Students+with+Physical+Disabilities

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=Definition and Classification of Physical Disabilities:= Physical disabilities (also referred to as "orthopedic impairments"), according to //Music in Special Education// by Mary Ademak, Ph.D., and Alice-Ann Darrow, Ph.D., refer to impairments caused by congenital anomaly, disease, and acquired impairments (pp. 268). According to the U.S. Department of Education, there are over 73,000 students ages 6-21 with physical disabilities. These physical disabilities are classified generally using two sets of criteria:

1. According to the extremities involved:
 * Hemiplegia (one side of the body is impaired).
 * Diplegia (the legs are more significantly impaired than the arms).
 * Monoplegia (only one limb is impaired).
 * Paraplegia (only the legs are impaired).
 * Quadriplegia (all four limbs are impaired).

2. According to the time of the onset of the disability:
 * Congenital disabilities (present from birth).
 * Adventitious disabilities (occurring sometime after birth).

Helpful internet resources:

 * KidsNeeds
 * CanChild Center for Childhood Disability Research
 * The National Organization on Disability

1. Neurological Conditions

 * **Cerebral Palsy**-
 * Cerebral palsy is the most prevalent physical disability among children in schools.
 * It typically results from injury to the brain during prenatal development or birth, but can also result from trauma to the brain in early childhood caused by oxygen deprivation, injury, or infection.
 * Cerebral palsy affects muscle control resulting in various muscular dysfunctions, such as the tightening of one or more muscle groups, poor balance, a lack of hand function, or abrupt and uncontrolled movements.
 * [|United Cerebral Palsy Association]
 * **Seizure Disorders-**
 * Seizure disorders result from irregular and abnormal electrical impulses in the brain.
 * Many children who have cerebral palsy are also diagnosed as having a seizure disorder, as well as those who have experience trauma or injury to the brain.
 * There are two types of seizures: Grand mal seizures, which are experienced by sixty percent of those with seizure disorders, and petite mal seizures. Grand mal seizures cause stiffening of the body, often accompanied by drooling and irregular breathing, followed by large jerking movements. Petit mal seizures, in contrast, are evidenced only by rapid eye movements or blinking. Children with seizure disorders often progress from petit mal seizures to grand mal seizures when they are older.
 * [|Seizure Disorders]
 * **Spina Bifida-**
 * Spina bifida (also called Myelomeningocele ) is caused by abnormal prenatal development during which the opening to the spinal column did not close.
 * Resulting physical disabilities are dependent on the location of the opening:
 * Spina bifida occulta occurs when only a small section of the vertebrae is missing and there is no protrusion from the spinal column and does not cause any physical diability.
 * Meningocele spina bifida occurs when there is a small protrusion from the spinal column, but it also does not result in physical disability.
 * Myelomeningocele spina bifida occurs when both a section of vertebrae as well as the covering of the spinal column protrude. This typically results in paralysis of the lower half of the body and a loss of control of bodily functions.
 * [|U.S. National Library of Medicine - Myelomeningocele]
 * **Spinal Cord Injuries-**
 * Spinal cord injuries are typically a result of trauma caused by diving or car accidents or gun shot wounds.
 * The resulting disabilities are dependent on the severity and location of the injury and can result in either complete or incomplete loss of mobility or feeling.
 * Those with spinal cord injuries often also experience respiratory problems, urinary tract infections, and pressure sores.
 * [|United Spinal Association]

2. Musculoskeletal Conditions

 * **Muscular Dystrophy-**
 * Muscular dystrophy is a hereditary condition in which the muscles degenerate progressively, though at varying rates depending on the type of dystrophy.
 * Duchenne muscular dystrophy is the most common among children, typically affecting boys, and presents itself in the first years of life. It occurs in approximately 1 out of every 3,000 births, according to the National Institute on Neurological Disorders and Strokes.
 * **Amputations and Congenital Malformations-**
 * Abbreviated or missing limbs (whether because of accident, disease or condition at birth), spinal misalignment, or clubfoot.
 * Most children with these types of disabilities are able to thrive in mainstream classes, having learned to function without any specialized equipment.
 * **Osteogenesis Imperfecta-**
 * Typically referred to as brittle bone disorder, causes fragility of the bone resulting in frequent and sometimes unexplained breaks.
 * There are four types of brittle bone disorder:
 * Type I - The most common and mildest form, results in low muscle tone and joint problems.
 * Type II-IV - These increasingly severe forms result in smaller stature, more frequent breaks, hearing loss, spinal problems, and bone deformities.
 * Children with brittle bone disorder generally require little or no accommodation in the regular classroom.
 * **Achondroplasia -**
 * Achondroplasia is the most prevalent form of skeletal dysplasia in which the bones do not develop properly.
 * This can result in achondroplastic dwarfism which is "characterized by an average-size trunk, short arms and legs, and a slightly enlarged head and prominent forehead" (Ademak, Darrow, pp. 272).
 * **Juvenile Rheumatoid Arthritis-**
 * Juvenile Rheumatoid Arthritis is the most common type of arthritis in children, affecting the joints by causing inflammation, stiffness, damage or changes in the growth of the joints.
 * The severity of the disability is based on the number of joints affected, and systemic onset JRA also causes inflammation of internal organs. JRA can result in a lack of mobility, strength and endurance.

General Factors that Influence the Impact and Severity of the Disability:

 * 1) The duration of the disability.
 * 2) The age of onset.
 * 3) Limitation of age-appropriate activities.
 * 4) The visibility of the disability.
 * 5) Length of expected survival.
 * 6) Degree of mobility.
 * 7) Degree of physical functioning.
 * 8) Cognitive abilities.
 * 9) Emotional or social implications.
 * 10) Sensory functioning.
 * 11) Communication functioning.
 * 12) Course of the disability (stable or progressive)
 * 13) Unpredictability of the disability.

(Taken from //Issues Involved in the Definition and Classification of Chronic Health Conditions//, E.C. Perrin, et al. 1993.)

Primary source: //Music in Special Education.// Mary S. Ademak, Ph.D., MT-BC and Alice-Anne Darrow, Ph.D., MT-BC. The American Music Association, Inc., 2005.

=Pedagogical Strategies for Working with Students with Disabilities:=

Adapting the Environment:

 * Adjustable desks or tables to accommodate wheelchairs.
 * Entry ramps.
 * Wider aisles.
 * Instrument storage at an accessible height.
 * Accommodation for assistive technology.

Adapting Instruments:

 * Using touch sensitive pads.
 * Adding Velcro straps, larger knobs, stands to hold the instrument, or color coded systems.
 * WestMusic produces commercially adapted instruments.
 * Consider the size and weight of the instrument and the accessibility of storage.

Cognitive Considerations for Music Instruction:

 * Students may be more successful in learning by rote than by reading music.
 * Students may find more success in playing a rhythm instrument rather than a melodic instrument.
 * Fine motor function may require additional concentration which inhibits their ability to watch the conductor or read their music.

Source: //Music in Special Education.// Mary S. Ademak, Ph.D., MT-BC and Alice-Anne Darrow, Ph.D., MT-BC. The American Music Association, Inc., 2005.

=Useful Technology Tools:=

Soundbeam:
Soundbeam enables students with very little movement capability to produce musical sounds. It can be used with students who have any amount of movement capability, even as small as the blink of an eye. Using Soundbeam, students can explore different musical sounds and scales, improvise and create music without needing an understanding of music theory, notation, or the ability to perform on a traditional musical instrument. []

Here is an example of what one student with very severe physical disabilities was able to create using the Soundbeam:

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Kaossilator:
The Kaossilator allows students with limited hand use to manipulate sounds using a touch sensitive pad. They can choose from numerous timbres (some electronic and some more traditional sounds) and any key and create higher or lower pitches by moving their finger to different places on the pad. The student is able to record an eight second sound clip, which is then repeated as a loop, and they can continue to record over the loop to add different sounds and textures. Like the Soundbeam, the Kaossilator does not require any knowledge of music theory, but it as the pad is not very large, it does require some fine motor control to operate the knobs and buttons and manipulate sounds using the pad. @http://www.zzounds.com/item--KORKP3

A demonstration of how the Kaossilator works:

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Super Switch Ensemble: Access to Music
The Super Switch Ensemble enables students with physical disabilities to make music in ensemble while strengthening their fine motor skills and aiding cognitive and social development. The students control the sounds using switchboards that can be adapted for their area of strength, giving students who are unable to play traditional instruments an opportunity to produce music and to collaborate with other students.The students manipulate pre-programmed instrument sounds and songs and can engage with musical activities. http://www.switchintime.com/

An article about a performance using the Super Switch Ensemble: [|Disabled Students Use Their Heads to Make Music]

GarageBand:
GarageBand is a software program for Mac that gives students with fine motor skills, but who may be unable to use traditional instruments, a creative outlet to compose and arrange music. GarageBand has a loop sequencer, a recorder, and allows for the input of pre-recorded files or for creating music with MIDI instruments using a keyboard. The program's attractive interface gives students a visual representation of the sounds they are hearing and could be useful in teaching about timbre, form, texture and the benefits of repetition in composition. Additionally, the large variety of loops available as part of the program allows students who may have very little musical knowledge or experience the resources to be very successful in creating and arranging their own music. [|GarageBand Information]

A tutorial on using GarageBand:

media type="youtube" key="HMuQchbJRG0" height="315" width="560"

The Amazing Slow Downer
The Amazing Slow Downer is a program which allows the user to adjust the tempo of a piece of music and export that file to save it to the desktop or to a CD. Because students with physical disabilities often learn more effectively by rote, this program could allow you to create practice recordings at tempos slower than the performance tempo. Additionally, because physical disabilities often effect fine motor control, the student may never be able to play a quickly moving piece of music at its given tempo. [|Information about the Amazing Slow Downer]

iNudge
iNudge is an free, online web application based on a matrix sequencer which allows students to create loops using a variety of timbres by dragging their mouse across a small grid.It allows students with limited mobility to experiment with loops in an easy-to-use format. [|iNudge]

An example of what can be done with the iNudge:

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Myna
Myna is a free web-based alternate to GarageBand. It serves many of the same purposes as GarageBand, though it does not offer quite as many possibilities. Still, students with disabilities would experience many of the same benefits of GarageBand using Myna. [|Aviary Myna]

Note: The same website that hosts Myna, Aviary, also includes a loop-based sequencer similar to iNudge, though with some additional possibilities for instruments and scales. You can explore it further at [|Aviary Music Creator]