This chapter discusses the use of concrete and virtual manipulatives to support the teaching and assessment of mathematics for students with visual impairment (VI), intellectual disability (ID), Autism Spectrum Disorder (ASD), and multiple disabilities (MD). Grounded in research on mathematics education and assistive technology, it emphasizes the importance of accessible and practical resources to promote conceptual understanding and mathematical literacy. The chapter presents a variety of physical manipulatives, including adapted fractional circles, the “Easy Build®” toy, Cuisenaire rods, the Golden Material, geoplane, multiplane, abacus, geometric solids, Platonic solids, and modeling clay. Many of these materials were originally designed or adapted for students with VI, incorporating tactile and visual features, but are also applicable to students with other disabilities when guided by a teacher acting as a mediator. Furthermore, the chapter highlights virtual manipulable materials and assistive technologies, such as Monet software and online platforms, which offer interactive and customizable alternatives to traditional materials. These digital tools can enhance independence, engagement, and accessibility. Overall, the integration of concrete and virtual resources, combined with intentional teacher mediation, contributes to more inclusive mathematics education and promotes equitable learning opportunities for diverse students.