intellectual impairment Flashcards

1
Q

what is a learning disability

A
  • is a reduced intellectual ability and difficulty with everyday activities
  • can be intellectual, but also levels of self-care and levels of understanding
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2
Q

what does intellectual disability involve problems with

A
  • general mental abilities that affect functioning in 2 areas
  • intellectual functioning = such as learning, problem solving
  • adaptive functioning = activities of daily life such as communication and independent living
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3
Q

how much of the population does intellectual disability affect

A
  • 1%
  • and of those 85% have mild intellectual disability
  • males more likely
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4
Q

what is the difference between learning difficulty and learning disability

A
  • difficulty is something like dyslexia

- very different to disability

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5
Q

what is eugenics

A
  • a philosophical and social movement which sought to improve the human race
  • basically a principle whereby we improve the human race by removing those who are not good
  • eugenic = well born
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6
Q

what is positive eugenics

A
  • encouraging those with ‘desirable traits’ to reproduce more
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7
Q

what is negative eugenics

A
  • discouraging those with ‘undesirable traits’ to reproduce less
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8
Q

what is Lennox hospital

A
  • opened in 1936
    • Number of atrocious acts that are speculated to have taken palce here
    • Those with impairment or disability were taken away from society and taken to this hospital where they were attempted to be corrected
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9
Q

what led to the closure of these institutions

A
  • the concept of normalisation, reinforced by legislation
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10
Q

what is the different between impairment and disability

A
  • impairment = any loss or abnormality of psychological, physiological or anatomic structure or function
  • disability = any restriction or lack of ability to perform an activity in the manner or within the range considered normal for a human being
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11
Q

what does the WHO describe impairment and disability as

A
  • impairment = problem in body function or structure

- disability = an umbrella term, covering impairments, activity limitations, and participation restrictions

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12
Q

what is the social model of disability

A
  • Disability is caused by the way society is organised, rather than by a person’s impairment or difference
  • Social organisation (for example, work practices, buildings or products) that takes little or no account of people who have impairments and/or
  • Social organisation that creates segregated and second-rate provision (for example, segregated welfare provision, transport, employment, education and leisure facilities)
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13
Q

what is the medical model of disability

A
  • The medical model of disability says people are disabled by their impairments or differences
  • Under the medical model, these impairments or differences should be ‘fixed’ or changed by medical and other treatments
  • Healthcare practices partly responsible
  • Saying they have a problem, and are going to fix it
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14
Q

what are barriers to social model

A
  • segregated social prevision
  • inflexible organisational procedure and practises
  • inaccessible information
  • inaccessible buildings
  • inaccessible transport
  • negative cultural representations
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15
Q

what are the heredity causes of a preconception learning disability

A
  • parental genotype
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16
Q

what is the environmental cause of preconception learning disability

A
  • maternal health
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17
Q

what is the heredity cause of pre-natal learning disability

A
  • chromosomal

- genetic

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18
Q

what is the environmental cause of pre-natal learning disability

A
  • infection
  • maternal health
  • nutrition
  • toxic agents
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19
Q

what are the environmental causes or perinatal learning disability

A
  • prematurity

- injury

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20
Q

what are the heredity causes of postnatal learning disability

A
  • untreated genetic disorders
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21
Q

what are the environmental causes of postnatal learning disability

A
  • infection
  • trauma
  • toxic agents
  • nutrition
  • sensory social deprivation
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22
Q

what is the association between ASD and learning disability

A
  • not everyone with ASD has a learning disability, there is an association however
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23
Q

what syndromes can be associated with a learning disability

A
  • autistic spectrum disorders
  • downs syndrome
  • cerebral palsy
  • fragiel X syndrome
  • prader willis
  • PKU
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24
Q

what is Down syndrome

A
  • neurodevelopment disorder of the genetic origin affecting chromosome 21
  • most commonly it is due to full trisomy of chromosome 21 (95%)
  • small number of cases it is due to mosaicism
  • ## occurs in 1 in 700 births
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25
what has resulted in less DS births
- antenatal screening and subsequent termination
26
what is the greatest risk factor for DS
- advanced maternal age - women over the ager of 35 are more likely to have a child with DS with the risk continuing to increase with advancing age
27
what are the medical features of DS
- congenital heart diseae - alzheimers dementia - epilepsy - leukaemia - hearing impairments - diabetes mellitus - coeliac disease - thyroid disease - intellectual impairment
28
what dental disease can be associated with DS
- oral hygiene - oral function - impaired migration of gingival fibroblasts - saliva - periodontal pathogens - immune system related factors - impaired neutrophil chemotaxis
29
what is cerebral palsy
- 1 in 400 affected - neurological conditions that affect movement and co-ordination - muscle stiffness or floppiness = hypotonia - muscle weakness - random and uncontrolled body movements - balance and co-ordination problems - defined by movement, limbs affected or severity
30
what is Prader Willis
- chromosome 15 - 1 in 15,000 affected - constant desire to eat food = never full, link from brain to stomach not working so don't feel full - restricted growth, leading to short stature - reduced muscle tone = hypotonia - learning difficulties - lack of sexual development - behavioural problems, such as temper tantrums or stubbornness
31
what are the berries to oral healthcare
- user/carer - professional service providers - physical barriers - cultural issues
32
in what families is learning disability more common
- those of a lower socioeconomic status
33
what are the benefits of primary care access
- proximity, - relationships may already be established - family members may attend practice
34
what are some specialist services
- special care dentistry - blend of services necessary - risk of neglect of care if mainstreaming - referral - complex cases = SCD - advice
35
how can we prepare for patient coming into surgery
- social stories = pictures, prepare patient before they come in - hospital/health passport = good to get information before you even have patient into surgery - pre-visit = scout the place - multiple visits with slow progress - liaise with community disability nurse/team for help w
36
when is best for patients to come to surgery
- start of a session | - don't be late for them as can cause stress
37
what ar key points about verbal communication
- speak naturally and clearly - ask to repeat information - ask yes or no questions - don't lead patient responses - allow enough time to communicate with your patient - don't interrupt or finish patient's sentences
38
what are some adjuncts to communication
- makaton - picture boards - letter boards - talking mats - draw - write
39
how can you create the right atmosphere for the patient
- non-threatening environment - friendly - acclimatise - consider augmentative techniques
40
what can help you get access to the mouth
- Bedi sheild = made of plastic and put finger to get patient to open mouth and then patient bites down on it, bu they are known to fracture - open wide mouth rests = patient opens mouth and place it in horizontal then turn it vertical to get wider open = less likely to break
41
what is clinical holding
- considered if other techniques fail - should only take place if patient consents - always record in notes and justify - is a form of restraint and needs to be scrutinised fully - controversial subject
42
what needs to be known about medical history
- a diagnosis? - medical conditions = epilepsy, psychiatric conditions, congenital defect in other systems - liaise with other colleagues
43
what needs to be known about social history
- living arrangement - support - transport - likes/dislikes
44
what are risk factors for oral health for patients with learning disability
- poor motor control - imbrication of teeth - lack of cleansing - pouching and limits food clearance - mouth breathing - reduced saliva - medications - rewarding = less common now
45
how can treatment complexity be influenced
- by the severity of the learning disability
46
what prevention can be used
- toothpastes = need to be careful they won't eat the toothpaste - toothbrush advice
47
what is self-injurious behaviour
- self-biting or hands, arms, lips and tongue
48
what can self-injurious behaviour be linked to sometimes
- cerebral palsy - autism - tourettes - leach-Nyan syndrome - profound neuro-disability - exaggerated or abnormal oral reflex, habit, pain and/or frustrations
49
what are some treatment strategies for SIB
- symptomatic relief - reassurance - distraction - pharmacological Treatment - behavioural psychology such as positive reinforcement - construction of oral appliances - extraction of specific anterior teeth, but that could transfer the SIB to another area of the mouth - orthognathic surgery to create an open bite and prevent SIB
50
how can drooling happen
- difficulty moving saliva to the back of the throat - poor mouth closure - jaw instability - tongue thrusting - increased saliva production is very rare
51
how can you treat bruxism/NCTSL
- construction of splints may be helpful but their success is dependent on patient compliance - an opinion should be sought from an appropriate dental specialist if required
52
what is some advice for erosion
- fluoride mouthwash unless there are swelling difficulties - toothpaste which is low in abrasion, low acidity, high fluoride - brushing should be delayed for at least one hour after consuming acidic food or drink - professional application of varnish - dentine bonding agents - referral to an appropriate dental specialist - reduce or eliminate intake of carbonated and acidic drinks and acidic fruits - chew sugar-free gum, suck a sugar-free sweet
53
what can be done for dry mouth
- saliva replacment - the use of sugar-free chewing gum and sugar-free fluid is advised - the mouth should be examined regularly - fluoride rinses or high fluoride containing toothpaste are advised
54
what can be done for feeding problems
* Individual assessment should be carried out * Good oral hygiene should be promoted * An intensive regime should be followed to prevent oral disease * A multi-professional approach is advised * A low foaming toothpaste is recommended * The use of a suction toothbrush can be of benefit * Therapy should be carried out to try and reduce oral defensiveness * If the mouth is healthy, then we know that is they do aspirate, they are less likely to get pneumonia
55
what can be given to alter diet
- thickeners and taster
56
what do thickeners do
- make food easier to swallow to prevent aspiration
57
what are some tasters
- honey, jam, chocolate
58
what needs to be considered if thinking about using LA
- ability to cooperate - volume of treatment - type of treatment - behavioural techniques and patient management
59
what is good about conscious sedation
- reduces fear and anxiety, augmenting pain control - more flexible than GA = less risk with it - available in primary care
60
what is a problem about conscious sedation
- need for IV access - need to maintain airway - keep breathing - level of understanding is necessary
61
what are the pros of using GA
- comprehensive care - potentially more controllable environment if medical diseaes - opportunity for joint working - aftercare and monitoring
62
what are the cons of using GA
- risk of death, brain damage - need support for 24 hours after - organisation of procedure - complex restorative dental treatment - teeth of dubious prognosis removed - difficult working environment - no improvement in coping mechanism
63
what are the indications of using GA
- a clear inability to co-operate with the provision of dental care using other patient management techniques
64
what does GA require
* Systematic assessment - Full History and Consent * Ideally seen by the dentist who will perform GA * Anaesthetist assessment prior to treatment session * Admissions Protocol * Treatment – what is possible under GA? * Post op – medical issues in/out patient, someone to look after them
65
what is the 3 fold role of dental practitioner
- recognise = identify adult at risk - respond = mange the acute situation and inform other services as required - record = document and report in detail the information obtained