Module 2 - Inclusive Schooling 2015

MUKUBA UNIVERSITY
MODULE 2
EDU 410: INCLUSIVE SCHOOLING
Mukuba University
Kitwe-Zambia
Education Department
Copyright
© Mukuba University 2015
No part of this module may be reproduced or transmitted in any form or by any

means, electronic or mechanical, including photocopying, recording or by any
information storage and retrieval system, without permission in writing from the
publisher.
Mukuba University
Education Department
P.O Box 20382

Kitwe
Zambia
Telephone: +260212251346
E-mail: [email protected]
Website: www.mukuba.edu.zm
Acknowledgements
The Mukuba University, Education Department wishes to thank those below for their contribution to
this Module:
AUTHOR
Chisangano E. N Senior Lecturer – Education Department

EDU 410 – INCLUSIVE SCHOOLING
Contents
About this Module 1
How this Module is structured ....................................................................................... 1
Module overview 3
Welcome to Inclusive Schooling Module 2 .................................................................... 3
EDU 410 – Inclusive Schooling, Module 2 .................................................................... 3
Course outcomes ........................................................................................................... 3
Timeframe ..................................................................................................................... 4
Study skills .................................................................................................................... 4
Need help? .................................................................................................................... 4
Assignments .................................................................................................................. 5
Assessments .................................................................................................................. 5
Getting around this Module 6

Margin icons ................................................................................................................. 6
Unit 1 7
Learners with Visual Impairments ................................................................................. 7
1.0 Introduction .................................................................................................... 7
1.1 Definitions of Visual Impairment.................................................................... 9
Unit summary.............................................................................................................. 27
Assignment ................................................................................................................. 27
Assessment .................................................................................................................. 27
Unit 2 29
Learners with Mental Challenges (Mental retardation)................................................. 29
2.0 Introduction .................................................................................................. 29
2.1 Definition of intellectual disability ................................................................ 31
2.2 Causes of intellectual disability..................................................................... 33
Unit summary.............................................................................................................. 43
Assignment ................................................................................................................. 43
Assessment .................................................................................................................. 43
Unit 3 44
Learners with Communication Disorders and those with Hearing Impairments ............ 44
3.0 Introduction .................................................................................................. 44
3.2 Types of Communication disorders............................................................... 46
3.3 Teaching adaptations in an inclusive setting.................................................. 49
3.7 Sign Language .............................................................................................. 60
ii Contents
3.7 Teaching Methods ........................................................................................ 61

Unit summary.............................................................................................................. 64
Assignment ................................................................................................................. 64
Assessment .................................................................................................................. 64
Unit 4 66
Physical, Health Impairments and Albinism ................................................................ 66
4.0 Introduction .................................................................................................. 66
4.1 Physical Impairments ................................................................................... 67
4.3 Albinism....................................................................................................... 78
Unit summary.............................................................................................................. 82
Assignment ................................................................................................................. 82
Assessment .................................................................................................................. 83
Readings ..................................................................................................................... 84
About this Module
P.
O.
B
O
X Inclusive Schooling, Module 2 has been produced by Mukuba University.
20 All Modules produced by Mukuba University are structured in the same
38 way, as outlined below.
2,
KI
T
How this Module is structured
W
E
–
ZThe course overview
A
M The course overview gives you a general introduction to the course.
BI Information contained in the course overview will help you determine:
A.
P  If the course is suitable for you.
h
o  What you will already need to know.
n
e:  What you can expect from the course.
02
12  How much time you will need to invest to complete the course.
23
90 The overview also provides guidance on:
03
/0  Study skills.
21
22  Where to get help.
39
09  Course assignments and assessments.
5
 Activity icons.
E-
m  Units.
ail
:
c We strongly recommend that you read the overview carefully before
o starting your study.
se
tc
o
@The course content
Z
a The course is broken down into units. Each unit comprises:
m
 An introduction to the unit content.
te
l.z
m  Unit outcomes.
 New terminology.
1
Learners with Visual Impairments
 Core content of the unit with a variety of learning activities.
 A unit summary.
 Assignments and/or assessments, as applicable.
Resources
For those interested in learning more on this subject, we provide you with
a list of additional resources at the end of this Module; these may be
books, articles or web sites.
Your comments
After completing Inclusive Schooling Module 2 we would appreciate it if
you would take a few moments to give us your feedback on any aspect of
this course. Your feedback might include comments on:
 Course content and structure.
 Course reading materials and resources.
 Course assignments.
 Course assessments.
 Course duration.
 Course support (assigned tutors, technical help, etc.)
Your constructive feedback will help us to improve and enhance this

course.
2
Module overview
P.
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B
O
X
20
Welcome to Inclusive Schooling
38
2,
Module 2
KI
T
W
E This module is designed to equip students with practical skills and
– necessary knowledge relevant to teaching children with special
Z educational needs in an inclusive school setup.
A
M
BI
EDU 410 – Inclusive Schooling,
A.
P
Module 2
h
o
n
e: This module is intended for people (teachers) who hold secondary school
02 teachers‘ diplomas and wish to upgrade themselves to degree level.
12
23 Prospective students will need to have a secondary school teacher‘s
90 diploma.
03
/0
21
Course outcomes
22
39
09
5 Upon completion of Inclusive Schooling, Module 2, you will be able to:
E-  Identify learners with visual impairments .

m
ail  Explain the causes, levels and educational characteristics of learners with
: intellectual disabilities.
c
o  Discuss the various types, causes and characteristics of learners with
communication disorders and those with hearing impairments.
se
tc
 Describe the various types, causes, and signs of physical a nd health
o
impairments.
@
Z  Demonstrate an understanding of albinism, its causes, characteristics and
a educational implications.
m
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l.z
m
3
Module overview Learners with Visual Impairments
Timeframe
This module is expected to be covered within a period of 100 hours.
The 100 hours will include studying the actual module including all the
activities.
How long?
Study skills
As an adult learner your approach to learning will be different to that
from your school days: you will choose what you want to study, you will
have professional and/or personal motivation for doing so and you will
most likely be fitting your study activities around other professional or
domestic responsibilities.
Essentially you will be taking control of your learning environment. As a

consequence, you will need to consider performance issues related to
time management, goal setting, stress management, etc. Perhaps you will
also need to reacquaint yourself in areas such as essay planning, coping
with exams and using the web as a learning resource.
Your most significant considerations will be time and space i.e. the time
you dedicate to your learning and the environment in which you engage
in that learning.
We recommend that you take time now—before starting your self-

study—to familiarize yourself with these issues.
Need help?
Should you require help in the course of your studies, do not hesitate to
contact the following:
- Local resource centre coordinators,
- Course tutors/lecturers
4
P.
O.
Assignments
B
O
X
20 You will be expected to write at least two assignments in an academic
38 year. One of the assignments will be given to you during this residential
2, school.
KI
T The assignments should be handed in to the course lecturers during the
W residential sessions.
E
– You will be required to submit the assignments in the order in which they
Z will be given to you.
A
M
BI
A.
P
Assessments
h
o
n
e: You will be expected to write two tutor – marked tests and three self
02 marked tests in this course. The tutor – marked tests will be written
12 during the residential sessions. Each module will carry at least one self –
23 marked test.
90
The tutor – marked tests will be released in the proceeding residential
03
sessions.
/0
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22
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09
5
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Getting around this Module Learners with Visual Impairments
Getting around this Module
Margin icons
While working through this module you will notice the frequent use of
margin icons. These icons serve to ―signpost‖ a particular piece of text, a
new task or change in activity; they have been included to help you to
find your way around this module.
A complete icon set is shown below. We suggest that you familiarize

yourself with the icons and their meaning before starting your study.
Activity Assessment Assignment
Discussion Help Note it!
Outcomes Reading Study skills
Summary Terminology Time
6
Unit 1
P.
O.
B
O
X
20
Learners with Visual Impairments
38
2,
KI
T
W1.0 Introduction
E
– Welcome to Unit 1 which will discuss Learners with Visual
Z
Impairments. It is our hope that you greatly benefited from the
A
M previous module which introduced you to the field of special
BI
A. education, and Inclusive schooling in particular. In this unit, we
P will focus on learners with visual impairments. There are children
h
o who enter school with some degree of visual impairment. Most of
n
e: these problems can be fully corrected with medication or glasses
02 and have little or no effect on social or educational development.
12
23 However, some visual impairments are so severe they cannot be
90 corrected.
03
/0
21 This Unit defines visual impairment, outlines the causes, types,
22
39 signs for visual loss, orientation and mobility training, Braille
09 writing and reading; and teaching adaptations.
5
E- In your own words, how can you define visual impairment? Write
m
ail this in the space provided below.
:
c ………………………………………………………………………
o
se
tc ………………………………………………………………………
o
@ ………………………………………………………………………
Z
a
m ………………………………………………………………………
te
l.z
m You are only given five minutes to attempt this question.
7
Unit 1 Learners with Visual Impairments
Well done! Your answer may have been differently framed but has
the same meaning with the explanation below. You will realise that
some of the answers you have given constitute misconceptions held
by society about the visually impaired. In this unit however, we
will discuss the documented causes of visual impairments.
Upon completion of this unit you will be able to:
 Identify the causes and signs of visual impairments.
 Understand and practice Braille reading and writing.
 Explain Braille for mathematics and science.
 Discuss teaching methods in an inclusive setting.
Visual perception: Ability to interpret visual stimuli and make sense

of the world.
Snellen chart: The chart commonly used for vision screening of

people with visual acuity problems, in need of
more thorough evaluation by eye specialists.
Refractive errors: A collection of sight problems that require glasses

to correct.
Presbiopia: When flexibility of the lens in the eyes declines,

typically due to age, an individual would
experience difficulty in reading.
8
P.
O.
1.1 Definitions of Visual Impairment
B
O Visual impairment is a condition in which one has poor sight and
X therefore he or she cannot do certain or all functions requiring the
20
38 use of sight. A person who is visually impaired can either be blind
2, or partially sighted. Visual impairment may also imply problems
KI
T resulting in difficulties seeing objects even with correction.
W
E According to the American Medical Association, the criteria for
– blindness is the general visual acuity of 20/200 feet or less. A score
Z
A of 20/20 means that a subject sees at twenty feet what the normal
M
BI eye sees at twenty feet. Legally, a definition distinguishes blind,
A. partially sighted or low-vision children on the basis of tests of
P
h visual acuity.
o
n Visual acuity refers to the ability to see things at a distance. If there
e:
02 is a visual defect in which the visual field is contracted, this may
12
23 result in a visual impairment.
90
03 An eye specialist (Ophthalmologist) will examine the visual
/0
21 acuity, refractive errors and binocular difficulties. Visual acuity
22 refers to the ability to see things at a distance. If there is a visual
39
09 defect in which the visual field is contracted, this may result in a
5
visual impairment.
E-
m Visual impairments fall along a continuum, with normal vision at
ail
: one end and profound visual disability (blindness) at the other.
c
o According to Barraga (1983), ―a visually handicapped child is one
se whose visual impairment interferes with his optimal learning and
tc
o achievement, unless adaptations are made in the methods of
@ expressing learning experiences, the nature of the materials used,
Z
a and/or in the learning environment‖ (p.25).
m
te
l.z
m
9
You will be interested to know that visual acuity is measured by

having people to read or discriminate objects at a distance of 20
feet. Those who are able to read the letters correctly within that
distance are said to have normal vision. A person who needs to
stand at a distance of 20 feet to see with correction what people
with normal vision see at 200 feet is said to be blind.
Learners with visual impairments face difficulties in reading and

writing. You will therefore agree that these difficulties have serious
implications in the education of learners with visual impairments.
In the space provided below, state the possible difficulties that
learners with visual impairments face in school. You will be
expected to spend not more than 5 minutes on this activity.
Activity 1.1.1
State at least 4 possible difficulties that learners with impairments

face in schools.
1. ............................................................................................................
..........................................................................................................
2. ............................................................................................................
.........................................................................................................
3. ............................................................................................................
.........................................................................................................
4. ............................................................................................................
..........................................................................................................
You are expected to spend not less than 10 minutes on this activity.
10
P. 1.1.2 Classifications of Visual Impairments
O.
B
Visual impairments can be classified in several ways. You will
O
X have discovered that the difficulties faced by learners with visual
20
38 impairments depend on the severity of impairment. To that effect,
2, such learners will be categorised as follows:
KI
T
W Low vision – These are individuals with sight but are
E
– unable to view things at a long or normal viewing distant
Z even with eye glasses. Their vision is on 20/200 feet or less.
A
M However, this group can read print when assisted by a
BI
A. variety of devices.
P
h Partially sighted – This refers to visual problems that
o
n result in a need. People who score between 20/70 and
e:
20/200 feet on tests of visual acuity, with correction, are
02
12 legally partially sighted. Persons who are partially sighted
23
90 can see within a certain distance but require the use of
03 spectacles and other visual aids.
/0
21
22 Blind – A person is functionally blind if he or she has very
39
09 limited field of vision and can hardly see at a distance of
5 20/200 feet. This means that one can only see at 20 feet
E- what someone with normal sight can see at 200 feet. He or
m
ail she learns by using Braille or other visual media. A person
: who is totally blind receives no useful information through
c
o the sense of vision, and uses tactile and auditory senses for
se all learning.
tc
o
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a
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1.2 Parts of the human eye
1.2.1 Parts and functions of the eye

The human eye is a complex system of interrelated parts which can
become defective due to hereditary anomaly, disease, accident or
other causes. The eye has been called a camera for the brain. Let us
now look at the parts of the eye and their functions.
Just as we said earlier on, the eye is like a camera, has a diaphragm
known as the iris. The iris is the coloured muscular partition that
expands and contracts to regulate the amount of light admitted
through the central opening, or pupil. The lens is behind the iris.
The lens is an elastic biconvex body that focuses onto the retina
the light reflected from objects in the line of vision. The retina is
the light-sensitive innermost layer of tissue at the back of the
eyeball. The cornea is the transparent anterior (front) portion of the
tough outer coat of the eyeball.
On the other hand, however, the eye has three anatomical systems;
the optical system, the muscular system, and the nervous system.
Effective vision of the eye therefore depends upon the proper
12
functioning of these systems, and damage to any of these systems
P.
O. may result to visual impairment. You may be interested to know
B that the causes of visual impairment are also grouped into three
O
X broad categories, namely; refractive errors, structural impairment,
20
38 and cortical visual impairment. Let us now focus our attention to
2, these broad categories of causes of visual impairment.
KI
T
W 1.2.2 Types of visual impairments
E
–
Z Refractive errors: This refers to a collection of sight problems that
A require glasses to correct. The normal eye refracts or bends light
M
BI rays so that a clear image falls on the retina but for many people,
A.
P the size, and shape of the eye prevents light rays from converging
h on the retina. There are three types of refractive errors as follows:
o
n
e: i. Myopia, which is also known as short sightedness. A
02 person with myopia can see nearby objects without any
12
23 corrective lenses, but will have difficulty in defining distant
90
03 objects. The cause is light rays entering the eye will be
/0 focused in front of the retina instead of focusing on the
21
22 retina.
39
09
ii. Hypermetropia, which is also known as far sightedness. A
5
person with this condition can see the distant things clearly.
E-
m The main complaint a person with hypermetropia has is eye
ail strain and headache after reading for a long time. The cause
:
c is the light rays entering the eye will be focussed behind the
o
se retina because of the reduced eyeball size and curvature its
tc components.
o
@
Z iii. Astigmatism, refers to distorted or blurred vision caused by
a
irregularities in the cornea of the eye that produces images
m
te to the retina not in equal focus. It is as a result of the optical
l.z
m power of the eye either being too powerful or too weak
across one of its meridians.
13
Structural Impairment: Visual impairment can be caused by

development of, damage to, or malfunction of one or more parts of
the eye‘s muscular systems. The main causes are cataracts and
glaucoma, while there are also others like; nystagus and strabismus.
Cortical Visual Impairment (CVI): This refers to decreased

vision or blindness due to known or suspected damage to, or
malfunction of the parts of the brain that interpret visual
information. Causes of cortical visual impairment are; head injury,
insufficient oxygen at birth, hydrocephalus, and infections of the
nervous system. Children with CVI may have additional disabilities
like cerebral palsy, and seizure disorders, and intellectual
disabilities
There has been too much reading for you! Let us now have a light
moment and study the picture below of a visually impaired child.
Having looked at the picture above, how can you describe it to

someone? You have five minutes to do this.
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P. 1.3 Causes of visual impairments
O.
B Visual impairments emanate from hereditary and environmental
O
factors that may affect the child either before or after birth. The
X
20 following are some of the causes.
38
2,
KI (a) Injuries and poisonings (accidents)
T
W (b) Albinism – this is an inherited condition which results in
E
– decreased pigment which causes abnormal optic nerve
Z
A development. These individuals may have decreased visual
M acuity and are also sensitive to light.
BI
A.
P (c) Vitamin A deficiency – Recent studies have shown that
h Vitamin A deficiency is the leading cause of night
o
n blindness. It has been estimated 70% of children who
e:
02 become blind are affected by Vitamin A deficiency.
12
23 (d) Diseases of the eye:
90
03
/0 i) Ambiopia – (lazy eye). This is the suppression of images of
21 the eye, usually as a result of the eye having a poor
22
39 acuity of being turned in or out. Children with ambiopia
09
5 may have some function field loss and poor or absent
perception.
E-
m
ail ii) Cataract – this is the cloudiness of the lens making it
:
c difficult for light to pass through the lens, therefore
o vision is affected. Some types of cataract are
se
tc progressive, while others remain unchanged. Some of
o the cataracts remain in one eye (unilateral) while in
@
Z some cases both eyes will be affected (bilateral).
a
m Children with cataract may have reduced visual acuity
te and blurred vision, poor vision and low light sensitivity.
l.z
m These conditions have serious implications in education.
15
iii) Glaucoma – this is increased pressure in the eye due to the

blockage of normal flow of fluid in the eye. The vision
of children with glaucoma fluctuates based on changes
in pressure. A child with glaucoma may also have
peripheral field loss (inability to see distance), poor
light vision and low light sensitivity. If not treated, the
condition may lead to damage to the optic nerve.
Glaucoma is caused by among others, measles,
hypertension and syphilis.
iv) Nystagus – this is the involuntary movement of the eye.

These movements can be horizontal, vertical, circular or
mixed. Children with nystagus may have difficulties
maintaining fixation resulting in reduced visual acuity
and fatigue.
v) Strabismus – muscle imbalance resulting in the inability of

both eyes to look directly at an object. You may be
interested to know that there are different types of
strabismus which include:
a. Estropia – inward turn of the eye.
b. Exotropia – outside turn of the eye.
c. Hypertropia – upward eye turn.
d. Hypotropia – downward turn of the eye.
Learners with this condition usually have problems with
visual coordination.
vi) Optic nerve atrophy – this is damage or degeneration to

the optic nerve which carries visual signals to the eye.
Visual loss will be depended on the amount of damage, but
16
may include blurred vision, poor colour coordination and
P.
O. poor sight vision.
B
O (e) Prenatal Conditions – these are conditions which affect
X
20 the child from conception to birth. The following are some
38
2, of the conditions which may cause blindness in babies.
KI
T Meningitis
W
E
Drug and alcohol abuse by the expectant mother
–
Z
A German measles (Rubella)
M
BI Accidents
A.
P Traditional medicine
h
o Cerebral palsy
n
e: Low birth weight (below 1000g)
02
12
Un-prescribed drugs.
23
90
03 Please note that usually, Cerebral palsy, strabismus and
/0 hydrocephalus cause blindness as a result of radiation from ultra
21
22 sounds.
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09
5 1.3.1 Characteristics of learners with V.I
Difficulties in work requiring close use of the eyes
E-
m Holds books close or far away from the eyes
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c Unable to read continuously for a long time
o
se Often over-sensitive to light
tc
o Inability to see chalkboard and other distant objects
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Z Difficulties in reading
a
m Squints/ screws up one‘s eyes
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l.z Handwriting is poorly spaced
m
They tilt their head to one side when reading
17
They have uncertain movements
They blink more than usual
They usually bump into objects when moving
You could have noticed from our discussion that the causes of
visual impairment that we have discussed might be different from
the traditional ones that society believes in. As we indicated earlier
on, such causes are usually attributed to witchcraft but are difficult
to prove scientifically. You should therefore be able to confidently
tell others what really causes visual impairments based on what we
have learnt.
Have you ever taken time to think about how learners with visual
impairments get about their daily activities in our society? This is
the question we will focus our attention on in the next section as we
consider the orientation and mobility of learners with visual
impairment.
1.3.2 Orientation and mobility training

The greatest limitation imposed on blindness is the problem of
becoming acquainted with one‘s environment. For improving
mobility, adults with visual impairments use tools such as long
canes, guide dogs and sighted guides, but children also must learn
to move about the environment independently and safely so
acceralation and mobility have become part of the curriculum in
all programmes involving learners with visual impairments.
Orientation and mobility involve the understanding of ones

location in a given environment (orientation) coupled with the
ability to physically move through that environment safely and
independently (mobility). The goal of any mobility programme is
to bring the individual to his or her highest desired level of safe
and independent travel. Learners with visual impairment become
independent when they can move about in the environment to
18
meet their own needs. These skills are central to a strong
P.
O. curriculum that stresses independent mobility. Much of
B orientation and mobility training involves teaching visual skills
O
X that can be used. Such visual skills include:
20
38
2, Scanning – use of head and eye movement to search for
KI and locate the target. Horizontal scanning can pick up
T
W vertical targets such as poles that hold street lights and
E
– vertical scanning helps locate the street sign itself.
Z
A Tracing – includes following visually single or multiple
M
BI stationary lines. To help maintain a line of direction,
A.
P learners with visual impairments can use hedge lines and
h base boards.
o
n
e: Tracking – involves visually following a moving
02
object/target such as a car or pedestrian. Special
12
23 education teachers will provide orientation and mobility
90
03 instruction to teach the child to use sensory information
/0 in order to establish and maintain his or her own position
21
22 in the environment and move safely, efficiently and
39
09 gracefully. The skill areas that are covered in such
5 instruction include the following:
E-
m 1. Ability to identify and make use of
ail landmarks and clues.
:
c
o 2. Knowledge and use of campus direction.
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o 3. Knowledge and use of indoor and town
@ number systems.
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a
m 4. Ability to align the body to objects and
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with sound for the purpose of maintaining
l.z
m the straight line of travel.
19
5. The use of systematic search pattern to

explore novel objects and environment.
6. Recovery skills.
7. The knowledge of where, how and when to

solicit aid (ability to avoid obstacles).
You will note that research has shown that it is the sense of hearing
that helps children with visual impairment to sense an object. It is
not that they have a special sense but merely use their remaining
senses with greater efficiency than sighted persons. Some schools
use physical education programmes to sharpen the orientation and
mobility of visually impaired children. Mobility of children with
visual impairments can also be increased by removing obstacles
whenever possible.
Having discussed orientation and mobility training for learners with

visual impairments, indicate the skills that such learners use to get
about within your school environment. Do these learners use
conventional methods or traditional methods of mobility and
orientation?
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P. ………………………………………………………………………
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38 ………………………………………………………………………
2,
KI ………………………………………………………………………
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W ………………………………………………………………………
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– ………………………………………………………………………
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A You will be expected to answer these questions in the space
M
BI provided within 5 minutes.
A.
P 1.4 Braille writing and reading
h
o
Earlier in this unit, we mentioned that learners with visual
n
e: impairments who are blind use Braille as one of their learning
02
12 strategies. For such students, skill in reading and writing through
23 Braille is important not only for learning but also for
90
03 communication. Let us now focus our attention on Braille writing
/0
21 for learners with visual impairments.
22
39 Braille writing was invented by Louis Braille, a blind Frenchman in
09
5 1829. Braille writing is another part of the curriculum for profound
visual impairments. It is taught after the child learns Braille
E-
m reading. Various devices are used for writing the symbol. The
ail
: system is based on a six-dot cell that is two dots wide and three
c dots high. Raised dots are placed between the folding halves of the
o
se slate. The writing is done in reverse order by hand using a slate and
tc
o stylus, by pressing the stylus. Symbols are embossed on heavy
@ paper from left to right and users usually read with hands, one
Z
a leading and the other following.
m
te The easiest and fastest however, is the Perkins Brailler which is
l.z
m like a typewriter. It has six keys (one for each of the dot positions)
and a spacing bar. You might be interested to know that a
21
proficient user can type 40 to 60 words per minute. Using Braille is

a key skill for communication with sighted people. Punctuation,
music and mathematical with scientific notations are based on the
system. Standard English Braille was accepted in 1932 as the
system for general use although many other communication
systems have been tried.
See the Braille alphabet below.
BRAILLE ALPHABET
22
P.
O.
B 1.4.1 Braille for mathematics and science
O
X Braille writing and reading is also used to teach mathematics and
20
38 science to learners with visual impairments. Did you know this? It
2, is worthy mentioning here that the same system of writing and
KI
T reading Braille used in letters can also apply in mathematics and
W
E science notation. However, to distinguish letters from numbers, a
– number symbol precedes each Braille cell that carries the number.
Z
A You will notice this in the illustrations that follow below.
M
BI
A.
P
h
o
n
e: Braille Alphabet:
02
12
23
90 a b c d e f g h i
03 j
/0
21
22
39 k l m n o p q r s
09 t
5
E-
m u v w x y z
ail
:
c ! ' , - . ? Capital
o
se Numbers:
tc
o
@
Z # 0 1 2 3 4 5 6 7 8
a
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1.4.2 Teaching methods for learners with V.I
23
Learners with visual impairments can be taught using the

following methods:
(a) Use of concrete objects – The learners with visual

impairments, unlike those with normal vision, greatly
depend on other senses to learn. It is therefore important
that the teacher avails the actual objects to such learners as
a learner progresses. If actual objects are not available,
models of such objects are used.
(b) Individualised Teaching – This is a very important

component in the teaching of learners with visual
impairments. These learners require a lot of individual
attention from the teachers. This demands therefore that the
teacher pays particular attention to the needs of each
learner. In order to effectively employ this method in class,
the teacher needs to draw up an Individual Education
Programme (IEP) for each learner. With the help of other
professionals, the formulated IEP can effectively be
implemented by the teacher.
It is important for you to note that the two methods we have

introduced to you above are among the most commonly used
methods to teach learners with visual impairments.
1.4.3 Teaching learners with V.I in an inclusive setting
The above methods are among the most commonly used methods
to teach learners with visual impairments. However, the following
teaching adaptations can be made:
 If the student is partially sighted, he/she should sit where

lighting is appropriate.
 Provide means for the acquisition and recording of data in

an appropriate mode.
24
P.  Handouts should be available in large print, audio tape,
O. computer disk or Braille formats.
B
O
X  Bring closer short sighted learners to sit in front and long
20
sighted learners far from the board.
38
2,
KI  Use multimedia teaching strategies where Braille material
T
W can read on computers and students listen.
E
–  Use multisensory teaching strategies; use the sense of
Z
A hearing, touch and taste for learners to experience.
M
BI
A.
P
h
o
n
e:
02
12
23
90
03
/0
21
22
39
09
5
E-
m
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:
c
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Z
a
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25
Activity 1.4.1
Having discussed the teaching techniques for learners with visual

impairment, try and answer the following questions.
1. What are the techniques used in helping visually impaired

learners move around safely and independently in an
environment?
a) ………………………………………………………
b) ………………………………………………………
c) ………………………………………………………
d) ………………………………………………………
………………………………………………………
2. Mention some of the special devices which visually

impaired pupils use.
a) ……………………………………………………..
b) ……………………………………………………..
c) …………………………………………………….
d) …………………………………………………….
e) …………………………………………………….
3. What is the other name for a Snellen chart?
………………………………………………………………
Well done! Compare the answers you have given to those
given at the back of the module.
26
P.
O.
Unit summary
B
O
X
20 In this unit you learnt identification of learners with visual
38 impairments, causes of visual impairments, orientation and
2, mobility training for learners with visual impairments; as well as
KI Braille reading and writing. We have also introduced you to
T
W Braille for mathematics and science; and the teaching methods used
E in the education of learners with visual impairments. You will need
– to appreciate that learners with visual impairments face a lot of
Z difficulties which have educational implications. It is therefore
A
M important that appropriate teaching methods are used by the teacher
BI in order to alleviate these difficulties. In the next unit, we will look
A. at the education of learners with communication disorders.
P
h
o
n
e:
02
12
Assignment
23
90
03
/0 Tutor – marked assignment:
21
22 The assignment question will be given to you during the residential
39 school.
09
5
E-
m
ail
:
c
o
se
Assessment
tc
o
@
Z There is no assessment item for this topic. Thank you!
a
m
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l.z
m
27
Unit 2
P.
O.
B
O
X
20
Learners with Mental Challenges
38
2,
(Mental retardation)
KI
T
W
E
– 2.0 Introduction
Z
A Welcome to Unit 2 which is Mental Challenges. In the previous
M unit we looked at learners with visual impairments. This unit will
BI
A. focus on the learners with mental challenges also known as
P
h intellectual disabilities. You may be interested to know that
o intellectual disabilities have commonly been referred to as mental
n
e: retardation. However, the term intellectual disability is now more
02 preferred to mental retardation. You could have been one of the
12
23 people who had believed that intellectual disability is equivalent to
90
03 mental illness. However, in this unit, you will come to appreciate
/0 that there exists a huge difference between mental illness and
21
22 intellectual disabilities. When the term mental retardation was
39
09 commonly used to refer to intellectual disabilities, this belief was
5 even much more alive to many people. You will agree that even in
E- your community there are still some people who believe that
m intellectual disabilities constitute mental illness.
ail
:
c
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a
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29
Unit 2 Learners with Mental Challenges (Mental retardation)
 Define the term mental challenges/intellectual disability.
 Understand the difference between mental illness and intellectual disability.
 Explain the various causes of mental challenges.
 Demonstrate an understanding of the activities for daily living for learners

with intellectual disabilities.
 Discuss the various approaches for teaching learners with intellectual

disabilities.
Fragile X syndrome A restriction in the end of the X chromosome that

may result in mental retardation or learning
disabilities.
Cerebral palsy A condition caused by damage to the motor

control centres of the brain before birth, during the
birth process or after birth.
Down syndrome A chromosomal abnormality that leads to mild or

moderate mental retardation and at times, a variety
of hearing, skeletal, and heart problems.
30
P.
O.
2.1 Definition of intellectual disability
B
O Awareness of the existence of children with intellectual disability
X has been present for centuries, but the exact nature of the condition,
20
38 its identification, and societal attitudes towards it have been
2, constantly changing. We have always known that some children
KI
T learn more slowly than their age mates and as a consequence, have
W
E difficulty adapting to social and educational demands.
–
Z Let us now look at the most common definition of intellectual
A
M disability which was devised by the American Association of
BI
A. Mental Retardation (AAMR):
P
h ―Intellectual disability refers to significantly sub-average general
o
n intellectual functioning existing concurrently with deficits in
e: adaptive behaviour and manifested during the developmental
02
12 period‖ (Grossman, 1983:1).
23
90
03 What do these words mean? Significantly sub-average general
/0 intellectual functioning is often considered a score on a standard
21
22 intelligence test lower than that obtained by 97 to 98 per cent of
39 people of the same age. Deficit in adaptive behaviour is a person‘s
09
5 failure to meet standards of independence and social responsibility
E- expected of his or her age and cultural group. This includes;
m
ail Socialisation
:
c
o Physical development
se
tc
o Language development
@
Z
a Independent functioning like; eating, toileting, bathing, etc.
m
te Self-direction (use of initiative).
l.z
m
31
The developmental period is the time from birth to the age of

18years. Having looked at this definition, let us now look at the
difference between mental illness and mental retardation.
You might have been one of those people that thought that mental
illness was the same as mental retardation. There exists a big
difference between the two terms. The first one is that mental
illness is curable in most cases, whereas mental retardation is not
amendable to treatment. Secondly, mental illness may be caused by
personal problems and disorders which might occur to someone at
any age and may not be permanent, while mental retardation
happens during the developmental period.
Activity 2.1.1
What are some of the causes of intellectual disability that you

know? In the space below, write down at least three causes of
intellectual disability.
1. ..........................................................................................
..........................................................................................
..........................................................................................
2. ..........................................................................................
..........................................................................................
..........................................................................................
3. ..........................................................................................
..........................................................................................
You are expected to spend not more than 10 minutes on this
activity.
32
P. 2.2 Causes of intellectual disability
O.
B
O These may be divided into two broad categories:
X
20 (a) Organic or biological factors
38
2, (b) Environmental factors
KI
T
W
E Organic or biological factors
–
Z 1. Genetic factors- may be established at the time of
A
M conception in two ways; through transmission of some
BI defective genes and chromosomes of one or both parents, or
A.
P on account of chromosomal aberrations. An example of this
h
is Down Syndrome.
o
n
e: 2. Infection: If the mother suffers from an infectious disease
02
12 like syphilis, and Rubella (German measles), she may
23 transmit it to the developing foetus.
90
03
/0 3. Intoxication: A number of toxic agents like carbon
21
22 monoxide, mercury, lead, and various immunological
39 agents like anti-tetanus serum or the use of vaccines for
09
5 small pox, rabies and typhoid may result in brain damage
during development after birth. Large doses of x-ray in
E-
m radio therapy in the abdominal region of the pregnant
ail
: mother and also overdose of drugs administered to the
c infant lead to toxicity and brain damage.
o
se
tc 4. Trauma: Maybe caused on account of physical damage to
o
@ the brain in the form of injuries prior to birth, at the time of
Z delivery, or following birth.
a
m
te 5. Metabolic and endocrine disorders: maybe caused by
l.z various disturbances in the metabolism by which body cells
m
are built up and broken down, and by which energy is made
available for their functioning. The chemical errors
33
involving metabolism of the fat cause Tay-Sachs disease

while disturbed protein metabolism causes Phenylketonuria
(PKU).
6. Tumours: Maybe caused by brain damage associated with

brain tumours and other new growths.
7. Accidental brain injury: An accidental injury to the brain

and disorders of the internal glands can damage the nervous
system.
8. Acute illness: Acute illnesses like; measles, jaundice,

meningitis, small pox, or typhoid in the post-natal period
affects the child‘s development.
Below is a picture of a child with profound intellectual disability.
34
P. Environmental influences (Socio-psychological
O. factors)
B
O Children who are denied the satisfaction of their psychological and
X
20 social needs become over sensitive to psychological stress. The
38 early childhood deprivation like lack of adequate mothering and
2,
KI parental care results in a retarded rate of development. The severe
T
W environmental deprivation in the form of physical, cultural,
E emotional and intellectual poverty especially during infancy and
–
Z childhood results in the retardation of a child‘s intellectual
A
development even when his potential at birth is normal. This
M
BI includes malnutrition, insufficient resources for intellectual
A.
P development, unhygienic conditions, and uncleanliness.
h
o
n
e: Activity 2.2.1
02
12
23 What are some of the features you noticed in the picture of a child
90 with profound mental retardation?
03
/0
21 1. ................................................................................................
22
39 ................................................................................................
09
5 ................................................................................................
E-
m 2. ................................................................................................
ail
:
c ................................................................................................
o
se ................................................................................................
tc
o
@ 3. ................................................................................................
Z
a ................................................................................................
m
te ...............................................................................................
l.z
m
35
4. ................................................................................................
................................................................................................
................................................................................................
You are expected to spend not more than 10 minutes on this

activity. The answers are to the activity are found in the
classifications below under profound mental disabilities.
2.3 Levels of intellectual disability

Intellectual disability covers a broad range of children and adults
who differ from one another in the severity of developmental delay,
in the causes of the condition, and in the special educational
strategies that have been designed for them. You will discover
that intellectual disability ranges from mild to profound. These
levels are derived from the Stanford-Binet Intelligence Quotient
(IQ) test and are explained in detail below, including their
characteristics.
1. Mild intellectual disability – A child with mild intellectual

disability will show signs of delayed development early in
life, and learn to walk, talk, feed and toilet themselves a
year later than the average child. Speech disturbances are
common among them. However, they have the capacity to
develop in three areas; academically (at the primary and
advanced elementary grade levels), socially (to be able to
live independently in the community), and vocationally (to
be partially or totally self-supporting as an adult). They are
considered to be educable.
2. Moderate Intellectual disability – From early infancy or

childhood, they show signs of retardation in almost all areas
of development, and though they manage to speak, their
rate of learning is too slow. They are unable to do work that
36
requires initiative, originality, abstract thinking, memory or
P.
O. consistent attention and cannot be expected to acquire the
B basic skills of reading and writing. Physically they appear
O
X clumsy, suffer from motor in- coordination and present a
20
38 dull and somewhat vacuous personality. However, with
2, early diagnosis, parental help and adequate training and
KI
T support, they can achieve considerable independence in all
W
spheres of life. They can achieve a degree of adult social
E
– responsibility, learn basic academic skills, and acquire some
Z
A vocational skills. They are considered to be trainable.
M
BI 3. Severe Intellectual disability – They are grossly retarded
A.
P in development from birth onward and show severe motor
h
o and speech retardation. The majority of them display a
n relatively little interest in their surroundings and many of
e:
02 them never master even the necessary skills and functions
12 like feeding and dressing themselves, or bladder and bowel
23
90 control. They need care and supervision of others with a
03
/0 great need of institutionalisation. This group is neither
21 educable nor trainable. They also never attain an intellectual
22
39 level greater than that of the average four-year old child.
09
5
4. Profound Intellectual disability – This group is
E- characterised by the most severe symptoms of intellectual
m
ail disability. The individuals in this category never attain an
: adult life and intellectual level greater than that of an
c
o average two-year old child and are severely deficient both
se
tc in their capabilities and adaptive behaviour. The symptoms
o associated with them are retarded growth, physical
@
Z deformities, and pathology of the central nervous system,
a
m mutism, severe speech disturbances, motor in-coordination,
te deafness and convulsive seizures. Their lifespan as a result
l.z
m of their lower resistance is too short. Essentially, they need
to be institutionalised as their condition deteriorates on
37
account of the biased attitude of their parents and stress

demands of their environment.
2.4 Activities for daily living
As you have learned earlier, learners with intellectual disabilities

normally experience difficulties in adaptive behaviour. It is
therefore important that teachers and caregivers introduce skills for
daily living for such learners. The activities for daily living include
the following:
1. Communication skills: The ability to comprehend and

express information through symbolic behaviour (such as
spoken words, written, sign language) or non symbolic
behaviours (such as facial expression) teach them skills to
communicate with others, and they will learn from their
peers.
2. Self-care skills: These are skills involved in toileting,

eating dressing, hygiene and grooming.
3. Home living skills: Skills related to functioning within the

home, which include clothing care, housekeeping, food
preparation and home safety.
4. Social skills: These are skills related to social exchanges

with other individuals, including initiating interaction and
terminating interaction with others, responding to pertinent
situation cues, and recognising feelings.
5. Community use skills: These are skills related to the

appropriate use of resources including shopping at stores
and markets, purchasing and obtaining services using public
transport and or facilities.
38
P. Other than the home living skills that you have been exposed to
O. above, which other skills are important for learners with mental
B
O challenges in the home? Write down at least five such skills in the
X
space below.
20
38
2, ............................................................................................................
KI
T ............................................................................................................
W
E ............................................................................................................
–
Z
A ............................................................................................................
M
BI ............................................................................................................
A.
P ............................................................................................................
h
o ............................................................................................................
n
e: ............................................................................................................
02
12 ............................................................................................................
23
90
03 ............................................................................................................
/0
21 ............................................................................................................
22
39 ............................................................................................................
09
5 ............................................................................................................
E- ............................................................................................................
m
ail ............................................................................................................
:
c
o ............................................................................................................
se
tc ............................................................................................................
o
@ ............................................................................................................
Z
a
m Well done! Can we now move to the other daily living skills for
te
l.z learners with mental challenges?
m
39
6. Self-direction skills: These skills are related to making

choices, following a schedule, initiating activities
appropriate to the setting, and completing necessary or
acquired tasks.
7. Health and safety skills: These skills are important in the

maintenance of one‘s health in terms of eating, illness,
treatment and prevention, basic first aid; sexuality and basic
safety considerations.
8. Functional academics: Cognitive abilities and skills related

to learning at school that also have application in one‘s life
(e.g. writing, reading, using basic practical maths concepts,
awareness of physical environment, and one‘s health and
sexuality).
9. Leisure skills: The development of leisure and recreational

interests (i.e. self-entertainment and interaction) that reflect
personal preferences and choices.
10. Work: Skills related to holding a part or full-time job or

jobs in the community in terms of specific job skills,
appropriate social behaviour, and related work skills (e.g.
completion of tasks, awareness of schedules, ability to take
criticism and improve skills).
These are activities of daily living that you need to learn about
learners with mental challenges. Having learnt about these skills,
what then would be the educational approaches for teaching
learners with mental challenges? This is what will be discussed in
the proceeding section.
40
P. 2.5 Teaching methods for mentally challenged
O.
B
O Some of the educational approaches for teaching learners with
X intellectual disabilities include the following:
20
38
2, 1. Peer tutoring: Peers have been found to be very helpful as
KI
T mediators for learners with intellectual disabilities. Several
W variables must be taken into consideration for effective
E
– implementation of peer tutoring programmes with learners of
Z mild and moderate intellectual disabilities. First, the
A
M instructional objective must be formulated. In addition, time
BI
A. must be available for the programme. The tutors must be
P selected and trained and both the tutor and the tutee must be
h
o engaged in the evaluation process.
n
e:
02 2. Cognitive behaviour modification: Cognitive modification
12 techniques including self instruction and encoding have been
23
90 used for learners with intellectual disabilities. The first step self
03 instruction package for use with learners with intellectual
/0
21 disabilities was developed by Burgio, Whiteman and John
22
39 (1980). Using this strategy Burgio and associates produced
09 direct and specialised changes in the behaviour of learners with
5
intellectual disabilities on writing and mathematical tasks. In
E-
m addition, learners‘ off-task behaviours decreased. In oral
ail reading tasks, Rose (1984) found simple self instructional to be
:
c effective with learners with intellectual disabilities. Learners
o with intellectual disabilities can also be taught strategies for
se
tc generalisation of skills.
o
@
Z 3. Technological aids: Technology has also emerged as a means
a of mediating the environment for learners with intellectual
m
te disabilities. Technology can support educational activities,
l.z
provide, restore and extend the learners‘ physical ability and
m
provide opportunities for greater participation in the
41
mainstream classes. Gadner and Bales (1981) report that

learners with intellectual disabilities positively evaluated the
use of computers and that the learners found the computers
attractive and increased their confidence, self esteem and ability
to learn some tasks.
4. Social skills training: Active rehearsal in combination with

other instructional lectures is more effective than instructions,
reinforcement and demonstration alone. The most frequently
applied and successful training procedures are as a result of
visual instruction, practice and contingent reinforcement.
5. Instructional strategies: Instructional strategies that have been

used with learners with intellectual disability include sequential
prompting, and individualised instruction. When using
sequential prompting, teachers should provide learners with just
enough support to ensure success, but not so much that the
learner‘s personal resources are not challenged.
Teachers should individualise in respect to the learner‘s style

and rate. Among the modifications that may be made in an
effort to individualise instruction for learners with disabilities
are:
 Showing the pace of instruction
 Shortening the length of instructional practices
 Breaking down instructional objectives into sub-

objectives
 Simplifying instruction i.e. reading each concept

separately.
42
P.
O.
Unit summary
B
O
X
20 In this unit you were introduced to teaching learners with intellectual
38 disabilities in an inclusive setting. This included the definitions, causes,
2,
KI levels, and also the educational approaches used to teach learners with
T intellectual disabilities. You will realise that quite a number of pupils
W
E with intellectual disability are found in regular schools either in units or
– ordinary classrooms. For this group, are source necessary for extra
Z
A lessons. For those whose handicap is greater, a special class or special
M school is required where they follow a distinctive curriculum. It is
BI
A. therefore, important that you use the knowledge you have acquired to try
P and help these learners. The next topic introduces you to teaching learners
h
with communication disorders and those with hearing impairments.
o
n
e:
02
12
23
Assignment
90
03
/0
21 The assignment will be given to you during the residential school.
22
39
09
5
E-
m
ail
:
c
o
Assessment
se
tc
o
@ Self –marked assessment
Z
a From your own experience in your local community/school, outline at
m least five characteristics of learners with intellectual disability.
te
l.z
m You will answer this question in your own study material.
43
Unit 3 Learners with Communication Disorders and those with
Hearing Impairments
Unit 3
Learners with Communication

Disorders and those with Hearing
Impairments
3.0 Introduction
Welcome to Unit 3 which will introduce you to learners with
communication disorders and those with hearing disorders. We shall
divide this Unit into two parts, starting with communication disorders,
and then hearing impairment.
3.1 Defining Communication Disorders
You will agree with us that communication is the core of human

interaction. In our schools we might have come across some pupils who
have communication problems, knowingly or unknowingly. In this unit,
we shall define communication disorders; give the types, causes, and
characteristics, and also the teaching adaptations.
Communication is the exchange of thoughts, information, feelings

and ideas. Verbal communication occurs through speech and
talking. However, messages can be transmitted in other ways such
as through writing, reading, use of a telephone and computer. Non-
verbal communication on the other hand is done through gestures
and facial expressions such as wink. Speech is a systematic oral
production of words of a given language. Sounds become speech
only if they produce words that have meaning.
Having defined communication, we can now define communication

disorder. You will be interested to know that a communication
disorder is an impairment of the ability to receive, send, process
44
and comprehend concepts of verbal, non-verbal and graphic
P.
O. symbols. A communication disorder may be evident in the process
B of hearing, language and speech. It may be developmental or
O
X acquired and individuals may demonstrate one or any combination
20
38 of communication disorders.
2,
KI
T
W
E Upon completion of this unit you will be able to:
–
Z  Define Communication disorders .
A
M  Describe the different types of communication disorders.
BI
A.  Explain the teaching adaptations for communication disorders in an
Inclusive setting.
P
h
o
n
e:
02
12 Voice: The intonation and quality of the production of
23 words, such as pitch, loudness, and resonance.
90
03 Receptive language: The ability to take in a message and understand it
/0 (listening with understanding to oral language or
21 reading written language with comprehension).
22
Pragmatics: Language rules that address the social context in
39
which communication occurs.
09
5
Phonation: The production of sound by the vibration of the
vocal cords.
E-
m
Language: A code whereby ideas about the world are
ail represented through a conventional system of
: arbitrary signals for communication.
c
o
Dyslexia: A severe reading disability involving difficulties in
se understanding the relationship between sounds and
tc letters.
o
@
Z
a
m
te
l.z
m
45
Hearing Impairments
3.2 Types of Communication disorders

You will note that initially, it might be difficult for you to identify
the type of communication disorder that a child in your class might
have. However, with time, you will learn to appreciate the different
forms of these disorders. You will be interested to know that
communication disorders can be put in three broad categories. The
two major ones are Speech disorders and Language disorders.
However, there is also hearing disorders.
Before we look at the categories of communication disorders in

detail, let us do an activity.
Activity 3.2.1
Define the term speech in your own understanding
..................................................................................................................................................
..................................................................................................................................................
..................................................................................................................................................
..................................................................................................................................................
..................................................................................................................................................
..................................................................................................................................................
..................................................................................................................................................
Good attempt! Let us now discuss speech and the disorders that affect speech in learners with
communication disorders.
46
P. ‗
O.
B Speech disorders
O
X
20 A speech disorder is impairment in the articulation of speech
38
2, sounds, fluency and voice. The following are some of the disorders:
KI
T (a) An articulation disorder is uncommon production of
W
E speech sounds characterised by substitutions, omissions,
– additions and distortions that may interfere with
Z
A intelligibility.
M
BI
A. (b) A fluency disorder is an interruption in the flow of speech
P characterised by uncommon rate, breaking rhythm and
h
o repetitions in sounds, syllables, words and phrases. This
n
may be accompanied by excessive tension, struggle
e:
02 behaviour and secondary mannerisms. A good example of
12
23 this disorder is a stuttering pupil.
90
03 (c) A Voice disorder is characterised by the normal production
/0
21 and an absence of vocal quality, pitch loudness and duration
22
39 which is inappropriate for an individual‘s age and sex. A
09 good example of this disorder is a pupil with dysphonia.
5
E- Language disorders
m
ail
: Language disorders constitute impaired comprehension or the use
c of spoken, written and other symbol system. The disorder may
o
se involve the form of language (phonology, morphology and syntax),
tc
o the content of language in communication (pragmatics) in any
@ combination.
Z
a
m (a) Syntax is the system governing the order and
te combination of words to form sentences and the
l.z
m relationship among the elements within the
sentence.
47
Hearing Impairments
(b) Semantics is a system that governs the meaning of

words and sentences.
(c) Morphology is the system that governs the structure

of words and the construction of word form.
(d) Phonology is the sound system of the language and

the rules that govern the sound combination.
The disorders that may result from the above forms and content of
language include the following:
Stuttering is a disorder of fluency which manifests in

reputations, prolongations and hesitations of sounds and
syllables.
Apraxia is the impairment in the ability to plan the

movement of speech.
Aphasia is impairment in the ability to communicate

and it is mainly caused by brain damage. Forms of
aphasia are also receptive and expressive.
Dysnomia is the deficiency in the ability to remember

and produce words.
Global language disorder – this disorder appears when

the child has both receptive and expressive disorders.
Receptive language is the process of understanding
verbal symbols while expressive language is the process
of producing verbal language.
48
P. The picture below shows a learner with communication disorder
O. receiving instruction from his teacher.
B
O
X
20
38
2,
KI
T
W
E
–
Z
A
M
BI
A.
P
h
o
n
e:
02
12
23
90
03
/0 3.3 Teaching methods
21
22 The following are some of the teaching adaptations that might be used in
39 teaching learners with communication disorders.
09
5
1. Speech and language therapy – The speech, language
E- pathologist brings to each therapy session a considerable
m
ail knowledge base and set of skills to recognise and remediate
:
c each child‘s specific problem (i.e. errors in articulation,
o syntax and voice). The choice of therapy depends on the
se
tc assessment of the child‘s needs. The most common
o
therapeutic procedure for most young children with deficits
@
Z is ―role playing‖. Play is a way all children learn speech and
a
m language. In the therapy session, therapists model the way
te children who are not disabled learn language.
l.z
m
2. Interactive approach- Teachers and therapists focus on the
social use of the language (pragmatics) and emphasise
49
Hearing Impairments
functional communication in a natural environment. The

popular form of treatment is the interactive approach. In this
approach the teacher or speech language therapist tries to
capitalise on the natural inclination of the child to talk about
what he or she is doing or wants to do. To encourage the
correct use of language and words, the teacher provides
remediation sessions while the child is eating, playing and
visiting some community settings such as markets. The aim
of this technique is to increase the child‘s amount of talk,
the more the child talks the more they gradually increase
and gain accuracy and increase their vocabulary.
3. Drill method – Through chorus answers, repeating after the

tutor, over and over by the pupils.
4. Control stuttering – By encouraging the learner to read

aloud and strongly sensitise them (let them speak freely).
Let them be involved in play outdoors like cheering and
public activities.
5. Phonological training – involves teaching the pupils

phonological awareness. This is the ability to recognise that
words can be divided into smaller units such as syllable and
phonemes.
6. Games – Through games, we are able to assess and

improve the auditory span of the children. In the use of
games, children do not realise that they are learning. What
is normally tested in the game is the ability to think and
recognise. Did you ever wonder why teachers at nursery
school level usually rely on play and games to teach? You
will be interested to know that play and games are very
essential in the teaching of language in children.
50
P.
O. Activity 3.3.1
B
O
X Have you ever realised that hearing disorders also affect learners
20
38 with communication disorders? Before we focus our attention to
2, the next topic Hearing Impairment, let us answer the following
KI
T question. What hearing disorders are common with the learners
W
with communication disorders?
E
–
Z ………………………………………………………………………
A
M ………………………………………………………………………
BI
A. ………………………………………………………………………
P
h
………………………………………………………………………
o
n
e: ………………………………………………………………………
02
12 ………………………………………………………………………
23
90 ………………………………………………………………………
03
/0 ………………………………………………………………………
21
22 ………………………………………………………………………
39
09 ………………………………………………………………………
5
E- ………………………………………………………………………
m
ail ………………………………………………………………………
:
c ………………………………………………………………………
o
se
tc Well done! You will discover that the answers you have given will
o
@ be similar to the ones we have given at the back of the module.
Z
a
m
te
l.z 3.4 Learners with Hearing Impairments
m
51
Hearing Impairments
You will realise that human beings have five very important senses
that help them to communicate with one another and to understand
the environment in which they live in. When one sense is missing,
then the way human beings sense the environment becomes
different. Learning in the classroom is predominated by the sense
of hearing. Certain impediments however, make it impossible for
all of us to perceive sound in the same way. Can you imagine how
life would be like without the sense of hearing?
3.4.1 Defining Hearing Impairment
You may be interested to know that hearing losses are defined in

terms of the degree of loss, the age at which the loss occurs (before
birth – pre-lingual deafness, or after birth – post-lingual deafness)
and the type of loss. A hearing disorder is as a result of auditory
sensitivity of the physiological auditory system. Please note that a
hearing disorder may limit the development, comprehension,
production or maintenance of speech and language. Hearing
disorders are classified according to difficulties in detection,
recognition, discrimination, comprehension and perception of
auditory information. Individuals with hearing disorders may be
described as deaf, and hard-of-hearing. Let us now look at the two
below.
The Individuals with Disabilities Education Act (IDEA) defines

deafness as a hearing impairment, so ―severe that the child is
impaired in processing linguistic information through hearing, with
or without amplification, that adversely affects the child‖
(NICHCY, 2000: 26). Other authorities define deafness as a
hearing disorder that limits the individual’s oral communication
performance to the extent that the primary sensory input for
communication may be other than the auditory channel. Students
52
who are deaf are not able to use their hearing to understand speech,
P.
O. even with a hearing aid.
B
O Being hard- of- hearing is defined as ―an impairment in hearing,
X
20 whether permanent or fluctuating, not adversely affecting a child’s
38
2, performance‖ (NICHCY, 2000:27). Students who are hard-of-
KI hearing have a significant hearing loss in one or both ears that
T
W requires some special adaptations; they are able to use hearing to
E understand speech, often through the use of hearing aids (Heward,
–
Z 2000). The hard-of-hearing individuals rely on the auditory
A
M channels as the primary sensory input of communication.
BI
A.
P
h
o Upon completion of this unit you will be able to:
n
e:  List the causes of hearing impairments.
02
12  Discuss Education Audiology.
23
90  Practice the alphabet used in sign language.
03
/0  Explain the meaning of total communication.
21
22  Identify teaching methods used in the education of learners with
39 hearing impairments.
09
5
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53
Hearing Impairments
3.4.2 Types of hearing loss
Before we focus our attention to the types of hearing loss, let us

look at the diagram with parts of the human ear. It is important that
you study these parts and master them.
The Human Ear
The types of hearing loss are divided into three main categories as
follow:
Sensori-neural hearing losses, which occur where the neural

mechanisms of hearing (particularly the cochlea – where the sound
waves are translated into neural messages and the neural pass-ways
of the brain) have not developed adequately or have become
damaged. This type of hearing loss may be caused by diseases,
injuries, genetic syndromes, or exposure to loud noise. For the
profoundly impaired, cochlea implants can be considered, and
hearing aids may also be used.
54
P. Conductive hearing losses, which are caused by interferences with
O. the transmission of sound from the outer ear to the inner ear; this
B
O interference can occur in either the outer or middle ear. It occurs
X
where there is some obstruction, infection or other interference
20
38 with the physical transmission of sound waves. Blockage to the ear
2,
KI can be caused by wax, ear infections like ottitis media or any type
T of malformation to the ear canal. Conductive hearing losses are
W
E temporal and can be corrected by medication or surgery
–
Z
A Mixed hearing losses, result from problems of the outer ear as well
M as the inner or middle ear, combining both conductive and sensori –
BI
A. neural hearing difficulties. Distorted sounds and difficulties with
P sound levels are common and hearing aids may be used together
h
o with medical treatment to alleviate the problem.
n
e:
02 3.4.3 Causes of hearing impairment
12
23
90 Newton & Strokes (1999) state that over half the causes of
03 permanent deafness or hard-of-hearing are prenatal in origin.
/0
21 These causes are estimated to be one-third environmental or
22
39 acquired, and one-third unknown (Steinberg & Knightly, 1997).
09 Some authorities however, divide the causes into one-half genetic
5
and one-half environmental. The genetic causes are disorders
E-
m inherited from one or both parents. Children with other genetic
ail defects may have associated hearing disorders. For example,
:
c children with Down syndrome have narrow ear canals and are
o prone to middle ear infections, which may cause hearing losses.
se
tc Individuals with cleft palates also may have repeated middle ear
o
@ infections, which may result in conductive hearing losses (Roisen,
Z 1997). The environmental effects that begin before birth are
a
m associated with illness or infections the mother may have had
te
l.z during pregnancy. Uncontrolled diabetes in the mother for
m example, may cause a hearing loss in her child.
55
Hearing Impairments
The following are some of the causes of hearing impairment:
1. Genetic – hereditary causes
2. Physical trauma
3. Medication (un prescribed & strong/over doses)
4. Diseases affecting the ear – such as German measles or

rubella
5. Otitis media – infection of the middle ear
6. Accidents
7. Meningitis
8. Lack of oxygen (Asphyxia) during birth
9. Noise pollutions especially if they are loud and

persistent.
10. Low birth weight in babies.
Levels of hearing impairment
Levels of hearing impairment range from mild, moderate, severe, to

profound. Children with mild or moderate hearing losses are
usually placed in mainstream classes. Those with severe and
profound losses tend to be placed in units in mainstream schools or
in special schools where sign language is used as a medium of
instruction and communication.
3.5 Education Audiology
As you might have noticed from the above discussion, there are a
here are a number of causes of hearing impairment. Identifying
children with hearing impairments sometimes can also be a
challenge to the teacher. Education audiology is an applied science
of audiology in the classroom, which studies hearing, balance, and
related disorders. It is a clinical profession whose unique mission is
56
the evaluation of hearing. Those who practice the applied field of
P.
O. audiology in education are called Education Audiologists.
B
O
X Education audiology is there to determine the frequency of the left
20 and right ear in an effort to assess the hearing impaired. Hearing
38
2, loss is mostly measured using a pure tone audiometer. This is an
KI
T electronic device which produces pure tones near the outer ear and
W an individual states whether he or she hears the sound at a certain
E
– intensity or frequency. The audiometer presents pure tones, not
Z
A speech to the individual who receives the tones in a headset. The
M unit of measurement used in assessing hearing impairment is
BI
A. known as decibels (dB) and the results are plotted on a special
P graph called audiogram. The audiometer is set at 15 to 20 dB when
h
o screening children. Perception of sound between 15 and 20 dB or
n
e: slightly above is considered normal hearing.
02
12 Before we go to the next sub-topic, let us do the activity on the next page.
23
90
03
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21
22
39
09
5
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57
Hearing Impairments
Activity 3.5.1
List at least five classroom signs (social and educational

characteristics) you would look for in the identification of a child
with hearing impairment in your class ?
1. ………………………………………………………………
………………………………………………………………
2. ………………………………………………………………
………………………………………………………………
3. ………………………………………………………………
………………………………………………………………
4. ………………………………………………………………
………………………………………………………………
5. ………………………………………………………………
………………………………………………………………
You are to spend not more than 10 minutes for this activity.
Check for answers at the back of the Module.
58
P.
O.
B 3.6 Characteristics of children with H.I
O
X Children with hearing impairments will usually show some of the
20
38 following characteristics:
2,
KI Use gestures to communicate;
T
W
Speak too loudly, too softly or in a monotone voice;
E
–
Z Confusion of similar sounding words;
A
M Poor articulation of sounds;
BI
A. Responding slowly to instructions;
P
h Often giving inappropriate responses;
o
n Tilt their heads in the direction of sound;
e:
02
12 Frequent requests for repetitions;
23
90 Inattentiveness and speaking very quietly;
03
/0 Extremely watchful when a person is speaking, in order to
21 lip-read;
22
39 Have delayed speech;
09
5 Have pus in their ears;
E- Breath through the mouth;
m
ail Tend to have poor balance;
:
c Reports of buzzing or ringing in the ears;
o
se
Have regular sore throats, colds, tonsillitis.
tc
o
@ (First 10 are behavioural while the last 6 are physical
Z characteristics)
a
m
te Have you ever come across someone in your community that uses
l.z sign language? If yes, how much interest have you had in them?
m
We shall now introduce you to sign language.
59
Hearing Impairments
3.7 Sign Language

Sign language is ―the use of gestures to represent words, ideas and
concepts” (Heward & Orlansky, 1988:279). It is a unique and
most traditionally known language for the deaf. Sign language is a
means of communicating using gestures, facial expressions and
body language. Signs are used to indicate concepts or groups of
words rather than individual words. Variations in sign language,
divergent signs, and ―homemade‖ signs are used when the
appropriate sign is unknown, difficult to form, or nonexistent. Sign
language has an alphabet of letters and symbols.
Let us now focus our attention to the sign language alphabet on the
next page.
60
P.
O.
Sign language alphabet
B
O
X
20
38
2,
KI
T
W
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A
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A.
P
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02
12
23
90
03
/0
21
22
39
09
5
E-
m
ail
: 3.7 Teaching Methods
c
o There are three main types of communication used in teaching
se
tc children with hearing impairments in Zambia. These are:
o
@ 1. Oral communication – This is the use of speech sounds as
Z
a the essential element of integration into the hearing world.
m
te Emphasis here is on the use of residual hearing,
l.z amplification, and speech /language training. Persons who
m
are hard of hearing or deaf use whatever hearing and speech
abilities a person has including finger spelling.
61
Hearing Impairments
2. Total communication – This method combines finger

spelling, signs, lip reading and auditory amplification. The
position the total communication approach is that
simultaneous use of multiple communication techniques
enhances an individual‘s ability to communicate,
comprehend, and learn. This is the most common method of
classroom communication.
3. Sign language – This is the natural language of the deaf.

Sign language has its own grammar and syntax, and the
objective of this approach is to provide a foundation in the
use of vocabulary and syntax rules in the classroom. It
differs from region to region. In Zambia we use the British
sign language because of our being a former British colony.
As you might have noticed, the priority in the education of learners

with hearing impairment is to ensure that all learners with usable
hearing have the maximum opportunity to develop listening and
oral skills, with the maximum opportunity to speak for themselves,
to be understood and to participate actively in decisions regarding
their own lives and goals.
62
P. 3.8 Teaching learners with H.I in an inclusive class
O.
B
To help in teaching learners with hearing impairment, the following
O
X strategies can be used:
20
38
2,  Use of assistive technology
KI
T  Make speech louder and clearer
W
E
–  Minimise background noise
Z
A
M  Encourage lip reading
BI
A.  Use assistant teachers or sign language interpreters
P
h
o  Provide hearing aids
n
e:  Increase children‘s attention by use of listening games and
02
12 reading frequently with them
23
90
03  Promote language learning through interactive games,
/0 positive feedback, adding words to help the child
21
22
39  Refer learners for medical examinations and possible
09 cochlea implants.
5
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:
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o
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Hearing Impairments
Unit summary
In this unit you learnt about the learners with communication and
hearing disorders. We discussed the different types of
communication and hearing disorders. We also looked at the
various characteristics and the methods that you would use as a
teacher to teach these learners. It is our sincere hope that you have
greatly benefited from this unit. In the unit that follows, we will
consider the education of learners with physical and health
impairments.
Assignment
The assignment will be given to you during the residential school.
Assessment
64
P.
O.
B
O
X
20
38
2,
KI
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A
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BI
A.
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02
12
23
90
03
/0
21
22
39
09
5
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65
66 Unit 4 Physical, Health Impairments and Albinism
Unit 4
Physical, Health Impairments and

Albinism
4.0 Introduction
Welcome to Unit 4 which looks at physical, health impairments
and albinism. We hope you enjoyed the last topic on learners with
communication disorders and hearing impairments.This unit is
concerned with infants and children whose physical disabilities
interfere with their ability to interact with people and objects in
their environment to the extent that they are not able to achieve the
normal milestones of development that are easily accomplished by
their age peers. Our focus will be on education of learners with
physical, health impairments and albinism. Learners with physical
disabilities and health conditions mainly encounter difficulties that
are centred on mobility between their homes and the school.
 Describe learners with physical and health impairments.
 Define the term albinism and its implications in an inclusive setting.
 Discuss the concept of physiotherapy.
 Implement the various strategies used in the education of children with

physical and health impairments.
66
P. Human Immuno – A virus that breaks down the body‘s immune
deficiency Virus: system.
O.
B
Cystic Fibrosis: A genetic disease that affects a child‘s breathing
O
and digestion.
X
20
Diabetes: A disorder in which the blood sugar of the
38 individual is abnormally high because the body
2, does not produce enough insulin or because the
KI body is insensitive to the insulin that is produced.
T
W Health impairment: A variety of health problems that dictate the need
E for special medical or educational services.
–
Z
A
M
BI
A.
P
h
o
n
e: 4.1 Physical Impairments
02
12 4.1.1 Definitions
23
90 There are many definitions of physical disability, but we shall look
03
/0 at a few. Physical disability is a condition that interferes with a
21 child‘s disability to use his or her body. Many but not all, physical
22
39 disabilities are orthopaedic impairments. Orthopaedic impairment
09 generally refers to conditions of the muscular or skeletal system
5
and sometimes to physically disabling conditions of the nervous
E-
m system. Connor et al. (1988) states that physical disability or
ail orthopaedic impairment includes severe disabilities that adversely
:
c affect educational performance. When a child‘s condition whether
o
se medical or physical interferes with his/her ability to take part in
tc routine school/home activities, the child has a physical disability.
o
@
Z Let us now look at the types of physical disabilities.
a
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67
4.1.2 Types of physical disabilities

Children with physical disabilities have many different conditions.
Although there are important differences among the conditions,
there are also similarities. Most affect one system of the body in
particular: The neurological system (the brain, spinal cord, and
nerves) or the musculoskeletal system (the muscles, bones and
joints).
The severity or degree of the child‘s physical involvement is a
major component in classification. The severity of physical
involvement can be described in functional terms according to the
impact the disability has on mobility and motor skills:
You will note that physical disabilities fall under various categories
depending on their causes. Let us now look at some of those with
neurological in nature:
Cerebral palsy
This refers to the disorder of movement caused by damage to the

motor control areas of the brain. Cerebral refers to the brain and
palsy to disorders in movement. The damage that results in cerebral
palsy can occur before birth, during birth or after birth. It may also
be defined as a neurological condition, which may send wrong
signals to the brain or interprets feedback wrongly. When there is
spinal injury or deformity, pathways between the brain and the
muscles are interrupted, so messages are transmitted but never
received. The result of this may be loss of sensation beyond the
point where the spinal cord is damaged or there may be paralysis.
The condition affects muscle tone (the degree of tension in the

muscles), interferes with voluntary movement and full control of
the muscles and delays gloss and fine motor development. Muscles
and joints are tight and stiff and movements are limited to affected
areas of the body. Approximately 40% of children with cerebral
68
palsy have normal intelligence while the remainder has mild to
P.
O. severe intellectual impairment.
B
O Epilepsy
X
20
38 Did you know that epilepsy is a physical disorder and not a health
2,
KI impairment? It is the disorder that occurs when the brain cells are
T not working properly. It is often called a seizure disorder. When it
W
E occurs in one hemisphere of the brain, it is referred to as partial
– seizure and if it affects both hemispheres it is called generalized
Z
A seizure. Some children may experience both types and this is called
M
BI mixed seizure disorders.
A.
P Epilepsy may be caused by firing of neurons, minor damage to the
h brain, cerebral palsy or tumour. The most common seizure is the
o
n one that involves firing of neurons in both hemispheres of the brain
e:
02 The characteristics of epilepsy depend on the degree of the disease.
12 However, the following are the general observations:
23
90 Uncontrolled jerking of the body
03 Incontinence
/0
21 Sweating
22 Other seizures involve a child showing blank expression, and at
39
09 times blinking before becoming unconscious, and may be unaware
5 of the surroundings and cannot be awakened.
E-
m
Spina Bifida
ail
: This is one of the disabilities that occur as a result of neural tube
c
o defects. The neural tube is what develops into a spinal cord and the
se brain in a developing embryo. Where there is spina bifida, the
tc
o neural tube and the vertebrate do not develop normally. It may
@
Z attack the unborn child in rapid cell division. The bones do not fuse
a together during the early stages of development. The degree of this
m
te disability may differ from tiny, insignificant defects shown only by
l.z a dimple at the base of the spine, to a gross lesion in which the
m
spinal cord and its coverings may be visible or even open at birth.
69
The disorders we have discussed so far constitute neurological

disorders. Let us now turn your attention to musculoskeletal
disorders.
Musculoskeletal conditions
This includes muscles and their supporting frame (skeleton).

Musculoskeletal conditions often severely limit a child‘s motor
skills and can increase their social discomfort, but usually do not
impair intellectual and academic abilities. Conditions that affect the
musculoskeletal system can result in progressive muscle weakness,
a disease known as Muscular dystrophy, inflammation of the joints
disease known as Arthritis or loss of various parts of the body due
to Amputation.
Muscular Dystrophy
This is an inherited condition, occurring primarily in males, in
which muscles weaken and deteriorate. The weakness usually
appears around 3 to 4 years of age and worsens progressively. By
age 11 most victims can no longer walk. Death usually comes
between the ages of 25 and 35 from respiratory failure or cardiac
arrest (Lyle & Obringer, 1983).
We believe you could have seen children in your school with these
conditions. It is possible that you could have come across children
with these conditions only that you did not know what they were
known as.
4.1.3 Physiotherapy
Have you ever taken time to really understand what physiotherapy
really is? This is the provision of services to people to develop,
maintain and restore maximum movement and functional ability
throughout the lifespan. It includes the provision of services in
circumstances where movement and function are threatened by the
process of aging or that of injury or disease.
70
P. Physiotherapy is concerned with identifying and maximizing
O. movement potential, within the spheres of promotion, prevention,
B
O treatment and rehabilitation. It involves the interaction between
X
persons with physical disabilities, families, and care givers in a
20
38 process of assessing movement potential and in establishing agreed
2,
KI upon goals and objectives using knowledge and skills unique to
T physiotherapists. Physiotherapy interventions may include spinal
W
E and extremity manipulation, therapeutic exercise,
–
Z electrotherapeutic mechanical agents, functional training, provision
A of aids and appliances, patient education and counseling;
M
BI documentation and coordination, and communication. Intervention
A. may also be aimed at prevention of impairments, functional
P
h limitations, disability and injury including the promotion and
o
n maintenance of health, quality of life, and fitness in all ages and
e: populations.
02
12
23 Some of the conditions that physiotherapists manage include:
90
03 Spinal and joint conditions, such as arthritis,
/0
21 Muscular control,
22
39 Cerebral palsy,
09
5
Neurological conditions, and
E-
m Wounds.
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71
4.2 Health Impairments

4.2.1 Definitions
The term health impairment refers to a variety of health problems
that dictate the need for special medical or educational services.
Health impairment is also a condition that requires on-going
medical attention Health impairments include asthma, sickle cell
anaemia, cancers, HIV AIDS, cystic fibrosis, heart disease,
haemophilia etc.
As we explained earlier on, children with health impairments

require on-going medical attention. You will note that just like
physical disabilities, health impairments stem from a wide variety
of conditions. These include the following:
4.2.2 Types of health impairments
(a) Metabolic disorders: There are many metabolic disorders,

which affect school-going children. These children may encounter
osteogenesis imperfector or brittle bone disease. This condition
results in multiple fractures and maybe misinterpreted as child
abuse. The affected children normally have normal intelligence.
Care must be taken when involving them in physical activities so as
to avoid them sustaining fractures.
(b) Cardiopulmonary conditions: The cardiopulmonary system

includes the heart and lungs. When a health problem affects the
cardiopulmonary system a child may have problems in breathing
such as asthma or the heart may not pump blood properly.
It is important for you to know that some children with these

conditions can not run, climb stairs or even walk. Although it is
possible to limit strenuous exercises for these children, simply
sitting in school the whole day takes more energy than some of
72
them can produce. Their inability to take part in normal activities
P.
O. with their age mates can create social problems for these children.
B
O Adding to these problems is the high susceptibility of these
X
20 children to illness. Frequent absences put them at an academic
38
2, disadvantage inspite of their normal intelligence. Let us now look
KI at some of these conditions in detail:
T
W
E Asthma
–
Z This is a pulmonary condition characterized by shortness of breath,
A
M wheezing and coughing. Asthma is a condition affecting the
BI
A. person‘s breathing. It usually has three features:
P
h Lungs are swollen
o
n
e: Breathing is difficult
02
12 The air-ways react negatively to a variety of
23 environmental conditions e.g. dust, smoke, cold air and
90 exercise.
03
/0 Asthma may also cause acute constriction of bronchial tubes. In
21
22 children, the condition varies from mild to severe. It does not
39 usually pose a major problem for the teachers of children with this
09
5 condition. However, all teachers need to know how to deal with
frequent absences of children with severe asthma and what
E-
m symptoms indicate that a child is asthmatic.
ail
:
c Sickle Cell Anaemia
o
se Sickle cell anaemia is an inherited blood disease. Oxygen carrying
tc
o red blood cells usually are round but in children with sickle cell
@
they are crescent or sickle shaped (like a half moon). The sickle
Z
a cells are not as flexible as the round shaped cells and can be
m
te trapped in body organs. When the red blood cells are trapped,
l.z oxygen is not carried through the body and the result is shortage in
m
oxygen. This can leave the child highly vulnerable to infection.
Currently, massive dosages of penicillin are administered to
73
children with sickle cell to prevent the development of infection.

The penicillin dosage continues throughout early childhood until
the immune system can fight the infections.
Activity 4.2.2.1
1. What is AIDS and how is it transmitted?
2. Explain at least 4 ways in which your school is helping the

affected learners to cope with this condition?
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
Well done! For the answer to question 1, check the back of the
module. Let us now consider other health impairments that afflict
learners in school.
Diabetes
This is a chronic (lifelong) disease marked by high levels of sugar

in the blood, either because the body does not produce enough
insulin, or because cells do not respond to the insulin that is
produced. This high blood sugar produces the classical symptoms
of polyuria (frequent urination), polydispsia, (increased thirst) and
polyphagia (increased hunger).
Diabetes can cause serious health complications including heart

disease, kidney failure, blindness, etc. It is the seventh leading
cause of death in most countries. Some of the symptoms of diabetes
are; Excessive thirst, frequent urination, unexplained weight loss,
74
extreme hunger, sudden vision changes, sores that are slow to heal,
P.
O. more infections than usual, feeling tired most of the time, tingling
B or numbness in hands and feet, and experiencing very dry skin.
O
X
20 Hypertension (High blood pressure)
38
2,
KI Hypertension is the term used to describe high blood pressure.
T Blood pressure is the measurement of the force against the walls of
W
E one‘s arteries as the heart pumps blood through the body. Blood
– pressure readings are measured in milimetres of mercury (mmHg)
Z
A and usually given as two numbers – for example, 110 over 90
M
BI (written as 110/90 mmHg).
A.
P The top number is considered high usually if it is over 140, and
h
o considered normal if it is below 120. The bottom number is
n
e: considered higher if it is over 90 most of the time, and considered
02 normal if it is below 80.
12
23
90 Cystic Fibrosis
03
/0 This is an exocrine gland disorder that causes overproduction of
21
22 thick mucous which can obstruct glands and destroy pancreatic
39
09 tissue. It is frequently related to chronic respiratory disease in
5 which mucous blocks the lungs, and a person is unable to remove
E- bacteria and from the lungs, so the lungs collapse. Frequent health
m problems include; middle ear infections, diabetes, cirrhosis of the
ail
: liver, and high levels of sodium chloride. Children with this
c
o condition can have frequent chest and sinus infections, and suffer
se from heat exhaustion. In teenagers, it causes delayed puberty.
tc
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4.2.3 Teaching adaptations for learners with physical
and health impairments
Having discussed the various physical impairments and health

conditions that affect our learners, it is important to know the
approaches that can be employed in teaching these learners. The
following are some of the teaching strategies that you might need
to use in teaching these learners:
Adapting the learning environment- The academic curriculum

and skills necessarily present problems to children with physical
disabilities. Children who miss school frequently for long periods
because of illness or surgery however, may require special attention
to catch up. Some children with health problems are unable to last a
full day in school, so the teacher must teach the essentials over a
short period of time or encourage home instruction. Instructional
adaptations are needed in order for kids with physical disabilities to
participate fully and benefit from classroom instruction.
Inclusion- there has been a growing need for schools to educate

learners in inclusive school settings and to offer services necessary
in that environment. Learners with physical disabilities with no
other impairment can achieve the greatest potential in regular a
classroom. If children with physical disabilities are going to learn
to live in integrated environments as adults, they must attend
regular schools and classes to the greatest extent possible.
Adjustments like providing additional space for the movement of a
wheelchair, extra time to change classes or access to computer
terminals are often the key to enabling a child to participate in a
challenging curriculum in a meaningful social interaction.
Accessibility of facilities- learners with physical disabilities should

in as much as possible be subjected to less restrictive environments
by ensuring that public buildings be accessible to all people. New
76
buildings being constructed should be accessible to all. Older
P.
O. buildings should be renovated by adding rumps at entrances or
B installing elevators in storey buildings.
O
X
20 Adapting teaching strategies - Increasing the understanding of
38
2, disabling conditions. As a teacher of children with a physical
KI disability you should learn as much as possible about the condition
T
W meaning its cause, treatment and educational implications.
E Teachers can also help learners adjust to physical disabilities by
–
Z helping them see their disability as just one aspect of their lives and
A
M of themselves. This can be done through individual or group
BI counseling.
A.
P
h Increasing the sense of control - It is important to help learners
o
n with physical disabilities understand that they have the ability to
e: control some aspects of life that they had no control over.
02
12
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4.3 Albinism
4.3.1 Definitions
It is our hope all of you have at one point or the other come across
an albino. If not, do not worry. In this sub unit shall briefly define
the term albinism, look at he causes, educational implications and
adaptations.
Albinism is an inherited genetic condition that reduces the amount

of melanin pigment formed in the skin, hair and/or eyes. It is
characterised by a deficit in the production in melanin and by
partial or complete absence of pigment in the skin, hair and eyes.
The degree of pigmentation varies. An individual with complete
absence of melanin is called an albino, while one with only a small
amount of melanin is described as an albinoid.
Having defined albinism, let us now focus our attention to the

causes.
4.4.2 Causes of Albinism
The cause of albinism is a mutation in one of several genes. Each

of the genes provides the chemically coded instruction for making
one of several proteins involved in the production of melanin.
Melanin is produced by cells known as melanocytes, found in skin
and eyes.
In most types of albinism, a person inherits two copies of a mutual

gene – one from each parent in order to have albinism (recessive
inheritance) If a person only has one copy, then he or she wont
have the disorder.
In the following paragraphs, we shall look at the characteristics of

albinos.
78
P. The picture of an albino below will help you understand better.
O. Please take note of the features.
B
O
X
20
38
2,
KI
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4.4.3 Characteristics of Albinism
You may be interested to note that a person with albinism is

generally as healthy as any other person. However, problems with
skin and vision are particularly common. People with albinism are
very pale with fair hair and very light eyes. In some people, the
eyes appear red or purple, depending on the amount of pigment.
This happens due to the little colour found in the iris. The reddish
and pinkish colours are due to the blood vessels inside the eye
which show through the iris.
Have you ever wondered why most albinos wear hats and
sunglasses? People with albinism lack melanin. Melanin is the dark
pigment which protects the skin from the sun‘s ultraviolet
radiation. As a result, their skin can burn more easily from over
exposure and they need to take precautions to avoid damage to the
skin. On the other hand, vision problems result from abnormal
development of the retina and abnormal patterns of nerve
connections between the eye and the brain. Lack of pigment in the
eyes results in problems with eye sight, both related and unrelated
to photosensitivity, which generally leads to discomfort in bright
light. What then should we do as teachers to help our pupils with
albinism? This will be our discussion in the next sub-topic.
4.4.4 Teaching Albinos in an Inclusive Setting
When dealing with pupils with albinism, it is important that as

teachers, we try as much as possible to help them learn with less
difficulty. Some of the strategies we would use are listed below:
 Avoid outdoor teaching where there is too much light.
 Let the pupil use screen lenses for eye protection when
using a computer.
 Teacher‘s handwriting on the board should be clear.
80
P.  There should be no segregation with sitting arrangements
O. and when giving responsibilities.
B
O
X  When teaching using group work method or subjective
20
approach, make them group leaders.
38
2,
KI  Encourage pupils to take precautions and avoid exposure to
T
W UV light, by using high factor sunscreen, protective
E clothing and hats.
–
Z
A  Discourage negative comments coming from other
M
BI members of the class, and encourage them to be equals.
A.
P  When they have serious eye problems, let them consult or
h
o seek advice from optometrists or ophthalmologists.
n
e:
02
12
23
90
03 Activity 4.4.4
/0
21 What are some of the vision aids that can be used in visual
22 rehabilitation of learners with albinism?
39
09 ………………………………………………………………………
5
………………………………………………………………………
E-
m ………………………………………………………………………
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:
………………………………………………………………………
c
o
se ………………………………………………………………………
tc
o ............................................................................................................
@
Z ............................................................................................................
a
m ...........................................................................................................
te
l.z
m You are expected to spend not more than ten minutes on this
activity. Answers are given at the back of the module. Assess
yourself genuinely.
81
Unit summary
In this unit you learnt about learners with physical disabilities and
health conditions. You were also introduced to different types,
causes and signs of the two conditions, and the teaching strategies..
In addition, you leant how to deal with pupils with albinism in an
inclusive school. We hope you have greatly benefited from this unit
and that you will put into practice some of the intervention
measures to help your pupils.
We also hope you found the module interesting and educative.

Your comments and recommendations are very welcome.
Assignment
The assignment will be given during the residential school.
82
P.
O.
Assessment
B
O
X
20 Self-marked assessment
38
2, In your local community where you come from, briefly describe
KI society‘s attitudes on children with disabilities. What are some of
T the local names you know given to these children?
W
E
–
Z You are expected to answer this question in your own study material.
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Readings
Heward, W.L. & Orlansky, M.D. (1988) Exceptional Children, (Third
Edition), Columbus, Merrill Publishing Company.
Kasonde-Ng‘andu, S. and Moberg, S. (2001) Moving Towards Inclusive
Schooling: A baseline study on the Special
Educational Needs in the Western and North-Western
Provinces of Zambia, Lusaka, Ministry of Education.
Kirk, S.A., Gallagher, J.J. & Anastasiow, N.J. (2003) Educating
Exceptional Children, (Tenth Edition), New York,
Houghton Mifflin Company.
Ministry of Education (MOE), (1996) Educating Our Future: National
Policy on Education, Lusaka, MOE.
84
P.
O.
B ANSWERS FOR ASSESSMENT AND ACTIVITIES
O IN THE MODULE
X
20 Activity 1.4.1 – Unit 1
38
2,
KI 1. Techniques used for guiding learners with V.I in mobility
T
W a) The use of a White cane/Long cane/Hoover cane.
E
– b) The use of a Sighted Human Guide.
Z
A c) The use of Guide dogs.
M
BI d) The use of Electronic aids worn around the neck to
A.
P produce warning signal when objects are in one‘s
h pathway.
o
n 2. Special devices used by V.I children
e:
02 a) Lamps
12
23 b) Tape recorders
90
03 c) Abacus
/0
21 d) Talking calculators
22
39
e) Perkins brailler
09
5
f) Writing frames/Braille paper/Stylus
E-
m 3. The ‗E‘ chart
ail
: Activity 3.5.1 – Unit 3
c
o
se Classroom signs (social and educational characteristics) for
tc learners with H.I
o
@
Z Use gestures to communicate;
a
m Speak too loudly, too softly or in a monotone voice;
te
l.z
m Confusion of similar sounding words;
Poor articulation of sounds;
85
Responding slowly to instructions;
Often giving inappropriate responses;
Tilt their heads in the direction of sound;
Frequent requests for repetitions;
Inattentiveness and speaking very quietly;
Extremely watchful when a person is speaking, in order to

lip-read;
Activity 3.5.1 – Unit 3
Acquired Immune Deficiency Syndrome (AIDS): AIDS is the

breakdown of the body‘s immune system caused by HIV. Ninety
per cent of AIDS cases in kids are the result of a virus being
transmitted from the infected mother during pregnancy, birth
process, or breast feeding. About one-third, acquire the virus during
pregnancy and most others during child birth. A child may also
become infected through a contaminated blood transfusion. Among
adults, the condition is transmitted through:
Sexual contact
Using contaminated needles to administer blood
Through transfusion of contaminated blood.
Adolescents exposed to any of these are as much at risk as adults.

The outlook for kids who have AIDS is grim. They have severe
developmental delays, brain damage and early death. Not all
children born with HIV develop AIDS.
Children who are infected with AIDS face a lot of problems in

school. These may range from prolonged absence to dropping out
of school due to their on-going medical condition.
The end.
86

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MUKUBA UNIVERSITY

No part of this module may be reproduced or transmitted in any form or by any

P.O Box 20382

Chisangano E. N Senior Lecturer – Education Department

Getting around this Module 6

3.7 Teaching Methods ........................................................................................ 61

 Core content of the unit with a variety of learning activities.

 Assignments and/or assessments, as applicable.

 Course content and structure.

 Course reading materials and resources.

 Course support (assigned tutors, technical help, etc.)

Your constructive feedback will help us to improve and enhance this

E-  Identify learners with visual impairments .

Essentially you will be taking control of your learning environment. As a

We recommend that you take time now—before starting your self-

- Local resource centre coordinators,

Getting around this Module

A complete icon set is shown below. We suggest that you familiarize

Activity Assessment Assignment

Discussion Help Note it!

Outcomes Reading Study skills

Summary Terminology Time

Upon completion of this unit you will be able to:

 Identify the causes and signs of visual impairments.

 Understand and practice Braille reading and writing.

 Explain Braille for mathematics and science.

 Discuss teaching methods in an inclusive setting.

Visual perception: Ability to interpret visual stimuli and make sense

Snellen chart: The chart commonly used for vision screening of

Refractive errors: A collection of sight problems that require glasses

Presbiopia: When flexibility of the lens in the eyes declines,

You will be interested to know that visual acuity is measured by

Learners with visual impairments face difficulties in reading and

State at least 4 possible difficulties that learners with impairments

1.2 Parts of the human eye

1.2.1 Parts and functions of the eye

Structural Impairment: Visual impairment can be caused by

Cortical Visual Impairment (CVI): This refers to decreased

Having looked at the picture above, how can you describe it to

iii) Glaucoma – this is increased pressure in the eye due to the

iv) Nystagus – this is the involuntary movement of the eye.

v) Strabismus – muscle imbalance resulting in the inability of

a. Estropia – inward turn of the eye.

b. Exotropia – outside turn of the eye.

c. Hypertropia – upward eye turn.

d. Hypotropia – downward turn of the eye.

Learners with this condition usually have problems with

vi) Optic nerve atrophy – this is damage or degeneration to

They have uncertain movements

They blink more than usual

They usually bump into objects when moving

1.3.2 Orientation and mobility training

Orientation and mobility involve the understanding of ones

5. The use of systematic search pattern to

7. The knowledge of where, how and when to

Having discussed orientation and mobility training for learners with

proficient user can type 40 to 60 words per minute. Using Braille is

See the Braille alphabet below.

Learners with visual impairments can be taught using the

(a) Use of concrete objects – The learners with visual