HSC302 Exam 2

IDEA part C

Policy establishing early intervention services

Physical, cognitive, communication, social, adaptive

developmental areas early intervention

Who is eligible for early intervention services?

children ages 0-3
diagnosed physical/mental condition
existing delay

In florida.. delay is

2 standard deviations in one of the five areas below the mean
1.5 standard deviations below the mean in 2 of the 5 areas

natural environments include

same aged peers that are not experiencing delays

least restrictive environment

children who get special education should be in the same classrooms as other kids

individualized education plan (IEP)

each child has their own educational plan that will allow them to meet their educational goals

toxic stress

-interprets and responds to environment signals
-causes wear and tear on the body when it is under constant level of toxic stress

serve/return

new neural connections from the brain as young children instinctively serve through babbling, facial expressions and gestures, and adults return by responding in a very directed, meaningful way

neurodevelopmental condition

identified in childhood, lifelong, group of conditions with onset in the developmental period, manifest easily

discrete trial training (DTT)

involves breaking down complex behaviors into a number of elements, which are separately and sequentially reinforced to build up into the desired behavior

evidence based trainings

-social skills groups
-PEERS (young adults)
-peer mediated interventions

Intellectual disability 85%

can live independently

Moderate ID 10%

independent living may be achieved with moderate levels of support

severe ID 3.5%

required daily assistance with self care activities and safety supervision
extensive support needed for daily activities

profound ID 1.5%

required 24 hour care
pervasive support needed for daily routines

customized employment

job carving: analyzing work duties and identifying specific tasks
job sharing: two workers share the duties of a full time job

Supported employment

job coach for training, job sharing

autism spectrum disorder

cause unknown, genetic, older parents, (down syn, fragile x, retts), very low birth rate
4.5x as many boys
onset usually between 12-24 months

diagnosis for ASD

difficulty communicating, restricted interests, symptoms that hurt person's ability to function, early childhood symptoms, repetitive behaviors

echolalia

repeating certain words or behaviors

sensory processing disorder

sensory info goes into the brain but does not get organized into appropriate responses, info gets mixed up and responses become inappropriate

Severity levels ASD

1: require support
2: require substantial support
3: require very substantial support

Reasons for developing CP

prenatal, perinatal, postnatal

PRENATAL causes of CP

heredity, infections, lack of oxygen, Rh incompatibility, prematurity, metabolic disorders

PERINATAL causes of CP

lack of oxygen, trauma birth injury

POSTNATAL causes of CP

traumatic head injuries, shaken baby, infections, brain hemorrhages, anoxia, tumor, TAKE PLACE IN 1st YEAR

movement with CP

-ataxia (poor muscle control causes clumsiness)
-atonia (lack of muscle tone)
-spasticity (exaggerated muscle tone resulting in muscle stiffness and contractions.. most common manifestation)
-dystonia (muscle contractions causing twisting or repetitive movements)
-hyperkinetic (any unwanted excess movement)

Types of CP

most common: pyramidal or spastic (65-75% of all cases)
extrapyramidal or nonspastic types of CP are responsible for 20% of cases

CP diagnosis

difficult to diagnose, no definitive test, 40% incorrectly diagnosed

Used for diagnosing CP

CT, MRI, ultrasound, lumbar puncture, serum uric acid and blood urine assays, viral and parasitic titers (TORCH)..intrauterine infections, chromosomal studies

impact of body structures/function on activity and participation

-static (not progressive) does not get worse over time
-keeps brain from telling rest of body what to do
-difficulty talking, seeing, hearing, sitting, swallowing
-normal intelligence
-lack of control of muscle function
-gait disturbance, mobility limitations

interventions for CP

direct treatment is unavailable
-secondary treatments include: therapy, tone-altering meds, braces wheelchairs, crutches, orthopedic and neurosurgical procedures to correct deformities/tone

muscular dystrophy

-chronic, incurable
-progressive
-caused by genetic tissue in producing dystrophin
-muscle cells deteriorate
-muscle fibers become fat

function of dystrophin

strengthen muscle fibers and protect them from injury as muscle contracts and relaxes

Limb-girdle MD

-males and females equally
-rare
-presents in early childhood to late adulthood
-affects shoulders and hips first
(may present with lordosis or scoliosis)
-intellect and senses unaffected

facioscapulohumeral (FSH) MD

progressive weakness to face, upper arms, shoulders
-1 in 20,000 people males and females
-possible hearing loss and retinal vasculopathy
-appears during childhood or into adulthood

myotonic dystrophy: type 1 and 2

most common beginning in adulthood
-40,000 people in US
-rare
-inability to relax muscles following contraction
-facial and neck muscles affected first
-cataracts, cardiac conduction, infertility, droopy eyelids, mask like face
-type 1 is more common

Duchenne (most common MD)

- x chromosome (boys)
-inherited
-seen early
-frequent falls
-waddling gait, walking on toes, large calf muscles
-commonly using wheelchair by 12
-DMD gene encodes dystrophin

Becker MD

-slow progression
-less severe than DMD
-similar problems but milder, presents later
-symptoms begin in teens, mid 20s
-weakness affects hips, pelvis, thighs, shoulders first

MD changes in body structure/functions

-progressive
-muscular weakness
-complications like cardiomyopathy, contractures, scoliosis and lordosis, breathing issues, swallowing problems, cognitive issues

interventions supporting MD

bathroom aids, standing frame, mechanical lifts, mobility aids(walkers, wheelchairs), sip and puff wheelchair, tongue drive system

-medications: steroids slow muscle damage, side effects can cause weight gain and susceptibility to infection
-respiratory treatment: spirometry, cough assist, flu shot, ventilator

lordosis

sway back, sticking out butt like gymnast

kyphosis

hump back

muscular fibrosis

impairs muscle function, negatively affects muscle regeneration after injury

causes of Cystic Fibrosis

-genetic
-chronic, incurable
-progressive

how CP affects lungs

-thick, viscous mucus obstructs airways
-chronic productive cough
-frequent infections/hospitalizations
-atelectasis
-gradual loss of pulmonary function

TREATMENT:
-chest PT
-inflatable chest, portable breathing devices
-avoiding exposure to dust, air pollutants
-breathing techniques
-dislodging mucus
-respiratory devices (vest to get rid of mucus)
-double lung transplant (extreme measure)

how CP affects pancreas

-mucus blocks ducts
-digestive enzymes cannot do their job
-lack of absorption of nutrients
-can lead to diabetes over time

treatment:
-oral pancreatic enzymes
-supplements A,D, E, K
-high calorie diet

how CP affects liver/intestines

- Bile obstructed
- Inflammatory process
- Scarred tissue– cirrhosis (late stage)

preventing liver damage: clinical eval, liver enzyme eval, ultrasound

Intestines:
breakdown of food incomplete, secretions thicken feces, can lead to rectal prolapse

how CP affects sweat glands

-imbalance of chloride concentration in sweat
(salty sweat)
-dehydration
increased HR, fatigue, weakness, decreased BP

how CP affects reproductive system

males mostly infertile (97-98%)
-born with malformed or blocked vas deferens
-no external problems

females may be fertile
-more difficult to conceive

causes of Sickle cell disease

-inherited disease caused by deficit in a gene
-blood disorder
-life span of 40-50 years

complications from sickle cell disease

- Acute chest syndrome (pain, cough fever, hypoxia, lung infiltrates)
- Stroke– frequently in children (may be silent)
- Retinopathy
- Cardiomegaly
- Renal problems (hematuria, proteinuria)
- Osteonecrosis (especially hip, shoulder)
- Leg ulcers (non-healing)
- Priapism
- Splenic sequestration crisis
- anemia (acquired = extrinsic ) ( inherited = intrinsic )

treatment for sickle cell disease

blood transfusions, corticosteroids, IV immune globulin, splenectomy

Bone marrow transplantation

-stay in unit to avoid infection
-find suitable donor
-potent antibiotics
-can take a year for recovery
-84% cured (children)
-stem cells taken from donor
-recipient takes meds to destroy own bone marrow stem cells
-donor cells are injected

PROBLEMS:
-high risk even with correct match
-graft vs host disease

vaso-occlusive episodes

-rigid sickle cells with increased adhesiveness
-obstruction of blood flow
-bone marrow produces RBCs (can't keep up)

human leukocyte antigen

-type of molecule found on the surface of most cells in the body
-plays an important role in body's immune response to foreign substances

causes of Hemophilia

-inherited chronic bleeding condition
-sporadic, acquired, rare
-lack of protein in blood
-defect in clotting factors

Hemophilia A

more common, defect in clotting factor 8

Hemophilia B

defect in clotting factor 9

mild clotting

possible prolonged bleeding after injury or surgery /25% of people

moderate clotting

spontaneous bleeding into joints and muscles; excessive bleeding after injury or minor surgery

severe clotting

spontaneous bleeding into joints and muscles, brain, nose, severe bruising /60% of people

treatment of Hemophilia

no cure
-immediate intervention when bleeding
-HTCs, comprehensive hemophilia centers
-synthetic hormone for mild cases
-liver transplant
-replacement therapy (IV infusion... plasma)

Hemarthrosis

bleeding into joint

epistaxis

nose bleeds with no obvious reasons

hemostasis

-clot formation
-fibrin forms clot

inhibitor

antibody against infusion
-can be caused by infection caused by infusion

antibody

blood protein produced in response to and counteracting a specific antigen

anatomy of the eyeball

light passing through eye

enters through pupil --> passes through lens --> sensory info registers on retina --> conversion to electrical impulses to optic nerve --> message taken to occipital lobe

legal blindness

20/200

blind spot (scotoma)

decreased area of vision
(normal where the optic nerve and blood vessels leave eyeball)

nystagmus

eyes moving rapidly and involuntarily

strabismus

misalignment of both eyes, may be crossed, may only have one normal eye, or lazy eye

Shellen Eye Chart and Tumbling Es

- Positioned 20 feet away from chart
- Measures visual acuity
- Sharpness of vision
- Discernment of forms and shapes
- Does not detect glaucoma or diabetic retinopathy

Retinal health

Optical Coherence Tomography (OCT)
- Non- invasive imaging test
- Light waves record 3D images
- Cross sectional images of the retina
- Shows thickness of the retina
- Shows any evidence of fluid leaks
- Monitors treatment
- Determine if there is a problem with retina

Visualization of eyeball/related structures

- P; pupils
- E; equal
- R; round
- R; reactive to
- L; light and
- A; accommodation
- Abnormal eye exam (Not of equal size
Not round
Not reactive to light
Not accommodating to focus on objects near or far)

intraocular pressure

tonometry
normal pressure is 12-22 mm Hg
-air puff tonometry is commonly used on children
-goldmann tonometry is very accurate (cornea is flattened, numbing drops used)

ophthalmologist

deals with disorders/disease of the eye, performs surgery

optometrist

assesses vision abnormalities, prescribes glasses/contacts

optician

supplies/sells optical instruments, lenses

cataracts

Lens becomes cloudy
- Blurry vision
- Poor night vision
- Halo around lights
- Diplopia
- Occurs in most people by the age of 80
- At risk; smokers, sunbathers, steroid users, diabetics
- Affect 1 or both eyes
- Treatment; surgery

macular degeneration

Loss of central vision
- Leading cause of vision loss for those over 50
- At risk; smokers, family history
- Slow or fast progression
- Occurs in 1 or both eyes
- Dry (most common) vs wet form
- Dry; stuff
- Wet; hemorrhaging
- Diagnosis; dilation

diabetic retinopathy

Affects blood vessels of the retina in those with diabetes
- Blurry vision
- Floating spots or streaks
- Blindness
- May cause other problems like diabetic macular edema, neurovascular glaucoma and
retinal detachment
- Serious disease
- Assessments
- Dilation
- Fluorescein angiogram
- Treatment
- Injections
- Laser TX
- Surgery

glaucoma

Loss of peripheral vision due to damage of the optic nerve
- At risk: over 60, black or latino over 40, family history
- Occurs in 1 or both eyes
- Slow process in developing symptoms
- Without treatment– blindness
- Common to have high intraocular pressure
- Eye pressure varies
- Dilation
- Treatment
- Eye drops
- Laser
- Surgery

retinitis pigmentosa

Hereditary, degenerative disease
- Progressive peripheral vision loss
- Night vision impaired– may be first symptom
- Central vision may be adequate or may be impaired
- Tunnel vision
- No cure
- Low vision aids
- Vitamin A might help

myopia

nearsighted, can see things up close

hyperopia

farsighted, can see things far away

vitrectomy

removes vitreous fluid from eye

outer ear

collects sound waves and directs to eardrum

middle ear

transfers acoustic energy from compression waves in air to fluid membrane waves within cochlea

inner ear

vibration of 3 bones stimulates hair cells, stimulating nerve endings, damage would be more permanent

conductive hearing loss

Most common in children
- Temporary or permanent
- One or both ears
- Infection of ear canal or middle ear
- Congenital malformation
- Perforation or scarring of eardrum
- Cerumen build up
- dislocation of the 3 middle ear bones
- Foreign objects in canal
- Otosclerosis (middle ear)
- Unusual growths in outer/ middle ear

sensorineural hearing loss

Permanent
- Usually both ears
- Damage to inner ear or nerve
- Most common type of ADULT hearing loss
- May be present at birth
- Typically not treated medically/ surgically
- No good option
- May be caused by
- injury/ viral infections/ high fever
- Ototoxic drugs
- Genetic conditions
- Tumors
- Diabetes, stroke, menieres, meningitis
- Prolonged loud noise exposure

Prelingual/postlingual deafness/prevocational deafness

Prelingual (before 3 years):
- Can cause lag in speech production/ understanding
Postlingual:
- After they have learned how to speak
Prevocational:
- Before 19

cochlear implants

expensive, invasive surgery, requires auditory rehab

physiologic vertigo

perception of motion rotating and spinning, dizziness, tinnitus

benign paroxysmal positional vertigo

common, debris in semicircular canals, helps with orientation

presbycusis

Degenerative changes
- Age related structural changes in middle ear bones
- Slow onset– rage of mild to severe
- Higher tones affected first
- May involve word discrimination issues
- Tx; hearing aids