Multiple Disabilities --
a disability category in IDEA
Multiple Disabilities

Characteristics and Background Information:
Children with multiple disabilities will have a combination of various disabilities that may include:
speech, physical mobility, learning, intellectual disability, visual, hearing, brain injury and possibly
others. Along with
multiple disabilities, they can also exhibit sensory losses and behavior and or
social problems. Children with
multiple disabilities - also referred to as multiple exceptionalities --
will vary in severity and characteristics. These students may exhibit weakness in auditory processing and have
speech limitations. Physical mobility will often be an area of need. These students may have difficulty attaining
and remembering skills and or transferring these skills from one situation to another. Support is usually needed
beyond the confines of the classroom. There are often medical implications with some of the more severe
multiple disabilities which could include students with cerebral palsy and severe autism and brain injuries.
There are many educational implications for these students.

A cross-classification of disabilities that involves significant physical, sensory, intellectual, and/or social-interpersonal
performance differences. The need for extensive services and supports is evident in all environmental settings.

Concomitant impairments (such as intellectual disability-blindness or intellectual disability-orthopedic impairment), the
combination of which causes such severe educational needs that they cannot be accommodated in special education
programs solely for one of the impairments.
Multiple disabilities does not include deaf-blindness.

Cerebral Palsy (CP)

“Cerebral” means brain. “Palsy” means a disorder of movement. CP refers to a group of non-progressive neuromuscular problems of varying severity.

CP is caused by damage to the brain, primarily to the part of the brain that controls motor functions. However other parts of
the brain may also be affected. In such cases the person affected has more than one disability.

The extent of the damage varies from person to person. Mild disability might mean fine motor skills, like using scissors or
writing, are difficult. Severe disability can mean poor movement of all four limbs, the trunk and neck. The child may even
have difficulty in swallowing.


   ~Cerebral Palsy means damage to the brain.
   ~Early diagnosis has the benefit of early intervention strategies.
   ~Medications and surgery cannot cure this condition.
   ~A youngster with
cerebral palsy  generally has more than one disability.
Cerebral palsy is not hereditary.
Cerebral palsy is not contagious.
Cerebral palsy is not progressive.

There are three major types of cerebral palsy, and some individuals may have symptoms of
more than one type.

Spastic cerebral palsy. About 70 to 80 percent of affected individuals have spastic cerebral palsy, in which muscles are
stiff, making movement difficult. When both legs are affected
(spastic diplegia), a child may have difficulty walking because
tight muscles in the hips and legs cause legs to turn inward and cross at the knees (called
scissoring). In other cases, only
one side of the body is affected
(spastic hemiplegia), often with the arm more severely affected than the leg. Most severe
spastic quadriplegia, in which all four limbs and the trunk are affected, often along with the muscles controlling the mouth
and tongue. Children with
spastic quadriplegia often have intellectual disability and other problems.

Athetoid or dyskinetic cerebral palsy. About 10 to 20 percent of affected individuals have the athetoid form, which affects
the entire body. It is characterized by fluctuations in muscle tone (varying from too tight to too loose) and sometimes is
associated with uncontrolled movements (which can be slow and writhing or rapid and jerky). Children often have trouble
learning to control their bodies well enough to sit and walk. Because muscles of the face and tongue can be affected, there
also can be difficulties with sucking, swallowing and speech.

Ataxic cerebral palsy. About 5 to 10 percent of affected individuals have the ataxic form, which affects balance and
coordination. They may walk with an unsteady gait with feet far apart, and they have difficulty with motions that require precise
coordination, such as writing.

In about 70 percent of cases,
cerebral palsy results from events occurring before birth that can disrupt normal development of the
brain. Contrary to common belief, lack of oxygen reaching the fetus during labor and delivery contributes to only a small minority of
cases of
cerebral palsy.

Some of the known causes of cerebral palsy include:

Infections during pregnancy. Certain infections in the mother, including rubella (German measles),
cytomegalovirus (a usually mild viral infection) and toxoplasmosis (a usually mild parasitic
infection) can cause brain damage and result in
cerebral palsy. Recent studies suggest that
maternal infections involving the placental membranes (
may contribute to
cerebral palsy in full-term as well as preterm babies
(those born before 37 completed weeks of pregnancy). A 2003 study at the
University of California at San Francisco found that full-term babies were
four times more likely to develop
cerebral palsy if they were exposed to
chorioamnionitis in the womb. Reproductive/urinary tract infections
also may increase the risk of preterm delivery, another risk factor for
cerebral palsy.

Insufficient oxygen reaching the fetus. For example, when the placenta
is not functioning properly or it tears away from the wall of the uterus
before delivery, the fetus may not receive sufficient oxygen.

Prematurity. Premature babies who weigh less than 3 1/3 pounds are up to 30 times more likely to develop cerebral palsy than full-term babies.
Many of these tiny babies suffer from
bleeding in the brain, which can damage delicate brain tissue, or develop periventricular leukomalacia,
destruction of nerves around the fluid-filled cavities (ventricles) in the brain.

Asphyxia during labor and delivery. Until recently, it was widely believed that asphyxia (lack of oxygen) during a difficult delivery was the cause of
most cases of
cerebral palsy. The ACOG/AAP report shows that fewer than 10 percent of the type of brain injuries that can result in cerebral palsy
are caused by asphyxia.

Blood Diseases. Rh disease, an incompatibility between the blood of the mother and her fetus, can cause severe jaundice and brain damage,
resulting in
cerebral palsy.  Rh disease usually can be prevented by giving an Rh-negative woman an injection of a blood product called Rh immune
globulin around the 28th week of pregnancy and again after the birth of an Rh-positive baby. Blood clotting disorders (
thrombophilias) in either
mother or baby also may increase the risk.

Severe jaundice. Jaundice, yellowing of the skin and the whites of the eyes caused by the build-up of a pigment called bilirubin in the blood,
occasionally becomes severe. Without treatment, severe jaundice can pose a risk of permanent brain damage resulting in
athetoid cerebral palsy.

Other birth defects. Babies with brain malformations, numerous genetic diseases and other physical birth defects are at increased risk of
cerebral palsy.

Acquired cerebral palsy. About 10 percent of children with cerebral palsy acquire it after birth due to brain injuries that occur during the first two
years of life. The most common causes of such injuries are
brain infections (such as meningitis) and head injuries.

OTHER FACTORS that may influence the occurrence of cerebral palsy:

 ~parents over age 35;
 ~very young parents;        
 ~genetic disorders;
 ~malnutrition; vitamin deficiencies; amino acid intolerance;
 ~alcohol, drugs, poisons, toxins from smoking;
 ~Human Immunodeficiency Virus;
 ~syphilis, chicken pox, uterine infection;
 ~placental abnormalities; vascular blockages;
 ~neurological tissue destruction;
 ~inflammation and infection of the uterine lining;
 ~insufficient blood flow to the placenta;
 ~infections such as listeria, meningitis, streptococcus group B (bacterial), septicemia (bacteria in the

 ~hypoglycemia, hypothyroidism;
 ~respiratory distress syndrome;
 ~meningitis, encephalitis;
 ~multiple births -- twins, triplets, etc.;
 ~stroke -- hemorrhagic or embolic stroke;
 ~trauma -- abuse, accidents.
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