Multiple Disabilities

DEFINITION

According to the Individuals with Disabilities Education Act’s (IDEA)

“Multiple disabilities” means concomitant impairments i.e which occurs naturally such as mental retardation-blindness, mental retardation-orthopedic impairment etc., The combination of which causes such severe educational needs that they cannot be accommodated in special education programs solely for one of the impairments. The term does not include deaf blindness. (because there is a separate classification for deaf-blindness in laws like Individuals with Disabilities Education Act’s)

Children with multiple disabilities will have a combination of various disabilities that may include speech, physical mobility, learning, mental retardation, visual, hearing, brain injury and possibly others. Along with multiple disabilities, they can also exhibit sensory losses and behavior and or social problems.

SCREENING AND IDENTIFICATION

• A student with multiple disabilities shall be evaluated by the procedures for each disability; and shall meet the standards for two or more disabilities.
• Direct observation of the child by the team may also provide valuable assessment data.
• A systematic in-depth assessment of the child shall be conducted in terms of medical (including neurological, when indicated), psychological and educational needs by a multidisciplinary team.
• A developmental history, if needed.
• Other assessments of the characteristics of speech and language impairments. If the student exhibits impairments in any one or more of the following areas: cognition, fine motor, perceptual motor, communication, social or emotional, and perception or memory. These assessments shall be completed by specialists knowledgeable in the specific characteristics being assessed.

CAUSES

In children, early severe impairment of the brain is generally the main cause of multiple disabilities, affecting several areas of the neurological activity (intelligence, motricity, sensory sensitivity). Sometimes, the cause the disability is simply unknown. Some of the causes include

• Chromosomal abnormalities
• Premature birth
• Negative prenatal influences
• Difficulties after birth
• Poor development of the brain or spinal cord
• Infections
• Genetic disorders
• Injuries from accidents
• Metabolic disorders
• Traumatic brain injury

CHARACTERISTICS

People with severe or multiple disabilities may exhibit a wide range of characteristics, depending on the combination and severity of disabilities, and the person’s age. Children with multiple disabilities will typically share deficits in five distinct areas of development: intellectual functioning, adaptive skills, motor skills, sensory functioning, and communication skills.

Psychological

• May Feel/have tendency to withdraw from society
• Students with multiple disabilities may become fearful, angry, and upset in the face of forced or unexpected changes.
• May execute self-injurious behavior

Behavioral

• May display an immature behavior inconsistent with chronological age
• May exhibit an impulsive behavior and low frustration level.
• May have difficulty forming interpersonal relationships. May have limited self-care skills and independent community living skills.

Physical/health

• A variety of medical problems may accompany severe disabilities. Examples include seizures, sensory loss, hydrocephalus, and scoliosis(spine has a side curve).
• May be physically clumsy and awkward.
• May be unsuccessful in performing activities involving motor skills.

TYPES OF MULTIPLE DISABILITIES

• Autism spectrum disorder with Visual Impairment/ Hearing Impairment.
• Child with Learning disabilities and Cerebral Palsy
• Physically handicapped with Visual Impairment
• Intellectual disability and a sensory impairment such as a Visual impairment or blindness/ hearing Impairment
• Mental retardation and Cerebral Palsy
• Locomotor disability and Speech impairment

In the Rights of Persons with disability Act— there is no separate classification for Deaf-blindness. So, in India deaf-blindness would be part of the category Multiple Disabilities.

IMPACT OF MULTIPLE DISABILITIES

ON Activities of Daily Living(ADL) AND MOBILITY

1. Locomotor disability and visual impairment can restrict the ability of individuals in performing the activities of daily living and their mobility.
2. Developmental delay in gross and fine motor milestones can limit the basic activities of daily living such as eating, dressing, toileting and, as well as instrumental activities of daily living such as writing, shopping, cooking, gardening, visiting friends and temples.
3. Involving in games, using transport, mobile phones and computers will be challenging due to limitations in understanding and in using complex thinking.
4. Mobility difficulties increase the risk of dependency and are an important public health concern.
5. Mobility limitations can often restrict activity and social participation, bring about isolation, anxiety and depression, and contribute to an overall poorer quality of life.

ON SOCIAL AND COMMUNICATION

1. Social skills are the skills we use to communicate and interact with each other, both verbally and non-verbally, through gestures, body language and our personal appearance.
2. Many children and adults on the Autism spectrum disorder need help in learning how to act in different types of social situations.
3. It can be harder to learn and build up these skills. They prefer to be alone and avoids social interaction.
4. Cerebral palsy can affect a person ability to finely coordinate the muscles around the mouth and tongue that are needed for speech. The coordinated breathing that is needed to support speech can also be affected.
5. Experiences fatigue when speaking to a person for a long.
6. Children with Hearing impairment take extra attention to understand and difficulty in understanding and learning from new experiences and information.

ON ACADEMICS

1. Students with Multiple disabilities may find difficulty in finishing assignments / tests in prescribed time limit.
2. Requires additional time, support of compatible assistive technology and exemptions for coping with curricular demands.
3. Student need specialized furniture or transport means.
4. Difficulty in using regular writing tools like holding a pen to write for continuously for long time. Activities involving use of hands like turning pages, writing, taking out books from bag can be difficult hence have to be adapted suitably.
5. Challenges with input, output and information processing when working on assignments, tests, and /or exams.

IMPORTANCE OF THERAPEUTIC INTERVENTION

A therapeutic intervention is an effort made by individuals or groups to improve the well-being of someone else who either is in need of help.

Therapeutic Management/ Rehabilitation is the restoration of the physically disabled to the maximize their physical, educational, economic independence and social integration.

1. These interventions or procedures are generally not carried out by medical staff but by direct support staff members or therapists (such as physiotherapists or speech therapists).
2. Educational challenges associated with multiple disabilities is a complex task headed by the student’s individualized education program (IEP) team.
3. The center of the planning process should be the student, and the strengths and desires of the student should guide the entire process.
4. Staying mindful about medical conditions can assist with classroom placement, as can being aware of a student’s intelligence level.
5. Physiotherapy remedial therapeutic interventions in the form of passive movements wherein full range of movement is given to each joint to overcome contractures and joint stiffness. Gentle massage is given as a preliminary to starting exercises, to improve venous and lymphatic drainage and to help relaxation of muscles.
6. They can ease physical challenges, and in turn, they can improve a student’s ability to function inside the classroom.
7. Occupational therapy helps in maintaining the physical skills of a person with disability, assist a person with disability to move from dependence to independence, maximize personal productivity, well-being and quality of life.
8. Someone who is limited with communication receive ongoing Speech and language therapy so that they can learn to communicate their daily and basic needs and wants to others in their environment.
9. Alternative communication methods, including text-to-speech technologies, hearing aids and sign language, can neutralize communication problems.
10. Assistive technology and special education aids can be helpful here as well. Meanwhile, an assigned aid can provide assistance when functioning independently is difficult or impossible.