MULTIPLE DISABILITY P . KAMARAJ, Faculty , NIEPMD, ECR , - PowerPoint Presentation

1. MULTIPLE DISABILITYP . KAMARAJ, Faculty , NIEPMD, ECR ,Muttukadu , ChennaiKamaraj_nimh@yahoo.com9840380628

2. TNTEU , B.Ed –SPECIAL EDUCATION PROGRAMCourse 5 : Assessment and Identification of Needs of Persons with Multiple Disabilities Unit –III : Multiple Disabilities and other disability conditionsSub Unit 3.1 : Multiple Disabilities Meaning , Definitions and classificationsSub Unit 3.2 : Various combinations of Multiple Disabilities and Associated conditions such as epilepsy motor and sensory conditionSub Unit 3.3 : Implication of Functional limitations for Education of children with multiple disabilities

3. MULTIPLE DISABILITIESchildren with multiple disabilities are often calledSevere handicappedSeverely and profoundly handicap Dual sensory impaired Additional disabilitiesMultiple disabilities

4. DEFINITION“Multiple disabilities” means concomitant impairments (such as mental retardation-blindness, mental retardation orthopedic impairment), the combination of which causes such severe educational problems that the students cannot be accommodated in Special Education program solely for one of the impairment. The term does not include students with deaf-blindness - USOSE (2004)

5. DEFINITIONMultiple Disability” mean a combination of two or more disabilities as defined in clause (i) of section (2) of the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act 1995

6. DEFINITIONThose children excluded from school on the basis of extensive mental, physical, and or behavioral impairments that are permanent in nature

7. CLASSIFICATIONSThe classification of children with Multiple Disabilities are based on the combinations and severityModerate , Severe & Profound condition of any one of the disability in the combination makes the person become multiple disabilities. In the diagnostic assessment and evaluation process it is addressed that the impairment or the disability condition is more than 60 % among the bench mark disabilities become multiple disabilities in turn they are also called as the children having high support needs.

8. THE COMBINATIONS OF MULTIPLE DISABILITIESThe children with Multiple disabilities may be reported with various combinations as given belowA child may have reported with concomitant impairment of Intellectual and locomotor disability or A child may have reported with concomitant impairment of Intellectual and sensory disability or A child may have reported with concomitant impairment of Intellectual and any other developmental disabilities Such as Intellectual Disability (ID) + Autism Spectrum Disorders (ASD) , ID + Cerebral Palsy (CP) ID+ Deafblind(DB) or DB or ASD+ DB or CP+DB etc. …

9. CHARACTERISTIC FEATUREGeneral appearanceSelf help activities Motor functionLanguage & CommunicationSensoryLearning Social and EmotionalPhysical/Health condition

10. GENERAL APPEARANCEUnder build / Thin builtUnsteady of body controlClumsiness of appearanceMicro cephalic or hydro cephalic headSquint Pigeon chest DroolsAsymmetrical body features Flexed or Drooped body conditionRetarder physical growth

11. MOTOR FUNCTIONSPresence of abnormal reflexesUnstable body conditionNo active movements of body and limbs Developing abnormal pattern of posture and movementsFlexion and hyper tonicity of joins and musclesExtended or Hypo tonicity of joins and musclesSits or stands with supportsLying on the floor or bed for long timeDrags the body for movements Depend on others for his mobilityCarries by others manually or using a wheel chair Hesitate to move around and experiences of fall or hurt while moving around

12. SELF HELP ACTIVITIESPoor oral hygiene Decay of the toothShow feeble movement of feedingShows difficulties in sucking , swallowing , biting and chewingPoor intakeChokes while feeding Poor toilet skill , no toilet indication, cries after defecation and urinationCooperates for brushing , bathing and dressing.Custodial of other for his self help activities Vulnerable to gets infected due to poor maintenance of his clothes, body and places

13. LANGUAGE AND COMMUNICATIONSevere to profound delay in language and communication developmentVery poor in using the body or limbs for communicationCries or coos or vocalises for communicationUses minimal facial expression for communicationUses eye gazing for communicationShows agitate movement or moves his limbs for communication Depend on AAC

14. SENSORYPresence of sensory impairment Uses residual senses for the functional activitiesShows hyper or hyposensitivity in one or more of the seven sensesDoes not use effectively the sensory modalities for learningPoor abstractionDoes not involve effectively the metacognitive process for learningDoesn't get much opportunity for learning. Poor anticipation and reactionsHesitates to explore with environment /surroundings

15. SOCIAL AND EMOTIONALLooks FearfulGets frustrated , angry and upset that can be observed in the face. Have difficulty forming interpersonal relationshipNo or hardly any friendsDoesn’t react immediately any emotional situationsDoes not able participate effectively in the games and playNo or minimal exposed to the visitors and other community functions Poor maintenance of his body , clothes and surroundingsNot able to defend or indicate on certain circumstances and Victim of ant bites , mosquitoes bites or any other insect bites.

16. LEARNINGHas poor gross fine motor movementsUses his/her residual senses for learningShows very poor or lethargic response to stimuliShows poor visual, auditory ,tactile and kinesthetic processing skills Forgets skills through disuse Has limited abstract thinkingDifficulty in locating the directions of soundDifficulties in visual tracking and visual discrimination Exposed to limited environment for learning Experience of being isolated at home or at other places

17. HEALTHFebrile convulsion or Seizures / Epileptic conditions may be having Simple , Partial to Complex seizuresMetabolic disorders liken MPS I&II ,PKU etc. Undernourished /MalnourishedConstipation sometimes bleedingsSensory loss –loss of hearing threshold and visual acuity and poor reflexarc Hydrocephalus and scoliosisPhysically clumsy and awkward No reactions to various sensory insults like hot or cold contacts , spicy or any other tastes , bad smells.

18. ASSESSMENT TO UNDERSTAND THE BIO-BEHAVIOURL STATEBIO BEHAVIOURAL STATE It has 3 parts A-Behavior stateB-Learning environment C- Format for recording the data

19. ASSESSMENTBEHAVIOR STATE:Sleep statesIntermediate statePreferred awake stageOther awake stage

20. ASSESSMENTLEARNING ENVIRONMENT VARIABLES:MaterialsModalityActivitySocial contactPositionEnvironmental/Setting

21. ASSESSMENTFORMAT FOR RECORDING:30 observation records to be made in each data sheets

22. THE SIGNIFICANCE OF BBS ASSESSMENT The BBS assessment will help special educators and the therapist to understand to find the right time ( Active Alert Time) for providing the intervention and to avoid certain times for the child to take rest.It also provide the information on engaging the child for intervention with the right persons , the materials preferred by the child to learn in the appropriate place and context.

23. IMPLICATION OF LEARNING Children with multiple disabilities are experiencing various difficulties in performing their activity of daily living , using their motor skills effectively , learning the content like any other children , communicating with others effectively. The also have the difficulties in using the space and establishing the social relationship with others.The BBS gives the directions to understand the feasibilities of using the active time, place , persons and the materials for planning the intervention programThe program checklist which is developed by NIEPID (formerly called NIMH) for children with Profound Intellectual Disability is found to be useful for developing the functional activities to enable them to live as closely as possible with their family and community.The support Intensity program developed by American Association of Intellectual and Developmental Disability (AAIDD) provides a meaningful direction to the special education teachers , therapist and the parents to develop appropriate supports to perform the skills.

24. FACP –PMR ASSESSMENT It has 4 sections Section A covers checklist of skillsSection B covers checklist of problem behavior Section C coves checklist of general problems Section D covers progress report

25. SKILLS IDENTIFIED FOR FACILITATING THE LEARNING OF CHILDREN WITH SEVERE AND PROFOUND INTELLECTUAL DISABILITIES (MULTIPLE DISABILITIES) 1.Eating Skills -14 Items identified2.Drinking Skills-8 items identified 3.Toileting skills-16 items identified 4.Dressing Skills-9 items were identified 5.Motor skills -36 items identified 6.Communication Skills-19 items identified 7.Social Skills-12 items identified 8.Visual Skills-10 items identified

26. INDIVIDUALISED CARE AND TRAINING PLANSl NoActivityCurrent LevelPositioningProcedureMaterialEvaluationRemarks

27. ASSESSMENT ON SUPPORT INTENSITY NEED IN VARIOUS AREASSUPPORT INTENSITY NEED ANALYSIS USING SISHome living activitiesCommunity and Neighborhood activitiesSchool Participation ActivitiesSchool Learning Activities including the use of technologyHealth and Safety ActivitiesAdvocacy ActivitiesMedical & BehaviouralOther assessment related to Physical therapy , occupational therapy and the Speech therapy will have its own schedule to follow.

28. ASSESSMENT ON SCHOOL PARTICIPATION ACTIVITIESSchool participation activities: ExamplesBeing included in general education class room including the library and technology roomsParticipating in activities in common school areas (e.g . play ground hall ways ,cafeteria)Participating in co-curricular Getting to school (includes accessible transportations)Moving around with in the school and transitioning between activitiesFacilities for Participating in large scale test taking activities required by state education system.Following class room and school rulesKeeping track of personnel belongings at school & Keeping track of schedule at schoolBarrier free Space for the children with multiple disability to participate in activates

29. ASSESSMENT ON SCHOOL LEARNING ACTIVITIESSchool learning activities: ExampleAppropriate seating arrangements for learning Accessing grade level curriculum content and curriculum accessLearning academic skills using assistive technologies Learning and using metacognitive skillsCompleting academic tasks using assistive technologyLearning how to use and using problem solving and self regulation strategies in the class roomParticipating in class room level evaluation such as tests in flexible wayAccessing health and physical education curriculaCompleting homework assignment

30. SCORE ON MEDICAL AND BEHAVIOURAL ACTIVITIESMedical and Behavioural activities:0= No support needed1 = some support needed (i.e., providing monitoring and /occasional assistance) 2 = Extensive support needed (i.e., providing regular assistance to manage the medical condition or behavior)

31. TYPES OF SUPPORT REQUIRES0=None1=Monitoring2=Verbal/gestural prompting3=Partial Physical assistance4=Full Physical Assistance

32. FREQUENCY OF SUPPORT REQUIRES0=Negligible 1=Infrequently2=Frequently3=Very frequently4=Always

33. DAILY SUPPORT TIME REQUIRES0=None1=Less than 30 Minutes2=30 Minutes to less than 2 hours3=2 Hours to less than 4 Hours4=4Hours or More

34. INDIVIDUALISED SUPPORT PLANBased on the intensity of support needed on the type of support , frequency , time and support required for medical and behavioural aspect the resources are developed in the process of Individualised Support PlanThe individualised support plan is focused on successful achievement of the activities targeted for the child with all kind of supportsThis support plan does not give importance on the activities which the children shows unsuccessful.

35. REFERENCESIndividuals with Disability Education Act (2004) United StatesMyreddy.V., Narayan .J.(2004)FACP –PMR .NIEPID (formerly NIMH) .Secunderabad.AAIDD(2016). Support Intensity Scale.US