Special Needs Pt 4 CP and ASD Flashcards

1
Q

Define Cerebral Palsy–what are symptoms and dx criteria, etiology? prevalence per 1000? Face/mouth, muscles, reflexes?

A

A disorder of movement and posture
- result of injury to brain motor areas
- Static/ non progressive
- 2-4 cases/1000 children
- Perinatal complications is most common cause however 1/3 no clear cause
- Symptoms/Criteria:
Posturing, abnormal movements,
- Oropharyngeal problems (tongue thrust, grimace, dyspagia);
- Strabismus,
- inc/decreased muscle tone,
- evolutional response (persistent primitive reflexes, failure to develop equilibrium, failure to develop protective reflexes);
- Reflexes–increased deep tendon reflexes

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2
Q

Subtypes of Cerebral palsy: what is the most common type?

A
  1. Spastic diplegia and quadriplegia: 75% of CP it is the most common form.
  2. Hemiparesis: asymmetric CNS damage, uneven strength/poor balance, progressive scoliosis
  3. Athetoid or ataxic: involuntary movements
  4. Hypotonic
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3
Q

CP : associated findings (body)

A
  1. Strabismus
  2. GI problems
  3. Seizures
  4. Spinal problems
  5. Microcephaly
  6. Hearing loss
  7. 50% may have mental developmental delay, this increases more with bilaterally affected patients–most are normal or near normal just talk differently caution not to ‘talk down’ to pts
  8. behavioral problems
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4
Q

Oral findings for patients with CP?

A
  • Increased DMFS of permanent teeth
  • Lower salivary flow rate, lower pH, lower buffer ability
  • enamel erosion
  • poor gingival health
  • delayed permanent molar eruption
  • malocclusion
  • tongue thrust
  • bruxism
  • impaired gag reflex, dysfunctional swallowing, drooling
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5
Q

Drooling tx for CP patients: what has been shown to be effective?

A
  1. Maxillary appliances
    - Botox in submandibular gland, or transdermal scopolamine
    - Surgery: bilateral submandibular gland excision w/parotid rerouting most effective at 88%
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6
Q

Autism: definition, w/’current update’ of definition

A

A neurodevelopmental disorder which is characterized by 3 behaviors:

  1. Difficulty interacting socially
  2. Problems with verbal and non-verbal communication
  3. Repetitive behaviors or narrow, obsessive interests
    * *w/difficulty in balance, movement, memory, and visual perception skills therefore
    - - A more current definition: autism is a global behavioral disorder affecting how the brain processes info it gets especially when that information is complex
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7
Q

Epidemiology of ‘classic’ autism? ASD? Ethnicity? Gender? Inheritance?

A
  • 1 to 2/1000 live births for classic autism
  • ASD is 6/1000
  • No ethnic differences
  • Males 3-4x more likely to be affected
  • affected females have more severe disabilities
  • 3% of families have >1 child w/autism
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8
Q

Etiology of ASD?

Probable causes? What is autism associated with?

A

Autism appears to be a genetically influenced condition where environmental factors affect the biological process or modulate gene expression in the nervous system

  1. Family genetics (80-90%): mroe closely child is related to person w/ASD more likely child will have ASD
  2. Syndromic ASD (10-20%): assoc w/down, fragile X, Rett syndromes; also assoc w/PKU, teratogens, mitochondrial disorders
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9
Q

Conditions associated w/ASD?

A

Seizures: by adulthood 1/3 of ASD have had 2 unprovoked seizures

  • Macrocephaly
  • psychiatric disorder requiring medications
  • GERD
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10
Q

Early signs of autism?

A
  • No babbling or gesturing by 12 months
  • No words by 16 months
  • No social interaction : smile, eye contact
  • Restricted interests and activities
  • Lack of imagination in play
  • Compulsive behaviors may be evident
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11
Q

Autistic Regression

A
  • Los off previously acquired speech/social skills

- Child was developing normally achieving milestones

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12
Q

Characteristics of Autism

A

Impaired social interaction

  • impaired verbal/nonverbal communication
  • restricted repetitive patterns of behavior
  • Poor body awareness/clumsiness
  • Conduct problems
  • Familial pattern
  • distorted sensory input
  • Difficulty completing complex tasks
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13
Q

Asperger Sydrome: characteristics

A
  • Normal curiosity, adaptive behavior and self-help skills during the 1st 3 years
  • Qualitative impairment in social interaction
  • No delay in language/cognition
  • More common than Autism
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14
Q

Common deficits in ASD?

A

Cognitive rigidity

Abnormal regulation of Attention, arousal, sleep, sensory processing

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15
Q

Cognitive Deficits in ASD? What are some clinical observations of this?

A
  1. Theory of Mind: what others think, ability to recognize and understand mental states of self/others and use this to predict behaviors (aspergers)
  2. Central coherence: can’t see the big picture, patients have a piecemeal view of the world, child tries to impose order (organizing objects etc)
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16
Q

What areas of the brain are affected? How?

A
  • Cerebral cortex: center of reasoning, planning, judgement and language
      • Prefrontal cortex will have more neurons
      • Mirror neurons = ability to feel empathy
  • Limbic system: regulates emotion
  • Cerebellum : site of most commonly observed brain abnormalities in ASD: nystagmus (involuntary eye movements), tremor, ataxia
17
Q

Educational management of ASD: goals

A

Dx EARLY: earlier the better by 2 years of age preferable

  • Intensive intervention schedule: 25 hours/week w/low student/teacher ratio, family involvement
  • Focus on structure, routine, minimal distractions
  • Applied behavior analysis (ABA): operant conditioning, learning to learn, teaching specific skills
18
Q

Medications and classes of meds that may be used to help with Autism behaviors

A
  1. Hyperactivity: ritalin.concerta
  2. Repetitive behaviors: fluoxetine (prozac)- antidepressant, decreases compulsive behaviors, decreases self-mutilation,
  3. aggressive behaviors: carbamazepine (tegretol), risperidone (resperdal), ariprizole (abilify)
19
Q

Aripirazole (Abilify): Indications, adverse orofacial rxn, systemic side fx?

A
  1. Irritability
  2. Excess saliva, drool, nausea
  3. Tremors, weight gain, sedation, nausea/vomit
20
Q

Carbamazepine (Tegretol): Indications, adverse orofacial rxn, systemic side fx?

A
  1. Mood stabilization, antiaggression, anticonvulsant
  2. Xerostomia, stomatitis glossitis, carb cravings
  3. Lowers WBC and increases platelets w/long term use
21
Q

Clonidine (Catapres): Indications, adverse orofacial rxn, systemic side fx?

A
  1. Calm hyperactivity, reduce impulsivity
  2. Xerosteomia, dysphagia, dialadentis
  3. Potentiates CNS depressants, heart arrhythmias
22
Q

Fluoxetine (prozac): Indications, adverse orofacial rxn, systemic side fx?

A
  1. Antidepressant, reduce reptitive thoughts, lower compulsive behaviors, antianxiety, prevent self mutilation
  2. Xerostomia, altered taste, bruxism, stomatitis, glossitis, gingivitis, jaw pain, discolored tongue
  3. Diarrhea, nausea, somnolence, dizzy, increase bleeding time, potentiates CNS depressants
23
Q

Methylphenidate (Ritalin, concerta): Indications, adverse orofacial rxn, systemic side fx?

A
  1. Calm hyperactivity, enhance attention
  2. Xerostomia
  3. Tachycardia, nervous, anorexia, insomia, potentiates TCA
24
Q

Olanapine (zyprexa): Indications, adverse orofacial rxn, systemic side fx?

A
  1. Anti-pscychotic, lower delusions, reduce hallucinations
  2. Xerostomia, dysphagia, stomatitis, glossitis, gingivitis, tongue/facial edema
  3. Potentiates CNS depressants
25
Q

Risperidone (Risperidal): Indications, adverse orofacial rxn, systemic side fx?

A
  1. 1typical neuroleptic, antipsychotic, antiaggression, lessen agitation, reduce hallucinations, lower delusions
  2. Xerostomia, dysphagia, altered taste, stomatitis, glossitis, discolored tongue, tongue/facial edema,
  3. Potentiates CNS depression, weight gain, sedation
26
Q

Pervasive Developmental Disorder: characterized as?

A

Atypical autism: kids have less severe social impairment

27
Q

CDD : Childhood disintegrative disorder: what occurs?

A

Normal growth and development for 2-4 years and then autism like symptoms begin to developm

28
Q

Rett disorder: gender? similar to? clincal features (body, head/mouth)

A

Similar pattern to Childhood Disintegrative Disorder but occurs earlier and mostly in girls
- postnatal neurological disorder of the grey matter of the brain, nonverbal, 50% non-ambulatory, 80% have seizures

Clinical:

  • deceleration of the rate of head growth (microcephaly over time), small hands, small feet
  • Repetitive stereotyped hand movements, such as wringing and/or repeatedly putting hands into the mouth
  • Prone to GI disorders
  • Scoliosis, growth failure, and constipation are very common