Disabilities

Learning Disability

learning disabilities are heterogenous conditions but are defined by 3 core criteria: lower intellectual ability (usually defined as an 1Q of less Than 70), significant impairment of social or adaptive functioning and onset in childhood

LDs in the UK

1.5 million individuals with a learning disability

• 1.2 million of these reside within England.

• There are around around adults in the uk with a learning disability who are of working age

• 2.16% of adults in the Uk have a learning disability

• 2.51. of children in the Uk have a learning disability

Disability is the Uk

• Associated with low income, unemployment and low educational
  qualifications

• Incidence and experience of disability differs by socioeconomic status, gender, age, religion and ennicity

• Disability people are more likely to be unemployed and paid less man non disabled people

• 50% of disabled people of working age are in employment (80% in non disabled people)

National Developments and Policies

- 1847 charity for the AsyIum of Idiots

- lead to 4 regional 'voluntary' large asylums in England 1850-60s

- Earlswood Asylum was impetus for establishment of northern, eastern, western, midlands counties

Institutionalism

• Loss of contact wich outside word; location, restricted visiting

• Dependence rather than independence

  • routine tasks performed by a nurse

• personal events and anniversaries unnoticed on overcrowded wards

• Minimal privacy in large impersonal dormitories

• Loss of personal effects and clothing

• over reliance on medication as a sedative

Legislation

• Menta Health Act

• Equality Act

• Disability Discrimination Act

• Mental Capacity Act

• Human Rights Act

Medical Model of Disability

• Traditional view or health care professionals - useful because it is related to treatment needs

• A person is limited and defined by the impairment /condition

• views disability as ill health | a diagnosis

• Focuses around medical care to "fix" the impairment

• Views the disability as a feature of the person, directly caused by the disease /trauma/ condition which requires medical care

Social Model of Disability

• The disadvantage of restriction of activity caused by a social. organisation, which takes little or no account or people who have impairments and thus excludes them from taking part in the mainstream of social activities

• This social model considers disability to be a form of discrimination that leads to oppression.

• society is responsible for the creation of disability through social cultural and environmental barriers

Biopsychosocial model

• an integration of social and medical models

• This model takes into account al factors

  • Health conditions

  • External environmental factors (attitudes, legislation, architecture, terrain, etc)

  • Internal Personal Factors (gender, age, education, personality)

HCP Role

• improve disability awareness

  • CAN do

  • celebrate differences and achievements

• Involve patients in decision making

  • Patient centred care

• champion and advocate for the needs of our patients

Physical disabilities

• Limited physical ability to compiere every day tasks

• orthopaedic, neuromuscular, cardiovascular or pulmonary disorder

• Hereditary or congenital eg from birth

• Acquired - injury Or infection

• Neuromuscular disability - cerebral palsy, head injury

• Musculoskeletal disability - muscular dystrophy, loss of limbs

common Physical Disabilities

• cerebral palsy

• Muscular dystrophy

• others

• Sensory impairments

Cerebral Palsy

A group of permenant disorders of the development of movement and posture causing activity limilations that are attributed to non-progressive disturbances that occurred in the developing foctal or infant brain. The motor disorder or cerebral palsy are often accompanied by disturbance a sensation, perception, cognition, communication and behaviour, by epilepsy and by secondary musculoskeletal problems.

Essentially - a group of disorders affecting movement and coordination

• 1 in 400 births

• Motor disorder -permanent

• Non progressive

• Foetal or infant brain
  Disturbance of sensation, perception, cognition, communication, behaviour

• Epilepsy

• Musculoskeletal problems

Causes

• infection

• Oxygen deprivation

• Abnormal brain development

• Restricted intra-uterine growth

• Neonatal stroke

• Generic-rare

Risk Factors

• Difficult Or premature birth

• Twins or multiple births

• Mother’s age <20, >40

• Father's age <20

• 1st child| 5th+ child

• Low birth weight

Spastic Cerebral Palsy (70-90%)

• Hypertonia

• Diplegia

• Decreased range or movement

• Quadriplegia

• impaired mobility|speech

• Hemiplegia

Dyskinetic Cerebral Palsy (15%)

• Dystonic, athetoid, choreoathetoid

• uncontrolled involuntary Hypotonic to hypertonic

• Difficulty controlling tongue, breathing and vocal chords

Ataxic cerebral easy (4%)

• Inability to activate correct pattern of muscles during movement

• Difficulty with balance

• Difficulty with spatial awareness

• speech and language affected.

Spastic Sub-types: hemiplegia, diplegia, quadriplegia

Dyskinetic sub-types: theropod and systonic

Comorbidities

• Secondary musculoskeletal problems (spine, hips)

• Learning or cognitive impairment (45%., 25% - severe)

• constipation or muscle spasms

• Problems with sleep and sleep patterns

• sensory impairment (8% hearing, visual acuity)

• speech, language or feeding difficulties, dysphasia

• Epilepsy (30%)

• spatial awareness or perception

• Behavioural or psychological problems

challenging Behaviour

• self injurious behaviour

• Aggressive behaviour towards others

• stereotyped behaviours

• Non person directed behaviour

• Exacerbated by multiple impairments| difficuLties

Dental implications

• unable to clean teeth

• Bruxism

• soft diet

• Rumination

• Difficulty chewing or swallowing

• pouching

• Tongue thrusting

• Pica

• Jaw dislocation

Muscular Dystrophy

• Hereditary condition marked by progressive weakening and wasting of muscles

• 21 types

• Myasthenia gravis

• Duchenne muscular dystrophy

Duchenne Muscular Dystrophy

• Neuromuscular genetic condition

  • Lack of dystrophin, 1 in 3500 male births

• confirmed - blood test for creatine kinase

• Progressive muscle weakness

  • 8-11 often wheelchair users can develop learning and behavioural difficulties

• Muscle fibres replaced by Fatty or fibrous tissue

• Life expectancy - 30 years

sensory impairment

• One of the senses is no longer normal - does not have to be full loss

• visual, hearing, multisensory

visual impairment

• 360000 in England registered

• Degree of sight loss chat cannot be corrected by glasses or contact lenses

• partially sighted / sight impaired

  • 1 in 5 over 75

• Blindness|severe sight impairment

• visual field acuity affected

Macular regeneration - central part of back of eye affected

cataracts - cloudy patches on lens

Glaucoma - fuid build up|blockage

diabetic retinopathy - build up of glucose in blood vessels

Hearing impairment

• Hearing affected by injury or condition

• congenital or acquired

• Conductive hearing loss (blockage / bones)

• sensorineural hearing loss (hairs/bones)

• Mixed hearing loss

Management:

- digital hearing aid

- sign language

-implants

Multisensory impairments

• combination oE visual and hearing difficulties

• Deaf-blind

• congenital (rubella ICMV)

• Acquired (usher's syndrome)

• Charge (colombact eye, heart defects, urinary problems, etc)

• Down syndrome

Wheelchair users

• comfort

• safely

• Maximum mobility with minimum effort

• Manual or electric

• moulded

Bariatric Patients

• Risk assessment and process planning for bariatric patient handling pathways

• survey: 212 trusts and 10 case studies

• >50% trusts had no bariatric policy

Genetic risks:

• patient factors

• building/vehicle space and design

• equipment

• communication

• organisation /staff Issues

Dental implications

• Delayed presentation

• Poorer oral hygiene

• unable to access healthcare

• Higher rate of carres /perio

• reliance on others for OH

• issues with dexterity

• refusing support with OH

• connective tissue disorders (LD/PD)

Barriers

• that limit or prevent people from receiving adequate health care

Barriers

• unable to access surgery

  • carers

  • Accessible building

  • Ambulance

• Facilities

  • Wheelchair access

  • Disabled toilets

  • Hoists

  • Manual handling equipment

• Anxiety

  • IHS/IVS/GA available

• Location of clinics

• Staff have knowledge|skill to provide treatment

• Access to medical/dental specialists

Communication

• Non verbal

  • body movement

  • changes in breathing pattern

  • eye pointing

  • localising

  • leading others to objects or activities

• Alphabet based

  • manual alphabet

  • braille

• symbols

  • objects

  • pictures

• sign systems and languages

  • BSL

  • Makaton

• Speech based

  • clear speech

  • lip reading

  • tadoma

Reasonable Adjustments

under the equality act 2010, healthcare services must consider the needs of people with disabilities in the way they organise their buildings, policies and services. These are called 'reasonable adjustments’ and reflect the fact that some people with disabilities may have particular needs that standard services do not adequately meet.

summary

• Peopie with LD/PD are a diverse group

• May have challenges accessing care

• important to celebrate and acknowledge diversity of our patients

• Important to ensure treatment is patient centred

• Important that patients are involved in care decisions

• important to advocate for our patients