Intellectual Impairment (c) Flashcards

1
Q

Intellectual disability involves problems with general mental abilities that affect functioning in which 2 areas?

A

intellectual disability involves problems with general mental abilities that affect functioning in 2 areas:

  • intellectual functioning
    • learning, problem solving, judgement
  • adaptive functioning
    • activities of daily life such as communication and independent living
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2
Q

Who is more likely to be diagnosed with an intellectual disability - males or females?

A

males are more likely to be diagnosed with an intellectual disability than females

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3
Q

What learning disability labels are appropriate to use?

A

appropriate learning disability labels:

  • person with an intellectual impairment
  • person with a learning difficulty
  • person with a learning disability
  • person with additional care needs
  • person with additional support needs
  • person who requires special care
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4
Q

What is a problem in body function or structure known as?

A

an impairment is a problem in body function or structure

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5
Q

What is activity limitation?

A

activity limitation is a difficulty encountered by an individual in executing a task or action

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6
Q

What is participation restriction?

A

participation restriction is a problem experienced by an individual in involvement in life situations

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7
Q

What is the social model of disability?

A

the social model of disability is the theory that disability is caused by the way that society is organised, rather than by a person’s impairment or difference

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8
Q

The X model of disability is the thinking that disability is caused by the way that society is organised, rather than by a person’s disability or difference

A

X - social

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9
Q

What is the medical model of disability?

A

the medical model of disability is the thinking that people, are disabled by their medical impairments or differences

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10
Q

What are barriers to a social model of disability?

A

barriers to a social model of disability:

  • segregated social provision
  • inflexible organisational procedures and practices
  • inaccessible information
  • inaccessible buildings
  • inaccessible transport
  • negative cultural representations
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11
Q

Whta are causes of learning disability?

A

causes of learning disability:

  • pre-conception
    • hereditary - parental genotype
    • environmental - maternal health
  • pre-natal
    • hereditary - chromosomal, genetic
    • environmental - infection, maternal health, nutrition, toxic agents
  • peri-natal
    • environmental - prematurity, injury
  • post-natal
    • hereditary - untreated genetic disorders (PKU)
    • environmental - infection, trauma, toxic agents, nutrition, sensory social deprivation
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12
Q

What are examples of syndromes associated with learning disability?

A

syndromes associated with learning disability:

  • autistic spectrum disorders
  • Down’s Syndrome
  • cerebral palsy
  • fragile X syndrome
  • prader willi
  • PKU
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13
Q

Down’s Syndrome is a neurodevelopmental disorder of genetic origin affecting chromosome X

A

X - 21

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14
Q

What is the single greatest risk factor for Down’s Syndrome?

A

the single greatest risk factor for Down’s Syndrome is advanced maternal age

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15
Q

Women over the age of X are more likely to have a child with Down’s Syndrome and this risk continues with advancing age

A

X - 35

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16
Q

Prader Willi is a condition affecting which chromosome?

A

Prader Willi is a syndrome affecting chromosome 15

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17
Q

What is there a constant desire to do in people with Prader Willi?

A

with Prader Willi, there is a constant desire to eat food

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18
Q

With Prader Willi, there is X growth

A

X - restricted

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19
Q

With Prader Willi, what can be said about muscle tone?

A

with Prader Willi, there is reduced muscle tone (hypotonia)

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20
Q

With Prader Willi, there is a lack of X development

A

X - sexual

21
Q

With Prader Willi, what are common behavioural problems?

A

with Prader Willi, there are behavioural problems such as temper tantrums or stubborness

22
Q

What medical condition is being described?:

  • neurological condition affecting movement and coordination
  • muscle stiffness or floppiness (hypotonia)
  • muscle weakness
  • random and uncontrolled body movements
  • balance and coordination problems
A

cerebral palsy:

  • neurological condition affecting movement and coordination
  • muscle stiffness of floppiness (hypotonia)
  • muscle weakness
  • random and uncontorlled body problems
  • balance and coordination problems
23
Q

Learning disability is more common in families of X socioeconomic status

24
Q

What are the benefits of people with intellectual impairment accessing primary care services?

A

benefits of people with intellectual impairment accessing primary care services:

  • proximity usually good for transport
  • relationships may already have been established
  • family members may already attend the practice
  • longitudinal care - prevention and floow up
  • equal opportunity to services
25
What are steps to take to geting people with an intellectual impairment to your surgery?
getting a person with an intellectual impairment into the surgery: * preparation * social stories (autism) * hospital/health passport * pre-visit to scout the place out is a good idea * multiple visits with slow progress * liaise with community disability nurse/team for help
26
When a patient with intellectual impairment is attending for an appointment, you should limit their time spent in the **X**
X - waiting room
27
What are adjuncts to communication?
adjuncts to communication: * Makaton * picture boards * letter boards * talking mats * drawing * writing
28
What is the right environment when treating patients with intellectual impairment?
creating the right environment with patients with intellectual impairment: * non-threatening environment * friendly * acclimitise them to the environment with multiple visits * consider augmentive techniques such as relaxation and music * the environment can be fun - singing, laughing
29
What things should be kept in mind during the patient's first visit?
the patient's first visit: * find out what you can prior to the first visit * keep it simple * don't expect too much * build trust and relationships * sometimes managing to see inside the mouth is an achievement
30
What adjuncts can be used in the examination?
examination adjuncts: * bedi shield * open wide mouth rests * head support
31
When can clinical holding take place?
clinical holding should only take place if: * the patient consents * there is no capacity and it is deemed of benefit - the patient may present a safety risk to them self or others * unplanned emergencies, where a patient presents a significant risk
32
What should you obtain from the patient's social history?
social history: * living arrangements * support * transport * likes and dislikes
33
What may the complexity of treatment provided be influenced by in patients with intellectula impairment?
the complexity of treatment provided may be influenced by the **severity of the learning disability**
34
What are risk factors for oral disease in patients with intellectual impairment?
risk factors: * poor motor control * imbrication of teeth * lack of cleansing * pouching and limited food clearance * mouth breathing → reduced saliva * medications * rewarding - less common
35
What toothbrushing advice can be given for patients with intellectual impairment?
toothbrushing advice - patients with intellectual impairment: * pick a good time of day/night, when the patient is relaxed * wear gloves * stand behind the patient, slightly to one side of them * may vary according to what is comfortable for the patient and carer * adapted toothbrush may be useful * keep brushing systematic * encourage the person to do as much as possible
36
What is self-injurious behaviour?
self-injurious behaviour is **self biting** of hands, arms, lips and tongue
37
What are treatment strategies for self injurious behaviour?
treatment strategies for self injurious behaviour: * symptomatic relief * reassurance for patients, parents and carers with monitoring of the situation * distraction when this behaviour is observed * pharmacological treatment (haloperidol, diazepam, carbamazepine) * behavioural psychology such as positive reinforcement * construction of oral appliances * extraction of specific anterior teeth (although this may transfer the self-injurious behaviour to another area of the mouth rather than resolve the behaviour) * orthognathic (jaw) surgery to create an open bite and prevent self injurious biting
38
Construction of **X** in bruxism/NCTSL may be helpful
X - splints
39
What is appropriate erosion advice to give these patients?
erosio advice: * fluoride mouthwash unless there are swallowing difficulties * toothpaste which is low in abrasion, low acidity, high fluoride and anti-hypersensitivity * brushing should be delayed for at least one hour after consuming acidic foods or drinks * dentine bonding agents may be of value * referral to an appropriate dental specialist may be advised * reduce or eliminate intake of carbonated and acidic drinks and acidic fruits, or include these as part of meal times * chew sugar-free gum, suck a sugar-free lozenge or eat cheese after an acidic meal
40
What adjuncts can be helpful and advised in patients with dry mouths?
dry mouth: * saliva replacements * sugar-free chewing gum/fluids * fluoride rinses or high fluoride containing toothpastes
41
A low **X** toothpaste is recommended in patients with feeding problems
X - foaming
42
What are the aims of conscious sedation?
aims of conscious sedation: * reducing fear and anxiety * augmenting pain control * minimising movement * incraesing safety
43
What is more flexible, GA or conscious sedation?
**conscious sedation** is more flexible than GA
44
What kind of access is needed in conscious sedation?
**IV access** is needed in conscious sedation
45
What are the indications for GA?
indications for GA: * clear inability to co-operate with the provision of dental care using other patient management techniques including sedation * contraindications to the use of sedation
46
What are positives for general anaesthesia?
positives for general anaesthesia: * comprehensive care * potentially more controllable environment if there are medical diseases * opportunity for joint working * aftercare and monitoring - inpatient
47
What are negatives to general anaesthesia?
negatives to general anaesthesia: * risk of death or brian damage * need support for at leats 24 hours post-op * organisation of procedure * complex restorative dental treatment is not possible * teeth of dubious prognosis are removed to reduce the risk of future GAs being scheduled * difficult working environment * no improvement in coping mechanisms
48
The role of the dental practitioner in adult protection is three-fold - what are the 3 Rs to represent this?
the role of the dental practitioner in adult protection is three-fold: * **recognise** - being able to identify an adult at risk * **respond** - manage the acute situation and informt other services as required * **record** - document and report in detail the information obtained and the actions taken