Special Populations

Question 1

prevalence of disabilities and incidence of legal blindness in these populations

Answer 1

> 3,000,000 individuals have one or more handicapping conditions
(legal blindness is 200x more frequent in these populations)

Question 2

how is developmental disability defined and what are some characteristics

Answer 2

• severe, chronic, mental or physical impairment
• occurs at conception or soon after birth
• characteristics: continue indefinitely, varied functional abilities
• need for early identification/intervention

Question 3

definition and characteristics of cerebral palsy

Answer 3

• multiply handicapping condition from brain maldevelopment or damage before, during, or shortly after birth
• characterized by motor dysfunction and associated problems

Question 4

general signs of cerebral palsy and %

Answer 4

• locomotor difficulty (100%)
• speech disorders (90%)
• visual disorders (70+%)
• mental retardation (50%)
• seizures (35%)
• hearing impaired (20%)
• swallowing and drooling (10%)

Question 5

spasticity is common in cerebral palsy (80%), what are the subclassifications of this?

Answer 5

-hemiplegia (one side of body, common in full term children)
-quadriplegia (both arms, both legs, head and trunk)
-diplegia (trunk and all 4 extremities, mostly legs, common in preterm infants)
-paraplegia (involves the legs)
(others w/small incidence are athetosis, rigidity, ataxia, tremor, or mixed)

Question 6

incidence and etiology of cerebral palsy (and %)

Answer 6

incidence: 2: 1,000
etiology:
-inherited (10%)
-prenatal (50%)
-perinatal (33%)
-postnatal (17%)

Question 7

what are some visual characteristics of cerebral palsy?

Answer 7

• Strabismus (60%, mainly esotropia)
• Refractive Error (60%, mainly hyperopia)
• Amblyopia (20%)
• Gaze Restrictions (18%)

Question 8

what are some ocular disease characteristics of cerebral palsy?

Answer 8

• optic atrophy (7%)

- nystagmus (6%)

Question 9

3 examining pearls for patients with cerebral palsy

Answer 9

• leave in wheelchair (want proper positioning)
• may use preferential looking
• strabismus may be neurological in nature: discuss before surgery referral

Question 10

why does down syndrome occur and how common is it?

Answer 10

• an extra chromosome 21 or an extra part of it in each cell body (trisomy 21)
• most common chromosomal abnormality encountered
• incidence: 1:600 to 00 live births (1:50 with women older than 44)

Question 11

some facts about down syndrome (defects that are more common, characteristics, etc.)

Answer 11

• detected with ultrasound/amniocentesis
• associated with congenital heart defects
• acute leukemia more common
• mental retardation is universal
• good socialization skills

Question 12

3 etiologies of down syndrome (modes of genetic transmission)

Answer 12

• nondisjunction trisomy 21 (most common): extra 21 chromosome
• translocation (normal number of chromosomes, but a portion of a chromosome 21 or 22 attaches to another of 13, 14, or 15)
• mosaicism (1%): some affected cells, some normal cells

Question 13

common identifying features of down syndrome

Answer 13

• short stature
• brachycephalic skill
• flat occipital lobe
• low set ears
• flat nasal bridge
• small oral cavity and protruding tongue

Question 14

common ocular features of down syndrome

Answer 14

• epicanthal folds
• upward slanted eyes/ oblique palpebral fissures
• iris anomalies like brush field’s spots (pale grey irregular discoloration in the mid peripheral iris) and iris hypoplasia (95%)
• retinal changes (early bifurcation of vessels, RPE disturbances)

Question 15

visual characteristics of down syndrome

Answer 15

• strabismus (40%, mainly high AC/A esotropia)
• refractive error (42-73%, mainly hyperopia but myopia common too)
• accommodative dysfunction (92% had amps <10 D and 50% were <4D)
• nystagmus (8%)

Question 16

ocular disease characteristics of down syndrome

Answer 16

• blepharitis/ conjunctivitis (40%)
• keratoconus (15%)
• cataracts, expect early-9yo due to premature aging complex

Question 17

autism is a behavioral syndrome characterized by abnormalities in:

Answer 17

• understanding and using language
• responses to sensory stimulation
• responses to change and insistence on routines
• social interaction

Question 18

incidence and stats on autism

Answer 18

• CDC estimates 1% of children, more frequent in boys

- recurrence risk of 9% in subsequent child

Question 19

4 characteristics of autism

Answer 19

• atypical, delayed, or unequal development
• atypical responses to sensory stimuli (tactile, auditory, visual, and/or gustatory dysfunction)
• disorders of communication/social interactions
• significant deficits in speech/language development

Question 20

visual characteristics of autism

Answer 20

• strabismus (21-84%, IXT: variable)
• poor fixations and pursuits
• refractive error (no specific trends)

Question 21

visual behaviors seen in autism

Answer 21

• limited or no eye contact
• visual avoidance
• extreme lateral gaze
• eye pressing
• hand flicking
• light gazing

Question 22

treatment options for patients with autism

Answer 22

• highly structured special education
• strict regulation in diet
• medication (ADHD meds? SSRIs?)

Question 23

2 types of behavioral therapy that may be used in patients with autism

Answer 23

• applied behavior analytics (ABA): developed by Lovas

- relationship development intervention (RDI)

Question 24

what is the “Applied behavior analytics (ABA)” developed by Lovas

Answer 24

-applied behavior analytics (ABA): developed by Lovas
-A= antecedent (directive)
-B=behavior
-C= consequence
(most mainstream, “do something and get reward or punishment”)

Question 25

what is the relationship development intervention (RDI) developed by Gutstein?

Answer 25

• parent centered through lifestyle changes
• lays missing pathways
• improves flexible thinking

Question 26

2 examination pearls for children with autism

Answer 26

• limit distractions (remove clutter)

- stimulate large muscle groups (oral stimulation, chewing, eating)