KIN120 Final Flashcards
(98 cards)
1
Q
Adapting should lead to the following indicators?
A
Warm and positive climate
Ensuring success-oriented activities
Time spent on lesson objectives
On-task behaviors that are linked to lesson objectives
Shared responsibility for learning and demonstrated
self-determination (choice making)
2
Q
INPUTS THAT INFLUENCE TEACHING?
A
−People (both students and teachers): age, gender,
socioeconomic class, culture, self concept, attitudes,
knowledge, actual and perceived competence, creativity,
expectations, perceptions, emotions, fears etc.
−Environment: class size, facilities, equipment, school,
home and community resourses, lighting, sounds, smells
etc.
Time: can include things such as instructional time, time
spent on activities, prep time, time of day, willingness of
the participant to ‘put in the time’ to learn a skill, etc.
−Opportunity: can be broken down into family, school and
community (positives and negatives) in relation to
individual students. Is largely determined by cultural,
economic, and moral variables.
3
Q
LEVELS OF ASSISTANCE IIN EFFECTIVE TEACHING?
A
In performing a task or a sequence of tasks, participants
require different levels of assistance: physical, visual,
verbal, or a combination of these
4
Q
3 elements (ABC’s of Behavior)?
A
I. Antecedent (Stimulus)
II. Behavior (Response)
III. Consequence (Reinforcer)
5
Q
METHODS USED TO STRENGTHEN OR
MAINTAIN BEHAVIOURS?
A
Reinforcement:
−Purpose of any reinforcement is to increase or strengthen
behaviour or response over time
−The contingent presentation of a consequence or event
immediately following a specified response that
increases the likelihood of that behaviour occurring
again.
6
Q
METHODS USED TO STRENGTHEN OR
MAINTAIN BEHAVIORS?
A
Positive Reinforcement (R+): −Presentation of a favourable event (reward)
Negative Reinforcement (R–
):
−Omission or removal of an unfavourable event
(escape)
7
Q
What is Punishment?
A
Punishment designed to prevent or stop a behaviour from occurring
8
Q
Positive Punishment?
A
An event that decreases the probability that a response will be
repeated in the future
− Don’t jump off cliff to avoid injury
− Don’t steal because fear of punishment
9
Q
Negative Punishment?
A
Weakening of a response by the omission of favourable stimulus
− Lose license for reckless driving (license is the favourable
stimulus)
10
Q
ISSUES TO CONSIDER WHEN USING R+?
A
Reinforce every behaviour when teaching something new
−Reinforcers should be functional, age-appropriate,
individual and easily provided
−Opportunity for a higher probability behaviour will
reinforce any lower probability behaviour
• Don’t get dessert unless you eat your vegetables at
dinner
11
Q
ISSUES TO CONSIDER WHEN USING R–?
A
The word negative means the event has been
contingently removed or taken away
−It does not mean the consequence is negative
12
Q
PROCEDURES TO ELIMINATE OR
DECREASE A BEHAVIOUR?
A
Punishment
−Unlike Reinforcement, punishment is used to
decrease a behaviour
Issues to Consider: −Does not build a positive relationship −Emotional responses are likely −Potentially addictive to punisher −Teaches people what NOT to do
Time Out(s) −Extension of punishment concept −Based on assumption that some R+ in the environment is maintaining behavior −Removal from the opportunity to receive R+
Signal Interference
−Use of a signal to communicate disapproval
−1-2-3 Magic
Proximity
−Think about the individual’s social groups
13
Q
PRINCIPLES FOR MANAGING THE
ENVIRONMENT?
A
- Use optimal structure
- Reduce space
- Eliminate irrelevant stimuli
- Highlight relevant stimuli
14
Q
INSTRUCTIONAL APPROACHES FOR EFFECTIVE TEACHING?
A
- ETA
- Bottom-up
- Top-down
Other helpful techniques 1. Task Analysis Breaking a skill down into smaller components Forward Chaining Backwards Chaining
15
Q
Definition of ID?
A
§Characterized by significant limitations both in intellectual functioning and in adaptive behaviour expressed in conceptual, social, and practical adaptive skills.
Originates before the
age of 18
16
Q
The following assumptions are
essential to the application of ID:
A
1. Limitations in functioning must be considered within the context of community environments typical of the individual’s age, peers and culture.
2. Valid assessment considers cultural and linguistic diversity as well as differences in communication, sensory, motor, and behavioral factors.
- Within an individual,
limitations often coexist
with strengths. - An important purpose of
describing limitations is to
develop a profile of needed
supports.
5. With appropriate personalized supports over a sustained period, the life functioning of the person with ID generally will improve.
17
Q
Adaptive behaviour?
A
A collection of conceptual, social and practical skills that have been learned by people in order to function in their everyday lives
18
Q
Three (3) Adaptive
Behaviour Categories? (ID)
A
- Conceptual: Language,
reading & writing, money,
time, number concepts - Social: Interpersonal skills,
social responsibility, selfesteem, gullibility, following
rules, obeying laws, and
avoiding victimization - Practical: ADL (personal
care), occupational skills,
use of money, safety, health
care, travel/transportation,
schedules/routines, use of
the telephone
19
Q
What are
Supports?
A
Resources and strategies that aim to promote the development, education, interests, and personal wellbeing of a person and that enhance individual functioning.
Support needs are psychological constructs referring to the pattern and intensity of supports necessary for a person to participate in activities linked with normative human functioning.
Services are one type of
support provided by
agencies and
professionals
Individual functioning
results from interaction of
supports
Appropriate supports will
improve functioning
20
Q
Causes of ID?
A
Causes can be genetic,
congenital, or may occur
spontaneously and not
caused by heredity
21
Q
Prenatal causes of ID?
A
Prenatal:
Chromosomal disorders
Brain formation disorders
(i.e. Neural Tube fails to
form properly)
Errors of metabolism (i.e.
protein synthesis)
Environmental (i.e. toxins,
drug/alcohol use)
22
Q
Perinatal causes of ID?
A
Perinatal:
(Around childbirth especially
5 months before and one
month after)
Abnormal labour &
delivery
Head trauma
Infection
Intracranial hemorrhage
Nutritional imbalance
23
Q
Postnatal causes of ID?
A
Postnatal:
Head injuries
Infections
Degenerative
Seizure disorders
Toxic-metabolic
Malnutrition
Environmental deprivation − i.e. disease-producing conditions, inadequate medical care, isolation, and environmental health hazards
24
Q
Chromosomal Abnormalities of ID?
A
22 are autosomes, and one (1) sex chromosome §Chromosomal abnormalities affect about 7 in every 1000 births
Usually result from chance
errors in cell division
With each cell division 23 pairs of chromosomes should be passed on, each carrying the full DNA and genes to determine further development
Of the 23 pairs in each cell, 22 are autosomes (important for specific genetic markers) and one is the sex chromosome pair, designated XX (female) or XY (male)
Abnormalities can occur in
either autosomes or sex
chromosomes
Most common autosomal
chromosome disorder is Down Syndrome
A common sex linked
chromosome disorder is Turner Syndrome
25
What is Trisomy 21
| (Down Syndrome)?
A chromosomal
abnormality that affects
intellectual and physical
development
Trisomy 21 (most common)
Translocation (when one
chromosome breaks off and
attaches to another)
Mosaicism (very rare)
Detected through amniocentesis
```
Risk is about 1 in 800, but varies
with maternal age:
− Age 25 = 1/1000
− Over 35 = 1/400
− Over 45 = 1/35-40
```
26
Common features of Down Syndrome?
Common Features:
Flattened back of skull, short
neck
Small oral cavity
Hypotonic muscle tone during
childhood
Joint looseness (hypotonicity & lax ligaments)
Short stature
Short limbs with short, broad
hands and feet
Almond-shaped, slanted eye
(strabismus, myopic)
Flattened facial features
27
Defects of Down Syndrome?
Hypotonia (lack of muscle
mass) and skeletal concerns
Motor development delays
Balance deficits
Left-handedness and
asymmetrical strength
Visual and hearing concerns
Heart and lung problems
Fitness and obesity
Health and temperament
28
Issues that may arise with Down Syndrome?
17% of persons with DS
Atlantoaxial is a joint between
first 2 cervical vertebrae
Ligaments and muscles
surrounding the joint are ‘lax’
which can cause instability
Because of instability, the
vertebrae can slip out of
alignment easily
```
Particular sports that cause
forceful bending of neck
(gymnastics, swimming, diving,
soccer) can cause damage to
spinal cord
```
Persons with DS are required to have x-rays to determine if the condition is present or not
29
ID with
Associated
Conditions?
Seizures
Cerebral palsy
```
Dual diagnosis (mental
health)
```
Pain insensitivity and
indifference
30
Considerations
for Physical
Activity for ID?
Communication and Self Direction:
Augmentative/alternative
communication
```
Range from low-tech
alternatives like picture
boards and notebooks to
high-tech devices that use
synthetic or digitized
speech
```
Time delay to respond
−10 seconds without
prompting
Cognitive Ability:
Attention (pay attention to one aspect of a
task or pay attention to everything including
irrelevant stimuli)
Memory or Retention:
(long term memory
is equal to peers. May have difficulties with
short term memory)
Add rehearsal strategies and provide
multiple trials
Modeling, verbal rehearsal, self talk and imagery
Feedback:
```
Feedback should include questioning
about process as well as product.
i.e. Did the movement feel good, did you
tuck your head when you did the forward
roll etc.
```
Task Analysis, Repetition, Generalization:
Might require more time and/or
attempts
Motor Performance:
```
Motor development and
delays (slowness)
− Slowness in the use of righting,
propping, postural reactions
and processing instruction
```
Influence of physical
constraints:
Height; Weight
Obesity
Physical fitness and active
lifestyle
Low intensity and long
duration activities like
walking, dancing and water
activities
31
Movement difficulties are
| due to five (5) sources? (ID)
```
1. Deficiencies in knowledge
base or lack of access to it
2. Failure to use spontaneous
strategies (need cues)
3. Inadequate metacognitive
knowledge and
understanding (need to
‘think’ throughout the day)
4. Executive control and motor
planning weaknesses
(start/stop actions, adapt to
change)
5. Low motivation and
inadequate practice
```
32
KnowledgeBased Model?
Use of a knowledge-based
model to guide instruction
implies:
```
Careful teaching of facts
and processes with
emphasis on problem
solving so learners are
actively involved
```
33
What are Learning
| Disabilities?
```
Refers to a number of
disorders which may
affect the acquisition,
organization, retention,
understanding or use of
verbal or nonverbal
information.
```
As such, learning
disabilities are distinct
from ID.
34
Who does LD effect?
```
These disorders affect
learning in individuals
who otherwise
demonstrate at least
average abilities
essential for thinking
and/or reasoning.
```
35
Characteristics of LD?
Heterogeneous group
of disorders
Not due to other
disabilities
Identifiable or inferred
CNS dysfunction
Brain development is
affected
Not an intellectual
disability
Show average abilities
essential for thinking
and/or reasoning
36
What does LD result from?
```
Results from impairments in
one or more processes
related to: Perceiving,
thinking, remembering or
learning.
```
37
LD is Included but not limited to?
```
-Language processing
• Phonological processing
• Visual spatial processing
• Processing speed
Memory and attention • Executive functions (e.g.
planning and decisionmaking).
```
38
LD may interfere with the
acquisition and use of
one or more of the
following?
```
• Oral Language (e.g.
listening, speaking,
understanding);
• Reading (e.g. decoding,
phonetic knowledge,
word recognition,
comprehension);
• Written Language (e.g.
spelling and written
expression);
• Mathematics (e.g.
computation, problem
solving).
```
39
T or F: Learning disabilities are lifelong
True
40
Some individuals with
LD also experience
motor disabilities like?
• Perceptual motor
• Motor coordination
• Movement related
problems
‘DCD’ can occur with
or without LD
41
What is Developmental
| Coordination Disorder?
```
“Performance in daily
activities that require
motor coordination is
substantially below that
expected given the
person’s chronological
age and measured
intelligence.
```
```
This may be marked
delays in achieving
motor milestones,
dropping things, poor
performance in sports,
or poor handwriting.”
```
42
Defects of?
Developmental delays
in motor skills
Poor movement skills,
interference in ADL
Withdraw from physical
activity
• Low fitness levels
• Reduced skill
acquisition
• No practice
Psychosocial difficulties
(poor self esteem and
social isolation)
43
Diagnosis of DCD?
```
1. Condition
significantly interferes
with academic
achievement or ADL
2. The condition is not
caused by a general
medical disorder or
PDD
3. If ID is present, the
motor difficulties are
in excess of those
usually associated
with it
```
44
PA Considerations
(Applicable to LD
and DCD)?
1: Immature Body Image and
Agnosias:
```
Partial or total inability to
recognize objects by use of
the senses. Inability to
identify body parts and
surfaces, inability to
translate knowledge of
right and left into following
movement instructions and
difficulty in making
judgments about body
shape, size and proportions.
```
Improve through action
songs, dances and games
that refer to body parts.
Provide opportunities for
children to see themselves
in the mirror, on video tape
or film
2: Poor Spatial Orientation:
```
• Unsure of direction,
difficult to estimate
height, distance,
width…bump into
things, hard to duck or
step over.
```
```
• Recommended games
must involve obstacle
courses, mazes and
maps. Orienteering,
and treasure hunts are
good.
```
```
• Instruction should
include cue detection
as well as self-talk and
rehearsal (both visual
and verbal).
```
3: Overflow Movements:
```
• Inability to keep
opposite limbs
motionless when
performing tasks with
other arm
```
4: Dissociation:
```
• Problems perceiving
and organizing parts
into wholes, easier to
engage in whole
body activities so
focus only on one
thing (look at target,
don’t worry about
stance)
```
5: Figure Background:
• Inability to pick out
and/or figure out of
complex background
```
6: Motor Planning and
Sequencing
• Difficult to initiate
movement, stop
movement, put
movement into
correct order.
```
```
Intervention involves:
• Games
• Dance
• Water play
• Gymnastic routines (in
which an increasing
number of movements
must be remembered
and chained into
sequences)
```
7: Temporal Organization,
Rhythm and Force:
```
• Difficult to organize
parts into wholes, lack
of rhythm to dance
• Include early
instruction to music,
rhythm, and dance.
• Use background music
or a strong percussive
beet.
• Music should be
carefully selected to
reinforce the natural
rhythm of the skill and
the desired
performance speed
```
45
Instructional
Strategies/PA
Considerations?
1) Modality:
```
• Which approach to
instruction works best?
• Visual or auditory
(present information
in the preferred
modality)
```
2) Match cognitive style: (Refers to persons approach to analyzing and responding to stimuli)
3) Field Dependent:
```
Strongly
influenced by the visual field.
See wholes and have trouble
finding embedded figures and
details. Tend to have a fast
conceptual tempo, spend little
time planning, and need
external structure.
```
4) Field Independent – Focus on
details, analytical, reflective
People with LD are more
likely to be FD than FI
```
Awareness of cognitive
styles helps instructors to
match instruction demands
to strengths then gradually
remediate weaknesses
```
5) Self-Talk and Verbal
Rehearsal
6) Motivation and Self
Concept Enhancement"
```
• May have lower self
concept and
esteem due to
repeated failures or
bad experiences
```
```
• Provide opportunity
for success and
activities that are
meaningful (things
that can carry over
to other
environments)
```
46
What is self talk?
```
Successful in
helping children learn
motor sequences,
improve performance
and control impulsivity.
```
• Self talk usually refers to
talking oneself through an
activity or sequence.
• Ex. Jumping Jack
47
What is verbal rehearsal?
Talking about the required
movements before doing
them
48
What is Attention Deficit
| Hyperactivity Disorder -ADHD?
Interferes with a person’s ability to sustain attention or focus on a task and to control impulsive behaviour
Inability to maintain focus or attention
Impulsive behavior
Interferes with daily activities
Not a learning disability
Neurobiological disability
Genetic connection
49
Behaviours of ADHD?
1) Distractibility
Super-sensitivity and limited ability
to tune out internal and
environmental stimuli
2) Impulsive
Lack restraint; react immediately
without thinking
3) Hyperactive
Persistent, heightened, sustained
activity
50
Prevalence of ADHD?
3-5% of Canadian children have ADHD
Boys are affected more
51
How is ADHD diagnosed?
Distractibility, impulsivity, hyperactivity
52
Diagnosis of ADHD in
| Children?
§ Rule out other conditions
§ Assess academic, social, emotional
functioning. attention span
§ Observation
Consider the following:
§ severity, early onset, duration,
impact, settings
53
Types of ADHD?
```
Predominantly inattentive (AD)
§ Predominantly hyperactive impulsive (HD)
§ AD/HD combined
```
54
Treatment for ADHD?
A combination of education, behavioural,
psychosocial and medication treatments is
thought to be the most effective approach.
This comprehensive approach to treatment is
called “multimodal” and often includes:
§ Behavioral Interventions
§ Medication
Behavioral Interventions:
§ Try to change the physical and social
environment to modify the behaviour of the
person with AD/HD (i.e., problem solving, social
skills, cognitive behavioural therapy)
§ Medication
§ Prognosis:
§ Armed with an understanding of the disability
and its implications, and with appropriate
treatment, strategies and support, individuals
with AD/HD can succeed.
55
Co-Occurring Conditions or
| Concerns Associated with ADHD?
```
Learning disabilities
§ Depression
§ Anxiety
§ Substance abuse
§ Aggressive & defiant
behaviours
§ High risk behaviours
§ Emotional problems
§ Perseveration
§ Social perception
inadequacies
```
56
Strategies & Considerations
| for PA for ADHD?
Manage the Environment:
```
I. Structure program
§ Keep directions simple
§ Be proactive
§ Respond to behaviour
§ Use frequent eye contact
II. Reduce environmental space
III. Eliminate irrelevant stimuli
IV. Enhance instructional stimuli
```
§ Routine, no surprises, know what to expect
§ Lane markers, know boundaries, create limits
§ Keep things neat, clean, well ordered
(eliminate what is not important)
§ Use color to keep attention
57
What is Cerebral Palsy?
Chronic neurological disorder of
movement and posture caused by a
defect or lesion on immature brain
• Varies in severity
58
What does cerebral mean?
brain.
59
What does palsy mean?
Disorder of posture or
| movement; lack of movement
60
CP is primarily a?
Motor defecit
61
Severity levels of CP?
• Mild (i.e. general clumsiness may have a
slight limp)
• Severe (ambulatory difficulty, inability to
speak with spoken words, almost no control
of motor function)
Varying degrees of damage to the brain
result in differing degrees of impairment.
62
Visible Signs Range of CP?
• No visible signs TO cognitive, sensory,
perceptual difficulties and no motor
control with speech difficulties
• Continuum of intelligence
63
PRENATAL causes of CP?
```
Fetal anoxia
• Poor
nutrition
• Chemical
toxins
• Maternal
health
problems
```
64
PERINATAL causes of CP?
```
• Premature
birth
• Difficult
delivery
• Prolonged
labour
```
65
POSTNATAL causes of CP?
```
• Head injury
(brain
hemorrhages,
infections,
tumors)
• Physical abuse
```
66
T or F: 90% of CP cases occurs during the
| prenatal and perinatal periods?
True.
67
Why does a person who has Stroke, Acquired Brain Injury (ABI) not labeled as CP?
A person who sustain injuries to the
motor portion of the brain after age 2-5
exhibit similar motor impairments but
are labeled differently
68
The effects Depends on which area of the brain has been damaged. What are they?
```
• Muscle tightness or spasm
• Involuntary movement
• Difficulty with:
• gross motor skills such as walking or running
• fine motor skills such as writing and
speaking
• Abnormal physical sensations
• These effects may
cause associated
problems such as
difficulties in
feeding, poor
bladder and bowel
control, breathing
problems, and
pressure sores.
```
69
Classification/Types of CP
| (CP disorders classified according to two factors)?
```
1. Limb Involvement
• Monoplegia
• Diplegia
• Hemiplegia
• Triplegia
• Quadriplegia
```
```
2. Muscle Tone/Movement
• Spasticity
• Athetosis
• Ataxia
• People with CP have abnormal
muscle tone to varying
degrees.
• Three major types are
recognized BUT most people
have mixed types and the
diagnosis indicates which is
most prominent.
```
70
What is spastic cP?
Most common (50-60%)
• Excessive muscle tone, abnormal tightness
and stiffness characterized by hypertonic
involuntary muscle contractions
• Difficulty relaxing muscles when attempting
purposeful movement
71
SPASTIC CP: Hyperactive Stretch Reflex?
• Spasticity affects flexor muscle groups
• Spastic lower limbs may be rotated inward,
flexed at hip joint, knees flexed and
adducted, heels are lifted off of ground
• Upper limb involvement leads to pronated
forearms with flexion at elbows, wrists and
fingers
72
SPASTIC CP: Contractures/Deformities?
Typically muscles on one side relax when
others contract
• If contractures are present this does not
happen
• Tends to affect the antigravity muscles
(flexor and adductor muscle groups)
• Associated with a hyperactive stretch
reflex
73
What is Athetosis (CP)?
(30%)
```
• Overflow of motor impulses so muscles are
characterized by constant, slow,
unpredictable and purposeless movement
caused by fluctuating muscle tone
(hypotonic and/or hypertonic).
```
• Fluctuating muscle tone
• Problems with visual pursuit and focus (can
affect ability to perform hand-eye
coordination)
* Involuntary & purposeless movement
* Fine muscle coordination is difficult
* Commonly affects upper extremities and head
* Many will use wheelchairs for mobility
* Gait is described as unsteady
74
What is Ataxia (CP)?
10%
• Damage to cerebellum (feedback
mechanism of brain and organizes
information to coordinate muscle functions)
* Poor balance and trunk control
* Uncoordinated movement
• Involuntary movement of trunk and
extremities
* Hypotonic
* Walk with wide gate
75
Classification of CP according to Severity?
* Mild
* Can walk, speech somewhat affected
* Moderate
* Difficulty with speech and locomotion
* Severe
* Use of wheelchair, difficult to understand
76
Associated Medical/Health
| Concerns of CP?
```
• Oral Dental
• Speech (35-75%)
• Visual (55-60%)
• Sensory deficits
• Convulsive disorders
(25-50%)
• ID (30-70%)
• Hip dislocation, scoliosis,
foot deformities
• Major reflex problems
(80-90%)
```
77
Pathological Reflexes of CP?
* Infant reflexes
* Involuntary & predictable
* Typically indicative of a mature nervous system
• In CP, reflexes are not integrated
• Reflexes interfere with smooth,
coordinated movement
78
Reflexes effected by CP?
```
• Asymmetrical Tonic Neck
Reflex
• When head is turned to
one side, arm on that side
extends while opposite
arm flexes
```
• Startle Reflex
```
• Severe Gag Reflex
• Problems with feeding and oral hygiene
• Slow eating, spillage, poor (or no)
coordination of oral muscles and
swallowing mechanisms
• Inadequate nutrition
• Dehydration
• Metabolism of medication
```
79
Considerations for Physical
| Activity for CP?
```
Spasticity
• Relaxed atmosphere
• Warm water swimming beneficial
• Perform slow, prolonged stretches
• Work through full ROM
```
• Avoid abnormal, involuntary, non-functional
muscle patterns
• Transport skills (encourage independent
movement)
• Manipulation skills (make use of functional ability)
• Mechanical and muscle inefficiency (a lot of
energy is used for movement)
• Flexibility – stretch daily
```
• Delayed motor development
• Limits the physical, mental, emotional
stimulation that children require
• Suggested that motor performance at age 7
is indicative of motor performance as an
adult
• Early intervention
```
• Adopt principle of keeping body parts in alignment
• Avoid abnormal postures and stereotyped patterns
• Injury, deviations
• If flexion is present place in extension and
vice versa
80
Seating someone in their
| wheelchair?
• Must have proper alignment
• Hips at 90o and in contact with back of chair
• Thighs slightly abducted and in contact with
seat
• Knees, elbows, ankles at 90 deg flexion
• Limit pressure on back of knees
• Feet should be flat
• Head and neck in midline
81
What is Spinal Paralysis?
Broad term for conditions caused by injury or disease to the
spinal cord and/or spinal nerves
Paralysis can be complete (total) or incomplete (partial)
Paresis is muscle weaknesses in partial paralysis
82
What does spinal paralysis involve?
```
Spinal paralysis involves
the central (spinal
cord and nerves) and
autonomic (vital
functions) nervous
system
```
83
SP: Severity of Condition?
Depends on two (2) criteria…
− Level of lesion
− Is it complete or incomplete?
¡ Higher the lesion = Less functioning
¡ Complete lesions = Less functioning
84
Functioning & The Spinal Cord?
```
¡ Cervical
− Arms, hands, breathing
¡ Thoracic
− Balance, trunk control, forceful breathing
¡ Lumbar
− Leg and foot movements
¡ Sacral
− Bowel, bladder, sexual function
```
85
Quadriplegia (Tetraplegia)?
¡ Involvement of all four limbs and the trunk
¡ 50% of persons with quadriplegia have incomplete lesions
− ‘Walking Quads
86
Quadriplegia
| (Tetraplegia): High-Level Quads?
```
− C1 – C4 lesions
− Use motorized
chairs for mobility
− Powerchair sports
(soccer & bowling
```
87
Quadriplegia
| (Tetraplegia): Low-Level Quads?
```
− C5 – C8 lesions
− Use manual chairs
and participate in
many wheelchair
sports
− Wheelchair rugby
```
88
Paraplegia?
¡ Involvement of the legs but often includes trunk balance as
well
¡ For sport programming, trunk balance is the most useful
criterion in determining level of participation
89
Spina Bifida?
¡ Congenital defect of spinal column caused by failure of
neural arch of a vertebra to properly develop and enclose
spinal cord
¡ Incidence related to gender (more girls are affected), race
(more Caucasians are affected), geographical location (more
common in Great Britain and Ireland), and socioeconomic
status
¡ Occurs between the 19th and 32nd day of gestations
(normally this is when the neural tube develops and closes)
90
SPINA BIFIDA – MENINGOMYELOCELE/
| MYELOMENINGOCELE?
```
− Spinal cord and
meninges protrude
into sac
− Hydrocephalus
(4 – 5 times more
common than other type)
− Surgery is required
to close wound (does
not lessen disability)
```
91
Hydrocephalus?
```
80% of myelomeningocele develop
hydrocephalus
¡ Present at birth or develop within first
6 weeks
¡ Results in enlarged head, pressure on
brain which can cause brain damage
and/or death
¡ Problem is treated with a shunt
− A tube to drain off the fluid into the
abdominal cavity
¡ Shunt does not require any special care
− Person should not hang upside down
for extended periods as shunt may
become blocked
− Avoid different types of head trauma
that may damage shunt/placement
(i.e. heading a ball in soccer)
```
92
Ways to help Hydrocephalus?
```
¡ The insertion of a shunt has
two main functions…
− It allows fluid to go only
in one direction
− The valve allows fluid to
flow out only when the
pressure in the head has
exceeded some value
```
93
SPINA BIFIDA –
| MENINGOCELE?
```
− Meninges protrude
(outpouching of the
coverings of the
spinal cord but the
cord and nerves
remain within
vertebral column.)
− Paralysis is rare
(surgery is required
to close wound)
```
94
SPINA BIFIDA –
| OCCULTA?
```
− Posterior arches of
vertebrae fail to form
− No outpouching.
Does not cause
paralysis or muscle
weakness (associated
with back problems)
```
95
Time of onset can have two (2)
| different impacts on development what are?
Congenital = Less
experience/socialization
into sport
Acquired = More
experience/socialization
into sport
96
CONGENITAL PARALYSIS: CONSIDERATIONS FOR
| PHYSICAL ACTIVITY?
¡ Congenital SCI, be sure to focus on
developmental activities
¡ Development of trunk, shoulder, arm and hand
control and strength is important
− Pushing, pulling and lifting with arms are
major goals
− Push and pull toys, scooter boards,
parachute activities, apparatus
climbing/hanging, weight lifting are high
priority
97
SPINA BIFIDA:
CONSIDERATIONS
FOR PHYSICAL
ACTIVITY?
¡ Latex sensitivity
− Allergic reactions to latex rubber and
powder; food and objects that have
been in contact with latex
¡ Cognitive functioning
− IQ’s are average
− A large percentage of individuals have:
¡ Perceptual-motor deficits, specific learning
disabilities, and attention deficits
¡ Strabismus (crossed eyes) is relatively
common
− May partially explain visual perception
problems
Extended Sitting:
− Tendency for the hip, knee and ankle flexors to become
to tight. This can result in contractures
− Ulcers or pressure sores
− Bruises and friction burns
− Obesity b/c of low energy expenditure
```
Sensation & Skin
Breakdown:
¡ Inability to feel sensation makes
persons vulnerable to injury and skin
breakdown.
− Ex. Wrinkles in socks and poorly
fitted shoes or braces cause
blisters that become infected
¡ Persons with spinal paralysis should be
taught to inspect their body regularly
to see that all sores are cared for.
```
```
Temperature Control:
¡ Spinal paralysis above T8 renders the
body incapable of adapting to
temperature changes
− Body assumes the same
temperature as the environment
¡ Special attention needs to be given to
appropriate clothing, heating and air
conditioning
¡ Fluid intake is related to temp control
```
Contractures:
− ROM exercises
¡ Atrophy of limbs
− Overtime paralyzed limbs decrease
in size and loose the shape
associated with good muscle tone
```
Spasms:
− Paralyzed muscles in people with
lesions above L1 often jerk
involuntary
− Frustrating/embarrassing - draws
attention and interfere in ADL’s
− Occasional spasms are good for
circulation
− When spasms are too severe
several treatment options are
available (physical therapy, drug
therapy, nerve blocks and surgery)
```
¡ Catheterization, Timing of Bathroom Breaks:
¡ All persons with spinal paralysis above S2 have some kind of
bladder dysfunction, requiring that they urinate in different ways
¡ Retention of urine leads to urinary and kidney infections
¡ A major cause of illness and death among persons with spinal
paralysis
¡ Defecation is managed by:
− Scheduling time and amount of eating as well as by regulating
time of bowel movements
− Surgical procedures create and opening in the abdomen and a
tube is inserted that connects to the intestine and an external
bag
```
Sexual Function:
− Innervated by the same nerves as
urinary function (S2 to S4)
− Lesions above the sacral region
may make it necessary to alter
roles, methods, and positioning for
sex depending on weather the
lesions are complete or
incomplete
− Capacity for erection, ejaculation
and orgasm must be evaluated
individually
− Menstruation is not affected
```
Heart & Circulatory Function:
− Low resting heart rates
− Persons with quadriplegia and high level paraplegia have
abnormally
− Maximum heart rates and target zones used in aerobic
exercise programs for AB persons are not appropriate in
high level spinal paralysis
− Assessment should be done
− Pooling of blood in the veins of paralyzed limbs
− Need to move limbs from time to time.
¡ Blood Pressure:
− Baseline blood pressure with lesions above T6 is typically
low
− Blood pressure responses to exercises must be interpreted
in light of this fact.
− Autonomic Dysreflexia (AD) is a life threatening pathology
that sometimes occurs in lesions above T6
− Sudden onset of high blood pressure, slowed heartbeat,
sweating, & sever headache
− Triggered by a stimulus within the body (i.e. distended
bladder or colon)
98
```
SPINA BIFIDA:
CONSIDERATIONS
FOR PHYSICAL
ACTIVITY: Posture & Orthopaedic
Concerns?
```
```
¡ Paralysis causes an imbalance
between muscle groups that
further complicates the
orthopaedic problems of
growing children
− Plantar flexion, hip dislocation,
toeing inward, scoliosis,
hyperlordosis, gluteus medius
lurch, crouched gait
```
