Children with Special Needs PDF

‫‪Community Health Nursing‬‬ ‫‪Children with special needs‬‬ ‫ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ...

‫‪Community Health Nursing‬‬ ‫‪Children with special needs‬‬ ‫ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬ ‫‪Zagazig University - Faculty of Nursing‬‬ ‫‪-1-‬‬  Children with special needs Outlines  Introduction.  Meaning of children with special needs.  International Classification of Functioning Disability and Health Framework (ICF).  Concepts of impairment, disability and handicap.  Causes of major handicapping conditions.  Effects of handicapping on individuals, families and communities.  Major types and classification of disabilities.  Barriers and challenges for persons with special needs.  Prevention of disability.  Community services for prevention of handicapping.  Community health nurse role for persons with disability. Learning objectives By the end of this lecture, the student will be able to:  State the concept of children with special needs.  Discuss the ICF.  Define the concepts of impairment, disability and handicap.  Classify the causes of major handicapping conditions.  Describe the effects of handicapping on individuals, families and communities.  Enumerate the major types and classification of disabilities.  Illustrate barriers and challenges for persons with special needs.  Apply the three level of prevention of disability.  Recognize community services for prevention of handicapping.  Display the roles of community heath nurse for the disabled people. ‫ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬ Zagazig University - Faculty of Nursing -2-  Introduction Disability is part of being human. World Health Organization (WHO) has estimated that 1.3 billion people – about 16% of the global population – currently experience significant disability. According to the latest statistics issued by the Central Agency for Public Mobilization and Statistics (CAPMAS) in Egypt 2020, there were more than 20 million Egyptians with special needs; including 76.5 percent with mild disability, 18.9 percent with moderate disability, and 4.5 percent are completely disabled. This number is increasing due in part to population ageing and an increase in the prevalence of noncommunicable diseases. Disability results from the interaction between individuals with a health condition, such as cerebral palsy, Down syndrome and depression, with personal and environmental factors including negative attitudes, inaccessible transportation and public buildings, and limited social support. A handicap is a disadvantage resulting from impairment or disability that limits the social role of an individual, e.g. being unable to learn or work somewhere due to limited access. In Egypt, “a disabled person” means a person who need rehabilitation service to meet the basic needs in society because impairment such as movement-related function, sensory function and mental function brings physical, social, economic and psychological disability. Children with special needs (CWSN) Children with special needs (CWSN) are those who have a disability of some kind and need special assistance and care. Children who are handicapped, disabled, or disadvantaged are generally described as being unable to cope with the stresses of daily life. They are also stated to as "differently abled" children. The type of these children's disabilities determines their special needs. To categories disabled children broadly, there are three categories: Physically disabled children, mentally disadvantaged children, socially maladjusted ‫ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬ Zagazig University - Faculty of Nursing -3- children. Certain disabilities are incurable. Early identification, specialized education, and training can, however, greatly aid children with disabilities in leading independent lives. International Classification of Functioning, Disability, and Health (ICF): In the ICF document, disability serves as a broad term for impairments, activity limitations, or participation restrictions. It is linked with functioning, a term that encompasses all body functions, activities, and participation. The ICF took into account body functions and structures, activities and participation, environmental factors, and personal factors. This allows a multidimensional evaluation of an individual’s circumstances in terms of functioning, disability, and health. Melding the “medical model” of health and health care for disabled persons with the “social model,” the ICF provided a biopsychosocial approach for assessing people with disabilities, emphasizing the observation that no two people with the same disease or disability have the same level of functioning. The following definitions serve to explain the ICF in terms of health: ◆ Impairments are problems in body function or structure. ◆ Body functions are the physiologic functions of body systems (cognition and affective). ◆ Body structures: anatomic parts of the body (motor) such as organs or limbs. ◆ Activity is the execution of a task or action by an individual. ◆ Participation including personal and interpersonal roles (social roles, education and employment). ◆ Activity limitations are difficulties in executing activities (selfcare, basic ADLs and Instrumental Activities of Daily Living (IADLs), or mobility). ◆ Participation restrictions are problems an individual may experience when involved in life situations. ◆ Environmental factors make up the physical, social, and attitudinal environments in which people live and conduct their lives. ‫ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬ Zagazig University - Faculty of Nursing -4- ◆ Personal factors may play a role in disability at any level. International Classification of Functioning, Disability, and Health (ICF) approved by the world health assembly 2001 Concept of Disability According to (WHO): I. Impairment (first stage): Impairment is an abnormality of psychological, physiological or anatomical structure or function. It occurs at level of body organ. Example: Physical impairments such as: Missing or defective body part, an amputated limb, paralysis, sight and hearing impairment. Impairment in body organ such as heart disease, diabetes or epilepsy. Mental impairments: Including learning disabilities and mental illness. II. Disability (second stage): It is any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being. It occurs at individual level. It is an activity limitation, such as difficulty seeing, hearing, walking, or problem solving. III. Handicap (third or final stage): ‫ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬ Zagazig University - Faculty of Nursing -5-  It is the result when an individual with an impairment or disability cannot fulfill a normal life role (at societal level). It is a participation restriction in normal daily activities, such as working, engaging in social and recreational activities or obtaining health care and preventive services. Handicaps refer to the interactions of people and their societies. Example: Person cannot get a job because employers do not want employees who cannot walk. Types of handicapping 1. Congenital handicapping: Show at time of birth or progress in the first year of life due to: a. Genetic disorder. b. Adverse in utero exposure.  Forms of congenital malformation: Down syndrome, cleft palate, mental retardation, congenital deafness, heart disease and kidney disease. 2. Acquired handicapping due to: a. Accidents and injuries: Due to birth injuries, home accident and road or traffic accidents. b. Infectious disease: Such as T.B, Diphtheria, syphilis or meningitis.  Forms of acquired handicapping: Impaired vision, blindness, impaired hearing, deafness, speech defects, muscle paralysis, skeletal deformities, rheumatic vulvar lesions affecting the heart, epilepsy and amputation of limbs. 3. Other types of handicapping as: a. Geriatric handicapping: Due to chronic illness or pain which interfere with the individual`s quality of life as (arthritis and other musculoskeletal problems, heart disease and stroke, mental health problems and diabetes). b. Occupational handicapping: Such as mechanical accident (fall from high, moving hazard substance in the air) and contact infection (HBV- HCV). ‫ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬ Zagazig University - Faculty of Nursing -6- Causes of major handicapping conditions: A. Familial or genetic factors: Familial inherited diseases and anomalies (due to abnormal quality and number of genes) such as Down syndrome and congenital deafness. B. Prenatal factors and perinatal factors: 1. Congenital anomalies (adverse in utero exposure) due to:  Infections during pregnancy  Drugs, live vaccines or radiations during pregnancy  Placental insufficiencies caused by bleeding, smoking, hypertension.  Malnutrition of the pregnant e.g. Iodine deficiency. 2. Delivery and neonatal factors:  Moderate or severe asphyxia during labor.  Low birth weight or preterm labor.  Low Apgar scores and brain insult by late resuscitation.  High bilirubin and exchange transfusion. 3. Infantile and childhood factors:  Problems of feeding  Convulsions and other neurological diseases  Accidents of various types (cars, drowning, intoxications)  Severe illnesses of various reasons e.g. infections (meningitis, encephalitis), chronic nephritis, liver diseases (both hereditary and infectious), pulmonary diseases (bronchial asthma), and epilepsy. 4. Social reasons:  Family violence, child abuse and child neglect.  Large birth order in poor families.  Poverty and severe malnutrition. ‫ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬ Zagazig University - Faculty of Nursing -7- Classification of disabilities: 1. Physical disability 2. Sensory disability 3. Communication disability 4. Intellectual disability 5. Pervasive developmental disorders 6. Learning disabilities 7. Gifted and talented 8. Multiple disabilities 1. Physical disability: A physical disability is any impairment, which limits the physical function of one or more limbs or fine or gross motor ability. Other physical disabilities include impairments that limit other facets of daily living, such as respiratory disorders and epilepsy. For example, cerebral palsy, neural tube defects or spinal cord injury. Definition: Cerebral palsy (CP) is a group of disorders that affect a person’s ability to move and maintain balance and posture. CP is the most common motor disability in childhood. Cerebral means having to do with the brain. Palsy means weakness or problems with using the muscles. CP is caused by abnormal brain development or damage to the developing brain that affects a person’s ability to control the muscles. 2. Sensory disability: Sensory disabilities affect how a person gathers information from the world around them. For example, visual or hearing impairment 3. Communication disability (Speech and language disorders): Language disorder is characterized by persistent difficulties in the acquisition and use of spoken, written, or sign language; deficits in comprehension or production include a reduced vocabulary, limited sentence structure, and impairments in discourse include articulation problems, voice disorders, fluency problems (such as stuttering) and disorder of expression.  Specific Communication disorders ‫ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬ Zagazig University - Faculty of Nursing -8-  a. Aphasia refers to difficulties in the ability to understand or express oneself through speech. b. Agraphia refers to difficulties with writing ability. c. Alexia refers to difficulties with reading ability. 4. Intellectual (cognitive) disability: Mentally Challenged Children Mentally challenged children, Mental retardation (MR), relate to those children who show below average intelligence as well as difficulties in meeting the demands of everyday life whether it is in communicating and fraternizing with other or attending to fixing and domestic chores. Mentally challenged is an experimental disability, which first appears in children under the age of 18. It's defined as an intellectual functioning position Intelligence Quotient score (I.Q.) below 70, that's well below average and significant limitations in diurnal living chops. Myths Related to Mentally Challenged Mentally challenged is an internal illness. Mentally challenged isn't common. Mentally challenged is an always caused by heritable factor. Mentally challenged can be caused by alcohol beach vitamins, almonds and rich nutritional food. Mentally challenged is due to fate. Mentally challenged can be completely cured. Mentally challenged cannot be trained or educated. Mentally challenged is due to small size of the brain. Mentally challenged is due to exposure to decline at the time of gestation or birth of the child. Mentally challenged can come normal in life as they grow age. Diagnosis: Criteria for Diagnosis: i. Significantly sub-average general intellectual functioning: IQ below 70 (two standard deviations below the mean). ii. Significant limitations in at least 2 areas of adaptive functioning:  Communication ‫ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬ Zagazig University - Faculty of Nursing -9-   Self-care  Home living  Social/interpersonal skills  Use of community resources  Functional academic skills iii. Onset occurs prior to age 18 5. Pervasive developmental disorders: Pervasive developmental disorders are characterized by delays in the development of multiple basic functions including socialization and communication that have traditionally been referred to as Autism Spectrum Disorder (ASD). A person with autism usually has problems interacting with people in the following ways:  Does not pay attention or stay focused on an activity for as long a time as other children of the same age  Focuses on unusual objects for long periods of time; enjoys this more than interacting with others may prefer to be alone  May avoid or lack eye contact and not imitate others.  May not point or use other hand gestures and not understand social cues.  May not speak at all or be severely language delayed.  May be unable to initiate or engage in a conversation.  May be unable to use their imagination during play i.e. pretending a banana is a telephone). 6. Learning Disabilities (Dyslexia): Affect person’s ability to acquire, process, and/or use either, spoken, read, written or nonverbal information (organization/planning, functional literacy skills, memory, reasoning, problem solving, perceptual skills). ‫ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬ Zagazig University - Faculty of Nursing - 10 -   Dyspraxia: The inability to motor plan, to make an appropriate body response.  Dysgraphia: Difficulty with the act of writing both in the technical as well as the expressive sense. There may also be difficulty with spelling.  Dyscalculia: Difficulty with calculations.  Attention Deficit and Hyperactivity Disorder (ADHD): Hyperactivity, distractibility and impulsivity. 7. Gifted and talented: Gifted and talented learners are defined as those children and young people who perform or have the capability to perform at higher levels compared to others of the same age, experience, and environment in one or more domains.  Gifted: Mean those pupils who are capable of excelling academically in one or more subjects such as English, drama or technology.  Talented: Refers to those pupils who may excel in practical skills such as sport, leadership, artistic performance, or in an area of vocational skill. 8. Multiple disabilities: Concomitant impairments (such as intellectual disability, blindness or intellectual disability, orthopedic impairment). Barriers and challenges for persons with special needs 1. Attitudinal barriers: Such as stereotyping (people sometimes stereotype those with disabilities, assuming their quality of life is poor or that they are unhealthy because of their impairments), stigma, prejudice, and discrimination. 2. Communication barriers: Experienced by people, who have disabilities that affect hearing, speaking, reading, writing, and or understanding. This could be videos that do not include captioning, no large print option for people with vision difficulties or even technical language that prevents someone who thinks differently from understanding a message. ‫ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬ Zagazig University - Faculty of Nursing - 11 - 3. Physical barriers: Physical barriers are any objects or structures that prevent or block mobility and access. From steps that someone in a wheelchair cannot use, to a piece of medical equipment that requires a person with a physical disability to stand up to use it. 4. Policy barriers: These kinds of barriers happen when there is a lack of awareness or inclusion when it comes to activities or programs being accessible to people with disabilities. Federally funded services, accommodations or even government policies need to be inclusive. 5. Social barriers: People with disabilities are less likely to get jobs or complete high school, and are more at risk of experiencing family violence than those without a disability. 6. Programmatic barriers: Examples of programmatic barriers include:  Inconvenient scheduling  Lack of accessible equipment (such as mammography screening equipment)  Insufficient time set aside for medical examination and procedures  Little or no communication with patients or participants  Provider’s attitudes, knowledge, and understanding of people with disabilities 7. Transportation barriers: Lack of adequate or accessible transportation that interferes with a person’s ability to be independent and to function in society. Effects of handicapping on individuals, families and communities: A. Effects on disabled individuals Persons with disabilities are more vulnerable to physical, sexual and psychological abuse, violence and exploitation than non-disabled. 1. Physical effects and related health problems: Such as limited activity, risk for infection, problems related to nutrition, oral health and hygiene. 2. Psychological effects: Such as social isolation, low self-esteem, powerlessness and stigma. ‫ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬ Zagazig University - Faculty of Nursing - 12 - B. Effects on families Families of disabled persons suffer from stress, social stigma, financial problems and the need for external resources to help in meeting role expectations. On the other hand, parents have difficulties to accept the child with disabilities. Parents seem to go through the following six stages: 1. Shock: Ask themselves 2. Denial: They move 3. Guilt: Usually many questions as to the from doctor to doctor partner may blame a cause of the disability, who is seeking answers to their spouse as the cause of responsible for the cause, and predicament and hoping the problem leading to why them. for a more promising marital upheavals, or assessment. divorce. 4. Depression: A deep sense 5. Rejection: If the 6. Acceptance: They of sorrow and sadness may depression is not come to terms with follow the period of guilt. checked, the parents reality and accept the Depressed parents may may reject themselves child like any other withdrawal into them and and the child. child in the family only may seek for support for the that he/she has child and themselves challenges accessioned by the disability. C. Effects on communities: Handicapped individuals affect the financial condition and the health sector as they need care, support devices, rehabilitation and physiotherapy which affect the provision of governmental or private centers, in addition to the provision of trained specialists; this increases the need to reallocate resources and to comply with legislation. It also affects various sectors such as social affairs, education and the transportation sector to facilitate their movement in public places. Levels of prevention of handicapping This is an important approach developed by WHO, visualizing prevention at many levels, including early intervention can be considered as preventive measures. The levels include health promotion, specific protection, early detection and intervention, disability limitation, and rehabilitation. ‫ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬ Zagazig University - Faculty of Nursing - 13 - Level Approach Interventions  It consists of Actions and measures that inhibit the risk factor emergence of risk factors in the form of reduction targeted environmental, economic, social, and towards an behavioral conditions and cultural entire patterns of living such as: population through a  social services to reduce the risk of focus on disability caused by infections, poor social and environmental housing, and inadequate diet by providing conditions funds to cover basic needs for those in financial straits.  Educational effort helps new parents develop parenting skills.  Social prevention efforts include child protection to reduce the injury and neglect of children. Health promotion  Health education, especially for adolescent girls (Avoid marriages in Measures aimed at a susceptible population or blood relations like kinsman sisters. Get individual married before 35 years of age and one should have children before the age of 35 years to avoid MR).  Improvement of nutritional status in community.  Optimum health care facilities.  Improvements in pre, peri and postnatal care. ‫ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬ Zagazig University - Faculty of Nursing - 14 - Level Approach Interventions Specific protection  Rubella immunization for women before pregnancy.  Universal iodization of salt.  Folic acid administration in early pregnancy.  Genetic counseling.  Prenatal screening for congenital malformation and genetic disorders.  Detection and care for high-risk pregnancies.  Prevention of damage because of Rh incompatibility.  Universal immunization for children. Early diagnosis and  Neonatal screening for treatable treatment disorders.  Intervention with “at risk” babies.  Early detection and intervention of developmental delay. Disability limitation and  Stimulation, training and rehabilitation education, and vocational opportunities.  Mainstreaming / integration.  Support for families.  Parental self-help groups. Community services for prevention of handicapping: A. Preventive services B. Curative services C. Rehabilitative services D. Educational services E. Transportation services F. Mass media service ‫ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬ Zagazig University - Faculty of Nursing - 15 - A. Preventive services: 1. Pre-pregnancy planning  To establish good nutritional and exercise habits and to prevent bad habits such as smoking or alcohol abuse.  To see a doctor at least three months before conception to checks for any medical conditions in the mother e.g. thyroid disease or diabetes; infections such as venereal disease; and Rh factor incompatibility. 2. Prenatal care: Include the following  Administration of folic acid in early pregnancy.  Prenatal screening for congenital malformation and genetic disorders.  Detection and care for high-risk pregnancies.  Prevention of damage because of Rh incompatibility. 3. Natal and postnatal care: To prevent birth injuries and infection. 4. Social and economic programs to prevent disability: Programs such as social assistance, income subsidies, and unemployment insurance. 5. Prevention of injuries: Initiatives to improve streets and roads or improve traffic control systems, providing safe playing areas, and bicycle paths. 6. Legislation: Law protects against violence, pollution and injury. 7. Immunization: Such as rubella immunization give to women before pregnancy, tetanus vaccination during pregnant, and polio vaccine. B. Curative services: Including the following:  Early detection, diagnosis, and treatment services.  Proper evaluation of the case physically, psychologically, mentally and socially to plan the management program  Counseling and educational programs to help them cope with problems. C. Rehabilitative services: Rehabilitation is defined as “a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment”. ‫ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬ Zagazig University - Faculty of Nursing - 16 -   Types of Rehabilitation: 1. Medical rehabilitation: Involves medical management of squeal e.g. treating seizures or infections. Medical rehabilitation services include counseling, occupational, physical, speech therapy and massage therapy. 2. Physical rehabilitation: Involves physiotherapy, provision of prosthesis for missing limbs, corrective surgeries for malformations. 3. Psychological rehabilitation: To teach emotional, cognitive, and social skills that help live and work as independently as possible. 4. Educational Rehabilitation: Learning sign language for the hearing and speech impaired, braille for the visually impaired. 5. Occupational/ Vocational Rehabilitation: Training the individual to acquire new skill and providing access to assistive devices. 6. Social Rehabilitation: Involves integrating the individual into the society and helping them to live as independently as possible. E.g., provision of assistive devices e.g. wheel chairs, guide canes, joining support groups, creating accessible public facilities. D. Educational Services: Include services to support the ability to learn in school, such as progressive national and local policy, trained staff, accessible facilities, flexible curricula and teaching methods, and educational resources. E. Transportation services: Special transportation requirements include:  Find buses, taxis, trains, or others, and modify them according to scientific and practical standards to provide them with safety.  Allocating special parking space with markings for all disabilities.  Roads and sidewalks, they should be available on roads, at entrances to buildings, sidewalks, and corridors with slopes.  Placing audio-visual alerts on traffic lights and crossing points of the facility to assist the visually and hearing-impaired while crossing. ‫ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬ Zagazig University - Faculty of Nursing - 17 - F. Mass media service: The media can be a vital instrument in raising awareness, countering stigma and misinformation, and considering them as a part of human diversity. Community health nurse role for a child with a disability: Community health nurses are in a prime position to advocate for the health needs of the disabled. Community health nurses can help make needed changes at the individual, family, and community levels. Nurses can help the parents and family members adjust to a child with a disability by: providing information about the child's condition, providing sources of emotional support from social networks and support groups, empowering and enabling the parent for decision making on behalf of the child, and establishing a partnership between the parent and health care team. The community health nurse's advocacy for the person affected by a disability extends beyond a resource and referral coordinator role or speaking on the other's behalf. The nurse should provide information and then leave the choice up to the person. The community health nurse's support should continue even when the client or family's health care decisions conflict with the health care provider's recommendations. Consider as an example of the variety of roles (clinician, educator, advocate, manager, collaborator, leader, and researcher) and multilevel (individual, family and community) practice that the community health nurse assumes with respect to a 55-year-old female client who uses a wheelchair. The client has difficulty obtaining a gynecologic examination because of the lack of accessible examination tables at the local clinic; as a result, she has not had an examination for more than 20 years. Recognizing the need for a complete examination, the community health nurse arranges with the clinic to find appropriate alternatives that will aid the client in receiving the needed examination. ‫ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬ Zagazig University - Faculty of Nursing - 18 -  References Disabled World. (2020). Disabilities: Definition, Types and Models of Disability. Retrieved (May 20, 2022), from https://www.disabledworld.com/disability/types/. Khushaboo1 & Kavita, D. (2022). Children with Special Needs, International Journal of Novel Research and Development, Volume 7, Issue 7, pp. 694-700. Ferrari, J. (2022). Language Disorder. Retrieved (May 10, 2022), from https://psychbite.com/mental-disorders/neurodevelopmentaldisorders/ communication-disorders/language-disorder/ Institute of Entrepreneurship Development (2021). Social inclusion and human rights 6 Barriers to Disability Inclusion. Retrieved (May 10, 2022), from https://ied.eu/project-updates/projects/it-in-touch/6barriers-to- disability-inclusion. kulkarni, M. (2020). Causes and types of developmental disability Retrived (May 20, 2022), from https://slideplayer.com /slide/6039177/ Marryland Coalition of Families. (2022). What is an Emotional Disability? Retrieved (June 10, 2022), from https://www.mdcoalition.org/what-is-an-emotional-disability/ National Association for Gifted Children (2019). What is Giftedness? Retrieved (June 18, 2022), from http://www.nagc.org/resources publications /resources/what-giftedness World Health Organization (2023). Disabilities. Retrieved (March, 2023), from http://www.emro.who.int/health-topics /disabilities/index.html. National Center on Birth Defects and Developmental Disabilities and Centers for Disease Control and Prevention(2020). Common Barriers to Participation Experienced by People with Disabilities. Retrieved (June 8, 2022), from https://www.cdc.gov/ncbddd/disabilityandhealth/disability- barriers.html The Individuals with Disabilities Education Act (IDEA) (2018). Sec. 300.8 (c) (7) - Individuals with Disabilities Education Act. Retrived (June 18, 2022), from https://sites.ed.gov/idea/regs/b/a/300.8/c/7 ‫ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬ Zagazig University - Faculty of Nursing - 19 -  QUIZ 1. Provide an example of primary, secondary, and tertiary prevention practices for disabled individuals? 2. List some myths related to mentally challenged children? 3. Discuss barriers and challenges for persons with special needs? 4. Explain the role of community health nurse for child with disability? ‫ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬ Zagazig University - Faculty of Nursing - 20 -