The View from Above: Emphasizing Performance

in Practice

The View from Above: Emphasizing Performance

in Practice

Shifting focus away from a students’ disability

Shifting focus away from a students’ disability

Ask Yourself . . .Ask Yourself . . . What is the emphasis of our educational practice and

the focus of our testing? Do we take a ‘bottom-up’ approach (i.e. looking first

at symptoms of and weaknesses related to disabilities before performance)?

If how a person performs is our concern, then is our current focus of practice and assessment too narrow?

What is the emphasis of our educational practice and the focus of our testing?

Do we take a ‘bottom-up’ approach (i.e. looking first

at symptoms of and weaknesses related to disabilities before performance)?

If how a person performs is our concern, then is our current focus of practice and assessment too narrow?

CASE STUDY: IEP for Forrest GumpCASE STUDY: IEP for Forrest Gump

Eligibility: Mental Retardation (IQ < 80)

Areas of Strength: Speed (“magic legs”), eye-hand coordination, loyalty, perserverance

Areas of Weakness: Cognitive, speech (tone), social skills

Impact of Disability: Tormented by peers, referred to as “the local idiot”

Supports: A caring Momma, some clever sayings, Lieutenant Dan (1-to-1)

Eligibility: Mental Retardation (IQ < 80)

Areas of Strength: Speed (“magic legs”), eye-hand coordination, loyalty, perserverance

Areas of Weakness: Cognitive, speech (tone), social skills

Impact of Disability: Tormented by peers, referred to as “the local idiot”

Supports: A caring Momma, some clever sayings, Lieutenant Dan (1-to-1)

Forrest Gump: ACTIVITIES & ENVIRONMENT

Forrest Gump: ACTIVITIES & ENVIRONMENT

Graduated University of Alabama “after 5 years of playing football”

In army, medal of honor winner and ping-pong champion

Shrimpin’ boat captain and owner of Bubba-Gump shrimp company (following hurricane)

Best friend of Bubba, Husband of Jenny, Father of little Forrest

Graduated University of Alabama “after 5 years of playing football”

In army, medal of honor winner and ping-pong champion

Shrimpin’ boat captain and owner of Bubba-Gump shrimp company (following hurricane)

Best friend of Bubba, Husband of Jenny, Father of little Forrest

Forrest GumpTOP-DOWN vs. BOTTOM-UP

Forrest GumpTOP-DOWN vs. BOTTOM-UP

o Fictional, Exaggerated, and Humorous but also a Telling Example

o The view from below:

Maybe misses the possibilities for success in his life with focus on mental retardation and weaknesses

o The view from above:

Shows the successes possible given his activities of choice and the contexts (including luck & timing) that supported his performance

o Fictional, Exaggerated, and Humorous but also a Telling Example

o The view from below:

Maybe misses the possibilities for success in his life with focus on mental retardation and weaknesses

o The view from above:

Shows the successes possible given his activities of choice and the contexts (including luck & timing) that supported his performance

The WHO and ICFThe WHO and ICF

The World Health Organization – WHO – has proposed and revised definitions of disability to

emphasize performance (activities and participation) and environment as key determinants

of health and disability

Disability – an umbrella term, covering impairments, activity limitations,

and participation restrictions

The World Health Organization – WHO – has proposed and revised definitions of disability to

emphasize performance (activities and participation) and environment as key determinants

of health and disability

Disability – an umbrella term, covering impairments, activity limitations,

and participation restrictions

Defining DisabilityDefining Disability Impairment - a problem in body function or structure Activity limitation - a difficulty encountered by an

individual in executing a task or action Participation restriction - a problem experienced by

an individual in involvement in life situations

Thus disability is a complex phenomenon, reflecting an interaction between features of a person's body and features of the society in which he or she lives.

Impairment - a problem in body function or structure Activity limitation - a difficulty encountered by an

individual in executing a task or action Participation restriction - a problem experienced by

an individual in involvement in life situations

Thus disability is a complex phenomenon, reflecting an interaction between features of a person's body and features of the society in which he or she lives.

CONSIDERCONSIDER Emphasis in IEPs and assessments appears to be on impairment

(e.g. eligibility, areas of strength, and areas of weakness) or the component parts of performance

‘Impact of Disability’ statement is now required, which describes the affect of impairment on performance of activities and participation limitations; but should activity and participation be considered in terms of areas of strengths and weaknesses rather than just what is impacted?

‘Access’ is a term we use - e.g. “student can access her educational program” - which would seem to reflect the interface or interaction between a person’s body and the environment, but how much do we consider the environment or contextual side of this interaction

Focus on impairment alone de-contextualizes the student both from the educational activity and the educational environment

CONSIDERCONSIDER Emphasis in IEPs and assessments appears to be on impairment

(e.g. eligibility, areas of strength, and areas of weakness) or the component parts of performance

‘Impact of Disability’ statement is now required, which describes the affect of impairment on performance of activities and participation limitations; but should activity and participation be considered in terms of areas of strengths and weaknesses rather than just what is impacted?

‘Access’ is a term we use - e.g. “student can access her educational program” - which would seem to reflect the interface or interaction between a person’s body and the environment, but how much do we consider the environment or contextual side of this interaction

Focus on impairment alone de-contextualizes the student both from the educational activity and the educational environment

CASE STUDY: IEP for Stephen HawkingCASE STUDY: IEP for Stephen Hawking

Eligibility: Orthopedic Impairment (ALS / Lou Gehrig’s Disease)

Areas of Strength: Cognitive

Areas of Weakness: All physical and motor abilities, speech

Impact of Disability: Complete dependence for all ADLs and physical activities

Supports: 24 hour nursing care and sophisticated assistive technology

Eligibility: Orthopedic Impairment (ALS / Lou Gehrig’s Disease)

Areas of Strength: Cognitive

Areas of Weakness: All physical and motor abilities, speech

Impact of Disability: Complete dependence for all ADLs and physical activities

Supports: 24 hour nursing care and sophisticated assistive technology

Stephen Hawking: ACTIVITIES & CONTEXT

Stephen Hawking: ACTIVITIES & CONTEXT

In academia, where ideas are valued, he develops ground-breaking theories and is a brilliant scientist

He communicates with friends and colleagues and lectures to packed auditoriums on topics beyond most people’s comprehension

In his personal life, he maintains relationships including marriage

In academia, where ideas are valued, he develops ground-breaking theories and is a brilliant scientist

He communicates with friends and colleagues and lectures to packed auditoriums on topics beyond most people’s comprehension

In his personal life, he maintains relationships including marriage

Stephen Hawking: IMPAIRMENT vs. PERFORMANCE

Stephen Hawking: IMPAIRMENT vs. PERFORMANCE

Impairment - in terms of body structure and function, he could not be more impaired with regard to motor abilities

Activity Performance - he is perhaps unparalleled in his theory development and scientific endeavor

Contextual Factors - performance in academic realm where it is a culture of ideas; lives in an historical context in which technology enables him to participate in chosen life activities fully when otherwise he might not have had a voice

Impairment - in terms of body structure and function, he could not be more impaired with regard to motor abilities

Activity Performance - he is perhaps unparalleled in his theory development and scientific endeavor

Contextual Factors - performance in academic realm where it is a culture of ideas; lives in an historical context in which technology enables him to participate in chosen life activities fully when otherwise he might not have had a voice

International Classification of Functioning, International Classification of Functioning, Disability and Health (ICF)Disability and Health (ICF)

International Classification of Functioning, International Classification of Functioning, Disability and Health (ICF)Disability and Health (ICF)

o The ICF is WHO's framework for measuring health and disabilityThe ICF is WHO's framework for measuring health and disabilityo Acknowledges that every human being can experience a decrement in Acknowledges that every human being can experience a decrement in

health and thereby experience some degree of disabilityhealth and thereby experience some degree of disability o thus, ICF 'mainstreams' the experience of disability and thus, ICF 'mainstreams' the experience of disability and

recognizes it as a universal human experiencerecognizes it as a universal human experienceo Shifts the focus from cause to impact, placing all health conditions on Shifts the focus from cause to impact, placing all health conditions on

an equal footing allowing them to be compared using a common an equal footing allowing them to be compared using a common metric - the ruler of health and disabilitymetric - the ruler of health and disability

o Takes into account the social aspects of disability and does not see Takes into account the social aspects of disability and does not see disability only as 'medical' or 'biological' dysfunctiondisability only as 'medical' or 'biological' dysfunction

o Records the impact of the environment on the person's functioning by Records the impact of the environment on the person's functioning by including Contextual Factorsincluding Contextual Factors

o The ICF is WHO's framework for measuring health and disabilityThe ICF is WHO's framework for measuring health and disabilityo Acknowledges that every human being can experience a decrement in Acknowledges that every human being can experience a decrement in

health and thereby experience some degree of disabilityhealth and thereby experience some degree of disability o thus, ICF 'mainstreams' the experience of disability and thus, ICF 'mainstreams' the experience of disability and

recognizes it as a universal human experiencerecognizes it as a universal human experienceo Shifts the focus from cause to impact, placing all health conditions on Shifts the focus from cause to impact, placing all health conditions on

an equal footing allowing them to be compared using a common an equal footing allowing them to be compared using a common metric - the ruler of health and disabilitymetric - the ruler of health and disability

o Takes into account the social aspects of disability and does not see Takes into account the social aspects of disability and does not see disability only as 'medical' or 'biological' dysfunctiondisability only as 'medical' or 'biological' dysfunction

o Records the impact of the environment on the person's functioning by Records the impact of the environment on the person's functioning by including Contextual Factorsincluding Contextual Factors

What does this mean?What does this mean?o Body structure and function are one of a number of

factors in health & disability on equal footing with activities and participation, not the sole or primary concern

o Environmental factors are a significant determinant

o Shifts the focus from underlying cause(s) to impact o The RULER

o Health = Successful Performance of and Participation in Life Activities

o Disability = Activity limitations and Participation Restrictions

o Body structure and function are one of a number of factors in health & disability on equal footing with activities and participation, not the sole or primary concern

o Environmental factors are a significant determinant

o Shifts the focus from underlying cause(s) to impact o The RULER

o Health = Successful Performance of and Participation in Life Activities

o Disability = Activity limitations and Participation Restrictions

CASE STUDY: Body Structure & Function in Sports

CASE STUDY: Body Structure & Function in Sports

7 feet

225 lbs.

Long, rangy

Jumps High

Fast

6 feet

185 lbs.

Fit and lean

Good balance

Strong

Which one is the more successful athlete?

Sports: ACTIVITY & CONTEXT

Sports: ACTIVITY & CONTEXT

Kevin Garnett (KG)

Prep to Pro

NBA All Star

$100+ million contract

NBA Champion

Cael Sanderson

Amateur

Only 4-time NCAA Champion

W/L Record: 159-0

Olympic Gold-Medalist

ACTIVITY: Basketball ACTIVITY: Basketball CONTEXT: Pro LeagueCONTEXT: Pro League

ACTIVITY: Wrestling ACTIVITY: Wrestling CONTEXT: College & OlympicsCONTEXT: College & Olympics

Sports:Defining DISABILITY

Sports:Defining DISABILITY

Focusing on Body Structure and Function alone would likely lead to the conclusion that KG is the superior athlete compared to Cael Sanderson based upon their measurables

However, given their chosen activities and contexts, they are both highly successful athletes

Reversing roles, either one would be significantly ‘disabled’ in the other’s sport relative to their current successes and ‘health’ in their own sport

Focusing on Body Structure and Function alone would likely lead to the conclusion that KG is the superior athlete compared to Cael Sanderson based upon their measurables

However, given their chosen activities and contexts, they are both highly successful athletes

Reversing roles, either one would be significantly ‘disabled’ in the other’s sport relative to their current successes and ‘health’ in their own sport

Consider the element of the ICF that: Consider the element of the ICF that:

“Every human being can experience a decrement in health and thereby

experience some degree of disability . . . thus, ICF 'mainstreams'

the experience of disability and recognizes it as a universal human

experience.”

“Every human being can experience a decrement in health and thereby

experience some degree of disability . . . thus, ICF 'mainstreams'

the experience of disability and recognizes it as a universal human

experience.”

CASE STUDY: Yourself

HOW AM I DISABLED?CASE STUDY: Yourself

HOW AM I DISABLED?

Some Possibilities (in case you have trouble seeing past your own perfection)

Some Possibilities (in case you have trouble seeing past your own perfection)

Technology - sometimes the ON button eludes you

Shopping - the case for most guys Cooking - your food doesn’t look

or taste like on the food network Sports - goofy, awkward, and/or

clumsy and just don’t see the point of it all (or of sweating)

Driving - on the cell phone or not Dating - goofy, awkward, and/or

clumsy and just don’t see the point of it all (or of sweating about it)

Technology - sometimes the ON button eludes you

Shopping - the case for most guys Cooking - your food doesn’t look

or taste like on the food network Sports - goofy, awkward, and/or

clumsy and just don’t see the point of it all (or of sweating)

Driving - on the cell phone or not Dating - goofy, awkward, and/or

clumsy and just don’t see the point of it all (or of sweating about it)

CASE STUDY: Yourself

WHY AM I DISABLED?CASE STUDY: Yourself

WHY AM I DISABLED? According to the ICF definition, we all

experience disability at some time It becomes a question of what the source of

the disability might be Likely, it is a function of an activity

limitation and/or participation restriction as well as context as much, if not more so, than a function of an impairment to our body structure of function

According to the ICF definition, we all experience disability at some time

It becomes a question of what the source of the disability might be

Likely, it is a function of an activity limitation and/or participation restriction as well as context as much, if not more so, than a function of an impairment to our body structure of function

CASE STUDY: Yourself

HOW DO I ADDRESS MY DISABILITY?

CASE STUDY: Yourself

HOW DO I ADDRESS MY DISABILITY? Changing your body structure and function

through practice, skill development, some form of rehabilitation or medical approach

Changing the activity and/or context, by EITHER not engaging in the activity and removing oneself from the context that demands it OR simplifying the activity and altering the environment

Likely some degree of both approaches, with the former likely being a longer process and the latter having a more immediate impact

Changing your body structure and function through practice, skill development, some form of rehabilitation or medical approach

Changing the activity and/or context, by EITHER not engaging in the activity and removing oneself from the context that demands it OR simplifying the activity and altering the environment

Likely some degree of both approaches, with the former likely being a longer process and the latter having a more immediate impact

Embracing the ICF in the educational environment and potential effects on assessment and practice

Embracing the ICF in the educational environment and potential effects on assessment and practice

Top-down approach - team discussion starts with activity limitations and participation restrictions

Assessment - progresses from this starting point to determine sources of disability - nature of activity, body structure and function, environmental and contextual factors

Practice - treatment and service provision consist of longer term approaches such as skill development and remediation as well as short term approaches and strategies to change the activity or context

Top-down approach - team discussion starts with activity limitations and participation restrictions

Assessment - progresses from this starting point to determine sources of disability - nature of activity, body structure and function, environmental and contextual factors

Practice - treatment and service provision consist of longer term approaches such as skill development and remediation as well as short term approaches and strategies to change the activity or context