Chapter 18: Cognitive & Sensory Impairment Flashcards
What is a cognitive impairment?
any type of mental difficulty or deficiency
What is the outdated name for intellectual disability? What are the 3 components of intellectual disability?
- intellectual disability FKA mental retardation
- 3 components:
1. intellectual function = IQ < 70 - 75
2. functional strengths and weaknesses
3. age younger than 18 at time of diagnosis
What is a developmental disability? What are the 3 components?
- developmental disability: any delay or lag in a child meeting their milestones
- 3 components:
1. physical
2. cognitive
3. social
What are some examples of early behavioral signs of cognitive impairment?
- no response to eye contact, voice, or movement
- irritability
- poor or slow feeding
- poor eye contact during feeding
- diminished spontaneous activity
– these are not diagnositc – these just help prompt us to take a closer look
What are some primary prevention strategies for cognitive impairment?
4 strategies
- support for preterm and high-risk infants
- rubella immunization
- genetic counseling
- maternal counseling
* folic acid supplements
* fetal alcohol syndrome
* lead exposure
What is Down syndrome? What causes Down syndrome? What are some characteristic physical features of Down syndrome?
6 characteristics
- AKA trisomy 21 – extra chromosome 21
- etiology is unknown but linked with increased incidents with advanced maternal age
- characteristics:
1. upward, slanted eyes
2. large forehead
3. flat nasal bridge
4. protruding tongue
5. hypotonia – not very strong muscles
6. mottled skin
What are some congential anomalies that result from Down syndrome?
6 anomalies
- heart defects – usually septal defects
- renal disorders
- Hirschsprung disease
- tracheoesophageal fistula
- altered immune function
- skeletal defects – atlantoaxial instability
What is fragile X syndrome? How is it passed down? What are some classic physical characteristics of fragile X syndrome?
13 characteristics
- fragile X: genetic disorder that results in a lack of production of the FMRP protein, which is needed for brain development
- X-linked dominant genetic inheritance – more common in males than females
- characteristics:
1. large head circumference
2. long face
3. prognathism – protrusion of mandible
4. large ears
5. long palpebral fissures
6. strabismus – crossed eyes
7. mitral valve prolapse
8. hypotonia
9. macroorchidism – increase of testicular volume by at least 2x for age
10. high, arched palate
11. hyperextensible finger joints
12. palmar crease
13. flat feet
What are some behavioral features of fragile X syndrome?
6 features
- mild to severe cognitive impairment
- delayed speech and language
- hyperactivity
- hypersensitivity
- autistic-like behaviors
- intolerance to a change in routine
How is fragile X syndrome therapeutically managed?
3 management
- administration of serotonin agents to help with behavior control
- administration of stimulants for hyperactivity (similar to those given for ADHD)
- administration of protein replacements or gene therapy
What is the difference between slight and profound hearing loss?
- slight to moderately severe hearing loss: residual hearing is enough to process linguistic information through use of hearing aid
- severe to profound hearing loss: processing of linguistic information is impossible with or without a hearing aid
What are some causes of hearing impairment?
7 causes
- anatomic malformation
- low birth weight
- ototoxic drugs
- chronic ear infections
- perinatal asphyxia
- perinatal infections
- cerebral palsy
Distinguish between conductive, sensorineural, and mixed conductive-sensorineural hearing loss? How they treated?
-
conductive: sound cannot pass through the outer and middle ear
– hearing aids help amplify noise -
sensorineural: inner ear damage that results in nerve deafness
– cochlear implants -
mixed conductive-sensorineural: damage to both inner and outer/middle ear
– this may be caused by recurrent otitis media with complications
What are some manifestations of hearing impairment in infancy?
4 manifestations
- lack of startle reflex
- absence of babbling by age 7 months
- general indifference to sound
- lack of response to the spoken word
What is the main concern with profound hearing impairment?
speech development
How can hearing impairment be prevented?
3 preventions
- treatment and management of recurrent otitis media
- prenatal preventive measures
- avoid exposure to noise pollution
What is considered a visual impairment?
visual loss that cannot be corrected with regular prescription lenses
Distinguish between partially sighted and legal blindness?
- partially sighted: acuity of 20/70 to 20/200
- legal blindness: acuity of 20/200 or less
What are some causes of visual impairments?
4 causes
- perinatal or postnatal infections – gonorrhea, chlamydia infection, rubella, syphilis, toxoplasmosis
- retinopathy of prematurity
- perinatal or postnatal trauma
- unknown causes
Why do we have to be cautious with medications when treating conjunctivitis in children?
- steroid eye drops may make eye infections worse and cause visual acuity problems
- systemic steroids cause immunosuppression which can cause acuity problems
How is visual acuity assessed in infancy and childhood?
- infancy:
1. check responses to visual stimuli
2. parental observations and concerns
3. expect binocularity after age 4 months - childhood:
1. visual acuity testing – Snellen charts (maybe not be letters depending on age; could be shapes, colors, pictures, etc.)
What are some preventions of visual impairment for children?
4 preventions
- prenatal care
- prevention of prematurity
- rubella immunizations
- safety counseling to prevent eye injuries
What is a retinoblastoma?
a congenital malignant tumor, arising from the retina
How is retinoblastoma diagnosed?
5 diagnostic indicators
- leucokoria – whitish “glow” in the pupil – most common sign
- strabismus – second most common sign
- red and painful eye
- glaucoma
- blindness – late sign
How are retinoblastomas treated?
- early-stage, unilateral tumor:
– irradiation
– cryotherapy
– attempt to preserve useful vision in affected eye - bilateral tumor:
– attempted to preserve useful vision in the least affected eye - advanced tumor:
– enucleation – removal of the eye from the orbit
– chemotherapy
What are autism spectrum disorders (ASDs)?
- complex neurodevelopmental disorders of brain function
- a wide range from mild to severe (high to low functioning)
- autistic disorder and Asperger syndrome are used almost interchangably
What are some theories regarding the causes of ASD?
- hereditary
- medical problems
- immune factors may increase incidence
- environmental factors may increase incidence
- high risk of recurrence in families
- higher incidence in males vs. females
- no supportive evidence links ASD to MMR vaccine or vaccines with thimerosal
What are the 4 diagnostic criteria for ASD?
- impairment in social interaction
- impairment in communication
- restrictive, repetitive, and stereotyped patterns of behavior, interests, and activities
- delays or abnormal functioning with onset before 3 years old
What are some ways to therapeutically manage ASD?
7 management
- no treatment – management therapies used instead
1. minimize input to prevent overstimulation
2. have familiar faces in the room
3. keep to a routine to minimize anxiety
4. behavior therapy
5. speech therapy
6. family counseling – alleviate parents’ feelings of guilt and shame
7. encourage home care for children
