down syndrome..ppt 010133333333333333335

It is very nice

1. MENTAL RETARDATION/DOWN SYNDROME/LEARNING DISABILITY AND O.T MANAGEMENTS.

2. OUTLINES Definitions Overview Causes Types Signs and symptoms Team involved General management Goals O.T management Precautions .

3. INTRODUCTION: Humans cells normally contain 23 pairs of chromosomes. One chromosomes in each pair comes from your father and the other from your mother.

4. DOWN SYNDROME Down syndrome also a genetic abnormality that occurs due to an extra copy of chromosomes 21.It causes developmental delays that ranges from moderate to severe. It cannot be cured but managed with educational interventions, specialized parenting techiques,and community engagement.

5. PREVALENCE / INCIDENCE. It occurs in about 1 in 500 infants. A marked variability is seen, however depending on maternal age. for mothers younger than 20 years, the incidence is about 1 in 2,000, for mothers older than 40 years, it rises to about 1 in 40 overall and it is the most frequent form of intellectual disability (mental retardation).

6. DIAGNOSIS Down syndrome can be diagnosed during pregnancy or after birth. Chorionic villus sampling (c v s) test or Amniocentesis is carried out. After birth, the diagnosis is usually due to the child appearance as there are often clear physical characteristics of down syndrome.

7. CAUSES The exact cause of down syndrome is not completely understood but can be attributed to. Increase maternal age You had another baby with down syndrome

8. TYPES OF DOWN SYNDROME. There are 3 types of chromosomal patterns that result in down syndrome. Trisomy 21 Translocation Mosaicism.

9. TRISOMY 21 – It is an extra number of chromosomes in the number 21 chromosomes making it 3 pairs instead of 2. It occurs in about 95% of cases and it is the leading cause of birth defect. TRANSLOCATION – This occurs when part of chromosomes 21 becomes attached (translocated) on to another chromosomes, such as number 14 or 21

10. MOSAIC DOWN SYNDROME – Mosaicism is a condition in which cells within the same person have a different genetic makeup.

11. SIGNS AND SYMPTOMS The symptoms of down syndrome include. Behavioral symptoms Poor judgment Impulsiveness Delayed speech and language development Short attention span.

12. PHYSICAL SYMPTOMS Distinctive, flattened facial features Short neck Upward slanted eyes Unusually shaped small ears Poor muscle tone (floppy) Deep groove between first and second toe Breathing problems Single deep crease across the palm of the hand.

13. COGNITIVE SYMPTOMS Moderate to severe Development delays Cognitive impairment Slowed learning Below average intelligence Slowed pace of development milestone .

14. TEAM INVOLVED Audiologist Developmental pediatrician Clinical resource nurse Physiotherapist Occupational therapist Speech language pathologist.

15. Is There A Cure For Down Syndrome? No, there is no cure. It cannot be prevented Scientists do not know why problems involving chromosome 21 occur. Down syndrome is not caused by anything either of the parents did or did not do.

16. Can Down Syndrome Be Diagnosed Prenatally? Yes, it can be diagnosed or more likely ruled out. Alpha fetoprotein (AFP) blood test, a screening test, can be done around the 16th week of pregnancy. Amniocentesis or chorionic villus sampling are the most reliable tests used, but should be used cautiously due to the risks associated with them. Fetal ultrasonography Amniocentesis. Alpha feto protein.

17. CONT….. Echocardiogram—at prenatal visit or at birth Thyroid screening , or thyroxine- newborn, 6 mo , 12 mo , and annually thereafter Hearing evaluations—at birth, every 6 mo thereafter until 3 yr , then annually Ophthalmology evaluation—by 6 mo , then annually or more frequently as indicated X-ray screening for atlantoaxial instability—once between 3 and 5 yr. Growth—height and weight

18. MEDICAL MANAGEMENT Medications can be used to treat certain conditions. If a person with Down syndrome has a seizure disorder, they would benefit from taking anti-seizure medications. People with thyroid problems often take thyroid replacement hormones.

19. SURGICAL 40% of children with Down syndrome have congenital heart defects. some heart defects are more severe and will require surgery. Children with Down syndrome can have intestinal defects that also require surgery. Some

20. ROLE OF OCCUPATIONAL THERAPIST Evaluation: Demographic data History( prenatal, perinatal and postnatal) On observation On examination Muscle tone Developmental milestones Sensory modulation Hand function Gross motor skills Fine motor skills Oral motor skills. Cognitive perceptual skills. Social interaction skills. Communication skills. Play.

21. Problems present in following areas Self-care Productivity Leisure Sensory-motor Cognitive Psychosocial

22. APPROACHES Behavior modifications approach. Neurodevelopment therapy. Rood’s approach. Rehabilitation approach.(Later stage)

23. Prognosis The life expectancy among persons with Down syndrome has increased significantly up from 25 years in 1980. The causes of death have also changed, most of people with Down syndrome who live into their 40s and 50s The person achieves independent mobility. The person achieves oral control and self-feeding skills. The person demonstrate leisure skills and interests.

24. Precautions Be aware of possible instability or subluxation. Be aware possible cardiac pathology. Be aware of possible seizures disorders. Be aware of difficulties with ears that may affect balance and hearing. Be aware of visual disorders.

25. MENTAL RETARDATION Mental retardation is define as an IQ score or level below 70 in addition to deficits in two or more adaptive behaviors that affect everyday living. Children with mental retardation are limited in self care, communication, home living, social/ interpersonal skills, and functional academics skills.

26. TYPES OF MENTAL RETARDATION Syndromic intellectual disability – In which intellectual deficit is associated with other medical conditions e.g. down syndrome, fragile x syndrome. Non syndromic intellectual disability – In which intellectual deficit appears without other abnormality.

27. LEVELS OF M.D Mild : IQ -50-53 (80%) Moderate : IQ -35-50(10%) Severe :3-4% -(20-34) Profound : (1-2%) less than 20. MILD MD- At this level individual. Takes longer to learn to talk, but can communicate well once he/she knows how.

28. Fully independent in self care Has problem in feeding and writing MODERATE MR Is slow in understanding and using language Slow learner Unable to leave alone. Has only a limited ability to communicate. SEVERE MR Has noticeable motor impairment Abnormal development of CNS.

29. PROFOUND MR Is unable to understand instruction Dependent in self care Require constant help and supervision

30. CAUSES Trauma before or during birth Genetics abnormalities Lead poisoning Severe malnutrition Early child hood sickness e.g. meningitis

31. DIAGNOSIS Interviews with patients Observation of the child Standard test Adaptive functioning- this refers to the skills needed to live independently which include language, social skills and self care.

32. SIGNS AND SYMPTOMS Difficulty in rolling over, sitting up, crawling, or walking late Behavioral problems such as explosive tantrums. Delays in oral development Deficits in memory skills Difficulty in learning social skills Difficulty with problem solving skills.

33. TEAMS INVOLVED Psychologist Psychiatrist Doctors Nurses Speech therapist Occupational therapist Nutritionist Pediatricians Social workers.

34. PROBLEMS RELEVANT TO O.T Self care- e.g grooming. Productivity – may have poorly developed play skills. Leisure –may have few leisure activities. Sensori motor – may have poor joint stability Cognitive – the person may be

35. LEARNING DISABILITY – describes a group of problems that affect the ability of a child to master school tasks, process information and communicate effectively. Learning disability, learning disorder and learning difficulty are used interchangeably. They differ in many ways.

36. Disorder -Refers to significant learning problems in academic problems. Learning disability – On the other hand is an official clinical diagnosis whereby the individual meets certain criteria's as determined by the professional. Learning disorder – Is used to describe a group of disorder characterized by inadequate development of specific academics, language and speech skills.

37. TYPES OF LEARNING DISORDER Reading (dyslexia) Mathematics (dyscalculia) Writing (dysgraphia). The unknown factor is the disorder that affect the brain ability to receive and process information.

38. Children with learning disability have trouble performing specific types of skills or completing tasks, if let to figure things out by themselves or if taught in convectional ways.

39. TYPES OF LEARNING DISABILITY Learning disability can be categorized by Either the type of information processing affected by disability. By specific difficulties caused by a processing deficit.

40. BY STAGE OF INFORMATION PROCESSING LD falls into broad categories based on the four stages of information processing. Input Integration Storage Output.

41. Input – This is the information perceived through the senses such as visual and auditory perception.Diffuculty with visual perception can cause problems with recognizing shape, position or size of item seen. Difficulties with auditory perception can make it difficult to screen out competing sounds in other to focus on one of them e.g. sound of the teacher, voice in the classroom setting.

42. Integration – This is the stage during which perceived input is interpreted. Student with problems in this areas may be unable to tell a story, unable to memorize such as days of the week. Storage – Most memory difficulties occur with ones short term memory which can make it difficulty to learn new material without more repetitions than usual. Output – Information comes out of the brain either through words that is language output or through muscle activity such as gesturing, writing, drawing.

43. BY FUNCTIONS IMPAIRED . Deficit in any area of information processing can manifest in a variety of specific learning disability. It is possible for an individual to have more than one of these difficulties . This is referred to as co morbidity or re occurrence.

44. CAUSES Heredity – Children with learning disability are likely to have parents or other relatives with similar difficulties. Problems during pregnancy and birth – Learning disability can result from anomalies in the developing brain, illness or injuries, fetal exposure to drugs and alcohol. Low birth weight, oxygen ,deprivation or by premature or prolonged labour.

45. Accident after birth –LD can also be caused by head injuries, malnutrition, or toxic exposure (heavy metals or pesticides)

46. SIGNS AND SYMPTOMS . Short attention span Poor memory Difficulty following directions Inability to discriminate between letters, numerals and sounds. Poor reading and /or writing ability. Immature speech Doesn’t adjust well to change.

47. TEAMS INVOLVED A multidisciplinary team effort is needed in the management. They include’ Primary care physician Psychiatrist Neurologist Psychologist Social worker Speech pathologist Occupational therapist Pediatrician.

48. PROBLEMS AREAS Self care – e.g. tying shoe lace. Productivity – May have poorly developed play skills. Leisure – The person may few leisure activities. Sensory motor – May have problem in joint stability. Cognitive – The person may be easily distracted, may have short term memory loss.

49. Psychosocial –Has poor self perception. May be withdraw. May have mild dysphasia. They may also have problems running, climbing, learning to ride a bicycle, handwriting, buttoning the shirts or tying shoe lace.

50. O.T MANAGEMENT. TREATMENT AND INTERVENTION. Self care. Improve daily living skills. Use schedule board to list daily task. Provide checklist of activity to perform. Productivity. Improve level of academics by promoting better adaptive & organization skills.

51. Leisure. Increase the person exposure to leisure activity of possible interest. Sensori motor. Promote object management including manipulations. Promote effective total body management in a wide variety of activities that requires dynamic balance and agility. Cognitive. Increase attention span and concentration. Teach the person always to check the work that has been done to see if it is correct.

52. PRECAUTIONS Observe child for signs of sensory overload such as blanching, flushing and perspiring Observe child for signs Monitor child for potential accident due to lack of skills or lack of judgment on the part of the child.

53. OUTCOMES The person is able to perform activities of daily living. The person demonstrate improvement in play & academics skills T he person shows improvement in coping skills The person demonstrate improved social skills.

54. REFERENCE USED. Quick reference to O.T second edition by Kathlyn L Reed.