1. Inclusion of
pupil with
quadriplegia
PORTUGAL
2013
Case Study elaborated by CRTIC Chaves
Maria Adalgisa Babo
Joaquim Virgílio Perfeito Ribeiro

2. 2
Introduction
This case study was elaborated in the scope of the european project SENnet and it
takes place in the Schools Cluster Gomes Monteiro, Boticas, in Portugal.
Its purpose is to research the impact of inclusive technology used by a pupil with
permanent disability, in a mainstream school. The pupil’s condition affects her
activity and participation, who is unable to carry out daily life routines. The
assistive technology helps her to minimize certain limitations, allowing access to
the curriculum.
The pupil’s functioning profile is described as well as the physical environment
that surrounds her, according to the International Classification of Functioning,
Disability and Health from the World Health Organization, which was adopted by SEN
legislation in Portugal, and its components of activity, participation and environment are
relevant for children and youth attending school.
The evaluation process for assigning assistive technology is reported, held at the
ICT Resource Centre for Special Education (CRTIC Chaves).
The analysis of this pupil’s case is contextualized in the regular classroom with the
involvement of the staff and parents in order to promote her inclusion and autonomy.
Who conducted the case study?
The ICT Resource Center for Special Education (CRTIC-Chaves) is located in the
region of Trás-os-Montes. This region has a unique landscape and rich cultural
heritage.
The main economic resources are based in agriculture, cattle ranching and
commerce in urban centers.
The Centre is situated in a geographical location with good accessibility. It is
opened to the entire educational community that is supposed to cover and, among
other duties, aims to respond appropriately to the specific needs of the pupils in a
personalized way, with the support of qualified staff and special equipment and
adapted materials. The target population consists of all pupils with permanent

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limitations regarding activity and participation in one or more life areas, due to
functional and structural body alterations, resulting in permanent difficulties in
communicating and learning and limitations in mobility, autonomy, interpersonal
and social participation, from Early Childhood through Secondary Education.
The team that conducted the study consists of two teachers working at the CRTIC
Chaves - Maria Adalgisa Ferreira da Silva Babo and Joaquim Virgílio Perfeito
Ribeiro, both specialized in the field of mental / motor disability, with a career of
over 25 years in special education.
The teachers have technical skills that allows them to handle and advise the use of
assistive technology and assess pupils’ needs in different contexts.
Institution where the case study was conducted
Schools Cluster Gomes Monteiro – Primary School of Boticas.
Date (beginning and end of case study)
From 12th January to 23rd May
Period of observation (beginning and end)
From 1st April to 23rd May 2013
Pupil’s age
Cristiana is 8 years old
Context
The Primary School (Schools Cluster Gomes Monteiro) is situated in the village of Boticas.
The municipality of Boticas is located in the North of Portugal, in the province of Trás-os-
Montes, Vila Real district, Alto Tras-os-Montes. It is also part of the Municipalities
Association of Alto Tamega (AMAT).

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It extends as far as 322.41 km2 and has about 5,750 inhabitants (census 2011).
This school serves the whole municipality and is installed in a recent building, 12 years in
operation.
The total number of students is about 420, distributed by school years, from grade 1 up to
9 years of compulsory schoolingi.
About 16% of the population of the municipality has not completed compulsory education,
46% have primary schooling, 11% have the 2nd cycle of basic education and 10% have the
3rd cycle. About 10% have secondary education, attended in the town of Chaves at a
distance of 25 kilometers from the village of Boticas.
OBJECTIVES (general and specific objectives)
The main purpose is to assess the impact of using assistive technology for reading and
writing by a pupil with tetraparesis, neuromuscular problems of unknown etiology.
The objectives are:
To observe the interaction of the student with assistive devices;
To verify the best use of devices supporting the teaching / learning process;
To check the need for more effective devices
Bibliography and references
ABC.MED.BR, 2013. Tetraplegia: o que é? Quais as causas e os sintomas? Como é o
tratamento? Disponível em: <http://www.abc.med.br/p/348064/tetraplegia-o-que-e-
quais-as-causas-e-os-sintomas-como-e-o-tratamento.htm>.
Ainscow, M. (1997). Educação para todos: torná-la uma realidade. In Caminhos para as
escolas inclusivas, pp. 11-31. Lisboa: Instituto de Inovação Educacional.
Barthorpe, T. (1989). Curriculum accesses for all. Ed. Mike Hinson-Longman
Batshaw, Mark L.; PERRET, Yvonne M.; “ Criança com Deficiência – Uma Orientação
Médica“; 1ª Edição, 1990, Livraria Santos Editora
Bautista, Rafael, et al; “Necessidades Educativas Especiais”; 1ª Edição, 1997, DINALIVRO.
Crespo, Alexandra et al; “ Educação Especial - Manual de Apoio à Prática”, 2008, Ministério
da educação – DGIDC

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Pereira, Filomena;“ Educação Inclusiva da Retórica à Prática – Resultados do plano de Ação
2005 - 2009”, 2009, DGIDC e DSEEASE
Stainback, S.; Stainback, W.; Jackson, J.H. (1999). Hacia las aulas inclusivas. In Susan
William (Coord.), Aulas Inclusivas. Madrid: Narcea Editores
Decreto-Lei nº 3/2008, de 7 de janeiro
Classificação Internacional da Funcionalidade, Incapacidade e de Saúde- CIF-CJ
http://moodle.dgidc.min-edu.pt/
http://www.dgidc.min-edu.pt/educacaoespecial/index.php?s=directorio&pid=58
Methodology and tools
The methodology followed the case study approach , a descriptive study focused on a
pupil. It used different tools to analyze the case:
- Document analysis
- Comments
- Meetings
- Interviews with SEN teacher, class teacher, mother
- Video recording in school
Pupil’s Functioning Profile
According to medical report, Cristiana has a neuromuscular disease of unknown etiology.
She was subjected to tracheotomy since neonatal period, requiring mechanical ventilation.
The mobility is severely affected, she moves in a wheelchair, with pad positioning and
stabilization.
She presents serious difficulty in the respiratory system, specifically the breathing
function (b440.3)ii
With regard to the neuromuscular skeletal functions, the child has the mobility impaired,
presenting a severe dysfunction of mobility of the joints and bones (b710.3), control of
voluntary movement (b760.3), involuntary movement functions (b765.3) and sensations
related to muscles and movement (b 780.3) - also presents severe disability in functions
related to muscle power (b730.3), muscle tone (b735.3), muscle endurance (b740.3),
motor reflexes (b750.3) gait pattern dysfunction (b770.4).

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She has serious difficulty in changing the basic positions of the body (d410.3) and
maintaining body position (d415.3). She reveals difficulty in performing tasks such as
lifting and carrying objects (d430.2), and difficulty in moving objects with lower limbs
(d435.4) has severe difficulty in performing fine motor activities with the hands (d 440.3)
and is not capable of using the foot (d446.4), floor (d450.4) and move (d455.3).
This condition affects seriously her activity and participation, limiting it to general tasks
and requirements. She presents a moderate deficit in carrying out multiple tasks (d220.2),
to carry out the daily routine (d230.2), and a slight deficit in performing simple tasks
(d210.1).
Regarding self-care, the pupil has a hard time taking care of her body parts (d520.3) to
wash or dry up (d510.3).
She has difficulties to perform tasks and coordinate gestures to dress up (d540.3), eating
(d550.2), drinking (d560.1) and cannot take care of her own safety (d571.3).
The pupil requires continued support by an adult to perform the tasks, since all areas of
her behavior are compromised. She performs learning activities using a computer, yet
reveals tiredness in their realization, particularly in literacy and numeracy. She expresses
difficulty in concentrating, paying and maintaining attention to problems, distracting
herself for no apparent reason (d160.2).
She reveals slight difficulty in solving simple problems (d175.1) due to impaired judgment
and concentration. Unrelated data provided in order to find possible solutions to the
resolution. She has difficulties in formulating and sorting ideas, concepts and images. Due
to her muscle problem, she has great difficulties in manipulating objects for learning
(d131.2). She is not able to write independently with the help of computer (d145.1).
Reveals uncertainty in knowledge and always needs guidance from the teacher.
Her mother shows great concern and attention in monitoring her school and social life.
Schoolfellows also act as facilitators (e325.2). She is well accepted by peers, they include
her in games and are always available to help.
Educational Measures
Based on this assessment CRTIC Chaves has recommended the following educational
measures in the framework of Decree-Law No. 3/2008 of 7 January, to be implemented:
a) Article 17 - Personalized Pedagogical Support

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Strategies reinforcement to develop together with the student in her group / class,
in the organization of space and activities:
o the same classroom for all subjects (except PE/Gym);
o organization of the space of the classroom, adequate positioning of the
pupil, close to the whiteboard;
o use of adapted desk to prevent incorrect postures;
o use of whiteboard in the classroom.
Skills reinforcement to develop a SEN specific program shared with the family:
o program to develop skills in the use of assistive technology, encouraging its
use and daily application in different contexts.
b) Article 18 - Individual Curricular Adaptations
Exemption of activity proved difficult to implement due to pupil’s disability
c) Article 20 - Adaptations in the assessment process
Change of type of test:
o delivery of assessment tools in digital format made available in the pupil’s
computer
Assessment tools:
o oral participation, worksheets, summative tests, formative records, team
work and other evaluation tools specific to different subjects.
Assessment terms:
o promotion of oral assessment;
o Office software use to record and evaluate in digital format;
o extending testing time and exams, 30 minutes extra and in a separate
room.
d) Article 22 - Assistive Technologies
o Use of assistive technology in different contexts in daily life:
• personal computer laptop;
• kids keyboard;
• kidtrack;
• adapted desk.

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Teaching Methodology
The SEN teacher supports class teacher reinforcing writing and reading skills in the use of
special software, namely «Aventuras II» as well as Office software (Word).
Aventuras II allows every pupil to use its own workbook. Contents produced by the pupil
are added as evidence of what the pupil learns. The pupil writes sentences, expressions or
words, adds images, photos or drawings, illustrates words with drawings associating
them, divides sentences. Pupils can record their own voice associating text and image.
This software helps to improve language skills, since it includes portuguese texts for
reading practice and many proverbs. It includes ready-made thematic workbooks, but the
teacher also produces some thematic contents so that the pupils may explore and learn.
The software has 5 educational games; (i) spider game which connects words to images;
(ii) ant game which produces words with two syllables; (iii) bee game which produces
words with 3 syllables; (iv) monkey game which stimulates to write names corresponding
to images, with audio feature; (v) cat game to order elements of a sentence or phrase.
Teachers promote the use of assistive technology recommended by CRTIC, stimulating its
daily use in different contexts, either at school or at home.
Tests are adapted to digital format suitable to Cristiana’s needs, so that equal
opportunities with peers are guaranteed.
The SEN teacher gives support 3 days a week in the classroom to Cristiana.
Pedagogical situation
The muscle tone does not allow Cristiana to hold objects effectively and therefore
the use of the hand is seriously compromised, since it cannot hold a pencil, pen,
spoon, etc.. This condition affects school attendance since all handling,
conventional means of performing tasks is damaged (writing on paper, painting on
paper, book reading, editing / paper, etc.).
With regard to our assessment, held for the first time in 2010, we have tried
various peripherals for accessibility, since the conventional mouse at home in
family PC could not be manipulated by the child. She uses KidTrac, Joystick,
Helpijoy in free computer games. Yet none of these peripherals have the desired

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effect, as they require, apart from handling and coordination, some hand muscle
strength. We’ve experimented finally, IntelliKeys and this type of keyboard is the
most appropriate for the pupil, as it is flat and the student may exert pressure on
the keys using the entire surface of her hand. This device was used by the pupil to
introduce her to the computer.
Later on, in 2012, the characteristics of functionality of Cristiana led us to consider
that her performance in reading and writing might improve, if she used the
following devices, experimented during reassessment:
"Kids Keyboard" (Lifetech product): considering its bright colours and
larger size keys (than the conventional ones), for better distinction of
letters, numbers and symbols, which enables better learning, reading and
writing and is easy to use. The keys are sturdy and responsive to the fingers
of the child. It also has a USB connection and software plug-in);
"KidTRAC" mouse: trackball with shape and dimension that allows
adequate hand support. Very easy to use, connects to computer through a
USB port and starts running automatically).
The pupil uses these products with "Office" software. However, we have advised the use
of "Adventures II" software as well, also tested, since it can be used systematically and in
an organized way, used as individual workbook, a virtual environment for easy self-
correction.
The next step for a future reevaluation will take place when the pupil will have acquired
the reading and writing skills. Then, we’ll test the use of virtual keyboards with auto scan
and selection with a pressure switch.
Collaborators in the study
Pupil - Cristiana Borges Afonso
Parent - Anabela Borges Afonso
Class teacher - Rosária Moura Martins
SEN teacher - Maria Júlia Natividade

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Links (complementary to study)
Video of Cristiana in the classroom environment
https://dl.dropboxusercontent.com/u/28022157/CRTIC%20Chaves_Cristiana_Portugal_2013.
m2p
https://dl.dropboxusercontent.com/u/28022157/CRTIC%20Chaves_Cristiana_Portugal_2013.
wmv
https://dl.dropboxusercontent.com/u/28022157/CRTIC%20Chaves_Cristiana_Portugal_2013.
mov
http://youtu.be/Z4da8KMka60
Powerpoint (PT version) - http://www.slideshare.net/slideshow/embed_code/24837683
Powerpoint (EN version) - http://www.slideshare.net/idabrandao/case-study-se-
nnetchaves2013en
i
At present, compulsory schooling is 12 years in Portugal, from 5 years old (pre-school) to 18 years old,
stated by law in 2009 (Lei n.º 85/2009, de 27 de agosto)
ii
The International Classification of Functioning (ICF – Children and Youth) is adopted by SEN law in
Portugal, since 2008 (D.L. nº 3/2008, 7 de janeiro)