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

Question 1

Definition of Mental Retardation (MR)

Answer 1

• 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

Question 2

Adaptive Skills affected by MR

Answer 2

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

Question 3

MR impairments

Answer 3

• Neuro-muscular
• Musculoskeletal
• Developmental
• Cognitive
• Affective

Question 4

MR Medical Classifications

Answer 4

• 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

Question 5

MR Etiologies

Answer 5

• 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

Question 6

MR Learning impairments

Answer 6

• 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

Question 7

Piaget’s Theory of Intellectual Development

Answer 7

• 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)

Question 8

Piaget - Sensimotor stage

Answer 8

• 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

Question 9

Piaget - Preoperative stage

Answer 9

• 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

Question 10

Piaget - Concrete stage

Answer 10

• 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

Question 11

Piaget - Formal operations stage

Answer 11

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

Question 12

MR Interventions

Answer 12

• 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

Question 13

MR Focused Intervention

Answer 13

• Multi-modal teaching: Children learn best

- Plan, Present, Picture, Practice, Perform

Question 14

MR Focused Interventions (5)

Answer 14

• 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

Question 15

MR: Visual Deficits

Answer 15

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

Question 16

MR: Auditory

Answer 16

• 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)

Question 17

MR: Tactile

Answer 17

• 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

Question 18

MR: Vestibular System

Answer 18

• 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

Question 19

MR: Self-Stimulation

Answer 19

• 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

Question 20

MR: Memory

Answer 20

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

Question 21

MR: Transfer of Learning

Answer 21

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

Question 22

Down’s Syndrome

Answer 22

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

Question 23

Down’s: Associated pathologies

Answer 23

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

Question 24

Down’s: Musculoskeletal

Answer 24

• 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

Question 25

Down’s: Other physical characteristics

Answer 25

• 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

Question 26

Down’s: Interventions

Answer 26

• 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

Question 27

Down’s: Health promotion

Answer 27

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

Question 28

Down’s: Precautions

Answer 28

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

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