ALD Flashcards
Describe the social model
Society causes disability
The environment is not supportive
Removing barriers necessary
How would the social model aim to help people with Down syndrome
Remove barriers
Increase adaptations
Change perception
Describe the genetic differences in those with Down syndrome
Extra chromosome 21
94-96% trisomy 21
Translocation- 2-4% piece of 21 breaks off
Mosaicism- 1-2% additional chromosome but not in every cell
Prevalence of Down syndrome in LD
21%
Name some features of Down syndrome
50% have heart defect
75% have hearing loss
50% require glasses
LE- 50-60 years
With reference to literature describe first word use in people with Down syndrome
Berglund (2001)
- 80% children didn’t produce first word until 2
75% reached 50 word milestone by 5 yrs
What is the difference in performance in children with Down syndrome in grammar
Poorer in receptive grammar
Perform similarly to children with Williams syndrome on receptive grammar (just LD?)
Perform differently on expressive grammar
Vicari (2000) children with Down syndrome produce shorter MLU and make more errors
Down syndrome evidence by Vicari (2000)
Poorer grammar than vocabulary
Shorter mean length utterances
Speech features in Down syndrome
Slower to develop
Different pattern of errors
Phonological loop poorer
Poorer language may be linked to poorer auditory skills?
When hearing a word, semantic, phonological and articulatory information not stored
Discuss stammering in Down syndrome
Common
Awareness may fade quicker
Communication system under stress
What is important to consider when working with people with Down syndrome
Use salient materials- things that interest them
Errorless learning- allowing success- increase self esteem
Meaningful outcomes- functional skills
What are the personal, environmental and social factors to consider when working with people with challenging behaviour
Personal- characteristics- mental health?
Environmental- staff training? How are they being supported?
Social- who do they communicate with? How?
Describe the heirarchy of needs
Maslow (1943) Physiological Safety Love/ belonging Esteem Self actualisation- morality, spontaneity
What are slow and fast triggers?
Slow- didn’t happen immediately before event- eg tired
Fast- immediately before- eg being told you aren’t allowed to do something
What are the 5 good communication standards?
- how best to communicate
- services support individual with communication
- staff value and use best approaches to communication
- service creates opportunity that make individuals want to communicate
- individuals supported to understand and express needs
What is involved in a care plan when working on behaviour support
Contributions from all MDT and patients
How to manage triggers
How to improve QoL to reduce frequency of behaviours
What to look for in assessment when looking at behaviour management?
History Physical and mental health Observations Comprehension? Communication environment? How do they communicate?
Define PMLD
Have profound intellectual disability Have more than one disability - eg impairment of vision - physical impairment - complex health needs
Features of PMLD
Severely limited understanding
Typically non verbal
High level of support needed
What is the mental capacity act, date?
2005
States every person over 16 has capacity to make own decisions unless proven otherwise
What is looked at in the assessment of capacity?
Impairment in the functioning of the mind
Understand all relevant information
Consider all options
Communicate decision
Is capacity the same for every decision
No capacity is decision specific
Every effort must be made to make the information meaningful before lack of capacity is deemed
What is the SLT role in supporting comprehension for capacity
Do they understand spoken/written word
Could information be made meaningful with photos/ symbols?
What is Accessible information standards?
2016
People with disability must be provided with information they can easily read/ understand
Service providers must
-identify information and communication needs
- record “”
-share “”
- meet “”
What is DisDat?
Disability distress assessment tool
- identifies distress cues
- a means of providing a clearer picture of an individuals language of distress
What is a communication dictionary
a dictionary of how that individual expresses a word/concept
Eg with photos of facial expressions
Give some fundamentals of communication that are used in intensive interaction
- sharing personal space
- exchanging eye contact
- exchanging vocalisations
- physical contacts
- enjoying being with another person
Observable outcomes of intensive interaction
Increased social initiation Increased tolerance of physical proximity Increased eye contact Increased vocalisations Improved joint attention
Discuss Firths dual aspect model
2008
Shows initial rapid expansion in sociability and communication
Then plateauing but longer term acquisition
What is the tiered model of health and social care
1- capability in community
2- capability in mainstream
3- capability in specialist services
4- specialist interventions
What does a CPA coordinator do?
Coordinates care
Knows what all MDT are doing with individual
Name an assessment that is standardised for LD
CASP
Communication assessment profile
What are communication passports and communication books?
Communication passport- key information about individual in easy read format for other professionals
Communication book- represent words and sentences with symbols and pictures
What aids can SLTs put in place for ALD
Objects of reference Communication book Visual timetables First/next Talking mats
What are talking mats?
Topic
Options
Visual scale
Allows a conversation around chosen topic
Key drivers - level 1
Death by indifference- 2007
Healthcare for all - 2008
Valuing people now - 2009 (making information accessible)
Key drivers level 2
Death by indifference 2007
CIPOLD 2013
(Gov response was to put 18 recommendations in place for health and social care)
What is Death by Indifference
Supports that there is institutional discrimination within NHS. That people with LD get worse healthcare
What were the CIPOLD findings?
- PWLD seen as low priority
- little understanding around LD
- do not properly consult family
- rely on estimates of QoL
- complaints system ineffective
5 steps of Accessible Information Standard 2016
- ask if they have communication needs
- record those needs
- flag the persons file and explain
- share information with other NHS professionals
- meet the communication needs
What level 3 interventions can be put in place
- staff training
- positive behaviour support
- service development
- changing of environment
Level 3 key drivers?
Winterbourne View (2012)
Diagnostic criteria for LD
IQ < 70
2 limitations of adaptive functioning
What did Watling 2011 find
People with LD at risk of digital exclusion
Discuss matching the individual to the technology
Scherer 1995 Look at - functional needs - gender/ age - environments of use - cost - cultural factors - physical factors
What physical factors need to be considered when planning assistive technology
- spasms?
- fatigue?
- posture?
What environmental factors need to be considered when planning assistive technology?
Lighting? Funding? Noise Daily routine Can they do it independently
Name some types of technological support that can be offered
Text to speak
Audio description
Easy read (large print)
Mounting to wheelchairs
Environmental control eg blinds
Benefits of assistive technology
Social interaction enriched
self determination
Self representation
Social inclusion - dating? Reduced isolation
Barriers with assistive technology?
Lack of funding
Lack of awareness as to what is available
Individual characteristics- eg lack of literacy
Online safety
Website design complexity
