Orthopaedic impairments and motor disorders

Orthopaedic impairments concern disorders of bones, joints, and associated muscles, tendons and ligaments and physical disability; and include spinal curvature, limb deficiencies, talipes (club foot) and juvenile rheumatoid arthritis. Some definitions of orthopaedic impairment include neuromotor impairments such as muscular dystrophy, cerebral palsy and neural tube defects, which, like general orthopaedic impairments, can limit movement and may require similar educational and therapeutic provision.

Orthopaedic impairment does not necessarily require special educational provision. Where a child attends ordinary school, the SENCO will ensure she has access to specialist advice including medical advice and support.

Curriculum
In all aspects of the curriculum where special equipment may be necessary, the school will aim for the pupil’s maximum involvement. So long as safety requirements are taken fully into account, many physical education activities may be available. Often, games and associated rules can be adapted for universal participation or alternative activities arranged leading towards similar learning goals.

Positioning and movement
Resources such as pads, cushions, sidelyer or wedge, help ensure children are correctly positioned. For comfortable and correct seating, pelvic position is important, and supports may be used for the trunk and shoulders. Furniture is designed to take account of pupil’s stature and the need for good posture and support. Tables can be adjusted to different heights and their surfaces angled. Hoists and other devices may be needed to support safe moving of the student. Among assistive walking devices are a PVC pipe walker and crutches. Manual or powered wheelchairs may be used or toys as mobility aids such as a hand propelled wheeler (Bigge, Best and Heller, 2001, pp199-212).

Access
Giving pupils with orthopaedic impairments better access to classrooms and other facilities may involve wheelchair access ramps and continuous areas of smooth floor surfaces to enable movement. Separate rooms can enable personal care procedures to be carried out in privacy. Toilets will be adapted as necessary. In the classrooms and elsewhere there will be sufficient room for a pupil requiring mobility aids and space to keep equipment such as walking frames accessible but where they will not trip other pupils.

Modifications
Environmental modifications involve location of materials and equipment (eg a wheelchair backpack); work surface modifications (eg a supine stander with a cut out tray); and object modifications. Finnie (1997) delineated modifications regarding: object stabilisation (eg clamping the bases of items to tables); boundaries (eg edges on a wheelchair tray); grasping aids (eg enlarging items by wrapping tape round them); and manipulation aids (eg long-handled combs). The pupil may have his own set of equipment for various subjects modified as necessary, for example, adapted scissors. In food preparation lessons, adapted equipment may include special controls on cookers, devices such as food choppers that can be used with one hand, and height adjustable sinks and cooking surfaces.

Environmental control
Environmental control may involve using appliances such as communication devices, computers, or home lighting operated in various ways including electrically, by infrared, radio control or ultrasound. Switches operated by different movements and pressures enable further control over the environment and can be activated by pushing, pulling, tilting, puffing, eye blinking and other means (Bigge, Best and Heller, 2001, pp219-221).

Therapy and care
Medical practitioners, physiotherapists, occupational therapists, prosthetists and others contribute to the child’s wellbeing. Their services may be provided outside or within school working closely with teachers. Healthcare professionals provide preparatory training for school staff in any intimate care procedures. Counselling may be available to allow the pupil to talk through issues such restrictions on activities and developing relationships.

Flexibility
Flexible arrival and departure times for lessons may enable some pupils with orthopaedic impairment to start their route to the next lesson when corridors are relatively free. Outside the classroom, supervision will balance safety with encouraging socialisation and independence. Similarly in-class adult support is given only as required, encouraging the pupil to develop independence. For trips, teacher’s pre-visits can help check physical access, for example regarding wheelchairs or the height of facilities and displays. Flexible arrangements for pupil absences include home tuition and emailed work supporting home study.

Safety procedures
For particular hazards, risk assessments usually involve identifying a potential danger and taking steps to minimise the risk for all children, a group of children or a particular child. Moving and handling may involve potential hazards and risk assessments may be carried out on these procedures, supported by training for the adults involved. Fire procedures take account of issues such as easy wheelchair egress from a fire exit. Safety procedures are followed where adults help students in wheelchairs with steps using devices such as a ‘stair climber’. Procedures and responsibilities for administering medication will be clear and supported by staff training as necessary.

Further reading
Bigge, JL, Best, SJ and Heller, KW (2001) (4th edition) Teaching Individuals with Physical, Health or Multiple Disabilities. Merrill-Prentice Hall: Upper Saddle River, NJ.
Finnie, N (1997) Handling the Young Child with Cerebral Palsy at Home. Butterworth-Heinemann: Oxford.

Dr Michael Farrell is a special education consultant. His recent books include the ‘New Directions in SEN’ Effective Teachers’ Guides (Routledge, 2006).