Neurologic Disorders in Childhood Flashcards
Children with intellectual disabilities have difficulties in both ….
Intellectual functioning (communicating, learning, problem solving) and adaptive behavior (everyday social skills, routines, hygiene)
Possible signs of intellectual disability
children may:
- sit up, crawl, or walk later than other children
- learn to talk later or have trouble speaking
- find it hard to remember things
- have trouble understanding social rules/ appropriate behavior
- have trouble seeing the results of their actions
- have trouble solving problems
- have problems with receptive/expressive language
Causes of intellectual disability
- genetic syndromes
- environmental causes
- nutritional
environmental causes of intellectual disability
- alcohol
- prenatal infection
- early childhood central nervous system infections
- TBI
Intellectual Disability Management
- Timely identification and referral
- Early Intervention services, special education, & vocational rehabilitation
- Interdisciplinary care to manage ID and comorbidities (medical and mental health)
Autism Spectrum Disorder
ASD is defined in terms of persistent, significant impairments in social interaction and communication as well as restrictive, repetitive behaviors and activities.
What type of disorder is ASD?
neurobiological
how is ASD diagnosed?
behaviorally
Newest terminology for ASD
Neuroatypical
What ASD is:
- Primarily a disorder of communication, social relating and sensory processing
- Can occur in conjunction with any other disability
- A disorder of higher-level processing
Common neurological issues in individuals with ASD
- Apraxia
- Sensory processing problems
- Epilepsy
- Cognitive impairments
- Failure to develop speech
- Doesn’t respond to name
- Auditory discrimination problems
- Lack of eye contact
- Hypotonia
- Difficulty with motor planning
- Toe walking
- Lack of fear – risk takers/impulsive
Possible causes of ASD
Many factors: likely environmental and genetic
Management of ASD
- No cure and no “one size fits all” treatment
- Early Intervention (EI), educational services, behavioral/communication therapies
- Aimed to help children learn critical social, communication, functional, and social behavioral skills
- Adjunctive medications to address: hyperactivity, antipsychotics, antidepressants, anti-anxiety, Epilepsy, sleep disorders, and nutritional deficiencies
Physical management of ASD
- Vestibular activities
- Activities to increase proprioception
- Deep pressure
- Vibration
- Physical exercise
- Jogging
- Swimming
- Equine-assisted therapy
Seizure
A transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain
Epilepsy
- A disease of the brain characterized by an enduring predisposition to generate epileptic seizures, and by the neurobiologic, cognitive, psychological, and social consequences of this condition
Criteria for Epilepsy
- At least two unprovoked (or reflex) seizures occurring >24 hours apart
- At least one unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years
What size of the brain do generalized seizures affect?
Both sides of the brain
General Seizures- Absence (petit mal)
rapid blinking or a few seconds of staring into space
Generalizes seizures- Tonic-clonic (grand mal)
• Cry out • Lose consciousness • Fall to the ground • Have muscle jerks or spasms *person may feel tired after
Focal Seizures
Located in just one area of the brain
Simple Focal Seizures
Affect a small part of the brain
twitching; change in sensation - strange taste or smell
Complex Focal Seizures
can make a person with epilepsy confused or dazed (unresponsive for up to a few minutes)
Focal Seizures- Secondary generalized seizures
begin in one part of the brain, but then spread to both sides of the brain (i.e. a focal seizure, followed by a generalized seizure)
Unprovoked (Epileptic) Seizures
Absence of a temporary or reversible factor lower the threshold and producing a seizure at that point in time
Provoked (Non-Epileptic) Seizures
Presence of a temporary or reversible factor including: • Fever • Substance withdrawal • Concussion/TBI • Lack of sleep • Flashing lights • Tumor • COVID-19 virus infection • Dehydration • Side effect of medication (pain, antidepressants)
Down Syndrome
Trisomy 21: The most frequent chromosomal abnormality among live-born infants and the most common genetic cause of intellectual disability in
the world
is the prevalence of DS increasing or decreasing?
increasing
DS Physical Characteristics
- Singular palmar crease
- epicanthal fold
- brush field spots
- protruding, large wrinkled tongue
- congenital heart disease
- intestinal defects
- shortened 5th finger
Conditions associated with DS
- Atlantoaxial instability (no diving, wrestling, gymnastics)
Is survival rate for DS increasing or decreasing?
increasing
DS is more likely to be diagnosed with:
- Testicular or blood cancer
- Mental health conditions
- Bronchitis
- Pneumonia
- GI, Neuro, Thyroid and Bone Diseases
DS is less likely to be diagnosed with:
- Solid tumors
- Heart Disease
- STDs
- Influenza
- Sinusitis
- Diabetes
Spina Bifida Occulta
More common
tuft of hair
Spina Bifida Meningocele
Meninges on outside of lumbrosacral spine but tissues intact
Spina Bifida Myelomeningocele
Meninges and tissues outside
Spina Bifida Lipomyelomeningeocele
Meninges and tissues outside + adipose cyst around spinal cord that become entangled and causes further deficits
Spina Bifida Risk Factors
Likely an interaction of a genetic predisposition with an environmental trigger
Reducing risk of Spina Bifida
- 400 micrograms of folic acid
- Control preexisting conditions (e.g. obesity, diabetes, etc.) prior to conceiving
- Avoid overheating your body (e.g. sauna, hot tub, fever, etc.)
Spina Bifida Associated Medical Conditions
- Latex sensitivity/allergy
- Hydrocephalus
- Chiari II Malformation
- Tethered Cord
- Bladder/bowel dysfunction
- Pressure ulcers
- Spinal deformity
Chiari II Malformation
Herniated cerebellum due to enlarged foramen ovale
Tethered cord syndrome
- central back pain
- changes in bowel/bladder function
- LMN sxs
- tensioning resulting in UMN sxs
- worsening of foot deformity
what is Cerebral Palsy
-Disorder of the development of movement and posture causing activity
limitation
-Attributed to non-progressive disturbances that occurred in the developing brain
Antenatal risk factors of Cerebral Palsy
- Prematurity and low birth weight
- intrauterine infections
- Multiple gestation
- Pregnancy complications
Perinatal Risk Factors for Cerebral Palsy
- Birth Asphyxia
- Complicated labor and delivery
Postnatal Risk Factors for Cerebral Palsy
- Non-accidental injury
- Head trauma
- Meningitis/ encephalitis
- Cardiopulmonary arrest
1 Risk factor for cerebral palsy
Premarturity and low birth weight
Classification of Cerebral Palsy- Movement Disorder
- Hypertonia: spasticity, dystonia, rigidity
- Hyperkinetic- Chorea, dystonia, athetosis, myoclonus, tremor, tics, stereotypes
- Negative: ataxia, weakness, decreased selective motor control
Classification of Cerebral Palsy- Anatomic distribution
- Hemiplegia
- Diplegia
- Triplegia
- Quadriplegia –involvement of head and neck
Severity of Cerebral Palsy
- LEVEL I - Walks without Limitations
- LEVEL II - Walks with Limitations
- LEVEL III - Walks Using a Hand-Held Mobility Device
- LEVEL IV - Self-Mobility with Limitations; May Use Powered Mobility
- LEVEL V - Transported in a Manual Wheelchair
Cerebral Palsy- Tone Management
- Oral medications
- Anti-spasmodic injections
- Selective Dorsal Rhizotomy (SDR)
- Baclofen pump implantation
Cerebral Palsy- General Classification of Orthopedic Surgeries
- Muscle/Tendon lengthening
- Tendon Transfers
- Osteotomies
