CHAPTER
17
Other Health-Impaired
Conditions
Francis M. Kozub
Chapter 17 Other Health-Impaired Conditions
OHI as Defined by IDEA
Limited strength, vitality, alertness
• Chronic or acute health problems
• Educational performance adversely affected
• Conditions are listed, but
– Other conditions not listed may be used to gain
services under OHI.
– Tourette syndrome was added in last reauthorization.
Potential Conditions
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Asthma
Diabetes
Epilepsy
Heart conditions
Hemophilia
Lead poisoning
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Leukemia
Nephritis
Rheumatic fever
Sickle cell anemia
Potentially others
Impact on Education Is Key
• All of these conditions can exist, but there
is no need for services based on IDEA.
– Kids missing school
– Unable to participate in general offerings (unique
motor needs)
– Unable to attend to lessons and so on
• Parents sometimes have been placated
using OHI (Grice, 2002).
Conditions Covered in Chapter 17
• Diabetes
• Seizure disorders
• Asthma
• Cancer
• Cardiovascular disorders
• Anemia
• AIDS and HIV
• Tourette syndrome
Diabetes
• Type 1
– Kids
– Insulin dependent
– Requires constant monitoring
• Type 2
– Older adults
– Not always insulin dependent
– Related to weight gain
Physical Education
and Diabetes (Type 1)
• Be aware of warning signs.
• Many factors affect blood glucose:
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Diet
Exercise
Stress
Hormones and periods of growth
• Foot care is important. (no barefeet in PE class)
• Plan exercise with respect to diet and insulin
concerns.
• Proper fluid intake is important.
Exercise and Diabetes
• Exercise will more commonly lower blood
glucose levels, but may also cause blood
glucose levels to rise, due to counter
regulatory hormones.
• Find out if the student is on the Diabetes
Pump:
Is the pump turned on?
Temperature changes can affect (degrade) the
insulin in the pump.
Handout
• Symptoms and Treatment of Insulin Shock
and Diabetic Coma
Seizure Disorders
• Epilepsy—repeated seizures require
medication.
• Occurs in only 1% of children
• Grand mal is most common form.
• Many kids have triggers or common factors
that cause seizures:
– Flashing lights
– Fatigue or stress
– Pain
• Exercise normalizes electrical function in
the brain (Colson Bloomquist, 2003).
Physical Education and Epilepsy
• Condition is not under control:
– Avoid heights.
– Practice appropriate first aid (don’t put anything in the mouth).
– Monitor duration and other key factors.
• Condition is under control:
– Use the buddy system in the pool.
– All other age-appropriate and monitored physical activities are
recommended (Lang, 1996).
Handout
• First Aid for Grand Mal Seizure
Asthma
• Inability to breathe due to contact with an
allergen or intrinsic factor.
• It affects about 5 million children.
• Chronic condition that can be life
threatening to some if not cared for properly
• On the rise in the United States
• As is true of seizures, there are various
triggers:
– Exercise induced (EIA)
Asthma Triggers
• Animal dander, dust, weather changes,
pollen, mold, tobacco smoke
• Exercise
Emergency Condtions with Asthma
• Bluish Color
• Decreased alertness
• Difficulty breathing
• Rapid pulse
• Sweating
• Shortness of breath
Physical Education and Asthma
• Exercise can be beneficial (raises
threshold).
• Have inhalers and emergency plan on hand.
– Some young kids need help administering
inhaler.
– Help nurse and parents monitor doses.
(continued)
Physical Education and Asthma
(continued)
• Humidity and other factors might affect
incidence.
• Communicate with parents.
• Be sensitive to fears of not breathing.
What Is Exercise Induced Asthma
(EIA)?
• Tightening of the muscles around the
airways.
• Distinct from other types of asthma because
it only happens with aerobic type exercise.
• Can be prevented by taking pre-exercise
medication and by warming up/cooling down.
• About 10% of the general population without
asthma, have EIA when they exercise.
Symptoms
• Symptoms include coughing, wheezing,
chest tightness and shortness of breath.
• Symptoms may begin during exercise and
can be worse 5 to 10 minutes after exercise.
• EIA can spontaneously resolve 20 to 30
minutes after starting.
•
Can be avoided by doing the
following
• Make sure your athletes give you an Asthma Action
Plan -Keep it with you on a clipboard.
• Athletes should use reliever (Albuterol) 1530minutes before strenuous activity begins.
• Do warm-up (5 5-10 minutes) and cool-down
exercises before and after activities.
• Do not allow other athletes to tease or berate the
athlete having asthma symptoms.
Continued
• If an athlete is complaining of breathing difficulty BELIEVE IT
and take action!
• Allow the athlete to continue to play only when you know their
breathing is normal again.
• Inform athletes parents of breathing difficulties
• and request they see a provider to be checked.
• Assign someone to stay with the athlete off the field/gym etc.
while the event continues.
• Never encourage an athlete to “tough it out out” when having
asthma symptoms.
Cancer
• Second leading cause of death in
individuals under age 14.
• Many types and symptoms:
– Loss of limb
– Can affect any part of the body
– Tumors
• Treatments can be as serious and affect
motor skill as much as the actual disease.
Physical Education and Cancer
• Physical activity and play are appropriate
for kids with cancer.
• Communicate with medical personnel to
determine intensity and general activity
appropriateness.
• Exercise is a key component in recovery.
• A loss of physical function might have
psychological effects.
Cardiovascular Disorders
• Include anything affecting heart, veins, or
lymphatic system:
– Acquired (caused by disease, such as rheumatic
fever)
– Congenital (heart defect)
• Appropriate prescriptions of movement and
general physical activity benefit people with
even the most serious heart conditions.
Physical Education
and Cardiovascular Disorders
• Basic weight-bearing and large muscle
movements are important in recovery.
• Intensity, frequency, and duration are
important to monitor and consult with a
physician.
• Set realistic fitness and movement goals at
the IEP meeting.
Anemia
• Sickle cell anemia is a common condition
affecting mainly African Americans.
• Defective hemoglobin results from a genetic
abnormality.
• Fatigue, bone and joint pains, and sores on
legs are common symptoms that might
affect physical activity.
Physical Education
and Sickle Cell Anemia
• Many individuals with sickle-cell anemia
participate at high levels of sport.
• Modify activities based on the individual’s
symptoms.
• Might have to reduce impact activities given
the issues with joint inflammation.
• Hot weather and high altitudes might
worsen condition.
• Close contact between educational
personnel and physician is needed.
AIDS and HIV
• Primarily the result of factors other than the
child’s poor choices:
– Mother infected
– Blood transfusion (hemophiliacs)
• AIDS and HIV are not synonymous.
– HIV positive—has virus but not showing symptoms
– Varied symptoms
• Understanding the condition (by the
teacher) is important to successfully
program for the child.
Physical Education and AIDS and HIV
• Children with HIV can participate in the
same activities as their peers.
• Practice universal precautions for attending
to bleeding and other types of situations.
• Children with AIDS might have activity
restrictions once symptoms begin to show.
• Exercise can affect side effects, such as
fatigue from medications.
Tourette Syndrome
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Exact cause unknown
Tics
Many comorbid conditions
Potential visual motor deficits
Medication side effects are numerous
Physical activity modifications are for the
most part not necessary
• Social considerations from peers
Physical Education
and Tourette Syndrome
• Educate peers about tics.
• Tics can have triggers:
– Stress
– Anxiety
• Activity modifications may not be
necessary.
(continued)
Physical Education
and Tourette Syndrome (continued)
• Comorbid conditions:
– Obsessive–compulsive disorder
– Behavior problems and attention deficits
– Visual–motor integration issues
Assessment
• Generic category, so children with a
suspected disability might be able to be
assessed using similar formats as those for
peers without disabilities.
• Content-referenced testing might be most
appropriate.
• Physical educators are part of the
multifactored evaluation.
Inclusion
• Modifications in intensity within an
inclusive class might be needed.
• Social and physical benefits of physical
education must be considered.
• Avoid overemphasis on medical aspects.
• Work with parents.
• Including physical educators on the IEP
team is critical to ensure appropriate
programming.
Summary
• OHI is a broad category that can include any
number of conditions and children with
diverse learning characteristics.
• Medical aspects separate OHI from other
disability conditions.
• The impact on education is critical in
determining if a child fits into the category
of OHI.