Chapter 1: Understanding Disabilities and Vulnerabilities

1.1 Definitions of Basic Terms (Impairment, Disability and Handicap)

Impairment
Impairment means a lack/abnormality of an anatomic, physiological or psychological
structure or function or deviation on a person.
It refers to any loss or abnormality of physiological, psychological or anatomical structure
or function. It is the absence of particular body part or organ. It could also a condition in
which the body exists but doesn‘t function. Some children, for instance, have impairments
such as eyes that do not see well, arms and legs that are deformed, or a brain not developing
in a typical way etc.

Disability
The term disability is ambiguous as there is no single agreement on the concept (Mitra,
2006) It is not synonymous with AKAL-GUDATENGA (የአካል ጉዳተኛ) meaning
impairment
The concept of disability is complex, dynamic, multidimensional, and contested (WHO and
World Bank, 2011).
The full inclusion of people with impairments in society can be inhibited by:
Attitudinal (societal barriers, such as stigma)
Physical barriers (environmental barriers, such as absence of stairs), and
Policy barriers (systemic barriers),
Where all together can create a disabling effect and inhibit disability inclusive development.
They are disabling factors
If these problems addressed, impairment may not lead to disability
Where all together can create a disabling effect and inhibit disability inclusive development.
Societal, environmental, and systemic barriers are the most popular disabling factors:
A disabled persons
Persons with disability

What is disability?
1. Medical Approach
Disability is pathology (physiological, biological and intellectual). Disability means
functional limitations due to physical, intellectual or psychic impairment, health or psychic
disorders on a person (WHO,1996). The medical definition has given rise to the idea that
people are individual objects to be ―treated‖, ―changed" or ―improved" and made more
―normal‖. The medical definition views the disabled person as needing to ―fit in ‖rather
than thinking about how society itself should change. This medical definition does not
adequately explain the interaction between societal conditions or expectations and unique
circumstances of an individual
The social definition of disability:
Disability is a highly varied and complex condition with a range of implications for
social identity and behavior.
Disability largely depends on the context and is a consequence of discrimination,
prejudice and exclusion.
Emphasizes the shortcomings in the environment and in many organized activities in society, for
example on information, communication and education, which prevent persons with disabilities
from participating on equal terms.

Medical model: Social model:

Child is faulty Child is valued

Diagnosis and labeling Strengths and needs identified

Impairment is focus of attention Barriers identified and solutions developed

Medical model: Social model:

Segregation and alternative services Resources made available

Re-entry if normal enough or permanent Diversity welcomed; child is welcomed

exclusion

Society remains unchanged Society evolves

Causes of disability
What do you think is the causes of disability?
Some people, especially in the past times, wrongly believe that disability is a
punishment from God.
There are some who still believe that disability is a form of personal punishment
for individual with disability, a kind of karma for their past mistakes, which is
totally unacceptable now days.
Disability can be caused by the following factors.
Genetic Causes
Abnormalities in genes and genetic inheritance can cause intellectual disability in children. In
some countries, Down syndrome is the most common genetic condition. Sometimes,

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diseases, illnesses, and over-exposure to x-rays can cause a genetic disorder.

Environmental
Poverty and malnutrition in pregnant mothers can cause a deficiency in vital minerals and
result in deformation issues in the unborn child. After birth, poverty and malnutrition can
also cause poor development of vital organs in the child, which can eventually lead to
disability. The use of drugs, alcohol, tobacco, the exposure to certain toxic chemicals and
illnesses, toxoplasmosis, cytomegalovirus, rubella and syphilis by a pregnant mother can
cause intellectual disability to the child. Childhood diseases such as a whooping cough,
measles, and chicken pox may lead to meningitis and encephalitis. This can cause damage to
the brain of the child. Toxic material such as lead and mercury can damage the brain too.
Unfortunate life events such as drowning, automobile accidents, falls and so on can result in
people losing their sight, hearing, limbs and other vital parts of their body and cause
disability.
Unknown Causes
The human body is a phenomenal thing. Scientists have still not figured out what and how
some things in the body, cells, brain, and genes come about. Humans have still not found all
the answers to all the defects in the human body .

Inaccessible environments
Sometimes society makes it difficult for people with some impairment to function freely.
When society develops infrastructure such as houses, roads, parks and other public places
without consideration to people with impairment, the basically make it impossible for them
to take care of themselves. For example, if a school is built with a ramp in addition to stairs,
it makes it easy for people with wheelchairs to move about freely. This way, their
impairment is not made worse. Lack of education, support services, health and opportunities
for people with impairment can cause additional disability to people with disabilities and
even people with no disability.
Some type of disabilities: Some nine major disabilities are listed and briefly discussed in the
coming pages below.
1.Visual impairment
Visual impairment in general designates two sub- classifications. These are blindness and
low vision.
Blindness, total or partial inability to see because of disease or disorder of the eye, optic
nerve, or brain. The term blindness typically refers to vision loss that is not
correctable with eyeglasses or contact lenses. Blindness may not mean a total absence
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 of sight, however. Some people who are considered blind may be able to perceive
slowly moving lights or colors.
The term low vision is used for moderately impaired vision. People with low vision may
have a visual impairment that affects only central vision—the area directly in front of
the eyes—or peripheral vision—the area to either side of and slightly behind the eyes.

Hearing Impairment
Different people define the term hearing impairment differently. The definitions given to
hearing impairment convey different meaning to different people. Different definitions and
terminologies may be used in different countries for different purpose. Pasonella and Carat
from legal point of view, define hearing impairment as a generic term indicating a continuum
of hearing loss from mild to profound, which includes the sub-classifications of the hard of
hearing and deaf.
Hard of Hearing: "A hearing impairment, whether permanent of fluctuating, which
adversely affects a child's educational performance but which is not included under the
definition of 'deaf'." Whelan, R. J. (1988). This term can also be used to describe
persons with enough (usually with hearing aids) as a primary modality of acquisition of
language and in communication with others.
Deaf: Those who have difficulty understanding speech, even with hearing aids but can
successfully communicate in sign language. Cultural definitions of deafness, on the
other hand, emphasize an individual‘s various abilities, use of sign language, and
connections with the culturally deaf community.

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3. Specific learning disability

Specific Learning Disability means a disorder in one or more of the basic psychological
processes involved in understanding or in using language, spoken or written, that may
manifest itself in the imperfect ability to listen, think, speak, read, write, spell, or to do
mathematical calculations.

The term includes such conditions as perceptual disabilities, brain injury, minimal brain
dysfunction, dyslexia, and developmental aphasia. The term does not include learning
problems that are primarily the result of visual, hearing, or motor disabilities; of intellectual
disability; of emotional disturbance; or of environmental, cultural, or economic disadvantage.
Learning disabilities should not be confused with learning problems which are primarily the
result of visual, hearing, or motor handicaps; of intellectual disability; of emotional
disturbance; or of environmental, cultural or economic disadvantages.

Generally speaking, people with learning disabilities are of average or above average
intelligence. There often appears to be a gap between the individual‘s potential and actual
achievement. This is why learning disabilities are referred to as ―hidden disabilities‖: the
person looks perfectly ―normal‖ and seems to be a very bright and intelligent person, yet
may be unable to demonstrate the skill level expected from someone of a similar age. A
learning disability cannot be cured or fixed; it is a lifelong challenge. However, with
appropriate support and intervention, people with learning disabilities can achieve success in
school, at work, in relationships, and in the community.

Types of Specific Learning Disabilities

Auditory Processing Disorder (APD)

Also known as Central Auditory Processing Disorder, this is a condition that adversely
affects how sound that travels unimpeded through the ear is processed or interpreted by the
brain. Individuals with APD do not recognize subtle differences between sounds in words,
even when the sounds are loud and clear enough to be heard. They can also find it difficult to
tell where sounds are coming from, to make sense of the order of sounds, or to block out
competing background noises.

A. Dyscalculia

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Dyscalculia is a specific learning disability that affects a person‘s ability to understand
numbers and learn math. Individuals with this type of LD may also have poor comprehension
of math symbols, may struggle with memorizing and organizing numbers, have difficulty
telling time, or have trouble with counting.
B. Dysgraphia
Dyscalculia is a specific learning disability that affects a person‘s handwriting ability and
fine motor skills. Problems may include illegible handwriting, inconsistent spacing, poor
spatial planning on paper, poor spelling, and difficulty composing writing as well as thinking
and writing at the same time.
C. Dyslexia
Dyslexia is a specific learning disability that affects reading and related language-based
processing skills. The severity can differ in each individual but can affect reading
fluency; decoding, reading comprehension, recall, writing, spelling, and sometimes
speech and can exist along with other related disorders. Dyslexia is sometimes referred to
as a Language-Based Learning Disability.
D. Language Processing Disorder
Language Processing Disorder is a specific type of Auditory Processing Disorder (APD) in
which there is difficulty attaching meaning to sound groups that form words, sentences and
stories. While an APD affects the interpretation of all sounds coming into the brain, a
Language Processing Disorder (LPD) relates only to the processing of language. LPD can
affect expressive language and/or receptive language.
E. Non-Verbal Learning Disabilities
Non-Verbal Learning Disabilities is a disorder which is usually characterized by a significant
discrepancy between higher verbal skills and weaker motor, visual-spatial and social skills.
Typically, an individual with NLD (or NVLD) has trouble interpreting nonverbal cues like
facial expressions or body language, and may have poor coordination.
F. Visual Perceptual/Visual Motor Deficit
Visual Perceptual/Visual Motor Deficit is a disorder that affects the understanding of
information that a person sees, or the ability to draw or copy. A characteristic seen in
people with learning disabilities such as Dysgraphia or Non-verbal LD, it can result in
missing subtle differences in shapes or printed letters, losing place frequently, struggles
with cutting, holding pencil too tightly, or poor eye/hand coordination.

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4.Speech and Language Impairments

Speech and language impairment means a communication disorder such as stuttering,

impaired articulation, language impairment, or a voice impairment that adversely affects a
child‘s educational performance. It is disorder that adversely affects the child's ability to talk,
understand, read, and write. This disability category can be divided into two groups: speech
impairments and language impairments.

Speech Impairments

There are three basic types of speech impairments: articulation disorders, fluency disorders,
and voice disorders. Articulation disorders are errors in the production of speech sounds that
may be related to anatomical or physiological limitations in the skeletal, muscular, or
neuromuscular support for speech production. These disorders include:

Omissions: (bo for boat)

Substitutions: (wabbit for rabbit)
Distortions: (shlip for sip)

Fluency disorders are difficulties with the rhythm and timing of speech characterized by
hesitations, repetitions, or prolongations of sounds, syllables, words, or phrases.
Common fluency disorders include:

Stuttering: rapid-fire repetitions of consonant or vowel sounds especially at the

beginning of words, prolongations, hesitations, interjections, and complete
verbal blocks
Cluttering: excessively fast and jerky speech

Voice disorders are problems with the quality or use of one's voice resulting from disorders
in the larynx. Voice disorders are characterized by abnormal production and/or absences of
vocal quality, pitch, loudness, resonance, and/or duration.

Language Impairments

There are five basic areas of language impairments: phonological disorders, morphological
disorders, semantic disorders, syntactical deficits, and pragmatic difficulties. Phonological
disorders are defined as the abnormal organization of the phonological system, or a

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significant deficit in speech production or perception. A child with a phonological
disorder may be described as hard to understand or as not saying the sounds correctly.
Apraxia of speech is a specific phonological disorder where the student may want to speak
but has difficulty planning what to say and the motor movements to use.

Morphological disorders are defined as difficulties with morphological inflections

(inflections on nouns, verbs, and adjectives that signal different kinds of meanings).

Semantic disorders are characterized by poor vocabulary development, inappropriate use of

word meanings, and/or inability to comprehend word meanings. These students will
demonstrate restrictions in word meanings, difficulty with multiple word meanings,
excessive use of nonspecific terms (e.g., thing and stuff), and indefinite references (e.g., that
and there).

Syntactic deficits are characterized by difficulty in acquiring the rules that govern word order
and others aspects of grammar such as subject-verb agreement. Typically, these students
produce shorter and less elaborate sentences with fewer cohesive conjunctions than their
peers.

Pragmatic difficulties are characterized as problems in understanding and using language in

different social contexts. These students may lack an understanding of the rules for making
eye contact, respecting personal space, requesting information, and introducing topics.

Inclusive life for persons with speech and language difficulties

How can schools create inclusive education for students with speech and language
difficulties? Discuss
How persons with speech and language difficulties should be employed and live
independent life?
How can persons with speech and language difficulties lead independent life in the
community?
What kind of technology they require for speech and language communication and
daily life activities?

5.Autism

Autism means a developmental disability significantly affecting verbal and nonverbal

communication and social interaction, generally evident before age three that adversely
affects a child‘s educational performance. Other characteristics often associated with autism

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are engaging in repetitive activities and stereotyped movements, resistance to environmental
change or change in daily routines, and unusual responses to sensory experiences. The term
autism does not apply if the child‘s educational performance is adversely affected primarily
because the child has an emotional disturbance, as defined in #5 below. A child who shows
the characteristics of autism after age 3 could be diagnosed as having autism if the criteria
above are satisfied.

Autism is a neurodevelopment disorder defined by impairments in social and communication

development, accompanied by stereotyped patterns of behavior and interest (Landa, 2007).
Autism is pervasive developmental disorder characterized by lack of normal sociability,
impaired communication and repetitive obsessive behavior such as politeness, turn-taking
(Young & Nettlebeck , 2005). Linked to Profound Learning Disability (PLDs) are further
impairments in the production of speech. Among these are (i) personal pronouns reversal for
instance the use of ―I‖ instead of ―you‖ and vice-versa, (ii) the misuse of such prepositions
as ―in‖, ―on‖, ―under‖, ―next to‖ (...), and (iii) the prevalence, in speech, of echolalia
formal repetition of other‘s utterances (Arron and Gittens, 1999). Children with autism vary
literally in their use of words, (Rutter, 1966). Communication deficiencies may leave a
lasting mark of social retardation on the child. The link, between social skills and language is
made evident by the often spontaneous appearance of affectionate and dependent behavior in
these children after they have been trained to speak (Churchill, 1966 & Hewett, 1965).

6. Emotional and Behavioral Disorders

According to Individuals with Disabilities Education Act (IDEA), the term Emotional and
Behavioral Disorders means a condition exhibiting one or more of the following
characteristics over a long period of time and to a marked degree that adversely affects
educational performance
1. An inability to learn that cannot be explained by intellectual, sensory, or health factors;
2. An inability to build or maintain satisfactory interpersonal relationships with peers and
teachers;

3. Inappropriate types of behavior or feelings under normal circumstances;

4. A general pervasive mood of unhappiness or depression; or

 5. A tendency to develop physical symptoms or fears associated with personal or school
problems.
Classification of behavioral and emotional disorders

An individual having behavioral or emotional disorders can exhibit widely varied types of
behavior. Therefore, different classification systems of behavioral and emotional disorders can
be used for special education. Different professionals have developed a classification system,
which shows some promise for educational practice. These include:
- Conduct disorder: individuals may seek attention, are disruptive and act out. The
disorder is classified by type: overt (with violence or tantrums) versus covert (with
lying, stealing, and/or drug use).
- Socialized aggression: individuals join subculture group of peers who are
openly disrespectful to their peers, teachers, and parents. Common are
delinquency and dropping out of school. Early symptoms include stealing,
running away from home, habitual lying, cruelty to animals, and fire setting.
- Attention problems: These individuals may have attention deficit, are easily
destructible and have poor concentration. They are frequently impulsive and may
not think the consequence of their actions.
- Anxiety/Withdrawn: These individuals are self-conscious, reserved, and unsure
of themselves. They typically have low self-esteem and withdraw from immediate
activities. They are also anxious and frequently depressed.
- Psychotic behavior: These individuals show more bizarre behavior. They may
hallucinate, deal in a fantasy world and may even talk in gibberish.
- Motor excess: These students are hyperactive. They cannot sit nor listen to others nor
keep their attention focused.
Kauffman (1993) conclude that emotion or behavioral disorders fall into two broad
classifications:
1. Externalizing Behavior: also called under controlled disorder, include such problems
disobedience, disruptiveness, fighting, tempers tantrums, irresponsibility, jealous,
anger, attention seeking etc…
2. Internalizing Behavior: also known as over controlled disorders, include such problems
anxiety, immaturity, shyness, social withdrawal, feeling of inadequacy (inferiority),
guilt, depression and worries a great deal

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 Causes of behavioral and emotional disorders

Behavioral and emotion disorders result from many causes, these includes the following.
1. Biological- includes genetic disorders, brain damage, and malnutrition, allergies,
temperament and damage to the central nervous system.
2. Family factors- include family interactions, family influence, child abuse, neglect, and
poor disciplinary practices at home.
3. Cultural factors- include some traditional and cultural negative practices, for example
watching violence and sexually oriented movies and TV programs.
4. Environmental factors- include peer pressure, living in impoverished areas, and schooling
practices that are unresponsive to individual needs.

7. Intellectual Disability

Intellectual disability is a disability characterized by significant limitations in both intellectual

functioning and in adaptive behavior, which covers many everyday social and practical skills.
This disability originates before the age of 18. An individual is considered to have an
intellectual disability based on the following three criteria:
1. Sub average intellectual functioning: It refers to general mental capacity, such as
learning, reasoning, problem solving, and so on. One way to measure intellectual
functioning is an IQ test. Generally, an IQ test score of around 70 or as high as 75 indicates
a limitation in intellectual functioning.
2. Significant limitations exist in two or more adaptive skill areas: It is the collection of
conceptual, social, and practical skills that are learned and performed by people in their
everyday lives.

- Conceptual skills—language and literacy; money, time, and number concepts; and
self-direction.

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- Social skills—interpersonal skills, social responsibility, self-esteem, gullibility,
innocence (i.e., suspicion), social problem solving, and the ability to follow
rules/obey laws and to avoid being victimized.
- Practical skills—activities of daily living (personal care), occupational skills,
healthcare, travel/transportation, schedules/routines, safety, use of money, use of
the telephone.

People with intellectual disabilities academic learning can be affected, as well as their ability
to adapt to home, school, and community environments are presented under the following
sub-headings:

General Cognition: People with intellectual disabilities vary physically and emotionally,
as well as by personality, disposition, and beliefs. Their apparent slowness in learning may
be related to the delayed rate of intellectual development (Wehman, 1997).

Learning and Memory: The learning and memory capabilities of people with intellectual
disabilities are significantly below average in comparison to peers without disabilities.
Children with intellectual disabilities may not spontaneously use appropriate learning or
memory retention strategies and may have difficulty in realizing the conditions or actions
that aid learning and memory. However, these strategies can be taught (Fletcher, Huffman,
& Bray, 2003; Hunt & Marshall, 2002; Werts, Wolery, Holocombe, & Gast, 1995; Wolery &
Schuster, 1997).

Attention: To acquire information, children must attend to the learning task for the
required length of time and control distractions. Children with intellectual disabilities may
have difficulty distinguishing and attending to relevant questions in both learning and social
situations (Saunders, 2001). The problem is not that the student will not pay attention, but
rather that the student does not understand or does not filter the information to get to the
salient features (Hunt & Marshall, 2002; Meyen & Skrtic, 1988).
Adaptive Skills: The adaptive skills of people with intellectual disabilities are often not
comparable to those of their peers without disabilities. A child with intellectual disabilities
may have difficulty in both learning and applying skills for a number of reasons, including a
higher level of distractibility, inattentiveness, failure to read social cues, and impulsive
behavior (Hardman et al., 2008). The lack or underdevelopment of these skills notably affects

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memory, rehearsal skills, organizational ability, and being in control of the process of
learning (Erez & Peled, 2001; Hunt & Marshall, 2002).
Speech and Language: People with intellectual disabilities may have delayed speech,
language comprehension and formulation difficulties. Language problems are generally
associated with delays in language development rather than with a bizarre use of language
(Beirne-Smith et al., 2006; Moore-Brown & Montgomery, 2006). People with intellectual
disabilities may show delayed functioning on pragmatic aspects of language, such as turn
taking, selecting acceptable topics for conversation, knowing when to speak knowing when
to be silent, and similar contextual skills (Haring, McCormick, & Haring, 1994; Yoder,
Retish, & Wade, 1996).
Motivation: People with intellectual disabilities are often described as lacking motivation,
or outer-directed behavior. Past experiences of failure and the anxiety generated by those
failures may make them appear to be fewer goals directed and lacking in motivation. The
result of failure is often learned helplessness. The history of failure is likely to lead to
dependence on external sources of reinforcement or reward rather than on internal sources of
reward. They are less likely to self-starters motivated by self-approval (Beirne-Smith et al.,
2002; Taylor et al., 2005).
Academic Achievement: The cognitive difficulties of children with mild to moderate
intellectual disabilities lead to persistent problems in academic achievement (Hughes et al.,
2002; Macmillan, Siperstein, & Gresham, 1996; Quenemoen, Thompson, & Thurlow, 2003;
Turnbull et al., 2004), unless intensive and extensive supports are provided.
Physical characteristics: Children with intellectual disabilities with differing biological
etiologies, may exhibit coexisting problems, such as physical, motor, orthopedic, visual and
auditory impairments, and health problems (Hallahan & Kauffman, 2006). A relationship
exists between the severity of the intellectual disabilities and the extent of physical
differences for the individual (Drew & Hardman, 2007; Horvat, 2000). The majority of
children with severe and profound intellectual disabilities have multiple disabilities that
affect nearly every aspect of intellectual and physical development (Westling & Fox, 2004).
Levels of support for individuals with intellectual disabilities

Levels of support range from intermittent (just occasional or ―as needed‖ for specific
activities) to pervasive (continuous in all realms of living).

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 Levels and areas of support for intellectual disabilities
Level of Duration of Frequency of Setting of support Amount of professional
support support support assistance
Intermittent Only as needed Occasional or Usually only one or Occasional consultation or
infrequent two (e.g. 1–2 classes monitoring by professional
or activities)
Limited As needed, but Regular, but Several settings, but Occasional or regular contact
sometimes frequency varies not usually all with professionals
continuing
Extensive Usually Regular, but Several settings, but Regular contact with
continuing frequency varies not usually all professionals at least once a
week
Pervasive May be lifelong Frequent Nearly all settings Continuous contact and
or continuous monitoring by professionals
Source: American Association on Mental Retardation, 2002: Schalock & Luckassen, 2004.

8. Physical disability/Orthopedic Impairment and Health impairment

Physical disability is a condition that interferes with the individual‘s ability to use his or her
body. Many but not all, physical disabilities are orthopedic impairments. (The term orthopedic
impairment generally refers to conditions of muscular or skeletal system and sometimes to
physical disabling conditions of the nervous system).
Health impairment is a condition that requires ongoing medical attention. It includes asthma,
heart defects, cancer, diabetes, hemophilia. HIV/AIDS, etc.

Classification and Characteristics

How can you classify physical impairment?

Physical disabilities:- based on the impact of physical disability on mobility and motor skills,
it is divided into three. These are:-
A. Mild physical disability:- these individuals are able to walk without aids and may make
normal developmental progress.
B. Moderate physical disability:- individuals can walk with braces and crutches and may
have difficulty with fine-motor skills and speech production.
C. Severe physical disability:-these are individuals who are wheel-chair dependent and may
need special help to achieve regular development.

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The physical disability could be broadly classified in to two
I. The neurological system (the brain, spinal cord & nerve) related problems.
II. Musculo skeletal system ( the muscles, bones and joints) are deficient due to
various causes.
I. Neurological system:-with a neurological condition like cerebral palsy or a traumatic brain
injury, the brain either sends the wrong instructions or interprets feedback incorrectly. In both
cases, the result is poorly coordinated movement. With the spinal cord injury or deformity, the
path ways between the brain and the muscles are interrupted, so messages are transmitted but
never received. The result is muscle paralysis and loss of sensation beyond the point where the
spinal cord or the nerve is damaged. These individuals may have motor skill deficits that can
range from mild in coordination to paralysis of the entire body. The most severely affected
children are totally dependent on other people or sophisticated equipment to carry out academic
and self-care task

Additional problems that can be associated with cerebral palsy include learning disabilities,
mental retardation. Seizures, speech impairments, eating problems, sensory impairments, and
joint and bone deformities such as spinal curvatures and contractures (permanently fixed, tight
muscles and joints). Approximately 40 percent of those with cerebral palsy have normal
intelligence; the remainders have from mild to severe retardation. This is an extremely
heterogeneous group having unique abilities and needs.
Epilepsy:-is disorder that occurs when the brain cells are not working properly and is often
called a seizure disorder.
- Some children and youth will epilepsy have only a momentary loss of attention
(petit mal seizures); others fall to the floor and then move uncontrollably
- Fortunately, once epilepsy is diagnosed, it can usually be controlled with
medication and does not interfere with performance in school. Most individuals
with epilepsy have normal intelligence.
- Epilepsy is a condition that affects 1 to 2 percent of the population. It is characterized
by recurring seizures, which are spontaneous abnormal discharge of electrical
impulses of the brain.

Spinal bifida and spinal cord injury:- damage to the spinal cord leads to paralysis and loss
of sensation in the affected areas of the body. The spinal blfida is a birth defect of the
backbone (spinal column). The cause si unknown but it usually occurs in the first twenty-six
days of pregnancy.

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II. Musculoskeletal system: - it includes ,
1. The muscles and their supporting framework and the
skeleton.
2. Progressive muscle weakness (muscular dystrophy);
3. Inflammation of the joints (arthritis), or
4. Loss of various parts of the body (amputation)

The list of the impairment and associated with musculoskeletal malformation are the following:
A. Muscular dystrophy:- is an inherited condition accruing mainly in males, in which
the muscles weaken and deteriorate. The weakness usually appears around 3 to 4
years of age and worsens progressively. By age 11 most victims can to longer walk.
Death usually comes between the ages of 25 and 35 from respiratory failure or
cardiac arrest.
B. Arthritis:-is an inflammation of the joints. Symptoms include swollen and stiff joints,
fever, and pain in the joints during acute periods. Prolonged inflammation can lead
joint deformities that can eventually affect mobility.
C. Amputation:- a small number of children have missing limbs because of
congenital abnormalities or injuiry or disease (malignant bone tumors in the limbs).
These children can use customized prosthetic devices (artificial hands, arms, or legs)
to replace limp functions and increase independence in daily activities.
Other muscle-skeletal disorders are:-
D. Marfan syndrome:- is a genetic disorder in which the muscles are poorly developed
and the spine is curved. Individuals with marfan syndrome may have either long, thin
limbs, prominent shoulder blades, spinal curvature, flat feet, or long fingers &
thumbs. The heart and blood vessels are usually affected. The greatest danger is
damage to aorta, which can lead to heart failure. Individuals with marfan syndrome
need to avoid heavy exercise and lifting heavy objects.
E. Achondroplasis:- is a genetic disorder that affects 1 in 10,000 births. Children with
this disorder usually develop a normal torso but have a straight upper back and a
curved lower back (sway back).
These children are at risk of sudden death during sleep from compression of the
spinal cord interfering with their breathing. The disability may be lessened through
the use of the back braces or by surgery.

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Polio:- is viral disease that invade the brain and cause severe paralysis of the total body system.
In its mild form results in partial paralysis. Post polio muscles that were previously damaged
weaken, and in some persons, other muscles that were not previously affected weaken as well.

Club foot:- is a major orthopedic problem affecting about 9,000 infants each year. This term is
used to describe various ankle or foot deformities, i.e
1. Twisting inward (equino varus), the most severe form
2. Sharply angled at the heel (calcanel vaigus), most common
3. The front part of the foot turned inward.
These conditions can be treated with physical therapy, and a cast on the foot can solve the
problem in most instances. In more severe cases, surgery is necessary. With early treatment,
most children can wear regular shoes and take part in all school activities.
Cleft lip and cleft palate:- are openings in the lip or roof of the mouth, respectively, that fail to
close before birth, the cause is unknown. Most cleft problems can be repaired through surgery.

Health Impairments

What are the common health problems of students?

Any disease that interferes with learning can make students eligible for special services.
These disease caused problems are as follow.
1. Heart disease:- this is common among young people. It is caused by improper
circulation of blood by the heart some of the disorders are congenital )present at
birth);others are the product of inflammatory heart disease. Some students have
heart value disorders; others have disorders of the blood vessels. His time heart
implantation helps children to get cured.
2. Cystic fibrosis:- is a hereditary disease that affects the lungs and pancreas. It leads to
recurrent respiratory and digestive problems including abnormal amounts of thick
mucus, sweet and saliva. The disease is so progressive and few who have it survive
beyond age 20. Children with such disease often spend significant timeout of school.
3. Acquired immune deficiency syndrome (AIDS):- is a very severe disease caused
by human immunodeficiency virus (HIV) infection and transmitted primarily
through exchange of bodily fluids in transfusions or unprotected sex, and by
contaminated needles in addictive drug use.

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 4. Hemophilia:- is a hereditary disease in which the blood clots very slowly or not all.
The disorder is transmitted by sex-linked recessive gene and nearly always occurs in
males.
5. Asthma: is a chronic respiratory condition characterized by repeared eplosde of
breathing difficulties especially while exhaling.
6. Diabetes: Developmental or hereditary disorder characterized by inadequate
secretion or use of insulin
7. Nephrosis & Nephritis Kidney disorders or diseases caused by infections,
poisoning, burns, accidents or other diseases
8. Sickle-cell anemia Hereditary and chronic blood disease (occurring primarly in
African Americans) characterized by red blood cells that are distored and that
do not circulate properly
9. Leukemia: Disease characterized by excessive production of white blood Cells
10. Lead poisoning Disorder caused by ingesting lead-based paint chips or other
substances containing lead
11. Rheumatic fever Disease characterized by painful swelling and inflammation

of the joints that can spread to the hear and central nervous system.
12. Tuberculosis Infectious disease that commonly affects the lungs and may
affect other tissues of the body.
13. Cancer Abnormal growth of cells that can affect any organ system.
Vulnerability
Vulnerable means being at risk of being harmed. Everyone can be harmed, so being
vulnerable is part of being human. In principle, everyone is vulnerable to some adverse event
or circumstance, but some people are more vulnerable than others. For instance, people with
disabilities are more likely as a group to experience greater vulnerability. They are also often
more severely affected by the vulnerability they experience. Based on the existing literature,
vulnerability can be generally defined as a complex phenomenon that refers to the following
dimensions:

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 Economic difficulties/lack of financial resources: poverty, low living standards, housing
problems (e.g. too damp, too expensive, too cold or difficult to heat) etc.;
Social exclusion: limited access to facilities such as transporatation, schools, libraries or
medical services;
Lack of social support from social networks: no assistance from family members, friends,
neighbors or colleagues (referring to practical help as well as emotional support) like
highly gifted individuals;
Stigmatization: being a victim of stereotypes, being devalued, confronted with
disgraceful behavior because of belonging to a particular social or ethnic group;
Health difficulties: disadvantages resulting from poor mental health, physical health or
disabilities;
Being a victim of crime: in family context especially of violence.

Causes of Vulnerability
Vulnerability may be causes by rapid population growth, poverty and hunger, poor health,
low levels of education, gender inequality, fragile and hazardous location, and lack of access
to resources and services, including knowledge and technological means, disintegration of
social patterns (social vulnerability). Other causes includes; lack of access to information and
knowledge, lack of public awareness, limited access to political power and representation
(political vulnerability), (Aysan,1993). When people are socially disadvantaged or lack
political voice, their vulnerability is exacerbated further. The economic vulnerability is
related to a number of interacting elements, including its importance in the overall national
economy, trade and foreign-exchange earnings, aid and investments, international prices of
commodities and inputs, and production and consumption patterns. Environmental
vulnerability concerns land degradation, earthquake, flood, hurricane, drought, storms
(Monsoon rain, El Niño), water scarcity, deforestation, and the other threats to biodiversity.

Characteristics of Vulnerable People

The following are thought to be characteristics of vulnerable people (with examples of
groups of potentially vulnerable people):
Less physically or mentally capable (infants, older adults, people with disabilities)
Fewer material and/or financial resources (low-income households, homeless)
Less knowledge or experience (children, illiterate, foreigners, tourists)
Restricted by society to grow and develop according to their needs and potentials

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People who are helped by others (who are then restricted by commitments) are still
vulnerable people, which includes the following extracted from various researches.
Women: particularly women in developing nations and those who are living in rural
areas are vulnerable for many backward traditional practices. These women are
oppressed by the culture and do not get access to education and employment
(Comfort et al., 1999; Morrow, 1999; McEntire et al. (2002; Thomalla et al. (2006;
Laukkonen et al. (2009; Rubin, 2010; GNCSODR, 2013; GP DRR, 2013).
Children: Significant number of children are vulnerable and at risk for development
(Morrow, 1999; McEntire et al., 2002; Thomalla et al., 2006; Laukkonen et al., 2009
Dinh et al., 2012; Rubin, 2010; GP DRR, 2013; GNCSODR, 2013; Dinh et al. (2012).
Children are vulnerable for psychological and physical abuse This include illegally
working children, children who are pregnant or become mothers, children born out of
marriage, children from a single-parent, delinquent children, homeless children, HIV-
infected children, uneducated children, institutionalized children, married children,
mentally ill children, migrant children, orphans, sexually exploited children, street
children, war-affected children…etc.
Minorities: some people are vulnerable due to their minority background. Particularly,
ethnic (cultural and linguistic minority), religious minority. These people are political
and socially discriminated (Comfort et al., 1999; Cardona, 2003; Brooks, 2003;
National Research Council, 2006; Cutter et al., 2010; ).
Poverty: People are vulnerable for many undesirable phenomena due to poverty. This
may be resulted in, poor households and large households, inequality, absences of
access to health services, important resources for life, lack of access to education,
information, financial and natural resources and lack of social networks (Morrow,
1999; McEntire et al., 2002; Brooks, 2003; Dwyer et al., 2004; Vincent, 2004;
Leichenko et al., 2004; National ResearchCouncil, 2006; Naudé et al., 2007; Kahn
and Salman, 2012; MacDonald, 2013).
Disabilities: People with disabilities very much vulnerable for many kind of risks.
This includes abuses, poverty, illiteracy, health problems, psychological and social
problems (Comfort et al., 1999; McEntire et al., 2002; Naudé et al., 2007; Cutter et
al., 2010; Dinh et al., 2012; . Balica et al., 2012; GNCSODR, 2013).

25
 Age: Old people or very young children are vulnerable for all kinds evils (Comfort et al.,
1999; Morrow, 1999; McEntire et al. 2002; Cardona (2003; Vincent, 2004; Naudé et
al., 2007; Dinh et al., 2012; Adikari et al., 2013; GNCSODR,2013).
Illiteracy and less education: People with high rates of illiteracy and lack quality
educational opportunities are vulnerable for absence all kinds of developments
(Cardona, 2003; Adger et al., 2004; Leichenko et al., 2004; Naudé et al., 2007; Kahn
and Salman, 2012; Adikari et al., 2013).
Sickness: Uncured health problems for example people living with HIV/AIDS are much
vulnerable for psychosocial problems, poverty and health (Vincent, 2004; Adger et
al., 2004; Naudé et al., 2007).
Gifted and Talentedness: Gifted and talented children are vulnerable for socio-
emotional developments. Due to lack of psychological support they may feel isolation
as they are pulled from their regular classrooms and given instruction in separate
settings and due to myths and expectations of themselves and the public (Shechtman
& Silektor, 2012, p. 63; Schuler, 2000).

Chapter Summary
Persons with disabilities, health impairments and vulnerable people are people who should be
productive and able to live independent life. Their impairment is not something that has
disabled them; rather, the social system is the major disabling factor. Disabilities do not only
affect an impaired persons; it affect the whole nation, when this people are neglected from
education and employment and when they are not actively participate in the social, political
and economic activities. These situations make them to lead dependent lives which in turn
affect the life of the nation. Hence, inclusiveness is an outlet for creating a society of
productivity who leads independent life.

26
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