Adaptive Domains, Inclusion, Appropriateness, Down Syndrome and Neural Tube Defects

Applying Normalization to the Adaptive Domain

• Adaptive domains include communication, socialization, academics, psychological well-being, and home living.

• The objective is to make theadaptive domains as normal as possible for individuals with disabilities. This involves facilitating skills in the least restrictive manner.

• Example (Cooking): For an 18-year-old, making spaghetti with meatballs would be a reasonable skill to normalize.

  • This could be achieved independently or with verbal prompts.

• Example (Community Use/Driving): For a 12-year-old, using a GPS app to get directions could be a reasonable skill.

  • They can also be taught rules of the road.

Concept of Inclusion

• Inclusion is about normalized, community-based intervention or least restrictive intervention.
• Originated from academic systems; inclusion means fully integrating someone into a regular education classroom.
• Example (Paraplegia): A client with paraplegia who needs to strengthen their arms should do exercises at a regular gym.
• Example (Sexuality/Socialization): A client wanting to take a peer on a date should go to a regular restaurant or movie theater.
• Inclusion should occur in natural environments.

Concept of Appropriateness

• There are two types of appropriateness: age appropriateness and activity appropriateness.

Age Appropriateness

• Providing activities or training that is appropriate for the client's chronological age.
• Chronological age is the actual number age. It is usually more important than mental age.
• Example: A 40-year-old with a mental age of 10 should be treated based on their chronological age (40).
• Example (Sumner Danbury School): Giving baby toys to a sixth-grade student is not age-appropriate. They should have something that a typical 11-year-old would use, with adaptations made as needed.

Activity Appropriateness

• Engaging in activities that are appropriate for the context.
• Example: Not wearing a three-piece suit to a swim party or a Speedo to a wedding.
• Example (Psych Tech Job Interview): Not wearing shorts, flip-flops, and a tank top to a job interview.

Normalizing Activities (Age Appropriate vs. Non-Age Appropriate)

• Baby Blocks vs. Computer Parts: Instead of playing with baby blocks, an older individual could be taught to plug in computer parts.
• Play-Doh vs. Pottery Wheel: Instead of playing with Play-Doh (meant for 3+), engage in pottery using a pottery wheel.
• Connect Four vs. Credit Card Scanner: If one can play Connect Four, they can learn to scan a credit card or tap a phone for purchases.
• Plastic Beads vs. Gemstones: Instead of plastic beads, use gemstones for making bracelets.
• Sand Jar vs. Artsy Materials: Instead of colored sand in a jar, use different sorts to make it more artsy.
• Sandbox vs. Zen Garden: Instead of playing in a sandbox, create a sand garden or Zen box.
• Animal Croquet vs. Regular Croquet: Instead of playing with little animal croquet, play regular croquet.
• Glitter and Glue on a Leaf vs. Framed Artwork: Instead of glitter and glue on a paper leaf, create framed artwork.
• Horse on a Merry-Go-Round vs. Real Horse: Riding a horse on a merry-go-round can transition to riding a real horse (hippo therapy is used for people with autism).
• Hit a bozo punching bag vs Hit a real punching bag at the Gym
• Lollipop vs Forever Flowers: Instead of making lollipop, created resin based flower.

Down Syndrome Objectives

• Down syndrome is a genetic syndrome involving extra pieces or a full extra chromosome.
• The rest of the notes focus on the medical complications and adaptive weaknesses associated with Down syndrome, as well as interventions and expected outcomes.

Medical Complications

• Congenital Heart Defect: About half of clients with Down syndrome have this.

  • Assume they do until proven otherwise.
  • Behavioral signs: chest pain, irregular heartbeat, low energy, poor peripheral circulation.
  • Strenuous activity should be approved by a doctor.

• Ophthalmic Disorder: Over half have some sort of ophthalmic disorder.

  • Expect them to wear glasses.
  • Use bright contrasting colors and increase font size and illumination.

• Hearing Loss: Two-thirds have some sort of hearing loss.

  • Expect them to have a hearing aid.
  • Speak clearly and directly to them, possibly augmenting speech with gestures.

• Endocrine Abnormalities: Up to 90% have endocrine abnormalities with hypothyroidism being a common one.

  • Treated with levothyroxine.

    • Signs of Thyroid Toxicity (Hyperthyroidism): exophthalmos sweating, diaphoresis, jitteriness, more energy.

• Growth: At least half are shorter than their peers.

• Obesity: At least 60% have obesity.

• Orthopedic Abnormalities: Weak ligamentations can lead to subluxation (mitral dislocation).

  • Atlantal axial subluxation: neck gets a little off, pressing on the nerve, impacting functional movements.

    • Signs of Subluxation: Loss of coordination, sloppier writing, spilling more, trouble with fine motor tasks.

• Dental Problems: Less prone to cavities but more prone to periodontal disease.

  • Malpouation contributes to gum and oral disease.
  • Oral hygiene is very important, especially at the gum line.
  • Traditional flossing does not work well water flossing is recommemded

• Skin Conditions: Half of clients have skin conditions (eczema, seborrhea, psoriasis).

  • Expect scratching, rashes, scaly or dry skin, and crusty areas.

    • As intervention perform skin assessment while assisting with bathing, if rash or crustiness is found let Physician know.

• Early Onset Alzheimer's: Full 20% will develop it, begin as early as their forties.

  • Disease onset comes early, progresses faster.

Medical Interventions and Potential Test Questions

• Cardiac abnormalities: Assume they have, and consult physician before strenuous activites.
• Dental issues- get oral cleaning three times per year if insurance allows.
• Ophthalmic disorders: Yearly eye inspections.
• Hearing loss: Hearing device checks, every ear exams. Be aware of non verbal cues if devices not available.
• Growth- monitor to prevent obesity
• Assess skin during bathing.
• Assess for Alzeimer's in early 40's by observing for decline.
• Xrays prior to playing impact sport (like football)

Expected Outcomes and Risk Factors

• Expected outcomes: In absence of Alzheimer's client integrate well into Society if in an inclusive environment.

  • Alzheimer's will impact outcome

• Risk Factors: Not perform oral hygiene, increase risk of oral disease.

  • Provide interventions.

Adaptive Weaknesses

• Short term verbal memory issue.

  • Give short and simple verbal prompts.

• Poor Spacial relationship which is strength that can be used to promote sign language and visual memory.

• Address vision, hearing, and using visual Spacial strength.

*Maxiziming inclussion help facilitate proper rolemodels.

Neural Tube Defects (NTDs)

• During embryonic development, the neural plate folds into a neural groove, which then closes to form a neural tube. A defect occurs when this tube fails to close properly.
• Terms to understand for an NTD include Menigocele, Myelomeningocele, Hydrocephalus and Anencephaly.

Types of Neural Tube Defects

Anencephaly

• The entire upper portion of the brain fails to develop.
• Often results in spontaneous miscarriage, and those that make it full term die within days of birth.
• The person whom has it is often referred to as anencephalic and often have thermal regulation issues

Meningocele

• Part of the meninges (connective tissue in the spinal column) protrudes out.
• Not considered serious because the meninges have no neurological function.

Myelomeningocele (or Meningiomyelocele)

• Not only does the connective tissue protrude, but part of the spinal cord does as well.
• This creates additional issues for the person which may include being wheelchair bound or additional assistance via other auxiliary methods.
  *Complications of a manor myocele- Depends of lesion, if below, there is no damage
  -If above there is issues.
• C level can lead to quadriplegic outcome
• L/ T level lead to paraplegic

Hydrocephalus

• Cerebrospinal spinal fluid is not able to travel up the full body without blockage and leads to kink.
  • Soft spot, lethargic can be uncorrected as baby
  • Shunt can get put in, where there can be pressure and fluid for increased spinal fluid and drained into system.
• Bulging Anterior Fontaine and down graded eye, is also known as the Sunsest phase is also a sign

Shunt

• Medical procedure to take spinal down and take to other level
• Medical Emergency- can go into brain cause inter cranial pressure