Students suffering from orthopedic and musculoskeletal disorders need physical management routines and instructional programs that strive to assist the student in achieving functional products in mobility, communication, work, socialization, and learning (Turnbull et al., 2007). The paper outlines individualized educational goals for a student with an orthopedic and musculoskeletal disorder (Juvenile Rheumatoid Arthritis) and analyzes the disorder with its associated disabilities. Furthermore, it briefly discusses the salient complications, financial effects, education system assistance, rehabilitation, and treatment of the disorder. Finally, it will discuss the educational interventions in addressing the situation and the teacher’s responsibility in meeting the student’s needs.
Two individualized education goals for a 12-year-old schooling boy with Juvenile Rheumatoid Arthritis
Annual Goal: the student will be participating in gross and fine motor activities involving the shoulder, hand, arm, and fingers used to produce written work, accessing of computer, and participating in physical education activities such as table tennis and volleyball.
(I) Objective: the student will be able to participate in the stretching program designed. The stretches will be done on each joint such as the elbow, shoulder, fingers, and wrist. Furthermore, the student will keep his records on a given chart by the physical teacher. The physical teacher will review the student’s exercise program weekly with the student.
(ii) 10 seconds of hold stretches done 5 times per session and two sessions each day for 6 weeks.
(Iii) 15 seconds of hold stretches and relax for another 20 seconds done 5 times per session and 2 sessions each day for 8 weeks.
(IV) 20 seconds of hold stretches and relaxes for another 20 seconds done 10 times per session and 2 sessions each day for 10 weeks
(V) 25 seconds of hold stretches and relaxes for another 20 seconds done 10 times per session and 2 sessions per day by 12 weeks.
Annual goal: the student will maintain or improve his ability to stand up and sit down independently from the chair for the whole school day without using assistive devices or bars.
(I) Objectives: the student will be able to participate in the school’s aquatic program 3 times each week for 30 minutes or as he can tolerate.
(ii) The student will swim in the pool 3 laps in 30 minutes by 6 weeks as measured by swimming coach documentation and self charting
(iii) The student will swim in the pool 5 laps in 30 minutes by 8 weeks as measured by swimming coach documentation and self charting
(IV) The student will swim 8 laps in the pool in 30 minutes by 10 weeks as measured by swimming coach documentation and self charting
(v) The student will swim 10 laps in the pool in 30 minutes by 12 weeks, measured by swimming coach documentation and self-charting.
Analysis of Juvenile Rheumatoid Arthritis and its associated specific disabilities
Juvenile Rheumatoid Arthritis (JRA) is one of the orthopedic diseases prevalent among children aged 6-9 years.JRA can lead to musculoskeletal functional deficiency and blindness (Dutton, 2005). According to the American Academy of Special Education Professionals (2006), in the diagnosis of JRA, the following criterion is applied:
- It occurred before the age of 16 years
- Multiple joints have the following findings; pain or tenderness with joint movement, limited range of motion, and elevated fever.
- The disease tends to be systemic, continues for more than six weeks, and has multiple joint inflammations.
JRA tends to develop with fever and is exclusive of other juvenile arthritis (Turnbull et al., 2007). Furthermore, it causes pain and stiffness in the swollen joints and may worsen, improve or remit throughout the child’s life.
Salient complications as a result of juvenile rheumatoid arthritis
The educational complications and implications for JRA students include limited mobility, excessive absence, diminished endurance, strength, and stamina (Dutton, 2005).
The social and psychological impacts of JRA differ among students. Furthermore, the condition frequently stresses the families with worries about the ability of the child to complete school successfully, acceptance by their peers, the student’s appearance, medical costs, and the child’s future. Moreover, the stressors can induce undue hardship on the student suffering from JRA, such as feelings of inadequacy, isolation, being insecurity among peers. The student may also be depressed or angry because of being segregated by peers in learning peer activities (Dutton, 2005).
Financial effects and assistance in the educational system
Teachers and other professionals in education can assist impaired students by encouraging them to work with their strengths rather than their limitations. Turnbull et al. (2007) think that the student should be involved in the planning and implementing of the individualized education plan’s objectives and goals. Moreover, If possible, the student should be encouraged to participate in social activities, and much effort to be invested in ensuring the student has the maximum amount of time interacting with peers. Furthermore, the classroom should be inclusive in embracing, recognizing, and celebrating differences and diversity.
According to the American Academy of Special Education Professionals (2006), students suffering from JVR should get a modification in their school programs through the individualized education plan, which gives the students access to an educational professional team including teachers, the student, parent, occupational therapist, physical therapist, school psychologist, school nurse, and the building administrator. This team is mandated to design and implement the individualized education plan for the student.
Rehabilitation and treatment options
The physical therapist is one of the major pillars for success to be realized for the student. Turnbull et al. (2007) claim that prevention of growth retardation is one of the major rehabilitation strategies a physical therapist uses when attending to students with JRA.
Students with JRA are at a high risk of falls due to muscle strength weakness and gross and fine motor skills reduction. Moreover, joint development and balance control are also claimed to be some of the causes of falling and stumbling down in the school or outside. Strengthening and stretching exercises must also be customized to fit the student’s school and home life. Therapeutic exercises can be done in combination with stretches. In addition, Dutton (2005) reports swim therapy as beneficial for joint mobility improvement.
Appropriate educational interventions in addressing orthopedic and musculoskeletal disorders (Juvenile Rheumatic Arthritis)
Similar to disable students, orthopedic-impaired students’ class accommodations also vary depending on the student’s individual needs. American Academy of Special Education Professionals (2006) further elaborates that since orthopedically impaired students have no cognitive impairments, special educators and general educators, in collaboration, should include the students in the normal general curriculum as much as they can.
Moreover, Turnbull et al. (2007) point out that for orthopedic and musculoskeletal disordered students to have access to the general curriculum, they may need the following accommodations.
- Seating arrangements that are special to develop useful movements and posture
- Instructions that are focused on fine and gross motor skills development
- Securing assistive devices and suitable augmentative communication
- Awareness of the condition and its effects on the impaired student, for instance, quickly getting tired
Because the nature of orthopedic impairments is multi-faceted, including other specialists in developing and implementing appropriate educational programs for the impaired student is important. Examples of these specialists, as stated by Dutton (2005), are:
- Physical therapists specialize in gross motor skills. These focus on the neck, torso, back, and legs.
- Occupational therapists that specialize in fine motor skills. These focus on the hands and arms in addition to activities of daily living such as bathing and dressing, among others.
- A speech-language specialist who helps the student with language and speech problems
- Adapted physical education teachers who specialize in working with occupational therapists and physical therapists in excise program development to assist the disabled students
- Other therapists, such as massage therapists and music therapists, among others.
Description of the responsibilities of the teacher in meeting the student’s needs with hip conditions, spine curvature, Juvenile Rheumatoid Arthritis, limb deficiencies, and musculoskeletal disorders
Orthopedic and musculoskeletal disabled students admitted to schools often require specialized knowledge and awareness of the teacher. The teacher is always the team leader of the professional team working in the development of physical and instructional management programs and compiling information for an individualized education plan that is necessary.
Turnbull et al. (2007) suggest that teachers collaborate with therapists at the start of each academic year to address the student’s need for adaptive equipment. These include checking equipment suitability, the equipment fits the student well, and determining the need for staff training.
Additionally, the teacher looks at the student’s entire school day, starting from home to school and back, doing an investigation on the student’s access to the whole educational environment, such as classroom change, restroom use, diapers or clothing change, music and physical education (Dutton, 2005).
The orthopedic impaired students may also have self-concept or emotional issues, which the teachers must address.
Turnbull, A., Turnbull, R. & Wehmeyer, M. L. (2007). Exceptional lives: Special education in today’s schools. Upper Saddle River, NJ: Pearson Merrill Prentice Hall.
Dutton, M. (2005). Orthopedic examination, evaluation, and intervention: A pocket handbook. New York: McGraw-Hill.
American Academy of Special Education Professionals. (2006). Orthopedic impairments. Retrieved May 25, 2013, from
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