Students with physical impairments often have difficulties with reading and writing skills. As a result, they are behind when compared to their non-disabled peers. This requires teachers of students with orthopedic impairments to know the obstacles that effect reading and writing instruction for their students. They also need to be able to use modifications, instructional strategies, computer software and assistive technology to meet their student's unique needs. Moreover, they must be able to identify a student's particular challenges in literacy instruction and work collaboratively with other personnel to ascertain that these issues are addressed. The following article discusses the barriers that students with physical impairments have in literacy instruction alone with a description of the Start-to-Finish Books and how they can be used to confront these difficulties, as well as be implemented into a language arts curriculum. "The Literacy Profile for Students with Physical Impairments, 2nd Edition" (Heller, 2003) is also introduced as a way to document student needs in literacy instruction and to facilitate collaboration among personnel to enable the Start-to-Finish Books to be utilized to their fullest extent. (Contains 4 tables.)