Attentional Deficit Disorders

ADD and ADHD can best be explained by highlighting some of the common characteristics of individuals with ADD/ADHD:

Distractibility

ADD and ADHD can best be explained by highlighting some of the common characteristics of individuals with ADD/ADHD:

DistractibilityDifficulty following directionsDifficulty working independentlyDifficulty focusing and concentratingDifficulty organizing school work and other responsibilitiesAvoiding activities that require sustained self-applicationPoor work habits and study skillsInconsistent performance in school workDifficulty "reading" social situationsDifficulty with rule-governed situations

                                          General Behaviors Associated with LD and ADD/ADHD

ImpulsivityImpatienceIntrusivenessHigh activity level

AggressivenessSocial immaturityLow self-esteemDifficulty handling transitionsEasily frustrated

ADD/ADHD Cause

General suspected causes of ADD/ADHD include:

neurological     brain damage    head injury    anoxiafetal alcohol syndromegeneticenvironmental    toxins    poor nutrition

Motor Behaviors of Individuals with ADD/ADHD

Poor dynamic balanceDelayed fine motor developmentExtraneous movementsPerseveration (tendency to continue an activity)Arrthymical patternsPoor motor planningMisapplied forcePremature, delayed or inappropriate responsesVaried performance levels (skilled in one activity, relativelyunskilled in another)

Teaching Suggestions

Use strategies to help the learner focus and maintain attention.Follow a routine.Plan smooth transitions.Alert a learner that a transition is about to occur.Develop a behavior management plan which includes:        positive reinforcement         quick redirection Use proximity control Have clear expectations.Post and verbalize expectations often.Create a relaxed environment.Incorporate "down time" into the lesson. Decrease distractions in the learning environment.Reduce clutter

Links

AUTISTIC DISORDER (Autism)  

Autistic disorder is defined as a presence of marked abnormal and impaired development in social interaction, communication and a markedly restricted repertoire of activity and interests. The autistic disorder must manifest itself before age 3. An autistic disorder adversely affects an individual's performance. The term does not apply if an individual's educational performance is adversely affected primarily because the individual has a serious emotional disturbance.

DIAGNOSTIC CRITERIA FOR INDIVIDUALS WITH AUTISTIC DISORDER

 A. A total of six (or more) items (1), (2), and (3), with at least two from (1) and one each from (2) and (3):

1. Qualitative impairment in social interaction, as manifested by at least two of the following:

(a) Marked impairment in the use of multiple nonverbal behaviors such as eye- to-eye gaze, facial expression, body postures and gestures to regulate social interaction (b) Failure to develop peer relationships appropriate to developmental level (c) A lack of spontaneous seeking to share enjoyment, interests or achievements with other people (d) Lack of social or emotional reciprocity

2. Qualitative impairments in communication manifested by at least one of the following:

(a) Delay in, or total lack of, the development of spoken language (not accompanied by an attempt to use alternative modes of communication) (b) In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others(c) Repetitive use of language or idiosyncratic language (d) Lack of varied, spontaneous make-believe play appropriate to developmental level

3. Restricted repetitive and stereotyped patterns of behavior, interests and activities, as manifested by at least one of the following:

(a) Preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal in intensity or focus

(b) Strict adherence to specific, nonfunctional routines or rituals (c) Stereotyped and repetitive motor mannerisms (i.e., hand slapping/flapping or twisting or complex whole body movements) (d) Persistent preoccupation with parts of objects

B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years:

(1) social interaction,

(2) language as used in social communication, or

(3) symbolic or imaginative play.

C. The disturbance is not better accounted for by Rhett's Disorder or Childhood Disintegrative Disorder.

SPECIAL CONSIDERATIONS AND TEACHING TIPS:

• Utilize Premack principle with individuals with autism (pairing something liked with something disliked).

• Use teaching stations or a similar teaching technique that changes activities regularly.

• Teach to the preferred modality.

• Eliminate unnecessary external stimuli.

• Limit the amount of relevant stimuli presented at one time.

• Limit the use of prompts if appropriate for the individuals with autism.

• Teach in a game-like environment to facilitate generalization.

• Improve motor skill acquisition by using reinforcement, task analysis and physical prompting.

• Utilize sensory stimulation to increase attention span and decrease self- stimulation.

• Use vigorous aerobic exercise to reduce self-stimulatory and off task behaviors.

• Create a highly-structured environment.

• Use transitions that depict activities between each activity.

• Use the same organization and equipment each day.

Information on this sheet contains only suggested guidelines. Each person must be considered individually, and in many cases, a physician's written consent should be obtained. Developed by Texas Woman's University Graduate Adapted Physical Education Program in cooperation with Denton ISD (French, 1997).

CEREBRAL PALSY DEFINITION:

Cerebral Palsy (CP) is a non-progressive condition caused by damage to the brain, usually occurring before, during or shortly following birth. “Cerebral” refers to brain and “palsy” refers to a disorder of movement or posture.

TYPES OF CP:

Spastic: muscles are tense, contracted and resistant to movement. This makes muscle movement “jerky” and uncertain. These individuals have exaggerated stretch reflexes that cause them to respond to rapid passive stretching with vigorous muscle contractions. Spastic CP is the most common type of CP. muscles are tense, contracted and resistant to movement. This makes muscle movement “jerky” and uncertain. These individuals have exaggerated stretch reflexes that cause them to respond to rapid passive stretching with vigorous muscle contractions. Spastic CP is the most common type of CP.

Athetoid: characterized by involuntary movements of the body parts affected. The hands may twist and turn, and often there is facial grimacing, tonguing and drooling. Because of the presence of primitive reflexes and inability to control muscles, posture is unpredictable.

Ataxia: disturbance or lack of balance and coordination. Individual may sway when standing, have trouble maintaining balance and may walk with feet spread wide apart to avoid falling. disturbance or lack of balance and coordination. Individual may sway when standing, have trouble maintaining balance and may walk with feet spread wide apart to avoid falling.

CAUSES OF CP *: CAUSES OF CP *:

Illness during pregnancy Lack of oxygen supply to the fetus Child abuse

Premature delivery Lead poisoning Illness early in the infant's life

* The most common cause of CP is an insufficient amount of oxygen reaching the fetus or newborn baby's brain.

COMMON CHARACTERISTICS OF CP:

Persistence of primitive reflexes Involuntary movement Disturbance in gait and

mobilitySlow to develop equilibrium reflexes Loss of perceptual ability Seizures

Hyperactivity Spasms Difficulty with speechLearning disability or mental retardation

Poor depth perception and poor tracking ability due to difficulty with coordinating eye movements

TEACHING TIPS FOR INDIVIDUALS WITH CP:

• Take caution at the hip joint when doing activities. Individuals with CP who use wheelchairs are at high risk for hip dislocation.

• Adapt activities and modify rules and/or the environment to permit participation in group games.

• Use larger balls that enable the fingers to be in extension. This inhibits the hand grasp reflex.

• Teach striking activities with an open hand (i.e., use a tether ball or a balloon suspended on a string).

• Utilize communication boards.

• Provide frequent rest periods.

• Integrate relaxation training into the lesson.

SUGGESTED ACTIVITIES FOR INDIVIDUALS WITH CP:

Stretching exercises Tether ball or balloon activities  Manual wheelchair maneuvers to build upper body strength

Soccer (individual can use the wheelchair to kick the ball)

Aquatic activities Physical fitness activities to strengthen large and small muscle groups

Bowling Rhythm activitiesBaseball (use a plastic bat and ball, i.e., placed on a cone, or suspended on a string)

 Information on this sheet contains only suggested guidelines. Each person must be considered individually, and in many cases, a physician's written consent should be obtained. Developed by Texas Woman's University Graduate Adapted Physical Education Program in cooperation with Denton ISD (French, 1997).

CYSTIC FIBROSIS

DEFINITION:

Cystic Fibrosis (CF) is a congenital disease of the exocrine glands primarily affecting the gastrointestinal and respiratory systems. The lungs, pancreas, intestines, and sweat glands are the primary organs affected.

Cystic Fibrosis is currently the most common fatal genetic disease in the United States. The median age of survival for a person with CF is 31 years. Cystic fibrosis affects approximately 30,000 children and young adults. It occurs in approximately one of every 3,300 live births.

In about 10% of the cases, the diagnosis of CF is not made until the individual is in the late teens.

SYMPTOMS:

• High concentration of sodium and chloride in the human sweat

• Persistent coughing, wheezing and pneumonia

• Excessive appetite, but poor weight gain and weight maintenance

• Chronic production of abnormally thick mucus

• Progressive lung damage as disease continues its course

TREATMENT:

Postural drainage (also called chest physical therapy) requires vigorous movement, "clapping" or "pounding" with cupped hands, on the back and chest to dislodge thick mucus from the lungs. Antibiotics are used to treat lung infections and are administered intravenously, via pill, and/or medicated vapors which are inhaled to open up clogged airways.

When the digestive system is affected, the body does not absorb enough nutrients. An enriched diet with high caloric, and fat and protein intake is suggested. Twice the recommended daily allowance of vitamins and enzymes is also recommended.

COMMONLY USED MEDICATIONS:

Pulmozyme, a mucus thinning drug

Ibuprofen, an anti-inflammatory

TOBI, tobramycin solution for inhalation

Phenylnbutyrate, to address metabolic disorders

HELPFUL HINTS:

• Always get parent and physician permission before an individual with CF participates in a physical activity.

• Allow the individual with CF to monitor and control his/her own activity levels.

• Encourage those with Cystic fibrosis to cough out the mucus in their lungs before, during, and after participation in activity.

• With the permission of the individual and/or parents of the individual with CF, provide information for other individuals involved in the program about CF with particular emphasis on the fact that it is not a communicable disease.

• Precautions should be taken to minimize exposure to respiratory infections.

• A participant's fluid intake should be monitored before, during and after exercise.

• An individual with CF may need to take medications or use an inhaler during activity.

CONTRAINDICATED ACTIVITIES:

• High diving and, without a physician's permission, scuba diving.

SUGGESTED ACTIVITIES:

• Badminton, racquetball and tennis

• Bicycling

• Swimming (most participants will prefer to wear a nose clip)

• Volleyball

• Active walking or jogging

• Dance

• Aerobic dance

Begin with low-intensity exercise and increase intensity as the individual willtolerate it.

Information on this fact sheet contains only suggested guidelines. Each physical education and physical activity program must be individually designed to meet the unique needs of the individual. A physician's written consent must be obtained before an individual participates in such a program.

With thanks to the TWU Master's Level Course, "Issues in Adapted Physical Education," taught by Kerrie Berends, Summer, 1998; (edited by Huettig, Fall, 1998).

DOWN SYNDROME

DEFINITION:

Down syndrome is the most common and readily identifiable chromosomal condition associated with mental retardation. It is caused by a chromosomal abnormality. For some unexplained reason, an accident in cell development results in 47 instead of the usual 46 chromosomes. This extra chromosome has an impact on psychomotor, cognitive, and language development. In most cases, the diagnosis of Down syndrome is made according to results from a chromosome test administered shortly after birth.

INCIDENCE

• A child with Down syndrome is born in one of 1000 live births.

• It is historically associated with "advanced" maternal age, age over 35 years, but improved health and longevity may have an impact on that data.

• One in 80 infants with Down syndrome have biological mothers older than 40 years.

• Parents of any age may have a child with Down syndrome.

• There is no association between Down syndrome and any given culture, ethnic group, socioeconomic status, or geographic region.

POSSIBLE PHYSICAL CHARACTERISTICS

• Small skull

• Slanting, almond-shaped eyes

• Flat-bridged nose

• Palmar crease

• Short stature, short fingers, toes, limbs, and neck

• Tendency to be overweight

• Small oral cavity, which makes tongue look large and protruding

• Possible delays in reflex integration

• Significant delay in acquisition of major motor milestones

• Hypotonia, with associated tendency to have loose joints and difficulty with subluxation and dislocation

• Floppy Infant Syndrome during infancy

ATLANTOAXIAL INSTABILITY (AAI):

Individuals with Down syndrome have a tendency to have atlantoaxial instability, a condition in which there is increased mobility between the first and second cervical vertebrae. Studies suggest this condition occurs in 15% of children with Down syndrome. AAI is usually diagnosed with X-rays of the cervical spine; these X-rays are necessary, because typically there are no symptoms associated with AAI. 

When symptoms occur they are typically associated with subluxation, an incomplete or partial dislocation, of the joint between the first and second cervical vertebrae. These include:

• Changes in bowler or bladder function• Difficulty walking• Weakness in one or more extremity• Neck pain, changes in neck posture/position, and limited range of         motion• Progressive clumsiness and loss of coordination• Hypersensitivity

PRECAUTIONARY MEASURES:

• Have X-rays on file (school nurse's office, Special Olympics office, recreation center, etc.) prior to participation in physical activity.

• Teacher, coach, or recreation director should communicate with the student or athlete's parent(s) and physician.

• It is suggested that students and athletes with Down syndrome be restricted from participation in gymnastics, diving, the butterfly stroke in swimming, the high jump, "heading" in soccer, and any warm-up exercise which places pressure on the muscles of the neck. Note: A physician may clear a student or athlete to participate.

TEACHING TIPS:

• Use strong visual, tactile, auditory, and kinesthetic stimuli as clues.• Use a systematic, structured style of instruction.• Use short one-word and two-word verbal instructions.• Use demonstration as an effective instructional tool.• Provide opportunities for choice of activities to encourage decision   making skills.• A whole-part-whole instructional strategy may help learners process   information.• Peer partners may be helpful in the learning environment.• "Catch 'em being good."

With thanks to the TWU Master's Level Course, "Issues in Adapted Physical Education," taught by Kerrie Berends, Summer, 1998 (edited by Huettig, Fall, 1998).

HEARING IMPAIRMENT AND DEAFNESS

“Deaf” means a hearing impairment which is so severe that the individual is impaired in processing linguistic information through hearing, without amplification, which adversely affects educational performance.

“Hard of Hearing” means a hearing impairment, whether permanent or fluctuating, which adversely affects an individual's educational performance but which is not included under the above definition of deaf.

BEHAVIORAL CHARACTERISTICS OF HEARING IMPAIRED INDIVIDUALS

Lack of attention Turns or cocks head Uses gesturesImitates others Acts out Reluctant to participate orally

Responds to noises instead of words

Preoccupied with things, not people Monotone quality in voice

Lack of speech development Works best in small groups Difficulty in following directions

TEACHING TIPS

• Position yourself where the individual with the hearing impairment can see your lips and maintain eye contact; do not turn your back on the individual with a hearing impairment and talk.

• When outdoors, position yourself so that you face the sun rather than the individual with a hearing impairment.

• Use visual attention-getters (i.e., bright cones, jersey flags).

• Provide adequate lighting in the teaching environment.

• Encourage the use of what hearing the individual with a hearing impairment may have.

• Coordinate communication methods (oral, sign, total communication) with your school.

• Learn some basic signs and use them during instruction.

• Refrain from having long lines and circle formations when giving information.

• Demonstrate or have another participant demonstrate.

• Stand still while giving instructions and keep instructions simple and direct.

• Select activities that allow the individual with a hearing impairment to be actively involved throughout.

• Familiarize the individual with a hearing impairment with rules and strategies of a game

before introducing the activity to the rest of the class.

Information on this sheet contains only suggested guidelines. Each person must be considered individually, and in many cases, a physician's written consent should be obtained. Developed by Texas Woman's University Graduate Adapted Physical Education Program in cooperation with Denton ISD (French, 1997).

LEARNING DISABILITY

A learning disability is a disorder in one or more of the basic psychological processes involved in understanding or using language, spoken or written, which may manifest itself in the imperfect ability to listen, think, speak, write, spell, or perform mathematical calculations. The term includes such conditions as perceptual disabilities, minimal brain dysfunction, dyslexia, developmental aphasia, and attention deficit disorder.

POSSIBLE BEHAVIORAL CHARACTERISTICS

• Significantly different behaviors such as difficulty in beginning or finishing tasks, organization, consistency in behavior, or peer relationships

• Below average auditory comprehension, listening, and spoken language

• Academic problems

• Orientation difficulties including time concept and poor directionality relationships (i.e., south, north, far, near, under, behind, on, or close)

• Motor difficulties, including poor coordination, clumsiness, very poor balance, awkward movements, poor manual dexterity, and lack of rhythm in movements

• Impulsiveness and poor decision making skills

• Inability to sit or stand in one place for extended periods of time and hyperactivity

• Difficulty with visual-motor movements

• Delayed bilateral coordination (using both sides of the body together)

COMMONLY USED MEDICATIONS

Ritalin Cylert DexadrineBenzadrine Methedrine

POSSIBLE SIDE EFFECTS

•Depressed appetite

•Sleeplessness

•Balance and coordination may be affected

TEACHING TIPS

• Increase alternative ways to get positive attention from peers or teachers.

• Instruct the individual to continue with the easier part of a task or do a substitute task while waiting for the teacher's help.

• Inform the individual with a learning disability in advance of anticipated difficult tasks or situations where extra control will be needed.

• Decrease the length of the task and make lessons brief.

• Provide short, clear instructions.

• Break lessons into shorter segments (task-analysis).

• Present new information in small quantities.

• Allow the individual with a disability a “mini-break” when his/her tension level appears to be building.

• Deliver reinforcements immediately and more frequently than usual.

• Repeat directions to the individual with a learning disability.

• Have the individual with a learning disability repeat/explain the task back to you.

• Obtain frequent responses and input from the individual with a learning disability.

• Avoid changing the learning environment frequently (use routines).

• Eliminate distractions (visual and auditory).

Information on this sheet contains only suggested guidelines. Each person must be considered individually, and in many cases, a physician's written consent should be obtained. Developed by Texas Woman's University Graduate Adapted Physical Education Program in cooperation with Denton ISD (French, 1997)

Multiple Sclerosis

Description:

Multiple Sclerosis is a progressive neurological disease of the central nervous system.  In multiple sclerosis, segments of the myelin sheath covering the nerves disintegrate and are replaced by scar tissue.  This consequently distorts or prevents the nerve impulses that dictate muscle control.  MS involves onsets of 'attacks' and subsequent remission.  Most people with MS are diagnosed between the ages of 20 and 40.

Causes:

There appear to be multiple causes in MS, possibly including viruses and environmental, genetic, and immune system factors. Among the well-established epidemiological observations on MS are:

MS is more common among Caucasians (particularly those of northern European ancestry) than other races, and is almost unheard of in some populations, such as Eskimos.

MS is twice as common in women compared to men.

Certain localized outbreaks or clusters of MS have been identified, but their significance is not known.

In certain populations, a genetic marker has been linked to MS. A particular genetic trait occurs more frequently in people with MS than in those who do not have the disease.

Symptoms:

The initial symptoms of MS are most often:

Difficulty in walking Abnormal sensations such as numbness or "pins and needles"Pain and loss of vision

Less common initial symptoms may include:

TremorIncoordination Slurred speech Sudden onset of paralysis, similar to a stroke Decline in cognitive function—the ability to think, reason, and remember.

Symptoms may progress to include:

Partial or complete paralysisLoss of bladder or bowel controlWeaknessHand tremorsNumbnessDragging of one or both feetLoss of balanceLoss of coordination

Instructional Strategies:

Instruction should be individualized based on the progression of the condition.

Particular attention needs to be paid to the emotional state of the individual.

Increase and maintenance of flexibility and range of motion is important to ease and prevent contractures.

Consistent and regulated physical activity is imperative to prevent atrophy and maintain and improve motor coordination and balance abilities.

Warm water is contraindicated. See the Multiple Sclerosis Aquatics Page for guidelines regarding water activity

MUSCULAR DYSTROPHY DEFINITION

Muscular Dystrophy: A disease of the muscular system characterized by weakness and atrophy of the muscles of the body. The disease is progressive and remission does not occur. The rate of progression is different for each set of muscles.

TYPES OF MUSCULAR DYSTROPHY

Duchenne: Occurs primarily in males and presents itself between the ages of 3 and 7 years. This type of muscular dystrophy is most common and most severe. This type affects the pelvic girdle and then moves to the shoulder girdle.

Facioscapularhumeral: The most common form of muscular dystrophy in adults. This type affects both genders equally. Appears in adolescence but is not usually diagnosed until adulthood. Characterized by progressive weakness of the shoulder muscles and weakness of the face muscles. Life span for individuals with this type is normal.

Limb-Girdle: Occurs anytime from age 10 and on. Both genders are equally affected. Early symptoms include difficulty in raising the arms above shoulder level or difficulty in climbing stairs. Initially muscle weakness is either in the shoulder girdle muscles or the hip and thigh muscles.

CHARACTERISTICS OF MUSCULAR DYSTROPHY

Tendency to tire quickly Walking on tip toes Lack of motivation because of limitations Waddling gait with legs far apart

Tendency to lose fine manual dexterity Pseudohypertrophy particularly in the calf muscles

Gower's sign (moving to all fours and then “climbing up the legs” when changing from a prone to standing)

Postural changes due to progressive muscle weakness

EIGHT STAGES OF DUCHENNE MUSCULAR DYSTROPHY

1. Ambulates with mild waddling gait and lordosis. Climbs stairs and curbs without assistance.

2. Ambulates with moderate waddling gait and lordosis. Needs support to climb stairs and curbs.

3. Ambulates with moderately severe waddling gait and lordosis. Cannot climb stairs or curbs.

4. Ambulates with severe waddling gait and lordosis. Unable to rise from a standard height chair.

5. Wheelchair independence. Sits erect and can roll chair and perform all activities of daily living (ADL) and wheelchair activities without assistance.

6. Wheelchair with dependence. Needs assistance when performing ADL and wheelchair activities.

7. Wheelchair with dependence. Sits erect only with support. Able to do minimal ADL.

8. Bed patient. Needs maximum assistance for ADL.

TEACHING TIPS FOR INDIVIDUALS WITH MUSCULAR DYSTROPHY

Individually designed activity program Allow for full participation in games and athletics while condition is in early stages

Be aware that the individual may tire more easily Introduce sedentary recreational activities that will carry over when the individual

is in a wheelchair Allow the individual to be in an aquatic environment as much as possible Design stretching and strengthening programs for the individual to maintain

functional skills Encourage movement and dance activities that allow the individual to express

emotions Due to progressive muscle weakness, respiratory and cardiac problems become

evident. Encourage breathing games and exercises when the individual is confined to the wheelchair

Information on this sheet contains only suggested guidelines. Each person must be considered individually, and in many cases, a physician's written consent should be obtained. Developed by Texas Woman's University Graduate Adapted Physical Education Program in cooperation with Denton ISD (French, 1997).

OBESITY

Obesity is a national epidemic. It is estimated that at least one of every four individuals in the United States is obese.  Though not technically a disability, obesity is associated with conditions that are directly related to disability. Obesity is defined as the presence of an abnormally large amount of body fat or adipose tissue. An individual who is obese is considered to be 20% or more above his/her ideal body weight.

Overweight is defined as body weight above an established standard which is related to height. An individual who is overweight is considered to be 10% or more above his/her ideal weight.

The most common reason for being overweight is that the individual's food and caloric consumption is greater than energy expenditure. It has been estimated that 10% or more of school-aged children are considered overweight.

CAUSES FOR OVERWEIGHT AND OBESITY

Caloric intake exceeds energy expenditureSignificant inactivity (particularly associated with TV and videogame use)Genetic predisposition (Prader-Willi Syndrome)Metabolic disturbancesEndocrine dysfunction (specifically the pituitary and thyroid function)Emotional disturbance

TYPICAL CHARACTERISTICS OF INDIVIDUALS WHO ARE OBESE

Poor self-conceptImmature social and emotional behaviorsHeightened sensitivity to criticismMotor awkwardnessPrefers solitary and sedentary activities

TREATMENT AND PROGRAMMING FOR INDIVIDUALS WHO ARE OBESE

• Create an environment that will enable the individual to have successful experiences in a compatible, supportive social group.

• Develop an individualized regularly scheduled progressive, low-impact, aerobic exercise program (walking, aquarobics, stationary cycling)

• Implement a lifestyle management program that includes increasing activity, decreasing calorie intake, and reducing stress.

    • Counting calories     • Calculating energy expenditure     • Cutting down on the amount of food consumed     • Setting short-term goals     • Provide frequent feedback about progress and give social         reinforcement when weight loss occurs     • Seeking medical attention if the problem is because of glandular         dysfunction     • Seeking counseling advice when emotional causes are the problem

• Monitor any type of strenuous physical activity.

• Avoid activities that involve quick movements or sudden stops which might damage the knee and ankle joints.

• Allow the individual to have privacy when dressing.          dysfunction     • Seeking counseling advice when emotional causes are the problem

• Monitor any type of strenuous physical activity.

• Avoid activities that involve quick movements or sudden stops which might damage the knee and ankle joints.

• Allow the individual to have privacy when dressing.

SUGGESTED ACTIVITIES FOR INDIVIDUALS WHO ARE OBESE

•Walking

•Bicycling

•Swimming

•Water aerobics

Most individuals who are obese/overweight in childhood continue to be obese/overweight in adulthood. Active lifestyles and sound nutrition practices should be initiated in the home. Parents need to serve as role models so that individuals will develop and continue a healthy lifestyle into adulthood.

Information on this sheet contains only suggested guidelines. Each person must be considered individually, and in many cases, a physician's written consent should be obtained. Developed by Texas Woman's University Graduate Adapted Physical Education Program in cooperation with Denton ISD (French, 1997, Huettig, 1999).

PRENATAL DRUG EXPOSURE andFETAL ALCOHOL SYNDROME

Over one million women in the United States who use alcohol, nicotine, cocaine and other drugs increase the risk of giving birth to babies with developmental delays. Fetal alcohol exposure is the nations leading cause of mental retardation. Approximately 5,000-10,000 babies are born each year with severe Fetal Alcohol Syndrome (FAS). FAS is defined as defects to the developing fetus due to excessive alcohol consumption during pregnancy causing mental retardation, facial anomalies or heart defects in the child. Approximately 11% of all newborns in the United States (375,000 infants) are exposed to drugs in utero.

CHARACTERISTICS OF FETAL ALCOHOL SYNDROME (FAS)

• Craniofacial defects (almond-shaped eyes, sunken nasal bridge, small flat midface)

• Significant growth retardation before and after birth

• Poor sucking behaviors in infants

• Disrupted sleep behaviors

• Tremors and abnormal reflexes

• Delays in fine and gross motor behavior

• Hyperactivity

• Speech delays

• Difficulties with verbal comprehension

CHARACTERISTICS OF “CRACK BABIES”

• Tremors

• Chronic irritability

• Poor visual orientation

• Strokes and/or seizures as infants

• Smaller head circumference

• Missing bowels

• Violent tendencies

• Hyperactivity

• Learning difficulties

• Little or no understanding of cause and effect

• Aggression towards peers

• Inability to play spontaneously

• Impulsive

• Distractible

• Low Apgar scores (Apgar scores are indicators of the infant's status immediately after birth, including breathing, color, heart rate, muscle tone and overall behavior)

TEACHING TIPS

• Create exploration and play activities for the child's development needs.

SPINA BIFIDA

Spina Bifida is the most common congenital spinal defect. Spina Bifida is caused by failure of the neural arch of the vertebra to properly develop and enclose the spinal cord. This usually occurs between the fourth and sixth week of pregnancy.

TYPES OF SPINA BIFIDA

* Myelomeningocele: Most severe type of Spina Bifida. Spinal cord, nerve roots and lining (meninges) protrude out into a sac from an opening in the spine.

* Meningocele: The spinal cord lining protrudes out into a sac, but the spinal cord and nerves are not displaced.

* Oculta: The least severe type. Vertebral arches fail to fuse, but there is no protrusion of the spinal cord lining or the spinal cord itself. This type does not cause paralysis or muscle weakness and usually is not diagnosed unless an x-ray is taken.

* Myelomeningocele and Meningocele require surgical correction.

MEDICAL CONDITIONS ASSOCIATED WITH SPINA BIFIDA

Hydrocephalus: Increased cerebrospinal fluid in the ventricles of the brain. This condition is surgically corrected by placing a shunt into the ventricles of the brain to drain excess fluid.

Neurological Impairments: Range from mild muscle imbalance to sensory loss in the lower limbs to paralysis of one or both legs to lack of control of bowels and bladder.

Skin Breakdown/Lesions: Due to lack of sensation in the lower limbs, it is critical to continuously check the individual for skin problems.

TEACHING TIPS FOR INDIVIDUALS WITH SPINA BIFIDA

• Develop activities that utilize the head, trunk, shoulders, arms and hands.

• Develop activities that encourage pushing, pulling and lifting (i.e., scooterboards, parachutes, hanging and climbing, and weight training).

• Avoid activities that could displace a shunt or put pressure on the sensitive areas of the spine.

• Encourage walking whenever possible.

• Teach functional movement skills.

• Develop stretching exercises to improve flexibility and to achieve full range of motion.

Information on this sheet contains only suggested guidelines. Each student must beconsidered individually, and in many cases, a physician's written consent should be obtained. Developed by Texas Woman's University Graduate Adapted Physical Education Program in cooperation with Denton ISD (French, 1997).

TRAUMATIC BRAIN INJURY

Traumatic brain injury (TBI) is injury caused to the head that results in minor to serious brain injury. It is caused by either an open head injury where there is a penetrating lesion or closed

head injury where there is no outward injury.

LEVELS OF TBI: Minor: Common bump to the head with no evidence of concussion. Generally not seen by a

physician. Mild: Brief loss of consciousness, if any, with accompanying symptoms of concussion, such as

vomiting, lethargy or lack of recall of the injury. Moderate: Evidence of concussion; loss of consciousness for less than 5 minutes. Severe: Concussion or skull fracture; loss of consciousness for 5 to 30 minutes.

Serious: Loss of consciousness for more than 30 minutes; concussion or skull fracture and noticeable neurological signs.

COMMON CAUSES OF TBI:

Motor vehicle accidents Child abuse Sport injuries Falls Bicycle accidents Assaults

COMMONLY USED MEDICATIONS *:

Methylprednisolone Dantrium Ritalin Phenobarbital Thorazine Tegretol

Navane Lasix ElavilValium Codeine MannitolDilantin Haldol Solumedrol

* Symptoms may be masked and cautions must be taken when exercising if the individual is on medication.

COMMON CHARACTERISTICS OF TBI:

Decrease in motivation Abnormal reflexes Visual perceptual deficitsMotor apraxia Visual perceptual deficits Sequencing deficits

Agitation Speech apraxia Memory deficitsDecreased mobility Decreased range of motion Decreased fine motor ability

Impulsive Change in personality Decreased attention spanExpressive deficits Receptive deficits  

TEACHING TIPS AND SPECIAL CONSIDERATIONS:

• Each case must be considered individually.

• Each case must be developed based on the individual's needs.

• Schedule rest periods as needed.

• Make provisions for taping lectures and extra time to complete written work.

• Monitor the individual if he/she is on any medication.

• Program the goals based upon what is achievable for the level of the head injury.

• Monitor the individual's agitation and frustration levels during activity.

• Avoid activities that involve contact with the head or could lead to contact with the head.

Information on this sheet contains only suggested guidelines. Each person must be considered individually, and in many cases, a physician's written consent should be

obtained. Developed by Texas Woman's University Graduate Adapted Physical Education Program in cooperation with Denton ISD (French, 1997).

VISUAL IMPAIRMENTS AND BLINDNESS DEFINITION

Visual Impairment (VI) is an impairment in vision which, even with correction, adversely affects an individual's educational performance. This term includes individuals who are partially sighted and blind.

TYPES OF VISION:

Refractive Vision (Acuity): The degree of detail that can be seen in an object. The product of light rays bending and reaching receptors (rods and cones) of the retina. Refraction is influenced by the size and shape of the eyeball which changes with age. Refractive vision includes myopia (nearsightedness), hyperopia (farsightedness) and astigmatism (blurring or distortion of the image).

Orthoptic Vision: Refers to the activity of the six external muscles of the eye responsible for providing coordinated movements of the eyes. Orthoptic vision includes binocular vision (the ability of the eyes to coordinate), depth perception (including strabismus, amblyopia and alternating) and nystagmus (constant involuntary movement of the eyeballs).

Visual acuity is commonly tested using the Snellen Eye Chart. The effect of impaired vision can negatively impact motor development. The age onset commonly determines future problems in these areas.

Refractive problems are commonly corrected using prescription glasses or surgery.

Orthoptic vision problems can sometimes be treated with surgery; however, the problem may be corrected with a special lens or with eye exercises. When depth perception problems exist, students should refrain from participating in activities that require judging where in space moving objects are located.

INDICATORS OF VISUAL IMPAIRMENTS:

Lack of coordination in directing vision of both eyes

Difficulty visually tracking an object

Avoidance of climbing apparatus

Difficulty going down steps one at a time

Sensitivity to normal light levels

Walking overcautiously and hesitantly

Faltering and stumbling when walking even on an even surface

Walking down steps using a marked time pattern

Body tension

Eyelids are crusted and red

Eyes are bloodshot

Frequent rubbing of the eyes

Squinting

TEACHING TIPS FOR INDIVIDUALS WITH VISUAL IMPAIRMENTS:

Ensure optimal lighting to ensure use of residual vision.

Keep equipment and objects in the same place

Keep the activity area free of clutter.

Alter the playing surface texture (i.e., sand, dirt, asphalt) or increase ordecrease the grade to indicate play area boundaries.

Place audio devices inside balls and bean bags; use beepers by goals andbases.

Use brightly colored equipment and boundaries, that differ from the ground (red balls on green grass, blue lines on tan floor).

Allow the individual to use an "anchor" for orientation when running -a sighted partner or a rope suspended at hip level.

Use a movement exploration approach to maximize movement opportunities.

Use equipment with a wide variety of textures.

Insist the individual wear eye protection (goggles).

Asperger Syndrome

Description:

Asperger Syndrome is classified as a Pervasive Developmental Disorder affecting two-way social interaction and verbal and non-verbal communication.   Individuals with Asperger's syndrome typically demonstrate a reluctance to accept change, inflexibility of thought and have all-absorbing narrow areas of interest.   Individuals usually have excellent extremely rote memory skills (facts, figures, dates, times etc.) and many excel in math and science. There is a range of severity of symptoms within the syndrome.

 Characteristics:

Individuals with Asperger Syndrome often have many of the characteristics listed below:

Speech may be repetitive and stilted.

Voice tone may be flat and emotionless.

Individuals may demonstrate an inability to make friends, seeming indifferent and withdrawn.

Social interaction is often one-sided.

Cognitive and communicative development are relatively normal for the first few years of development.

Idiosyncratic interests are common.

Verbal skills are usually excellent and, in some individuals, may be advanced.

Individuals may have difficulty with nonverbal communication.

Individuals may have major difficulties with social interaction.

Restricted and unusual patterns of interest and behavior are typical.

Individuals may demonstrate repetitive routines, ritualized behavior, and may have difficulty with change.

Motor deficits and motor awkwardness are common.

Odd postures may be typical.

Asperger's Syndrome is more common in boys than girls.

Motor Assessment:

A formal motor assessment will often not lead to accurate results as an individual with Asperger's Syndrome may not always respond to test directions. It is important to assess using observation and written and video documentation in the natural setting. Interviews with the parents, and professionals knowledgeable with the child should be included in the assessment process.

Teaching Suggestions:

Individuals with Asperger's Syndrome will be particularly effective in gross motor activities that are repetitive -- swimming, stationary bicycling, rowing, and walking.

 Appropriate social behavior should be taught and reinforced.

Allow the student to lead class activities or assist others when possible.

Use a parts-to-whole verbal teaching approach.

Keep verbal instructions simple. Supplement with lists or pictures.

Encourage.  Praise any achievement. Reward progress.

                              With some young children, who appear not to listen, 'singing' your words can have a beneficial effect.

Limit any choices to two or three items.

Limit 'special interest' time to set amounts of time each day if you can.

Use turn taking activities as much as possible.

Pre-warn the student of transitions.

Try to build in some flexibility in their routine, if they learn early that things do change and often without warning - it can help.

Try to identify stress triggers - avoid them if possible - be ready to distract with some alternative.

Teach coping strategies.