Special Needs Pt 4 CP and ASD Flashcards
Define Cerebral Palsy–what are symptoms and dx criteria, etiology? prevalence per 1000? Face/mouth, muscles, reflexes?
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
Subtypes of Cerebral palsy: what is the most common type?
- Spastic diplegia and quadriplegia: 75% of CP it is the most common form.
- Hemiparesis: asymmetric CNS damage, uneven strength/poor balance, progressive scoliosis
- Athetoid or ataxic: involuntary movements
- Hypotonic
CP : associated findings (body)
- Strabismus
- GI problems
- Seizures
- Spinal problems
- Microcephaly
- Hearing loss
- 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
- behavioral problems
Oral findings for patients with CP?
- 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
Drooling tx for CP patients: what has been shown to be effective?
- Maxillary appliances
- Botox in submandibular gland, or transdermal scopolamine
- Surgery: bilateral submandibular gland excision w/parotid rerouting most effective at 88%
Autism: definition, w/’current update’ of definition
A neurodevelopmental disorder which is characterized by 3 behaviors:
- Difficulty interacting socially
- Problems with verbal and non-verbal communication
- 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
Epidemiology of ‘classic’ autism? ASD? Ethnicity? Gender? Inheritance?
- 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
Etiology of ASD?
Probable causes? What is autism associated with?
Autism appears to be a genetically influenced condition where environmental factors affect the biological process or modulate gene expression in the nervous system
- Family genetics (80-90%): mroe closely child is related to person w/ASD more likely child will have ASD
- Syndromic ASD (10-20%): assoc w/down, fragile X, Rett syndromes; also assoc w/PKU, teratogens, mitochondrial disorders
Conditions associated w/ASD?
Seizures: by adulthood 1/3 of ASD have had 2 unprovoked seizures
- Macrocephaly
- psychiatric disorder requiring medications
- GERD
Early signs of autism?
- 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
Autistic Regression
- Los off previously acquired speech/social skills
- Child was developing normally achieving milestones
Characteristics of Autism
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
Asperger Sydrome: characteristics
- 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
Common deficits in ASD?
Cognitive rigidity
Abnormal regulation of Attention, arousal, sleep, sensory processing
Cognitive Deficits in ASD? What are some clinical observations of this?
- Theory of Mind: what others think, ability to recognize and understand mental states of self/others and use this to predict behaviors (aspergers)
- Central coherence: can’t see the big picture, patients have a piecemeal view of the world, child tries to impose order (organizing objects etc)
What areas of the brain are affected? How?
- 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
Educational management of ASD: goals
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
Medications and classes of meds that may be used to help with Autism behaviors
- Hyperactivity: ritalin.concerta
- Repetitive behaviors: fluoxetine (prozac)- antidepressant, decreases compulsive behaviors, decreases self-mutilation,
- aggressive behaviors: carbamazepine (tegretol), risperidone (resperdal), ariprizole (abilify)
Aripirazole (Abilify): Indications, adverse orofacial rxn, systemic side fx?
- Irritability
- Excess saliva, drool, nausea
- Tremors, weight gain, sedation, nausea/vomit
Carbamazepine (Tegretol): Indications, adverse orofacial rxn, systemic side fx?
- Mood stabilization, antiaggression, anticonvulsant
- Xerostomia, stomatitis glossitis, carb cravings
- Lowers WBC and increases platelets w/long term use
Clonidine (Catapres): Indications, adverse orofacial rxn, systemic side fx?
- Calm hyperactivity, reduce impulsivity
- Xerosteomia, dysphagia, dialadentis
- Potentiates CNS depressants, heart arrhythmias
Fluoxetine (prozac): Indications, adverse orofacial rxn, systemic side fx?
- Antidepressant, reduce reptitive thoughts, lower compulsive behaviors, antianxiety, prevent self mutilation
- Xerostomia, altered taste, bruxism, stomatitis, glossitis, gingivitis, jaw pain, discolored tongue
- Diarrhea, nausea, somnolence, dizzy, increase bleeding time, potentiates CNS depressants
Methylphenidate (Ritalin, concerta): Indications, adverse orofacial rxn, systemic side fx?
- Calm hyperactivity, enhance attention
- Xerostomia
- Tachycardia, nervous, anorexia, insomia, potentiates TCA
Olanapine (zyprexa): Indications, adverse orofacial rxn, systemic side fx?
- Anti-pscychotic, lower delusions, reduce hallucinations
- Xerostomia, dysphagia, stomatitis, glossitis, gingivitis, tongue/facial edema
- Potentiates CNS depressants
Risperidone (Risperidal): Indications, adverse orofacial rxn, systemic side fx?
- 1typical neuroleptic, antipsychotic, antiaggression, lessen agitation, reduce hallucinations, lower delusions
- Xerostomia, dysphagia, altered taste, stomatitis, glossitis, discolored tongue, tongue/facial edema,
- Potentiates CNS depression, weight gain, sedation
Pervasive Developmental Disorder: characterized as?
Atypical autism: kids have less severe social impairment
CDD : Childhood disintegrative disorder: what occurs?
Normal growth and development for 2-4 years and then autism like symptoms begin to developm
Rett disorder: gender? similar to? clincal features (body, head/mouth)
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
