Physical disability

In the early years, children may have some difficulties in learning to move skilfully. This is not unusual. However,
for some children, the muscles and nerves that control body movements may not be properly formed or may
become damaged causing a physical disability.
Contents

What is a physical disability?

Causes of physical disabilities

Role of a physiotherapist

Role of an occupational therapist

Role of a speech pathologist

Other important professionals

Special equipment

What you can do

Preschool and school

Resources

References and further reading

In the early years, children may have some difficulties in learning to move skilfully. This is not unusual. However,
for some children, the muscles and nerves that control body movements may not be properly formed or may
become damaged causing a physical disability. There are organisations and services that can help you and your
child if your child has a physical disability.
For children with a disability and their families life can be quite different to other families.

Children with a disability

Disability - brothers and sisters

Living with a disability (Teen topic)

What is a physical disability?

A physical disability is any condition that permanently prevents normal body movement and/or control. There are
many different types of physical disabilities. Some of the main ones include:
Muscular dystrophies
When a child has muscular dystrophy, this means that the muscle fibres in the body gradually weaken over time.
Children can have different types of muscular dystrophy. The most common type is Duchenne Muscular

Dystrophy which occurs only in boys. All types of muscular dystrophy are genetic even though other family
members may not have the condition.
Acquired brain and spinal injuries
Physical disabilities may result from permanent injuries to the brain, spinal cord or limbs that prevent proper
movement in parts of the body.
Spina bifida
Sometimes, a baby's spinal cord (the nerves that run down the spine) do not develop normally during pregnancy.
When this happens, the child can have a physical disability called spina bifida. The type and amount of disability
caused by spina bifida will depend upon the level of the abnormality of the spinal cord. Children with spina bifida
may have:

partial or full paralysis of the legs

difficulties with bowel and bladder control.

They may also have:

hydrocephalus (high pressure on the brain because of fluid not being drained away as normal)

bone and joint deformities (they may not grow normally)

curvature (bending) of the spine.

Cerebral palsy
Cerebral palsy is caused by damage to the par ts of the brain which control movement during the early stages of
development. In most cases, this damage occurs during pregnancy. However, damage can sometimes occur
during birth and from brain injuries in early infancy (such as lack of oxygen from near drowning, meningitis, head
injury or being shaken).
Children with cerebral palsy may have difficulties with:

posture (the ability to put the body in a chosen position and keep it there)

movement of body parts or the whole body

muscle weakness or tightness

involuntary muscle movements (spasms)

balance and coordination

talking and eating.

Children can have different types of cerebral palsy:

hemiplegia (involves muscle movements and weakness on one side of the body)

diplegia (involves muscle movements and weakness in the lower part of the body)

quadriplegia (involves muscle movements and weakness in both arms and both legs)

ataxia (involves problems with balance and coordination).

There is much more about Cerebral Palsy in the booklet 'Cerebral Palsy - an information guide for parents'
written for the Royal Children's Hospital (Victoria)
http://www.rch.org.au/emplibrary/cdr/CPBooklet.pdf
Multiple disabilities
Some children with physical disabilities will have other disabilities, such as intellectual, visual or hearing
impairments. They may also have communication difficulties or other medical conditions such as epilepsy or
asthma. When a child has several different types of disability, professionals talk about multiple disabilities rather
than listing separate conditions.

Causes of physical disabilities

There are many different causes for physical disabilities. These include:

inherited or genetic disorders, such as muscular dystrophy

conditions present at birth (congenital), such as spina bifida

serious illness affecting the brain, nerves or muscles, such as meningitis

spinal cord injury

brain injury.

Role of a physiotherapist
Physiotherapists can help children with disabilities and their families by:

assisting the child to learn how to use parts of the body and develop physical skills

helping a child to become mobile (either independently or by using equipment)

helping parents to become skilful in assisting their child including lifting, positioning and physical care

working with staff from the child's preschool or school

Types of Learning Disabilities

Learning disabilities are neurologically-based processing problems. These processing problems

can interfere with learning basic skills such as reading, writing and/or math. They can also
interfere with higher level skills such as organization, time planning, abstract reasoning, long or
short term memory and attention. It is important to realize that learning disabilities can affect an
individuals life beyond academics and can impact relationships with family, friends and in the
workplace.
Since difficulties with reading, writing and/or math are recognizable problems during the school
years, the signs and symptoms of learning disabilities are most often diagnosed during that time.
However, some individuals do not receive an evaluation until they are in post-secondary
education or adults in the workforce. Other individuals with learning disabilities may never
receive an evaluation and go through life, never knowing why they have difficulties with
academics and why they may be having problems in their jobs or in relationships with family and
friends.
Learning disabilities should not be confused with learning problems which are primarily the result
of visual, hearing, or motor handicaps; of mental retardation; of emotional disturbance; or of
environmental, cultural or economic disadvantages.
Generally speaking, people with learning disabilities are of average or above average
intelligence. There often appears to be a gap between the individuals potential and actual
achievement. This is why learning disabilities are referred to as hidden disabilities: the person
looks perfectly normal and seems to be a very bright and intelligent person, yet may be unable
to demonstrate the skill level expected from someone of a similar age.
A learning disability cannot be cured or fixed; it is a lifelong challenge. However, with appropriate
support and intervention, people with learning disabilities can achieve success in school, at work,
in relationships, and in the community.
In Federal law, under the Individuals with Disabilities Education Act (IDEA), the term is specific
learning disability, one of 13 categories of disability under that law.
Learning Disabilities is an umbrella term describing a number of other, more specific learning
disabilities, such as dyslexia and dysgraphia. Find the signs and symptoms of each, plus
strategies to help below.

Specific Learning Disabilities

Auditory Processing Disorder (APD)

Also known as Central Auditory Processing Disorder, this is a condition that adversely affects
how sound that travels unimpeded through the ear is processed or interpreted by the brain.
Individuals with APD do not recognize subtle differences between sounds in words, even when
the sounds are loud and clear enough to be heard. They can also find it difficult to tell where
sounds are coming from, to make sense of the order of sounds, or to block out competing
background noises.

Dyscalculia
A specific learning disability that affects a persons ability to understand numbers and learn
math facts. Individuals with this type of LD may also have poor comprehension of math
symbols, may struggle with memorizing and organizing numbers, have difficulty telling time,
or have trouble with counting.

Dysgraphia
A specific learning disability that affects a persons handwriting ability and fine motor skills.
Problems may include illegible handwriting, inconsistent spacing, poor spatial planning on paper,
poor spelling, and difficulty composing writing as well as thinking and writing at the same time.

Dyslexia
A specific learning disability that affects reading and related language-based processing skills.
The severity can differ in each individual but can affect reading fluency, decoding, reading
comprehension, recall, writing, spelling, and sometimes speech and can exist along with other
related disorders. Dyslexia is sometimes referred to as a Language-Based Learning Disability.

Language Processing Disorder

A specific type of Auditory Processing Disorder (APD) in which there is difficulty attaching
meaning to sound groups that form words, sentences and stories. While an APD affects the
interpretation of all sounds coming into the brain, a Language Processing Disorder (LPD) relates

only to the processing of language. LPD can affect expressive language and/or receptive
language.

Non-Verbal Learning Disabilities

A disorder which is usually characterized by a significant discrepancy between higher verbal
skills and weaker motor, visual-spatial and social skills. Typically, an individual with NLD (or
NVLD) has trouble interpreting nonverbal cues like facial expressions or body language, and may
have poor coordination.

Visual Perceptual/Visual Motor Deficit

A disorder that affects the understanding of information that a person sees, or the ability to draw
or copy. A characteristic seen in people with learning disabilities such as Dysgraphia or Nonverbal LD, it can result in missing subtle differences in shapes or printed letters, losing place
frequently, struggles with cutting, holding pencil too tightly, or poor eye/hand coordination.

Related Disorders

ADHD
A disorder that includes difficulty staying focused and paying attention, difficulty controlling
behavior and hyperactivity. Although ADHD is not considered a learning disability, research
indicates that from 30-50 percent of children with ADHD also have a specific learning disability,
and that the two conditions can interact to make learning extremely challenging.

Dyspraxia
A disorder that is characterized by difficulty in muscle control, which causes problems with
movement and coordination, language and speech, and can affect learning. Although not a
learning disability, dyspraxia often exists along with dyslexia, dyscalculia or ADHD.

Executive Functioning
An inefficiency in the cognitive management systems of the brain that affects a variety of
neuropsychological processes such as planning, organization, strategizing, paying attention to
and remembering details, and managing time and space. Although not a learning disability,
different patterns of weakness in executive functioning are almost always seen in the learning
profiles of individuals who have specific learning disabilities or ADHD.

What are learning disabilities?

Learning disabilities, or learning disorders, are an umbrella term for a wide variety of learning
problems. A learning disability is not a problem with intelligence or motivation. Kids with learning
disabilities arent lazy or dumb. In fact, most are just as smart as everyone else. Their brains are
simply wired differently. This difference affects how they receive and process information.
Simply put, children and adults with learning disabilities see, hear, and understand things
differently. This can lead to trouble with learning new information and skills, and putting them to
use. The most common types of learning disabilities involve problems with reading, writing, math,
reasoning, listening, and speaking.

Children with learning disabilities can, and do, succeed

It can be tough to face the possibility that your child has a learning disorder. No parents want to
see their children suffer. You may wonder what it could mean for your childs future, or worry
about how your kid will make it through school. Perhaps youre concerned that by calling attention
to your child's learning problems he or she might be labeled "slow" or assigned to a less
challenging class.
But the important thing to remember is that most kids with learning disabilities are just as smart
as everyone else. They just need to be taught in ways that are tailored to their unique learning
styles. By learning more about learning disabilities in general, and your childs learning difficulties
in particular, you can help pave the way for success at school and beyond.

Signs and symptoms of learning disabilities and disorders

If you're worried, don't wait
If you suspect that your child's learning difficulties may require special assistance, please do not
delay in finding support. The sooner you move forward, the better your child's chances for
reaching his or her full potential.
Learning disabilities look very different from one child to another. One child may struggle with
reading and spelling, while another loves books but cant understand math. Still another child may
have difficulty understanding what others are saying or communicating out loud. The problems are
very different, but they are all learning disorders.
Its not always easy to identify learning disabilities. Because of the wide variations, there is no
single symptom or profile that you can look to as proof of a problem. However, some warning signs
are more common than others at different ages. If youre aware of what they are, youll be able to
catch a learning disorder early and quickly take steps to get your child help.
The following checklist lists some common red flags for learning disorders. Remember that children
who dont have learning disabilities may still experience some of these difficulties at various times.
The time for concern is when there is a consistent unevenness in your childs ability to master
certain skills.

Preschool signs and symptoms of learning disabilities

Problems pronouncing words

Trouble finding the right word

Difficulty rhyming

Trouble learning the alphabet, numbers, colors, shapes, days of the week

Difficulty following directions or learning routines

Difficulty controlling crayons, pencils, and scissors, or coloring within the lines

Trouble with buttons, zippers, snaps, learning to tie shoes

Ages 5-9 signs and symptoms of learning disabilities

Trouble learning the connection between letters and sounds

Unable to blend sounds to make words

Confuses basic words when reading

Consistently misspells words and makes frequent reading errors

Trouble learning basic math concepts

Difficulty telling time and remembering sequences

Slow to learn new skills

Ages 10-13 signs and symptoms of learning disabilities

Difficulty with reading comprehension or math skills

Trouble with open-ended test questions and word problems

Dislikes reading and writing; avoids reading aloud

Spells the same word differently in a single document

Poor organizational skills (bedroom, homework, desk is messy and disorganized)

Trouble following classroom discussions and expressing thoughts aloud

Poor handwriting

Paying attention to developmental milestones can help you identify learning disorders
Paying attention to normal developmental milestones for toddlers and preschoolers is very
important. Early detection of developmental differences may be an early signal of a learning
disability and problems that are spotted early can be easier to correct.
A developmental lag might not be considered a symptom of a learning disability until your child is
older, but if you recognize it when your child is young, you can intervene early. You know your
child better than anyone else does, so if you think there is a problem, it doesn't hurt to get an
evaluation. You can also ask your pediatrician for a developmental milestones chart.

Problems with reading, writing, and math

Learning disabilities are often grouped by school-area skill set. If your child is in school, the types
of learning disorders that are most conspicuous usually revolve around reading, writing, or math.

Learning disabilities in reading (dyslexia)

There are two types of learning disabilities in reading. Basic reading problems occur when there is
difficulty understanding the relationship between sounds, letters and words. Reading
comprehension problems occur when there is an inability to grasp the meaning of words, phrases,
and paragraphs.
Signs of reading difficulty include problems with:

letter and word recognition

understanding words and ideas

reading speed and fluency

general vocabulary skills

Learning disabilities in math (dyscalculia)

Learning disabilities in math vary greatly depending on the childs other strengths and weaknesses.
A childs ability to do math will be affected differently by a language learning disability, or a visual
disorder or a difficulty with sequencing, memory or organization.
A child with a math-based learning disorder may struggle with memorization and organization of
numbers, operation signs, and number facts (like 5+5=10 or 5x5=25). Children with math
learning disorders might also have trouble with counting principles (such as counting by twos or
counting by fives) or have difficulty telling time.

Learning disabilities in writing (dysgraphia)

Learning disabilities in writing can involve the physical act of writing or the mental activity of
comprehending and synthesizing information. Basic writing disorder refers to physical difficulty
forming words and letters. Expressive writing disability indicates a struggle to organize thoughts
on paper.
Symptoms of a written language learning disability revolve around the act of writing. They include
problems with:

neatness and consistency of writing

accurately copying letters and words

spelling consistency

writing organization and coherence

Other types of learning disabilities and disorders

Reading, writing, and math arent the only skills impacted by learning disorders. Other types of
learning disabilities involve difficulties with motor skills (movement and coordination),
understanding spoken language, distinguishing between sounds, and interpreting visual
information.

Learning disabilities in motor skills (dyspraxia)

Motor difficulty refers to problems with movement and coordination whether it is with fine motor
skills (cutting, writing) or gross motor skills (running, jumping). A motor disability is sometimes
referred to as an output activity meaning that it relates to the output of information from the
brain. In order to run, jump, write or cut something, the brain must be able to communicate with
the necessary limbs to complete the action.
Signs that your child might have a motor coordination disability include problems with physical
abilities that require hand-eye coordination, like holding a pencil or buttoning a shirt.

Learning disabilities in language (aphasia/dysphasia)

Language and communication learning disabilities involve the ability to understand or produce
spoken language. Language is also considered an output activity because it requires organizing
thoughts in the brain and calling upon the right words to verbally explain something or
communicate with someone else.
Signs of a language-based learning disorder involve problems with verbal language skills, such as
the ability to retell a story and the fluency of speech, as well as the ability to understand the
meaning of words, parts of speech, directions, etc.

Auditory and visual processing problems: the importance of the ears and eyes
The eyes and the ears are the primary means of delivering information to the brain, a process
sometimes called input. If either the eyes or the ears arent working properly, learning can suffer.

Auditory processing disorder Professionals may refer to the ability to hear well as
auditory processing skills or receptive language. The ability to hear things correctly
greatly impacts the ability to read, write and spell. An inability to distinguish subtle
differences in sound, or hearing sounds at the wrong speed make it difficult to sound out
words and understand the basic concepts of reading and writing.

Visual processing disorder Problems in visual perception include missing subtle

differences in shapes, reversing letters or numbers, skipping words, skipping lines,
misperceiving depth or distance, or having problems with eyehand coordination.
Professionals may refer to the work of the eyes as visual processing. Visual perception
can affect gross and fine motor skills, reading comprehension, and math.

Common Types of Learning Disabilities

Dyslexia

Difficulty reading

Problems reading, writing,

spelling, speaking

Dyscalculia

Difficulty with math

Problems doing math problems,

understanding time, using
money

Dysgraphia

Difficulty with writing

Problems with handwriting,

spelling, organizing ideas

Dyspraxia (Sensory

Difficulty with fine motor skills

Integration Disorder)

Problems with handeye

coordination, balance, manual
dexterity

Dysphasia/Aphasia

Difficulty with language

Problems understanding spoken

language, poor reading

Common Types of Learning Disabilities

comprehension

Auditory Processing

Difficulty hearing differences

Problems with reading,

Disorder

between sounds

comprehension, language

Visual Processing Disorder

Difficulty interpreting visual

Problems with reading, math,

information

maps, charts, symbols, pictures

Other disorders that make learning difficult

Difficulty in school doesnt always stem from a learning disability. Anxiety, depression, stressful
events, emotional trauma, and other conditions affecting concentration make learning more of a
challenge. In addition, ADHD and autism sometimes co-occur or are confused with learning
disabilities.

ADHD Attention deficit hyperactivity disorder (ADHD), while not considered a

learning disability, can certainly disrupt learning. Children with ADHD often have problems
sitting still, staying focused, following instructions, staying organized, and completing
homework.

Autism Difficulty mastering certain academic skills can stem from pervasive
developmental disorders such as autism and Aspergers syndrome. Children with autism
spectrum disorders may have trouble communicating, reading body language, learning
basic skills, making friends, and making eye contact.

A communication disorder is an impairment in the ability to receive, send, process,

and comprehend concepts or verbal, nonverbal and graphic symbol systems. A
communication disorder may be evident in the processes of hearing, language, and/or
speech. A communication disorder may range in severity from mild to profound. It may
be developmental or acquired. Individuals may demonstrate one or any combination of
communication disorders. A communication disorder may result in a primary disability or
it may be secondary to other disabilities.
A. A speech disorder is an impairment of the articulation of speech sounds, fluency
and/or voice.
1. An articulation disorder is the atypical production of speech sounds
characterized by substitutions, omissions, additions or distortions that may
interfere with intelligibility.

2. A fluency disorder is an interruption in the flow of speaking characterized

by atypical rate, rhythm, and repetitions in sounds, syllables, words, and
phrases. This may be accompanied by excessive tension, struggle
behavior, and secondary mannerisms.
3. A voice disorder is characterized by the abnormal production and/or
absences of vocal quality, pitch, loudness, resonance, and/or duration,
which is inappropriate for an individual's age and/or sex.
B. A language disorder is impaired comprehension and/or use of spoken, written
and/or other symbol systems. The disorder may involve (1) the form of language
(phonology, morphology, syntax), (2) the content of language (semantics), and/or
(3) the function of language in communication (pragmatics) in any combination.
1. Form of Language
a. Phonology is the sound system of a language and the rules that
govern the sound combinations.
b. Morphology is the system that governs the structure of words and
the construction of word forms.
c. Syntax is the system governing the order and combination of
words to form sentences, and the relationships among the
elements within a sentence.
2. Content of Language
a. Semantics is the system that governs the meanings of words and
sentences.
3. Function of Language
a. Pragmatics is the system that combines the above language
components in functional and socially appropriate communication.
C. A hearing disorder is the result of impaired auditory sensitivity of the
physiological auditory system. A hearing disorder may limit the development,
comprehension, production, and/or maintenance of speech and/or language.
Hearing disorders are classified according to difficulties in detection, recognition,
discrimination, comprehension, and perception of auditory information. Individuals
with hearing impairment may be described as deaf or hard of hearing.

1. Deaf is defined as a hearing disorder that limits an individual's aural/oral

communication performance to the extent that the primary sensory input
for communication may be other than the auditory channel.
2. Hard of hearing is defined as a hearing disorder, whether fluctuating or
permanent, which adversely affects an individual's ability to communicate.
The hard-of-hearing individual relies on the auditory channel as the
primary sensory input for communication.
D. Central auditory processing disorders are deficits in the information
processing of audible signals not attributed to impaired peripheral hearing
sensitivity or intellectual impairment. This information processing involves
perceptual, cognitive, and linguistic functions that, with appropriate interaction,
result in effective receptive communication of auditorily presented stimuli.
Specifically, CAPD refers to limitations in the ongoing transmission, analysis,
organization, transformation, elaboration, storage, retrieval, and use of
information contained in audible signals. CAPD may involve the listener's active
and passive (e.g., conscious and unconscious, mediated and unmediated,
controlled and automatic) ability to do the following:
1. attend, discriminate, and identify acoustic signals;
2. transform and continuously transmit information through both the
peripheral and central nervous systems;
3. filter, sort, and combine information at appropriate perceptual and
conceptual levels;
4. store and retrieve information efficiently; restore, organize, and use
retrieved information;
5. segment and decode acoustic stimuli using phonological, semantic,
syntactic, and pragmatic knowledge; and
6. attach meaning to a stream of acoustic signals through use of linguistic
and nonlinguistic contexts.
II. Communication Variations
A. Communication difference/dialect is a variation of a symbol system used by a
group of individuals that reflects and is determined by shared regional, social, or
cultural/ethnic factors. A regional, social, or cultural/ethnic variation of a symbol
system should not be considered a disorder of speech or language.

B. Augmentative/alternative communication systems attempt to compensate and

facilitate, temporarily or permanently, for the impairment and disability patterns of
individuals with severe expressive and/ or language comprehension disorders.
Augmentative/alternative communication may be required for individuals
demonstrating impairments in gestural, spoken, and/or written modalities.
C. There are two types of communication disorders: Those that affect speech (speech
disorders) and those that affect language (language disorders). Problems producing
speech sounds (articulation), controlling sounds that are produced (voice), and
controlling the rate and rhythm of speech (fluency) are generally considered speech
disorders. Problems with using proper forms of language (phonology, morphology,
syntax), using the content of language (semantics), and using the functions of
language (pragmatics) are generally considered language disorders. SPEECH
DISORDERS The American Speech-Language-Hearing Association (ASHA; 1982)
has developed formal definitions of each speech disorder: Articulation disorder is
defined as the abnormal production of speech sounds (p. 949). When a student says,
The wabbit wan don the woad, or poon for spoon, or 9 01-Book10-4916.qxd
2/14/2006 7:15 PM Page 9 gog for dog, he or she may be using spoken language
appropriately but is not producing sounds correctly. Voice disorder is defined as the
absence or abnormal production of vocal quality, pitch, loudness, resonance, and/or
duration (p. 949). Students with voice disorders sometimes sound hoarse or speak
loudly or in a high or low pitch. Fluency disorder is defined as the abnormal flow of
verbal expression, characterized by impaired rate and rhythm which may be
accompanied by struggle behavior (p. 949). S-saying th-the f-first s-sound o-of a-a
w-word and th-then s-saying th-the w-word illustrates this problem. LANGUAGE
DISORDERS All other communication problems are considered language disorders.
ASHA (1982) defines three kinds of language disorders specifically, problems
related to form, content, and function. Language form refers to the utterance or
sentence structure of what is saidphonology, morphology, and syntax. Language
content refers to meanings of words and sentences, including abstract concepts
semantics. Language function refers to the context in which language can be used and
the purpose of communicationpragmatics. Problems can be receptive (related to
hearing, listening to, or receiving language) and expressive (related to producing or
expressing language). Language Form, Function, and Content Phonology is concerned
with the smallest units of language (phonemes or speech sounds); morphology is
concerned with the smallest units of meaningful language (morphemes or words and
parts of words); and syntax is concerned with combining language units into
meaningful phrases, clauses, or sentences (grammatically correct language). Problems
with phonology, morphology, and syntax are evident when students are unable to
differentiate 10Teaching Students With Communication Disorders 01-Book104916.qxd 2/14/2006 7:15 PM Page 10 sounds (/b/ versus /p/), words (cat or cap), or
grammatically correct sentences (John go to the movies versus John goes to the
movies) or to produce appropriate sounds, words, or sentences. Semantics is
concerned with word and message meanings (vocabulary, comprehension, following

directions). Problems with semantics are evident when students are unable to identify
appropriate pictures when word names are provided (Find the grapes), answer
simple questions (Are apples fruits?), follow directions (Draw a line over the third
box), tell how words or messages are similar or different (How are apples, oranges,
and pears alike?), or understand abstract concepts (What is love?). Pragmatics is
concerned with the use and function of language in varying settings (i.e., following
social conversational rules). Problems with pragmatics are evident when students are
unable to use language in social situations to express feelings, create or understand
images, give or request information, or direct actions of listeners.