Inclusive and Supportive Education Congress International Special Education Conference Inclusion: Celebrating Diversity? 1st - 4th August 2005. Glasgow, Scotland

home about the conference programme registration accommodation contact

Inclusion of students with physical disabilities in municipal
schools in Campinas, Brazil: management issues

Lucia Reily
Catholic University of Campinas, Campinas SP, Brazil and
CEPRE-FCM, Unicamp, Campinas, SP, Brazil
lureily@aol.com

Over the last 15 years, legislation regulating policies for inclusion in municipal schools in Campinas, Brazil, has led to considerable broadening of possibilities for regular schooling for children with disabilities.  Notably, the 1988 Brazilian Constitution recognized the rights of people with disabilities to public education, preferably in the regular school system.   In this vein, another important set of policies was established through the Lei de Diretrizes e Bases da Educação Nacional of 1996 (roughly translated as Guidelines and Bases for National Education Law of 1996), regulating special education services and support programs to be made available for students with disabilities integrated in the regular school system (Ferreira and Ferreira, 2004).

The municipal education council of Campinas has taken the inclusive education model seriously.   In 1991, the movement for integration of students with disability was formally set in motion by means of a project called “Projeto Acesso e Permanência do Portador de Deficiência na Rede Pública Municipal” (roughly translated as ‘Access and Permanence of Persons with Disability in the Municipal Public System Project’.   This project, which aimed to offer ‘public education for all’, avoiding segregation in specialized institutions, went through various readjustments over the years, according to Moraes (1998), becoming firmly established as a ‘Special Education Program for the Municipal Schooling System’ by 1995.

In recent years, the number of children with special needs in Campinas municipal schools has greatly increased for at least three reasons: schools are obligated to receive all children; educational services have been enhanced through on-going courses and workshops for teachers; parents have come to believe that city schools are better options for their children (as opposed to institutions, state schools or staying at home).   As a result, we now have children with a variety of physical and neuromotor disabilities in regular classrooms, who before would have stayed at home or been sent to special schools.    It was formerly understood that if a child couldn’t communicate verbally and was unable to write, there was no sense in sending him to school at all!  

Quantitative data on inclusion in municipal schools in Campinas is unavailable to date, but we do know that specialized institutions still answer to close to 50% of the registered number of students with disabilities (Silva, 2003) who are receiving some kind of education .   In fact, the city council of Campinas-SP is one of the main collaborators maintaining services offered by philanthropic entities for educating the disabled . We do know that there continues to be a significant number of children and youth with disabilities who are excluded from any kind of educational service, private or public.   Some are cared for at home, a few are chronically hospitalized and some receive only clinical attention.

It might be helpful to include data on the Campinas municipal system of education for those who are unfamiliar with this large metropolitan are in the sate of São Paulo.   Campinas is the second major city in the state, with a population of over one million.   We present below numbers from a survey done in 2003 for the city of Campinas:

• 35.000 students registered in 40 elementary schools - 1 st (7 years) to 8 th (14 years) grade levels;
• 27.800 children (0 to 6 years) registered in 150 early childhood learning centers;
• 6000 children in partnership with specialized institutions for special education and early childhood NGOs;
• 5000 young people and adults in adult education courses for 1 st to 4 th year levels, many of whom are disabled persons who were left out of mainstream education during their childhood;
• 120 classrooms in 65 NGOs or institutions for education of young people and adults (EJA), through funding of teacher salaries and financial support.

Nationally, the official Brazilian school census of 2003 points to a general increase of 150% in the number of children with disabilities included in regular classrooms from 1998 to 2003.   For physical disability, the increase is over 200%. The numbers vary year by year, as can be verified in Table 1,   because of inconsistencies of diagnostic criteria used by those filling out the forms, however official data does demonstrate a definite increase of special needs students in regular school contexts.

Table 1. INCREASE OF REGISTRATION OF STUDENTS WITH SPECIAL NEEDS

The increased registration of children with disabilities in municipal schools has required the hiring of special education teachers for most of the local schools at preschool, elementary and adult education levels.   These special education teachers, who are obliged to present university degrees certifying training in special education, have been assigned to work in various special education services as consultants, as teachers of resource classes, or as specialists in one school or a group of schools where there are students with special needs (Moraes, 1998).  

Despite significant changes in educational policies and   the welcoming of diversity in the regular school system, teacher training has not managed to accompany these shifting times.    The fact of the matter is that special education teachers in the Campinas school system have not been professionally prepared to work with students with disabilities of such varied nature. Most special education teachers hired by the municipal council obtained their undergraduate degree in special education at the Catholic University of Campinas, where they were prepared to work with deafness and mental disability, or alternately at the State University of Campinas (Unicamp).   Only recently has the special education course at the Catholic University been broadened to include a wide spectrum of special needs future teachers will encounter in the regular school system.    Only one program at the State University of Marília, (UNESP-Marília) prepares future teachers in the state of São Paulo in the field of visual impairment and physical disability, and this center is in the western region of the state, quite distant from Campinas.  

Further Education for Special Education teachers in Campinas

This paper presents the results of further education with special education teachers in municipal schools in Campinas, using video documentation to talk about inclusion as experienced by children in municipal schools.  

We were asked to prepare teachers to work with students with physical disabilities.   We started with information on various kinds of disabilities, such as those caused by neuromotor lesions, orthopedic injury and metabolic or autoimmune diseases. Medical information was related to the students the teachers knew.   We worked out a schedule for visiting the schools and filmed the children involved in activities that highlighted aspects that preoccupied the special education teachers. Both the general school environment (including access from sidewalks to the front door, playground, cafeteria, bathroom facilities and public corridor areas) and classroom situations were recorded.

            We visited 7 schools, accompanied in each case by the special education teachers responsible for the children with special needs in the schools.   Permission to film in the school was negotiated with the school supervisor and city education council, as part of the proposal for case studies in the further education program on physical disabilities.   Permissions for videotaping the children had been obtained previously from parents or legal guardians, the great majority of whom were quite cooperative.   It was explained that these tapes would be used to help the special education teachers study each case and learn about physical disabilities through technical instruction by physical and occupational therapists who would work with the teachers on seating, mobility and resources for writing and table activities in general.

            Of the 47 children with physical disabilities under the care of the special education professionals in our group, we were able to film 16 students over the period of a year and a half, viewing the tapes soon after the documentation took place.   The order in which the visitations took place was meant to prioritize cases which could function as examples of specific kinds of needs (communication, mobility, writing, for example).

We began by looking at accessibility issues: how do the children come to school and get around, how do they move around the classroom and corridor space, the cafeteria, go to the library, use the bathroom and playground areas.   What kinds of equipment do they use? Then we focused on aspects related to communication and interaction, including visual information inside the classroom and in the general school area.   We also recorded art activities, play and reading and writing (when relevant) to see how children used their hands and managed specific instruments.   Furniture (tables and chairs) and seating, posture and handling of the children was viewed while the students were involved in some of these activities.   The chart below gives an overview of the children who were recorded, with ages, grade level and summarized descriptions of relevant information.

It is important to stress that we were at no time concerned about assessing the children’s scholastic performance, nor were we attempting to make a negative critical appraisal of the way these children were being handled in the municipal schools.

Table 2. Schools visited and chidren observed

Accessibility in the school environment – Pavement and walkways

            To our evaluation, none of the schools presented serious architectural obstacles requiring extensive remediation, mainly because all seven schools we visited were one storey buildings, which definitely facilitated mobility for students who used wheelchairs, walkers, crutches or who lacked coordination, or dragged their feet, etc.   On the other hand, however, none of the schools had seamless passageways from outside into the school building, through corridors and entrance points.   Generally, there were various levels inside every school, mainly from hallways into the cafeteria; the major obstacles were in the outside area and getting to the playground.  

Two of the schools with wheelchair users had successfully remediated obstacles such as steps by filling in small ramps with concrete. Some of the teachers were awaiting engineers from the public city works, who had been called in about ramps and toilet facilities.   Because of negative past experiences, several teachers expressed concern that the ramps would be too steep.   The Brazilian Technical Norms for Physical Access n°9050 stipulates that ramps should not exceed 8% inclination, but oftentimes these norms are ignored because  ramps must fit in available spaces.    

We worked with the teachers on how to understand how inclinations are calculated.   Of course, it is not the special education teachers’ responsibility to design accessible schools, nor do they have the technical knowledge to undertake this challenge. However, they expressed the need to work together with the team sent in to do the actual refurbishment, making sure they were basing their work on the latest accessibility regulations set forth by ABNT (Brazilian Association for Technical Norms).

            The only school with accessibility issues requiring large scale measures was a school in a very distant peripheral neighborhood.   This school posed a problem to everyone, not only to physically disabled persons, because the roads in the whole surrounding area were unpaved.   The school was on an incline, so rain water dug deep crevices in the dirt road in rainy weather.   In this school, the entrance gate was at the bottom, which meant going up a steep ramp to get to the entrance door.   Here, the best solution would probably be to open a side gate at the top of the hill for all the children, not only for the girl who used the wheelchair.  

- Handrails       

Only one of the schools had a handrail along the inside corridor, which was a great help to the student who walked with some difficulty.   One of the special education teachers from another school showed where she would like to install a rail along the walls of the covered recess area, which would enable the student with physical disability to go anywhere he wanted on his own.

- Doorways

For all schools we visited, the width of the doorways was within the standards of the NT 9050 (at least 80 cm wide), except in the toilets, which were too narrow in the majority of cases.  

Door knobs, however, were nowhere near universal design standards, and did not promote independent entry for children with poor muscle tone or dexterity.

- Toilet facilities

Overall, the toilet facilities of all seven schools required refurbishing in the following aspects (for starters):

There was a need to

1. widen the entry hall and turnabout for wheelchair users
2. place visual signs (picture options) on   door at lower levels
3. set aside one widened stall for physically disabled students
4. install handrails and supports
5. design doors and handles (and possibly locks) for physically disabled students to access independently
6. install appropriate toilet seating
7. install toilet paper racks at appropriate heights
8. design sink with handrail
9. install faucet with appropriate lever for water flow
10. place paper towel racks at appropriate levels for wheelchair users

One teacher had worked out an ingenious method of raising the child by letting him stand on her foot so that he could reach the faucet.   Improvisation is good, but school equipment should be constructed so that the child doesn’t have to depend on the presence of an adult to help with this kind of support.

Furniture and posture

- Seating

Having furniture specially fitted for each disabled student for classroom activities is still not a primary concern of the board of education in Campinas, though we have attempted to make special education teachers aware of how vital this aspect of inclusive education actually is for physically disabled students.   We have drawn attention to the importance of making sure the student is well positioned, with feet properly supported, adequate height of table, all of which will make a huge difference in his or her performance in the classroom, beginning with enhancing his or her ability to pay attention and concentrate, and participate in group activities.   Of course these same concerns are valid in other contexts, such as in the cafeteria or during play.

Authors such as Nancy Finnie (1974) and Sophie Levitt (1994) (both available in Portuguese) have established basic principles that are easy for educational personnel to understand, though the ideal solution would be to have supervision by the physical and occupational therapists who work clinically with the child.  

The children we observed presented varied conditions as to movement and posture, requiring individually fitted chairs and desks in most cases, especially when there was involvement of the central nervous system, affecting muscle tone, voluntary movement and balance.   Four of the children who presented severe physical conditions had wheelchairs, but one boy only used his for transport, not as seating in the classroom.    The teachers explained that families wait in queues for several months before the child’s chair is ready, and by the time it comes, sometimes he or she has already outgrown it.   When putting together seating and table arrangements, wheelchairs are often donated or borrowed. Family members and educational staff work together to adapt tabletops to the arms of the wheelchair, using Velcro, or strips of cloth to tie the boards on.   Although this initiative is commendable, often the working surfaces are not very stable if there is a lot of involuntary movement, which is usually the case in cerebral palsy.

In the early childhood education schools, the children sit on the floor in a circle to listen to stories, to do roll calling, for sing-alongs.  This is a routine activity in early childhood centers and preschools.   Despite the importance of being in the group like all the other kids, this position is not recommended for most children with neuromotor disfunction.   We observed that in children with hemiplegia, spasticity tended to exacerbate, causing further stiffness to the side that already showed atrophy.   Some of the children could have benefited from a corner seat for circle times.

Another situation that could be remedied was seating in the cafeteria. The children had their snacks or lunches at long tables, sitting on benches, irrespective of their height. Children with neurological disturbances need extra support; they need their feet supported flat on the ground, not swinging in the air.   Some could benefit from support for their bodies, arm rests, tabletops at the appropriate height, etc.   The children with severe disability had their special seating, but children with hemiparesis also needed to be looked after.   Sitting symmetrically and well balanced would enable them to hold silverware and eat better.   The same holds true for table activities in the classroom.

In the preschool classrooms, the children sat four to a table.   The chairs had backs, but they were not fitted to size, so many children, not just the children with physical conditions, had their feet dangling down, while the larger children hunched over their work.

Attempts were made in some cases to place telephone books under the child’s feet, but these would soon get kicked out, because they were not attached to the chair.

Having recorded these conditions, we did practical workshops with a physiotherapist and an occupational therapist where the teachers learned about physical handling, seating and adapting material and instruments to individual needs.

Health professionals and the school

In the Campinas schooling system, education and health are not fully integrated, which means there is no systematic institutional intervention model.   Students with moderate or severe disability receive care at local university hospitals or outpatients clinics or at the public rehabilitation center, but not all children receive treatment, because this requires family members available to take the children to weekly sessions, bus fare, and other issues.    It was encouraging to learn that the special education teachers in our group were in contact with physiotherapists as well as other health professionals involved in the child’s treatment program.   Some accompanied the child to the clinic to decide on new wheelchairs, others went along to doctors’ consultations to help “interpret” medical information to parents.   Nevertheless, all the children could have benefited from systematically scheduled visits to the school by a team of therapists caring for the child.   The special education teachers seemed to be aware of the importance of proper forms of lifting, carrying and posturing the children. However, to really understand how to handle children with cerebral palsy or other neurological disturbances so as to inhibit pathological reflexes (in the Bobath approach) requires ongoing supervision by trained professionals.   The teachers did their best to follow orientation, but there is just too much information to remember about each specific condition.

Language and communication

One of the major focuses of the program with the special education teachers was the issue of language and communication of non speaking students with cerebral palsy.   We presented Augmentative and Alternative Communication (AAC), which was a novel concept to many teachers, and they learned to use alternative communication (AAC) and did hands-on workshops with building communication boards.   Computer programs for word editing on screen and other technology options available on-line, and we downloaded some of them so that the teachers could become familiar with the options.   

- Making choices

It was also encouraging to perceive as we analyzed the video tapes that the special education teachers were preoccupied about making sure the children with disability had options and expressed their preferences.   So that they wouldn’t be run over by the demands and excitement of the classroom situation, the special education teachers used strategies such as clarifying the options, rephrasing the teacher’s instructions, putting into words what the child was doing and waiting to make sure what the assignment was understood.   They avoided choosing (colors, toys, activities) for the child, waiting to make sure that the child was involved in what was going on.   Several instances were filmed in which the special education teacher’s role as classroom mediator was clearly evident.   For non speaking students, a lot of interpretation of body language and facial expressions went on, because none of the schools used AAC.  

School Activities

- Activities at the table

All but two of the children we observed were preschoolers, and beginning literacy was going on in most of the classrooms.   In three cases, the children (Ta., Vi. and Y.) were engaged in parallel activities, because they were unable to perform the assignment their peers were working on, due to cognitive delay, lack of speech and/or lack of fine motor coordination.

Commercially designed instruments (splints, graphic instrument holders, head or chin sticks, etc.) adapted for use by people with problems in manual dexterity were not being used by the children we observed, although the Campinas school system has purchased some of these tools.   Some of the children we filmed would have benefited greatly from using appropriate instruments.   In graphic activities such as drawing, writing, cutting and gluing, the children with hemiparesis (D., L., E., A., Vi. etc.) all had to struggle to keep paper from slipping around on the table.   Taping the sheets down or using thicker paper could easily have done the trick, as the special education teachers quickly realized later when watching the film.   For people with hemiplegia, the increase in muscle tone on the affected side is a serious concern, which needs to be avoided as much as possible in simple daily classroom activities.

Other problems that hindered the disabled children’s school work were recorded:

• the use of pieces of paper too small to write or drawn on;
• not enough room on the table to work;
• sheets of paper that were too thin, and slid around;
• no lines or marks to direct where writing was to be initiated, etc.

One episode exemplifies a situation that the special education teachers professed to be typical of inclusion at the municipal schools.   B. adamantly rejected using any kind of special equipment or adaptations that differed from the instruments her classmates used.   She was able to write in block letters very slowly, clutching a pencil tightly; she fed herself with a regular spoon, but she certainly would have been able to coordinate her movements more fluently and with less spasticity with proper tools (thickened writing and drawing instruments, a curved spoon with good grip handle, special scissors).

Not wanting to be different seems to be an issue that comes up frequently, according to the special education teachers, meriting further studies.   To our understanding, children with learning potential such as B. has shown, need to be prepared to use the computer as an option for writing, because otherwise they will not be able to keep up in the upper grade levels.   Although her assertiveness is to be commended, and will certainly stand her in good stead throughout her life when she comes up against situations where she faces a competitive world, it is also important that she understand that difference does not have to mean stigma.

- Playground environment

We were able to record situations that showed that children who could hold their own in the classroom, where verbal abilities are highly valued, did not always fare as well outside in the playground, where moving fast was paramount.

The video tapes showed that hemiplegia, which would seem to be a minor condition, amazingly interferes a lot more than one would expect in a child’s participation in physical activities.   Earlier experiences of falling down, and being knocked over seem to take an early toll on children with hemiparesis, making them fearful of physical play. This is understandable, because even minor disabilities can be a hindrance on irregular surfaces such as grass, dirt or sand, where children are running around, racing each other and generally competing to see who can go faster, climb higher, hang from their knees, swing into the sky…

We filmed D. playing football with the other boys; mostly, he avoided the ball, hiding behind the goal.   He was afraid of the swing-set and the seesaw, though he did go haltingly down the slide when his turn came.   G., who had spina bifida, agreed to go up in the tree house, where he sat on the special education teacher’s lap, but he didn’t want to slide down with her.   He was afraid to go on the seesaw swing, but he went eventually, screaming gleefully.

Small children, such as Va., Aa and H., and children who were cognitively challenged, played mostly on their own, exploring the nature of objects in a sensorimotor fashion, as Piaget called it, with little apparent concern for their peers.  

T. was filmed playing dolls.   She didn’t seem to notice any differences between her abilities and those of her friends.   She involved one of her classmates in her make believe game, getting him to hold the baby while she wiped out the tub with a piece of cloth.   She was so busy, she didn’t notice that he was twisting the baby doll’s arms and legs almost off, turning the baby about in a most unfatherly manner, as little boys are wont to do.

Encouraging autonomy

The video tapes show several episodes where teachers were very careful to lead children in doing things on their own, with minimal physical assistance.  

• One teacher stabilized the padlock to the toilet stall for V., but he turned the key and opened the door on his own.  
• The teacher working with C. gave her enough stability so that she could get out of the sandbox by swinging her leg over the wall, but he didn’t lift her out himself.
• A. was able to hang his collage on the line with those of his peers, because the special ed. teacher held it in place while he pressed open the clothespin and stuck it on himself.

With children at the beginning stages of writing (copying words or letters) teachers helped guide the child’s hand, with their own hand over the child’s.   Questions were used to lead the child to seek his own answers.   The video documentation indicates how important it is for children to manage on their own, registering their smiles of self-satisfaction when the children realized they had been able to finish a task on their own.

Concluding thoughts

We recognize that this project does not offer a complete overview of physical disabilities in the Campinas municipal schools, but it did help teachers in the sequence of four further education courses on physical disabilities in inclusive schools learn about the nature of various kinds of physical disabilities and there manifestations.   It was impossible to attend to all issues, so our priorities included accessibility, communication, hand function and instrument use.   The documentation by video recording   enabled us to edit a video that is being used to discuss inclusion with teachers based on real, not idealized, situations.   Teaching staff as well as students in teacher training courses who work in the educational community of Campinas can identify with the classroom situations as they have been portrayed.   This is why we hope the board of education of Campinas will be able to put this video documentary to good purpose in the near future in other further education courses.  We also hope that the documentation of accessibility problems will be instrumental to correcting barriers on a broad scale in the Campinas municipal school system.

References

BRASIL (1996).   Educação especial no Brasil: perfil do financiamento e das despesas. Brasília: Ministério da Educação (MEC)/Secretaria da Educação Especial (SEESP).

FERREIRA, Maria Cecília Carareto & FERREIRA, Júlio Romero (2004).  Sobre inclusão, políticas públicas e práticas pedagógicas. IN: GÓES, Maria Cecília Rafael de & LAPLANE, Adriana Lia Friszman.   Políticas e práticas de educação inclusiva. Campinas, SP, Brazil: Papirus.

FINNIE, Nancy.   (1974). Handling the Young cerebral pasy child at home. London: Heinemann.

LEVITT, Sophie. (1994). Basic abilities: a whole approach: a developmental guide for children with disabilities. London: Souvenir Press.

MORAES, Mônica Cristina Martinez de. (1998).   Escola para todos: possibilidade a partir da formação continuada de professores em Educação Especial. Masters thesis.   São Paulo: USP, School of Education.

REILY, Lucia. (2004). Escola inclusiva: linguagem e mediação. Campinas, SP, Brazil: Papirus.

SILVA,Angélica Bronzatto de Paiva e. (2000). O aluno surdo na escola regular: imagem e ação do professor.   Masters thesis.   Campinas: Unicamp, School of Education.

SILVA, Shirley & ARELARO, Lisete Regina Gomes. (2003) Diversidade e exclusão: a sensibilidade de quem as vive. construindo alternativas de políticas de inclusão. Anais da ANPEd, GT 15. Caxambú, MG.

home . about the conference . programme . registration . accommodation . contact