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Define Orthopedic And Musculoskeletal Disorders Essay

Special education teachers have enormous responsibilities in terms of meeting the needs of students with orthopedic and musculo-skeletal disorders such as curvature of the spine, hip conditions, limb deficiency, and juvenile rheumatoid arthritis. The process of developing appropriate individualized education goals begins with educating oneself on specific characteristics of each disorder.

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Special education teachers have enormous responsibilities in terms of meeting the needs of students with orthopedic and musculoskeletal disorders such as curvature of the spine, hip conditions, limb deficiency, and juvenile rheumatoid arthritis. The process of developing appropriate individualized education goals begins with educating oneself on specific characteristics of each disorder. Students with orthopedic and musculoskeletal disorders require instructional programs and physical management routines that aim to assist the student in achieving “functional outcomes in communication, mobility, socialization, work, and learning” (Snell & Brown, 2006, p.291). The purpose of this paper is first to outline teacher responsibilities in terms of meeting the needs of this population. Next the author offers a brief synopsis of educational implications for the following conditions: curvature of the spine, hip conditions, and limb deficiency. The final segment is a comprehensive look at Juvenile Rheumatoid Arthritis (JRA) including specific disabilities associated with JRA, the prominent complications, financial effects and assistance in the educational system, treatment and rehabilitation options; and the educational interventions including two appropriate individualized educational goals designed to meet the needs of the student will be presented.  

Students arriving at school with orthopedic and musculoskeletal disabilities require specialized awareness and knowledge by the teacher. Often a team of professionals working together develop the instructional and physical management programs designed to insure the student receives a Free Appropriate Public Education (FAPE) in the Least Restrictive Environment (LRE) as required by federal law (Eric Digest, n.d.). The teacher serves as the team leader assisting in pulling together relevant team members and compiling necessary information for the Individualized Education Plan (IEP). Snell & Brown (2006) suggest at the beginning of each school year teachers work with therapists to address the adaptive equipment needs of the student. Checking whether the equipment still fits the student, the suitability of the equipment and determining if staff training is needed should be a priority. Furthermore, the teacher needs to look at the entire school day of the student from the bus ride to school and the bus ride home from school investigating how the student is accessing the complete educational environment including: change of classrooms, use of restroom, changing of diapers or clothing, physical education, music, library classes (2006). Exploring the student’s entire day offers the teacher valuable insight regarding the physical routines and instructional programs. Students with curvature of the spine, hip conditions limb deficiency musculoskeletal disorders and JRA will require differing adaptations and modifications. Occupational and physical therapists will most likely be included in the team of professionals serving the needs of students with orthopedic and musculoskeletal disorders (Snell & Brown, 2005).

The student with a severe curvature of the spine may have had multiple surgeries to correct the abnormality. Many of these students do not require specialized academic instruction. However, those with severe forms may need support related to movement may need support needed for mobility in the classroom and on campus. In addition, the student may have some emotional or self-concept issues. The teacher may consider addressing these issues with staff and the student’s classmates (Orthopedic and Musculoskeletal Disorders, 2010).

Hip conditions disrupt the movement of the hip limiting mobility and therefore impact the student’s ability to freely and easily move about the classroom or campus. Supportive bars, installed throughout the environment in order to make standing, sitting, or walking less debilitating. Emotional support may be needed as well for these students (Orthopedic and Musculoskeletal Disorders, 2010).

Limb deficiency is defined by Orthopedic and Musculoskeletal Disorders, 2010 as “the absence or abnormality of a limb (e.g. shortness of a limb). There are two primary categories of limb deficiency: terminal and intercalary deficiencies” (p.3).Terminal indicates the limb is partially intact. The upper portion has developed normally with the lower portion either missing or deformed. An intercalary deficiency results when all or part of the limb is missing. Students with these disorders will certainly require modification and accommodations to access school materials and the physical environment. Technology is frequently used for student to do written work, or for communication purposes. Nurses will most likely be key members of the team of educational professionals (Orthopedic and Musculoskeletal Disorders, 2010).

Osteogenesis imperfecta and arthrogryposis are disorders of the musculoskeletal system with no know cure. Osteogenesis imperfecta presents with very brittle bones that are easily and frequently broken and can be fatal. Arthrogryposis is considered a non progressing disorder. In this disorder, the child’s muscles are contracted at birth and may affect all functional movement of the arms and legs. Modifications may require multiple levels of splinting or casting. The student’s desk and school materials may require modifications for improved function and work output (Orthopedic and Musculoskeletal Disorders, 2010).

One of the most common chronic diseases found in children ages six to nine years of age is Juvenile Rheumatoid Arthritis. “JRA may lead to functional deficiency in the musculoskeletal system and blindness” (Cakmak & Bolukbas, 2005). The criteria for diagnosis of JRA includes (1) onset prior to the age of 16; (2) multiple joints involved with at least two of the following findings: limited range of motion, tenderness or pain with joint movement and elevated fever; (3) the disease is systemic and persists longer than six weeks which includes inflammation in multiple joints. JRA develops with a fever and is exclusionary of other forms of juvenile arthritis (2005). JRA causes painful swelling of the joints and stiffness and may improve, get worse or go into remission throughout the child’s life (Orthopedic and Musculoskeletal Disorders, 2010). The educational implications and complications for students with JRA include excessive absences, limited mobility and diminished strength, endurance and stamina. Because school is the occupation of the child, the needs of these students must be addressed to ensure optimum success (www.arthritis.org, 2011). Typically students when not experiencing the flare-up are to be encouraged to participate in all school activities with the accommodation of being allowed to self-limit activities in order to protect the joints. At times student with JRA take medications which must be monitored and may have side effects such as upset stomach. In these cases the student may require smaller and more frequent meals (2011).

The psychological and social impact of JRA will differ from student to student. Families are frequently stressed with worries about the child’s ability to succeed and finish school, how the student looks, and acceptance by peers, the ongoing cost of medical care, and how the child will grow into an independent and productive adult. Sibling worry they may contract the disease. These stressors can place undo hardship on the student with JRA such as feelings of isolation, inadequacy, being insecure with peers, In addition, the student may be angry or depressed because of feeling or being left out of typically developing peer activities (2010). Students with JRA should be listened to and observed for signs of depression, physical fatigue or pain. Teachers and other educational professionals can assist the student by encouraging him or her to work with strengths rather than limitations. When appropriate, the student needs to be involved in the planning and implementation of IEP goals and objectives. Whenever possible, the student should be encouraged to join in social activities and extra effort made to ensure the maximum amount of interaction with peers. The classroom should be one in which diversity and individual differences are recognized, embraced and celebrated (2010).

The student with JRA may receive modification for his or her school program by way of an Individualized education plan (IEP) which allows the student access to a team of educational professionals including the teacher, the parent, the student, OT, PT, school nurse, school psychologist, and a building administrator. This team will design and implement the IEP. PT will be one of the major contributors toward the success of the student. Cakmak & Bolukbas (2005) claim preventing growth retardation is one of the main rehabilitative strategies PT’s use when working with students with JRA. Children with JRA are at risk for a high number of falls due to weakness in muscle strength and a decrease in both fine and gross motor skills. Balance control and joint development are also cited as causal for stumbling and falling down in and out of school. Stretching and strengthening exercises need to be customized to fit in with the students home and school life. Stretches can be done in combination with therapeutic exercises. In addition, Cakmak & Bolukbas report swim therapy to be significantly beneficial for improving joint mobility (2005).

The following are two goals and objectives for a 13 year old ninth grade boy with JRA:

  1. Annual Goal: Johnny will be able to participate in fine and gross motor activities involving the use of shoulder, arm, hand and fingers in order to produce written work, computer access and participate in PE activities such as volleyball and table tennis.
    1. Objective: Johnny will participate in the following stretching program. Stretches will be administered to each joint area-shoulder, elbow, wrist, fingers. Johnny will keep records on chart given by PT. PT to do a weekly review of exercise program with Johnny.
    2. Stretches for 10 second hold, 5 times in each session 2 sessions per day until 6/19/11.
    3. Stretches for 15 second hold, 20 second relax 5 times in each session 2 sessions per day until 11/15/11.
    4. Stretches for 20 second hold relax 20 seconds. 10 times in each session 2 sessions per day until 1/19/12.
    5. Stretches for 25 second hold, relax 20 seconds 10 times in each session 2 sessions per day until 6/19/11 (2005).
  2. Annual Goal: Johnny will improve or maintain his ability to sit down and stand up from a chair independently through out the school day without the use of bars or assistive devices.
    1. Objective-Johnny will participate in the school aquatic program 3 times per week for up to 30 minutes or as tolerated.
    2. Johnny will swim 3 laps in the pool in 30 minutes by 6/19/11 as measured by self charting and swim coach documentation.
    3. Johnny will swim 5 laps in the pool in 30 minutes by 11/1511 as measured by self charting and swim coach documentation.
    4. Johnny will swim 8 laps in the pool in 30 minutes by 1/19/12 as measured by self charting and swim coach documentation.
    5. Johnny will swim 10 laps in the pool in 30 minutes by 6/19/12 as measured by self charting and swim coach documentation.

In the case of the specific student with JRA, the PT would be the qualified professional to manage the data and routines for the student. The swim coach provides the student the least restrictive environment for the student as well as highly desired peer participation. The teacher may be called upon to organize and facilitate the IEP and document student progress while collaborating with others on the team. 

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Were you a student at Grand Canyon when writing this? SPE 573?

An outstanding and well-researched article.  If I could have voted it up twice I would have done.  In spite of being The Lead in a Learning Support Department in a mainstream school for many years and having a daughter with Myotonic Muscular Dystrophy, this is actually an area that I need to read a bit more about.  it is great to see Knoji writers still actually writing articles!

Chris this is a fine article which is sure to benefit the disabled.

Thank you everyone for your kind comments and feedback.

0

0 answersPosted on Jan 27, 2012

Well explained, even breaking it down into each type of problem and how to deal with it.

+Paulose

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44 answersPosted on Jan 24, 2012

Interesting post. Voted up. Thank you.

Chris, this is such a great article, will be sending to my niece, she teaches children with disabilities! Voted up!!! xoxoxo

john doe

0

155 answersPosted on Jan 19, 2012

What a really great piece of work.

Very informative, good work!

An excellent presentation, Chris.

You have expertly discussed the topic.

This is a really a worthy academic piece of writing.

Well explained and has great value.thank you.

Special cases require special tools. Good facts Chris.

Musculoskeletal Disorders (MSDs) are a common and costly problem for people and companies across the United States.

  • MSDs are the single largest category of workplace injuries and are responsible for almost 30% of all worker’s compensation costs. (source: BLS)
  • U.S. companies spent 50 billion dollars on direct costs of MSDs in 2011. (source: CDC)
  • Indirect costs can be up to five times the direct costs of MSDs. (source: OSHA)
  • The average MSD comes with a direct cost of almost $15,000. (source: BLS)

The economic and human costs of MSDs are unnecessary. Musculoskeletal disorders are preventable.

To lay the foundation for an MSD prevention strategy, it’s important to understand what MSDs are and what causes them. With this knowledge, you’ll be able to allocate your time, attention and resources most effectively to prevent MSDs.

Definition of Musculoskeletal Disorder

So what is a musculoskeletal disorder?

It’s simple.

Musculoskeletal Disorders or MSDs are injuries and disorders that affect the human body’s movement or musculoskeletal system (i.e. muscles, tendons, ligaments, nerves, discs, blood vessels, etc.).

Common MSDs include:

  • Carpal Tunnel Syndrome
  • Tendonitis
  • Muscle / Tendon strain
  • Ligament Sprain
  • Tension Neck Syndrome
  • Thoracic Outlet Compression
  • Rotator Cuff Tendonitis
  • Epicondylitis
  • Radial Tunnel Syndrome
  • Digital Neuritis
  • Trigger Finger / Thumb
  • DeQuervain’s Syndrome
  • Mechanical Back Syndrome
  • Degenerative Disc Disease
  • Ruptured / Herniated Disc,
  • and many more.

We use the term “musculoskeletal disorder” because it accurately describes the problem.

Other common names for MSDs are “repetitive motion injury”, “repetitive stress injury”, “overuse injury” and many more. The problem with using that kind of terminology is that it implicates a singular cause for damage to the musculoskeletal system – repetition and stress. This is limiting because more and more research is pointing to multiple causative risk factors leading to MSDs.

Interested in learning how to prevent common and costly MSDs? Get instant access to our free MSD Prevention 101 training course. Click here to sign up today.

The Cause of Musculoskeletal Disorders – Exposure to Risk Factors

When a worker is exposed to MSD risk factors, they begin to fatigue. When fatigue outruns their body’s recovery system, they develop a musculoskeletal imbalance. Over time, as fatigue continues to outrun recovery and the musculoskeletal imbalance persists, a musculoskeletal disorder develops.

These risk factors can be broken up into two categories: work-related (ergonomic) risk factors and individual-related risk factors.

So the root cause of MSDs is exposure to MSD risk factors – both work-related risk factors and individual-related risk factors.

Work-related Risk Factors

Workplace design plays a crucial role in the development of an MSD.

When a worker is asked to do work that is outside his body’s capabilities and limitations, he is being asked to put his musculoskeletal system at risk. In these situations, an objective evaluation of the workstation design tells us the worker’s recovery system will not be able to keep up with the fatigue that will be caused by performing the job. The evaluation will tell us that ergonomic risk factors are present, the worker is at risk of developing a musculoskeletal imbalance and a musculoskeletal disorder is an imminent reality.

There are three primary ergonomic risk factors.

  • High task repetition. Many work tasks and cycles are repetitive in nature, and are frequently controlled by hourly or daily production targets and work processes. High task repetition, when combined with other risks factors such high force and/or awkward postures, can contribute to the formation of MSD. A job is considered highly repetitive if the cycle time is 30 seconds or less.
  • Forceful exertions. Many work tasks require high force loads on the human body. Muscle effort increases in response to high force requirements, increasing associated fatigue which can lead to MSD.
  • Repetitive or sustained awkward postures. Awkward postures place excessive force on joints and overload the muscles and tendons around the effected joint. Joints of the body are most efficient when they operate closest to the mid-range motion of the joint. Risk of MSD is increased when joints are worked outside of this mid-range repetitively or for sustained periods of time without adequate recovery time.

Exposure to these workplace risk factors puts workers at a higher level of MSD risk. It’s common sense: high task repetition, forceful exertions and repetitive/sustained awkward postures fatigue the worker’s body beyond their ability to recover, leading to a musculoskeletal imbalance and eventually an MSD.

Evidence Base of Work-Related Risk Factors:

Musculoskeletal Disorders and Workplace Factors
NIOSH / U.S. Department of Health & Human Services

The conclusion of this 590 page report is simple and straightforward:

“A substantial body of credible epidemiologic research provides strong evidence of an association between MSDs and certain work-related physical factors when there are high levels of exposure and especially in combination with exposure to more than one physical factor (e.g., repetitive lifting of heavy objects in extreme or awkward postures [Table 1]).

The strength of the associations reported in the various studies for specific risk factors after adjustments for other factors varies from modest to strong. The largest increases in risk are generally observed in studies with a wide range of exposure conditions and careful observation or measurement of exposures.”

Work-related Musculoskeletal Disorders: The Epidemiologic Evidence and the Debate
Journal of Electromyography and Kinesiology

“Thus there is an international near-consensus that musculoskeletal disorders are causally related to occupational ergonomic stressors, such as repetitive and stereotyped motions, forceful exertions, non-neutral postures, vibration, and combinations of these exposures.”

Additional reading:

Individual-related Risk Factors

Human beings are multi-dimensional. Limiting ourselves to a singular cause of MSDs will limit our ability to create a prevention strategy that addresses the multi-dimensional worker.

We need to address both workplace risk factors and individual risk factors.

Individual risk factors include:

  • Poor work practices. Workers who use poor work practices, body mechanics and lifting techniques are introducing unnecessary risk factors that can contribute to MSDs. These poor practices create unnecessary stress on their bodies that increases fatigue and decreases their body’s ability to properly recover.
  • Poor overall health habits. Workers who smoke, drink excessively, are obese, or exhibit numerous other poor health habits are putting themselves at risk for not only musculoskeletal disorders, but also for other chronic diseases that will shorten their life and health span.
  • Poor rest and recovery. MSDs develop when fatigue outruns the workers recovery system, causing a musculoskeletal imbalance. Workers who do not get adequate rest and recovery put themselves at higher risk.
  • Poor nutrition, fitness and hydration. For a country as developed as the United States, an alarming number of people are malnourished, dehydrated and at such a poor level of physical fitness that climbing one flight of stairs puts many people out of breath. Workers who do not take care of their bodies are putting themselves at a higher risk of developing musculoskeletal and chronic health problems.

Exposure to these individual risk factors puts workers at a higher level of MSD risk. Just like workplace risk factors, individual risk factors are common sense:  when a worker uses poor work practice, has bad health habits, doesn’t get adequate rest and recovery and doesn’t take care of their bodies with a good nutrition and fitness regimen, they are at greater risk for fatigue to outrun their recovery system. Having a poor overall health profile puts them at greater risk of developing a musculoskeletal imbalance and eventually an MSD.

Not convinced? Here is what the scientific literature has to say.

Evidence Base of Individual-related Risk Factors:

NIOSH Total Worker Health
NIOSH

NIOSH supports a multi-dimensional view of workers, which they call “Total Worker Health”. This strategy integrates health protection with health promotion because they recognize that, “emerging evidence recognizes that both work-related factors and health factors beyond the workplace jointly contribute to many health and safety problems that confront today’s workers and their families.”

Total Worker Healthis a strategy integrating occupational safety and health protection with health promotion to prevent worker injury and illness and to advance health and well-being.”

Here is a quote from the NIOSH Total Worker Health Seminal Research Papers (2012):

“Today, emerging evidence recognizes that both work-related factors and health factors beyond the workplace jointly contribute to many health and safety problems that confront today’s workers and their families. Traditionally, workplace health and safety programs have been compartmentalized. Health protection programs have focused squarely on safety, reducing worker exposures to risk factors arising in the work environment itself. And most workplace health promotion programs have focused exclusively on lifestyle factors off-the-job that place workers at risk. A growing body of science supports the effectiveness of combining these efforts through workplace interventions that integrate health protection and health promotion programs.”

Work-related Musculoskeletal Disorders: Prevention report
European Agency for Safety and Health at Work

“Epidemiological studies have shown that some personal risk factors for MSDs such as smoking, being overweight, or in poor physical shape are the same factors as those relating to poor general health. Therefore general health promotion at the workplace might be one option to prevent MSDs.”

“Practice shows that the collaboration of people with expertise in different areas (e.g. engineering, psychology, human relations) is advantageous as this allows MSD-related issues to be approached in a global way. However, the involvement and participation of all employees and their representatives is crucial to success in such a holistic approach and, moreover, in creating a culture where ergonomics and the prevention of musculoskeletal disorders is embedded in every part of the process.”

Work-related Musculoskeletal Disorders Assessment and Prevention
InTech

“The recognition of personal risk factors can be useful in providing training, administrative controls, and awareness.  Personal or individual risk factors can impact the likelihood for occurrence of a WMSD (McCauley-Bell & Badiru, 1996a; McCauley-Bell & Badiru, 1996b). These factors vary depending on the study but may include age, gender, smoking, physical activity, strength, anthropometry and previous WMSD, and degenerative joint diseases (McCauley Bush, 2011).” …

Besides risk factors related to work other risk factors contribute to its development, namely factors intrinsic to the worker and factors unrelated to work. A risk factor is any source or situation with the potential to cause injury or lead to the development of a disease. The variety and complexity of the factors that contribute to the appearance of these disorders explains the difficulties often encountered, to determine the best suited ergonomic intervention to be accomplished in a given workplace, to control them. Moreover, despite all the available knowledge some uncertainty remains about the level of exposure to risk factors that triggers WMSD. In addition there is significant variability of individual response to the risk factors exposure. The literature review and epidemiological studies have shown that in the genesis of the WMSD three sets of risk factors can be considered (Bernard, 1997; Buckle & Devereux, 1999; Nunes, 2009a):  Physical factors – e.g., sustained or awkward postures, repetition of the same movements, forceful exertions, hand-arm vibration, all-body vibration, mechanical compression, and cold;  Psychosocial factors – e.g., work pace, autonomy, monotony, work/rest cycle, task demands, social support from colleagues and management and job uncertainty;  Individual factors – e.g., age, gender, professional activities, sport activities, domestic activities, recreational activities, alcohol/tobacco consumption and, previous WMSD.”

Work-related Musculoskeletal Disorders: The Epidemiologic Evidence and the Debate
Journal of Electromyography and Kinesiology

“As with most chronic diseases, MSDs have multiple risk factors, both occupational and non-occupational. In addition to work demands, other aspects of daily life, such as sports and housework, may present physical stresses to the musculoskeletal tissues. The musculoskeletal and peripheral nerve tissues are affected by systemic diseases such as rheumatoid arthritis, gout, lupus, and diabetes. Risk varies by age, gender, socioeconomic status, and ethnicity. Other suspected risk factors include obesity, smoking, muscle strength and other aspects of work capacity.”

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