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The following materials are published and used by CDA as outlines for conducting continued education clinics.

Developmental and Cognitive Disabilities, An Outline

December 2003
Mental Retardation, Down's Syndrome, Autism, Asperger, Epilepsy.

GENERAL INFORMATION

By definition, a developmental disability is a condition resulting from congenial abnormalities, trauma, disease, or deprivation that interrupts or delays normal fetal, infantile, or juvenile growth and development. The onset is before age 18, and duration is indefinite. Some of the more common conditions include mental retardation, cerebral palsy, autism, epilepsy, and Down's syndrome.

A cognitive disability consists of damage to, or deterioration of, any portion of the brain that affects the ability to process information, coordinate and control the body, or move in space. Cognitive disabilities are classified as either organic (related to diseases such as Alzheimer's, Parkinson's, Huntington's, brain tumors, cerebrovascular disease) or non-organic (cause by injury or trauma, such as traumatic brain injury).

Mental Retardation

Mental retardation (MR) refers to subnormal intellectual ability present from birth or early infancy, manifested by abnormal development and associated with difficulties in learning and social adaptation. This disability constitutes the largest percentage of all people with developmental disabilities. More than 250 specific causes have been identified and grouped into two main categories: medical (hereditary, prenatal, trauma to mother/infant) and social (lack of mental stimulation, physical abuse, poverty).

A classification system has been developed to describe MR based on the person's mental ability (IQ), social behavior (social quotient), and rate of infantile physical development. The four levels and their relative percentage of MR individuals are:

  • Mild - IQ between 51 and 70; capable of learning academic and prevocational skills with some special training.
  • Moderate - IQ between 36 and 50; capable of learning academic skills during school age and can be independent in familiar surroundings. Can perform semi-skilled work and function in community homes as adults.
  • Severe - IQ between 21 and 35; physical disabilities such as visual deficiencies or motor dysfunction are common. May have limited communication skills but are able to care for personal needs.
  • Profound - IQ of 20 or less; show minimal responsiveness and may have physical disabilities. Self-care skills and communication may be somewhat limited.
Down's Syndrome

Down's syndrome is the result of having three of chromosome 21, instead of the usual two of each chromosome. Down's syndrome causes mild to severe retardation in 100 percent of the cases. It occurs in one of every 660 newborns, making it one of the most common malformation in human embryos that survive to birth.

Common characteristics include a flat face, a short neck, oval eyes, hypotonia (flaccid musculature), hypoplasia of the midphalanx of the fifth finger (a short middle bone in the middle bone in the little finger), a wide gap between the first and second toes, heart defects in 30 to 50 percent of cases, gastrointestinal defects in 10 percent of cases, and cervical instability due to poor development at C1 and C2.

Autism

A very short definition: uneven developmental patterns in the acquisition of motor, sensory, social, play or learning skills.

Autism is a life-long disability that becomes evident sometime during the first three years of a child's life. Autism is a neurologically based disorder; it affects the way a child communicates, interacts with other people and perceives and reacts to the world.

Patterns of behavior that are characteristic of autism include impairment of reciprocal social interactions, impaired communication skills, repetitive behaviors and a restricted range of interests. Not all children with autism behave in the same way. Each child might display a different combination of behaviors ranging from mild to severe. This is what is meant by Autism Spectrum Disorder (ASD). Five sub-categories of ASD have been defined: Autistic Disorder, Pervasive Developmental Disorder (PDD), Asperger's Syndrome (AS), Rett's Syndrome, and Childhood Disintegrative Disorder.

Characteristics of Autism

A child with autism may exhibit one or more of the following characteristics:
  • Various levels of delayed communication, including impaired language acquisition and comprehension as well as other related difficulties.
  • Difficulties or differences in understanding social situations and/or relationships.
  • Responses to sensory information that are unusual, inconsistent, repetitive or unconventional.
  • Stereotypic or repetitive patterns of behavior; persistent preoccupation with or attachment to objects.
  • Difficulties in adjusting to change in routines, environments, activities and/or schedules.
  • Difficulties in abstract thinking involving awareness, judgment and generalization.
Epilepsy

Epilepsy is the result of a temporary electrochemical imbalance within the regulatory mechanism of the brain. A sudden overload of energy may swamp the brain, causing partial or complete, brief or prolonged lapses in consciousness, known as epileptic seizures. It is estimated that one in every 100 hundred people may have some form of epilepsy.

MEDICATIONS: USE OF MEDICATIONS AND POSSIBLE SIDE EFFECTS

Type Examples Uses Side Effects
Antibiotic Penicillin, Keflex, Ceclor, Cipro, tetracycline infection dizziness, drowsiness, sun sensitivity
Antispasm Flexeril, Valium, Robaxin, Soma back pain, cerebral palsy lethargy, blurred vision
Anti-inflammatory Motrin, Advil, Naprosyn, Indocin swelling, joint pain, arthritis, gout headaches, rash, convulsions
Analgestic Tylenol w/codeine, Percodan, Demorol seizures sun sensitivity, rash, blurred or double vision
Anti-Depressant Elavil, Prozac, Zoloft depression drowsiness, dizziness, blurred vision
Anti-Coagulant Coumadin, Heparin blood clot prevention hemorrhage
Anti-diabetic Insulin, Diabinese, Glucophage diabetes nausea, vomiting, hypoglycemia


EVALUATION

A medical history should contain a written evaluation of a student's abilities. Using this as a guideline, an on-site, practical assessment is completed prior to skiing or snowboarding. Appropriate equipment may then be selected.

The Cognitive Assessment

The cognitive assessment occurs throughout the evaluation process. Evaluate the following to help you develop the best lesson plan for the particular student:

Assessing Cognitive Development

Indications of arrested cognitive development include:


Questions to assist the instructor in assessing cognitive development include the following:


Assessing Physical Development

The physical assessment allows the instructor to gather specific information about the student's disability and physical condition beyond that provided in the student information form. Before conducting a physical assessment, ask questions that will help you understand your student's disability. The information gathered can guide you in selecting and teaching techniques:


As you gather more information, the student may need to do some simple exercises to help you evaluate:

In addition to these physical issues, ask about the student's prior experience with skiing, snowboarding, and other sports. Did the student ski or snowboard or participate in some other sport before becoming disabled? Prior athletes have good body awareness - an advantage when learning to ski or snowboard with adaptive equipment. If the student currently participates in another sport, you can usually draw similarities to help the student learn the snowsport.

Equipment

Use the above evaluations to choose the appropriate equipment. Equipment needs will vary with each individual.

Ski Bra Helps with lateral stability and muscle control. A metal device that clamps onto the tips of the skis to keep errant ski tips together. A variation, the trombone ski bra, is useful for maintaining the skis in a parallel position. It can slide back and forth to allow for walking and independent leg movement while skiing.
Bamboo Poles Used when guiding, the instructor holds one bamboo pole in each hand, and a student is either directly behind or in front of the instructor, holding the opposite ends of the poles at hip level. They also allow student and instructor to ski side by side.
Reins Lengths of one-inch webbing with clasps on one end. We use them from behind the student to help control speed and turns. They can be attached to a ski bra or around boot cuffs at the ankle. Reins can also be used to pull your student through the lift line or flat terrain.
"Blind Skier and "Blind Skier Guide" bibs We use these bibs while skiing or snowboarding to alert other Powderhorn guests of your student's presence on the slopes. Must be worn while on the mountain.
Two-Way Radios They eliminate the need to yell and provide you with a backup signaling system.


TEACHING INFORMATION

The teaching progression for developmental and cognitive disabilities closely follows the method set forth by the PSIA. In addition, the instructor needs to consider the student's comprehension level, sequencing abilities, and behavior to form a successful lesson plan. Instructors will also benefit from familiarity with the behavior modification techniques and teaching alternatives.

Using Fun, Games, and Props for Learning

Props can often be very helpful in establishing physical boundaries for each student.

Examples include:


Example of Communication Card


Behavior Modification

Behavior modification is the use of some system of reward or punishment to change undesirable behavior. The following examples may help when giving ski lessons:

Time-Out

A time-out is when the lesson is suspended for a prescribed amount of time. Avoid excess stimulation or any activity that may be regarded as pleasurable or rewarding. Use the time-out as a teaching aid, rather than punishment. A break in the action removes any positive reinforcement for the inappropriate behavior and gives the student a chance to change it. Remember the following time-out tips:

  • Make sure the length of time-out fits the behavior.

  • Use the time-out to shift attention from student's "manipulation" to your leadership and avoid overemphasizing the negative behavior.

  • Enforce the rules established at the start of the lesson consistently to avoid mixed messages.

  • Respond to inappropriate behavior the first time rather than putting it off and hoping it is not repeated. Consider issuing a warning that allows the student to make the correct choice: "You have a choice, John. If you hit me again, we will go inside and stop skiing. If you don't hit me, we will keep skiing."

  • Be patient when using "discipline" and do not get angry; instead, be blasé. Students may have trouble distinguishing between positive and negative comments.

  • The length of the time-out in minutes should equal the child's age.


Be firm when preventing or putting an end to inappropriate behavior. Try to use time-outs for the more aggressive or antisocial behaviors, such as hitting or talking back. For "minor" infractions, consider ignoring the behavior or redirecting it to another activity. Forget about softening the blow of a time-out. Simply tell the student when the time-out is over, and then act as if nothing unusual has happened.

Modeling Behavior

Through modeling, the instructor can guide the student toward appropriate and effective interactions on the hill. Students will tend to imitate the instructor at even the subtlest level. They duplicate not only behavior, but also attitudes; keep yours positive.

Motivators

These can range from favorite munchies (dispensed with discretion) to using a number system to count down the remaining runs until going in for a treat. Returning to a student's favorite run or lending the student a favorite article of clothing might also be used as motivators. Experiment with methods that stimulate the student and provide an incentive to continue.

Written behavior contracts

If student has a history of behavior problems, a simple, one-line contract such as "I promise to ski safely and keep my speed down on the hill" may suffice. The student and instructor sign the contract, and the instructor then keeps it handy during the lesson and shows it to a student as needed. Be sure that the student has the intellectual capacity to understand the concept of a contract.

Deep Breathing

This can be used as a relaxation technique. Have the student stop and take a deep breath or do rhythmic breathing exercises to relax the mind and muscles.

Environmental Changes

Removing the student from an over-stimulating or threatening environment can bring about behavior change or calmness. Examples of negative environmental stimuli are noisy, crowded buildings, loud snowmaking guns, or the presence of an overprotective caregiver. Simply move the student to another location.

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