Students suffering from orthopedic and musculoskeletal disorders need physical management routines and instructional programs that strive to assist the student achieve functional products in mobility, communication, work, socialization and learning (Turnbull et al, 2007). The paper outlines evaluated individualized educational goals for a student with a type of orthopedic and musculoskeletal disorder (Juvenile Rheumatoid Arthritis), analyze the disorder with its associated disabilities. Furthermore, it briefly discusses the salient complications, financial effects and education system assistance, rehabilitation and the treatment of the disorder. Finally, it will discuss the educational interventions in addressing the situation and the responsibility of the teacher in meeting the needs of the student.
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 shoulder, hand, arm and fingers use with the aim of producing written work, accessing of computer and participation in physical education activities such as table tennis and volley ball.
(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 do a weekly review on the student’s exercise program with the student.
(ii) 10 seconds of hold stretches done 5 times per session and 2 sessions each day by 6 weeks.
(Iii) 15 seconds of hold stretches and relax for another 20 seconds done 5 times per session and 2 sessions each day by 8 weeks.
(IV) 20 seconds of hold stretches and relaxes for another 20 seconds done 10 times per session and 2 sessions each day by 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 of the school day without use of assistive devices or bars.
(I) Objectives: the student will be able to take part in the aquatic program of the school 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 as measured by swimming coach documentation and self charting.
Analysis of the 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 American Academy of Special Education Professionals (2006), in diagnosis of JRA, the following criterion is applied:
- It occurred before 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 tend to be systemic and continues and continues for more than six weeks and has multiple joint inflammation
JRA tend to develop with fever and is totally exclusive of other juvenile arthritis (Turnbull et al, 2007). Furthermore, it causes pain and stiffness in the swollen joints and may get worse, improve or remit throughout the life of the child.
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 stress the families with worries about the ability of the child to complete the school successfully, acceptance by their peers, the appearance of the student, medical costs and the future of the child. Moreover, the stressors can induce undue hardship on the student suffering from JRA such as the feelings of inadequacy, isolation, being insecure among the peers. The student may also be depressed or angry because of being segregated by the peers in learning peer activities (Dutton, 2005).
Financial effects and assistance in the educational system
The teachers and other professional in the education can assist the impaired student by encouraging her or him to work with his/her strengths rather than the limitations. Turnbull et al (2007) is of the opinion that the student should be involved in the planning and the implementation 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 to ensure the student has maximum amount of time in interacting with the peers. Furthermore, the classroom should an inclusive in which difference and diversity are embraced, recognized and celebrated.
According to American Academy of Special Education Professionals (2006), students suffering from JVR should get modification in their school programs through the individualized education plan which gives the students an access to 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 strategy of rehabilitation a physical therapist use when attending to students with JRA.
Students with JRA are at a high risk of number of falls due to the muscle strength weakness and reduction of both gross and fine motor skills. 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 also need to be individualized and customized to fit with the student’s school and home life. Therapeutic exercises can be done in combination with stretches. In addition Dutton (2005) repots swim therapy as beneficial or joint mobility improvement significantly.
Appropriate educational interventions in addressing orthopedic and musculoskeletal disorders (Juvenile Rheumatic Arthritis)
Similar to the disable students, orthopedic impaired student’s class accommodations also varies depending on the students’ individual needs. American Academy of Special Education Professionals (2006) further elaborates that since orthopedic impaired students have no cognitive impairments, special educators and the general educators in collaboration should include the students in the normal general curriculum as much as they can.
Moreover, Turnbull et al (2007) is of points out that for the orthopedic and the musculoskeletal disordered students to have an 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 augmentative communication that are suitable
- Awareness on the condition and its effects on the impaired student for instance quickly getting tired
Because the nature of orthopedic impairments is multi faceted, inclusion of other specialists in development and implementation of appropriate education program for the impaired student. Examples of these specialists as stated by Dutton (2005) are:
- Physical therapists specialized on gross motor skills. These focuses on the neck, torso, back and the legs.
- Occupational therapists that specialize in fine motor skills. These focuses on the hands and arms in addition to activities of daily living such as bathing and dressing among others.
- Speech-language specialist who help the student with language and speech problems
- Adapted physical education teachers who specializes on working with the occupational therapists and the physical therapists in excise program development to assist the disable students
- Other therapists such as the massage therapists and music therapists among others.
Description of the responsibilities of the teacher in meeting the students needs with hip conditions, spine curvature, Juvenile Rheumatoid Arthritis, limb deficiencies and musculoskeletal disorders
Orthopedic and musculoskeletal disable students admitted in schools often require specialized knowledge and awareness of the teacher. The teacher is always the team leader of the professional team working in development of physical and instructional management program and compiling information for individualized education plan that is necessary.
Turnbull et al (2007) suggests that teachers work with in collaboration with therapists at the start of each academic year to address the student’s need for adaptive equipments. These includes checking equipment suitability, the equipment fit well the student and determination the need of the staff training.
Additionally, the teacher looks the student’s entire school day starting from home to school and back, doing investigation on 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 need to 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). Orthopaedic 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