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10 - Rehabilitation > 10-16 Mental Retardation (including Down's Syndrome) > Flashcards

10-16 Mental Retardation (including Down's Syndrome) Flashcards

1
Q

Definition of Mental Retardation (MR)

A
  • Limitations in both intellectual and adaptive skills
  • Occurs before 18 yo
  • Sub average intellect along with at least limitations in at least 2 skills
  • 1/2 of population with MR diagnosed
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2
Q

Adaptive Skills affected by MR

A
  • Communication
  • Self-care
  • Home living
  • Social/interpersonal skills
  • Use of community resources
  • Self-direction
  • Health and safety
  • Functional academic skills
  • Leisure
  • Work
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3
Q

MR impairments

A
  • Neuro-muscular
  • Musculoskeletal
  • Developmental
  • Cognitive
  • Affective
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4
Q

MR Medical Classifications

A
  • Mild: IQ 50-55 to 70
  • Moderate: IQ 35-40 to 50-55
  • Severe: IQ 20-25 to 35-40
  • Profound: IQ Below 20-25
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5
Q

MR Etiologies

A
  • Over 350 etiologies for intellectual disabilities
  • Prenatal Onset: Chromosomal, Syndrome, Inborn errors of metabolism, Developmental disorders of brain formation, Environmental influences
  • Perinatal Onset: Intrauterine, Neonatal
  • Postnatal Onset: Head injuries, Infections, Demyelinating, Degenerative, Seizure, Toxic-Metabolic, Malnutrition, Environmental deprivation
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6
Q

MR Learning impairments

A
  • Impaired ability to:
  • Utilize advanced cog processes
  • Manage dual-tasking or multi-tasking
  • Organization of complex info
  • Task performance and task mastery
  • Function in different environments in ways to get them to function better
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7
Q

Piaget’s Theory of Intellectual Development

A
  • Attempts to explain normal and abnormal intellectual development
  • 4 stages of developmental process: Sensimotor (0-18 mo), Preoperative (2-7 yrs), Concrete (7-12 yrs), Formal operations (12 yrs and older)
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8
Q

Piaget - Sensimotor stage

A
  • 0-18 mo
  • Learn primarily through exploring senses, movements
  • Discoveries made through trial and error (experimentation)
  • Manipulate environment with strategies that create new understandings = accomodations
  • Severe MR will not progress past stage, will continue discovery stage
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9
Q

Piaget - Preoperative stage

A
  • 2-7 yo
  • Development of language
  • Beginning of abstract thought
  • Use of symbols for objects: Group, classify objects
  • Moderate IQ 35-55, may not develop beyond this stage
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10
Q

Piaget - Concrete stage

A
  • 7-12 yo
  • Ability to order, classify, relate experience to an organized whole
  • Increase problem solving
  • Recognize another person’s point of view
  • Mild IQ - Cannot progress beyond this stage
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11
Q

Piaget - Formal operations stage

A
  • 12 yo and older
  • Ability to reason and hypothesize
  • Child with MR seldom reaches this stage
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12
Q

MR Interventions

A
  • Basic general strategy: FUNCTION
  • Use concrete and more meaningful directions since MR less likely to get abstract concepts
  • Ex: Balance Bear - Works on balance, Holding toys, cups, etc. - Works on grasping/holding
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13
Q

MR Focused Intervention

A
  • Multi-modal teaching: Children learn best

- Plan, Present, Picture, Practice, Perform

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14
Q

MR Focused Interventions (5)

A
  • PLAN procedures for learning in specific, discrete steps (simplify)
  • PRESENT tasks in ways that are understood by child (consider special comm needs)
  • PICTURE of the task to be performed (Ex: Pics of skill, stick figures, Step-by-step process with PTA modeling task)
  • PRACTICE guiding child through steps of task (may use hand-over-hand technique)
  • PERFORM: Have child perform the task
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15
Q

MR: Visual Deficits

A
  • Abilities to ORIENT TO, FOCUS ON, TRACK (horizontal/vertical) visual stimulation
  • Postural improvements can sometimes improve visual
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16
Q

MR: Auditory

A
  • Possible responses to auditory stimulus: No response, simple orientation, movement toward, startle response
  • Auditory response includes types of loss: conduction (Eardrum), sensorineural (How brain interprets what is heard and whether it can be recognized)
17
Q

MR: Tactile

A
  • Tactile defensive (aversion to touch)
  • Aversive response to certain stimuli
  • Avoidance reactions of hands, feet, face (turn away)
  • Seen in children with hyperactivity or distractibility
  • Affects exploration of environment and learning
  • Compensatory behavior: labile, threatened, unable to cope, withdrawn, irritable, distractible
  • Interventions: Focus on tactile and proprioceptive systems; heavy touch, pressure, WB, avoid light touch and tickling
18
Q

MR: Vestibular System

A
  • Vestibular system has strong effect on MUSCLE TONE and MOVEMENT (affects what speed and direction we move)
  • Interventions/Goals:
  • Various movements
  • Improve balance
  • Activate muscle contraction
  • Promote awareness and eye contact
  • Increase spatial awareness and perception
  • Swings, barrels, scooter boards are good because all use movement stimuli
19
Q

MR: Self-Stimulation

A
  • Area of concern, especially for self-abuse (ex: constant mouthing of objects or hand, spinning, head banging, etc.)
  • Reasons: Fulfill basic sensory needs, reaction to overstimulation (frustration, inability to cope with sensory overload)
    Intervention: If discouraged, must substitute another appropriate sensory input
20
Q

MR: Memory

A
  • Repetition overcomes STM
  • Enhance LTM (strength of children with MR)
  • General strategies to compensate memory deficits: Practice, Review, Over-learning
21
Q

MR: Transfer of Learning

A
  • Ability to apply newly learned info to new situations (concrete stage)
  • Focus on meaningful interventions and situations: Easier to learn, easier to transfer
22
Q

Down’s Syndrome

A
  • Chromosomal disorder
  • Commonly called Trisomy 21
  • 47 chromosomes instead of 46
23
Q

Down’s: Associated pathologies

A
  • Cognitive impairments
  • Neuro-motor
  • Musculoskeletal
  • Cardiopulmonary
  • Visual deficits
  • Hearing deficits
  • Seizure disorders
  • Speech deficits
24
Q

Down’s: Musculoskeletal

A
  • Short stature
  • Hypotonia
  • Small hands and feet
  • Ligamentous laxity (due to collagen deficit): Pes planus (Flat feet), Patellar instability, Scoliosis (52%) Atlanto-axial instability (risk of atlantoaxial dislocation due to odontoid ligament laxity), Hip subluxation
25
Q

Down’s: Other physical characteristics

A
  • Bradycephaly = flattened back of head
  • Large fontanels (soft spot of skull)
  • Flat contour of face (underdeveloped facial bones, depressed nasal bridge, narrow nasal openings|)
  • Slightly slanted eyes
  • Umbilical hernia (90%)
  • Delayed integration of primitive reflexes
  • Single crease in palm of one or both hands
  • Wide space between 1st and 2nd toes
26
Q

Down’s: Interventions

A
  • Align compression and WB forces to stimulate longitudinal bone growth
  • Align WB support to promote jt stability and formation
  • Facilitate normal co-contraction, force production and increased muscle tone
27
Q

Down’s: Health promotion

A
  • Screen for scoliosis
  • Emphasize physical fitness to increase cardiopulmonary endurance and muscular strength
  • Encourage lifetime commitment to wellness
28
Q

Down’s: Precautions

A
  • Consider: hypotonia, ligamentous laxity, C1-C2 instability

- Avoid: Exaggerated neck flexion, extension. rotation, undue forces; contact sports; gymnastics

10 - Rehabilitation (25 decks)

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