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Injuries to the head among children enrolled in special education
Abstract
Injuries to the head comprise 20% to 39% of all school-related injuries. Head injuries among special education students have not been adequately described.
(1) To examine the incidence and characteristics of head injuries in children enrolled in special education and (2) to determine the factors that increase the risk of sustaining a head injury compared with an injury to another part of the body.
Pupil Accident Reports for 6769 students enrolled in 17 of 18 special education schools in 1 large urban school district during the academic years 1994-1998 were reviewed, and information on the nature of injury, external cause, and activity was abstracted. Head-injured and nonhead-injured cases were identified and compared by race, sex, age, characteristics of injury, and disability category.
Six hundred ninety-seven injury events were reported during the 4-year study period. The overall injury rate was 4.7 injuries per 100 student-years. Two hundred five children (29.4%) sustained injuries to the head, and the rate of head injury was 1.3 injuries per 100 student-years. Falls were the leading cause of injury. Head injuries were most commonly associated with physical education and unstructured play and usually occurred on the playground. Disproportionately more head than nonhead injuries were sustained in the classroom (12% vs 8%) and the bathroom (9% vs 3%). Compared with children with emotional/mental disabilities, children with multiple disabilities had the highest risk of a head injury (incidence density ratio, 2.4 [95% confidence interval, 1.6-3.5]), followed by children with physical disabilities (incidence density ratio, 1.8 [95% confidence interval, 1.1-3.1]). There appeared to be no significant difference in the rate of head injury by sex and age.
Modifications of the classroom, bathroom, and playground environments might reduce the risk of head injuries in children enrolled in special education. Special modifications and increased supervision may, in particular, reduce the risk of head injury for children with physical and multiple disabilities.
... [1][2][3] It is estimated that 5.8% to 18.0% of children in the United States have a chronic physical, developmental, behavioral, or emotional disability. 1,[4][5][6][7] In addition, children who have disabilities use many more health care services and, thus, have much higher health care expenses than do their peers who do not have disabilities. 4 Health promotion for children who have disabilities, especially to prevent secondary health conditions, is important. ...
... Many researchers have reported that children with disabilities have a higher risk of injury than do children without disabilities. 2,5,[10][11][12][13][14] However, previous studies are limited because they examine only 1 type of disability or they do not distinguish between types of disabilities. [10][11][12]14 In addition, the few studies that did distinguish between types of disabilities were focused only on 1 setting and on 1 type of injury. ...
... [10][11][12]14 In addition, the few studies that did distinguish between types of disabilities were focused only on 1 setting and on 1 type of injury. 5,13 The epidemiology of injury among children with disabilities has not been adequately studied. 11,[15][16][17] The knowledge base about injury risk among children with disabilities is lacking a study using a large nationally representative dataset that compares the injury risk between children with different types of disabilities while controlling for sociodemographic characteristics. ...
We sought to determine whether risk of injury differs among children on the basis of the type of disability, and whether the characteristics of injury episodes differ by disability status.
We used nationally representative data from the 1997-2005 National Health Interview Survey to compare medically attended injuries among children aged 0 to 17 years who had and did not have a disability. Characteristics of injury episodes were compared by disability status. We calculated prevalence and risk of injury by type of disability.
Children who had a single disability had a significantly higher prevalence of injury than children without a disability (3.8% vs 2.5%; P<.01). Characteristics of injury episodes did not differ significantly by disability status (P>.05). After we controlled for sociodemographic variables, we found that only children with emotional or behavioral problems had a significantly higher risk of injury compared with children without a disability (prevalence ratio=1.50; 95% confidence interval=1.15, 1.97; P<.01).
Children with certain types of disabilities are at a significantly higher risk of injuries than are children without disabilities, but the characteristics of injuries are similar.
... Children are particularly vulnerable to injuries as their activities in their surroundings increase before they develop the skills required to identify and respond to potential risks [27]. The reasons why children with disabilities have a higher risk of injury include deficiencies in motor skills, impaired causal reasoning, impaired mental processing, physical limitations, behavioral or emotional impairments, compromised adaptability, and potential adverse effects of medication used to treat their condition [8,[28][29][30][31][32][33]. ...
Although past studies have identified predictors related to child injuries with developmental disorders, national-level research in Asia is limited. The objective of this study was to explore the risk factors for child injuries with developmental disorders in Taiwan using a national-level integrated database for the period between 2004–2015 (The Maternal and Child Health Database, National Health Insurance Research Database, Census Registry, and Indigenous Household Registration). Children younger than 12 years old who had records of visiting the ER or being hospitalized due to injury or without injury were included in this study. A 1:1 nested case-control study (injury vs. noninjury) to examine the risk factors for child injury with developmental disorder was performed. A total of 2,167,930 children were enrolled. The risk factors were associated with repeated ER visits or hospitalization: being indigenous (adjusted odds ratio [AOR]: 1.51; CI: 1.45–1.57); having a developmental disorder (AOR: 1.74; CI: 1.70–1.78); and having parents with illicit drug use (AOR: 1.48; CI: 1.32–1.66), alcohol abuse (AOR: 1.21; CI: 1.07–1.37), or a history of mental illness (AOR: 1.43; CI: 1.41–1.46). Being indigenous, having developmental disorders, and having parents with history of illicit drug use, alcohol abuse, or mental illness were predictors related to injuries in children.
... This point underlines the importance of always using validated tools in clinical practice also for fall risk assessment. In children with intellectual disabilities, falls are a frequent event and lead to a further worsening of their clinical picture, with repercussions on their quality of life (15)(16)(17); however, to date there is no detailed information on this phenomenon with regard to children with severe disabilities. The 14 falls observed during our study period confirm the frequency and therefore the importance of this event, moreover in this context. ...
Introduction:
It is known in the literature that the main cause of physical impairment in children with severe disabilities is falling, which can worsen their already compromised condition. There are no specific scales for this population in the literature, neither in Italian nor in other languages. We created and validated a scale for assessing the risk of falling in children with severe disabilities.
Study design:
Observational prospective study.
Methods:
We enrolled children (inpatients or day-hospital) admitted to the "Santa Maria Bambina Centre" of the "Fondazione Onlus Sacra Famiglia" in Cesano Boscone, Milan; the Content Validity Index of the Scale was calculated to assess the content validity of a new scale (ALICE). Cronbach's alpha coefficient (α) was used to examine internal consistency, Spearman's rho coefficient to test inter-rater reliability. Sensitivity, specificity, positive and negative predictive values were calculated.
Results:
Out of 48 patients enrolled, 14 fell (29.2%). The ALICE scale, with cut-off set at 16, showed a sensitivity of 100%, a specificity of 88.2%, a positive predictive value of 77.8% and a negative predictive value of 100%. The Content Validity Index of the Scale (=0.93), inter-rater reliability (rho=0.91, p<0.001) and Cronbach's alpha (=0.72) were satisfactory.
Conclusions:
The ALICE scale seems reliable and valid in the disabled population and can be applied by nurses. Further studies with larger samples and a multicentre design are needed.
... Crianças, adolescentes e jovens com deficiência apresentam maiores riscos para acidentes em ambiente escolar do que seus pares (10,(29)(30) . Quando se trata de queda com TCE, esse risco também é maior entre as crianças com deficiência múltipla e física, se comparado com crianças com deficiência cognitiva (31) . ...
Objectives:
Analyze the effect of first aid training on the knowledge of multidisciplinary teams from special education schools, in school accidents.
Methods:
A quasi-experimental, before-and-after study with a single comparison group. Descriptive statistics and McNemar’s test were used to evaluate the effect of the intervention.
Results:
This study had the participation of 162 higher education professionals, predominantly teachers (82.1%), female (97.5%), aged over 40 (69.2%). An increase in correct answers was observed, with statistical significance (≤0.05), especially in proper handling in case of fall with traumatic brain injury, electric shock, and burn due to hot liquid (98.1%, 98.1% and 96.9% of proper response, respectively).
Conclusions:
First aid training for child accidents, through content exhibition, in a dialogical and practical way, proved to be efficient for multidisciplinary teams from special education schools for people with disabilities.
... Evidencia-se a importância de divulgar o conhecimento pois, quando uma criança cai de nível alto, é fundamental que ela não seja movida, considerando a possibilidade de lesão da coluna, e o eixo cabeça-pescoço-corpo deve ser mantido (23) . Acresce que crianças e adolescentes com alguma deficiência apresentam maior risco para TCE do que seus pares, principalmente quanto a criança apresenta paralisia cerebral, deficiência cognitiva ou deficiência múltipla (24) . ...
Objective:
to analyze the effect of an educational activity on first aid in school accidents.
Methodology:
a quasi-experimental, before-and-after type study, carried out with the technical staff of special schools for children with disabilities, in the state of Mato Grosso, between February and August 2017. McNemar’s non-parametric test was performed to analyze the effect of the educational activity.
Results:
76 mid-level professionals participated, 62 (81.6%) of whom were female and 66 (86.8%) Child Development Assistants. Of the professionals, 35 (46.1%) had never participated in training or an educational activity related to first aid. There was a significant increase in correct response to all the questions after the training (p <.05).
Conclusion:
the professionals of the technical staff presented insufficient prior knowledge regarding first aid and the training improved the safety of the students and contributed to the society in which they are included. The importance of the integration of nurses in the school environment was evidenced.
... We found that the pooled ORs of injury were 1.28, 1.75, and 1.86 in 0-4, 5-9, and ≥10-year-old age subgroups, respectively. Some researchers have reported that among children with disabilities, occurrence of injuries decreased with increasing age (Limbos et al. 2004;Ramirez et al. 2004), but these studies were focused on injuries in the school environment. However, our results are consistent with the study of Petridou and colleagues, who found that the injury OR for children with disabilities increased with increasing age (Petridou et al. 2003). ...
Children with disabilities are thought to have an increased risk of unintentional injuries, but quantitative syntheses of findings from previous studies have not been done. We conducted a systematic review and meta-analysis to assess whether pre-existing disability can increase the risk of unintentional injuries among children when they are compared to children without disability. We searched 13 electronic databases to identify original research published between 1 January 1990 and 28 February 2013. We included those studies that reported on unintentional injuries among children with pre-existing disabilities compared with children without disabilities. We conducted quality assessments and then calculated pooled odds ratios of injury using random-effects models. Fifteen eligible studies were included from 24,898 references initially identified, and there was a total sample of 83,286 children with disabilities drawn from the eligible studies. When compared with children without disabilities, the pooled OR of injury was 1.86 (95 % CI 1.65–2.10) in children with disabilities. The pooled ORs of injury were 1.28, 1.75, and 1.86 in the 0–4 years, 5–9 years, and ≥10 years of age subgroups, respectively. Compared with children without disabilities, the pooled OR was 1.75 (95 % CI 1.26–2.43) among those with International Classification of Functioning (ICF) limitations. When disability was defined as physical disabilities, the pooled OR was 2.39 (95 % CI 1.43–4.00), and among those with cognitive disabilities, the pooled OR was 1.77 (95 % CI 1.49–2.11). There was significant heterogeneity in the included studies. Compared with peers without disabilities, children with disabilities are at a significantly higher risk of injury. Teens with disabilities may be an important subgroup for future injury prevention efforts. More data are needed from low- and middle-income countries.
... For example, previous studies have demonstrated that disabled students can have high risks of injury in the classroom despite their limited exposure to physical activities and on the playing field. 29 Despite these limitations, the increased odds of injury reported by adolescents with disabling conditions in this study has parallels in other populations. 5-10 30-32 Research overseas has documented increased risk particularly relating to falls, 5 10 burns, 6 motor vehicles 7 and assaults. ...
Objective:
This study investigates the associations between living with a disabling condition and experiencing clinically attended injuries, risk behaviours and difficulties accessing healthcare for injury among adolescents attending secondary (high) schools in New Zealand.
Methods:
A nationally representative cross-sectional self-report survey conducted in 2012 captured health and well-being data from 8500 secondary school students using a multimedia computer-assisted interview. Respondents reporting a disability or a long-term condition with functional limitations were defined as adolescents with a disabling condition (index group of interest). The association between experience of disability (or not) and injuries, related risk factors and access to healthcare was investigated using logistic regression models.
Results:
One in six students (n=1268, 14.9%) reported a disabling condition. Compared with their peers, these students had significantly increased odds of needing treatment in the previous 12 months for an injury related to an RTC (OR 1.53; 95% CI 1.11 to 2.10), fall (OR 1.30; 95% CI 1.08 to 1.57), near drowning (OR 2.50; 95% CI 1.40 to 4.48), assault (OR 2.13; 95% CI 1.50 to 3.02) and self-harm (OR 4.25; 95% CI 3.03 to 5.96). Students with disabilities were also at increased odds of reporting they had problems accessing healthcare for injury (OR 1.51; 95% CI 1.27 to 1.81). Adolescents with disability were more likely than their peers to have been a passenger in a vehicle where the driver was under the influence of drugs (OR 1.29; 95% CI 1.03 to 1.62) or was driving dangerously (OR 1.40; 95% CI 1.21 to 1.62).
Conclusions:
Acknowledging the likely underestimation of effects in a mainstream school survey, adolescents with disability face elevated odds of injury and yet have poorer access to healthcare. Environmental and systemic causes of these disparities require greater attention with implementation of effective interventions.
... Many studies investigated injuries among children with disabilities and reported that children with disabilities have an increased risk for injuries compared with children without disabilities [9][10][11][12]. Evidences indicated that this risk might be due to characteristics in children that result from their disabilities, such as physical limitations, cognitive impairments, anti-social behavior, or inability to adapt to the environment [13][14][15][16][17]. Family and environmental factors is another proposed explanations for childhood injuries [18][19][20]. ...
Objectives
We compared the patterns of medically attended injuries between children with and without disabilities and explored the residential environment risks in five counties of Hubei Province in the People's Republic of China by a 1:1 matched case-control study based on the biopsychosocial model of the International Classification of Functioning, Disability and Health--ICF.Methods1201 children aged 1-14 with disabilities and 1201 their healthy counterparts matched as having the same gender, same age, and lived in the same neighborhood were recruited in our study. Characteristics of injuries in the past 12 months were compared between children with and without disabilities. The associations among disability status, home environment factors and injuries were examined in logistic regression analysis taking into account sociodemographic factors.ResultsChildren with disabilities had a significantly higher prevalence of injury than children without disabilities (10.2% vs. 4.4%; P
... Age OR range: 1.1e1.2 Gender OR: 1.2 Limbos, 2004 [10] Retrospective review of 1994e1997 Pupil Accident Reports from 17 special education schools in Los Angeles; n ¼ 6769 children 3e23 years old Annual evaluation for special education services using California Department of Education definitions; Reference group: students with emotional/mental disabilities Head injury was reported by the school staff in the Pupil Accident Reports; Intent was not assigned ...
We reviewed publications about nonfatal injuries among individuals with existing disabilities.
We identified original research articles reporting nonfatal injuries among individuals with disabilities by using three approaches: Search the PUBMED and MEDLINE electronic databases; scrutiny of the reference sections of identified publications; search of our own files. Studies that reported odds ratios or rate ratios of injuries for the disability variable and demographic variables of age, gender, race, and school education were included.
A significantly greater risk of injuries was found among individuals with disabilities compared with their peers. Findings were consistent among studies in children, adults, and workers with disabilities. This association did not seem to be explained by physical environmental hazards alone or study bias. We found no original study that developed and evaluated injury prevention programs targeting individuals with disabilities.
Disability status should be considered as an important covariate in injury epidemiologic research, particularly in injury research among older populations and in children with special care needs. Future research is needed to develop and to evaluate multidisciplinary interventions to prevent injuries among individuals with disabilities.
... Head injuries account for a large portion of school related injuries (Di Scala, Gallagher, & Schneps, 1997). Children with preexisting disabilities are at increased risk of head injury (Limbos, Ramirez, Park, Peek-Asa, & Kraus, 2004;Max et al., 2004), while those with specifi c preexisting learning disabilities are more susceptible to the effects of a TBI (Collins et al., 1999) TBI in children is related to defi cits in cognitive functioning, personality (Max et al., 2004), and emotional processing. For example, TBI affects immediate and short-term memory (Catroppa & Anderson, 2002), working memory (Levin et al., 2004;Roncadin, Guger, Archibald, Barnes, & Dennis, 2004), and attention (Catroppa & Anderson, 1999;Goldacre, Abisgold, Yeates, & Seagroatt, 2006). ...
This chapter has two goals: to provide the reader with a
general awareness of traumatic brain injury (TBI), mild
in particular, and the multiple complex issues involved
in this area, and to offer a detailed understanding of the
role of quantitative electroencephalography (qEEG) in
the assessment and treatment of the cognitive defi cits of
the TBI patient. Sections I–IV address the fi rst goal. Section
I discusses defi nitions, sports, vulnerable groups,
the concept of spontaneous cure, and roles of loss of
consciousness and post-traumatic amnesia criteria. Section
II addresses the biomechanics of a TBI. Section III
discusses the physical damage to the brain caused by
the TBI as measured by modern medical imaging. Section
IV reviews the neuropsychological and emotional
results of a TBI that may be clinically manifested in a
patient.
The second goal is addressed in section V, which
discusses the scientifi c basics of qEEG technology, development
of the technology over the past two decades,
and its application in the assessment of the TBI patient.
The coordinated allocation of resources (CAR) model
of brain functioning, which employs a cognitive challenge
or activation method, is discussed in the context
of how a TBI specifi cally affects brain and cognitive
functioning. An example of the differences between the
normative and the TBI response patterns are presented
in detail for the cognitive task of auditory memory. We
review the results of rehabilitation efforts employing
the CAR model, which have proved to be dramatically
superior to the minimal
... Evidence indicates that children with developmental disabilities or chronic medical conditions are at a higher risk for injury or accident than are children without these conditions (Xiang, Stallones, Chen, Hostetler, & Kelleher, 2005). It has been suggested that this risk could be due to characteristics in the children that result from their disabilities, such as impaired motor control, cognitive impairments, or antisocial behavior (Leland, Garrard, & Smith, 1994;Limbos, Ramirez, Park, Peek-Asa, & Kraus, 2004;Rowe et al., 2004;Sherrard, Tonge, & Ozanne-Smith, 2001;Slayter et al., 2006). Family factors, such as poor parental supervision, are another proposed explanation for childhood injuries (Bennett Murphy, 2001;Schwebel, Hodgens, & Sterling, 2006;Soubhi et al., 2004). ...
The objective of this study was to examine injury risk in children with autism, ADD/ADHD, learning disability, psychopathology, or other medical conditions. Children aged 3-5 years who participated in the National Survey of Children's Health were included. Six study groups were analyzed in this report: autism (n=82), ADD/ADHD (n=191), learning disability (n=307), psychopathology (n=210), other medical conditions (n=1802), and unaffected controls (n=13,398). The weighted prevalence of injury in each group was 24.2% (autism), 26.5% (ADD/ADHD), 9.3% (learning disability), 20.5% (psychopathology), 14.6% (other medical conditions), and 11.9% (unaffected controls). Compared to unaffected controls, the risk of injury was 2.15 (95% confidence interval (CI): 1.00-4.60), 2.74 (95% CI: 1.63-4.59), 2.06 (95% CI: 1.24-3.42), and 1.26 (95% CI: 1.00-1.58) in children with autism, ADD/ADHD, psychopathology, and other medical conditions, respectively, after adjusting for child sex, child age, number of children in the household, child race, and family poverty level. Children with autism, ADD/ADHD, and other psychopathology were about 2-3 times more likely to experience an injury that needs medical attention than unaffected controls. Future studies need to clarify the extent to which injuries in young children with autism, ADD/ADHD, and psychopathology are related to core symptoms, comorbid conditions, associated behaviors, or unintentional injuries due to lack of additional supervision from caregivers.
Amaç: Bu araştırma, özel eğitim kurumlarında engeli olan çocuklarla çalışan personelin ilk yardım bilgi düzeyleri ile bilgi düzeylerini etkileyen faktörleri belirlemek amacıyla tanımlayıcı olarak yapılmıştır. Yöntem: Bu araştırma, Türkiye’nin doğusunda bir ilde özel eğitim ve rehabilitasyon merkezlerinde çalışan 145 personel ile yapılmıştır. Verilerin toplanmasında bilgi formu ve Temel İlk Yardım Uygulamaları Anketi kullanılmıştır. Verilerin analizinde tanımlayıcı istatitikler, Mann Whitney U ve Kruskal Wallis testleri kullanılmıştır. Bulgular: Araştırmaya katılan personelin yaş ortalamasının 29.41±7.08 yıl, %66.2’sinin kadın ve %84.1’inin lisans mezunu olduğu belirlenmiştir. Personelin kurumdaki görev süresinin 4.19±3.85 yıl olduğu ve %66.2’sinin öğretmen olarak çalıştığı bulunmuştur. Katılımcıların %62.1’inin ilk yardım bilgisini orta düzey olarak değerlendirdiği ve Temel İlk Yardım Uygulamaları Anketi puan ortalamasının 14.22±2.66 puan ile ortalamanın üzerinde olduğu belirlenmiştir. Sonuç ve Öneriler: Araştırmada kurumda çalışan personelin Temel İlk Yardım Uygulamaları Anketi puanının ortalamanın üstünde olduğu belirlenmiştir. Eğitim alan ve ilk yardım eğitim düzeyini iyi olarak değerlendiren personelin puan ortalamasının daha yüksek olduğu belirlenmiştir. Özel eğitim kurumlarında çalışan personele düzenli, güncel ve nitelikli eğitim programlarının uygulanması ile bir çocuğun hayatının kurtarılabileceği veya ömür boyu sürebilecek sakatlıkların önüne geçilebileceği düşünülmektedir.
Purpose: To determine the effect of the Home Safety Education Program given to mothers with children with intellectual disability on their attitudes towards safety measures. Methods: This study, in a single group semi-experimental design, was carried out in a Special Education Application Center in 2020 (n= 29 mothers). The Scale for Mother’s Identification of Safety Measures against Home Accidents was used as data collection tool in the study. The Home Safety Education Program, consisting of 3 sessions for 2 weeks, was applied to the participants for home accidents. Descriptive statistics and Wilcoxon signed rank test were used to analyze the data. Results: Sixty-five percent of children with intellectual disability have had a home accident in the last year. The most common type of home accident is falling with 51.7%. A statistically significant difference was observed between the pre-education and post-education attitude scores regarding safety measures for home accidents of the mothers (Z= 4.704, p<0.001). Conclusion: The study shows that mothers with children with intellectual disability can learn the necessary information and gain a positive attitude to keep their children safe in the home environment.
Amaç: Zihinsel yetersizliği olan ve olmayan 3-6 yaş çocuklarda yaralanma riski ve sıklığı karşılaştırmak amacıyla yapılmıştır. Yöntem: İzmir ilinde bulunan bir anaokulu ve on iki Özel Eğitim ve Rehabilitasyon Merkezi’nde eğitim gören 3-6 yaş grubu çocukların anneleriyle yürütüldü. [zihinsel yetersizliği olan (n=100) ve zihinsel yetersizliği olmayan (n=100)] Veriler; Çocuk ve Aile Bilgi Formu, Yaralanma Davranışı Risk Kontrol Listesi ve Çocuklarda Yaralanma Sıklığı Anketi kullanılarak toplanıldı. Bulgular: Zihinsel yetersizliği olan çocukların yaralanma riskinin, zihinsel yetersizliği olmayan çocuklara göre 0.9 kat daha fazla olduğu saptanmıştır (p=0.003). Zihinsel yetersizliği olan çocukların son iki aydaki yaralanma sıklığı, zihinsel yetersizliği olmayan çocuklara göre daha fazladır. Sonuç ve Önerileri: Zihinsel yetersizliği olan çocukların yaralanma konusunda zihinsel yetersizliği olmayan çocuklara göre daha riskli bir grup olduğu ve daha fazla yaralandıkları görülmüştür. Bu çocukların annelerine; çocuklarının gelişim özellikleri, yaralanmalar, ilk yardım, evde bakım ve izlem hakkında eğitim verilerek, danışmanlık yapılmalıdır.
The purpose of the study is to determine the injury risk behaviors and home safety measures in children with an intellectual disability or autism spectrum disorder.
The study sample included mothers of 100 children between the ages of 2 and 12 years.
There was a significant difference between the home safety measures and the children's ages, the birth order of the children, and the mother's and father's ages. There was not a significant relationship between the children's ages, diagnosis, and Injury Behavior Checklist (IBC). There is a positive correlation between the total score of the Home Safety Measures Control List and IBC.
© 2015 NANDA International, Inc.
To systematically review studies measuring the influence of pre-existing disability on the risk of sustaining an injury.
Systematic review.
Electronic databases searched included Medline (Pubmed), ProQuest, Ovid and EMBASE.
Studies (1990-2010) in international peer-reviewed journals were identified with main inclusion criteria being that the study assessed involvement of injury sustained by persons with and without pre-existing disability.
Studies were collated by design and methods, and evaluation of results.
Twenty-two studies met the inclusion criteria of our review. All studies found that persons with disabilities were at a significantly higher risk of sustaining injuries than those without. Persons with disability had a 30-450% increased odds (odds ratio 1.3-5.5) of sustaining injury compared to persons without disability. Among persons with pre-existing disability, the high risk groups of sustaining an injury are children and elderly.
People with disabilities experience a higher risk to sustain an injury in comparison to the healthy population. There is a high need for large epidemiological studies of injury among persons with disability, to better address these unique risk profiles in order to prevent additional disability or secondary conditions.
The purpose of this chapter is to review selected psychosocial and sport medicine research on youth disability sport. I first focus on the physiological health benefits of sport participation as well as the prevalence and types of injuries. Physiologically, sport participants increase their functional abilities via enhanced cardiovascular fitness as well as muscular strength and endurance gains. Also, the energy demands of sport can help offset caloric imbalances that contribute to overweight and obesity among youth with disabilities. However, sport doesn't simply convey benefits and no risks. The risk of physical injury (e.g., overuse injuries to the shoulders of wheelchair basketball players) is often thought to be greater relative to individuals without disabilities. Lastly, I examine the psychological effects of sport participation. For instance, youth with disabilities are thought to experience enhanced self-perceptions (e.g., confidence) via sport experiences (e.g., mastery experiences). Sport is also a vehicle to develop friendships, increase social support, and reduce loneliness. However, sport is also a setting where children with disabilities may experience psychological harm as the result of exclusion and teasing from able bodied youth in sport. In summary, sport participation can lead to physical and mental health benefits and as well as some deleterious physical and emotional outcomes.
The aim of this study was to compare rates, nature, and mechanisms of school injuries in children with and without disabilities.
We conducted a retrospective cohort study with repeated measures of 269 919 children with and without disabilities who were enrolled in 35 adapted schools from a large urban school district. Reports of injuries sustained from 1994 to 1998 were collected by the district's insurance division, and disability was assessed using special education guidelines determined by the California Department of Education. A generalized estimating equations model was used to estimate rate ratios, accounting for the repeated, nested nature of the data.
Children with disabilities had more than double the rate of injury reported than children without disabilities (incidence density ratio [IDR] 2.3, 95% CI, 2.2-2.5). Almost one third of these injuries were due to fights, roughhousing, and assaults. Among all disabled children, those with orthopedic disabilities had the highest risk, with rates over 5 times that of children without disabilities (IDR 5.4, 95% CI, 4.4-6.6). Children with cognitive disabilities had comparatively lower rates of injury than children with physical disabilities.
For children with disabilities, physical impairment may play a greater role than cognitive impairment in managing risk for injury at school. Individual education programs (IEP), developed for children in special education, could be tailored to include injury prevention strategies.
Physical activity in sports comes with an inherent risk for injury. For children with disabilities, their injury risk may be complicated by preexisting disability. However, very little research exists on sports injuries to young athletes with disabilities. To best manage potential injuries to children with disabilities, data on sports injury patterns are needed. The purpose of this study was to measure the frequency of and risk factors for injury to high school athletes with disabilities.
A total of 210 athletes from 8 special education high schools that are part of an interscholastic sports league participated in the study. Seven of the 8 schools were followed for 1 season each of basketball, softball, soccer, and field hockey, and 1 school enrolled only during field hockey. Data were collected from coaches on daily exposure sessions (game, practice, and conditioning, as well as length of session), athlete characteristics (disability, gender, age, seizure history, and behavioral problems), and nature of injuries resulting in any type of medical treatment.
Thirty-eight injuries were reported among 512 special athletes for a rate of 2.0 per 1000 athlete exposures. Soccer (3.7 per 1000) had the highest rate of injury. More than half of the injuries were abrasions and contusions. Those at highest risk for injury were athletes with autism, athletes with histories of seizures, and starters. Athletes with autism had approximately 5 times the injury rate of athletes with mental disabilities. Athletes with seizures had >2.5 times the rate of injury reported among those with no seizure history.
This adapted sports program is a reasonably safe activity for children with disabilities. Nonetheless, findings have important implications for prevention. The preparticipation medical examination may be an excellent opportunity to create special guidelines, particularly for athletes with autism and seizure history.
Trisomy 21 (Down syndrome) is a common condition encountered by the pediatric surgeon. The surgical anomalies associated with Down syndrome now have treatment options that were previously considered futile. An effective surgical team approach to these children involves knowledge of the unique pathophysiology of trisomy 21 and an appreciation for the desires of the family and the needs of the child.
Surgical techniques benefit children with Down syndrome equally as typical children. Pessimism regarding the outcome of surgical treatment of colorectal anomalies is fading, with evidence of nearly equivalent outcomes. Several autoimmune disorders impact children with Down syndrome. Idiosyncratic susceptibility to infections and malignancy is noted. Unique anesthetic complications and aerodigestive tract disorders have been identified. Many anomalies have surgical options that enhance the quality of life.
There is optimism in the surgical treatment of children with Down syndrome. Improved operations, better anesthetic management and recognition of problems specific to the child with trisomy 21 make it safer and ethical to offer surgical solutions. Societal acceptance and mainstream participation are on the rise. The astute, compassionate pediatric surgeon does much to enhance the quality of life of these children and of the families who love them.
This study assessed the role of certain individual characteristics in school injury among male and female adolescents. The sample included 2,398 subjects attending middle schools and high schools. Respondents completed a self-administered questionnaire at the beginning of the school year. School nurse completed a questionnaire on injury for each school injury occurred during the school year. The data was analyzed with the adjusted odds ratios (ORa) computed via the logistic models. The school injury was common (13% for both sexes). Sports/physical training injury was more frequent among girls (8.8% vs. 6.6%, P < 0.05) contrarily to the other types of injury (4.6% vs. 8.8%, P = 0.001). Sports/physical training injury was strongly associated with age <15 years (ORa 3.42) and presence of previous injury (2.63) among boys, and with age <15 years (2.02), presence of previous injury (2.94), not easily irritated (1.89), and irresponsible (1.59) among girls. The other types of injury were highly related to age <15 years (ORa 4.18), frequent use of psychotropic drugs (1.76), not living with both parents (1.65), being not calm (2.03), and presence of previous injury (1.82) among boys, and to age <15 years (2.59), obesity (3.24), and being not calm (1.84) among girls. The present study identified a number of potential risk factors for school injury among male and female adolescents. Preventive measures should be taken to make adolescents, their parents and teachers more aware of the risks and to find remedial measures.
Students with disabilities are at risk for poor health outcomes; however, the causes and consequences of injury in this group are not well understood. The epidemiologies of injuries among students with and without disabilities were profiled and compared.
The cross-sectional, 2002 Health Behaviour in School-aged Children Survey, was administered to a representative sample of 7235 students (grades 6-10) from Canada. Students who reported at least one functional difficulty due to a health condition were classified as having a disability. Primary outcomes were: (i) Medically attended injury; (ii) multiple injuries, and (iii) serious injury experiences during a 12-month period.
Some 16.3% of students reported a disability. Injuries were more common in students with disabilities compared to those without disabilities (67% vs. 51% annually, p < 0.01). Students with disabilities experienced 30% increases in the risk for medically attended injury, multiple injury, and serious injury as compared to their peers. Consistent and statistically significant associations (p < 0.05) were identified between different types of disability and all injury outcomes.
Canadian students who report disabilities experience higher risks for injury than their peers, perhaps due to an inability to perceive and avoid environmental hazards. Injury prevention programmes are needed to address these unique risk profiles in order to prevent additional disability or secondary conditions.
The incidence of casualties in an institution for mentally retarded children is shown to be about three times as great as in the normal Danish child population. The circumstances concerned are analysed by means of a retrospective investigation to elucidate the mechanisms involved and the contributory factors. The investigation reveals that there is a definite relationship between the degree of mental handicap and the underlying disease (e.g. epilepsy and/or cerebral paresis, mon-golism etc.) and the incidence of casualties. Other types of incapacity such as motor handicap, anaesthesia, defective sight or hearing and other physical disease (e.g. hydrocephalus) may predispose to accidents. Some children are undoubtedly more accident-prone than others and the cause may be found in their disease (most frequently epilepsy) while, in others, purposeless motor activity and the inability to learn from experience combined with severe or profound mental retardation appear to be responsible. Phases of accident-proneness may be associated with the acquiring of new skills.
Some prophylactic measures are suggested which should be considered when new institutions are planned.
A broad spectrum of somatic, developmental, handicap, environmental, emotional and mental factors interplay in the production of accidents in mentally retarded patients. Attempts should be made to analyse the mechanism of every accident so that appropriate prophylactic measures can be undertaken.
To present an epidemiologic profile of children with special health care needs using a new definition of the population developed by the federal Maternal and Child Health Bureau.
We operationalized the new definition using the recently released 1994 National Health Interview Survey on Disability. Estimates are based on 30 032 completed interviews for children <18 years old. The overall response rate was 87%.
Eighteen percent of US children <18 years old in 1994, or 12.6 million children nationally, had a chronic physical, developmental, behavioral, or emotional condition and required health and related services of a type or amount beyond that required by children generally. This estimate includes children with existing special health care needs but excludes the at-risk population. Prevalence was higher for older children, boys, African-Americans, and children from low-income and single-parent households. Children with existing special health care needs had three times as many bed days and school absence days as other children. An estimated 11% of children with existing special health care needs were uninsured, 6% were without a usual source of health care, 18% were reported as dissatisfied with one or more aspects of care received at their usual source of care, and 13% had one or more unmet health needs in the past year.
A substantial minority of US children were identified as having an existing special health care need using national survey data. Children with existing special health care needs are disproportionately poor and socially disadvantaged. Moreover, many of these children face significant barriers to health care.