple births, STDs, poor nutrition, effects of anesthetics or analgesics
  • Early childhood: head injury, near drowning, poison ingestion, illness/infection, genetics

Presumed causes


  • It is a physical impairment that affects movement.
  • Four types:
    • spastic
    • atheotid/ dyskinetic
    • ataxic
    • any combination of those above

  • Test an infant's motor skills
  • Examine the mother's and infant's medical histories.
  • Test the infant's reflexes and early development of hand preference.
  • Look for signs of slow development, abnormal muscle tone, and unusual posture.

Types of O.I.

Characteristics of CP

  • It is a disease that weakens the muscles and has 43 types, most of which are caused by alterations in specific genes.
  • The most common is Duchenne muscular dystrophy, which only affects boys.
  • It is a genetic disease passed from mother to son due to a spontaneous genetic mutation.

Muscular Dystrophy


  • Difficulty with fine motor tasks, maintaining balance, and chewing, and swallowing
  • Involuntary movements
  • Abnormal reflexes
  • Weak/ tight muscles
  • Poor coordination
  • Speech difficulties

  • it can be diagnosed through an EMG (electromyogram), blood test, and/or a muscle biopsy.
    • High levels of creatine kinase in the blood test means that the muscles are damaged.

Types of O.I.

Characteristics of MD

2-6 years of age
  • frequent falling
  • difficulty getting up from sitting/ lying position
  • waddling gait;
  • fattening of the leg muscles

Later on in life
  • wheelchair by age 12
  • late teens/ early 20s, respiratory and cardiovascular problems develop and ultimately result in death

  • Refer any physical barriers to classroom accessibility.
  • Permit students to record the course material.
  • Team the student with a lab partner or assistant.
  • Allow in-class assignments to be completed out of class and extended deadlines/ employ INC when appropriate.
  • Allow extended time on tests.
  • Oral or taped exams may be given to students who cannot write answers for themselves.
  • Occassional allowance for late arrivals can be given if students are using devices such as crutches, wheelchairs, canes, or walkers.
  • Rearrange desks to allow extra space needed for wheelchairs, walkers, canes, and crutches.

Instructional Strategies to Help Students with Mobility Impairments

Mobility aids, such as a wheelchair, are frequently required for these pupils, in addition to augmentative and alternative communication (AAC) devices or other assistive technology devices (for example, an adapted keyboard).


Augmentative and alternative communication (AAC)

Symbols, aids, strategies, and techniques used as a supplement or alternative to oral language (Gargiulio & Bouck, 2019)


Assistive Technology Devices

Any item, piece of equipment, or product system that increases, maintains, or improves functional capabilities of individuals with disabilities.

Physical, Health, and Low-incidence Disabilities

Educational Placement

Other Health Impairments (IDEA)

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


Causes of these diseases vary. Most result from infections, genetic factors, environmental influences, prenatal influences, perinatal influences, and postnatal influences.

Other Health Impairments (IDEA)

  • can be divided into two areas: major health impairments and infectious diseases
  • Special education services aren't really required unless the conditions are severe they have an adverse impact on educational performance due to treatment effects, numerous absences, fatigue and decreased stamina

major health impairments

  • it is a sudden, excessive, uncontrolled electrical activity in the brain that results in motor or sensory symptoms or changes in emotions, cognition, or autonomic functions (Epilepsy Foundation of America, 2018d).


Potential causes

  • Some can be treated effectively; others don't have cure.
  • Many should be attended to immediately, and some even result in death.
  • Teachers need to ensure that students with MHI have individualized health care plans that detail their medical information, treatments and treatment effects, and emergency care plans.

  • May be due to a high fever, ingestion of certain drugs or poisons, alcohol or drug withdrawal, certain metabolic conditions, or chemical imbalances
  • Prenatal or perinatal brain injury, head trauma, lasting effects of infections (meningitis, congenital malformations, or unknown causes)
  • Epilepsy- seizure disorder; the seizures are recurrent

major health impairments

  • focal onset- seizure activity begins in one area on one side of the brain
  • generalized onset- seizure activity begins on both sides of the brain at the same time
  • unknown onset- seizure activity is not observed/ onset is not able to be identified
(Epilepsy Foundation
of America, 2018c; Fisher et al., 2017)



  • It may be characterized by altered consciousness, motor activity, sensory phenomena, inappropriate behaviors, or some combination of these.
  • Type depends on the brain location where the abnormal electrical activity begins and the symptoms that result.

  • Focal onset impaired awareness seizure- A type of seizure that begins in one part of the brain whereby the person exhibits purposeless motor activity for a brief period of time; consciousness is impaired.
  • Absence seizures- petit mal seizures; the individual loses consciousness and stops moving for a very brief time.
  • Tonic-clonic seizure- the individual loses consciousness, becomes very stiff, and then begins making rhythmic jerking motions

Most Common Types

Source: American Epilepsy Foundation (2019)

major health impairments

  • The student should have an individualized health care plan containing the child's medical info (side effects) and emergency care procedures and should be given to all school personnel working with and supervising the child.
  • Seizure Observation Form should be accomplished by teachers often assisting and observing the student's seizure .
  • Minimize embarrassment when there is a loss of bladder control.
  • Help children understand seizures using age-appropriate language.

Seizure Treatment

Steps when seizures happen

  • most common: medication
  • when severe and can't be controlled by medication: surgery on part of the brain, special diets, and electrical stimulation of the vagus nerve (Zelleke, Depositario-Cabacar, & Gaillard, 2019).


  • the airways in a person’s lungs are extra sensitive to stimuli in the environment
  • Asthmatic children breathe properly until they are exposed to a material or environment that causes an asthma attack, such as dust, chemicals, smoking, cold weather, pollen, animal dander, or exercise.
  • When an asthma episode strikes, the person has trouble breathing because the room for air to travel in and out of the lungs narrows, making breathing even more difficult.
  • Shortness of breath, wheezing, coughing, and difficult breathing are all symptoms of an asthma attack.


  • Reduced exposure to environmental factors and medication are usually used to treat it.
  • These, as well as any prescription adverse effects and emergency protocols to follow in the event of an asthma attack, should be included in the student's individualized health care plan.
  • Teachers should know each student's asthma triggers and, when possible, reduce or remove them.
  • Teachers should understand that many asthma medications are stimulants and may cause the student to experience hyperactivity, shakiness, and difficulty paying attention.
  • Additionally, teachers should have a plan to assist the student in completing missed work due to absences related to asthma.


  • practice proper handwashing hygiene
  • teach and follow respiratory etiquette (sneezing or coughing into a tissue or bent elbow)
  • clean and disinfect surfaces and equipment frequently following recommended procedures
  • follow additional recommendations
  • (wearing gloves or facemasks) when working with students who require help that may bring the adult in contact with bodily fluids (Centers for Disease Control and Prevention, 2018d).
  • These don't intend to single out students with infectious diseases .
  • Teachers should be aware of a student’s condition and provide needed supports.

School personnel should: `` ````

  • Several infectious diseases fall under other health impairment.
  • Some are readily transmittable (such as tuberculosis); others may pose little to no threat in the school environment (such as HIV/AIDS).
  • It is a must for teachers to practice standard precautions year-round regardless of whether or not they know a student has an infectious disease.

Characteristics of Learners

Children experiencing chronic diseases and disabilities encounter either emotion-focused or problem-focused stressors

  • Emotion-focused stressors- the person regulates the feelings toward the stressor
  • Problem-focused stressors- the person tries to alter or regulate the stressor itself

Characteristics of Learners

Academic performance varies among illness types.

  • Children and adolescents with asthma have shown similar school performance compared to otherwise healthy children even if they missed school days.

  • Educational level, employment, and social maturity have all been demonstrated to be lower among children and adolescents with chronic disease and disability.

Ang Pinaka


Top 10 na mga sakit na nakamamatay sa Pilipinas



is caused by a bacterium called Mycobacterium tuberculosis that usually attack the lungs, but it can also attack any part of the body such as the kidney, spine, and brain.


High blood pressure

the long-term force of the blood against your artery walls is high enough that it may eventually cause health problems, such as heart disease.


Blood pressure

Systolic pressure- upper number that measures the pressure in arteries when the heart beats

Diastolic pressure- lower number that measures the pressure in arteries between beats



is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing.

This may be caused by bacteria, bacteria-like organisms, fungi, and viruses, including CoVid-19.



is a chronic (long-lasting) health condition that affects how your body turns food into energy.

Your body either doesn’t make enough insulin or can’t use the insulin it makes as well as it should.


Ischemic Stroke

occurs when the blood supply to part of the brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients.


Ischemic heart diseases

  • Ischemia- inadequate blood supply
  • Ischemic- an organ isn't getting enough blood and oxygen

Top killer diseases

What the article said:

from Philippine Statistics Authority

"Lack of exercise and decreased activity lead to other medical conditions like obesity, which may develop to Type 2 diabetes mellitus or adult diabetes."

Assessment of Students With Physical Disabilities,
Health Disabilities, and Low-incidence Disabilities

  • A student will need a medical evaluation by a licensed physician who provides a diagnosis of the student’s physical or health condition.
  • A comprehensive educational assessment (or, for preschool children, a developmental assessment) should be performed to determine the educational effects of the physical or health disability.
  • Assessments will document deficits in areas such as pre-academic functioning, academic functioning, adaptive behavior, motor development, language and communication skills, and social/emotional development.

Where are they situated when it comes to schooling/ learning?

  • general education classroom
  • a home or a hospital setting, with several other settings in between (such as resource room, separate class, separate school, and residential facility)
  • resource room for using assistive technology device
  • may need to be separated from the class

Educational considerations

Educational considerations for individuals with physical or health disabilities include the setting in which each student can receive an appropriate education, the impact of the physical or health disability on the student’s school performance, and the best ways of meeting the student needs in the educational setting.

Recommended Classroom Adaptations

  • Make environmental adaptations to accommodate students’ mobility and seating needs.
  • Use adaptations and assistive technology as determined by the special education teacher and educational team to provide access to the learning environment.
  • Assist students with physical disabilities to participate as much as possible in classroom activities requiring a motor response.
  • Use a variety of systematic instructional strategies that effectively address the student’s individual learning needs.
  • Use specialized instructional strategies specifically developed for students with physical disabilities as appropriate.

Recommended Classroom Adaptations

  • Assist students who utilize augmentative communication devices in learning to use them effectively in a variety of instructional and social settings throughout the school day. Allow students to respond to questions using their preferred mode of communication.
  • Allow more time for the student to respond, take tests, or hand in assignments when oral or written communication is affected by his or her disability. Reduce paper tasks, break up assignments into shorter segments, alternate test or assignment format.
  • Maintain a safe, healthy environment by observing for health-related problems and knowing the steps to take should a problem occur.


  • medical technology to sustain life and functionality
  • battery-operated pumps that deliver medication
  • complex, computerized prosthetic arms allowing a student to perform complex hand movements
  • inhalers and nebulizers for individuals with asthma
  • glucose monitoring devices and injection systems for individuals requiring insulin
  • ventilators for individuals who need additional support to breathe
  • gastrostomy tubes and supporting equipment for delivery of nutrition

Trends, Issues, and Controversies

  • Appropriate assessment of cognitive functioning and evaluation of what the student has learnt for students with severe physical limitations.

    • For example, psychological testing can be of limited value or accuracy when a young child cannot dependably move or speak and is not yet employing augmentative communication efficiently.
    • reliable means of response- A consistent, reliable way of answering questions. Examples: looking at the answer (eye gazing), touching the answer, hitting a switch to indicate the answer, or having the teacher move a finger across answers until the student makes a noise indicating the desired selection

Trends, Issues, and Controversies

  • Provision of specialized technology, adaptations, and instructional strategies

    • Funding concerns, accurate assessment, device selection, training to utilize the devices, and continuous technical assistance are all obstacles to obtaining and using the essential technology.

Trends, Issues, and Controversies

  • Curriculum
    • Some students with physical or health disabilities will follow a traditional academic program, while others will follow an adapted curriculum. When a student has severe physical limitations and complex communication demands, however, it may be difficult to tell where the student is functioning.
    • Students with severe physical and multiple disabilities should be taught and assessed periodically on more advanced skills to determine whether the student can learn them.
    • spread -The practice of spreading inferences to other unrelated aspects of a disability,often resulting in stereotyping.