KIN120 Final Flashcards
Adapting should lead to the following indicators?
Warm and positive climate
Ensuring success-oriented activities
Time spent on lesson objectives
On-task behaviors that are linked to lesson objectives
Shared responsibility for learning and demonstrated
self-determination (choice making)
INPUTS THAT INFLUENCE TEACHING?
−People (both students and teachers): age, gender,
socioeconomic class, culture, self concept, attitudes,
knowledge, actual and perceived competence, creativity,
expectations, perceptions, emotions, fears etc.
−Environment: class size, facilities, equipment, school,
home and community resourses, lighting, sounds, smells
etc.
Time: can include things such as instructional time, time
spent on activities, prep time, time of day, willingness of
the participant to ‘put in the time’ to learn a skill, etc.
−Opportunity: can be broken down into family, school and
community (positives and negatives) in relation to
individual students. Is largely determined by cultural,
economic, and moral variables.
LEVELS OF ASSISTANCE IIN EFFECTIVE TEACHING?
In performing a task or a sequence of tasks, participants
require different levels of assistance: physical, visual,
verbal, or a combination of these
3 elements (ABC’s of Behavior)?
I. Antecedent (Stimulus)
II. Behavior (Response)
III. Consequence (Reinforcer)
METHODS USED TO STRENGTHEN OR
MAINTAIN BEHAVIOURS?
Reinforcement:
−Purpose of any reinforcement is to increase or strengthen
behaviour or response over time
−The contingent presentation of a consequence or event
immediately following a specified response that
increases the likelihood of that behaviour occurring
again.
METHODS USED TO STRENGTHEN OR
MAINTAIN BEHAVIORS?
Positive Reinforcement (R+): −Presentation of a favourable event (reward)
Negative Reinforcement (R–
):
−Omission or removal of an unfavourable event
(escape)
What is Punishment?
Punishment designed to prevent or stop a behaviour from occurring
Positive Punishment?
An event that decreases the probability that a response will be
repeated in the future
− Don’t jump off cliff to avoid injury
− Don’t steal because fear of punishment
Negative Punishment?
Weakening of a response by the omission of favourable stimulus
− Lose license for reckless driving (license is the favourable
stimulus)
ISSUES TO CONSIDER WHEN USING R+?
Reinforce every behaviour when teaching something new
−Reinforcers should be functional, age-appropriate,
individual and easily provided
−Opportunity for a higher probability behaviour will
reinforce any lower probability behaviour
• Don’t get dessert unless you eat your vegetables at
dinner
ISSUES TO CONSIDER WHEN USING R–?
The word negative means the event has been
contingently removed or taken away
−It does not mean the consequence is negative
PROCEDURES TO ELIMINATE OR
DECREASE A BEHAVIOUR?
Punishment
−Unlike Reinforcement, punishment is used to
decrease a behaviour
Issues to Consider: −Does not build a positive relationship −Emotional responses are likely −Potentially addictive to punisher −Teaches people what NOT to do
Time Out(s) −Extension of punishment concept −Based on assumption that some R+ in the environment is maintaining behavior −Removal from the opportunity to receive R+
Signal Interference
−Use of a signal to communicate disapproval
−1-2-3 Magic
Proximity
−Think about the individual’s social groups
PRINCIPLES FOR MANAGING THE
ENVIRONMENT?
- Use optimal structure
- Reduce space
- Eliminate irrelevant stimuli
- Highlight relevant stimuli
INSTRUCTIONAL APPROACHES FOR EFFECTIVE TEACHING?
- ETA
- Bottom-up
- Top-down
Other helpful techniques 1. Task Analysis Breaking a skill down into smaller components Forward Chaining Backwards Chaining
Definition of ID?
§Characterized by significant limitations both in intellectual functioning and in adaptive behaviour expressed in conceptual, social, and practical adaptive skills.
Originates before the
age of 18
The following assumptions are
essential to the application of ID:
1. Limitations in functioning must be considered within the context of community environments typical of the individual’s age, peers and culture.
2. Valid assessment considers cultural and linguistic diversity as well as differences in communication, sensory, motor, and behavioral factors.
- Within an individual,
limitations often coexist
with strengths. - An important purpose of
describing limitations is to
develop a profile of needed
supports.
5. With appropriate personalized supports over a sustained period, the life functioning of the person with ID generally will improve.
Adaptive behaviour?
A collection of conceptual, social and practical skills that have been learned by people in order to function in their everyday lives
Three (3) Adaptive
Behaviour Categories? (ID)
- Conceptual: Language,
reading & writing, money,
time, number concepts - Social: Interpersonal skills,
social responsibility, selfesteem, gullibility, following
rules, obeying laws, and
avoiding victimization - Practical: ADL (personal
care), occupational skills,
use of money, safety, health
care, travel/transportation,
schedules/routines, use of
the telephone
What are
Supports?
Resources and strategies that aim to promote the development, education, interests, and personal wellbeing of a person and that enhance individual functioning.
Support needs are psychological constructs referring to the pattern and intensity of supports necessary for a person to participate in activities linked with normative human functioning.
Services are one type of
support provided by
agencies and
professionals
Individual functioning
results from interaction of
supports
Appropriate supports will
improve functioning
Causes of ID?
Causes can be genetic,
congenital, or may occur
spontaneously and not
caused by heredity
Prenatal causes of ID?
Prenatal:
Chromosomal disorders
Brain formation disorders
(i.e. Neural Tube fails to
form properly)
Errors of metabolism (i.e.
protein synthesis)
Environmental (i.e. toxins,
drug/alcohol use)
Perinatal causes of ID?
Perinatal:
(Around childbirth especially
5 months before and one
month after)
Abnormal labour &
delivery
Head trauma
Infection
Intracranial hemorrhage
Nutritional imbalance
Postnatal causes of ID?
Postnatal:
Head injuries
Infections
Degenerative
Seizure disorders
Toxic-metabolic
Malnutrition
Environmental deprivation − i.e. disease-producing conditions, inadequate medical care, isolation, and environmental health hazards
Chromosomal Abnormalities of ID?
22 are autosomes, and one (1) sex chromosome §Chromosomal abnormalities affect about 7 in every 1000 births
Usually result from chance
errors in cell division
With each cell division 23 pairs of chromosomes should be passed on, each carrying the full DNA and genes to determine further development
Of the 23 pairs in each cell, 22 are autosomes (important for specific genetic markers) and one is the sex chromosome pair, designated XX (female) or XY (male)
Abnormalities can occur in
either autosomes or sex
chromosomes
Most common autosomal
chromosome disorder is Down Syndrome
A common sex linked
chromosome disorder is Turner Syndrome
What is Trisomy 21
(Down Syndrome)?
A chromosomal
abnormality that affects
intellectual and physical
development
Trisomy 21 (most common)
Translocation (when one
chromosome breaks off and
attaches to another)
Mosaicism (very rare)
Detected through amniocentesis
Risk is about 1 in 800, but varies with maternal age: − Age 25 = 1/1000 − Over 35 = 1/400 − Over 45 = 1/35-40
Common features of Down Syndrome?
Common Features:
Flattened back of skull, short
neck
Small oral cavity
Hypotonic muscle tone during
childhood
Joint looseness (hypotonicity & lax ligaments)
Short stature
Short limbs with short, broad
hands and feet
Almond-shaped, slanted eye
(strabismus, myopic)
Flattened facial features
Defects of Down Syndrome?
Hypotonia (lack of muscle
mass) and skeletal concerns
Motor development delays
Balance deficits
Left-handedness and
asymmetrical strength
Visual and hearing concerns
Heart and lung problems
Fitness and obesity
Health and temperament
Issues that may arise with Down Syndrome?
17% of persons with DS
Atlantoaxial is a joint between
first 2 cervical vertebrae
Ligaments and muscles
surrounding the joint are ‘lax’
which can cause instability
Because of instability, the
vertebrae can slip out of
alignment easily
Particular sports that cause forceful bending of neck (gymnastics, swimming, diving, soccer) can cause damage to spinal cord
Persons with DS are required to have x-rays to determine if the condition is present or not
ID with
Associated
Conditions?
Seizures
Cerebral palsy
Dual diagnosis (mental health)
Pain insensitivity and
indifference
Considerations
for Physical
Activity for ID?
Communication and Self Direction:
Augmentative/alternative
communication
Range from low-tech alternatives like picture boards and notebooks to high-tech devices that use synthetic or digitized speech
Time delay to respond
−10 seconds without
prompting
Cognitive Ability:
Attention (pay attention to one aspect of a
task or pay attention to everything including
irrelevant stimuli)
Memory or Retention:
(long term memory
is equal to peers. May have difficulties with
short term memory)
Add rehearsal strategies and provide
multiple trials
Modeling, verbal rehearsal, self talk and imagery
Feedback:
Feedback should include questioning about process as well as product. i.e. Did the movement feel good, did you tuck your head when you did the forward roll etc.
Task Analysis, Repetition, Generalization:
Might require more time and/or
attempts
Motor Performance:
Motor development and delays (slowness) − Slowness in the use of righting, propping, postural reactions and processing instruction
Influence of physical
constraints:
Height; Weight
Obesity
Physical fitness and active
lifestyle
Low intensity and long
duration activities like
walking, dancing and water
activities
Movement difficulties are
due to five (5) sources? (ID)
1. Deficiencies in knowledge base or lack of access to it 2. Failure to use spontaneous strategies (need cues) 3. Inadequate metacognitive knowledge and understanding (need to ‘think’ throughout the day) 4. Executive control and motor planning weaknesses (start/stop actions, adapt to change) 5. Low motivation and inadequate practice
KnowledgeBased Model?
Use of a knowledge-based
model to guide instruction
implies:
Careful teaching of facts and processes with emphasis on problem solving so learners are actively involved
What are Learning
Disabilities?
Refers to a number of disorders which may affect the acquisition, organization, retention, understanding or use of verbal or nonverbal information.
As such, learning
disabilities are distinct
from ID.
Who does LD effect?
These disorders affect learning in individuals who otherwise demonstrate at least average abilities essential for thinking and/or reasoning.
Characteristics of LD?
Heterogeneous group
of disorders
Not due to other
disabilities
Identifiable or inferred
CNS dysfunction
Brain development is
affected
Not an intellectual
disability
Show average abilities
essential for thinking
and/or reasoning
What does LD result from?
Results from impairments in one or more processes related to: Perceiving, thinking, remembering or learning.
LD is Included but not limited to?
-Language processing • Phonological processing • Visual spatial processing • Processing speed Memory and attention • Executive functions (e.g. planning and decisionmaking).
LD may interfere with the
acquisition and use of
one or more of the
following?
• Oral Language (e.g. listening, speaking, understanding); • Reading (e.g. decoding, phonetic knowledge, word recognition, comprehension); • Written Language (e.g. spelling and written expression); • Mathematics (e.g. computation, problem solving).
T or F: Learning disabilities are lifelong
True
Some individuals with
LD also experience
motor disabilities like?
• Perceptual motor
• Motor coordination
• Movement related
problems
‘DCD’ can occur with
or without LD
What is Developmental
Coordination Disorder?
“Performance in daily activities that require motor coordination is substantially below that expected given the person’s chronological age and measured intelligence.
This may be marked delays in achieving motor milestones, dropping things, poor performance in sports, or poor handwriting.”
Defects of?
Developmental delays
in motor skills
Poor movement skills,
interference in ADL
Withdraw from physical
activity
• Low fitness levels
• Reduced skill
acquisition
• No practice
Psychosocial difficulties
(poor self esteem and
social isolation)
Diagnosis of DCD?
1. Condition significantly interferes with academic achievement or ADL 2. The condition is not caused by a general medical disorder or PDD 3. If ID is present, the motor difficulties are in excess of those usually associated with it
PA Considerations
(Applicable to LD
and DCD)?
1: Immature Body Image and
Agnosias:
Partial or total inability to recognize objects by use of the senses. Inability to identify body parts and surfaces, inability to translate knowledge of right and left into following movement instructions and difficulty in making judgments about body shape, size and proportions.
Improve through action
songs, dances and games
that refer to body parts.
Provide opportunities for
children to see themselves
in the mirror, on video tape
or film
2: Poor Spatial Orientation:
• Unsure of direction, difficult to estimate height, distance, width…bump into things, hard to duck or step over.
• Recommended games must involve obstacle courses, mazes and maps. Orienteering, and treasure hunts are good.
• Instruction should include cue detection as well as self-talk and rehearsal (both visual and verbal).
3: Overflow Movements:
• Inability to keep opposite limbs motionless when performing tasks with other arm
4: Dissociation:
• Problems perceiving and organizing parts into wholes, easier to engage in whole body activities so focus only on one thing (look at target, don’t worry about stance)
5: Figure Background:
• Inability to pick out
and/or figure out of
complex background
6: Motor Planning and Sequencing • Difficult to initiate movement, stop movement, put movement into correct order.
Intervention involves: • Games • Dance • Water play • Gymnastic routines (in which an increasing number of movements must be remembered and chained into sequences)
7: Temporal Organization,
Rhythm and Force:
• Difficult to organize parts into wholes, lack of rhythm to dance • Include early instruction to music, rhythm, and dance. • Use background music or a strong percussive beet. • Music should be carefully selected to reinforce the natural rhythm of the skill and the desired performance speed
Instructional
Strategies/PA
Considerations?
1) Modality:
• Which approach to instruction works best? • Visual or auditory (present information in the preferred modality)
2) Match cognitive style: (Refers to persons approach to analyzing and responding to stimuli)
3) Field Dependent:
Strongly influenced by the visual field. See wholes and have trouble finding embedded figures and details. Tend to have a fast conceptual tempo, spend little time planning, and need external structure.
4) Field Independent – Focus on
details, analytical, reflective
People with LD are more
likely to be FD than FI
Awareness of cognitive styles helps instructors to match instruction demands to strengths then gradually remediate weaknesses
5) Self-Talk and Verbal
Rehearsal
6) Motivation and Self
Concept Enhancement”
• May have lower self concept and esteem due to repeated failures or bad experiences
• Provide opportunity for success and activities that are meaningful (things that can carry over to other environments)
What is self talk?
Successful in helping children learn motor sequences, improve performance and control impulsivity.
• Self talk usually refers to
talking oneself through an
activity or sequence.
• Ex. Jumping Jack
What is verbal rehearsal?
Talking about the required
movements before doing
them
What is Attention Deficit
Hyperactivity Disorder -ADHD?
Interferes with a person’s ability to sustain attention or focus on a task and to control impulsive behaviour
Inability to maintain focus or attention
Impulsive behavior
Interferes with daily activities
Not a learning disability
Neurobiological disability
Genetic connection
Behaviours of ADHD?
1) Distractibility
Super-sensitivity and limited ability
to tune out internal and
environmental stimuli
2) Impulsive
Lack restraint; react immediately
without thinking
3) Hyperactive
Persistent, heightened, sustained
activity
Prevalence of ADHD?
3-5% of Canadian children have ADHD
Boys are affected more
How is ADHD diagnosed?
Distractibility, impulsivity, hyperactivity
Diagnosis of ADHD in
Children?
§ Rule out other conditions
§ Assess academic, social, emotional
functioning. attention span
§ Observation
Consider the following:
§ severity, early onset, duration,
impact, settings
Types of ADHD?
Predominantly inattentive (AD) § Predominantly hyperactive impulsive (HD) § AD/HD combined
Treatment for ADHD?
A combination of education, behavioural,
psychosocial and medication treatments is
thought to be the most effective approach.
This comprehensive approach to treatment is
called “multimodal” and often includes:
§ Behavioral Interventions
§ Medication
Behavioral Interventions:
§ Try to change the physical and social
environment to modify the behaviour of the
person with AD/HD (i.e., problem solving, social
skills, cognitive behavioural therapy)
§ Medication
§ Prognosis:
§ Armed with an understanding of the disability
and its implications, and with appropriate
treatment, strategies and support, individuals
with AD/HD can succeed.
Co-Occurring Conditions or
Concerns Associated with ADHD?
Learning disabilities § Depression § Anxiety § Substance abuse § Aggressive & defiant behaviours § High risk behaviours § Emotional problems § Perseveration § Social perception inadequacies
Strategies & Considerations
for PA for ADHD?
Manage the Environment:
I. Structure program § Keep directions simple § Be proactive § Respond to behaviour § Use frequent eye contact II. Reduce environmental space III. Eliminate irrelevant stimuli IV. Enhance instructional stimuli
§ Routine, no surprises, know what to expect
§ Lane markers, know boundaries, create limits
§ Keep things neat, clean, well ordered
(eliminate what is not important)
§ Use color to keep attention
What is Cerebral Palsy?
Chronic neurological disorder of
movement and posture caused by a
defect or lesion on immature brain
• Varies in severity
What does cerebral mean?
brain.
What does palsy mean?
Disorder of posture or
movement; lack of movement
CP is primarily a?
Motor defecit
Severity levels of CP?
• Mild (i.e. general clumsiness may have a
slight limp)
• Severe (ambulatory difficulty, inability to
speak with spoken words, almost no control
of motor function)
Varying degrees of damage to the brain
result in differing degrees of impairment.
Visible Signs Range of CP?
• No visible signs TO cognitive, sensory,
perceptual difficulties and no motor
control with speech difficulties
• Continuum of intelligence
PRENATAL causes of CP?
Fetal anoxia • Poor nutrition • Chemical toxins • Maternal health problems
PERINATAL causes of CP?
• Premature birth • Difficult delivery • Prolonged labour
POSTNATAL causes of CP?
• Head injury (brain hemorrhages, infections, tumors) • Physical abuse
T or F: 90% of CP cases occurs during the
prenatal and perinatal periods?
True.
Why does a person who has Stroke, Acquired Brain Injury (ABI) not labeled as CP?
A person who sustain injuries to the
motor portion of the brain after age 2-5
exhibit similar motor impairments but
are labeled differently
The effects Depends on which area of the brain has been damaged. What are they?
• Muscle tightness or spasm • Involuntary movement • Difficulty with: • gross motor skills such as walking or running • fine motor skills such as writing and speaking • Abnormal physical sensations • These effects may cause associated problems such as difficulties in feeding, poor bladder and bowel control, breathing problems, and pressure sores.
Classification/Types of CP
(CP disorders classified according to two factors)?
1. Limb Involvement • Monoplegia • Diplegia • Hemiplegia • Triplegia • Quadriplegia
2. Muscle Tone/Movement • Spasticity • Athetosis • Ataxia • People with CP have abnormal muscle tone to varying degrees. • Three major types are recognized BUT most people have mixed types and the diagnosis indicates which is most prominent.
What is spastic cP?
Most common (50-60%)
• Excessive muscle tone, abnormal tightness
and stiffness characterized by hypertonic
involuntary muscle contractions
• Difficulty relaxing muscles when attempting
purposeful movement
SPASTIC CP: Hyperactive Stretch Reflex?
• Spasticity affects flexor muscle groups
• Spastic lower limbs may be rotated inward,
flexed at hip joint, knees flexed and
adducted, heels are lifted off of ground
• Upper limb involvement leads to pronated
forearms with flexion at elbows, wrists and
fingers
SPASTIC CP: Contractures/Deformities?
Typically muscles on one side relax when
others contract
• If contractures are present this does not
happen
• Tends to affect the antigravity muscles
(flexor and adductor muscle groups)
• Associated with a hyperactive stretch
reflex
What is Athetosis (CP)?
(30%)
• Overflow of motor impulses so muscles are characterized by constant, slow, unpredictable and purposeless movement caused by fluctuating muscle tone (hypotonic and/or hypertonic).
• Fluctuating muscle tone
• Problems with visual pursuit and focus (can
affect ability to perform hand-eye
coordination)
- Involuntary & purposeless movement
- Fine muscle coordination is difficult
- Commonly affects upper extremities and head
- Many will use wheelchairs for mobility
- Gait is described as unsteady
What is Ataxia (CP)?
10%
• Damage to cerebellum (feedback
mechanism of brain and organizes
information to coordinate muscle functions)
- Poor balance and trunk control
- Uncoordinated movement
• Involuntary movement of trunk and
extremities
- Hypotonic
- Walk with wide gate
Classification of CP according to Severity?
- Mild
- Can walk, speech somewhat affected
- Moderate
- Difficulty with speech and locomotion
- Severe
- Use of wheelchair, difficult to understand
Associated Medical/Health
Concerns of CP?
• Oral Dental • Speech (35-75%) • Visual (55-60%) • Sensory deficits • Convulsive disorders (25-50%) • ID (30-70%) • Hip dislocation, scoliosis, foot deformities • Major reflex problems (80-90%)
Pathological Reflexes of CP?
- Infant reflexes
- Involuntary & predictable
- Typically indicative of a mature nervous system
• In CP, reflexes are not integrated
• Reflexes interfere with smooth,
coordinated movement
Reflexes effected by CP?
• Asymmetrical Tonic Neck Reflex • When head is turned to one side, arm on that side extends while opposite arm flexes
• Startle Reflex
• Severe Gag Reflex • Problems with feeding and oral hygiene • Slow eating, spillage, poor (or no) coordination of oral muscles and swallowing mechanisms • Inadequate nutrition • Dehydration • Metabolism of medication
Considerations for Physical
Activity for CP?
Spasticity • Relaxed atmosphere • Warm water swimming beneficial • Perform slow, prolonged stretches • Work through full ROM
• Avoid abnormal, involuntary, non-functional
muscle patterns
• Transport skills (encourage independent
movement)
• Manipulation skills (make use of functional ability)
• Mechanical and muscle inefficiency (a lot of
energy is used for movement)
• Flexibility – stretch daily
• Delayed motor development • Limits the physical, mental, emotional stimulation that children require • Suggested that motor performance at age 7 is indicative of motor performance as an adult • Early intervention
• Adopt principle of keeping body parts in alignment
• Avoid abnormal postures and stereotyped patterns
• Injury, deviations
• If flexion is present place in extension and
vice versa
Seating someone in their
wheelchair?
• Must have proper alignment
• Hips at 90o and in contact with back of chair
• Thighs slightly abducted and in contact with
seat
• Knees, elbows, ankles at 90 deg flexion
• Limit pressure on back of knees
• Feet should be flat
• Head and neck in midline
What is Spinal Paralysis?
Broad term for conditions caused by injury or disease to the
spinal cord and/or spinal nerves
Paralysis can be complete (total) or incomplete (partial)
Paresis is muscle weaknesses in partial paralysis
What does spinal paralysis involve?
Spinal paralysis involves the central (spinal cord and nerves) and autonomic (vital functions) nervous system
SP: Severity of Condition?
Depends on two (2) criteria…
− Level of lesion
− Is it complete or incomplete?
¡ Higher the lesion = Less functioning
¡ Complete lesions = Less functioning
Functioning & The Spinal Cord?
¡ Cervical − Arms, hands, breathing ¡ Thoracic − Balance, trunk control, forceful breathing ¡ Lumbar − Leg and foot movements ¡ Sacral − Bowel, bladder, sexual function
Quadriplegia (Tetraplegia)?
¡ Involvement of all four limbs and the trunk
¡ 50% of persons with quadriplegia have incomplete lesions
− ‘Walking Quads
Quadriplegia
(Tetraplegia): High-Level Quads?
− C1 – C4 lesions − Use motorized chairs for mobility − Powerchair sports (soccer & bowling
Quadriplegia
(Tetraplegia): Low-Level Quads?
− C5 – C8 lesions − Use manual chairs and participate in many wheelchair sports − Wheelchair rugby
Paraplegia?
¡ Involvement of the legs but often includes trunk balance as
well
¡ For sport programming, trunk balance is the most useful
criterion in determining level of participation
Spina Bifida?
¡ Congenital defect of spinal column caused by failure of
neural arch of a vertebra to properly develop and enclose
spinal cord
¡ Incidence related to gender (more girls are affected), race
(more Caucasians are affected), geographical location (more
common in Great Britain and Ireland), and socioeconomic
status
¡ Occurs between the 19th and 32nd day of gestations
(normally this is when the neural tube develops and closes)
SPINA BIFIDA – MENINGOMYELOCELE/
MYELOMENINGOCELE?
− Spinal cord and meninges protrude into sac − Hydrocephalus (4 – 5 times more common than other type) − Surgery is required to close wound (does not lessen disability)
Hydrocephalus?
80% of myelomeningocele develop hydrocephalus ¡ Present at birth or develop within first 6 weeks ¡ Results in enlarged head, pressure on brain which can cause brain damage and/or death ¡ Problem is treated with a shunt − A tube to drain off the fluid into the abdominal cavity ¡ Shunt does not require any special care − Person should not hang upside down for extended periods as shunt may become blocked − Avoid different types of head trauma that may damage shunt/placement (i.e. heading a ball in soccer)
Ways to help Hydrocephalus?
¡ The insertion of a shunt has two main functions… − It allows fluid to go only in one direction − The valve allows fluid to flow out only when the pressure in the head has exceeded some value
SPINA BIFIDA –
MENINGOCELE?
− Meninges protrude (outpouching of the coverings of the spinal cord but the cord and nerves remain within vertebral column.) − Paralysis is rare (surgery is required to close wound)
SPINA BIFIDA –
OCCULTA?
− Posterior arches of vertebrae fail to form − No outpouching. Does not cause paralysis or muscle weakness (associated with back problems)
Time of onset can have two (2)
different impacts on development what are?
Congenital = Less
experience/socialization
into sport
Acquired = More
experience/socialization
into sport
CONGENITAL PARALYSIS: CONSIDERATIONS FOR
PHYSICAL ACTIVITY?
¡ Congenital SCI, be sure to focus on
developmental activities
¡ Development of trunk, shoulder, arm and hand
control and strength is important
− Pushing, pulling and lifting with arms are
major goals
− Push and pull toys, scooter boards,
parachute activities, apparatus
climbing/hanging, weight lifting are high
priority
SPINA BIFIDA:
CONSIDERATIONS
FOR PHYSICAL
ACTIVITY?
¡ Latex sensitivity
− Allergic reactions to latex rubber and
powder; food and objects that have
been in contact with latex
¡ Cognitive functioning
− IQ’s are average
− A large percentage of individuals have:
¡ Perceptual-motor deficits, specific learning
disabilities, and attention deficits
¡ Strabismus (crossed eyes) is relatively
common
− May partially explain visual perception
problems
Extended Sitting:
− Tendency for the hip, knee and ankle flexors to become
to tight. This can result in contractures
− Ulcers or pressure sores
− Bruises and friction burns
− Obesity b/c of low energy expenditure
Sensation & Skin Breakdown: ¡ Inability to feel sensation makes persons vulnerable to injury and skin breakdown. − Ex. Wrinkles in socks and poorly fitted shoes or braces cause blisters that become infected ¡ Persons with spinal paralysis should be taught to inspect their body regularly to see that all sores are cared for.
Temperature Control: ¡ Spinal paralysis above T8 renders the body incapable of adapting to temperature changes − Body assumes the same temperature as the environment ¡ Special attention needs to be given to appropriate clothing, heating and air conditioning ¡ Fluid intake is related to temp control
Contractures:
− ROM exercises
¡ Atrophy of limbs
− Overtime paralyzed limbs decrease
in size and loose the shape
associated with good muscle tone
Spasms: − Paralyzed muscles in people with lesions above L1 often jerk involuntary − Frustrating/embarrassing - draws attention and interfere in ADL’s − Occasional spasms are good for circulation − When spasms are too severe several treatment options are available (physical therapy, drug therapy, nerve blocks and surgery)
¡ Catheterization, Timing of Bathroom Breaks:
¡ All persons with spinal paralysis above S2 have some kind of
bladder dysfunction, requiring that they urinate in different ways
¡ Retention of urine leads to urinary and kidney infections
¡ A major cause of illness and death among persons with spinal
paralysis
¡ Defecation is managed by:
− Scheduling time and amount of eating as well as by regulating
time of bowel movements
− Surgical procedures create and opening in the abdomen and a
tube is inserted that connects to the intestine and an external
bag
Sexual Function: − Innervated by the same nerves as urinary function (S2 to S4) − Lesions above the sacral region may make it necessary to alter roles, methods, and positioning for sex depending on weather the lesions are complete or incomplete − Capacity for erection, ejaculation and orgasm must be evaluated individually − Menstruation is not affected
Heart & Circulatory Function:
− Low resting heart rates
− Persons with quadriplegia and high level paraplegia have
abnormally
− Maximum heart rates and target zones used in aerobic
exercise programs for AB persons are not appropriate in
high level spinal paralysis
− Assessment should be done
− Pooling of blood in the veins of paralyzed limbs
− Need to move limbs from time to time.
¡ Blood Pressure:
− Baseline blood pressure with lesions above T6 is typically
low
− Blood pressure responses to exercises must be interpreted
in light of this fact.
− Autonomic Dysreflexia (AD) is a life threatening pathology
that sometimes occurs in lesions above T6
− Sudden onset of high blood pressure, slowed heartbeat,
sweating, & sever headache
− Triggered by a stimulus within the body (i.e. distended
bladder or colon)
SPINA BIFIDA: CONSIDERATIONS FOR PHYSICAL ACTIVITY: Posture & Orthopaedic Concerns?
¡ Paralysis causes an imbalance between muscle groups that further complicates the orthopaedic problems of growing children − Plantar flexion, hip dislocation, toeing inward, scoliosis, hyperlordosis, gluteus medius lurch, crouched gait
