Special Care - Intellectual impairment Flashcards
What is intellectual impairment?
reduced intellectual ability and difficulty with everyday activities which affects someone for their whole life
- can either be born with it or develop it as a child
What are the 2 types of functioning that can be affected in an LI?
intellectual functioning - low IQ associated problems i.e. problem solving and judgement
adaptive functioning - problems with activities of daily life
What is the difference between impairment and disability?
Impairment is considered at an organ/system level
disability is considered with function;
a restriction in ability to perform an activity in the manner considered as normal for a human due to impairement
What syndromes are associated with learning disability?
ASD - not all DS Cerebral palsy - not all Fragile X Prader willi PKU
What causes DS? (3)
Trisomy of chromosome 21
mosaicism
chromosomal rearrangement of 21
What is a risk factor for having a child with DS?
Advanced maternal age
What medically features are commonly associated with DS? (9)
Intellectual impairment
congenital heart defects
alzheimers
epilepsy
leukaemia
hearing impairment
diabetes mellitus
coeliac and oral manifestations
thyroid disease
What are the dental implications of DS? (5)
Head positioning - atlanto-occipital instability
increased risk of periodontal disease
macroglossia
class III malocclusion
AOB
Why is DS associated with a higher incidence of periodontal disease? (5)
Altered immune system
poor manual dexterity and OH
don’t have full clearance when swallowing
higher prevalence of periodontal pathogens
altered saliva
What is Prader Willi?
genetic disorder which affects chromosome 15
What are the characteristics of prader willi?
constant desire to eat as they’re never full
intellectual impairment
lack of sexual development
behavioural problems - tantrum, stubborn
What is cerebral palsy?
neurological condition that affects movement and coordination and sometimes intellectual impairment - not always
What are the characteristics of CP?
Dependant on what type they have;
Muscle weakness and stiffness
uncontrolled body movement - intention tremor
balance and co-ordination problems
What are the benefits of providing care for people with learning disabilities in a primary care setting?
There are primary care setting closer to the patients which makes transport easier and less expensive
Family members and carers can attend with the patient
can provide longitudinal care - prevention, treatment, falls up
can establish a relationship
How do we prepare those with learning disabilities for the first visit?
send social stories home with the patient that prepares them for visiting the practice and receiving treatment
allow pre-visits - acclimatisation and trust
carry out a health passport - allows you to assess likes and dislikes (triggers)
when is best to carry out treatment on patients with learning disabilities? (2)
At the start of the day - so you’re not running late and so they don’t have to wait in the waiting room for long
find out what also suits them in terms of mood and medication administration times
What communication adjunct are useful for non-verbal patients?
Picture boards Makaton talking mats drawing and writing PECS - autism
What communication adjunct is not used for consent?
Talking mats
How can we gain better access to the mouth for patients with learning disabilities? (4)
Bedi shield
open wide mouth rest
mirrors with an internal light
head support and clinical holding - last resort and requires consent
What is the limitation of the bed shield?
can fracture
When should clinical holding be used? (3)
In an unplanned emergency
when the patient has consented and other people in the room have too
if the patient has no capacity and is at risk to themselves and others.
must record why it was used in the notes
What are the risk factors for oral disease in patients with learning disabilities? (4)
poor motor control - cannot carry out OH
mouth breathing and Dry mouth
imbrication (overlapping) of teeth
pouching and limited food clearance (leave food in the buccal sulcus)
What OH advice can we give to carers/people with learning disabilities? (5)
toothpastes with no taste or foam e.g. oranurse
establish a routine - brush at the same time every morning/night
start from a different quadrant every time you brush and ensure u use a systematic technique
use an adaptive toothbrush that suits the individual
stand behind and to the side
self injurious behaviour is associated with some LD, What are treatment strategies? (5)
distraction and challenge behaviour
behaviour psychology
pharmacological treatment i.e. diazepam
construct oral appliances
extract specific teeth - limited as they can use other teeth
