Physical Impairments Exam 6 Flashcards
What is the difference between Impairment, activity limitations, participatuon restrictions?
**Impairments **
Result of pathology, accident or disease and include any loss or abnormality in function, which may or may not be permanent
* 5 functions: Communication, movement, mental ability, medical health, sensory perception
Activity Limiatation
* Difficulty in executing major life activities as a result of a health condition
Participation restrictions
* Inability to take part in life situations for reasons beyond control
What is the ADA defining disabilities?
A disability meets criteria:
* Has a physical or mental impairment that substantially limits one or more major life activities
* Has a record of impairment limiting major life activity
* Is regarded as having an impairment
Categorized as:
* Developmental- Occur congenitally or during child develop (before 22 years old)
* Acquired- Occur after the age of 22 or Caused by disease, trauma, or bodily injury
* Age-associated- Occur later in life, over the age of 65, Chronic diseases
What is Spinal Cord Dysfunction & Injuries?
- Total or partial loss of sensory, motor, and autonomic function occurs below the level of injury
- Fracture, dislocation, or both of one or more vertebrae
- Compression, stretching, bending, or severing of cord
What is the cause of spinal cord injuries?
- Viral and bacterial infections
- Progressive degenerative disorders
- Vascular accidents
- Congenital conditions
- Most common is trauma: Motor vehicle accidents, falls, diving accidents, violence
- Adolescents and young adult men
What are the symptoms of paralysis?
- Nature of injury
- Level of injury- Different areas of body controlled at different levels
- Most severe = injury above C6
- Complete Lesion: No sensation or motor function
- Incomplete Lesion: Some sensation or motor function
What are the medical management for spinal cord injuries?
- Surgery
- Medications:Steroids reduce inflammation
- Physical, occupational,or speech therapy
- Continuous care support
- Manage secondary complications
What are the medical management for secondary complications of spinal cord injuries?
- Respiratory Function: Inability to functionally cough
- Spasticity: Muscle-reflex spasms
- Pressure Sores- Decubitus ulcer, Cutaneous tissue broken or destroyed → destruction of subcutaneous tissue → secondary bacterial infection
- Body Temperature: high-level injury → inability to regulate
- Infections: Urinary, decubitus ulcer, respiratory
- Occurs above t6 injury
What is the dental management for spinal cord injury ?
- Transfer patient from wheelchair to dental chair
- Gravity-drained urinary appliance
- Susceptibility to postural hypotension
- Frequent body position changes
- Pad areas to relieve pressure and prevent sores
- Four-Handed Dental Hygiene
- Monitor vitals and body’s signs
What are the mouth held implements and its criteria ?
- uses: to increase independence, activities possble: light switches or telephone keys etc.
- adequate oral orthosis: does not harmoral tissue, comfort, easy care, inexpensive
What is spina bifida?
- Congenital cleft in the bony encasement of the spinal
cord (opening) - Neutral tube defect where spinal column fails to close
What are three most severe types of spina bifida?
** Spina bifida occulta**
* No outpouching of meninges or spinal cord through cleft
* No symptoms
Meningocele
* Protrusion of meninges through skull or spinal column
* Paralysis uncommon
Myelomeningocele
* Spinal cord protrusion or out pouching of spinal cord and its covering (meninges) through an opening (spina bifida)
* Flaccid paralysis of legs and lower trunk → depends on protrusion level
What are the medical management for spina bifida ?
- Neurosurgery: closes opening to prevent infections
Paralysis not lessened
Orthopedic surgery - Reduce or correct deformities
Support truck and lower limbs with bracing
Ambulation - Hydrocephalus treatment
Permanent drainage system
Ventriculoatrial (VA) shunt or ventriculoperitoneal (VP) shunt
What is Spina Bifida: Hydrocephalus?
- Abnormal buildup of cerebrospinal fluid in the ventricles of the brain
- Congenital or acquired
Cerebrospinal fluid
* “Shock absorber”
* Deliver nutrients, remove waste
* Balance blood amount changes
* Flows between brain and spine
What is the dental management for spina bifida?
- Premedication with ventriculoatrial (VA) shunts
- Increased latex sensitivity
- Medication side effects → gingival enlargement from seizure
medications
What is muscular dystrophies?
- Progressive severe weakness and loss of use of muscle groups
- Unknown cause
- Limited to skeletal muscles; cardiac rarely involved
- All muscular dystrophies are rare
What is Duchenne?
- Males
- Symptoms between 2-5 years
and before 10 years - Severe disablement by puberty
- Wheelchair confined
- Life expectancy <30 years
- Musculature – muscle enlargement (calves)
- Weakness of hips →frequent falls, difficulty standing
- Lordosis – abdominal protuberance
- Gait – waddling; walking on toes; flatfoot
What is facioscapulohumeral?
- Males and females affected equally
- Symptoms between10-18 years; after
puberty appear - Slower disablement
- Normal life expectancy
- Facial muscles involved; obicularis oris
- Scapulae prominent; shoulder muscles weak; difficulty raising arms
- Difficulty closing eyes completely
What is the medical management for duchenne?
- Gene therapy targets dystrophin protein
- Corticosteroids
- Psychosocial, cognitive, behavioral or physical therapy
What is the medical management for facioscapulohumeral?
- Surgery to stabilize scapulae
- Orthoses
- Occupational therapy
What is the dental management for both types of muscular dystrophies?
- Type of muscluar dystrophy
- Medications and medical management
- No medical consultations
- Communicate with occulational and physical therapy about home care needs
- Oral manifestations- facial muscle weakness- inadequate rinising
What is bells palsy?
- Paralysis of facial muscles innervated by 7th (VII) cranial nerve
- Unknown cause- Bacterial and viral infections and Injury, Trauma from tooth removal or oral surgery
- Incidence increases with each decade
- Younger: females more
- Males older than 50 years
What are the signs and symptoms for bells palsy and its prognosis?
Signs and Symptoms
* Abrupt weakness or facial muscle paralysis
* One side of face
* Mouth – corner droops, uncontrollable salivation
* Eye – eyelids may not close, watering or drooping of lower lid increases infection risk
Prognosis
* Return to normal within a month, spontaneous recovery
* Lasting residual effects; permanent paralysis
What are the medical management for bells palsy?
Palliative
* Eye protection during sleep; eye drops
* Massage involved muscles
* Hot compresses
Medications (i.e., steroids)
Surgical
* Improve appearance, facial symmetry, eye/mouth control
* Repair of facial nerve
* Nerve transplantation and grafts
* Muscle grafts
What is Cerebral palsy?
- Prenatal, natal, or postnatal injury to portions of the brain resulting in paralysis or disruption of motor parts
- Occur at any age
What is the dental management for bells palsy?
- Involved side lacks self-cleaning ability
- Precautions with anesthetic use on opposite side of involved side
- Protective eyewear → eyelid lacks natural ability to close for protection
What is the causes of bells palsy?
Prenatal
* Gestational or delivery anoxia
* Maternal infection
* Blood type incompatibility
* Severe nutritional lack during gestation
* Maternal diabetes endocrine imbalance
Postnatal (< 3 years)
* Infectious diseases (meningitis or encephalitis)
* Lead poisoning
* Direct accidental trauma
* Battery
What are the caracterisitcs of cerebral palsy and its motor types?
Characteristics
- Classified by motor activity
- Different parts of brain damaged in each type
Types can be mixed
* Motor Types
* Spastic
* Athetoid
* Ataxia
* Mixed
What is spastic ?
- Brain damage to motor area of cerebral cortex
- Increase muscle tone, tension, activity
- Sudden spasms
- Complete or partial loss of ability to control muscle movement
- Lack of control
What is Ataxia?
- Brain damage to cerebellum
- Loss of equilibrium; balance and orientation difficult; walk uncertain; difficulty sitting upright
- Lack of coordination of voluntary muscles
What is athetoid?
- Brain damage to basal ganglia
- Constant, involuntary, unorganized muscular movement
- Lack of ability to direct muscles in desired motion- Most difficult dental patient
- Grimacing, drooling, speech defects
- Exaggerated muscle movement
What is the medical management for cerebral palsy?
- Surgical, orthopedic, medical care
- Speech, physical, occupational therapy
- Bracing of lower limbs
- Use of cane, crutches, walker, wheelchair
- Tranquilizers to reduce tension, aid in limiting problems associated with nerve damage
What is the denal management for cerebral palsy?
Complicated → difficult cooperation
* Athetoid ≠ lack of cooperation
* Inability to communicate ≠ lack of comprehension
* Address patient directly, not through caregiver
Uncontrolled movement → injury
* Bite block
Assistance during appointment
* Caregiver, family
* Sedation premedication
What are the oral manifestations for cerebral palsy?
- Disturbances in musculature
- Malocclusion
- Attrition: Most extensive in athetoid type
- Fractured teeth
- Dental caries
- Seizures = phenytoin-induced gingival overgrowth
- Inflammation related to mouth breathing
- Increased biofilm, calculus, food retention
