Physical Therapy Management for the Child with Intellectual Disability Focus on Down Syndrome Flashcards Preview

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Flashcards in Physical Therapy Management for the Child with Intellectual Disability Focus on Down Syndrome Deck (58):
1

a state in which function is impaired in intellectual functioning and adaptation skills
 

intellectual disability

2

3 major criteria for intellectual disability:

  1. Manifest before 18 y/o. 
  2. IQ falls 2 SD below the mean (< 65-75 )
  3. Difficulties with: Communication, self care, home living, social skills, leisure, work, etc.

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3

Domains of adaptive function impairment:
 

  1. Conceptual: language, reading, math, general knowledge.
  2. Social:  empathy, interpersonal skills, ability to maintain friendships 
  3. Practical: work, personal care, job, organization, etc.

4

Vineland Adaptive Behavior Scales
 

assess adaptive behavior (mostly O.T.)

5

To fulfill the diagnostic  criteria for intellectual disabilities, deficits in_______ or more areas of adaptive functioning must be present, thus showing a generalized limitation in adaptive skill level.

two

6

Cri-du-chat syndrome:

  • Hypotonia

7

Cytomegalovirus   (prenatal infection)

Hypertonia

TORCH disorder: TORCH Syndrome refers to infection of a developing fetus or newborn by any of a group of infectious agents. "TORCH" is an acronym meaning (T)oxoplasmosis, (O)ther Agents, (R)ubella (also known as German Measles), (C)ytomegalovirus, and (H)erpes Simplex. 

8

De Lange Syndrome

  • Spastiscity
  • Microcephaly
  • Dysmorphism 

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9

Fetal alcohol syndrome

facial features:

 

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10

Fragile X syndrome

  • Hypotonia, poor coordination and motor planning
  • seizures
  • missdiagnosed with autism

11

Lesch–Nyhan syndrome

  • Difficult behavior: bang their own head
  • Hypotonia

12

Prader–Willi syndrome

  • Severe hypotonia and feeding problems in infancy

13

Rett syndrome:

  • girls only
  • repetitive hand motion
  • can't talk

14

Motor impairment seen in children with intellectual  impairment

  • Hypotonia
  • Motor Control
  • Postural Control
  • Balance
  • Force Production
  • Flexibility (increased)
     

15

Chromosomal disorder that results in  47 chromosomes instead of 46 

Down Syndrome

(trisomy 21 )

16

There are 3 chromosomal patterns that result in Down syndrome:

(types of Down Syndrome)

  1. Trisomy 21:  three #21 chromosomes (95%)
  2. Translocation: a part of chromosome #21 breaks off during cell division and attaches to another  chromosome.  (4%)
  3. Mosaicism:  nondisjunction of chromosome #21 (1-2%)

17

 When a part of chromosome #21 breaks off during cell division and attaches to another chromosome. 

Translocation

18

is caused by a faulty cell division that results in the baby having three #21 chromosomes instead of two

Trisomy 21

19

When this happens, there is a mixture of two types of cells, some containing 46 chromosomes and some with 47. 

Mosaicism

20

When this happens, it may indicate that one of the parents is carrying chromosomal material that is arranged in an unusual manner. 

Translocation

21

Down syndrome is usually identified at

birth or shortly thereafter. 

22

 Initially. the diagnosis is based on _________________ that are commonly seen in babies with
Down syndrome

physical characteristics

The diagnosis must be confirmed by a chromosome study (karyotype). A karyotype provides a visual display of the chromosomes grouped by their size, number and shape. Chromosomes may be studied by examining blood or tissue cells.
 

23

Approximately 40 - 60% of the children with Down syndrome have

congenital heart defects

  • It is very important that an echocardiogram be performed on all newborns with Down syndrome in order to identify any serious cardiac problems that might be present.
  • Some of the heart conditions require surgery while others only require careful monitoring.
     

24

True or false: children with Down syndrome have a higher incidence of infection, respiratory, vision and hearing problems as well as thyroid and other medical conditions. 

true

25

The average life expectancy of individuals with Down syndrome is ______ with many living into their sixties and seventies. 

55 years

Premature aging is seen in these individuals

 

26

Most children with Down syndrome have mild to moderate impairments but it is important to note that they are more like...
 

other children than they are different.

  • Most children attend their neighborhood schools, some in regular classes and others in special education classes. Some children have more significant needs and require a more specialized program.
     

27

Three diagnostic tests are currently available:
 

  1. Amniocentesis is performed between 12 and 20 weeks gestation.
  2. Chronic Villus Sampling (CVS) is conducted between 8 and 12 weeks.
  3. Percutaneous Umbilical Blood Sampling (PUBS) is performed after 20 weeks.
     

28

Brain weight _____ of normal
 

~ 76%

29

Neuropathology in Down syndrome:

  • Macrobrachycepahaly
  • Decreased number of secondary sulci
  • Decrease number of neurons and synapses
  • Delayed or lack of mylenation
  • 85% have some form of seizure disorder
  • Increase in Alzheimer Neurofibrilary Tangles with age
     

30

visual and hearing problems in Down syndrome:

  • Adult onset cataracts
  • Far sightedness
  • Strabismus (crossed eyes)
  • Nystagmus
  • Otitis media (inflammation of the middle ear)
  • Bilateral Hearing Loss
     

31

Musculoskeletal deficits in Down syndrome:

  • Decrease in stature (greatest deficiency in growth between 6 – 24 months)
  • Decrease leg length
  • Decrease length in metacarpal and phalangeal length
  • Absent palmaris longus
  • Lack of differentiation of zygomaticus major and minor
  • Hypotonia and ligamentous laxity causing instability of joints and increase incidence of atlantoaxial subluxation
  • Decreased Strength
     

32

In Down syndrome, hypotonia and ligamentous laxity causing instability of
joints and increase incidence of

atlantoaxial subluxation 

33

Simian crease in Down Syndrome

a single crease observed across the palm of the hand 

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34

Musculoskeletal problems in Down syndrome:

  • Pes Plannus
  • Patellar instability
  • Atlanto-axial instability
  • Scoliosis
  • Hip dysplasia

35

Early signs of atlanto-axial instability or dislocation include

  • Changes in DTR’s,
  • clonus,
  • gait disturbance,
  • urinary retention
     

36

tharapist working with pt with Down syndrome  should avoid positions of exaggerated neck flexion, extension, rotation, be cautious with approximation of c-spine, cautious with inverted positions and tumbling. Why?

atlanto axial dislocation/instability

  • Contact sports generally contraindicated
  • Can be treated surgically with C1-C2 fusion
     

37

to facilitate normal co-contraction?

weight bearing exercises

38

Score above 2 in the Morgan-Paleg Hypotionia Scale

 

recommend services

39

Morgan-Paleg Hypotionia hypotonia Scale:
 

  1. Head control
  2. Vertical Suspension
  3. Sitting
  4. Hip Abduction
  5. Ankle Dorsiflexion
  6. Standing
     

40

Assessment of Ligamentous Laxity
 

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Score of > /= 4/9 considered indicative of generalized hypermobility
 

41

NDT approach

neurodevelopmental treatment

42

Postural Control Activities:
 

  • Anti gravity work
  • MEDEK
  • Heavy Work 

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43

Intervention for Motor Control Issues:
 

  1. NDT approach
  2. Postural control activities (MEDEK, heavy work)
  3. Practice
  4. Orthotics
  5. Regular exercise

44

Have child fitted for orthotics when they are beginning to

pull to stand and cruise 

45

Wear orthotics _____of the time 

50%

46

During therapy use orthotics with

 

standing postural work or play

(may not in sitting)

47

orthotics are named by

the body parts that they cover

48

Neoprene compression garmets

These can provide increased body awareness and sensory feedback. Neoprene wraps can be purchased in the weight lifting section of stores such as Wal-mart, K-mart, Target. 

49

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Thera-Togs
 

50

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Hip Helpers® Support Shorts are the answer to excessive hip abduction in babies and toddlers
with low muscle tone. They have been found to improve rotational movement and limit “W” sitting in babies who are developing their movement skills

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51

True or false: Children with Hypotonia tend to lean into support  (sitting) systems 

true

52

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  • Seating Devices
  • Children with Hypotonia tend to lean into support systems
  • Children without head control may benefit from supportive seating at 3-6 months
  • Seating should be more dynamic

53

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  • Standers
  • Start at 9 months if child is not sitting Independently for play 

54

Suggested by Daminano (researcher) should be standard of care for children with DM

Treadmill

  • 8 min 5 x  a week for pre-walkers,
  • 20 min 5x a week for older children 

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55

Evidence for kids with Down Syndrome/hypotonia

  1. Treadmill training / orthotics
  2. Exercise and PT
  3. Whole body vibration (older kids)
  4. Compression garments
  5. Bicycling
  6. Kineseotaping
  7. Power Cars / Chairs
  8. Vestibular Sensory / Wii
     

56

strongest evidence for kids with Down Syndrome/hypotonia

Treadmill training / orthotics 

57

Aging with Down Syndrome
 

  • Hypothyroidism: resulting in Low energy levels, weight gain, bradycardia, constipation, dry skin
  • Cardiovascular Changes: including  mitral Valve prolapse, low cardiovasular
    capcity = ↑ risk of ♥ failure, ♥ disease, CV
  • MSK changes (osteoporosis)
  • Obesity
  • Alzheimer's (75%)
  • Depression

58

Impairments in ____________, rather than low IQ, are usually the presenting symptoms in individuals with intellectual disabilities. Adaptive skills are those skills considered to be central to successful life functioning and are frequently related to the need for supports for persons with intellectual disabilities.

adaptive functioning