Motor and Intellectual Disabilities: Types and School Intervention

Posted on Mar 13, 2025 in Naval Architecture and Marine Engineering

1. Introduction: Basic Concepts

• Deficiency/Deficit: Loss or abnormality of a structure or function (psychological, physiological, or anatomical).

Biological field; assessed by physicians.

• Disability: Restriction or absence of the ability to carry out activities expected in human beings. Psychological field; assessed by psychologists.
• Handicap: Disadvantageous situation for a person, due to a deficit or disability, that restricts the performance of an expected role.

Social field; assessed by social workers.

2. Concept of Motor Deficit

Organic (the physical structure/anatomy) or functional alterations of the osseous, articular, nervous, and/or muscular system that are long-lasting and frequently chronic, and affect posture, movement, orientation, and global and segmentary (limbs) coordination.

Other characteristics of motor deficits:

• Heterogeneous
• Congenital or acquired: peri- or post-natal
• Intelligence is preserved
• Prognosis (the future development – estimation) depends on:
  • Etiology (origin of the problem)
  • Degree of severity
  • Moment of appearance
  • Associated disabilities
  • Cognitive level
  • Treatment received

3. Classification of Motor Disorders

3.1. Cerebral Origin

3.1.1. Cerebral Palsy

• Persistent alteration of posture and movement, due to a brain dysfunction, before its growth and development has been completed.
• Etiology:
  • Prenatal (35%):
    • Retardation in embryo growth
    • Viral infections during pregnancy
    • Intoxication
    • X-Rays
    • Prematurity
  • Peri-natal (55%):
    • Anoxia (lack of oxygen)
    • Trauma (forceps)
    • Hemorrhage
  • Post-natal (10%):
    • Dehydration
    • Metabolic abnormalities
    • Brain trauma
    • Intoxication
• Types and symptoms:
  • Spastic
  • Athetoid
  • Ataxic

3.1.2. Brain Trauma

• Head traumatism that affects brain structures. Frequency due to traffic accidents.
• Consequences & symptoms:
  • Loss of consciousness; coma
  • Alterations depending on brain area damaged:
    • Frontal (Motricity and movement)
    • Parietal (Sensitivity)
    • Temporal (Hearing)
    • Occipital (Visual)
  • Right / Left hemisphere (contralateral consequences)
  • Primary area (I can’t see anything)
  • Secondary area (I can see but I don’t understand what I see because there is damage in my brain)

3.1.3. Multiple Sclerosis

• Disease caused by lesions in the white matter of the brain. Myelin covers around axons (of brain & spinal cord) damaged à demyelination à synapse deficits.

So, the myelin allows the nervous impulse to be faster. If there is white matter (myelin) damage, the communication between neurons will be slower.

• Etiology:
  • Genetics
  • Infections
• Consequences: Progressive or discrete increase of symptoms.
• Symptoms:
  • Loss of sensitivity
  • Motor disabilities (deficit in ability to control movements in the eyes)
  • Ataxia
  • Dysarthria (speech disorder caused by brain damage)
  • Fatigue and pain
  • Cognitive impairment
  • Emotional alterations

3.2. Spinal Origin

3.2.1. Spina Bifida

• Brain pathology caused by incomplete development of vertebrae in embryo. Vertebral arches do not fuse and the spinal cord is left unprotected.
• Etiology:
  • Congenital
  • Unknown: genetic and environmental factors
  • Folic acid deficit
• Types:
  • Occulta (The least severe)
    • Fissure at lumbar / sacrum level
    • No symptoms
  • Myelomeningocele (The most severe)
    • Fissure with nerve roots from the spinal cord, or even the cord itself.
    • Requires surgery to close the fissure at birth, but irreversible consequences.
• Symptoms and alterations:
  • Hydrocephalus (Cerebral Spinal Fluid accumulated à bigger head & mental retardation)
  • Hyposensitivity & paralysis
  • Malformations in lower limbs
  • Incontinence & renal infections (kidneys)
  • Intestine alterations

3.2.2. Spinal Trauma

• Partial or total lesion of the spinal cord. Consequence of accidents (traffic, work…)
• Symptoms according to the locus of the lesion:

Hemi- Tri-

Mono- Tetra- Para- plagia/paresis

• Symptoms and alterations:
  • Hydrocephalus (Cerebral Spinal Fluid accumulated à bigger head & mental retardation)
  • Hyposensitivity & paralysis
  • Malformations in lower limbs
  • Incontinence & renal infections (kidneys)
  • Intestine alterations

3.3. Muscular Origin

3.3.1. Duchenne de Boulogne’s Muscular Dystrophy

• Progressive and irreversible disease. Muscle atrophy.
• Etiology genetic: recessive gene in X chromosome à women transmit it but do not suffer it (they are carriers)
• Symptoms
  • Muscle weakness
  • Atrophy
  • Fatigue
  • Painful muscle spasms
  • Cramp
  • Hypotonicity
• Evolution:
  • Distal-proximal; ascendant
  • 1st (4-14y): weakness, fatigue à difficulties to walk
  • 2nd (14-20y): wheelchair, loss of strength and coordination; damage to vital organs à death

3.4. Osseous Origin

3.4.1. Congenital Malformations

• Congenital deformities or agenesis (there are no bones)
• Types:
  • Of the muscular-skeletal system:
    • Limbs (upper or lower):
      • Polydactyly: children who are born with more than 10 fingers.
      • Syndactyly: interdigital fusion or membrane
      • Impaired development of limbs: some limbs are not properly developed, so the function is not completely developed.
      • Lower limbs (feet): equinus, talus, varus, valgus, cavus, planus
    • Chondrodysplasia: impaired development of spinal column and bones.
  • Of the oral cavity:
    • Palatine fissure, uni/bilateral
    • Fissured lip
    • Ankyloglossia (short lingual frenum)
    • Macroglossia: bigger tongue

3.4.2. Osseous Lesions Due to Deviations of Spinal Column

• Excessive deviations of the spinal column.
• Types:
  • Hyperkyphosis (dorsal level; ventral-dorsal deviation)
  • Hyperlordosis (cervical or lumbar level ; ventral-dorsal deviation)
  • Scoliosis (lateral deviation to left or right)

4. Normal Intellectual Development

4.1. Piaget’s Stages

• Sensory motor (0 – 18/24 months)
  • Reflexes primary (only affects the child – 1 month), secondary (affects to the objects of the world – 4 months), and tertiary (the baby introduces variations in the objects – 12 months) circular reactions (the first time that the baby does an accidental movement. Later, they find it fun and they repeat it voluntarily) and object permanence* (when the adult left the object, the baby continues looking at the object)
• Concrete operations (2-11 years)
  • Pre-operatory subperiod (2-7): appearance of semiotic function (it is symbolic: something represents something. There is no relation between the significance and the meaning), internalization of action schemas into representation, magic thinking (difference between what is real and fantastic) and egocentrism (it is the idea that I have about myself)
  • Operatory (7-11): reversibility of thinking, conservation of substance*, weight, number, volume…

*Object permanence:

1^st) 8m: looks for hidden things but only in place A, not B

2^nd) 12m: looks for them in A and B

Precursor of representation because in order to think about something which is not present, we must know that it exists even we cannot see it.

*Conservation of substance, weight and volume:

*Animism: Idea that inanimate objects are alive. (Example: it rains because the clouds are crying)

*Meta-representation: thinking about your own thinking/language/memory… Derived from the ability of abstract thinking.

5. Conceptualization and Classification

• DSM:

A. Deficiency in intellectual functions, as reasoning, problem-solving, planning, abstract thinking, judgments, academic learning, and learning through experience, confirmed through clinical assessment and individualized, standardized intelligence tests.

B. Deficiencies in adaptive behavior that produce failure in the fulfillment of developmental and socio-cultural standards for personal autonomy and social responsibility. Without support, deficiencies restrict functioning in communication, social participation, and independent life, in many environments such as home, school, work, and community.

C. The onset of intellectual and adaptive deficiencies occurs during the period of development.

• Luckasson (2002):
  • Disability characterized by significant restrictions in intellectual functioning and in adaptive behavior.
  • Manifested in practical, social, and conceptual abilities.
  • Beginning before age 18.
  • Not on DSM-5, but on DSM-4
    • Mild: 55 to 70
    • Moderate: 40 to 55
    • Severe: 25 to 40
    • Deep: below 25
  • On DSM-5, qualitative categories based on functional ability.
  • They did not use IQ (intellectual quotient) anymore, they use a description of what they can do or not. But the numbers are the reference for us.

6. Etiology

6.1. Intrinsic

• Genetic alterations
  • Phenylketonuria
  • Galactosemia
• Chromosomal alterations
  • Autosomal: affected to alteration in some pairs of chromosomes (Down’s: 21)
    • Patau’s syndrome
    • Edwards’ syndrome
    • Down’s syndrome
  • Gonosomal: affected to chromosomes of the sex (X, Y). You can have the appearance of a boy but your internal organs are female.
    • Turner’s syndrome
    • Klinefelter’s syndrome

6.2. Extrinsic

• Prenatal
  • Infections
    • Rubella
    • Toxoplasmosis: the food has to be well cooked
  • Hormone alterations
    • Diabetes
  • Metabolic alterations
  • Nutritional deficit
  • Substance use
    • Smoking
    • Drug use
    • Alcohol consumption
  • Other prenatal factors
    • X-rays
• Perinatal
  • Prematurity
  • Hypoxia / anoxia: lack of oxygen
  • Intracranial hemorrhage
• Post-Natal
  • Infections
  • Hormone alterations
    • Hypoglycemia
  • Metabolic alterations
  • Malnutrition
  • Other postnatal factors
    • Brain trauma

7. Developmental Alterations

We can find some of these deficits, but it is not necessary.

• Sensory deficits
• Motor deficits
• Cognitive deficits:

• Attention: (disperse, easily distracted)
• Memory: working memory (when your mind retains things for a few seconds) and long-term memory:

It is important that the teacher creates a structured environment and logical meaningfulness.

• • Comprehension, abstract reasoning: arithmetic operations (+-*/)
  • Executive processes: problem-solving, planning, establishing relationships between variables or elements, comparing and contrasting…
  • Metacognition: knowledge about one’s knowledge, awareness of and control over one’s own cognitive processes
• Linguistic deficits

It is heterogeneous. It can be from no language to only articulatory problems.

• • Prelocutive stage: before the fully developed language. They have a lack of coordination between breathing and talking.
  • Limited gestures
  • Poor vocal emissions
  • Limited babbling
  • Deficient control of breathing and of speech organs
  • Phonological level: they have mental problems to discriminate the sounds.
    • Incomplete phonological development; speech errors
    • Deficient phoneme discrimination
    • Speech disorders: dyslalias, dysphemias, dysglossias…
  • Morphosyntactic level:
    • Alterations in acquisition and use of grammatical morphemes (gender and number coherence, verbal flexions…)
    • Slower development of sentence structuring. Complex sentences are infrequent, linguistic creativity limited. = Simple sentences
  • Lexical-semantic level
    • Slower lexical development
    • Reduced vocabulary: fewer semantic categories (basic and supraordinate levels), and fewer exemplars in each category (subordinate level).
• Behavioral alterations

*Some examples of syndromes with associated intellectual disability:

• Angelman’s syndrome
• Prader-Willi’s syndrome
• Fragile X syndrome
• Down’s syndrome
• Edwards’ syndrome
• Klinefelter’s syndrome

8. Intervention at School

8.1. Types of Schools

• Ordinary with support
• Specific

8.2. Curricular Options

• EBO: 6-16/18: areas = experience and development, body knowledge and experience and identity construction, knowledge of physical and social environment, communication and language.
• TVA: 2-3 years: personal autonomy, socio-communitary integration; professional training
• PCPI (Programas de Cualificación Profesional Inicial): 2 years (+ 1 in CAM): basic and professional training

8.3. Intervention in Classroom

What to teach:

Specific educational support for SWSEN in ordinary centers à ISA (reflected on DIAC)

• Inclusion of specific contents (e.g. learning AACS-Alternative and Augmentative Communication System) or of previous year contents
• Timing out of level or cycle: we can’t remove a unit or an aim. We can catch this and teach it at another moment.
• Significant modification (of aims) = modifying prescriptive elements of curriculum.
• Elimination (complete suppression of area, NOT in Primary)

How to teach

• Material, personal and environmental resources (mentioned in unit 2)
• Methodological resources and types of activities mentioned in unit 2 (flexible groupings, peer monitoring, corners, workshops, projects, graded activities…) + meaningful moments (with this, we will improve their personal autonomy) and ecological itineraries (we have to use everything that we use during the day as an excuse to teach something new).
• Precise instructions + modeling + shaping + direct experience (“hands-on”)

*Modeling (Modelado): I do something and the child observes me and imitates me.

*Shaping (Moldeamiento): includes modeling because we use visual, physical, and verbal support. Shaping is trying to teach something with steps and we do reinforcement to can pass to the next step.

• Flexibilization of educational stages (special schools until 21 years)

8.4. Individual Support Out of Classroom

• Early: as soon as possible. It affects the prognosis
• Planning of aims, activities, and assessment criteria
• Flexible timing
• Methodology adapted to the degree of intellectual disability
• Principles:
  • Functional
  • Integration in society
• Intervention in:
  • Oral language (auditory discrimination, praxias, syntax, vocabulary)
  • Written language (reading & writing: visual route, predominant, but also phonological if possible)
  • Mathematical concepts (especially functional for real-life: use of money…)
  • Orientation in space and time (e.g. transport; timetables; signs); use of pictograms and realia
    • Type of signs: iconic / ideographic / symbolic

9. Normal Language Development

• 1-4 m: Gurgling (sounds made with the throat: ga- ga)
• 6-8 m: Babbling (sounds made with lips: ba- ba/ ma- ma)
• 6-10 m: They have the ability to perceive and discriminate sounds of many languages, and when the child is 10 m, he won’t discriminate it, because they specialized in their own language.
• 9-11 m: We can observe Protoimperatives & Protodeclaratives (That are actions to communicate something) (Actions to show something)

-It is a reference of the typical development and for detecting alterations

– We call it PROTO because there are imperatives and declaratives, not words.

• 12-18 m:
  • Protowords: They are contextualized, the words are separated from the immediate context, only occur in a specific context (e.g., when the baby has the object at the moment)

• Over-extension
• Under-extension (use of the word very limited)

• • Holophrases: A single word that represents a whole sentence (e.g.: mummy! – because that dish is from mummy)
• 18 m:

Begins to do the first symbolic words, because they become symbolic, the child can speak about things that are not around. Not present at the moment.

• 18-24 m: word combinations (Subject- actions, subject- verb, subject- object..)
• 18-36 m: hyper-regulations (they do the typical mistake of doing irregular verbs, regular)
• 2-3.5 y: LEXICAL EXPLOSION (Huge increase of vocabulary)
• 3-6 y: They continue developing in all these levels phonological, phonetic, syntactic & lexical development, similar to adults, so their language is not as different as us.
• Reading and writing:
  • Phonological route
    • Learn the association between phoneme- grapheme
    • It allows to read every kind of word, even if it is an unknown word or a false word.
  • Visual route

They recognize the word because they associate the physical aspect of the word as a picture.

• To be an expert reader it is necessary to develop both, because the phonological route permits us to read every word, although we haven’t seen it never, and the visual route permits us to read quicker.

• With LOMCE, etc… we forgot a bit about the phonological route.

10. Language Impairments

Speech disorders:

• Dyslalia: articulation problem in functional causes
  • Auditory (mental representation of phonemes)
  • Praxic (motor execution of phonemes)
• Dysglossia: articulation problem in organic causes affecting mouth organs: lips, tongue, palate…
• Dysarthria: articulation problem in organic causes affecting the central nervous system.

Oral language disorders: *Articulation & grammar

• Simple language retardation * Vocabulary
• Dysphasia: Not a consequence of brain damage In different degrees of
• Aphasia severity – Expressive or

Less to the most severe

Written language disorders:

• Dyslexia *Phonological (dyslexia)
• Dysgraphia * Visual orthographic (dyslexia)

The classification can consider *Mixed (both routes are altered)

Similar to Dyslexia one. *Different degrees of severity, so with different intervention

Problem of motor ability to write

Disorders with a psychological origin:

• Dysphemia: stuttering

– It has a linguistic manifestation but the problem is psychological

Lack of fluency to speech

• Selective mutism

E.g.: The child has the ability to speak at home but not at school

11. Intervention

• Speech
  • Auditory discrimination – auditory representation of phonemes, by presenting different examples of pairs of words that sound the same, but mean different (e.g: P and B)
  • Problems in articulation – praxias, we have to work praxias, exercises useful for teaching the articulations of words.
  • A resource that we can use is some gestures, like Cued Speech
• Oral language
  • Multi-sensory stimulation in different semantic categories (animals, colors, objects…) in order to reach more vocabulary.
  • “Words trains” with pictograms, for sentence structuring
  • If it is necessary, teach manual signs (use Bimodal system) (to help the child to understand better and be fluent)
  • If it is possible, manual signs and pictograms will vanish progressively and we use only words, we have to take away the scaffolding.
• Written language
  • Phonological route
    • Association between phonemes and graphemes (the cards of your daughter)
    • Gestures and pictograms or fictional characters (e.g.: Letrilandia) to support this association.
    • 1st, VOWELS; 2nd, “TRANSPARENT” phonemes (l,m,s,p); 3rd, “OPAQUE” ones (g,j/c,z/v,b), sound different depending on what they go with.
  • Visual route
    • Association between global words and their meaning (proper names, “MAMÁ, PAPÁ”…)
    • Use of an image next to the written word.
• Psychological problems
  • Anxiety treatment (Jacobson/ global) methods
  • Gaining confidence, but not forcing
  • Games where communication is useful for winning the game
  • Use of therapy with brother or friend, people with whom the child feels comfortable.
  • Fun, physical activities, attractive to the child. Physical activities help the child to eliminate anxiety