Dissertation
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Should all physically disabled children be included into mainstream schools and how would this affect schools in a South African context?
Carla Nortje
4th year
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Center for Creative Education
Due date:29 July 2005
Submitted as an essential component of the Bachelor of Education degree
Evidence of original work
27th July 2005
To whom it may concern,
I, Carla Nortje, state that the following dissertation is my own original work. No part of this dissertation may be reproduced or transmitted in any form or by any electronic or mechanical means, including photocopying and recording, or by any information storage and retrieval system, without written permission from the writer. All rights are reserved.
Signature
CARLA NORTJE
Evidence of proof reading
27 July 2005
To whom it may concern,
I, Margie Nortje, confirm that I have proof read Carla Nortje’s final dissertation. I observed various grammar errors, as well as incorrect paragraph structures. I acknowledge that these have been corrected and submitted effectively.
I am, at the moment, studying a Bachelor of Arts (psychology). I, therefore, have experience in the literature field and have a good understanding of the English language.
Kind regards
MARGIE NORTJE
Contents
1.ACKNOWLEDGEMENTS …………………………………………………5
2.INTRODUCTION ……………………………………………………………6
3.THE PHYSICALLY DISABLED CHILD ………………………………….7-17
3.1.Examples of primary disabilities
3.1.1. Cerebral Palsy – a medical perspective
3.1.2. Muscular dystrophy – a medical perspective
3.1.3. Spina bifida – a medical perspective
3.2.Secondary disabilities pertaining to physical disabilities
3.2.1. Visual impairments
3.2.2. Hearing impairments
3.3.Particular problems that the physically disabled child
might experience
4.INCLUSION IN A SOUTH AFRICAN CONTEXT ..…………………..18-21
5.THE CURRICULUM ………………………………..……………………….22-24
6.THE EDUCATOR: SKILLS, ATTITUDES AND VALUES ……………..25-28
7.THE SCHOOL ENVIRONMENT ……….………………………………..29-33
8.SUPPORT INSIDE AND OUTSIDE OF THE CLASSROOM..………34-40
8.1.Support to educators
8.2.Support to children
8.3.Support to parents
9.PEOPLE IN THE MAINSTREAM SCHOOL ……………….…………..41-45
10.OVERVIEW AND CONCLUSION ……………………………………..46-48
REFERENCES
BIBLIOGRAPHY
APPENDIX 1
APPENDIX 2
1
1
Acknowledgements
I would like to thank Debbie Prudomme for being so willing to have an interview with me and I would like to thank her for all the information and ideas she provided. I would also like to thank Margie Nortje for taking the time to proof read my dissertation and supporting me by correcting various grammatical errors. I am very appreciative.
2
Introduction
“Mainstreaming or integrated education was an educational approach that arose from principles of normalization and integration and this has gained momentum in the last two decades” (Kapp, 1991:71). The integration approach was then reconstructed into an inclusive approach, which focused on educational aspects as well as social aspects of all children. Placement in mainstream schools is seen as a fundamental right for all children and in many countries this approach has shown the way that schools were segregated. This is seen as oppressive. Disabled children should, therefore receive their education as far as possible together with non-disabled children. In South Africa, at the moment, it has been said by many that it is easier for a physically disabled child to adjust and succeed in a mainstream school environment compared to children with learning, neurological, behavourial, visual or auditory disabilities. Within this dissertation, I will be investigating this statement as well as investigating the effects that these physically disabled children are having on mainstream schools. I used methods of empirical research (observation), action research (interview) as well as literature research. I made use of research books, the Internet and various journals. I then designed an interview and interviewed a person who has had prior experience with physically disabled learners in her class. I also observed a physically disabled child in the mainstream school environment.
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The physically disabled child
As said by Blackhurst and Berdine in Kapp (1991), “a physically disabled person … is one whose physical or health problems result in an impairment of normal interaction with society to the extent that specialized services and programs are required” (Kapp, 1991:419). Physical disabilities are considered an impairment of a permanent nature and include children with motor impairments such as injuries or diseases of the spine, muscles, bones and joints, as well as neurological impairments. The category ‘physical disability’ does include neurologically related disorders and disorders of the skeletal and muscular systems. It may occur in various degrees of severity from barely perceptible to profoundly disabled. Kapp (1991) states that children with cerebral palsy should be excluded from this category of disabilities due to the degree of severity and the particular and multiple nature of the disability. He believes that cerebral palsy should be in a separate category of disability. For the purpose of this dissertation, cerebral palsy will be included into the category of physical disabilities. I feel that it does include students with cerebral palsy, muscular dystrophy and spina bifida as well as many other disabilities and impairments. It is also known to include health impairments such as epilepsy, asthma and cystic fibrosis, arthritis, or diabetes (Pasanella, 1981:189).
Examples of primary disabilities
Cerebral Palsy – a medical perspective
Kapp (1991) affirms that in 1973 the Cerebral Palsy Division of the National Council for the Care of Cripples in South Africa proposed the following definition:
Cerebral Palsy is essentially a physical disability. It is caused by factors, which affect the not yet fully-grown brain prior to or during birth, or during the early postnatal period. The disability comprises one or more of the following characteristics: paralysis, weakness, inco-ordination and functional deviation of the motor system. Associated disabilities – mental, convulsive, sensory, perceptual and affective – are common.
(Kapp, 1991:270)
Since the brain is the center of control, not only of the motor system but also of many other functions such as intelligence, behaviour and personality, and since brain damage may also result in epilepsy, blindness, deafness, mental handicap and learning disability, one would expect to find that multiple handicaps are often associated with cerebral palsy. Therefore, the child that is primarily cerebral palsied may have any number of secondary handicaps as previously stated (Kapp, 1991).
Keats in Kapp (1991) gives a detailed account of various classifications of cerebral palsy. I will be focusing on the physiological classification whereby one observes the motor symptoms that are present. There are various types of motor symptoms within the physiological classification system. These types include the following: spasticity, athetosis, ataxia, atonia, myoclinic trembling, and mixed types.
- SPASTICITY
Cruickshank in Kapp (1991) states that this is a disharmonic muscle activity caused by damage to the motor areas of the brain. A sense of stiffness is seen as the main characteristic. Spasticity is regarded as the main form of cerebral palsy. Bowley and Gardner in Kapp (1991) suggest that it occurs in 75% of all cerebral palsied children. Typical characteristics of the spastic person include flexion in the wrist and elbow so that the lower arm is bent up stiffly against the upper arm (like a chicken wing), adduction and turning inward of the arm at the shoulder, adduction and flexion of the hip, flexion of the knee and raised heel in the foot. A very typical symptom is the ‘cerebral thumb’ whereby the thumb is folded into the palm with the other fingers clasped over it (See Appendix A for pictorial representation of typical symptoms of spasticity).
- ATHETOSIS
This is characterized by excessive involuntary movements following no fixed pattern and is described as irregular, arrhythmic wriggling and writhing. These movements may be fast or slow. If involuntary movements of the face, tongue or throat occur, this can often impede speech, as well as chewing and swallowing movements (Kapp, 1991:275).
- ATAXIA
Ataxia is characterized by poor coordination and is usually attributed to disturbances of balance, posture and kinaesthetic feedback processes. The outcome is an inability to maintain balance, which is associated with a lack of gross and fine motor coordination or clumsiness (Kapp, 1991:276).
- ATONIA
MacKeith in Kapp (1991) states that, until the child is six months old, all types of cerebral palsy usually assume the form of atonia and shows evidence of the syndrome of a ‘floppy’ baby. Some children show signs of decreased muscle tone long after the age of six months. Only a very small number of cerebral palsied children are atonic.
- MYOCLINIC TREMBLING
Myoclinic or light trembling is also sometimes found in cerebral palsied children (Kapp, 1991:277).
- MIXED TYPES
Some of these children display symptoms of more than one type. According to Bowley & Gardner as well as Cruickshank in Kapp (1991), “mixed types, mostly of spasticity and athetosis, comprise approximately 10% of all cerebral palsied children” (Kapp, 1991:277). It is, therefore, not a single disability, but a group of disabilities, which may involve different parts of the body and may vary in intensity from mild to severe. Kapp (1991) also reveals that real brain damage thus impedes the child’s muscle function and may also affect the mental capacity of the child. As previously mentioned, visual and aural losses may occur and this can cause the kind of neural deficits included under the concept of learning disabilities.
Muscular dystrophy – a medical perspective
Muscular dystrophy falls into the category of diseases of the nervous system. Kapp (1991) suggests that chronic diseases of the nervous system can be divided into two main groups, namely headaches and myopathy. Muscular dystrophy falls within the myopathy group and is one of the best-known forms of myopathy in children.
Myopathy refers to abnormal muscle functioning where the disorder is present in the muscle, but the cause does not necessarily lie in the muscle. Myopathy can manifest itself in muscle weakness, muscle cramps, myalgia (pain in muscles) and muscle limpness. (Kapp, 1991:169)
A summary of the disease muscular dystrophy can be observed in Kapp (1991:170). It is defined as a group of hereditary diseases that can cause progressive muscular weakness. There are various types, but the most commonly known form is the Duchenne-type. This type begins to show symptoms in childhood. Duchenne muscular dystrophy occurs only in boys. It starts in the lower limbs and spreads gradually to the rest of the body. The disease is evidenced from the age of two to five years. The first signs to be observed are that the child often falls, has difficulty climbing steps and standing up. These children develop a swinging step and are inclined to walk on their toes. Pseudo-hypertrophy of some muscles occurs whereby the muscles appear large, not as a result of enlarged muscle fibre, but because of connective tissue and fat that collect in the muscle. The Duchenne-type progresses quicker than the majority of other types, and the inefficiency of the muscles make it necessary for the child to use a wheelchair. The heart muscle and respiratory muscles are later also affected and lung infections often occur, especially during teenage years. These children become progressively less mobile and with the passing of time are able to move their muscles less and less.
According to Kapp (1991:170), treatment should be of a supportive nature and physiotherapy is needed to prevent contractures, to improve circulation and to keep children mobile for as long as possible. In agreement with this statement, I believe that all children with physical disabilities require support of various kinds. Children with muscular dystrophy should be protected as far as possible from infections, especially with regards to the respiratory tracts. These children usually die from lung infections and heart failure in their late teens (Kapp, 1991).
Spina bifida – a medical perspective
Spina bifida is a neurological related physical disability and is also known as spinal fissue. It is a multifactorial genetic abnormality. It is one of the most common abnormalities with which a baby may be born. Spina bifida is a congenital deviation of the neural tube (the spinal cord with the spinal column, which normally surrounds and protects it). With spina bifida one or more of the vertebrae of the vertebral column are not completely formed. An opening forms and at the opening the membrane may bulge to form a sac containing cerebrospinal fluid and part of the spinal cord. The sac is usually not covered with skin and the opening may appear at any place on the spinal column (Kapp, 1991).
Secondary disabilities pertaining to physical disabilities
Visual impairments
Visual impairments, as a primary or secondary impairment, are likely to affect all areas of development. Children with a primary physical disability already have mobility problems. Having a visual impairment would make the ability to move poorer as they are not able to monitor their movements and are not able to perceive depth and orientate themselves effectively. The child is very unlikely to be able to imitate or copy actions, and during the early years, the ability to imitate others has been said to be one way that children learn best. Visual impairments can also affect the child’s confidence within himself or herself when it comes to moving around.
According to Best (1992), average visual acuity is 6/6. Total blindness has been defined by the Department of Social Security (DSS) in Best (1992) as an acuity of less than 3/60. This is based on a person’s ability to see the letters on the Snellen acuity chart. Best (1992) affirms that, total blindness is either congenital or acquired. “The difference is important for, if the onset of blindness has occurred after 5 years of age, then the child will almost certainly have some visual memories which may help in imagining and understanding many concepts” (Best, 1992:3). In particular, these memories would help the child with spatial awareness and orientation, compared to a child who is congenitally blind.
Partial blindness covers the majority of children who are visually impaired. Best (1992) defines partial blindness as a visual acuity of between 3/60 and 6/60. The acuity score is determined by performance on various visual tasks. For example, identifying a stationary black-and-white image at a distance. Other tasks include seeing and identifying objects that are nearby, objects that are moving and objects in different lighting conditions. They need to be able to see while moving about and to change focus from one object to another.
Best (1992) affirms that language development may also be affected. The sequence of development may be the same as for a sighted child, but the route that the blind child uses to move between stages, and the age at which developments take place, may be affected. In particular, the meaning that children attach to words need to be considered. They may attach a slightly different meaning to words based on their tactile and auditory experiences. Imagine the number of plates that a sighted four year old has experienced. Not only those he has touched and used, but hundreds more he has seen in his house, friends houses, shops, books and television. His concept of ‘plates’ is likely to be wider than a blind child’s and include a greater variety of shapes, sizes, colours and materials.
Hearing impairments
A hearing impairment or hearing loss can either be congenital, acquired or presbycusis. As said by Goldstein (1989), congenital refers to the fact that the impairment exists at birth. It may be genetically determined or as a result of an infection such as rubella. Acquired hearing impairments can result from infections, trauma and certain categories of drugs. Presbycusis refers to a gradual hearing loss, especially in the high frequencies that accompany ageing. There are various types of hearing impairments, namely conductive, sensori-neural and mixed types. Conductive refers to any condition that impedes sound passing through the air reaching the inner ear normally. According to Goldstein (1989), the most common causes are: glue ear, oto-sclerosis (abnormal growth of the bone), meatal atresia (the canal is absent or very tiny), abnormalities of the ossicular chain (the three little bones in the middle ear), and lastly, perforated eardrums. Sensori-neural refers to peripheral damage and central damage, whereby there is damage of the nerves, or there is damage in the auditory pathways. Within the category of sensori-neural is the term ‘aphasics’, which refers to being able to detect sounds normally, but one cannot make sense of what they hear. Mixed types refer to the fact that the hearing impairment is caused by a sensori-neural loss with a conductive overlay. The sensori-neural component is incurable, while the conductive component is often amenable to treatment (Goldstein, 1992:118).
Particular problems that the physically disabled child might experience
Kapp (1991) puts forward various problems that children with physical disabilities might have. I have summarized his thoughts in addition to writing down my thoughts on this subject.
Physically disabled children often have psychosocial problems whereby they have a poor self-image, which results in the formation of a negative self-concept. They experience being different from other children and they feel inferior. These feelings contribute to feelings of helplessness and uselessness and lead to poor intrinsic motivation, which also can create problems in the child’s schoolwork. Physically disabled children experience themselves as being different from other people. They also acknowledge that other people consider them different and this often causes distance between these children and others. Therefore, these children experience socializing problems – especially with children in mainstream education.