Ministry of Human Resource Development Government of India
World Bank Group: Education Global Practice
Toolkit for Master Trainers in Preparing Teachers for Inclusive Education for Children with Special Needs
Making Inclusion Work Module 3: Including Children with Cerebral Palsy Master Trainers Material
Ministry of Human Resource Development Government of India
This material has been funded by UK aid from UK Government’s Department for International Development, however the views expressed do not necessarily reflect the UK Government’s official policies.
Cover and inside illustrations in this series of training modules by Navleen Kohli Design and Print: Macro Graphics Pvt. Ltd.
Table of Contents
Foreword
vii
Acknowledgements
ix
Overview
1
Unit I: Understanding Children with Cerebral Palsy
3
1. What is Cerebral Palsy?
3
2. Causes
4
3. Different Types of Cerebral Palsy
5
4. Associated Conditions
6
5. Diverse Manifestations of Cerebral Palsy in Children
7
5.1 Physical Development
8
5.2 Cognitive and Intellectual Development
9
5.3 Socio-Emotional Development
9
Unit II: Challenges in the Classroom and Beyond
11
1. Attitudinal Challenges
11
2. Challenges Due to Inaccessible Physical Environment
13
3. Challenges in Communication
14
4. Challenges in Learning
16
4.1 Perceptual Difficulties
16
5. Challenges in Handwriting
17
6. Challenges in Sports and Extra-curricular Activities
17
Unit III: Creating Enabling Environments 1. Strategies for Creating a Positive Atmosphere in Class and School
19 20
1.1 Beginning with Oneself
20
1.2 Facilitating Peer Interactions
21
1.3 Supporting the Self-esteem of a Student with Cerebral Palsy
23
2. Strategies for Facilitating Communication 2.1 Augmentative and Alternative Communication
23 25
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3. Strategies for Making the Physical Environment Accessible 3.1 Specific Furniture and Adaptations 3.2 Mobility Devices 3.3 Supporting a Child with Cerebral Palsy in Maintaining Posture 3.4 Physical Organisation of the Classroom 3.5 Other Accessibility Areas 4. Strategies to Include Children in Sports 5. Accommodation for Writing 6. Other Assistive Devices and Adaptive Equipment 6.1 Computer and Technology Assisted Instruction 7. Collaboration for Working Effectively with Children with Cerebral Palsy Unit IV: Curricular Transaction and Pedagogic Strategies 1. Assessment 1.1 Assessment of Reading Skills 1.2 Assessment of Writing and Related Issues 1.3 Assessment of Math 1.4 Assessment of Basic Language Skills 1.5 Assessing Social-Emotional Development 1.6 Assessing Physical, Sensory and Perceptual Development 2. Systematic and Effective Instruction 2.1 Universal Design of Learning 2.2. Differentiation Instruction and Lesson Planning 2.3 Classroom Environmental Considerations 2.4 Instructional Accommodations for Students with Cerebral Palsy 3. Instructional Strategies to Support Early Reading 3.1 Whole-Language Approach 3.2 Phonics Approach 3.3 Adapting Reading Materials for Students with Cerebral Palsy 4. Instructional Strategies to Support Early Numeracy 5. Teaching Writing to Learners with Cerebral Palsy 6. Evaluation Leading to Effective Instruction Annexures Annexure 1: Epilepsy First Aid Annexure 2: Helping Saliva Control Annexure 3: Classification by Number of Limbs Involved Annexure 4: Barrier-Free Guidelines for CWSN in SSA Annexure 5: Universal Design of Learning Annexure 6: Planning and Thinking Annexure 7: The Vocabulary Strategy Worksheet Annexure 8: Graphic Organizers: Story Map and Word Web Annexure 9: Spatial Concepts Worksheets References Online Resources
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29 31 34 35 36 38 38 41 44 44 45 47 48 50 50 51 51 51 52 53 54 55 58 59 59 60 61 62 66 74 74 77 77 80 82 83 84 85 86 87 88 89 91
FOREWORD The Right of Children to Free and Compulsory Education Act (2009) mandates free and compulsory elementary education to all children in the age group of 6-14 years. Sarva Shiksha Abhiyan (SSA) is the key vehicle for implementation of RTE Act. One of the important components of SSA is Inclusive Education of Children with Special Needs (CWSN). The thrust of SSA is on providing quality inclusive education to all children with special needs. However, inclusion implies equal opportunities and full participation of All children with special needs in school activities. For this, the environment has to be disabled-friendly and barrier free (77.37 percent of schools under SSA are now barrier-free). Necessary support services are needed; over 20 thousand resource persons have been appointed and close to 800 nongovernmental organizations are involved in this area. More and more children are being provided with much needed assistive devices and technologies, large print and Braille books to facilitate their inclusion in regular classrooms. Over 2.3 million children with special needs are now enrolled in schools in SSA. The critical link to making inclusion of CWSN happen in schools and classrooms is the teacher. Hence, capacities of the teachers need to be built up on those pedagogical practices that would address the needs of all children with special needs, especially those with high level support needs in a mainstream classroom. One of SSA’s goals is to ensure that there are enough trained teachers to respond to and address the challenge of inclusion. This series of five training modules on Making Inclusion work is a tremendous contribution to SSA’s ongoing efforts to prepare teachers to work with children of all abilities. Geared towards master trainers, the modules provide practical information on effective inclusion of CWSN, especially of children with autism spectrum disorder, cerebral palsy, deafblindness and hearing impairment in mainstream inclusive environments. They aim to build awareness of the challenges faced by children with these disabilities and share tested approaches in addressing these challenges. The modules are full of practical advice on how to create a classroom culture based on the principles of diversity, belonging and respect for individual differences. I am very pleased to dedicate this to the teachers of the country who have an immense role in making school a welcoming place for all children, including these with special needs.
(Prakash JavAdekar)
Foreword
In 2000, the Government of India embarked on a massive endeavor to universalize elementary education. The Sarva Shiksha Abhiyan—the Government’s Education for All programme—has supported efforts to ensure that all children ages 6-14 have access to free and compulsory education throughout the country—in villages, towns, cities and mega cities. All children regardless of social economic background, gender, and abilities have the fundamental right to schooling. SSA has a zero exclusion policy. The scale of the challenge was immense; in 2001 there were 205 million children of elementary schooling age. Fifteen years down the road, and in close partnership with State governments and communities across India much has been achieved. Access to schools has been nearly universalised and almost 98 percent of habitations have access to a school within a kilometre. SSA today covers more than 1.5 million schools and 4.5 million teachers have been added. One of the strongest pillars of the SSA programme continues to be the focus on equity, and progress has been significant. An equal number of girls and boys now attend school. The proportion of children from schedule castes and scheduled tribes enrolled in elementary schools now mirrors the SC and ST proportion in the general population. At this juncture it is critically important to work together to secure these tremendous gains for future generations, while continuing to make more progress on access, equity and quality of education. Since the adoption of the RTE in 2009, SSA has been increasingly focused on ensuring access to quality education for Children With Special Needs (CWSN). Despite concerted efforts and progress, far more needs to be done to ensure that children with disabilities are effectively included in the education system. Data also indicate that identification processes need to be strengthened as only 1.22 percent of all children have been identified as CWSN. SSA supports a multi-pronged strategy for the inclusion of CWSN. Some children are enrolled in Special Schools, others with severe disabilities are home schooled, and yet others go through a school readiness programme to prepare them for transition into a mainstream classroom— the ultimate goal of SSA. However, preparing children to fully participate in an inclusive education environment is only one part of the challenge. The school’s physical environment has to be disabled-friendly and barrier-free (82 percent of schools in India are now barrierfree). Necessary support services are needed; over 20 thousand resource persons have been appointed and close to 800 non-governmental organization are involved in this area. More and more children are provided with much needed assistive devices, large print and braille books
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and other technologies that allow children with special needs to be fully included in regular classrooms across India. The critical link to making inclusion of CWSN truly a reality in schools across India is the teacher. One of SSA’s goals in 2015 was to ensure that there are enough teachers to respond to the challenge of inclusion and that they have training, teaching-learning materials and academic support structure at the cluster, block and district levels. This series of five training modules on Making Inclusion Work is a tremendous contribution to SSA’s ongoing efforts to prepare teachers to work with children of all abilities. Geared toward master trainers, the modules provide practical information on effectively including CWSN, especially children with autism spectrum disorder, cerebral palsy, deafblindness and hearing impairment, in mainstream inclusive environments. They aim to build awareness of the challenges faced by students with these disabilities and more important, share tested approaches—tips and advice from experts in the field—to addressing these challenges. The modules are full of practical advice on how to create classrooms where all children participate and are given opportunities to thrive and learn from each other. I am very pleased to dedicate this to the teachers of the country who can make schools a welcome place of joy and learning for children with special needs.
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Acknowledgements
The World Bank is pleased to support Government of India efforts to include children with disabilities into regular classrooms. As part of broader, long-standing support to Sarva Shiksha Abhiyan (SSA), the World Bank helped produce the Toolkit for Master Trainers in Preparing Teachers for Inclusive Education for Children with Special Needs: Making Inclusion Work. The series of teacher training resource material comprises five modules addressing the inclusion of children with disabilities, particularly focusing on children with autism, cerebral palsy, deaf-blindness, and hearing impairment. The work was possible with funding from the United Kingdom’s Department for International Development. The toolkit was developed though a highly collaborative process, drawing on the extensive knowledge of domestic and international experts in pedagogy. A Writers’ Workshop in December 2014 brought together 13 experts from various institutes, including EdCil, Rehabilitation Council of India, National Council of Educational Research and Training, as well as Non-Governmental Organizations (NGO) to conceptualize and prepare early drafts of the resource material. We would like to acknowledge the immense contributions of all the participants: Prof. Sudesh Mukhopadhyay, Prof. Anupam Ahuja, Ruma Banerjee, Merry Barua, Bharti Baweja, Anupriya Chaddha, Dr. Indu Chaswal, Dr. Varsha Gathoo, Prof. Judith Hollenweger Haskell, Uttam Kumar, Bhushan Punani, Dr. Vandana Saxena, Anamika Singh, and Vinay Singh. Despite busy schedules, they all found time to contribute to this important initiative. The work also benefited from the sharing of knowledge from international experience. We would like to thank Amada Watkins of the European Agency for the Development of Special Needs and Inclusive Education, Filomena Pereira, Ministry of Education, Portugal, Aleksandra Posorac, Country Sector Coordinator, World Bank-Philippines, Michael Rosanoff, Autism Speaks, and Charlotte McClain-Nhlapo, Disability Advisor to the World Bank Group. The modules would not have been possible without the technical leadership of Dr. Renu Singh, who was instrumental in making this collaborative process a success. Dr. Singh worked closely with experts to develop, write and edit all five modules. We would also like to acknowledge the contributions of Ms. Navleen Kohli, who with her colourful illustrations helped enhance each module. Ms. Mamata Baruah also provided excellent support to help organize workshops. This module focuses on making inclusion work for children with cerebral palsy. We are particularly thankful to Mr. Bhushan Punani for his contribution to this module. It was
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primarily designed as a training resource for master trainers to then train teachers on how to identify—and successfully remove—barriers to learning, development, and participation faced by many children with cerebral palsy in classrooms across India. We fully recognize all the abilities of children with cerebral palsy, but here in this module we want to focus on providing comprehensive information about cerebral palsy, and on how all key stakeholders, particularly teachers, can respond effectively to address the needs of each individual child. Each unit of this module includes activities that master trainers can utilise to build awareness, foster reflection and help the teacher understand that children with cerebral palsy are not a homogeneous group. A “one solution fits all” approach does not work. It is critically important for teachers to try out different strategies to find those that work best for them, and for the child in his/her classroom. Every child is unique and different; each has different abilities, learns in different ways, and at a different pace. Inclusive barrier-free environments with a comprehensive support system should be created in every school. Material in this module aims to provide support to the class teacher to ensure that every child with cerebral palsy is provided an inclusive learning environment to reach their full potential.
Director: Amit Dar Practice Manager: Keiko Miwa Task Team Leaders: Dorota A. Nowak and Shabnam Sinha
x | Toolkit for Master Trainers in Preparing Teachers for Inclusive Education for Children with Special Needs
Overview
Objectives To enhance teachers’ knowledge about the characteristics of children with cerebral palsy To develop an understanding about the social and academic challenges faced by children with cerebral palsy in school—classrooms and beyond To develop an understanding of strategies that can create enabling environments for enhancing participation of students with cerebral palsy within and outside the classroom To support teachers’ development of adequate skills for curriculum transaction to include children with cerebral palsy in mainstream schools Table 1: Overview of Module OBJECTIVES
METHODOLOGY
EXPECTED OUTCOMES
Unit I: Understanding Students with Cerebral Palsy 1. To understand what is cerebral palsy 2. To understand the impact of cerebral palsy on a child 3. To develop an understanding and acceptance of the diversity within this group
Exercises, brainstorming, simulations, discussion on stories of change, and presentations
Teachers will be able to: yyUnderstand cerebral palsy, the different terminologies and types of cerebral palsy yyIdentify the impact of cerebral palsy on the development of a child
Unit II: Challenges in the Classroom and Beyond 1. To understand the barriers (both physical and communicational) that a child with cerebral palsy may face within learning environments. 2. To develop understanding of the impact of cerebral palsy on learning
Exercises, brainstorming Simulations, discussions and presentations
Teachers will understand how existing classroom situations can pose barriers to the articipation and learning of a student with cerebral palsy. They will be able to identify how to create ideal learning situations by focusing on improving the: yyPhysical environment, and infrastructure yyInteractions, activities yyInstructional processes and assessment
Overview | 1
Making Inclusion Work
OBJECTIVES
METHODOLOGY
EXPECTED OUTCOMES
Unit III: Creating Enabling Environments 1. To develop an understanding of required visual, structural and social supports in the environment to address diverse learning needs 2. To change perceptions and attitudes towards providing teacher and peer supports to enhance learning 3. To foster understanding of environments that support assistive and augmentative modes of communication 4. To understand how to provide positive behaviour supports to develop motivation and learning
Presentations, classroom discussion, brainstorming and activities
To develop an understanding of essential changes required in teacher attitudes and the environment, in teacher and student behaviour, to support learning for students with cerebral palsy. Teachers will be able to: yyDescribe how to use positive supports yyUse situation-based assistive devices for learning, communication, and socialisation yyDescribe and suggest ways to use students’ strengths for learning and socialisation yyExplain ways to use peer mediation yyDescribe ways to make their own communication more effective
Unit IV: Curricular Transaction and Pedagogic Strategies 1. To gain practical knowledge of modifying teaching – learning process for effective teaching of students with cerebral palsy 2. To develop educational plans to optimise the learning of the students with cerebral palsy 3. To gain experience and training in preparing teaching- learning materials related to the contents of the educational plan
At the end of the unit, teachers will be Simulations, able to: Brainstorming, discussions, yyAssess the current level of student’s presentations and performance demonstrations with yyUnderstand curriculum adaptation samples and ways to develop it yyLearn teaching strategies for children with cerebral palsy in an inclusive environment yyTransition plan for children with cerebral palsy yyUnderstand the importance of evaluation and ways to evaluate the learning achievements of children with cerebral palsy
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Unit I: Understanding Children with Cerebral Palsy
Table 2: Overview of Unit I OBJECTIVES
METHODOLOGY
EXPECTED OUTCOMES
Unit I: Understanding Students with Cerebral Palsy 1. To understand what is cerebral palsy 2. To understand the impact of cerebral palsy on a child 3. To develop an understanding and acceptance of the diversity within this group
Exercises, brainstorming simulations, discussion on stories of change, and presentations
Teachers will be able to: yyUnderstand cerebral palsy, the different terminologies and types of cerebral palsy yyIdentify the impact of cerebral palsy on the development of a child
1. What is Cerebral Palsy? Cerebral palsy is a broad term used to describe a multifaceted, non-progressive neurological condition affecting body movement and muscle co-ordination. Cerebral refers to the brain and palsy means weakness, paralysis or lack of muscle control. As a result of damage to a part of the brain, the messages sent between the brain and the muscles are affected. It is a complex condition characterised by great individual differences ranging from motor to cognitive behaviour. Some studies suggest that it occurs in about 2 to 2.5 in 1000 live births.1 Cerebral palsy primarily affects muscle control, muscle tone, reflex, posture, and balance. Thus, children with cerebral palsy can have problems such as muscle weakness, stiffness, awkwardness, slowness, shakiness, difficulty with balance, muscle tightness, poor coordination of limbs, involuntary movement, uncontrollable or jerky movements, and muscle spasms. It can also affect gross motor skills, such as walking or running; fine motor skills, such as writing and speaking; oral motor functioning perception and sensations. These problems can range from a child being slightly clumsy in one arm or leg, which is barely noticeable, to a child having a lot of difficulties in everyday functioning. Though cerebral palsy can be defined, having cerebral palsy does not define the person that has the condition. 1 Reddihough DS and Collins KJ (2003): The epidemiology and causes of cerebral palsy. Australian Journal of Physiotherapy 49: 7-12.
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2. Causes Development of the brain starts in early pregnancy, and maximum development occurs till age six. As shown in Figure 1 below, different parts of the brain control the movement of every muscle of the body—the cerebellum controls coordination, whereas the basal ganglia controls gross motor function. In cerebral palsy, there is damage to, or lack of development in, one of these areas of the brain, resulting in interference in messages being sent to and from the brain and body. Figure 1: The Human Brain
Damages in brain tissue result in varying degrees of damage of the nerve fibres. The damage to the nerve fibres disrupts the communication in neural circuits. Such injuries substantially influence the fundamental function of the large-scale circuits in the brain. Brain imaging studies indicate that brain damage, preceding cerebral palsy, are often found in the deep-lying areas of the brain’s white matter around the brain nuclei where supporting handlings of decoding sense stimuli are concentrated. These fundamental processes systematise the global task of organising, controlling, and managing all the sense stimuli that are computed in the brain.2 2
Source: www.cp-pack.eu / Knowledge about CP
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In some children, it is important to note that, despite a careful review and various tests, the cause of cerebral palsy remains unknown. With technologies such as MRI (Magnetic Resonance imaging) brain scans and sophisticated blood tests, more causes are slowly being identified. Points to remember zz
Cerebral palsy is not hereditary
zz
It is not a disease
zz
It is not infectious or contagious
zz
It is non-progressive
zz
It is not life threatening
3. Different Types of Cerebral Palsy Every person with cerebral palsy is a unique individual, but is likely to be classified by a doctor as having a particular type of cerebral palsy. Classification is often based on type of movement disorder and/or by the number of limbs affected.5 Classification by Movement Function Spastic cerebral palsy6 is the most common type. Spasticity means stiffness or tightness of muscles. The muscles are stiff because the message to the muscles is sent incorrectly through the damaged part of the brain. When students without cerebral palsy perform a movement, some groups of muscles become tighter, while others relax. In students with spastic cerebral palsy, both groups of muscles may become tighter, making movement difficult or even impossible. 3 For more information on epilepsy, see Annexure 2 4 Kernicterus is a very rare type of brain damage that occurs in a newborn with severe jaundice. 5 For more information on classification, visit http://cerebralpalsy.org/ 6 For more information, visit https://www.cerebralpalsy.org.au/wp-content/uploads/2013/04/early_school_years_fact_pack.pdf
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Module 3 : Including Children with Cerebral Palsy
The term cerebral palsy is used when the brain damage that leads to cerebral palsy, happens before or during birth, within a month after birth, or during the first years of a child’s life, while the brain is still developing. In a large number of cases, the cerebral motor cortex has not developed normally during fetal growth. In others, the damage is a result of injury to the brain either before, during, or after birth. Some possible causes of fetal growth problems may include: poor maternal nutrition; poor antenatal care; exposure to a toxic substance, including nicotine and alcohol; and infections in the mother like chickenpox or rubella (German measles). Medical conditions of the mother, such as thyroid problems, maternal diabetes, high blood pressure or seizures, also elevate the risk of having a child with cerebral palsy.3 During or shortly after birth, a premature birth, birth complications, low birth weight, low blood sugar levels of the baby, prolonged fits, jaundice and kernicterus4 or failure to receive enough oxygen can all put the child at risk of cerebral palsy. In early childhood, cerebral palsy may be caused by brain damage that occurs due to infections of the brain. Examples include meningitis or encephalitis during infancy; injuries to the brain, such as head injuries caused by motor vehicle crashes or child abuse; seizures; a lack of oxygen (asphyxia) due to accidents such as drowning or due to a problem with blood flow to the brain such as a stroke.
Making Inclusion Work
Athetoid cerebral palsy: Athetosis is the word used for involuntary, unpredictable movements that occur in this type of cerebral palsy. Involuntary movement is present even at rest and is often most noticeable when the person moves. Children with athetoid cerebral palsy often have very weak muscles or feel floppy when carried. Ataxic cerebral palsyis the least common type. Ataxia is the word used for unsteady, shaky movements or tremor. Children with ataxia may have trouble keeping their balance and may walk with a wide-based gait, combined with a mild tremor. Many children do not have just one type, but a mixture of several of these movement patterns. Classification by Number of Limbs Affected Classification based on the number of limbs affected by cerebral palsy provides a description of the extent a child is affected. This method is useful in ascertaining which limbs of the child are affected. The classification combines the root word “paresis” meaning weakened or “plegia/plegic” meaning paralysed with prefixes to denote whether one limb (mono) is affected or all four limbs (quadri). For additional information on classification see Annexure 3. Point to remember Technical words can be useful in describing the type and extent of CP, but they are medical labels. A label does not describe an individual person.
4. Associated Conditions The injury to the brain that caused cerebral palsy may also cause some children to have one or more of the following conditions. Remember no one child has all these conditions:
Vision: Children with cerebral palsy very commonly squint. Some children with cerebral palsy have difficulty understanding and organising visual information.
Hearing: Some children may have partial or complete hearing loss.
Speech: Some children may have difficulty talking; e.g., forming words and speaking clearly.
Communication/language difficulties: Some students with cerebral palsy may have difficulties understanding and expressing ideas. They may require support to follow instructions, construct sentences, give specific information or tell stories that make sense.
Orthopaedic problems: as children grow and develop, muscles with spasticity or stiffness may become shortened, causing muscle or joint contractures. Spinal deformities can make sitting, standing and walking difficult and cause chronic back pain.
Epilepsy: Some children may have epilepsy. This ranges from some having only occasional seizures and others having more frequent ones. (refer to Annexure 1 for information on epilepsy first aid).
Saliva loss: Due to poor muscle control, some students with cerebral palsy may have varying degrees of saliva loss or dribbling. The dribbling may be more noticeable when they are concentrating on a fine motor task (Annexure 2 presents approaches to helping students with saliva control).
6 | Toolkit for Master Trainers in Preparing Teachers for Inclusive Education for Children with Special Needs
Cerebral palsy is an umbrella term; there is no “typical” case of a child with cerebral palsy. Individuals with cerebral palsy differ greatly from individual to individual, and the degree of impairment varies from person to person. It impacts the physical, intellectual, and social development of each child differently and the impact differs to a great extent based on the environments and support available to the child from birth onwards.
ACTIVITY Understanding the different ways cerebral palsy influences children Instructions: 1. Divide teachers into small groups. 2. Give them the four case studies below and ask them to: zz
Reflect on how they would teach Hema, Jagdish, Poonam, and Nikhil in their classroom; and,
zz
Identify challenges regarding participation they would envisage in various settings in the school.
Case Studies
Hema was a premature baby and was diagnosed with spastic diplegia cerebral palsy. She
is now 9 years old and is in fourth grade. Her family supports her and has encouraged her to believe in herself and do her best. In school she finds it difficult to fit in as she feels she is different from her friends. She does not like other people to pity her or feel sorry for her. Sometimes in school, other children make fun of Hema or they talk to her as if she were a baby. This upsets her very much. She uses a walking frame to move from one place to another. She uses a computer as a writing aid because she finds it difficult to write legibly. Other students think this is not fair and this makes Hema angry. She hopes one day people will treat her just like any other child. Jagdish is an eight-year-old child with cerebral palsy which has been classified as athetoid and spastic, affecting voluntary muscle movement throughout his body. He displayed the ability to read at age four, much to the surprise of his parents. He communicates mainly through body motion and by spelling on an alphabet board. Until he began using an alphabet board, no one suspected his verbal and mathematical abilities. The alphabet board allowed Jagdish to demonstrate the extent of his talents. The learning aid allowed people to recognise the talents of a student who could not traditionally/independently explore his world nor easily communicate his thoughts and desires to those in his environment. The relaxed, positive atmosphere and the respect students showed towards him facilitated Jagdish’s development and created feelings of belonging. Recognition of his abilities by others helped to develop his self-confidence. Poonam is currently studying in class ten and is doing very well. She has cerebral palsy which has been classified as athetoid cerebral palsy. She is very bright, but has considerable motor difficulties. The main difficulties she experiences are in relation to movement control, balance, co-ordination and fine motor skills. Her left side is affected more than her right side and she finds it difficult to maintain stability. Although her general health is very good, she sometimes injures herself because of the involuntary movements she experiences.
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Module 3 : Including Children with Cerebral Palsy
5. Diverse Manifestations of Cerebral Palsy in Children
Making Inclusion Work
Nikhil is a student of class five in a government school. Nikhil has a cheerful personality and usually has a smile on his face. He enjoys going to school and learning. He enjoys interacting with his peers and school teachers. He also likes to hear jokes and knows a lot of good ones. He has cerebral palsy, which has been classified as spastic quadriplegia. He is unable to walk and uses a wheelchair to move around in school. Nikhil’s fine motor control abilities make it difficult for him to write with a regular pencil. He is able to push larger buttons and using these, he can work on a computer which he truly enjoys. Nikhil also talks extremely slowly. It is a little difficult to understand him at first, but soon you can make out what he is saying. He tries his best to participate in class. Nikhil dislikes being bored. He wants to participate and learn just like every other student.
5.1 Physical Development One aspect of physical development is the development of control over body movements.7 This results in increasing coordination between various parts of the body. These are classified into gross motor and fine motor skills. Gross Motor Skills are those that require muscle coordination of large muscles of the body, such as the shoulders, arms, back, legs and hips. Examples of activities in this category are walking, running, jumping, squatting, and throwing. Children with cerebral palsy will have varied abilities in the areas of sitting, standing and walking. Some may walk independently; others may require sticks, elbow crutches or walking frames; and some children may require a wheelchair. Fine motor skills are those which require the use of small muscles of the body such as the ankle, wrist, palm, fingers and toes. Examples of skills in this category are cutting, pasting, holding a glass, picking up an object, writing, signing, and holding with a hand. Children with cerebral palsy will have varied abilities in this area as well. While some children may be able to handle objects easily and successfully; others may not be able to use their hands due to poor coordination of fingers and upper limbs; and, others may have to use their hands for slowly performing precise functional activities. This may include skills such as pen use, typing, texting and swiping for touch screen devices, as well as tasks such as tying shoelaces, carrying objects or cutting food. When children are born, they have certain reflexes which disappear as they grow older. In children with cerebral palsy, these may not disappear. They get reflected as involuntary movements, so when a child begins a movement, instead of the desired action, an entirely different movement occurs. It is important to note again that these movements are not voluntary. Some of these involuntary movements are:
The student initiates movement and their whole body straightens (extends).
The student initiates movement and their whole body bends (flexes).
The student may attempt to grasp a cup of water and turns her/his head towards the glass to drink. When s/he does this, her/his arm on that that side straightens and the fingers open. To bring the cup to her/his mouth, s/he must turn her/his head the other way. The fingers close, the elbow and shoulder bend and they bring the cup towards the mouth, but by this time, their head is facing the other way. This is referred to as Asymmetrical Tonic Neck Reflux (ATNR).
As the child extends her/his neck, s/he will also simultaneously extend the arms and flex the hips and knees, bringing the body up into a cat-sit position. Conversely, when the
7 Nature and Effects of Cerebral Palsy and Mental Retardation, IGNOU, School of Continuing Education, New Delhi, p. 52.
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These movements affect the student’s functional participation in many activities. They can impact a student’s ability to obtain and maintain positions, which are crucial for learning throughout their day in school. This can include sitting on the floor, sitting at the desk and when transferring from one position to another. Weight bearing, gravity, stability, symmetry, weight-shift and disassociation are some of the other key movement issues affecting a student’s participation and learning within the school environment. Teachers also need to be aware that many children with cerebral palsy may experience pain due to sitting in one posture for long periods and reduced movement throughout their day. This may influence a student’s ability to function, socialise and learn. Empathy exercise Try sitting with one hip raised for 10 minutes. Imagine how your back would feel after sitting in this position for one hour or longer.
5.2 Cognitive and Intellectual Development Children with cerebral palsy can have varied interests and, like all other children, a wide range of intellectual ability. They may have a short attention span, motor planning difficulties such as organisation and sequencing, and difficulties reasoning, remembering, learning new skills, attending and organising information. This, in turn, makes it more difficult to learn communicating, self-care and social and personal safety skills, and affects the child’s educational progress. Before labelling a child as having an intellectual disability, it is important to ascertain whether the difficulties in academic tasks are due to the disability, the resultant lack of exposure and access to education or the denial of stimulating and enriching learning experiences.
5.3 Socio-Emotional Development8 Social development refers to the development of abilities that enable the individual to maintain relationships with people, learn ways of interacting with them and the ability to perform certain crucial social roles, such as those of different members of a family and community. The extent of difficulty students with CP face would depend on their experiences, capabilities and attitudes of people around them. They may encounter some of the following difficulties:
Making friends and relating to people due to communication and language problems
Playing with other students, which hinders their social interaction.
Social isolation as a result of environmental response to their physical appearance and presence of involuntary movements.
Similarly, difficulties in emotional development may result in often experiencing the following situations: 8 Based on Nature and Effects of Cerebral Palsy and Mental Retardation, IGNOU, School of Continuing Education, New Delhi, p. 66-69.
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Module 3 : Including Children with Cerebral Palsy
child flexes the neck, her/his hips and knees will extend so that the rear end will go up into the air. This is known as Symmetrical Tonic Neck Reflex (STNR).
Making Inclusion Work
People making fun of them, which may lower their self-confidence
Over protection
Lack of support leading to feelings of frustration
Lack of communication with significant others
ACTIVITY Simulation activity: understanding cerebral palsy9 Materials required: two pairs of thick socks and large shirt with buttons Instructions: 1. Ask for four volunteers for this activity and ask them to pair off. 2. Pass out a pair of socks and large shirt to each pair of volunteers and ask one person in each pair to put a thick sock on each hand. Then, ask them to put the shirt on, button it, unbutton it, and then sit down, facing their partner. 3. Ask them to exchange the materials and repeat the experiment. 4. Ask participants to discuss the following questions: zz
How did it feel to button the shirt with socks on your hands?
zz
What was easy about the task and what was difficult?
zz
How did it feel to have your partner watching you?
zz
Did you ever feel like giving up? When and why?
zz
Did you ever feel like laughing? Why or why not?
zz
What were your feelings and observations during the activity?
zz
What are your attitudes toward this disability?
zz
How did you feel about being observed while performing with socks on your hands and trying to do things with one hand?
This can be followed by asking other participants to attempt doing the following activities while using only one hand: zz
Tying shoes
zz
Opening a bottle
zz
Playing with a ball
zz
Holding a stack of papers and handing them out one at a time
zz
Going to the toilet
6. Discuss with the whole group how it feels to be observed and/or laughed at when you are trying as best as you can. 7. Explain that the rigidity that they felt in their arms and fingers is very much like the rigid muscles that most children with cerebral palsy have. It is very difficult for children to relax their muscles and many children with cerebral palsy need help to get their muscles to relax.
9 http://www.yale.edu/ynhti/curriculum/units/1992/1/92.01.05.x.html
10 | Toolkit for Master Trainers in Preparing Teachers for Inclusive Education for Children with Special Needs
Unit II:
Challenges in the Classroom and Beyond
Table 3: Overview of Unit II OBJECTIVES
METHODOLOGY
EXPECTED OUTCOMES
Unit II: Challenges in the Classroom and Beyond 1. To understand the barriers (both physical and communicational) that a child with cerebral palsy may face within learning environments. 2. To develop understanding of the impact of cerebral palsy on learning
Exercises, brainstorming, simulations, discussions and presentations
Teachers will understand how existing classroom situations can pose barriers to the participation and learning of a student with cerebral palsy. They will be able to identify how to create ideal learning situations by focusing on improving the: yyPhysical environment, and infrastructure yyInteractions, activities yyInstructional processes and assessment
A child with cerebral palsy in a mainstream classroom may face many challenges due to attitudinal, physical, systemic and pedagogical barriers to learning. Schools and teachers are in a position to address these barriers and create an inclusive environment that takes into consideration the diverse needs of children with cerebral palsy. But first, it is important for everyone to fully understand the challenges that children with cerebral palsy face. Also see section on “Barriers and Facilitators to Inclusion” in Unit I of Module 1: Inclusive Education.
1. Attitudinal Challenges Negative attitudes to disability are, arguably, the single biggest barrier to children with disabilities accessing and benefiting from mainstream education. Negative attitudes can be found among parents, community members, schools and teachers, government officials and even disabled children themselves. Fear, taboo, shame, lack of knowledge, misinformation and socio-economic values about human life, respect and dignity all encourage negative attitudes towards disability.10 Lack of 10 Schools for all - Including disabled children in education, Save the Children, 2002.
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Making Inclusion Work
support, name calling and other derogatory behaviours by the teachers and peers were among the primary reasons stated for negative school experiences amongst children with disabilities.11 Changing attitudes is never an easy proposition, but it is crucial for successful inclusion of children with cerebral palsy. With support from many people, students like Shirley—and there are many—can break stereotypes and succeed academically and professionally. (See next case study). Case Study: Shirley’s Success Despite being denied admission in a higher secondary school due to the severity of her cerebral palsy, Shirley did not lose hope and joined the National Institute of Open Schooling to complete her education. She learned to use computers for all assignments and worked diligently in her lessons and exams. She cleared her exams with distinction, which increased her confidence and motivated her to pursue an education in management. She joined a university to pursue a Bachelor’s degree in Business Administration.
11 E xperiences of children with disabilities in inclusive education, Action for Ability Development and Inclusion (AADI), 2014 (Draft Report).
12 | Toolkit for Master Trainers in Preparing Teachers for Inclusive Education for Children with Special Needs
Even though there are prescribed norms for all schools to become accessible, children with cerebral palsy still face challenges in accessing school facilities. School doors may be too narrow and heavy, the door handles may be difficult to use, corridors may be narrow, curbs may block access, or steps may not have handrails. All areas become inaccessible for wheelchair users when there are steps to go to an area and different floors in a school remain inaccessible to many children as well. Where there are provisions of ramps, they may not be usable at times because they are too steep. Children may be left alone in classrooms because they are not able to go to the playground or assembly grounds as they are inaccessible.12 All uneven surfaces may also make access difficult for children with cerebral palsy. The classrooms may not have enough space for, or allow movement of, wheelchairs within the room. The child may not be able to reach the teacher, if the teacher’s desk is on a platform, or books/teaching material stored in classrooms. Libraries, computer rooms, drinking water facilities, labs and other facilities in a school may also be inaccessible. At one level, these spaces may be inaccessible within themselves, but children may also face challenges in reaching these places within the school due to various physical obstacles in the environment. Signage and guiding lines for access are not available in the majority of schools. Toilets are also usually inaccessible and even when accessible, may not be well maintained or in usable condition. Dependency, or inter-dependence, is a normal part of daily life. However, the high level of dependency of some children with disabilities can be a barrier to inclusion in education and, in some cases, can leave them vulnerable to abuse. The more dependent children are, the more vulnerable they are to neglect, mistreatment and abuse. Transparency in care relations is, therefore, important for enabling children to complain and ask for confidentiality or assistance in preventing or dealing with mistreatment.13 When children with cerebral palsy need support in daily living activities, there is no support staff available to assist them. Currently, in most instances, parents are usually asked to support children if they want them to continue studying. As parents are not able to sustain this over a long period, it becomes one of the major reasons for children dropping out of school. Children may face issues of lack of privacy when there are no facilities where they can go to the toilet or change clothes. Girls mentioned that they would stop going to school during their menstrual cycles because of lack of toilet facilities in schools.14 Coming to school may also be an issue for many children. Road safety becomes a major concern and children become vulnerable to abuse in isolated areas. Girls with disabilities may face additional security and safety issues.15 If they are using transport, getting off from it to reach the class may pose additional barriers. The transport available may itself be inaccessible. In rural areas, children using wheelchairs and crutches find it difficult to reach school when the roads are not well maintained or there are no roads when schools are too far away. Carrying schoolbags can also become a problem for many children.16
12 Ibid. 13 Schools for all-Including disabled children in education, Save the Children, 2002. 14 Experiences of Children with Disabilities in Inclusive Education, Action for Ability Development and Inclusion (AADI), 2014 (Draft Report). 15 Schools for all-Including disabled children in education, Save the Children, 2002. 16 Experiences of children with disabilities in inclusive education, Action for Ability Development and Inclusion (AADI), 2014 (Draft Report).
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Module 3 : Including Children with Cerebral Palsy
2. Challenges Due to Inaccessible Physical Environment
Making Inclusion Work
3. Challenges in Communication Communication is the transfer of information from one student to another and depends on both communicators being able to send and receive messages. To communicate successfully, any student must be able to receive, interpret, and express language. Messages may be conveyed using a variety of communication methods and modes:
Vocalisation: sounds produced by the vocal tract that are not words
Speech: sounds produced by the vocal tract that are recognisable words
Gestures: recognisable movements that are symbols representing words or concepts, such as shrugging shoulder to indicate “I don’t know” or raising eyebrows to indicate surprise
Body movement
Writing
Cerebral palsy often affects the child’s ability to communicate.17 Children with cerebral palsy may have difficulties understanding spoken and written language, such as following instructions, understanding concepts and reading. Some students may have difficulty expressing themselves; they may have difficulty making a choice or request, naming objects, initiating or maintaining communication and finding the words they need. Other varied abilities of children with cerebral palsy in communication may include:
Clear speech like any other child or no speech, delays in speech development, and/or unclear speech
Ability to understand language, but inability to speak (i.e. receptive language ability, but no expressive language ability)
A child’s ability to understand language could also be affected by:
A poor attention span, decreasing the ability to process speech from other people.
A hearing impairment can also interfere to the point of affecting speech and language development.
Limited facial expressions may be due to cerebral palsy, because of low muscle tone, rather than a lack of interest, motivation or intelligence.
On the expressive side, neuromuscular disability can interfere with breath control, vocal cord movement, and lip, tongue, and palate motion, all of which can result in articulation problems and difficulty in speaking.18 Students may have challenges with the range, grading, speed, coordination, sensory feedback and motor planning of oral movements needed to use speech to expressively communicate. Communication may thus require a lot of effort.
Due to these difficulties, people around children with cerebral palsy may:
Avoid speaking directly to the child
Assume that because the child is unable to speak, s/he has nothing to say
17 F or additional information, see Lindsay Pennington’s Cerebral Palsy and Communication Paediatrics and Child Health,September 2008, Volume 18, Issue 9, pp. 405–409. 18 M iller, Freeman and Bachrach, Steven J. (1995): Cerebral Palsy – A Complete Guide for Caregiving, London: The John Hopkins University Press, P. 83.
14 | Toolkit for Master Trainers in Preparing Teachers for Inclusive Education for Children with Special Needs
Fail to listen to the student
Be misled or pretend that they understand when they have not
Dominate the conversation and control what is discussed. Students then end up talking about topics chosen by other people and are spoken down and perceived as incapable
Due to these difficulties, students with cerebral palsy:19
May become isolated or feel silenced and invisible
May not attempt to speak with people they assume will not understand them
May feel stigmatised and be made to feel invisible and powerless
May tend to be passive, use communication for a restricted range of functions, use mostly yes-no responses, make few requests and provide very little information. What a student may say may not be all that they have to say, as communication becomes limited because of speech difficulties.
ACTIVITY Communication challenge 1. Ask a volunteer to write a simple sentence on a piece of paper; for example, “The cat sat on a hot tin roof.” 2. The volunteer shows this sentence to another participant. 3. This person must share the written message with other participants without writing, speaking or using any letters of the alphabet. 4. Participants then discuss the following questions: Questions
Was it difficult to communicate using this method? If yes, why?
What would have helped?
How can we communicate with someone who cannot respond?
How can we help them communicate?
5. If more people want to try this activity, here are some suggested sentences: My teacher is wearing a very nice saree. I want a cold drink. I am afraid my teacher will get angry since I have not done my homework. My school is far from home. My foot hurts. I want a Samosa for lunch.
19 Levin, Karen Susan. (2013). The Communicative Participation of Adults with Cerebral Palsy, Dissertation presented for the degree of Doctor of Philosophy, Faculty of Arts and Social Sciences at Stellenbosch University.
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Module 3 : Including Children with Cerebral Palsy
Making Inclusion Work
4. Challenges in Learning Students with cerebral palsy can have a range of learning abilities and cognitive function, from being gifted to having intellectual challenges. There is no clear-cut relationship between cognitive functioning and the level of the child’s movement or communication challenges. In personal and professional lives, one monitors and observes other people’s movement to get information about them. Information can be gathered from eye contact, body language, postural demeanour, facial expression, gesture and speech, as well as vocal tone and volume, to make predictions and assumptions about people’s intentions. Teachers constantly observe and interpret the movements of all students in their classroom to provide feedback about each student’s engagement with the learning activity, with their peers and so on. This movement information becomes an integral part of the whole teaching-learning dynamic. Teachers tend to gather information based on observations and make conclusions on each child as a student. The most basic rule of thumb, when studying a student’s movement, is to not judge by appearances. Teachers should not assume that the way a student moves or looks will match the teacher’s perception of the student’s abilities. Students with cerebral palsy may have some gaps in their learning due to restricted experience caused by the nature of their physical impairment. Some students’ motor and/or sensory challenges may also affect their learning. For example, students with sensory processing challenges may find it difficult to filter sensory information to direct and maintain their attention. The student’s speed of response may be slowt due to delayed initiation of movement; i.e., they quickly processed the information cognitively, but it may take 20-30 seconds to organise their body to produce the movement response. Overall, a student’s capabilities may be underestimated if the sensory-motor challenges are misinterpreted as delayed cognitive processing or attention deficits. One of the impacts on learning is that students with movement challenges use both physical and mental energy managing their movement challenges. For some students, this may involve consciously suppressing additional movements, while others may be trying to maintain their posture so that they can sit up and concentrate. Overall, this physical and mental energy expenditure reduces the student’s ability to focus and concentrate and to attend to the curriculum. As cerebral palsy affects all of their movements, including oral movements for speech, it is difficult to determine the child’s true level of cognitive function until a method of communication is developed. Teachers cannot directly observe cognition; they can only infer based on how the student responds to particular tasks and situations; e.g., gesture, facial expression, pointing, selecting or manipulating materials, speaking and writing. All of these responses require movement control. Even if children know the answers to questions, they may not be able to answer and teachers may not be able to understand their responses.
4.1 Perceptual Difficulties Perception is the making sense of information gained from the senses. Visual and spatial issues may create difficulties for some children in making sense of the information they get through their eyes. Some children may face perceptual difficulties, such as visually judging the size, shape and depth of objects. A visual spatial difficulty may affect the understanding of left to right sequencing in reading and writing, as well as letter formation. More commonly, children
16 | Toolkit for Master Trainers in Preparing Teachers for Inclusive Education for Children with Special Needs
Spatial awareness alerts us as to where we are in relation to objects and people around us. For some children, this may pose a problem. If a child is walking or using a wheelchair, they may bump into things or move into spaces that are too small. In copy or book work, they may find it difficult to see an object or picture in their heads and may need to use real objects for counting and other maths games. Some children with cerebral palsy may also experience difficulty in tactile discrimination – the ability to recognise objects on the basis of touch. For instance, some experience difficulties in identifying a hard ball, sponge or other objects placed in their hand without looking at the object. Some children with cerebral palsy also contend with the loss of proprioceptive sensation or the ability to determine the position of body parts or objects in space.
5. Challenges in Handwriting Visual perception, muscle weakness resulting in weak pincer grip, and fine motor control can affect handwriting in children with cerebral palsy. Some of the motor challenges that students with cerebral palsy may experience include:
Grasping and maintaining grasp of a standard pencil or pen
Opening their hands to grasp a pencil
Stabilising their work with their non-writing hand
Maintaining a symmetrical upright posture when writing
Maintaining even pressure on their pencil/pen, resulting in a pencil mark being too light or too dark
Maintaining a rhythm of movement when writing; controlling the timing and grading of movements
Decreased endurance and increased fatigue, affecting both the quantity and quality of output
Pain in hands, neck and shoulder when writing
Learning motor automaticity of letter formation, i.e. being able to automatically access the correct movement patterns that allow efficient and economical completion of the letter shape, without having to think about the individual strokes a letter requires
These challenges are further exacerbated by the expectations of teachers when they:
Expect children to keep up writing speed with their peers
Fail to provide alternatives to writing work
Give undue importance to written work
6. Challenges in Sports and Extra-curricular Activities It is often observed that children with cerebral palsy remain excluded from sports and other extra-curricular activities in school. This is often due to a lack of flexibility in the rules
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Module 3 : Including Children with Cerebral Palsy
may have difficulty with pictures, line drawings and writing. Maths is particularly vulnerable to inadequate spatial skill, particularly the organisational aspects in the spatial context that give numbers their significance.
Making Inclusion Work
and processes associated with these activities. Although it is widely recognised that these activities lead to physical, creative and psychological benefits, such as enhanced self-concept and confidence, schools do not invest in making sports and other extra-curricular activities accessible for all.
ACTIVITY Obstacle awareness Instructions: 1. Ask participants to imagine that they are a child with cerebral palsy. Ask them to respond to the following questions: zz
What is your name? Age? Gender?
zz
What is the type of your cerebral palsy? (They may not know the answer to this.)
zz
Where do you live and with whom?
2. Ask them to think about the opportunities—and challenges and barriers—they may experience when coming to and being in school. 3. On a flip-chart, draw five circles inside each other. The smallest circle in the middle represents the child; the next represents the family, then the community and the school; and the largest circle represents wider social systems, such as the education system. Label the circles. 4. Are the opportunities and challenges at the level of the child, family, community, school or wider social systems? Ask them to plot their thoughts on the chart, using differently coloured pens to show opportunities and challenges. 5. Ask them to look at the chart. Are the opportunities and challenges evenly spread? Or do they focus on one level more than another?
Source: T his activity was adapted from “Schools for All: Including Disabled Children in Education”, Save the Children, 2002.
18 | Toolkit for Master Trainers in Preparing Teachers for Inclusive Education for Children with Special Needs
Unit III: Creating Enabling Environments
Table 4: Overview of Unit III OBJECTIVES
METHODOLOGY
EXPECTED OUTCOMES
Unit III: Creating Enabling Environments 1. To develop an understanding of required visual, structural and social supports in the environment to address diverse learning needs 2. To change perceptions and attitudes towards providing teacher and peer supports to enhance learning 3. To foster understanding of environments that support assistive and augmentative modes of communication 4. To understand how to provide positive behaviour supports to develop motivation and learning
Presentations, classroom discussion, brainstorming and activities
To develop an understanding of essential changes required in teacher attitudes and the environment, in teacher and student behaviour to support learning for students with cerebral palsy. Teachers will be able to: yyDescribe how to use positive supports yyUse situation-based assistive devices for learning, communication, and socialisation yyDescribe and suggest ways to use students’ strengths for learning and socialisation yyExplain ways to use peer mediation yyDescribe ways to make their own communication more effective
Successful inclusion means being included in all the activities of the school setting, including structured classroom activities, access to the school curriculum, assembly, sports, library and playground activities and transition between activities. To enable children with cerebral palsy to pursue their education effectively, it is essential to provide an accessible, barrier-free, appropriate and conducive learning environment. While the physical environment can be developed by creating an accessible building and infrastructure, it is also essential to address any attitudinal barriers amongst the peer group, educators and other staff. Teachers play a crucial role in encouraging children with cerebral palsy to participate in the learning environment. Encouraging and ensuring participation leads to increased confidence amongst children with cerebral palsy as they realise that they are a part of the classroom and school. It also minimises negative peer interactions and helps children to form positive relationships. The development of social competence and self-esteem is one of the important aims for all children, including students with cerebral palsy. For this to happen, it is important
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Making Inclusion Work
for teachers to get to know the student’s strengths and needs in all areas of development, as well as interests, likes and dislikes, to plan and support learning and inclusion of all students, including the student with cerebral palsy.
1. Strategies for Creating a Positive Atmosphere in Class and School 1.1 Beginning with Oneself Teachers need to examine their own attitude towards children with cerebral palsy before they can begin to effectively support them.
ACTIVITY Defining disability20 Instructions: 1. Divide participants into groups of 4-5. 2. Write the word “disability” in big letters on the blackboard. 3. Ask participants: What does disability mean to you? 4. Have participants write down any words and phrases that pop into their heads when thinking about the word “disability”. Point to Remember Our attitudes affect what we think and say, and how we behave when we are around different groups of people. 5. Participants then think about the words they have written. Ask them whether these terms have positive or negative meanings. Then have them label each term with P for positive, NN for negative or N for neutral (neither positive nor negative). 6. Have them reflect on what these labels reveal about their attitudes towards disability. Point to Remember Attitudes and beliefs come from many different sources – our friends, the media (radio, newspapers, internet, and television) and society in general. 7. Each group then brainstorms to find answers to the question: How do people in the community react to people who have cerebral palsy? Also see section on misconceptions in Unit II of Module 1: Inclusive Education. Teachers need to learn how to listen, be consistent and patient, and respect children’s individual learning styles. They also need to:21 zz
Accept that children learn at a different pace, and in different ways, and so plan lessons with diversity and difference in mind
20 Adapted from Whitehorse Disability Awareness Kit-A Resource Kit for Primary School Teachers, 2005. 21 Adapted from Schools for all-Including disabled children in education, Save the Children, 2002.
20 | Toolkit for Master Trainers in Preparing Teachers for Inclusive Education for Children with Special Needs
Plan activities according to the learning taking place, rather than according to a fixed interpretation of the curriculum
zz
Respond flexibly and creatively, both to the individual needs of particular children and to the needs of all children in the classroom
zz
Be aware that a proportion of all children in all classes will experience some difficulties in learning
zz
Focus on what the person can do, rather than only on what s/he cannot do
1.2 Facilitating Peer Interactions Teachers need to discuss with all students the importance of diversity and social inclusion. Give children all of the information they need about the classmate with cerebral palsy. The teacher needs to emphasise and model respect and acceptance of diversity. Give students examples of people that have disabilities that have contributed something unique to the world. This way, they will see that being different is valuable. Teachers can explain to children that a child with cerebral palsy may move differently or may speak differently than they do. However, the child with cerebral palsy has interests similar to those of other children, and in many cases, will have a lot in common with their peers. It is also important to address stereotypes as negative perceptions can be irritatingly difficult to break. Teachers can emphasise that all children – not only those with disabilities – are unique.
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Module 3 : Including Children with Cerebral Palsy
zz
Making Inclusion Work
Teachers can start a dialogue with students and answer their questions about a student’s disability and encourage them to talk and play with children with disabilities.
The teacher can organise some collaborative assignments, which encourage interaction between students with cerebral palsy and peers. One such assignment could have the child demonstrating to the class some of the aids s/he uses. The teacher can also provide encouragement by establishing a peer buddy system, where students, by rotation, provide the required assistance to the student with cerebral palsy. It is critical that teachers establish collaborative learning as the established norm, so that co-operation becomes an established value.
If the student uses an alternative form of communication, like a communication book or device, make sure it is available at recess and lunchtime. If required, teach peers how to interact with the student using the communication device or book.
Teachers need to ensure that no students are bullied, including children with cerebral palsy. Situations will often occur between students. When these happen, the teacher must take the students aside to discover the issue. They can then explain why bullying is wrong and why a student’s attitude needs to change. Teachers need to very firmly establish class rules to prevent bullying in any form.
Teachers must use co-operative language during instruction; e.g., “Share your ideas with a friend.” or “Is anyone available to help a classmate?”
22 | Toolkit for Master Trainers in Preparing Teachers for Inclusive Education for Children with Special Needs
Self-esteem stems from a sense of belonging and connectedness with one’s peers. To make sure a child develops a healthy self-image and learns in the classroom, a teacher needs to provide encouragement, as well as create opportunities for the student with cerebral palsy to encounter success. For example, if a child has mobility difficulties and uses a wheelchair, the teacher should identify ways for the student to have access to all materials and activities in school including sports, rather than just leaving them to be a mere spectator. Here are other strategies a teacher can use to build self-esteem:
Ensure the student with cerebral palsy is motivated and engaged in the classroom, as this is crucial for her/his emotional wellbeing.
Provide clear expectations, consistency, structure and routine for the class.
Use low-key cues, such as touching the student’s desk to signal the student to think about what s/he is doing without drawing the attention of classmates.
Provide support in transitioning from one activity or place to another. Cues, routines and purposeful activity during transitions may be helpful.
Monitor student for signs of anxiety or depression, such as visible tension, withdrawal, changes in grooming habits, missing or coming late to class, fatigue or incomplete assignments. If a child seems to have difficulty in reaching out or participating with the teacher or the students, ask the child directly how the teacher can help. Consider having a key person the student can check in with on a daily or weekly basis to assist with planning, self-monitoring and problem solving of any concerns or issues that may arise.
Support the development of confident children, so students feel comfortable asking for what they need and expressing their preferences.
Confer with the student’s parents and ask them to offer insights on how to support their child’s social and emotional wellbeing.
Be sensitive to the fact that children with cerebral palsy, like other children, want to fit into their classes. Therefore, while planning class activities, avoid those that draw unwanted attention and single them out.
Encourage efforts made by the child for any task, rather than offering false praise.
2. Strategies for Facilitating Communication Students with cerebral palsy may exhibit obvious speech impairments or they may not speak at all. Some students may communicate by writing notes, pointing to boards and others by using electronic speech-synthesisers. Some general guidelines to follow to facilitate communication include:
Be respectful of the child’s attempts to communicate and make sure that the child has space to make choices.
Reduce background noise so both student and teacher can concentrate on the conversation.
Face the child with cerebral palsy and do not hesitate to ask her /him to repeat a sentence if it was not understood. Difficulties in communication, if any, must be recognised. This will ease some of the stress or discomfort felt by both the student and teacher.
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Module 3 : Including Children with Cerebral Palsy
1.3 Supporting the Self-esteem of a Student with Cerebral Palsy
Making Inclusion Work
Find an established system for reliably signalling ‘yes’ and ‘no’. This needs to be recognised, since the student with cerebral palsy may not say ‘yes’ and ‘no’ in the usual manner. Some alternate ways are:22 Looking
up for ‘yes’ and down for ‘no’
Blinking
their eyes once for ‘yes’ and twice for ‘no’
A
tight fist for ‘yes’ or an open hand for ‘no’
Pointing Moving
at the words ‘yes’ and ‘no’ printed on cards
their foot up for ‘yes’ and keeping it still for ‘no’
Be patient and allow time for initiating and responding to the student with communication difficulties. For instance when asking a question, wait for a reply. This sounds obvious, but for some people, it may take them longer to reply than is customary. Let the student speak at her/his own speed and avoid completing words or sentences for her/him.
Recognise that initially experiencing personal discomfort is a completely normal reaction. Allow some time to follow the student’s articulation, as it is possible to develop an “ear” for the student’s speech patterns and, in this case, communication will become relatively easy.
Always be honest about how much has been understood as this will give the student an opportunity to explain points that have not been understood or ask for support. Ignoring the problem or pretending to understand only makes things worse.
In class, teachers should:
Simplify instructions by using simple language and breaking down instructions into smaller steps.
Repeat instructions and provide additional cues such as gestures, pictures, written words or showing the student what to do. It may be helpful to ask the student to repeat the instruction.
Encourage the student to ask for help if the instruction has not been understood.
22 First Steps-Developing communications skills for individuals with multiple disabilities, Communication Matters (Undated).
24 | Toolkit for Master Trainers in Preparing Teachers for Inclusive Education for Children with Special Needs
Encourage all attempts at communication and provide opportunities for the student to demonstrate understanding in her/his own way. Providing verbal/visual choices; e.g., pictures or objects, for the student to use in facilitating communication.
Support the student to achieve and maintain a stable, symmetrical position to talk.
Squat or sit down at eye-level with the student. Standing over a student may cause them to tip their head back to look at you, making oral movements for intelligible speech more difficult.
Stand back a little. This will help a student maintain eye contact with you without tipping their head back. Some student’s speech is also affected if they turn their head too far to the side.
Use the student’s specialised seating and equipment to support a stable, symmetrical, midline position for more intelligible speech.
Recognise that students with upper body weakness may not be able to raise their hands to participate in discussions. Establish an indicator that indicates that the student wishes to speak.
Appreciate that students with speech difficulties have important things to say and that appropriate interaction behaviour includes waiting for students with speech difficulties to complete statements, refraining from finishing their words or sentences and asking for rephrasing when they are difficult to comprehend.
Also see Understanding Different Learning Styles and Approaches in Developing Inclusive Pedagogy in Unit II of Module 1: Inclusive Education.
2.1 Augmentative and Alternative Communication Augmentative and Alternative Communication (AAC) includes all forms of communication, other than oral speech, that are used to express thoughts, needs, wants and ideas.23 Everyone uses AAC when making facial expressions and using symbols, pictures, gestures or other non-verbal cues. Children with severe speech or language disorders rely on AAC to enhance their communication in addition to their other means of communication which they may have adopted. Use of AAC enables students with cerebral palsy to enhance their inter-personal interaction, participation and performance in school, while boosting the self- confidence that comes with the ability of being able to communication and be understood. AAC systems are provided to supplement, rather than replace, children’s natural modes of communication and to extend the range of topics about which children can converse.24 For example, using an AAC system, a child may be able to request items that they cannot see and to which they cannot gesture, and to tell their parents about activities that happened at school. AAC boards can be built using alphabets, pictures or words to facilitate access to the vocabulary needed for students with cerebral palsy to participate in school, at home and in the community. Many students who use AAC make use of the alphabet to help clarify a spoken message (i.e., they make use of their speech and then spell a word if it is not understood);
23 For more information see www.asha.org/public/speech/disorders/aac 24 F or more information on AAC systems, see Lindsay Pennington’s Cerebral Palsy and Communication Paediatrics and Child Health, September 2008, Volume 18, Issue 9, Pages 405–409.
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Module 3 : Including Children with Cerebral Palsy
Making Inclusion Work
and they also make use of writing (if they have no fine motor difficulties), to prepare longer messages that may be difficult to speak aloud. For such students, communication boards may include a combination of frequently used words as well as an alphabet to spell words. There are two categories of AAC systems: unaided and aided. 1. Unaided Systems: The person with cerebral palsy relies on the body to communication, including gestures, body language, fingerspelling, sign language and Blissymbols.25
2. Aided Systems: These include use of paper, pencil, communication books (see below), communication board, alphabet-based methods, core vocabulary, photographs, synthesised speech output devices, picture symbols, computer-aided devices, mobile supported communications and other electronic devices. Communication Devices: Communication enhancing technology includes devices for improving augmentative and alternative communication; auditory devices and non-verbal communication, including eye tracking technology; symbol boards; voice synthesisers; head sticks and key guards for computers. With newer communication applications including Google talk, Viber, and WhatsApp, even mobile phones are emerging as a very effective and affordable tool for enhancing the communication of people with cerebral palsy.
Systems and devices are often divided into categories:
Signing
Graphic symbols such as Picture Communication Symbols, Rebus, Blissymbols
25 Training Module on Cerebral Palsy and Locomotor Impairment, New Delhi: Sarva Shiksa Abhiyan, P. 46.
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Module 3 : Including Children with Cerebral Palsy
Communication books
Simple digitised Voice Output Communication Aids (VOCAs), like Kathamala
Digitised voice output devices
Computer-based communication applications such as Awaz
Synthesised VOCAs
Communication applications Avaz
Source: www.avazapp.com
Kathamala, a voice output device
Source: photo from sambhav Resource Center, AADI.
Guidelines for communication with children with cerebral palsy using AAC
A child with cerebral palsy should be encouraged to use speech to the extent possible and use various forms of AAC to enhance communication. The AAC devices and methods should be considered supplementary to speech. If talking to a person using an AAC method of communication, the teacher should share the above thought with the
Unit III: Creating Enabling Environments | 27
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person. This will give the other person the opportunity to demonstrate the best way to communicate with each other.
Students with severe cerebral palsy, who are unable to spontaneously gesture or point, can be taught to communicate using an AAC.26
Students who use AAC require communication-accessible schools that support the student’s autonomous communication. Because communication is a two-way process, all communication partners need to take some responsibility for making communication effective and successful. Overtly
respect and value the student’s different ways of communicating and their AAC systems.
Encourage
students to communicate their own autonomous messages.
Be
aware that by answering a YES/NO question, the student is agreeing or disagreeing with another person’s idea; the student did not SAY anything.
Be
aware that when presented with a limited set of options, the student is CHOOSING or SELECTING; the student did not SAY anything.
The
student can SAY their own message when they have access to an AAC system with sufficient pictograph/whole words vocabulary and/or spelling to express their thoughts in their own words.
Provide
students with additional time to communicate their messages.
Ensure
the student’s AAC systems are always available for the student to initiate communication at any time they have something to say.
26 For more information see Cerebral Palsy Education Centre (CPEC) E-Learning Modules at http://www.cpec.org.au/train_ online.html
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willing to use the student’s AAC methods.
Be
willing to learn and implement strategies to support the student to develop their communication and language skills using the alternative form.
3. Strategies for Making the Physical Environment Accessible Also see Use of Assistive Devices, ICT and Other Resource Support to Meet the Specific Needs of CWSN in Unit III of Module 1: Inclusive Education.
Physical accessibility is central to creating an inclusive classroom and school. It is essential to ensure accessibility of students with cerebral palsy and other physical disabilities to classrooms and the entire school, including toilets, library, playgrounds and laboratories. For students with cerebral palsy, special seating arrangements may be necessary to meet their needs. Students may need lowered tables or spaces for wheelchairs. In labs, students who use wheelchairs may need lower lab tables to accommodate their chairs and allow for manipulation of tools or other equipment. Students who have upper body limitations may need note takers, extended exam time, tape recorders or scribes to record exam answers.
ACTIVITY Drawing an accessibility map of the school and surrounding areas Instructions: 1. Ask teachers to draw a rough map of their school, and surrounding communities where children live. 2. Assess the accessibility of all areas on the map for a student using a wheelchair. Could the student access all the places? Take part in all activities at the school? (The same exercise can be done for the training venue.) 3. Teachers should mark all the accessible and inaccessible areas on their maps. 4. Discuss what would need to change to ensure that the student in the wheelchair could access and participate fully. Source: T his activity has been adapted from All Equal All Different-KS1/Early Years Disability Equality Resource Pack: A Guide for Practitioners and Teachers, Disability Equality in Education and United Kingdom Disability Forum for European Affair, April 2004.
Barrier-free Schools: As per provisions of the Persons with Disabilities Act, 1995, and the Right to Education Act, 2009, it is mandatory to ensure provision of a barrier-free and accessible environment to students with disabilities, including children with cerebral palsy. Sarva Shiksha Abhiyan (SSA), Rashtriya Madhyamik Shiksha Abhiyaan (RMSA), as well as Inclusive Education of Children with Disabilities, has allocated resources for making all schools accessible. (See Annexure 4, BarrierFree Guidelines for CWSN in SSA).
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Be
Making Inclusion Work
What is meant by accessibility? For Whom? To What?
Accessibility for Whom? zz
Students who use a wheelchair, rollators, walkers or similar devices, crutches, callipers, walking sticks, elbow crutches, compensatory shoes and other orthosis
Accessibility to What? zz
Access to getting in and out of the school
zz
Getting on and off the transport
zz
Moving within the school and to different classrooms
zz
Going to the toilet, library, resource room, principal’s room, playrooms and playground
zz
Eating and drinking and going to the canteen, dining hall
zz
Using variety of furniture in the classroom, library, dining area, play room, and laboratory
How to ensure accessibility? zz
Include parents of students with disabilities in the School Management Committee
zz
Ensure ramps of suitable gradient and quality, non-skid floors and wide opening doors
zz
Provide handrails of appropriate quality with proper specifications in corridors, passageways, ramps, and toilets
zz
Ensure wide doors and enough space inside bathrooms, toilets as per standard specifications
zz
Teachers and school staff need to ensure that an accessible route of travel and accessible entrances/exits are available to the child.
zz
Provide an accessible classroom desk or portable wheelchair desk. Unobstructed hallways, aisles and means of way out are maintained.
zz
Doors have to open easily and need handles fixed at appropriate levels, not too high.
zz
Provide assistance through school staff or buddy system for reaching the class from the gate and getting off the vehicle, if needed.
zz
Give the student a second set of texts. It might be difficult for a student with a physical disability to bring books home.
zz
A wheelchair is part of a student’s personal space. Teachers are not to lean on a chair or touch it without asking permission to do so.
zz
Children with cerebral palsy and visual difficulties may require additional accommodations
zz
Ensure safety
Whom to orient as regards access? Teaching simple skills and basic understanding of specific needs of children with special needs in proper use of callipers, orthosis and rehabilitation devices to: zz
Class teachers
zz
Fellow students
zz
Support staff of the school
zz
Parents and siblings of children with cerebral palsy
zz
Any other service providers, including librarian, administrative staff, and counsellor.
Source: adapted from the Training Module on Cerebral Palsy and Locomotor Impairment, New Delhi, SSA, p. 21.
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Module 3 : Including Children with Cerebral Palsy
3.1 Specific Furniture and Adaptations A child, if well positioned, is able to participate with much more ease. For some children with cerebral palsy, special furniture will provide the extra support needed to maximise their physical ability for participating in classroom activities and tasks.27 As a general rule, while sitting, the trunk should be upright, with as much freedom of movement as possible for interaction with and visual regard for the environment. Feet should be flat on the floor, knees bending at right angles, with hips firmly against the back of the seat. For students who cannot achieve this desired position independently, various aids should be provided. Advantages of special furniture
zz
Improves muscle coordination Ensures better maintenance of posture Improves physical performance Enhances participation in academics and other activities
zz
Gives extra support and comfort
zz zz zz
zz
Precautions to be taken when using special furniture
zz
If the special furniture is not designed, placed and used properly, it may put the student at risk.
zz
As the student is growing, it is essential to adjust the furniture and its attachment regularly.
zz
As most furniture is static and cannot be moved frequently, it may isolate the user from other students.
zz
Similarly, consistent use of the same furniture for a prolonged time may be tiring and may cause stiffness in the knees, ankles and hip joints.
27 For more information, see Training Module on Cerebral Palsy and Locomotor Impairment, New Delhi: Sarva Shiksha Abhiyan, P. 22.
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Modifications to furniture:
Height of the seat
Width of the seat
Height of the back
Location and nature of the hand rest
Height of the seat from the floor
Floor seat to be provided for young children
Box seat to be provided by raising height of the floor seat
Making the box seat mobile by adding 4 castor wheels
Providing a pommel to separate stiff legs
Providing a ramped seat in case for children who tend slip forward
Providing a pelvic strap for stability for a child who tends to slip forward. A pelvic strap is also a safety factor; it prevents a child from falling out of the seat when the child is left alone. The strap should be made of thick cotton strapping 2 inches wide, which can be knotted in front.
Proving a cut-out tray along with a chair or wheelchair to support the child around the trunk and prevent forward leaning. Floor table for children who prefer to sit on the floor but require support. Cut-out in floor table will enhance stability for children who tend to lean sideways.
32 | Toolkit for Master Trainers in Preparing Teachers for Inclusive Education for Children with Special Needs
And yet other children may need multiple modifications in the furniture.
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Module 3 : Including Children with Cerebral Palsy
Some children with cerebral palsy may only need a foot strap to stay in a good position (to keep the body from becoming stiff).
Making Inclusion Work
3.2 Mobility Devices Mobility is the main concern of people with cerebral palsy. Some children with cerebral palsy have restricted mobility, and need devices to enhance their mobility. Depending on a child’s form of cerebral palsy, increasing mobility can be as simple as providing a walking cane or elbow crutch or as complex as enduring surgical interventions that allow a person to have balance or correct gait, or be comfortable seated in a wheelchair.28 Mobility enhancing technology which may require motion and gait analysis and includes orthotics and other mobility-enhancing devices, including: Walkers: with or without wheels, walkers are useful when the child has some upper body strength and coordination. These can be adjusted to the height of the student, and are affordable. Walkers are useful for children with cerebral palsy who tend to bend their knees and hips when standing and moving with support.29
Braces: Attached to a child’s back, arms and/or legs, braces provide stability where the body needs it. These enhance a child’s ability to stand and walk.
Canes/Crutches: Useful as they can be adjusted to the height of the child and support the body where it is needed.
Wheelchairs and Tricycles: are used when a child is unable to stand, use their legs and walk. Both manual and battery operated wheelchairs are available. It is one of the most useful solutions for people with restricted mobility. A service table with a cut-out can be provided
28 For additional information see “My Child - The Ultimate Resource for Everything for Cerebral Palsy” on www.cerebralpalsy.org 29 F or additional information, see Training Module on Cerebral Palsy and Locomotor Impairment, New Delhi: Sarva Shiksha Abhiyan, P. 33.
34 | Toolkit for Master Trainers in Preparing Teachers for Inclusive Education for Children with Special Needs
3.3 Supporting a Child with Cerebral Palsy in Maintaining Posture Teachers need to ensure that children with cerebral palsy are sitting in the correct posture, since good posture is required when reading and writing. It is essential to observe proper positioning as it maximises physical efficiency and the ability to manipulate materials. Reading difficulties are often a result of continuous improper positioning. Teachers should monitor the child’s safety and see to it that the child is not slipping or in pain. Teachers also need to know how to lift, carry, hold and position a chid to learn to control any muscle stiffness or uncontrolled muscle movements. Obviously, the best way to handle a child depends on age, type of cerebral palsy and how the body is affected. Teachers may need to show school staff how to transfer or carry a child in a way that will help the child develop the best possible control over their body and prevent strain or injury. A few practical suggestions zz
Try not to move the child suddenly or jerkily. The muscles may need time to respond to changes in position.
zz
Some children’s muscles tense (spasm). Let muscles tense and relax in their own time; do not force movements.
zz
Fear can make muscle spasms worse, so give the child as much support as needed when handling her/him. Be careful not to give more support than is needed.
zz
Encourage the child to spend time in different positions.
zz
Try to position the child so s/he can see what is going on around her/him.
zz
Wherever available, teachers should seek advice about seating and orthotics from physiotherapists and occupational therapists who can advise on specific arrangements for a child.
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Module 3 : Including Children with Cerebral Palsy
for support during functional activities. It is also advisable to provide a strap to enhance the stability and safety of user. A tricycle or a battery operated tricycle is good for mobility outside and for long travel. The seat and control mechanism, however, need to be modified to meet an individual’s specific needs.
Making Inclusion Work
3.4 Physical Organisation of the Classroom Physical organisation of a classroom includes the seating arrangement, space that allows for movement and manipulation of tasks, and the type and size of furniture. Some points to consider are:
The student’s seat and table should be appropriately sized and comfortable to work at while reading and writing. Wheelchair users can have tables to work on in their wheelchairs. Seats and tables should be the right type for the individual child’s needs and condition.
Teachers can help arrange the classroom so the student can easily get to different parts of the classroom. Seating should allow for easy entry and exit for a child using a mobility aid, but this does not mean that the child should always be seated near the exit.
Ensure there is clear space for the person using the mobility aid/wheelchair to move about freely and turn. This may mean moving the classroom furniture around.
The teacher can adopt student-centred seating arrangements such as round, U-shaped and study group type. The student-centred seating is beneficial for all students, including students with cerebral palsy, because it facilitates interaction between the students as well as with the teacher.
While making the timetable, the teacher can give students with mobility issues extra time to reach other classes during transition time. Teachers must understand that for reasons beyond their control, students with mobility impairments may be late to class as they may be unable to move quickly from one location to another.
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In certain activities, particularly those that involve moving around the classroom or group activities, ensure there is extra time for the person to complete a task or have their turn.
Ensure that short breaks are factored into planning for longer classroom activities since the child may tire easily.
Ensure that stationery and other classroom items are easily accessible.
Provide assistance, when requested.
Teachers should make sure a suitable amount of light is available. Ensure there is sufficient ventilation and suitable temperatures for concentration.
The classroom should be rich in reading and writing materials that the child with cerebral palsy can also manipulate to enhance the skills in question. This includes the classroom display. Allow visual aids to remain posted.
Seat the student so that s/he can see the material presented visually and is away from visual and/or auditory distractions.
Consider seat placement next to helpful peers.
Face a student with a hearing impairment when speaking.
Learning material should be within reach of all learners, including the wheelchair users.
Fixing papers to the table with clips or tape so that they do not move or fly away with the child’s movement.
Providing a weighted bracelet for the child to wear on the wrist to decrease tremors while using the hand.
Adding Velcro rope or non-slip mats under items which have a tendency to slide; for example blocks, plates, glass.
Placing rubber strips or pads under the material kept on the table such as pencil boxes and calculators to prevent them from slipping.
Attaching a string to materials so they can be easily pulled by the child.
Placing a wedge on the table to position the notebooks at an incline.
Using head page turners.
Using a book or magazine stand for children unable to hold book at an angle.
Using head pointers (see below).
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Making Inclusion Work
3.5 Other Accessibility Areas To ensure that daily living activities for the child with cerebral palsy are well supported by the school, teachers and school staff can:
Provide an accessible washroom/toilet
Assign classrooms close to an accessible washroom/toilet
Provide or allow the use of personal care attendant to assist the person
Schedule classes to allow extra time for activities of daily living
Daily use devices,30 including adapted cutlery and toileting aid, should be utilised as well.
Source: Sambhav Resource Center at AADI
4. Strategies to Include Children in Sports Children with cerebral palsy need to have fun and enjoy sports like other children. Thus, as with all other areas of school life, it is important that students with cerebral palsy are given the opportunity to participate in sports and physical education together with the rest of their peers. Active involvement in sports provides the unique opportunity to enjoy sports as either a participant or knowledgeable spectator throughout one’s life. School sports are not only a chance to be active, but also a social time where skills such as teamwork and leadership are learnt. With some preparation and activity modifications, a student with cerebral palsy can participate and achieve success during sports. Adaptive techniques and tools can enable children to participate in sports. Games can be modified to include children with cerebral palsy. Modified furniture, assistive devices and the use of adaptive technology will enable children to participate in sports and everyday games, including swings. Some pictures of adapted swings at AADI are shared below. The equipment used can be modified. Please note that when making/modifying equipment, check with the relevant educational authority with regards to safety requirements and guidelines. Children with cerebral palsy can be included and kept safe while taking healthy risks in sport activities. Consider the following points: 30 For more information see www.disability centre.ishtm.ac.uk
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Involve the student with cerebral palsy in deciding how an activity can be modified, if they have difficulty with the skills required. Sometimes the child may just need extra practise at the basic skills, with consistent verbal prompts or hand-over-hand assistance to learn the actions of the sport.
Focus on the student’s abilities; the equipment used can be modified. For example, the ball can be stabilised (suspended or placed on a tee) or modified (consider size, weight, firmness); add extra grips to the handle of a bat/racket to make them easier to hold. Another example, is using abigger dice to play Ludo.
The movement in the activity can be modified so that it is harder for the able-bodied participants. For example, in the game Stuck in the Mud, running can be replaced with
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Making Inclusion Work
skipping; students can take turns being disadvantaged in some way, such as wearing a blindfold or tying their legs together.
Pair the student with cerebral palsy with a more able-bodied student who can assist them in carrying out the skill. For example, the buddy can push the wheelchair in a relay or race. Below is a photo courtesy of the AADI annual report 2014-15 of children playing kho kho, along with their peers on wheelchairs in a government school.
The space parameters or distances of an activity can be modified. For example, the field of play can be reduced for students who tire easily.
The rules of the game can be modified. In netball, for example, allow students more time to throw the ball.
The number of participants in teams can be changed to even out differing levels of ability. Change the scoring system by simplifying it or don’t keep score at all. Keep individualised scores/times for children so that they are competing only against their personal best.
If students tire easily, allow them to be referees or scorers for part of the game.
Consider the most appropriate piece of equipment for students to participate in. Will they find it easier being in their walker, standing frame or wheelchair?
Children inside the school can play computer games using assistive technology and virtual games.
ACTIVITY Train games31 zz
Divide participants in groups of 3.
zz
Participants form a train.
zz
An equal number of people or more will become loose carriages (individuals).
zz
These carriages spread out and need to find a chain/train.
zz
When they do, the engine (lead individuals) leaves to join another train.
zz
People using wheelchairs or any other mobility aid can be part of both groups.
Special Games are only for people with disabilities. If available, participation in various sports can be encouraged: zz
Adapted sports are becoming popular among persons with cerebral palsy. These include wheelchair football, basketball, handball, and table tennis.
zz
The Cerebral Palsy International Sports and Recreation Association (CPIRSA) organises events for persons with cerebral palsy in alpine walking, athletics, cycling, race running, power lifting, table tennis and winter sports, including skiing.32
31 Adapted from Best Start: Inclusive Schools Project, Irish Wheelchair association. 32 For more information see www.cpirsa.org and http://specialolympicsbharat.org/
40 | Toolkit for Master Trainers in Preparing Teachers for Inclusive Education for Children with Special Needs
Skill development events, like the Abilympics,33 include activities such as embroidery, painting, needlework, etc. The curriculum for such activities is available on the Special Olympics website.34
Suggestions for School Trips Excursions or trips are an important part of school life. To ensure that students with cerebral palsy will be able to take part in a school excursion safely and successfully, careful thought needs to go into planning them. It is important to involve the student’s family in these discussions. Factors to consider: zz
Transport: are they able to travel with other students in the school bus?
zz
Can their equipment be transported safely?
zz
Access around the site: Are Is
there stairs, rough ground or steep slopes?
it wheelchair accessible?
What
form of mobility aid/s available to the student is/are the most suitable: walking sticks/ frame, manual wheelchair or powered wheelchair/scooter?
Are
disabled toilet facilities required and available?
zz
Does the student require individual supervision or can they be supervised as part of a group of students?
zz
Does the student have an adequate expressive system and/or identification to communicate with unfamiliar people; e.g., in case they get lost or are separated from the group?
zz
Does the student have their communication system with them?
Please do not be discouraged by this list. Well-planned excursions can be a wonderful time for all involved.
5. Accommodation for Writing Many students with cerebral palsy can develop excellent reading and spelling skills, but handwriting is often a problem. Case Study When Shirley joined the management college for her Bachelor’s in Business Administration, she realised that she needed to submit class assignments on a regular basis. It was essential for her to develop writing skills, so she purchased a laptop with soft keys and practiced operating it with her fingers. Through regular practice, she developed reasonably good speed. She downloaded material from the Internet and used it for her class assignments. She also started sharing this information with her colleagues and developed a library of her material. She also emailed her assignments to the faculty. As a result of these efforts, she completed her graduation with good marks. 33 A bilympic are vocational skill competitions for persons with disabilities to enable them to showcase and enhance their talent. Abilympic empower the contestants and help create public awareness about their abilities. http://www.abilympicsindia.org/ 34 Special Olympics ‘is a global movement of people who want to improve the lives of people with intellectual disabilities Through the power of sports, people with intellectual disabilities discover new strengths and abilities, skills and success… They also inspire people in their communities and elsewhere to open their hearts to a wider world of human talents and potential’. http://www.specialolympics.org/mission.aspx
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zz
Making Inclusion Work
As illustrated by Shirley’s experience, computers, the internet and other communication technologies can help. Teachers can also facilitate the learning process by providing accommodation to help students who struggle with writing.
Some useful guidance
If a child is able to write, provide proper positioning, allot extra time and ignore the quality of letters if they are legible.
If a child has very jerky writing and it is not legible, the child should be provided with the services of writers. Extra time should be provided for time-bound tasks. In many states, the service of a writer, who is one standard below such students, is provided. They are also provided 30 minutes extra for an examination lasting 3 hours.
Computers, laptops and tablets are another option now. Many schools have now started accepting soft copies of assignments and on-line examinations. With the assistance of an appropriate software and hardware, a child with cerebral palsy—like Shirley in the case study above—can conveniently use a computer for taking instructions, storing and retrieving information, accessing the Internet and using information technology for communication.
For children who have problems with writing, they can use recorded material and provide feedback or submit homework in recorded format. Most organisations working with people with visual impairment make recorded material of school and college textbooks readily available. Standard recorder material may be used. The children should be encouraged to record class lessons using recording machines, mobiles or any other recording devices.
For children with visual motor problems, the teacher may assign a dedicated homework partner or a note-taking friend who may make copies of these notes for children with cerebral palsy.
The teacher should provide extra time to enable the students with cerebral palsy to take notes or to dictate notes with the help of a writer or note-taker.
Provide a copy of the instructor’s notes or outline.35
35 http://web.richmond.k12.va.us/Portals/47/assets/Accommodations_and_Modifications_Guide.pdf
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Module 3 : Including Children with Cerebral Palsy
Example of grip aids and slant board.
Use writing and grip aids. Use a triangle pencil grip for better control, use a weighted pencil, vary the length and thickness of pencil, vary the writing implement (crayons, coloured pencils, fine markers).
Slant board (writing on an easel stand).
Put something textured (such as fine sandpaper) under the paper.
Provide various sizes of wide-ruled paper; gradually decrease size.
Purchase raised-line paper
Apply thin lines of glue over lines to make a raised edge when dry
Use a straight edge for writing
Skip every other line on paper
Enlarge assignment on a copier to make fill-in blanks larger
Use mounted scissors and paper holder for cutting
Highlight or outline areas to be filled in
Provide small mailing labels already typed with the student’s name
Reduce the amount of writing/pencil work required
Allow additional time for writing
Provide close-up model to copy from instead of board or overhead screen
Place an alphabet strip on desk if student has difficulty forming letters
Label maker for taking spelling tests
Recorder for giving oral answers that are later transcribed to paper
Partner to take dictation; i.e., someone else writes as student talks
More expensive accommodations include a digital notepad and computers with voice recognition capabilities:
Unit III: Creating Enabling Environments | 43
Making Inclusion Work
Teachers should remember that a child’s position is important for writing and it is important for the student to assume a variety of positions throughout the school day in order to prevent tightening of muscles. The teacher needs to organise a variety of appropriate measures to ensure that proper positioning can facilitate eye-hand coordination and improved motor control. From the gutter of my defeated dreams you pulled me to heights almost your own-from Christ Brown ‘The Life that inspired my Left Foot’ Christy Brown was born in 1932. He was a famous Irish painter and poet who had cerebral palsy. Having been dismissed as ‘mentally incapable’ by doctors in his childhood, Christy realised that he could use his left foot to hold a chalk and make marks. He had impaired speech and his mother was convinced he could be taught to read and write. She helped him learn to speak, read, and write, and he grew up to become a famous writer. His autobiography, My Left Foot, was made into an award winning film by the same name. Even though Christy had cerebral palsy, the condition did not stop him from improving his abilities and fulfilling his potential as a writer.” http://www.everydayhealth.com/healthy-living-pictures/sevenfamous-people-with-cerebral-palsy.aspx#07
6. Other Assistive Devices and Adaptive Equipment Assistive or adaptive technology is the name for a device that helps to increase, maintain or improve functional capabilities of individuals with disability or impairment. This technology offers a variety of choices to individuals to enhance their quality of life, their performance of activities and extent of independence. Aids developed should be supportive and enabling to meet the specific needs of individuals.
6.1 Computer and Technology Assisted Instruction Computers are an important type of assistive technology because they open up so many exciting possibilities for writing, speaking, finding information or controlling an individual’s environment.36 The computer is a blessing for people with limited speech, muscle coordination and finger movements. Computers and devices such as mobile phones, tablets and laptops enable the individual to access information and communicate. They also enable the trainer or caregiver to use the devices for giving instructions. These devices, with appropriate software, hardware and accessories, could be used for two-way communication, information storage, access to information and using AACs. Individual Communication: Once a student with cerebral palsy is enabled to operate the keyboard by using a wrist- mounted or head ring-mounted hammer device, then s/he can conveniently access the computer, and use the internet or other programmes. The cordless mouse, cordless keyboard, (see examples below) soft touch operated keyboard, smart screen, touch screen, and voice-activated screen are newer devices which enable a student with restricted movements to use computers. Once a student can operate a computer or other devices, they can access the internet and have an entire world of communication at their fingertips. The picture below shows how furniture modification (in this case a table cut out) can provide postural stability for the child using the computer. 36 For more information see www.computers-technology-cerebralpalsy.com
44 | Toolkit for Master Trainers in Preparing Teachers for Inclusive Education for Children with Special Needs
Computer-assisted classroom instruction: Computers or other devices can be used for classroom instruction. The use of special software which read screens, use synthesised speech or have speech recognition, and spell check and a thesaurus can be of immense support to children with cerebral palsy. Computers can also be used for testing, using both essay type and multiple choice questions with provision for instant evaluation.
7. Collaboration for Working Effectively with Children with Cerebral Palsy Every teacher needs the support of parents and other teachers, as well as specialists, such as a medical doctor, physiotherapist, and special education resource teachers to ensure that the unique needs of every student with cerebral palsy are adequately addressed. For example, there may be a requirement for assessment of physical aids (e.g. mobility devices, orthosis and assistive devices) and educational devices (e.g. adapted pencils and computers) to be provided. The type of support each person requires will vary. The focus of working together is to find optimum ways to support each child to reach the highest possible level of independence. If the student is receiving physical, occupational or speech/language therapy, specialists working with the child can give the teacher ideas on how to reinforce motor and speech development in the classroom. Resource teachers can advise the teacher on how to work with the various recommended aids and equipment and support the teacher in planning for effective instruction and learning environment. Regular meetings with people in this broader support network are critical to establishing communication channels that will ensure that the teacher does not feel isolated and can quickly find answers to questions about a child’s learning and social needs.
Some useful guidance
Meet with student and parents to discuss how the school can support a student’s needs related to cerebral palsy.
If the student is taking medications during the school day, discuss possible side effects with the parents.
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Module 3 : Including Children with Cerebral Palsy
Different types of computer mouse and wireless keyboard
Making Inclusion Work
Learn as much possible about how cerebral palsy may affect learning and social and emotional well-being.
Arrange for any equipment or classroom modifications that might be needed, as recommended by a specialist. This may include accommodations for mobility equipment (e.g., wheelchairs, standing frames and walkers), supportive seating, supportive toilet seats and/or mechanical lifts.
Determine if any changes to school timetables or schedules will have to be made to accommodate the student’s equipment and/or travel time from class to class.
Develop a system for sharing information with relevant staff members about the student’s condition and successful strategies.
Explore and promote the use of accessible education devises such as computers.
See also Unit IV on “Collaboration, Convergence and Teamwork” in Module 1: Inclusive Education.
ACTIVITY Making inclusion work for Manoj Instructions: 1. Divide participants into 4-5 groups. 2. Ask them to read the case study about Manoj and discuss the following questions: zz
What environmental barriers does Manoj face in school?
zz
If you were Manoj’s teacher, what steps would you take to support him?
zz
Do you think Manoj’s school is inclusive? Give reasons for your answers.
Case Study Manoj is an 8 years old boy who loves Hindi movies. He lives in a rented house in a slum in Patna with his three sisters. He is the eldest and has cerebral palsy. His father is a daily wage earner and supports the entire family. According to Manoj’s mother, he had seizures after his birth and did not develop like other children. He continued to have seizures and though he learned to talk very early, he was not able to walk and uses a wheelchair which an NGO has provided to him. He has been attending the nearby municipal school and the sisters push him to school everyday. The teacher is very fond of Manoj and says that he is one of the brightest students in her class. However, he has very few friends and cannot participate in assembly and sports. He also has difficulties accessing the school toilet.
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Unit IV: Curricular Transaction and Pedagogic Strategies
Table 5: Overview of Unit IV OBJECTIVES
METHODOLOGY
EXPECTED OUTCOMES
Unit IV: Curricular Transaction and Pedagogic Strategies 1. To gain practical knowledge of modifying teaching– learning process for effective teaching of students with cerebral palsy 2. To develop educational plans to optimise the learning of the students with cerebral palsy 3. To gain experience and training in preparing teaching- learning materials related to the contents of the educational plan
Simulations, brainstorming, discussions, presentations and demonstrations with samples
At the end of the unit, teachers will be able to: yyAssess the current level of student’s performance yyUnderstand curriculum adaptation and ways to develop it yyLearn teaching strategies for children with cerebral palsy in an inclusive environment yyTransition plan for children with cerebral palsy yyUnderstand the importance of evaluation and ways to evaluate the learning achievements of children with cerebral palsy
This unit provides an understanding of how to develop and apply strategies that are in tune with the learning characteristics of a child with cerebral palsy. It also combines strategies aligned with universal methods of learning that can be extended to all students. Therefore, the transactions are very inclusive. The resources and materials mentioned are safe, simple and cost effective, and can be used by all students in the class. The cerebral palsy-aware teacher will Develop an interest in and understanding of cerebral palsy Collate information profiling the child’s cerebral palsy and its implications for teaching Plan strategies for teaching, focusing on the child’s communication, social and behavioural needs,
and for providing access to the classroom curriculum Involve parents
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Making Inclusion Work
1. Assessment Children with cerebral palsy are an extremely heterogeneous group with unique strengths and abilities. There is no “typical” child with cerebral palsy. This implies that the teacher must acquire the skills to assess each child’s individual strengths and learning needs, as well as learning styles to help select and plan for appropriate approaches, materials, activities and environment to meet individual needs. The teacher should utilize both formative and summative assessments. A formative assessment can be thought of as an assessment for learning and a summative assessment as an assessment of learning. The purpose of the former is to improve achievement and support learning, while the purpose of the latter is to measure and verify learning. Undoubtedly, the special educator, psychologist, doctor and physiotherapist may all provide vital support to diagnose the child with cerebral palsy with associated conditions, such as sensory loss and epilepsy, and provide the necessary assistive devices. However, it is the teacher who must be in a position to systematically collect and then use information about that student’s level of achievement and/or development across various domains. An Individualised Educational Plan (IEP), developed in collaboration with a special educator and therapist, should detail information on the child’s diagnosis and her/his key interests, aspirations and strengths. Ten students with cerebral palsy may well present ten radically different profiles of instructional and therapeutic needs. The assessment must include listing the child’s present level of performance in various subject areas. A teacher should collect evidence about the development of a child with cerebral palsy development in the following areas:
Personal, Social, and Emotional
Communication, Language and Literacy
Mathematical Development
Physical Development
Knowledge and Understanding of the World
Creative Development
It is critical that the assessment process is not aimed at identifying deficiencies in the student, but rather viewed as a process to inform instruction. Therefore, the assessment needs to be an on-going and holistic affair to ensure effective planning to meet the student’s changing profile. It is exceedingly important that the tasks given for cognitive assessment take into account the physical limitations of the student, so that a lack of writing skills or clear oral response, due to dysarthria (or difficult or unclear articulation of speech), are not mistaken for intellectual impairment. In cases where children may have difficulty writing or in giving verbal responses, a writer, AAC board or other appropriate means of communication must be provided to make a proper assessment of the child’s level of development. Methods of Assessment: Teachers must not view assessment as a one-off event in which classroom life stops to conduct an assessment. Assessment is a continuous process which involves reflecting upon and interpreting events and activities in the classroom as they happen, requiring the teacher to undertake diagnostic teaching. In short, assessment requires that a teacher seek relevant information and modify an instructional strategy accordingly. Teacher observation is one of the most powerful means of gathering and recording relevant information about a student’s current level of functioning, as well as monitoring their progress.
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Anecdotal records are factual, non-judgmental notes of children’s activities. They are useful for recording spontaneous events. Portfolio Assessment: One method of authentic assessment is to create and review a portfolio of the child’s work. A portfolio is a record of the child’s process of learning; that is, what the child has learned and how s/he has learned it. Each portfolio entry should be dated and the context of the piece given. An example of how the context might be stated would be: “This was a piece of creative writing done by Sheela, with the support of a writer.” Continuous Assessment: Continuous assessment refers to making observations periodically to find out what a student knows, understands and can do. Specific tasks are given to the student based on what has been taught. By observing the learner, the teacher is in a position to understand what the student has learnt. By using continuous assessment, the teacher can adapt their planning and instruction to the needs of the student with cerebral palsy, ensuring the child’s success. By implementing a comprehensive, continuous assessment, supported by regular observation and portfolio assessment, the teacher can make sure that every learner with cerebral palsy is included academically and socially. For more on assessment in an inclusive classroom, see “Understanding the child’s needs and ways of providing support” in Unit II of Module 1: Inclusive Education.
ACTIVITY How do you assess? Instructions: Ask participants to discuss the following questions: zz
What does the word “assessment” mean to you?
zz
How is assessment carried out in your classroom?
zz
Do you think it is appropriate for assessing students with cerebral palsy? Why or why not?
Domains of Assessment: Like their peers, children with cerebral palsy have specific learning strengths and weaknesses. Three areas describe student learning strengths and needs: academics, social-emotional development and physical development. It is important to keep in mind that a student’s performance in school is the result of an interaction between the student and the instructional environment. Consequently, what happens in a classroom can either minimise—or magnify—the impact of students’ special needs on their learning. Problems in any one of these areas may prevent students from meeting classroom requirements, resulting in a need for adaptations. By analysing students’ learning needs and the specific demands of the classroom environment, teachers can reasonably accommodate most students with special needs in their classrooms. The teacher must, therefore, check for the level of functioning of the student with cerebral palsy in the following areas: reading, writing, math, basic language, social-emotional development, and physical, sensory and perceptual development.
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Module 3 : Including Children with Cerebral Palsy
During systematic observation, the child may be observed while working alone, in pairs, in small groups, at various times of the day and in various contexts, such as the playground or assembly.
Making Inclusion Work
1.1 Assessment of Reading Skills Although, many students with cerebral palsy may have very good reading skills, for some sensory issues and associated learning difficulties may cause reading difficult. You can use these informal guidelines to assess reading ability. Does the student:
Turn the pages of a book, one at a time?
Look at the pages from left to right and top to bottom?
Identify common logos, such Colgate, Nirma, Parle G, Pepsi, etc.?
Identify letters of the alphabet in upper and lower case and the Varnamala?
Associate sound to letters of the English alphabet, especially the lower case?
Blend phonemes to read unfamiliar CVC (consonant-vowel-consonant) words?
Use phonic knowledge (e.g., initial letters) to attempt longer unfamiliar words?
Read simple sentences independently?
Read sentences and answer what, where, who, how and why questions?
Use pictures to read a simple story silently and state its main idea?
1.2 Assessment of Writing and Related Issues An assessment of basic handwriting should include observations of execution, legibility and speed of writing. Execution includes correct and consistent pencil hold, posture and letter formation. The tripod grip over the pencil, sustaining the grip along with movement and maintaining certain stamina of writing have to be assessed. The directionality to form letters is also important. For instance, young children may draw a letter such as m using separate strokes, starting from the right side of the letter. Forming the letter by beginning on the left side, without lifting the pencil from the paper, is much more conducive to building the eventual speed of writing. Legibility involves the readability of letters, as well as spacing within and between words. Speed is important as children advance beyond the early grades so that they can use writing efficiently in a variety of tasks. If children have learned both manuscript and cursive, as is often the case with older youngsters, then assessment should consider the execution, legibility, and speed of both forms of writing. Expressive writing greatly depends on the language skills of the student. Narrations, descriptions and essay writing involves two skills: expressive language and formatting of the written content. Students with cerebral palsy may have difficulty formatting an answer, essay or narration, due to organising difficulties mentioned earlier. The assessment should cover the following observations and understanding of the concept of: introduction, main body of the content, and summarising.
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The basic math assessment refers to the numeral sense of the student in the primary classes, including:
Pre-math concepts: big and small, full and empty, more and less, long and short, far and near, fat and thin
Number identification: recognition of numerals by the numeral names
Ordering and sequencing of numbers: missing number, what comes after, what comes before
Quantity discrimination: greater and less, seriating numbers in ascending and descending orders
Number concept (value): counting, answering to how many?
Place value
Basic operations: written, as well as mental math
Additions with/without carrying over
Subtractions with/without borrowing
Statement sums
Similarly assess with multiplication and division
Time: names of the days of the week and the months
1.4 Assessment of Basic Language Skills Two basic types of language skills should be assessed: receptive and expressive. Receptive: includes understanding instructions, reading with comprehension and understanding tonal variations in speech of the teacher and peers. Expressive: includes using speech, sign or writing to express self-needs, feelings and sharing. When oral language is assessed broadly, five components are usually tapped (Rathvon, 2004): 1. Phonology: discriminating between and producing speech sounds. 2. Semantics: understanding word meaning. 3. Morphology: using and understanding word formation patterns that include roots, prefixes, suffixes and inflected endings. 4. Syntax: using correct phrasing and sentence organisation. 5. Pragmatics: using language to communicate effectively.
1.5 Assessing Social-Emotional Development Students’ social-emotional development involves classroom conduct, interpersonal skills and personal-psychological adjustment. Due to associated difficulties, such as communication challenges, the interpersonal skills of children with cerebral palsy, including initiating and carrying on conversations, coping with conflict, and establishing and maintaining friendships, may be affected. These skills have a huge influence on school adjustment and students lacking in peer support may feel isolated. This, in turn, may lead to a poor self-concept, affecting key motivational areas of self-image, frustration tolerance and proactive learning.
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1.3 Assessment of Math
Making Inclusion Work
1.6 Assessing Physical, Sensory and Perceptual Development It is important to get a good assessment of the student’s physical, sensory and perceptual functioning, including fine and gross motor skills, vision and hearing levels, and neurological functioning. If a child with cerebral palsy has a visual impairment, the teacher will need to determine how best to present material. Similarly, an understanding about a student’s attention difficulties can provide information regarding approaches to instruction. Positioning: Since proper positioning is especially necessary for reading and writing, position assessment is equally important. A particular student’s visual and perceptual impairments may require that reading material be placed at an optimal distance and angle. Some questions to help elicit information about the concerns in the area of seating and positioning include:
When does the student exhibit good/poor positioning?
Does the student lean in a certain direction?
Does the student hold their head, arms or other parts of their body in a certain way?
Does the student have positioning issues all day or just at certain times?
Where does the student have good/poor positioning?
Does the student express issues or concerns about their position?
Does the current seating and positioning promote or interfere with any activities?
Does the student have safety issues with regards to seating and positioning?
Are there barriers to seating and positioning within various locations around the school?
Important considerations when assessing children with cerebral palsy zz
Provide accommodations and/or alternatives to purely motoric responses. Since many children with cerebral palsy may have difficulty with fine motor tasks, such as completing a form board or writing, teachers need to provide alternatives to these tasks. If the child is verbal, s/he may provide options through vocalisation, while the teacher may complete the task.
zz
Alternatives to speech are needed because children with cerebral palsy often have articulation and speech difficulties due to poor control of facial and respiratory muscles. For those children who have no functional speech, the teacher needs to keep verbal responses from the student to the minimum, using objective type questions that need a yes/no response, or a multiple choice or true/false options to questions. In some cases, it may be necessary to use AACs.
ACTIVITY Assessing children with cerebral palsy Instructions: Divide participants into 4-5 groups and ask them to discuss in small groups how they would plan to undertake an assessment of Aarti an 8 year old child with cerebral palsy joining Grade 2 and a 14 year old boy Keerath joining Grade 8. Each group would share the areas of assessment that would be needed as well as educational goals they might suggest, based on their assessment.
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Systematic and effective instruction is good instruction. It is when specific learning objectives and procedures are clearly articulated. The instruction is relevant, accessible and responsive. The tasks are interesting and challenging, but reachable with effort. Students with cerebral palsy and other disabilities benefit from good instruction, just like any other student. It is critical that the students with cerebral palsy are not perceived as less competent, and taught through teachercontrolled and technique-driven methods that all too often induce the very inattentiveness, memory difficulties, low motivation and behavioural disruptions associated with the characteristics of students with disabilities (Gallagher, 2004). It is critical that teachers understand that disability is a result of the interaction between the individual and the environment. By critically reflecting on potentially disabling and restrictive aspects of their pedagogy, and challenging common assumptions about the learning characteristics of students with cerebral palsy, teachers could create the foundation of effective instruction. As pointed out by Thomas & Loxley (2001), effectively differentiating instruction in heterogeneous classrooms is a powerful tool that enables teachers to create inclusive schools and classrooms within which all children can be valued equally, treated with respect and provided with real opportunities at school. Refer to Annexure 7 “A framework for Adapting Curriculum” in Module 1: Inclusive Education. The module also includes explanation on adaptations and accommodations
Scaffolding: An effective teacher scaffolds to help the student move from what s/he already knows to new learning. Scaffolding instruction is “the systematic sequencing of prompted content, materials, tasks, and teacher and peer support to optimize learning.” (Dickson, Chard, and Simmons, 1993, p. 12)With appropriate scaffolding, or support, a student will be able to accomplish tasks that would otherwise be impossible to accomplish independently. Teaching readers who are facing difficulties requires that the teacher be constantly aware of “where students are” and “where they need to be”. Instructional support, or scaffolding, is temporary and should be taken away as soon as a student is able to perform a task without help. Strategy instruction: Successful learners tend to use an array of strategies to solve problems and mediate their own learning. Some students, however, may lack knowledge of effective learning strategies or may require guidance to develop self-regulatory skills. Teachers can provide such students with an outline of the critical steps in a task or process and how they should sequence or integrate these steps, via strategies or action plans that highlight efficient and effective ways to perform complex tasks, such as composing a passage. Providing students with explicit instruction in how to learn enables students to become more efficient learners.
Components of explicit strategy instruction
State process and content objectives.
Provide information about when and where to use the strategy.
Provide students with a rationale for using the strategy.
Provide students with a personal learning story related to strategy use.
Model using the “think aloud” strategy.
Provide students with guided instruction.
Provide students with evidence of strategy effectiveness.
Cue students for transfer and generalisation.
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Module 3 : Including Children with Cerebral Palsy
2. Systematic and Effective Instruction
Making Inclusion Work
Technology: The use of technology must be encouraged to support the student with cerebral palsy in participating in school activities, as well as to assist students in their assessment, depending on the characteristics of individual students. If you realise that a particular student with cerebral palsy is spending too much time and energy in writing and has the requisite fine motor competence and skills to use a computer, it is important to use technology to support the student. However, each student will require customised technology e.g. a computer with modified keys or those with visual impairment might require enlarged text. Low cost technology such as line magnifiers may also be used to enlarge a line of the text. Assistive technology can specifically address reading, writing and numeracy challenges. For example:
Word processing can address fine motor difficulties and reduce messy work.
Spell-checking tools can reduce some spelling difficulties.
The ability to place graphs and charts in assignments allows students to produce better quality assignments, reinforcing the value of published writing.
Cut-and-paste features in word processors allow students to manipulate text easily when editing, saving valuable time and effort.
Teachers may also consider supporting children with fine motor coordination difficulties that e.g. may not allow the student to hold and turn pages of a book. In such a case, a tape recorder or CD player with audio books will enable learners to listen to text (Edyburn et al, 2005).
2.1 Universal Design of Learning The Center for Applied Special Technology (CAST) applied the universal design concept, which originated in the field of architecture, to curriculum materials and instructional methods. The Universal Design for Learning (UDL) framework in curriculum establishes challenging, yet attainable goals for all students, and provides a flexible instructional design to give learners a variety of ways to access and process information and demonstrate what they have learned. It allows the curriculum to become accessible to a diversity of student by virtue of the variety that has been designed into what students will learn. (The result is “the design of instructional materials and activities that allows the learning goals to be achievable by students with wide differences in their abilities to see, hear, speak, move, read, write, understand English, attend, organize, engage, and remember.” (Orkwis & McLane 1998, p. 9). Annexure 5 on “What is Universal Design” in Module 1: Inclusive Education provides a fuller description of Universal Design for Learning.
As noted on the CAST website, the UDL framework promotes access to learning through multiple means of representation to give learners various ways of acquiring information and knowledge, expression to provide learners alternatives for demonstrating what they know, and, means of engagement to take advantage of the learners’ interests, offer appropriate challenges, and increase motivation. Much of the current literature on universal design for learning has focused on elementary and secondary education. However, these approaches to universal design open doors to increased educational possibilities for children of all ages.
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Differentiated Instruction (DI) is the process of “ensuring that what a student learns, how he/she learns it, and how the student demonstrates what he/she has learned is a match for that student’s readiness level, interests, and preferred mode of learning.” (Tomlinson, 2004, p. 188) When universal design strategies are combined with DI, a teacher can differentiate content (what each student specifically learns), processes (how each student learns) and products (what the student produces as evidence of learning). In addition, teachers can take into account and differentiate according to students’ current abilities, their interests and ways they learn best – i.e., learning style or multiple intelligences that are stronger for a student (Gardner, 1983). Teachers who use DI expect students to bring a variety of experiences, abilities, interests and styles to their learning; acknowledge that these affect students’ performance in the classroom; and address this natural diversity when planning and delivering rigorous and relevant, yet flexible and responsive, instruction. DI can be incorporated into the lesson plan through differentiation at the level of the lesson, task and activity – at the interface between the proposed curriculum and the learning needs of individual students. This implies adjusting tasks to the various interests, needs, aptitudes, experiences and previous achievements of diverse groups of pupils (Byers & Rose, 2004). This entails careful consideration of:
Content: allowing learners work on various aspects of the same subject matter;
Interest: ensuring that activities have relevance to pupils’ own experience and sources of motivation;
Level: enabling pupils to work on similar concepts at levels that reflect their previous achievements;
Access: so that material is presented to learners through various modes, whether aural, visual, tactile, concrete, symbolic, linguistic or via information technology;
Structure: whereby work may be presented; for example, in small, developmentally sequenced, subject-specific steps for some learners and in conceptually holistic integrated chunks for others;
Sequence: allowing learners access to material in varying orders, which may be planned in advance, taking into account learner characteristics and preference;
Pace: encouraging learners to work through material at varying speeds;
Response: acknowledging that learners will respond to similar activities in a variety of ways, either because the teacher has planned to request different outcomes from different individual learners or because learners spontaneously respond in different ways;
Teacher support: allowing individual learners different amounts and qualities of staff support, varying from intensive one-on-one input, through pauses permitting delayed responses;
Teaching style: ensuring that learners experience a range of approaches to teaching from didactic classroom presentations, through experiential field work;
Learning style: giving learners opportunities to respond to teaching in a variety of ways, whether by listening passively, participating actively in explorations or solving problems;
Grouping: offering a balance of individual, paired, group and whole class/ school learning experiences.
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2.2 Differentiation Instruction and Lesson Planning
Making Inclusion Work
Effective Systematic Instruction The ultimate success of an inclusive programme depends on the systematic implementation of efficient and effective instructional strategies. When teachers effectively differentiate instruction – constantly assessing students’ understandings, teaching responsively, and enabling students to demonstrate competence in varied, meaningful ways – students with and without disabilities can participate successfully as full members of heterogeneous inclusive classrooms. It is through direct and indirect instruction that the acquisition, generalisation and maintenance of targeted outcomes is realised. It is important to emphasise the concept of systematic instruction, since instructional strategies must be well planned. Drill and Repetition: Some students with cerebral palsy may need a lot of practice to generalise skills, so games that use math or reading skills will motivate children to use those skills across more social settings. Social Skill Training and Practice: Many children with disabilities such as cerebral palsy have difficulty with social interactions. Board games support waiting, turn taking and even losing gracefully, which all children struggle with. Games can even be adapted to support specific social skills, such as incorporating rules to a board game; e.g., saying ‘thank you’ every time someone passes you the dice. Peer Mediated Instruction: All children learn skills (academic and social) from peers. Games challenge stereotypical notions related to disability and can build positive peer relationships. Games are an effective tool to support instruction for all children, including children with cerebral palsy. A few games that are very popular and can be adapted are:
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Vocabulary Building Bingos: Children cover pictures of animals or items in other categories to build receptive language.
Math Fact Bingo: Call numbers and have students cover matching math facts; i.e., call “12” and students can cover 2 x 6 or 3 x 4.
Number/Alphabet Recognition Bingos: Customise the range of numbers and alphabets used for Bingo (see example below). Children with poor fine motor control can use adapted counters with handles.
Board Games: Teachers can build a board game based on the concept they will teach. The best games are those that are simple and can be adapted to support specific student needs;
ACTIVITY e.g., large dice or an adjustable spinner.
Exploring inclusive teaching and learning approaches 1. Divide participants into 4-5 small groups 2. Ask teachers to read the case study about Archana Case Study A social science class is going on in class 4 in a rural, government school. The topic is transport. The objective, as per the teacher’s unit plan, is to help children recognise different means of transport. There are nearly 35 children in the classroom, including Archana, a
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Module 3 : Including Children with Cerebral Palsy
Bingo: All children enjoy Bingo because it does not require too many rules, and since everyone plays through every game, it scores well on the engagement scale. The game requires that everyone listens, and teaches them how to identify the numbers, words or pictures on the card, place a cover on the squares or point to the chosen square and recognise the pattern of covered squares. Bingo can be adapted in many ways to reinforce what is being learned in class. For example:
Making Inclusion Work
student with cerebral palsy who uses a wheelchair and an AAC board. The classroom has been divided into two groups and each one has a toy vehicles and flash cards with pictures of means of transport used on land, water and air. The teacher asks the children in each group to divide the flash cards according to those used on land, water and air. Then she asks the children to show through action or enact how different types of transport move. She asks children which of these modes of transport they have used and where. She narrates a story about a child living in an abandoned railway carriage and his dreams of travelling around the country. In the end she writes the names of the different modes of transport on the blackboard. She then asks children to match the words written with the picture flash cards. The teacher encourages every child to come to the board for this activity and asks others to either write or draw a picture of what is written. Instruction: 3. Ask them to work in their groups on the following: zz
List out the different steps the teacher used in teaching
zz
What type of teaching methods did the teacher use?
zz
How did she get all children to participate?
zz
What type of resources did she use? Was it useful for all children, including Archana?
zz
What further recommendations would you suggest for the teacher to include Archana?
zz
How did she know if all the children had learned?
4. Ask each group to present their work to the whole group.
2.3 Classroom Environmental Considerations The classroom environment significantly influences what students learn. Identifying and analysing classroom requirements allows teachers to anticipate or explain problems a specific student with cerebral palsy might experience. Once this is analysed, the teacher is in a position to suitably modify the environment. Common classroom demands relate to classroom organisation, classroom grouping, and instructional materials methods. Classroom Organisation The ways in which a teacher establishes and maintains order in a classroom are referred to as classroom organisation (Doyle, 1986). Classroom organisation includes a number of factors:
Physical organisation, such as the use of wall and floor space and lighting
Classroom routines for academic and non-academic activities
Classroom climate or attitudes toward individual differences
Behaviour management, such as classroom rules and monitoring
The use of time for instructional and non-instructional activities
(Friend & Bursuck, 2006) Effective teachers structure the classroom environment by increasing student engagement and providing opportunities for student success, thus decreasing the likelihood of disruptive student behaviour. It is imperative that teachers explore the classroom environment to check for barriers to participation and access. As mentioned earlier, aisles should be clear and wide enough to be wheelchair accessible, materials should be accessible, and blackboard, charts and bulletin boards should be at eye level.
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zz
Creating a physical arrangement that eases movement, including for students in wheelchairs
zz
Making materials accessible with charts and blackboard visible to all students
zz
Minimising visual and auditory distractions
zz
Making efficient use of classroom time
zz
Ensuring positive student interactions
zz
Setting rules in collaboration with students, to communicate behavioural expectations as well as consequences for breaking rules
2.4 Instructional Accommodations for Students with Cerebral Palsy Instructional accommodations are typically defined as services or supports provided to help students gain full access to class content and instruction, and to demonstrate accurately what they know. Based on assessment in academic, social-emotional and physical domains mentioned earlier, the teacher will need to make requisite adaptations to meet a student’s specific needs. Teachers effectively differentiate instruction by constantly assessing students’ understandings, teaching responsively and enabling students to demonstrate competence in varied, meaningful ways. For example, in the case of students who may have difficulties in expressive and receptive language, the teacher may undertake accommodations such as:
Give students more time to respond verbally since it takes them longer to process oral language
Give students more time to complete written assignments, since they will take more time to express their thoughts on paper
Provide clear and concise instruction; pictorially, if needed
Encourage students to paraphrase instruction
Use co-operative learning methods in the classroom to encourage peer collaboration
Use a multi-sensory instructional approach (Visual-Auditory-Tactile-Kinaesthetic VAKT)
Provide a rich language environment with ample opportunities for children to listen and talk in small groups and pairs
Use demonstration and modelling to convey concepts to students
3. Instructional Strategies to Support Early Reading Reading is a complex process that requires many interlocking skills and processes to work together. These interlocking skills and strategies are employed before, during and after reading. Extensive research has found that phonological and phonemic awareness, vocabulary, reading fluency and reading comprehension are all important elements in teaching children to become proficient readers. As the figure below illustrates, focusing on any single element is not sufficient to comprise an effective reading programme. All elements need to be taught systematically and explicitly through a balanced approach for students to have the opportunity to become proficient readers who can gain knowledge from print.
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Effective classroom structuring takes into account:
Making Inclusion Work
adapted from Bos & Vaugh (2002)
Some approaches have been found to be promising when used with learners with severe speech and motor impairments. These include approaches such as language experience, literature-based, whole-language, basal and direct instruction. These can be divided into two major categories: whole-language and phonics approaches (Heller 2005).
3.1 Whole-Language Approach Whole language approach is considered a philosophy by many scholars and is often used interchangeably with whole language experience approach. In the whole language approach, the meaning of the text is dependent upon the background knowledge and understanding that the reader brings. It promotes reading and writing through the use of personal experience and oral language. It is based on the notion that learning to read is like learning to speak (Heller 2005). The Language Experience Approach (LEA) to reading instruction is based on the central principle to use a student’s vocabulary, language patterns and background of experience to create reading texts, making reading personal and meaningful. This approach involves three steps: Step 1: The teacher and student discuss an experience in which the child has participated. The discussion leads to developing language and vocabulary. Step 2: As the student formulates and expresses ideas, the teacher guides student in creating a dictated account. Step 3: Teacher writes the sentences in the child’s language and creates a personal book that is composed by the student and therefore easily comprehended. For children with cerebral palsy, this method is particularly useful, since it motivates children to get interested in reading. This method encourages children to express and discuss issues of interest and to build their own stories, based on pictures and drawings.
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Phonics instruction is reported to be a method that works well with learners with severe speech and physical impairments, if adapted and used with other approaches (Heller 2005). As a method in a classroom, phonics places great emphasis on reading precision, and children are encouraged to read the words exactly as they appear on the page. In using this approach, a child is exposed to individual components of words, the phonemes and graphemes, which help students develop an awareness of how language works and that oral language is made up of many parts. Hierarchy of Phonemic Awareness Skills To provide appropriate intervention, it is important to understand the hierarchy of skills involved in phonemic awareness. By singing songs, chanting rhymes, playing with words and listening to adults read word-play books, children develop their phonemic awareness. Students who do not develop this understanding will require explicit and direct instruction in phonics, beginning with grapheme- phoneme correspondence. Skills must be taught, beginning with simple skills and moving toward complex skills. These skills are:
Rhyme Recognition is the ability to identify whether a pair of words rhymes. For example, do pat and fat rhyme? (yes) Do fox and fairy rhyme? (no)
Rhyme Production is the ability to produce a rhyming word. For example, tell me a word that rhymes with “cat”, “dog”.
Alliteration Identification is the ability to identify the common sound in different words. For example, tell me the sound that is the same in baby, bark, and big (/b/).
Alliteration Discrimination is the ability to identify the word that has the odd sound. For example, tell me which word does not belong in bake, bug, and rat (rat).
Sentence Segmentation is the ability to identify individual words in a sentence. For example, clap for each word you hear in a sentence, “I love you”. The child should clap three times.
Segmenting Compound Words is the ability to identify big words that are made up of two little words. For example, clap one time for each little word you hear in this big word: “mailbox”, “snowman”.
Segmenting Words into Syllables is the ability to identify the number of beats or syllables in a word. For example, say a word and have the child clap one beat for each syllable: “cat” (1), “garden” (2), “dinosaur” (3), “dysfunctional” (4).
Blending Syllables is the ability to blend parts of words. For example, say “cup–cake” with a slight pause between the two words. Ask the child to identify the whole word (cupcake). Other examples are “pen–cil” and “hap–py”.
Segmenting Phonemes is the ability to identify the individual sounds in a word. For example, ask the child to say the word “cat” and place a block on the table for each sound in the word “c – a – t” (3), “f – l - a – g” (4), or “g – o” (2).
Blending Phonemes is the ability to blend phonemes or individual sounds in a word. Begin with two to three phonemes and progress to four. For example, say “g – o” or “s – oa – p” with a slight pause between each sound and ask the child to identify the word.
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3.2 Phonics Approach
Making Inclusion Work
Identifying the Initial Sound in a Word is the ability to identify the first sound heard in a word. For example, ask the child to identify the first sound in the word “time” (/t/).
Identifying the Final Sound in a Word is the ability to identify the last sound heard in a word. For example, ask the child to identify the last sound in the word “time” (/m/).
Identifying the Medial Sound in a Word is the ability to identify the middle sound heard in a word. For example, ask the child to identify the middle sound in the word “time” (/i/).
Deleting a Phoneme is the ability to manipulate the individual sounds of a word. For example, say the word “bat” and say it again without the /b/ (/at/).
Adding a Phoneme is the ability to add a sound to a group of sounds or to a one syllable word. For example, if you add the /b/ sound to /at/ you say “bat”. Add the /h/ sound to /it/ (“hit”) or add the /p/ sound to /op/ (“pop”).
Substituting the Initial Phoneme in a Word is the ability to change the first sound in a word. For example, say the word “cat” and then say it again with /b/ for /c/. You then have “bat” instead of “cat”.
Substituting the Final Phoneme in a Word is the ability to change the last sound in a word. For example, say the word “bit” and then say it again with /d/ for /t/. You then have “bid” instead of “bit”.
Substituting the Medial Vowel Phoneme in a Word is the ability to change the middle sound in a word. For example, say the word “bad” and then say it again with /u/ for /a/. You then have “bud” instead of “bad”.
3.3 Adapting Reading Materials for Students with Cerebral Palsy Adaptations can be made for supporting reading based on the student’s learning profile. Something as simple as gluing wooden craft sticks to each page of a book in a stair-step manner can significantly help a student with fine motor difficulties to turn the pages. To assist learners with cerebral palsy with speech impairments read using phonics instruction, teachers may use the few reading strategies that are adapted specifically for this group of learners. Phonics-type approaches can be used together with the non-verbal reading approach (Heller 2005). The non-verbal approach involves communication without speech and has been described as talking ‘inside the head’. This method can be utilised where a student is asked to silently say the word and the teacher devises an appropriate method of evaluating whether the child has understood; e.g., diagnostic array analysis and error analysis. Diagnostic array analysis is where a group of words is presented to the student to analyse and come up with the correct word. Error analysis is where the student sorts out words and identifies the errors through discrimination. In both ways, the pupil may perform the task through pointing, a gaze, noises or approximation of letter sounds according to the child’s ability.
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Tape-assisted reading is another means to support students with cerebral palsy, particularly if the student also has a visual impairment. Teachers would record themselves reading fluently; these tapes can be purposefully recorded at different levels of fluency, with each reading becoming increasingly fluent. Thus, students are more likely to be able to keep up with the initial rate and to read along with the tape at higher levels of fluency with practice. When students are engaged in tape-assisted reading, it is essential that they actually read along with the tape in a quiet voice, rather than simply listening to the tape. Students must be monitored carefully and continually. Vocabulary Development For some learners with cerebral palsy, developing and expanding their vocabulary is a complex process that requires various strategies. They must be taught to use an array of word-learning strategies as they approach new words in their reading and environment. Children with cerebral palsy may require direct vocabulary instruction due to lack of exposure or practice in oral language (Heller 2005). Teachers need to teach specific vocabulary and methods that learners can use to determine a word’s meaning. The specific vocabulary, for instance, could be selected from a text that will be read, such as a story or a lesson, and these words are presented in different contexts and activities to assist the learner comprehend their meaning.
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Heller (2005) presents three stages of teaching basic comprehension, a strategy she calls “BIG” which stands for, ‘Before reading, Investigate what’s going on during reading, and Get the big picture when you are done’. Before reading, learners could be exposed to the title and discuss it. In the course of reading, learners are asked to reflect on what they are reading; a teacher can ask oral questions to gauge their understanding of the text. After reading, the teacher provides written exercise or oral questions based on the text. When working on vocabulary development, teachers should consider that:
Students should be provided multiple exposure to words in a variety of contexts;
Words should be taught in the context of a selection or unit;
Teachers help students activate prior knowledge when learning new words;
Relationships are drawn between new words and known words and concepts.
A few strategies to promote effective vocabulary instruction include: Teaching Students to Monitor Their Understanding of Difficult Words: Teachers must also teach students to learn to identify words that they find difficult to understand as they read a text. One method to learn how to identify difficult words is called “clunks,” and then use “fixup” strategies to support understanding of these words. Fix-up strategies cue students to use word-level skills (e.g., break the word apart and look for smaller words you know) or context clues (e.g., read the sentence without the clunk and see if the word makes sense) to assist them in figuring out the meanings of words during reading. Another method is to teach students the following steps outlined in the Vocabulary Chart (see Annexure 6 “The Vocabulary Strategy Worksheet”). If you read a word that you do not understand: 1. Look for context clues. Reread the sentence and the surrounding sentences. 2. Can you break the word into parts? (If not, go to Step 3.)
Is there a prefix? What does it mean?
Is there a suffix? What does it mean?
Is there a root word? What does it mean?
Put the meaning of the word parts together. What is the meaning of the whole word?
3. Guess what the word means. 4. Insert your meaning into the original sentence to see whether it makes sense. 5. If needed, use the dictionary to confirm your meaning. Relevant Terms Affix: Any part that is added to a word; a prefix or a suffix Base word: A word that can stand alone and to which affixes can be added Prefix: A word part that is attached to the beginning of a word Root: A unit of meaning that cannot stand alone but that can be used to form words with related meanings Suffix: A word part that is attached to the end of a word
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Cognitive organisers assist students in remembering and following learning strategy procedures and have been used effectively with main idea instruction. Cognitive organisers often employ mnemonic devices that cue students to the steps of the strategy. Although cognitive organisers can be used with students of all ages, they are frequently used with older students who can learn to use the steps independently. Idol-Maestas (1985) developed an approach called TELLS for guiding students’ probing while reading a story. TELLS is an acronym that prompts students to follow a series of steps: T:
study story titles.
E:
examine and skim pages for clues.
L:
look for important words.
L:
look for difficult words.
S:
think about the story settings.
TELLS can be posted on a wall in the classroom and/or provided individually to students. The teacher helps students learn how to apply each of the steps, one at a time, and then use them all when reading a story.
Comprehension monitoring: Students are taught how to be aware of their understanding of the reading material. By teaching students self-questioning strategies, students are taught to self-monitor their reading, by asking themselves questions, make predictions, and find the answers to their questions. Students can use self-questioning strategies and focus on answering the 5 W’s (why, when, where, what and who). As students read, they lightly write in the margin the appropriate cue (one of the 5 W’s) and highlight the pertinent information. After reading, the students go back to the cues and use them as the basis for making notes and reviewing the content.
Question generation: Students are taught to ask themselves questions about various aspects of the story or informational text:
Title?
Settings: Where did the story take place? When did it happen?
Characters: Who was in the story? What was he/she like?
Problem/Goal: What was the main problem/goal?
Event: What happened first, second, third in the story?
Solution/resolution: How was the problem solved and goals achieved?
Use of graphic semantic organisers: Graphic organisers can be most useful in helping students to understand concepts as well as to connect prior knowledge to new concepts. Students need to be given explicit instruction and taught how to use graphic and semantic organisers (see Annexure 8 for examples of a story map and word web). Such organisers can be used before, during and after reading to help students connect new information to prior knowledge, compare and contrast, sequence events, identify important information in the text, see part-to-whole relationships and categorise information.
Prior Knowledge: Students are taught to relate the content of the text to their personal lives and attempt to make predictions based on their prior knowledge.
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Comprehension strategies: Stewart (1999) suggests that teaching aids can be used by teachers to illustrate or reinforce a skill, fact or idea, help learners improve reading and writing skills, and to relieve anxiety, fears, or boredom in a child. Examples of a teaching aid include:
Making Inclusion Work
Mental Imagery: Students are taught to create pictures in their heads that represent the text they have read. For example, you can try the following guided imagery activity (adapted from McLaughlin, M. & Allen, M.B. (2000)): Teacher
reads a descriptive passage to students pausing occasionally to share what he sees in his mind and the emotions s/he is feeling. Point out to students the rich text that helped create the images and emotions. (Be sure to include text that stimulates all 5 senses).
Teacher
asks students to close their eyes, breathe deeply and relax as he reads a descriptive passage.
Throughout
the passage, pause to ask students what they see, hear, taste, smell and feel. Ask the students what words helped them create the mental image and emotions.
Once
the students have developed this skill, have them silently read a descriptive passage and ‘see’ what they are reading.
Summarisation: Students learn how to find main ideas by answering questions such as: Where Who
does your story take place?
are the main characters and what are they like?
What
happens to them?
What
do they do about it?
What
happens at the end of the story?
Response cards: For supporting responsiveness of students with communication difficulties, response cards are a teaching strategy that creates a non-judgmental learning environment for students. Response cards can be cards, signs, or other low tech items that are simultaneously held up by students in the class to display their response to questions when presented by the teacher.
Naming: The child names objects big, small, round, square, heavy, light in weight and names the colours, etc.
Generalising: Once the child starts identifying and naming objects by sizes, shapes, colours, etc., the child should be given items of different colours, shapes and sizes and should be motivated to decide as to which s/he decides to sort, name and identify. By such repeated exercises, the child starts generalising the concepts.
Spatial concepts can be taught in relation to the body, objects in the environment, drawings or pictures or in relation to abstract objects. (Annexure 9 for examples of worksheets).
4. Instructional Strategies to Support Early Numeracy The NCERT position paper on teaching of mathematics (NCERT, 2006) proposed a shift in focus from mathematical content to mathematical learning environments, where a whole range of processes take precedence: formal problem solving, use of patterns, visualisation, representation, reasoning and mathematical communication. It emphasised that ‘Inclusion is a fundamental principle. Children with special needs, especially children with physical and mental disabilities, have as much right as every other child to learn mathematics, and their needs
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Teaching mathematic concepts For students to understand and work with formal mathematical concepts successfully, they must understand the concepts of classification, conservation, seriation, ordering and oneto-one correspondence. For students to develop their innate number sense, and a working knowledge of the above concepts, they must experience a great variety of interactions with their environment, exploring and manipulating, comparing, arranging and rearranging real objects and sets of objects: Matching of identical objects, identical in measurement, shape, size, weight and colours. The teacher can make her/his own matching games for the student by adapting the materials to match the student’s physical needs. Sorting of different object which are different texture, size, shapes and colours. The best example is sorting of different vegetables, pulses and grains. One-to-one correspondence: Children can find many opportunities in their daily life to experience one-to-one correspondence. They can place one sock inside one shoe or one shoe on one foot; they can place pieces in one-piece puzzles. Once children understand these relationships, they can link one number with one object and then count with understanding. Identifying objects which are big or small, of different colours, shapes and sizes. One of the best examples is identifying playing cards of similar types. Sorting and classifying is an important intellectual process that we go through when we seek to organize our world. Classifying requires us to create mental structures based on complex relationships and interrelationships.
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(in terms of pedagogy, learning material, etc.) have to be addressed seriously. The conceptual world of mathematics can bring great joy to these children, and it is our responsibility not to deprive them of such education.’ Numeracy is important to be taught to all children, including children with cerebral palsy. Since mathematics involves abstract concepts such as symbols which are difficult, teaching learners with cerebral palsy require adaptations in a number of areas based on the student’s individual learning styles and characteristics. Effective numeracy instruction depends on identifying the knowledge children already possess and building on that knowledge to help them take the next developmental step. Developmental progressions can help identify the next step by providing teachers with a road map for developmentally appropriate instruction. Utilising hands-on manipulatives and pictorial representations, before moving to abstract symbol supports builds understanding of abstract numerical concepts. Mathematical games, puzzles and stories involving numbers are useful to enable children to make these connections and to build upon their everyday understandings.
Making Inclusion Work
Board games for promoting matching and sorting pattern and colour Snappy Shapes Concept: Sorting order and pattern Equipment: one base board and 16 small cards with 4 ducks, flowers, hats and fish in green, yellow, blue and orange Hanging Clothes Concept: Sorting and classification Equipment: 1 base board with 4 clotheslines and 1 set of cut outs of clothes (tie, socks, shorts and vest) in red, blue, yellow and green (meaning 16 items of clothing; 4 of each item in 4 different colours) Adaptation 1: The clothesline can be removed and Velcro added to the clothes cut outs. This can also be played in pairs, so that another student places the clothing for the student with cerebral palsy, who might have poor fine motor skills. Adaptation 2: The game can be made more complex by adding intricate patterns clothes such as tee-shirts. Equipment: One base board with 5 clothes lines and one set of clothes. There are 5 subsets of tee-shirts with attributes of colour, size and pattern. Other important concepts are: Counting: Since children are interested in counting things around them, start with concrete objects such as windows in the room, eyes, noses, etc. Number dominoes can be made for children to match the number symbol and the number of objects. Simple cards that include objects, numbers and the name of the objects can be a good start. Activities to teach counting could include:
Have the child compare/match/sort groups of objects into sets; then have her/him identify the number of items in each set, identify them by name and by some pattern; e.g., clapping or ringing a bell the same number of times as the number in the set.
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Use counting songs and finger play to practice counting forward, backward, by twos, by fives, by tens, etc.
Students can play a game called “Guess My Number,” to reinforce and practice the concepts of “greater than” and “less than.” Let the partner write a numeral between 1 and 100 on a piece of paper without informing the student of the number. Ask the student to discover the secret numeral by asking “greater than” and “less than” questions.
Number facts: The number line is extremely useful in helping young children memorise and practice counting with ordinal numbers. In the beginning stage, the number line should be in the form of a concrete manipulative. It helps children develop greater flexibility in mental arithmetic as they actively construct mathematical meaning, number sense and understandings of number relationships. Example of a tactile number line
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As the child progresses, pictorial representations can be utilised to reinforce concepts such as in this sample worksheet. Once children are comfortable making verbal comparisons, teachers should encourage them to use counting to compare the magnitudes of two collections. The cardinality chart shown below can be a useful tool to help children make number comparisons. Teachers can use such a chart to demonstrate that the next number in the counting sequence is exactly one more than the previous number. Children can also use cardinality charts to reinforce the concepts of ‘what comes next’ in number relations and the increasing magnitude principle. Learning measurement concepts: Young children’s interest in measurement is primarily focused on finding out who or what is the biggest. One of the important concepts they need to learn is that “big” can mean many different things, depending on the property being considered. A jar may be bigger if we are talking about height, but smaller if we are talking about how much it holds. One of the underlying concepts that influences the young child’s understanding of measurement is the idea of conservation. Conservation is the recognition that a quantity or amount stays the same even though it has been rearranged in some way and appears to be different.
Example of a cardinality chart
Important Concepts zz
Shapes: Explaining circle, triangle, square, rectangle etc.
zz
Colours: Start from the primary colours, (red, blue and yellow) and then match and name before moving on to other colours.
zz
Position of spatial concepts: in-out, up-down, above-below, over-under, near-far, front-back, before-after.
zz
Concept of things that are either similar or different, both horizontally and vertically. These could be taught by matching or sorting objects or pictures.
Subitising is the ability to ‘see’ a small number of objects and know how many there are without counting. Subitising is what tells you what number you roll on a six-sided dice; most
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Dot Plate Activities: A common tool is a set of paper plates or cards with dot patterns. Dots can be easily made with big bindis.
Flashcards: Display basic “flash and response” flashcards for one to three seconds and ask students to respond with how many they saw. They can respond in several ways, all of which build different skills: As
an introductory activity or for younger students, have students recreate the pattern on a blank card on their desk.
Students
can give a verbal response.
Students
can hold up a number cards. This format allows all students to answer and allows the teacher to scan the responses held up.
Students
can write responses on white boards or point to AAC board with numerals.
Students
can also hold up the corresponding number of fingers. Have students share their finger representations and the differences. For example, for a plate showing 4, you could see some students with four fingers on one hand, or another with two fingers held up on each hand. Those students with fine motor difficulties may work with a peer to do this task.
Operations: For students to calculate using the four basic operations, it is critical that they have developed basic concepts (including more, less, many, etc.), one-to-one correspondence, and the concept of sets and basic number sense. As students begin to learn to calculate, the following teaching considerations should help:
Emphasise concept development rather than process or rote memorisation.
Apply operations to real life situations which are of interest to the student. For example, provide opportunities for students to determine the quantities of materials needed to play a game or complete a project and to estimate the price to purchase these materials. At first, provide examples for the student; then ask the student to provide their own examples, which they see as relevant uses of different operations.
When students are using manipulatives, encourage them to search the entire “field” to make sure they are aware of all the objects with which they must work. Using trays or mats can help to identify this field and the area they must search.
Word problems are very effective since they involve practical application of skills. To assist students in developing the skills necessary to solve word problems, it may be helpful to provide a problem solving model. First, identify the specific kinds of information needed in a particular problem; then provide two or three choices of operation statements to solve the problem. Eventually, students will be able to identify appropriate operations independently.
Teach the concept of complements or partners for addition, subtraction, multiplication and division. For example, the number 5 is made up of 2 and 3, 1 and 4; 24 is made up of the factors 8 and 3, or 2 and 12, etc. This concept not only increases the student’s ease with number facts; it also facilitates mental mathematics.
When teaching facts, focus on two or three related facts at a time. Emphasise accuracy first, then speed.
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adults no longer have to count the pips after playing board games for a while. Subitising is a fundamental skill in the development of students’ understanding of numbers. It helps children see small collections as one unit. This provides an early perceptual basis for number, but it is not yet number knowledge. Activities for teaching subitising include:
Making Inclusion Work
Activities for teaching basic operations zz
zz
zz
zz
The number line can be used for working on operations, relationships, fractions and decimals. Number lines are especially useful when they are stretched across the top of the student’s desk and particularly useful for students using a braillewriter. Students can find the larger number, count forward for addition and count backward for subtraction. Students can use number lines for working on positive and negative numbers, too. Flashcards can be used along with manipulatives for working on the basic operation facts and the Nemeth Braille Code. Later, students can braille out their own mathematical sentences. Students having difficulty learning addition, subtraction, multiplication or division can make cards of those facts with which they are having the most trouble. The teacher writes the problem on one side of the card and the answer on the reverse. Teachers can use creativity and relevant examples, scratch and sniff stickers, etc., to make these teaching aids interesting. Many models of these types of aids can be found in teachers’ stores. To practice mathematics facts, students can roll dice, then add, subtract, multiply or divide the numbers thrown.
Adaptations: Magnets can be attached to manipulatives and used on a tray to form groups for addition or subtraction problems, so that children can move these easily without the objects falling off the surface. At a more advanced level, individual tiles with numbers and signs of operation (and affixed to magnetic tape) can be arranged to form a variety of problems.
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ACTIVITY Inclusive teaching Materials required: Grade 3 and 4 NCERT books in Social Science and Math; Waste material (such as leaves, paper rolls, empty boxes, socks, buttons, wool, etc.)for creating Teaching Learning Material (TLM); scissors; 6 paint boxes; 45 medium paintbrushes; whistle; glue or Fevicol; coloured paper and chart paper.
Instructions: 1. Divide participants into 4 small groups. 2. Provide participants with the NCERT books on a preferred subject. 3. Give each group a case study of a child with cerebral palsy and tell them that this student is enrolled in their class.
Case Studies Manu is an 11 year boy from a lower middle income family living in Kolkata. He is studying in Grade 4 and has spastic diplegia and needs a crutch for walking. He is very fond of computers and gets a C grade in all subjects. He seems to do better in oral rather than written work and often does not complete his classwork. Vibha is 10 years old and is studying in Grade 4 in a small rural school in Himachal Pradesh. She is carried to school by her mother and cannot walk due to cerebral palsy. She is very cheerful, and loves to chat with her classmates. She finds it very difficult to copy from the blackboard and is still not able to read fluently. Juhi is a nine year old studying in Grade 3 of a municipal school of Jaipur. She comes to school with her older brother and walks with an awkward gait, due to cerebral palsy. She often falls, and is very shy. Her speech is not clear. She does all her classwork well, but does not have any friends. Nitin is a nine year old boy in Grade 3 of a government rural primary school in Andhra Pradesh. He belongs to a poor family and both his parents are daily wage earners. He uses a wheelchair, since he has cerebral palsy. He comes to school accompanied by his friend Manu who pushes his wheelchair. Nitin has problems accessing the toilet and also has difficulty in writing. His mother feels he does not hear sometimes. 4. Ask the participants to choose a topic of their choice and develop an inclusive lesson, keeping the learning needs of Manu, Vibha, Juhi and Nitin in mind. Using available waste material, each group will also develop TLMs that is accessible to the child with cerebral palsy. 5. Each group will transact the lesson in front of all participants in a mock classroom situation. 6. Collect feedback on each lesson from other participants and discuss.
37 To access the Shark game, visit http://www.ictgames.com/sharkNumbers/sharkNumbers_v5.html
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Place value: Place value is a complicated concept, which interweaves with other number relationships such as teen numbers, algorithms, bonds of 10, part, whole and others. To teach place value, you may ask students to group a variety of materials in groups of 10. This can include sticks, beans, and pencils. ICT games (e.g. Shark Game) are also very helpful for learning place value in one and two digit numbers.37
Making Inclusion Work
5. Teaching Writing to Learners with Cerebral Palsy Learners with motor impairment should be provided writing opportunities at an early age and if needed, appropriate technology to help them practice writing to promote literacy. Direct instruction in handwriting and sufficient practice is essential as are preparatory exercises to strengthen children’s pincer grasp and develop eye-hand coordination. Children with cerebral palsy who have muscle weakness, involuntary movements and poor finger and hand coordination may require a writing aid or alternative system to complete written assignments. Using different kinds of writing surfaces can make it easier for a student to write. For some children, it is easier to write on big paper. To keep the paper in place, it may be helpful to tape it down to the tabletop. For some children, a slanted surface is easier to use and a few students with cerebral palsy may require adapted pencils. (See section 4 on “Accommodations for Writing” in Unit III of this module.) It is also critical that teachers appreciate the physical effort that students with cerebral palsy make in completing a writing task and must provide them with sufficient time and necessary encouragement. Key things to remember zz
zz
zz
Balance the need to correct errors with the recognition that exhaustive corrections can discourage a student and spoil their sense of spontaneity and creativity. The writing of students with special needs tends to be shorter in length than that of other students, and may sometimes result in texts with spelling and grammatical errors, lack of organisational clarity and sparse supporting details. Help students with language difficulties to connect the way a text is organised with the writing process. During their reading sessions (before, during and after the reading), discuss text organisation and how the writer would have used the writing process. Establish student groups based on the instructional strategy being used. Different groups can meet specific instructional needs related to writing.
Provide students with resources. These can include customised dictionaries, concrete models of abstract mathematical concepts and adapted calculators. Also see “Early Literacy, Numeracy and Language” in Unit III of Module 1: Inclusive Education
6. Evaluation Leading to Effective Instruction Use a variety of assessment techniques and evaluation instruments. Multiple sources of information provide a valid picture of students’ learning and challenges. Use this information to assist with planning and revising instruction. An assessment of reading may reveal that comprehension problems of a particular student are a result of difficulties in quickly and accurately reading words or decoding. Students who cannot accurately read the words on the page often have problems with higher-level skills that require inference and interpretation of text. Students who can read simple words quickly and accurately, but are inaccurate readers of multi-syllable words, may need instruction in recognising common syllable patterns, as well as common prefixes and suffixes, along with a strategy for reading multi-syllable words. Students with more serious word reading problems may need a highly systematic and explicit intervention programme. Decisions about the need for word identification instruction should be based on diagnostic assessments and continuous progress monitoring.
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Adjusting test appearance such as margins, spacing, amount of print on page, type size, colour coding, and highlighted instructions
Adjusting test design
Allowing extra time for completing tests and assignments
Shortening tests or assignments
Breaking tests into chunks
It is important to provide students a range of options for demonstrating what they know and can do Assignments should be flexible and sensitive to learners’ talents and may include making a poster, writing a report, making an oral presentation, enacting a dramatic response, creating and singing a song or poem, drawing or working collaboratively. The Central Board of Secondary Education (CBSE) provides writers to write the examinations of children with cerebral palsy. The writer must have studied one grader lower than the student. The child with cerebral palsy is also eligible to get 30 minutes extra for an examination of 3 hours. Some points to remember: zz
zz
zz
zz
zz
zz
The teacher should be motivated to provide differential assessment to children with cerebral palsy in internal examination, as well as periodic and continuous evaluation. The teacher should also permit children to use assistive technology or alternative methods of examination. For example, verbal examination, use of computers or other devices of large print, etc., may be used for evaluation. For children with poor handwriting, encourage the student to write, while ignoring the quality of writing; i.e., spacing, etc. Provide adapted writing assignments with multiple type questions and give more time to complete assignments. For children who have trouble spelling, the meaning of the answers should be given importance instead of spelling mistakes, etc. For non-verbal children, all verbal examinations should be substituted with written or alternative methods of examination.
Since every child with cerebral palsy has a different learning profile, it is the teacher’s role to use a range of strategies to make curriculum more engaging and meaningful, personalising learning for every student and creating communities of learners who support and share in each other’s learning. This includes methods of assessing what the child has learnt which, in turn, will inform future teaching strategies.
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Modify test formats and procedures, and provide accommodations to allow students with cerebral palsy to display their knowledge. For example, students with cerebral palsy with visual processing and/or attention difficulties may perform better on oral tests or on paper and pencil tests that have more white space on the page. For students who struggle with written language but who are strong in the verbal domain, readers or scribes could be used, or students could demonstrate their knowledge by recording answers on tape. Suggestions for modifying test formats and procedures include:
Annexures
Annexure 1: Epilepsy First Aid Tonic-Clonic Seizures The person goes stiff, loses consciousness and then falls to the ground. This is followed by jerking movements. A blue tinge around the mouth is likely. This is due to irregular breathing. Loss of bladder and/or bowel control may happen. After a minute or two, the jerking movements should stop and consciousness may slowly return.
Do...
Protect the person from injury - (remove harmful objects that may be nearby)
Cushion their head
Look for an epilepsy identity card or identity jewellery
Aid breathing by gently placing them in the recovery position once the seizure has finished (see pictures)
Stay with the person until recovery is complete
Be calmly reassuring
Don’t...
Restrain the person’s movements
Put anything in the person’s mouth
Try to move them unless they are in danger
Give them anything to eat or drink until they are fully recovered
Attempt to bring them round
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Making Inclusion Work
Call for a doctor if...
You know it is the person’s first seizure, or
The seizure continues for more than five minutes, or
One tonic-clonic seizure follows another without the person regaining consciousness between seizures, or
The person is injured during the seizure, or
You believe the person needs urgent medical attention
Focal (Partial) Seizures Sometimes the person may not be aware of their surroundings or what they are doing. They may pluck at their clothes, smack their lips, swallow repeatedly and wander around.
Do...
Guide the person away from danger
Stay with the person until recovery is complete
Be calmly reassuring
Explain anything that they may have missed
Don’t...
Restrain the person
Act in a way that could frighten them, such as making abrupt movements or shouting at them
Assume the person is aware of what is happening or what has happened
Give the person anything to eat or drink until they are fully recovered
Attempt to bring them round
Call for a doctor if...
You know it is the person’s first seizure
The seizure continues for more than five minutes
The person is injured during the seizure
You believe the person needs urgent medical attention
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Some general first aid guidelines for people who have a seizure in a wheelchair:
Do...
Put the brakes on, to stop the chair from moving
Allow the person to remain seated in the chair during the seizure (unless one has been advised by a doctor to move them). Moving the person could possibly lead to injuries for the person having the seizure
If the person has a seatbelt or harness on, leave it fastened
If the person doesn’t have a seatbelt or harness, support them gently, so they don’t fall out of the chair
Cushion the person’s head and support it gently. A head rest, cushion or rolled up coat can be helpful
Don’t...
Restrain the person’s movements
Put anything in the person’s mouth
Give them anything to eat or drink until they are fully recovered
Attempt to bring them round
Source: https://www.epilepsy.org.uk/info/firstaid
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First Aid for People Who Use a Wheelchair
Making Inclusion Work
Annexure 2: Helping Saliva Control Learning to close lips Many children have lax lips that are incapable of making a firm seal. Some children have a retracted and short upper lip or have protruding teeth so that their lips are unable to meet. Inability to bring the lips together makes it more difficult to swallow properly and this may result in drooling. A series of exercises can be tried and it is important to make them fun. Team games can be used for groups of children:
Use facial expressions; for example, smiling, frowning, making faces in the mirror.
Lip articulations: mmmm, bbbb, ppppp, raspberries.
Blow musical instruments; e.g., a whistle.
Hold paper or a spatula between the lips for increasing amounts of time.
Practice obtaining a lip seal around an oral screen placed in front of the teeth as a mouth guard.
Suck liquid up a straw. Start with a short straw. Clear plastic tubing may be easier to use rather than straws. Thicken the liquid; for example, provide a thick shake to make the task more difficult.
Hold a bent full straw of liquid (with your finger over the top), release small amounts of liquid from the straw into the space between a child’s front lip and teeth (buccal cavity). Encourage the child to suck up the liquid.
Blowing games, such as blowing out candles (start with one candle and work up) and puffing bits of tissue or table tennis balls across the table. Children can be encouraged to blow out their cheeks and push the air from one side to another. Use a mirror to help them understand what is required.
Play games that require sucking air up a straw with the objective of picking up a pea or small pieces of paper. Ensure that the peas are larger than the straw! Count how many peas can be placed into a container in 3 minutes.
Learning to wipe and recognising when saliva has escaped Lots of children who drool have difficulty in knowing if their lips and chin are wet, and because of this, they do not think to wipe. It is helpful to put in place reminders for them, such as a cue or a reward. It is also useful to teach “swallow and wipe” together because the mouth is cleared of saliva with each wipe. Verbal reminders need to be very frequent. The following suggestions may also be useful:
Use touch cues; sometimes pressing a finger on the child’s top lip helps them to swallow.
Use visual cues such as coloured dots. When the child sees them, a swallow/wipe occurs. Signs such as parents touching their own lips with their fingers can be a cue.
Use auditory cues such as setting a kitchen timer and encouraging a swallow/wipe after the buzzer.
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Read a book. Swallow and wipe every two pages. Praise is a good reward. Food is not a good reward because it makes the child produce more saliva. Items such as stickers are preferable.
Always make sure there are plenty of opportunities for success. Make sure to check the child’s chin. When it is dry, praise or rewards can be given.
Provide a handkerchief, remembering that many children find it difficult to remove one from their pocket. They can have a handkerchief tied to their wrist for easy access, or alternately, a sweat band on the wrist can be used to wipe the chin. People in wheelchairs can have a foam ball on a gooseneck stand fitted. A handkerchief is placed over the ball and changed as required.
Source: http://www.rch.org.au/uploadedFiles/Main/Content/plastic/salivabook.pdf
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Making Inclusion Work
Annexure 3: Classification by Number of Limbs Involved Classification based on the number of limbs affected by cerebral palsy provides a description of the extent a child is affected. This method is useful in ascertaining which parts are affected. Paresis means weakened and plegia/plegic means paralysed. The prefixes and root words are combined to yield the classifications commonly used in practice today. Monoplegia/monoparesis means only one limb is affected. It is believed this may be a form of hemiplegia/hemiparesis (see below) where one limb is significantly impaired. Diplegia/diparesis usually indicates the legs are affected more than the arms; primarily affects the lower body. Hemiplegia/hemiparesis indicates the arm and leg on one side of the body is affected. Paraplegia/paraparesis means the lower half of the body, including both legs, is affected. Triplegia/tri paresis indicates three limbs are affected. This could be both arms and a leg, or both legs and an arm, or it could refer to one upper and one lower extremity and the face. Double hemiplegia/double hemiparesis indicates all four limbs are involved, but one side of the body is more affected than the other:
Tetraplegia/tetra paresis indicates that all four limbs are involved, but three limbs are more affected than the fourth.
Quadriplegia/quadriparesis means that all four limbs are involved.
Pentaplegia/pent paresis means all four limbs are involved, with neck and head paralysis often accompanied by eating and breathing complications.
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Access to physical environment:
The path from the gate to the school buildings and playground must be clear, levelled.
All entrances and doorways in the school buildings should be between minimum 4’ to 5’ feet wide.
The toilet inside the school should be accessible to CWSN. This toilet should be fitted with commode and grab-rails.
The drinking water outlet should be accessible to CWSN also.
Avoid sharp turns in the walkways.
The walkway must be clear of any hung and protruding obstructions such as windows, lights, low branches, flower pots and sign posts, etc.
A handrail should be provided at any dangerous point in the walkway. Guard rails and kerbs are a must in situations where there is a sudden change in the level of height, including stairs and verandas.
The ends of the handrails should be bent downwards to avoid injury.
Steps should be of equal and even heights.
Bright colours (preferably yellow) should be used at every change in slope, at the beginning and ending of a staircase for easy recognition.
All signage should be in print, visuals and Braille at the readable height (min. 3 ft) of the children.
All the surfaces should be non-slip, and loose gravel or cobbles should be avoided.
Natural lighting should be optimised. There should be enough windows to allow adequate ventilation and lighting.
Safety of all children should be ensured by provision of hazard-free environment; e.g., no broken window panes, broken steps, broken fixture and furniture, unsafe ceilings, etc.
The school/classroom design should allow the teacher to be able to pay personal attention to the child, including effective positioning and placement, keeping in mind the individual needs of CWSN.
Guidelines for children with moving difficulties and cerebral palsy:
Ensure wheel chair accessibility to classrooms, toilets, office rooms, playground, etc.
The prescribed gradient of the ramp - 1:12 - should be strictly adhered to and all ramps should be fitted with handrails.
Aids and appliances like callipers, wheel chairs, braces, special chairs, crutches, wedges, pencil grips, communication boards, etc., should be made available.
Ensure adequate space allocation to meet individual needs of children using assistive devices.
Ensure proper positioning and safe/careful handling of children with cerebral palsy, with the help of the resource teacher/parent.
All classes and teaching facilities for these children should be provided on the ground floor.
Arrange for a suitable writer for children with writing difficulties.
Ensure enough response time to children with cerebral palsy. This is important as they might have communication and speech problems.
Source: ssa.nic.in/inclusive-education/guidelines/BFA%20GUIDELINES.../file
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Annexure 4: Barrier-Free Guidelines for CWSN in SSA
Making Inclusion Work
Annexure 5: Universal Design of Learning Educational Applications of the Seven Principles of Universal Design for Learning Physical principle
Educational application
1. Equitable use — The design allows all users equal access and avoids segregating or stigmatizing anyone.
Equitable curriculum — Instruction uses a single curriculum that is accessible to students with widely diverse abilities; curriculum does not unnecessarily segregate students or call undue attention to their “differences.” Curriculum is designed to engage all students.
2. Flexibility in use — The design accommodates a wide range of individual preferences and abilities.
Flexible curriculum — The curriculum is designed to be presented flexibly to accommodate a range of individual abilities and preferences; it considers physical and sensory-motor disabilities as well as varied learning preferences and paces.
3. Simple and intuitive — The design is easy to understand.
Simple and intuitive instruction — Instruction is straightforward, provided in the mode most accessible to students; language, learning levels, and complexity of presentation can be adjusted; student progress is monitored on an ongoing basis to reset goals and instructional methods as needed.
4. Perceptible information — The design communicates necessary information effectively to the user, through different modes (pictorial, verbal, tactile), regardless of the user’s sensory abilities.
Multiple means of presentation — Curriculum provides multiple means of presentation to teach students in ways that will most effectively reach them, regardless of sensory ability, level of understanding or attention; presentation can be altered to meet recognition patterns of individual students.
5. Tolerance for error — The design minimizes hazards and the adverse consequences of accidental or unintended actions.
Success-oriented curriculum — The teacher encourages engagement with curriculum by eliminating unnecessary barriers to engagement; the teacher provides a supportive learning environment through ongoing assistance, applying principles of effective curriculum design as needed: e.g., teaching Big Ideas, priming background knowledge, scaffolding instruction, and so on.
6. Low physical effort— The design can be used efficiently and comfortably and with a minimum of fatigue.
Appropriate level of student effort — The overall classroom environment provides ease of access to curricular materials, promotes comfort, addresses motivation, and encourages student engagement by accommodating varied means of student response; assessment is ongoing, measuring performance; instruction may change based on results of assessment.
7. Size and space for approach and use— Appropriate size and space is provided for approach, reach, manipulation, and use, regardless of user’s body size, posture, or mobility.
Appropriate environment for learning — Classroom environment and the organization of curricular materials allow for variations in physical and cognitive access by students as well as for variations in instructional methods; classroom environment allows for varied student groupings; classroom space encourages learning.
Source: C . Mason, R. Orkwis, and R. Scott (2005) “Instructional Theories Supporting Universal Design for Learning—Teaching to Individual Learners,” Universal Design for Learning: A Guide for Teachers and Education Professionals, eds. Council for Exceptional Children and Merrill Education.
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Planning and Thinking Sheet Name:....................................................................... Date:������������������������������������������ Topic:�������������������������������������������������������������������������������������������������������������������������� Who am I writing for?���������������������������������������������������������������������������������������������������� Why am I writing this?��������������������������������������������������������������������������������������������������� What do I know about this topics?���������������������������������������������������������������������������������� ���������������������������������������������������������������������������������������������������������������������������������� ���������������������������������������������������������������������������������������������������������������������������������� What do I need to find out about this topic?��������������������������������������������������������������������� ���������������������������������������������������������������������������������������������������������������������������������� ���������������������������������������������������������������������������������������������������������������������������������� What have I learned from my research about this topic?���������������������������������������������������� ���������������������������������������������������������������������������������������������������������������������������������� ���������������������������������������������������������������������������������������������������������������������������������� What have I learned from my research about this topic?���������������������������������������������������� ���������������������������������������������������������������������������������������������������������������������������������� ���������������������������������������������������������������������������������������������������������������������������������� How can I organize main ideas and supporting details?
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What is my topic sentence?�������������������������������������������������������������������������������������������� How will I conclude my writing?�������������������������������������������������������������������������������������
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Annexure 6: Planning and Thinking
Making Inclusion Work
Annexure 7: The Vocabulary Strategy Worksheet Word: Context Sentence: 1. Look for context clues. a. Reread the sentence, looking for signal words and punctuation. List signal words and punctuation. b. Reread the sentences before and after the sentence with the word in it. Context Clues: 2. Look for word parts you know. Tell what each word part means. Prefix: Suffix: Root: Put the parts together. What does this mean? 3. What do you think the word means? 4. Try your meaning in the context sentence. Does it make sense? 5. Check the word with a dictionary if you need to. Remember that many words have more than one meaning, so look for the one that goes with the sentence in the book. Were you right?
86 | Toolkit for Master Trainers in Preparing Teachers for Inclusive Education for Children with Special Needs
Story Map Name.............................................Date................................................ Story Map Setting
Main Character
Problem
Supporting Characters
Title end Author
Solution
Word Web Synonyms (nouns)
Definition (adj.) • Something used to regulate weight/ eating
• Menu • Fare • Daily bread • Food • Nutrition
Synonyms (nouns) • Weight reduction plan • Fast • Abstinence from food • Starvation
Synonyms (verbs) Definition (v) • Participating in a structured eating plan
• Lose weight • Go without • Eat • Starve • Slim down • Reduce
Diet
Definition (n)
Synonyms (adjectives)
• What an organism usully eats
• Fat-free • Low-calorie • Reduced-sodium
Definition (n) • The selection of food and drink one eats regularly
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Annexure 8: Graphic Organizers: Story Map and Word Web
Making Inclusion Work
Annexure 9: Spatial Concepts Worksheets Name…………………………………Date………………………………… Colour the big animal (or colour the small object)
Name…………………………………Date………………………………… Colour the chicks yellow in the basket. Colour the hen NEAR the basket in red.
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References
Action for Ability Development and Inclusion (AADI). 2014. Experiences of Children with Disabilities in Inclusive Education. New Delhi, India. Bos, C. S. and S. Vaughn. 2006. Strategies for Teaching Students with Learning and Behaviour Problems. Boston: Allyn & Bacon. Byers, R. and R. Rose. 2004. Planning the Curriculum for Pupils with Special Educational Needs: A Practical Guide. New York: David Fulton Publishers. Dickson, S. V., Chard, D. J., & Simmons, D. C. 1993. “An Integrated Reading/Writing Curriculum: A Focus on Scaffolding. LD Forum, 18(4), 12-16. Disability Equality in Education and United Kingdom Disability Forum for European Affair. April 2004. All Equal All Different-KS1/Early Years Disability Equality Resource Pack: A Guide for Practitioners and Teachers. Edyburn, Dave, Kyle Higgins and Randall Boone, eds. 2005. Handbook of Special Education Technology Research and Practice. Whitefish Bay, WI: Knowledge by Design, Inc. First Steps-Developing communications skills for individuals with multiple disabilities, Communication Matters (undated). Friend, Marilyn and William D. Bursuck. 2006. Including Students with Special Needs: A Practical Guide for Classroom Teachers (Edition 4). Boston: Pearson/Allyn and Bacon. Gallagher, D. J. “The Importance of Constructivism and Constructivist Pedagogy for Disability Studies in Education”. Disability Studies Quarterly 24(2) 2004:1–15. Gardner, Howard. 1983. Frames of Mind: The Theory of Multiple Intelligences. New York: Basic Books. Haskell, M. and E. Barrett. 1993. The Education of Children with Physical and Neurological Difficulties. London: Chapman and Hall. Howden, Hilde. “Teaching Number Sense”. Arithmetic Teacher 36(6) 1989: 6-11. IGNOU School of Continuing Education. 2005. Nature and Effects of Cerebral Palsy and Mental Retardation. New Delhi, India. IGNOU. 2005. Awareness Cum Training Packages in Disability- Cerebral Palsy. New Delhi, India. Levin, Karen Susan. 2013. The Communicative Participation of Adults with Cerebral Palsy. Dissertation presented for the degree of Doctor of Philosophy, Faculty of Arts and Social Sciences at Stellenbosch University.
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Mason, C., R. Orkwis, and R. Scott, 2005. Instructional Theories Supporting Universal Design for Learning—Teaching to Individual Learners, Universal Design for Learning: A Guide for Teachers and Education Professionals, eds. Council for Exceptional Children and Merrill Education. McLaughlin, M. and M.B. Allen. 2000. Guided Comprehension: a Teaching Model for Grades 3-8. Newark, Delaware: International Reading Association. Miller, Freeman and Steven J. Bachrach. 1995. Cerebral Palsy – A Complete Guide for Caregiving. London: The John Hopkins University Press. Pennington, Lindsay. “Cerebral Palsy and Communication”. Paediatrics and Child Health, 18(9): 405–409. Rathvon, Natalie. 2004. Early Reading Assessment: A Practitioner’s Handbook. New York: The Guilford Press. Reddihough, D. S. and K. J. Collins. “The Epidemiology and Causes of Cerebral Palsy”. Australian Journal of Physiotherapy 49, 2003: 7-12. Royal Children’s Hospital. 2008. Cerebral Palsy-An Information Guide for Parents. London: UK. Sarva Shiksha Abhiyan. Training Module on Cerebral Palsy and Locomotor Impairment, New Delhi. Save the Children. 2002. Schools for All-Including Disabled Children in Education. London, UK. Stewart, E. “Learning Together: The Use of Mentoring for Faculty Development in the Integration of Technology”. Journal of Computing in Teacher Education 16(1) 1999: 15-19. Tankersley, Karen. 2003. The Threads of Reading: Strategies for Literacy Development. Alexandria: ASCD. The Ontario Federation for Cerebral Palsy. 2011. A Guide to Cerebral Palsy. Ontario, Canada. Thomas, G. and A. Loxley. 2001. Deconstructing Special Education and Constructing Inclusion. Buckingham, England: Open University Press. Tomlinson, Carol A. “Sharing responsibility for differentiating instruction”. Roper Review 26188, 2004. Tomlinson, Carol A. and Caroline Cunningham Eidson. 2003. Differentiation in Practice, Grades K-5: A Resource Guide for Differentiating Curriculum. Alexandria, VA: ASCD. Tomlinson, Carol A. and Sally M. Reis, eds. 2004. Differentiation for Gifted and Talented Students (Essential Readings in Gifted Education Series). Thousand Oaks: Corwin Press. Torgesen, J.K. “The prevention of reading difficulties”. Journal of School Psychology 40, 2002: 7-26. Vygotsky, Lev S. 1978. Mind in Society: The Development of Higher Psychological Processes. Cambridge: Harvard University Press. Whitehorse Disability Awareness Kit-A Resource Kit for Primary School Teachers, 2005. Wittrock, M. C., ed. 1986. Handbook of Research on Teaching (3rd Edition). New York: Macmillan. Woloshyn, V.E., A. Elliott and S. Kaucho. “So what exactly is explicit strategy instruction? A review of eight critical teaching steps”. The Reading Professor 24(1)2001:66-114.
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Online Resources
www.9jumpin.com.au www.abilympicsindia.org www.asha.org/public/speech/disorders/aac www.asu.edu/drs/fachandbook_physical.html www.brighthubeducation.com-special-ed-inclusion-strategies www.cdc.gov/ncbddd/cp/causes.html www.cerebralpalsy.org/information/acceptance/tips-for-teachers/ My Child: The Ultimate Resource for Everything for Cerebral Palsy. Available at http:// cerebralpalsy.org/about-mychild/ Early School Years Fact Pack: A Guide for School Staff. Available at www.cerebralpalsy.org.au/ wp-content/uploads/2013/04/early_school_years_fact_pack.pdf www.cerebralpalsycource.com/treatmetn_and_therapy/cp_treatment/index.html www.computers-technology-cerebralpalsy.com www.cpirsa.org www.educationworld.com/a_curr/shore/shore082.shtml#sthash.fPYMvLe3.dpuf https://www.epilepsy.org.uk/info/firstaid http://www.ictgames.com/sharkNumbers/sharkNumbers_v5.html www.ninds.nih.gov/disorders/cerebral_palsy/detail_cerebral_palsy.htm http://www.rch.org.au/uploadedFiles/Main/Content/plastic/salivabook.pdf http://ssa.nic.in/inclusive-education/guidelines/
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www.thecommunicationtrust.org.uk http://www.vcu.edu/partnership/C-SAL/downloadables/PDF/DisabilityAwarenessPacket.pdf Teaching All Students: Staff Guide to Accommodations and Modifications. Available at http://web.richmond.k12.va.us/Portals/47/assets/Accommodations_and_Modifications_ Guide.pdf Special Olympics www.specialolympics.org/mission.aspx www.yale.edu/ynhti/curriculum/units/1992/1/92.01.05.x.html http://www.activeschoolflag.ie/files/Best_Start_Schools_Inclusion_Project.pdf http://www.cpec.org.au/train_online.html
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