Education of Individuals With Physical Disabilities

In special education, physical disabilities are physical limitations or health problems that interfere with school attendance or learning to such an extent that special services, training, equipment, materials, or facilities are required. In the early twenty-first century, approximately 500,000 school children in the United States were classified as having physical disabilities or other health impairments for special education purposes. Since 1975, federal law (under the Education for All Handicapped Children Act, and since 1990, the Individuals with Disabilities Education Act [IDEA]) has mandated special education and related services for all students with physical disabilities that interfere with their education. Major classifications include neurological conditions, musculoskeletal conditions, and other health impairments.

Types and Causes of Physical Disabilities

Neurological conditions involve damage to the central nervous system (brain or spinal cord). In 1990 traumatic brain injury became a separate category of disability under IDEA. Other major neurological conditions include cerebral palsy, seizure disorder (or epilepsy), and spina bifida, a congenital condition in which the spinal cord protrudes through the backbone resulting in partial or total paralysis below the site of the nerve damage. Disabilities associated with neurological conditions vary from very mild to severe and may involve physical, cognitive, speech-language, or sensory abilities, or a combination thereof.

Musculoskeletal conditions include muscular dystrophy, juvenile rheumatoid arthritis, limb deficiencies or amputations, and a wide variety of other deformities or degeneration of muscles or bones affecting the ability to move, walk, stand, sit, or use the hands or feet normally. Other health impairments include a wide variety of infectious diseases and chronic problems such as diabetes, asthma, cystic fibrosis, immunodeficiency (including HIV and AIDS), hemophilia, fetal alcohol syndrome, and the malfunction or failure of vital organs.

Causes include infectious disease, congenital conditions or malformations, and developmental problems or chronic health problems that are poorly understood. A wide variety of disabilities, especially those associated with traumatic brain injury, result from vehicular accidents, gunshot wounds, burns, falls, and poisoning. Substance abuse and physical abuse by caretakers, infectious diseases, and substance abuse by the child or by the mother during pregnancy cause some disabilities. Advances in medicine and related treatments are reducing or eliminating physical disabilities resulting from some diseases, injuries, and chronic conditions. Advances in medicine, however, also increase the number of children surviving congenital anomalies, accidents, and diseases with severe disabilities.

The Basics and History of Special Education

Special education includes helping students have as normal an experience as possible in school. Much depends on access to the typical curriculum and use of adaptive devices when necessary. Emphasis is on overcoming attitudinal barriers among persons without disabilities to participation of students with physical disabilities in school and the community. Special educators must understand the operation of prostheses (artificial body parts), orthotics (braces and other corrective devices), and adaptive devices (wheelchairs, communication boards, and other gadgets enabling people to accomplish tasks).

Special education in public schools dates from the early twentieth century. Programs have emphasized major health problems of the era. In the first half of the twentieth century the focus was on crippling conditions and the effects of infectious diseases, particularly tuberculosis and polio. After antibiotic drugs and vaccines dramatically reduced or eliminated many infectious diseases in the mid-twentieth century, the focus changed to cerebral palsy, spina bifida, and other congenital conditions or chronic health problems. In the late twentieth century, increasing attention was given to traumatic brain injury, spinal cord injuries, and AIDS.

Trends and Controversies

Trends in the field are determined largely by changes in epidemiology and advances in medicine. The number of students needing special education and the focus of programs may change because of a resurgence of an infectious disease (e.g., tuberculosis), an advance in immunology (e.g., an effective vaccine for AIDS), or medical advances such as gene therapy, transplants, artificial organs, or extremely effective new treatments that reduce or eliminate a chronic health problem (as may occur for such conditions as diabetes, cystic fibrosis, and asthma). Advances in medicine and related services, such as physical therapy, technological applications, and adaptive devices that allow more normal functioning, may reduce or eliminate the need for special education or make education in a typical classroom feasible.

Issues and controversies include the extent to which placement in typical school environments is appropriate. Many students with even severe physical disabilities can attend regular schools and classes, given improved accessibility of school buildings, the use of technologies of treatment and adaptive devices, and improved attitudes of acceptance of disabilities in the school. Some students need highly specialized medical care and are thought to need education in the hospital where they are being treated or in a special class or school. A controversial issue is whether to include in regular schools and classes students who are near death or who have extreme physical and cognitive disabilities that leave them unresponsive to typical instruction.