Physically Impaired

The “Physically Impaired” (PI) category in special education is classified as a low-incidence disability area, representing approximately 1.5% of students receiving special education services. PI can be present from birth or acquired later in life, and is either progressive or non-progressive. It can vary in severity and potentially impact a student’s physical and academic functioning, necessitating specialized education and related services. Such supports include specialized equipment, technology, and individualized curricula and instruction to address their unique needs. A diverse range of conditions can lead to PI. Medical conditions associated with PI include:

• Arthrogryposis 
• Cerebral Palsy 
• Cerebral Palsy-Cognitive Functioning 
• Dystonia 
• Muscular Dystrophy 
• Osteogenesis Imperfecta 
• Spina Bifida 
• Spinal Cord Injury 
• Spinal Muscular Atrophy 

The effects of PI can manifest in various areas such as muscle tone, strength, posture, fine and gross motor skills, mobility, communication skills, processing, memory, perception, attention, executive functions, and psychosocial skills. Advances in medical technology and early diagnosis have improved survivability rates, allowing for earlier identification of PI within the educational system.

Identification

In Minnesota, to meet the eligibility criteria for PI services, a student must have a medically diagnosed physical impairment that is documented by a qualified healthcare provider such as a physician, advanced practice registered nurse (APRN), or physician assistant (PA). The impairment should result in educational needs related to organizational or independent work skills and difficulties in completing motoric aspects of classroom tasks within given time limits. These tasks encompass various educational settings, including physical education, the playground, restroom, lunchroom, hallways, and bus. Additionally, a student may qualify for services if the physical impairment adversely affects educational performance, as demonstrated by an achievement deficit of 1.0 standard deviation or more on an academic achievement test. The criteria do not involve a discrepancy between cognitive abilities and academic performance.

Rapid changes in the medical field and related technology over the past few years have made the medical diagnostic process more complex, with ever-changing terminology. This sometimes leads to medical diagnoses falling outside the spectrum of more traditional conditions typically associated with having PI. A general rule of thumb is that, regardless of the medical diagnosis, if it appears to be the primary cause of a physical or motor impairment, then the educational team could consider the diagnosis for PI qualification purposes. Some examples are hypotonia, ataxia, motor apraxia, developmental coordination disorder, and static encephalopathy, among others.

Characteristics

Students with physical impairments (often accompanied by neurological impairments) face challenges in their educational experience. They encounter difficulties in completing tasks that require motor skills within the same timeframe as their peers. This includes navigating the school environment, accessing classrooms and materials, participating in physical activities, and accomplishing classroom assignments that involve motor responses. Neurological impairments may also affect their organizational and independent work skills, leading to atypical learning profiles.

PI can influence a student’s learning style and ability to solve problems, process information, coordinate movement, participate in the classroom, learn new skills, and advocate for themselves. While many students with PI follow the standard curriculum, some adaptations may be necessary. These can involve modifying content to facilitate participation in specific subject areas, providing alternative methods for demonstrating knowledge or skills, offering additional staff support, and delivering supplementary instruction in mobility skills, keyboarding, specialized communication methods, and assistive technology. Additionally, the pace at which students progress through the curriculum may vary due to their unique needs.

Students with PI may experience reduced stamina and become easily fatigued. They might have a history of frequent hospitalization and require ongoing medical support. Furthermore, some students may have additional impairments such as intellectual disabilities, learning difficulties, or sensory impairments. Interestingly, PI can coexist with giftedness in some students, highlighting the importance of recognizing and nurturing their exceptional abilities alongside addressing their specific challenges.

Supporting Student Success

Individualized Education Plan (IEP) goals and objectives are essential in addressing the educational needs of students with disabilities. Oversight of the specialized services contained in IEPs for students with PI is provided by Physical and Health Disabilities (P/HD) teachers. These teachers hold the licensure title aligning with the Physically Impaired category and cater to students from birth through age 21. As per Minnesota Rule 3525.2350, P/HD teachers are essential members of the Individualized Education Plan (IEP) team and actively participate in planning and conducting evaluations for students with medically diagnosed physical impairments. They also deliver direct and/or indirect services, focusing on educational adaptations and instructional strategies for the student’s physical impairment. In the remainder of this section, information specific to IEP goals for students with PI, service delivery, and adaptions/accommodations will be highlighted.

IEP Goals

These goals should be based on the identified needs for the student’s medical diagnosis, as outlined in the evaluation report. While academic areas are essential, it is crucial to recognize that students’ needs extend beyond academics, encompassing skills necessary for independence in the educational environment.

Some examples of these non-academic needs include organization and planning, independent work completion, self-advocacy skills, fine and gross motor skills, disability awareness, problem-solving and reasoning, and the independent use of assistive technology and adaptive equipment. For students with progressive conditions such as Duchenne Muscular Dystrophy, where motor tasks may not show significant improvement, goals and objectives can be oriented toward the student’s understanding of their diagnosis, ability to direct others to meet their needs, and identification and utilization of available accommodations and resources.

The IEP team needs to consider the implications of the student’s prognosis and be realistic about the expected outcomes. If the student’s medical condition undergoes significant changes during the school year, the goals and objectives may need to be revised accordingly. Flexibility and ongoing assessment are key to ensuring that the IEP addresses the student’s evolving needs, promoting their independence and overall development in the educational setting.

Service Delivery Models

In Minnesota, the service delivery models for special education services are determined at the local level, but they are guided by the general framework and definition established by Minnesota Rule . There are two main models: direct and indirect service delivery.

The provision of direct services to students with PI is recommended by the IEP team, including the PI teacher, based on the student’s instructional needs and unique requirements related to their physical impairment. Direct services are typically provided on a limited basis and involve the PI teacher or related service providers (e.g., speech-language pathologist, occupational therapist, or physical therapist) who deliver instruction that other educational team members cannot replicate. However, it is essential to promote collaboration and a team-teaching approach whenever possible. This collaboration allows for a smoother transition of direct services to other classroom staff who are present daily and provides consistent and informed instruction. The service timeline for direct services should be determined during the IEP meetings, considering factors such as staff training needs and the customized pace of student skill attainment. It is essential to document direct services’ start and end dates on the IEP, along with a rationale for the timeline.

In addition to direct services, indirect services play a crucial role in meeting the needs of students with physical impairments. The level and type of instruction and services should be determined based on the student’s goals and objectives, seamlessly integrating them into the school day.  Indirect services include ongoing progress reviews, cooperative planning, consultations, demonstration teaching, and modifications in the environment, curriculum, materials, or equipment. Additionally, indirect services involve direct contact with students to monitor and observe their progress. These services extend beyond the students themselves and can be provided to regular education teachers, other special education teachers, related services professionals, paraprofessionals, support staff, and parents.

Collaboration among all team members is essential, and many times crucial if the P/HD teacher has an itinerant role and serves multiple schools. Professional connections should be maintained, and available modes of communication should be utilized to ensure open communication and documentation of services. Such documentation serves as a vital means of staying connected with students, families, and educational teams, allowing for ongoing support and monitoring of student progress.

Adaptations

It is crucial to provide adaptations and accommodations when necessary to promote effective and independent learning for students with PI. The following adjustments can enhance their access to learning tasks:

• Emergency evacuation plans
• Individualized health plans
• Modified school schedules
• Access to adaptive equipment and assistive technology
• Testing accommodations
• Extended assignment due dates
• Alternate response formats
• Additional adult support
• Alternate bus transport
• Alternate instructional settings (home, hospital)

However, there will be instances where students may opt to utilize compensatory skills rather than focusing on remediation strategies. A common example is handwriting, where some students with physical challenges may not develop functional handwriting skills despite individualized instruction or occupational therapy. In such cases, assistive technology such as word processing or electronic dictation can serve as compensatory strategies. Nevertheless, it is essential to recognize that not all students with PI will solely rely on compensatory strategies, as remediation may still be a viable option, depending on their skills. To ensure clarity and consistency, it is essential to document all adaptations to the student’s Individualized Education Plan (IEP).

To learn more about supporting students with PI, their families, and educators, check out: Physically Impaired Resources.

Note: The information shared in this section was remixed from Special Education Evaluation and Services for Students with Physical Impairments: A Manual for Minnesota Educators; Updated 2018.