DEVELOPMENTAL

DISABLITIES
 INTRODUCTION

Disability (Disability Act 2005) is “a substantial restriction in the capacity of

the person to carry on a profession, business or occupation in the state or to
participate in social or cultural life in the state by reason of an enduring
physical, sensory, mental health or intellectual impairment.”
 DEVELOPMENTAL DISABILITIES

• Developmental disabilities are a broad group of conditions that result from cognitive or physical impairments prior to
adulthood. These various conditions begin during the developmental period, typically lasting throughout the
person’s lifetime.
• Most developmental disabilities begin before a baby is born. However, some can occur at a later stage because
of injury, infection, or other factors. Impairments caused by a developmental disability can impact an individual’s
day-to-day functioning.
• Developmental disabilities are a set of physical and mental conditions that cause an impediment in the normal
functioning of various biological systems in the human body
• There are five types of developmental disabilities which include autism spectrum disorder (ASD), cerebral palsy (CP)
, intellectual disability (ID), attention deficit hyperactivity disorder (ADHD), and learning disabilities. Cognitive
disorders, motor disorders, Vision, Hearing and Speech Disabilities, Behavioral Disorders
• Developmental disabilities include limitations in function resulting from disorders of the developing
nervous system. These limitations manifest during infancy or childhood as delays in reaching
developmental milestones or as lack of function in one or multiple domains, including cognition, motor
performance, vision, hearing and speech, and behavior.
 INTELLECTUAL DISABILITIES
• Intellectual disabilities (commonly referred to as mental retardation in the USA) is defined by the American
Association on Mental Retardation as significant subaverage general intellectual functioning existing concurrently
with deficits in adaptive behaviors which are first manifested before the age of 18 years (Luck-asson et al., 1993).
• Intellectual disability (ID) is a broad disorder characterized by early onset limitations in intellectual functioning and
adaptive behavior.
• It is characterized by significantly subaverage intellectual functioning, existing concurrently with related limitations in
two or more of the following applicable adaptive skill areas: communication, self-care, home living, social skills,
community use, self-direction, health and safety, functional academics, leisure, and work. An age limit criterion (e.g.,
mental retardation manifesting before age 18) also was included in this definition.
• Children and youth with intellectual disabilities are typically differentiated by the dysfunctional severity
of their intellectual and adaptive behavior. The typical classifications are mild intellectual disabilities,
moderate intellectual disabilities, severe intellectual disabilities, and profound intellectual disabilities,
which typically require different levels of support (e.g., intermittent support, limited support, extensive
support, and pervasive support, respectively). While many of these children adjust reasonably well
socially, children and youth with severe intellectual disability typically have severe impairments and
require lifelong care
 EPIDEMIOLOGY

• Estimates of the prevalence of intellectual disabilities range from 1% to 3% of the population, depending
on whether persons with mild forms of intellectual disabilities are included. The prevalence appears to
be similar across ages, with some decrease at the oldest ages. However, the proportion of persons with
intellectual disabilities who show up in the service system varies, with the greatest proportion served in
the school age (McClaren & Bryson, 1987). It has been estimated that as many as 40% of adults with
intellectual disabilities are not known to the service system (Krauss, 1986).
• The prevalence of severe behavior problems among persons with mental retardation is also well
documented. Generally, persons with mild and moderate mental retardation and challenging behaviors
tend to exhibit behaviors related to hyperactivity, low frustration tolerance, physical and verbal
aggression, and other antisocial or socially inappropriate behaviors. Persons with severe levels of mental
retardation often are not aware of or interested in their immediate environment and tend to display self-
stimulatory, self-injurious, aggressive, and destructive behaviors. Severe behavior constitutes the single
most important variable influencing placement in an institution and is a major factor in community
placement failure (Aman & Singh, 1991).
• individuals with intellectual disability are often at risk for showing other behavior problems beyond those
captured in this definition. As a result, many individuals have been dually diagnosed with both
intellectual disability and other co-morbid conditions, such as psychiatric disorders.
• children with specific causes of their intellectual disabilities may be vulnerable to some psychiatric
conditions, but not others. For example, individuals with Prader–Willi syndrome show increased rates of
obsessive-compulsive behavior, including hoarding behavior, as well as well-documented obsessive food
ideation symptoms. Children with Williams syndrome are at increased risk of showing difficulties in the
area of anxiety and heightened fear responses. While children with Down syndrome tend to show lower
levels of psychopathology than other children with intellectual disability, there is evidence to suggest
that these individuals are at increased risk for autism and autism spectrum disorders, relative to the
prevalence rates observed in the typically developing population.
• Diagnosis of a comorbid psychiatric condition along with intellectual disability may pose many challenges to
clinicians and therapists. Researchers in this area have noted that many clinicians are prone to attribute the
behavior problems associated with psychiatric conditions to the diagnosis that a child already has, leading to the
phenomenon called diagnostic overshadowing. In other words, the diagnosis that a child already has – for
example, Down syndrome – becomes the explanation for poor communication and impairments in social interaction,
rather than exploring the alternative possibility that the child might meet criteria for autism as well. This is notable in
that impairments in social interaction are unusual in most children with Down syndrome, who tend to show
competence in achieving early intersubjective milestones in infancy and toddlerhood. Thus, understanding the
relative contributions of the intellectual disability and a possible comorbid disorder may make it possible to improve
the precision with which decisions are made regarding appropriate services and intervention strategies.
 DEVELOPMENTAL DISABILITIES

•f
Intellectual And Developmental Disability (IDD) is defined by significant
limitations in intellectual function and adaptive behavior as expressed
through perceptual, social and practical adaptive skills.
These limitations appear before the age of 18 (Luckasson Et Al., 2002).
 CNT
•Individuals with IDD develop at a slower rate than their peers and
experience some unique challenges in the areas of learning, social
adjustment, and independent living skills.
•Like all individuals, people with IDD require the same basic services
needed for normal development including education, vocational
preparation, health services, recreation, social interactions and emotional
support.
NB
•Concurrent with the transition from the medical to the social
model in health professions, in which the term 'mental retardation'
has been replaced with the term 'Intellectual And Developmental
Disability’ (IDD).
•Accordingly, classification of this disability has changed from
defining the population according to levels of delay, to defining it
according to the intensity of required supports
 Etiology of IDD
The etiological factors leading to these disabilities according to Ronen (2005)
include,
Genetics
Dietary and metabolic factors
Infections and poisoning
Traumatic Brain Injury during and following birth
Social And Environmental Factors
 General manifestations of IDD
•The population of people with intellectual and developmental disabilities is
diverse and complex.
•Individuals with intellectual and developmental disabilities manifest varying
levels of function with respect to skills of daily living, as well as varying
cognitive, intellectual, social, physical, emotional and behavioral
capabilities throughout their life cycle.
 CNT
The Intellectual limitations experienced by these individuals frequently co-
present with other limitations, such as:
I. Cerebral Palsy,
II. Autism Spectrum Disorders,
III. Down syndrome,
IV. Epilepsy,
V. Hearing And Visual Deficits, and other physical or emotional deficits.
CEREBRAL PALSY
 Introduction to CP
•Cerebral palsy is a disorder of posture and movement due to a dysfunction of the
brain.
•The cause of cerebral palsy can be identified in some instances to be head injury,
central nervous system infection or bleeding, certain birth defects, or insufficient
delivery of oxygen to the brain of the fetus or newborn. In many instances,
however, the cause is not known.
 types of Cerebral Palsy

Below are the most commonly used classification systems understood and used by qualified practitioners.
• Classification based on severity level
• Classification based on topographical distribution
• Classification based on motor function
• Classification based on gross motor function classification system
• here are several types of cerebral palsy, classified by the kind of movement affected, the body parts affected,
and how severe the symptoms are. Some types involve intellectual and developmental disabilities (IDDs) as
well as movement problems
 CLASSIFICATION BASED ON SEVERITY LEVEL

• Mild – Mild Cerebral Palsy means a child can move without assistance; his or her daily activities are not limited.

• Moderate – Moderate Cerebral Palsy means a child will need braces, medications, and adaptive technology to accomplish daily
activities.

• Severe – Severe Cerebral Palsy means a child will require a wheelchair and will have significant challenges in accomplishing daily
activities.

• No CP – No CP means the child has Cerebral Palsy signs, but the impairment was acquired after completion of brain development
and is therefore classified under the incident that caused the Cerebral Palsy, such as traumatic brain injury or encephalopathy.
 Classification based on topographical distribution

•Topographical classification describes body parts affected. The words are a combination of phrases combined for one single meaning. When
used with Motor Function Classification System, it provides a description of where and to what extent a child is affected by Cerebral Palsy. This
method is useful in ascertaining treatment protocol.
•Paresis means weakened
•Plegia/Plegic means paralyzed
•Monoplegia/monoparesis means only one limb is affected. It is believed this may be a form of hemiplegia/hemiparesis where one limb is
significantly impaired.
•Diplegia/diparesis usually indicates the legs are affected more than the arms; primarily affects the lower body.
•Hemiplegia/hemiparesis indicates the arm and leg on one side of the body are affected.
•Paraplegia/paraparesis means the lower half of the body, including both legs, is affected.
•Triplegia/triparesis indicates three limbs are affected. This could be both arms and a leg, or both legs and an arm. Or, it could refer to one
upper and one lower extremity and the face.
•Double hemiplegia/double hemiparesis indicates all four limbs are involved, but one side of the body is more affected than the other.
•Tetraplegia/tetraparesis indicates that all four limbs are involved, but three limbs are more affected than the fourth.

•Quadriplegia/quadriparesis means that all four limbs are involved.

•Pentaplegia/pentaparesis means all four limbs are involved, with neck and head paralysis often accompanied by eating and breathing
complications
 Classification based on motor function

• Spastic Cerebral Palsy is characterized by increased muscle tone..

• Non-spastic Cerebral Palsy will exhibit decreased or fluctuating muscle tone.

• Mixed A child’s impairments can fall into both categories, spastic and non-spastic, referred to as mixed
Cerebral Palsy. The most common form of mixed Cerebral Palsy involves some limbs affected by
spasticity and others by athetosis.
 SPASTIC CP

• Muscles continually contract, making limbs stiff, rigid, and resistant to flexing or relaxing. Reflexes can be exaggerated, while
movements tend to be jerky and awkward. Often, the arms and legs are affected. The tongue, mouth, and pharynx can be
affected, as well, impairing speech, eating, breathing, and swallowing. Spastic Cerebral Palsy is hypertonic and accounts for
70% to 80% of Cerebral Palsy cases. The injury to the brain occurs in the pyramidal tract and is referred to as upper motor
neuron damage. result in associated conditions such as hip dislocation, scoliosis, and limb deformities. One particular concern
is contracture, the constant contracting of muscles that results in painful joint deformities
 NON SPASTIC CP

• Non-spastic Cerebral Palsy is decreased and/or fluctuating muscle tone. Multiple forms of non-spastic Cerebral Palsy are each
characterized by particular impairments; one of the main characteristics of non-spastic Cerebral Palsy is involuntary movement.
Movement can be slow or fast, often repetitive, and sometimes rhythmic. Planned movements can exaggerate the effect – a condition
known as intention tremors. Stress can also worsen the involuntary movements, whereas sleeping often eliminates them.

• An injury in the brain outside the pyramidal tract causes non-spastic Cerebral Palsy. Due to the location of the injury, mental
impairment and seizures are less likely. Non-spastic Cerebral Palsy lowers the likelihood of joint and limb deformities. The ability to
speak may be impaired as a result of physical, not intellectual, impairment.

• Non-spastic Cerebral Palsy is divided into two groups, ataxic and dyskinetic. Together they make up 20% of Cerebral Palsy cases.
Broken down, dyskinetic makes up 15% of all Cerebral Palsy cases, and ataxic comprises 5%.
• Ataxic/ataxia

• Ataxic Cerebral Palsy affects coordinated movements. Balance and posture are involved. Walking gait
is often very wide and sometimes irregular. Control of eye movements and depth perception can be
impaired. Often, fine motor skills requiring coordination of the eyes and hands, such as writing, are
difficult. Does not produce involuntary movements, but instead indicates impaired balance and
coordination
 Dyskinetic

•Dyskinetic Cerebral Palsy is separated further into two different groups; athetoid and dystonic.

•Athetoid Cerebral Palsy includes cases with involuntary movement, especially in the arms, legs, and hands.

•Dystonia/Dystonic Cerebral Palsy encompasses cases that affect the trunk muscles more than the limbs and
results in fixed, twisted posture.

•Because non-spastic Cerebral Palsy is predominantly associated with involuntary movements, some may classify
Cerebral Palsy by the specific movement dysfunction, such as:

•Athetosis — slow, writhing movements that are often repetitive, sinuous, and rhythmic
• Chorea — irregular movements that are not repetitive or rhythmic, and tend to be more jerky and shaky

• Chorea — irregular movements that are not repetitive or rhythmic, and tend to be more jerky and shaky

• Choreoathetoid — a combination of chorea and athetosis; movements are irregular, but twisting and curving

• Dystonia — involuntary movements accompanied by an abnormal, sustained posture

 Classification based on Gross Motor Function Classification
System
GMFCS classification levels
•GMFCS Level I – walks without limitations.

•GMFCS Level II – walks with limitations. Limitations include walking long distances and balancing, but not as able as Level I to run or
jump; may require use of mobility devices when first learning to walk, usually prior to age 4; and may rely on wheeled mobility
equipment when outside of home for traveling long distances.

•GMFCS Level III – walks with adaptive equipment assistance. Requires hand-held mobility assistance to walk indoors, while utilizing
wheeled mobility outdoors, in the community and at school; can sit on own or with limited external support; and has some
independence in standing transfers.

•GMFCS Level IV – self-mobility with use of powered mobility assistance. Usually supported when sitting; self-mobility is limited; and
likely to be transported in manual wheelchair or powered mobility.

•GMFCS Level V – severe head and trunk control limitations. Requires extensive use of assisted technology and physical assistance;
and transported in a manual wheelchair, unless self-mobility can be achieved by learning to operate a powered wheelchair.
• Two terms used to describe muscle tone are:

• Hypertonia/Hypertonic — increased muscle tone, often resulting in very stiff limbs. Hypertonia is
associated with spastic Cerebral Palsy

• Hypotonia/Hypotonic — decreased muscle tone, often resulting in loose, floppy limbs. Hypotonia is
associated with non-spastic Cerebral Palsy
 Presentation of CP
• Signs and symptoms of cerebral palsy can vary greatly from person to person. Cerebral palsy can
affect the whole body, or it might be limited primarily to one or two limbs, or one side of the body.
Generally, signs and symptoms include problems with movement and coordination, speech and eating,
development, and other problems.
• Stiff and difficult movement, involuntary movement and balance problems, poor body tone, or a
combination of these can characterize cerebral palsy.
• It can affect all four extremities (quadriplegia), the lower extremities on one side only (hemiplegia), or
the lower extremities only (paraplegia).
• Speech problems may also be present
• Cerebral palsy is not a disease. It is neither progressive (i.e., it does not get worse) nor communicable.
Some people with cerebral palsy may have IDD; many, however, have normal or above-normal
intelligence
 MOVEMENT AND COORDINATION

• Stiff muscles and exaggerated reflexes (spasticity), the most common movement disorder
• Variations in muscle tone, such as being either too stiff or too floppy
• Stiff muscles with normal reflexes (rigidity)
• Lack of balance and muscle coordination (ataxia)
• Tremors or jerky involuntary movements
• Slow, writhing movements
• Favoring one side of the body, such as only reaching with one hand or dragging a leg while crawling
• Difficulty walking, such as walking on toes, a crouched gait, a scissors-like gait with knees crossing, a wide gait or an asymmetrical
gait
• Difficulty with fine motor skills,
 SPEECH AND EATING

• Delays in speech development

• Difficulty speaking
• Difficulty with sucking, chewing or eating
• Excessive drooling or problems with swallowing
 Development

• Delays in reaching motor skills milestones, such as sitting up or crawling

• Learning difficulties
• Intellectual disabilities
• Delayed growth, resulting in smaller size than would be expected
 Other problems

Damage to the brain can contribute to other neurological problems, such as:
• Seizures (epilepsy)
• Difficulty hearing
• Problems with vision and abnormal eye movements
• Abnormal touch or pain sensations
• Bladder and bowel problems, including constipation and urinary incontinence
• Mental health conditions, such as emotional disorders and behavioral problems
 DIAGNOSIS

Common tests & procedures

• Magnetic resonance imaging (MRI): MRI of the brain is performed to identify any abnormalities within the brain.
• Ultrasound: Cranial ultrasound is generally used for infants; it uses high-frequency sound waves to form images of
the brain.
• Electroencephalogram (EEG): Used to record electrical activities in the brain and check for seizures.
• Laboratory examination: To check for genetic or metabolic disorders.
• DEVELOPMENTAL MILESTONES CHECKLISTS
• GROWTH CHART
• PEDIATRICIAN
• DEVELOPMENTAL BEHAVIORAL PEDIATRICIAN
• GENETICIST
• NEUROLOGIST
• NEURORADIOLOGIST
• OPHTALMOLOGISTS
• ORTHOPEDIC SURGEON
• OTOLOGISTS
• NEONATOLOGISTS
• PEDIATRIC GENETICISTS
• Diagnosing Cerebral Palsy takes time. There is no test that confirms or rules out Cerebral Palsy.
• In severe cases, the child may be diagnosed soon after birth, but for the majority, diagnosis can be made in the first two years.
• For those with milder symptoms, a diagnosis may not be rendered until the brain is fully developed at three to five years of
age. For example, the average age of diagnosis for a child with spastic diplegia, a very common form of Cerebral Palsy, is
18 months.
• This can be a difficult time for parents who suspect something might be different about their child. Often, parents are first to
notice their child has missed one of the age-appropriate developmental milestones.
• If a growth factor is delayed, parents may hope their child is just a slow starter who will “catch up.” While this may be the case,
parents should inform the child’s doctor of concerns, nonetheless.
• Confirming Cerebral Palsy can involve many steps. The first is monitoring for key indicators such as:
• When does the child reach development milestones and growth chart standards for height and weight?
• How do the child’s reflexes react?
• Does it seem as if the child is able to focus on and hear his or her caregivers?
• Does posture and movement seem abnormal?
• If a baby is born prematurely, or at a low birth weight, he or she is monitored closely in the neonatal intensive
care unit of the hospital from time of birth. In extreme cases of child abuse, or shaken baby syndrome a
pediatric neurologist called to the hospital’s emergency or NICU unit will diagnosis the child’s condition. In the
majority of cases the child will attend regular well-baby visits where the pediatrician first uncovers signs of
Cerebral Palsy during examination. In some cases, it is the parents who notice symptoms they relay to the
child’s doctor during these visits.
• Developmental delay, abnormal growth charts, impaired muscle tone, and abnormal reflexes are early
indications of Cerebral Palsy. Because there is no test that definitely confirms or rules out Cerebral Palsy, other
conditions must be excluded from the list of possible causes, and Cerebral Palsy must be fully considered.
Other disorders and conditions can appear as Cerebral Palsy, and Cerebral Palsy is often accompanied by
associated conditions that complicate the process of diagnosis.
• Since there is no definitive test that can diagnose Cerebral Palsy, doctor’s may utilize one, or a combination, of the following to aid the diagnosis process:

•Assessing reproductive health factors

•Reviewing paternal health records
•Reviewing pregnancy, labor and delivery records
•Reviewing newborn screens conducted at birth
•Considering APGAR score
•Reviewing baby birth, medical, developmental and growth records
•Performing a physical examination of baby
•Performing additional screens (hearing, fatty acids, amino acids and hemoglobinopathies)
•Conducting neuroimaging tests to determine if brain damage exists
•Performing electroencephalography (EEG) or electromyography (EMG) to analyze nervous system function
•Conducting lab tests (blood work, urinalysis or genetic testing)
•Conducting evaluations (mobility, gait, speech, hearing, vision, feeding and digestion, cognitive and rehabilitation
needs)
 MANAGEMENT

• Habilitation and Rehabilitation

• A child with cerebral palsy usually starts these therapies in the first few years of life or soon after being diagnosed.
Physical therapy is one of the most important parts of treatment. It involves exercises and activities that can maintain
or improve muscle strength, balance, and movement. A physical therapist helps the child learn skills such as sitting,
walking, or using a wheelchair. Other types of therapy include:
• Occupational therapy. This type of therapy helps a child learn to do everyday activities such as dressing and going
to school.
• Recreational therapy. Participating in art programs, cultural activities, and sports can help improve a child’s physical
and intellectual skills.
• Speech and language therapy. A speech therapist can help a child learn to speak more clearly, help with
swallowing problems, and teach new ways to communicate, such as by using sign language or a special
communication device.
 PHYSIOTHERAPY

• Muscle training and exercises can help your child's strength, flexibility, balance, motor development and
mobility. You'll also learn how to safely care for your child's everyday needs at home, such as bathing
and feeding your child. Your therapist can provide guidance on how you can continue muscle training
and exercise at home between therapy visits.

• For the first 1 to 2 years after birth, both physical and occupational therapists work on issues such as
head and trunk control, rolling, and grasping. Later, both types of therapists are involved in wheelchair
assessments.
• Occupational therapy. Occupational therapists work to help your child gain independence in daily
activities and routines at home and school and in the community. Adaptive equipment recommended for
your child can include walkers, wide-based canes, standing and seating systems, or electric wheelchairs.
• Speech and language therapy. Speech-language pathologists can help improve your child's ability to
speak clearly or to communicate using sign language. They can also teach the use of communication
devices, such as a computer and voice synthesizer, if communication is difficult. Speech therapists can
also address difficulties with eating and swallowing.
• Recreational therapy. Some children benefit from regular or adaptive recreational or competitive sports,
such as therapeutic horseback riding or skiing. This type of therapy can help improve your child's motor
skills, speech and emotional well-being. Both adults and children benefit from regular physical activity
and exercise for general health and fitness.
• Orthotic devices. Braces, splints, and casts can be placed on the affected limbs and can improve
movement and balance. Other devices that can help with movement and posture include wheelchairs,
rolling walkers, and powered scooters.
• Assistive devices and technologies. These include special computer-based communication machines,
Velcro-fastened shoes, or crutches, which can help make daily life easier
 • Medication. Certain medications can relax stiff or overactive muscles and reduce abnormal movement. They may be taken by mouth, injected into
affected muscles, or infused into the fluid surrounding the spinal cord through a pump implanted near the spinal cord. For children who have
cerebral palsy and epilepsy (seizures), standard epileptic medications should be considered, but these medications may also have negative effects
on the developing brain.
Muscle or nerve injections. To treat tightening of a specific muscle, your doctor might recommend injections of onabotulinumtoxinA (Botox), or another
agent. The injections will need to be repeated about every three months.
• Side effects can include pain at the injection site and mild flu-like symptoms. Other more-serious side effects include difficulty breathing and
swallowing.
Oral muscle relaxants. Drugs such as baclofen, tizanidine (Zanaflex), diazepam (Valium) or dantrolene (Dantrium) are often used to relax muscles.
• In some cases, baclofen is pumped into the spinal cord with a tube (intrathecal baclofen). The pump is surgically implanted under the skin of the
abdomen.
Medications to reduce drooling. One option is Botox injections into the salivary glands.
• Surgery. A child may need surgery if symptoms are severe. For instance, surgery can lengthen stiff, tightly
contracted muscles. A surgeon can also place arms or legs in better positions or correct or improve an
abnormally curved spine. Sometimes, if other treatments have not worked, a surgeon can cut certain
nerves to treat abnormal, spastic movements. Before conducting surgery, it is important for a health care
provider to assess the procedure’s benefits by carefully analyzing biomechanics of the joints and
muscles.
 Surgical procedures

• Surgery may be needed to lessen muscle tightness or correct bone abnormalities caused by spasticity. These
treatments include:
• Orthopedic surgery. Children with severe contractures or deformities might need surgery on bones or joints to
place their arms, spine, hips or legs in their correct positions. Surgical procedures can also lengthen muscles
and lengthen or reposition tendons that are shortened by contractures. These corrections can lessen pain and
improve mobility. The procedures can also make it easier to use a walker, braces or crutches.
• Cutting nerve fibers (selective dorsal rhizotomy). In some severe cases, when other treatments haven't helped,
surgeons might cut the nerves serving specific spastic muscles in a procedure called selective dorsal rhizotomy.
This relaxes the muscle in the legs and reduces pain, but can cause numbness.
 Prognosis of CP

•The brain disorder causing cerebral palsy doesn't change with time, so the
symptoms usually don't worsen with age. However, as the child gets older, some
symptoms might become more or less apparent. And muscle shortening and
muscle rigidity can worsen if not treated aggressively.
•Persons with cerebral palsy are usually able to attain a substantial degree of
independence, while some may need considerable assistance.
•Early identification of cerebral palsy can lead to early intervention programs that
can lessen developmental problems.
 CNT
•Advanced technology has produced innovations in the areas of speech
and communication, self-care, adapted living arrangements, and work sites
creating a positive effect on the long-term welfare of persons with cerebral
palsy and increasing the ability of persons with cerebral palsy to live
independently in the community with varying degrees of support services
•What is cerebral palsy [Link]
•Symptoms of cerebral palsy [Link]
v=pm6BnzsqQbQ
•Types of cerebral palsy [Link]
•Caring for a child with cerebral palsy [Link]
v=ufmJVHu1_3s
•Health talk cerebral palsy [Link]
AUTISM SPECTRUM DISORDERS
 Introduction to ASD

•Autism Spectrum Disorder describes as a group of complex neuro-developmental

disorder that results from impairment in the development and functioning of an
immature brain, which manifests in early childhood (first three years of life) that
affects how people interact with others, communicate, learn, and behave.
•Autism is known as a “spectrum” disorder because there is wide variation in the
type and severity of symptoms people experience.
 TYPES OF ASD

• In the recent past, experts talked about different types of autism, such as autistic disorder, Asperger’s
syndrome, pervasive developmental disorder not otherwise specified (PDD-NOS). But now they are all
called “autism spectrum disorders
•Autistic Disorder- This is sometimes called “classic” autism. It is what most people think of when hearing the word “autism”.
People with autistic disorder usually have significant language delays, social and communication challenges, and unusual
behaviors and interests. Many people with autistic disorder also have intellectual disability
•Asperger's syndrome. This is on the milder end of the autism spectrum. People with Asperger syndrome usually have
milder symptoms of autistic disorder. They might have social challenges and unusual behaviors and interests. However,
they typically do not have problems with language or intellectual disability
•Pervasive developmental disorder, not otherwise specified (PDD-NOS). This is sometimes called “atypical autism,” or
PDD-NOS. People who meet some of the criteria for autistic disorder or Asperger syndrome, but not all, may be
diagnosed with atypical autism. These people usually have fewer and milder symptoms than those with autistic disorder.
The symptoms might cause only social and communication challenges.
• Childhood disintegrative disorder (CDD), also known as Heller’s Syndrome typically affects toddlers and pre-
schoolers. This is the rarest and most severe part of the spectrum. In this case, the child grows normally until (at
least) the age of 2 and then shows a sudden drop in social, communication and behavioral skills. CDD is often
overlooked initially by the parents as they tend to attribute this sudden impairment as a ‘transient and temporary’
phase for their child and would expect it to pass away. Often, these children also developed a seizure disorder.
Is Rett Syndrome an ASD?
• Rett’s syndrome occurs only in girls. Girls with Rett’s Syndrome suffer from significant communication impairment and
limited ability to use their hands for regular activity. Typically this syndrome deteriorates with the girl’s age, thus
requiring more support and time.
• Children with Rett syndrome often have behaviors similar to autism, and experts used to group it among spectrum
disorders. But now that it’s known to be caused by a genetic mutation, it’s no longer considered an ASD.
 SUPPORT CLASSIFICATION OF ASD

• LEVEL 1 mild autism

• LEVEL 2 moderate autism
• LEVEL 3 severe autism
 General features of ASD

ASD is characterized by impairment in three areas:

1. Social interaction
2. Verbal and nonverbal communication
3. Range of activities and interests.
They may also have Sensory processing dysfunctions
 A) SOCIAL INTERACTIONS

•Difficulty with social interaction may be shown, for example, by failure to cuddle,
•indifference or resistance to affection or physical contact,
• unable to make eye contact, or make little infrequent eye contact
•not responding or being slow to respond to to one’s name or to other verbal bids for
attention (Sometimes parents mistakenly suspect that the infant or young child is deaf
•Having trouble understanding another person’s point of view or being unable to predict or
understand other people’s actions
•Difficulties adjusting behaviors to social situations
•Difficulties sharing in imaginative play or in making friends
 B) COMMUNICATION
•Impairment in communication may include absent or delayed language, echolaic
language in which the person is only able to repeat what is said to him or her,
little or delayed use of gestures or facial expressions to communicate, and/or
unusual speech inflection such as a monotone (sing-song or flat and robot-like).
•Difficulty understanding humor and complex issues;
•Appearing not to look at or listen to people who are talking
•Infrequently sharing interest, emotion, or enjoyment of objects or activities
(including by infrequently pointing at or showing things to others)
 C) RANGE OF INTERESTS
•Restricted range of interests and activities may show itself in an attachment to just a
few objects such as a string or rubber band.
•Having a lasting intense interest in specific topics, such as numbers, details, or facts
•Repetitive behaviors such as spinning the wheels of a toy car or pram repeatedly, or
take the clothes on and off a doll repeatedly, incessant hand movements, rocking
back and forth, or repeated words (echolalia).
•There may be strong reactions to small changes in the environment.
•The older child may insist on following routines in a precise way and have a low
tolerance for frustration
 D) SENSORY PROCESSING
•Individuals with ASD present with sensory processing dysfunction (SPD).
•SPD is the abnormal response to sensory inputs.
Individuals with ASD may be hypersensitive (over-responsive) and/ or
hyposensitive (under-responsive) to a wide range of stimuli including sights, sounds,
smells, tastes, touch, balance (vestibular), body position and movement
(proprioception), and internal body cues and sensations (interoception).
• Are sensitive to the environment – for example, they might be more easily upset by noise or bright lights
than other children
• like their environment to stay the same – for example, they’ll eat only foods with certain textures or
colours, or they’ll want to wear the same clothes each day
• enjoy seeking out sensations – for example, they might rub objects on their lips or faces, or smell objects.
• People with ASD may also experience sleep problems and irritability.
• comorbidities such as gastrointestinal problems (reflux, chronic constipation, and diarrhea) occur in
46–85% of children with ASD (94, 95). Seizures occur in 11–39% of ASD cases (96). Sleep problems,
depression, emotional reactions and behaviors, sinusitis, headaches, mood swings and bipolar disorders
are other observed comorbidities
People on the autism spectrum also may have many strengths, including:
• Being able to learn things in detail and remember information for long periods of time
• Being strong visual and auditory learners
• Excelling in math, science, music, or art
 RISK FACTORS

Researchers don’t know the primary causes of ASD, but studies suggest that a person’s genes can act
together with aspects of their environment to affect development in ways that lead to ASD. Some factors
that are associated with an increased likelihood of developing ASD include:
• Having a sibling with ASD
• Having older parents
• Having certain genetic conditions (such as Down syndrome or Fragile X syndrome)
• Having a very low birth weight
 DIAGNOSIS

• Diagnosing autism spectrum disorder (ASD) can be difficult because there is no medical test, like a blood test, to diagnose the disorder. Doctors
look at the child’s developmental history and behavior to make a diagnosis.
• Currently, diagnosis is conducted mainly by observational screening tools that measure a child’s social and cognitive abilities. The two main tools
used in the diagnosis of ASD are DSM-5 and M-CHAT, which examine persistent deficits in interaction and social communication, and analyze
responses to “yes/no” items that cover different developmental domains to formulate a diagnosis. While many tools to screen and diagnose ASD
exist, two of the leading autism diagnostic tools in use today are DSM-5 and M-CHAT (Modified Checklist for Autism in Toddlers).
• Consequently, today’s clinical diagnosis of ASD is based on assessing behaviors as outlined in APA’s DSM-5 criteria (2, 12). Other disorders that
may co-occur with ASD. These include psychiatric disorders such as attention deficit hyperactivity disorder (ADHD), which is considered the most
common comorbidity in people with ASD (~ 28%) (13), along with other conditions and diseases including anxiety and phobias, dissociative
disorders, depression, bipolar disorder, and episodic mood disorders (13, 14). Physiological disorders (e.g., gastrointestinal disorders) and
genetic disorders (e.g., fragile X syndrome) may also be prevalen
• ASD can sometimes be detected at 18 months of age or younger. By age 2, a diagnosis by an experienced professional can be considered
reliable [1]. However, many children do not receive a final diagnosis until much older.
• A team of health care providers who have experience diagnosing ASD will conduct the diagnostic
evaluation. This team may include child neurologists, developmental pediatricians, speech-language
pathologists, child psychologists and psychiatrists, educational specialists, and occupational therapists.
The diagnostic evaluation is likely to include:
• Medical and neurological examinations
• Assessment of the child’s cognitive abilities
• Assessment of the child’s language abilities
• Observation of the child’s behavior
• An in-depth conversation with the child’s caregivers about the child’s behavior and development
• Assessment of age-appropriate skills needed to complete daily activities independently, such as eating, dressing, and toileting
Because ASD is a complex disorder that sometimes occurs with other illnesses or learning disorders, the comprehensive evaluation may include:
• Blood tests
• Hearing test
The outcome of the evaluation may result in a formal diagnosis and recommendations for treatment.
• According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a guide created by
the American Psychiatric Association that health care providers use to diagnose mental disorders,
people with ASD often have:

• Difficulty with communication and interaction with other people

• Restricted interests and repetitive behaviors
• Symptoms that affect their ability to function in school, work, and other areas of life
 Etiology, prognosis of ASD
•The definite etiology of ASD is unknown but both genetics, parental health
and environmental factors may influence development of ASD (WHO, 2021).
•There is no cure for ASD, however there exists a broad range of interventions
such as evidence- based psychosocial interventions, from early childhood and
across the life span that can optimize the development, health, well-being and
quality of life of people with autism.
 MANAGEMENT

• Many approaches are available to improve the abilities and skills, and quality of life of individuals with
ASD (45–48). These approaches involve families, clinical practitioners, and educators (49).
• The varied symptoms and functioning levels of autistic individuals requires individualized treatments (55).
There is consensus on the importance of providing therapy as soon as possible, immediately after
diagnosis or even in the case of suspected diagnosis (56–61). The involvement and training of parents
(62–64), siblings, and peers are also important
• Educational and behavioral interventions play a central role in addressing communication, social skills,
play, daily living competencies, academic skills, and inappropriate behavior
• Applied Behavior Analysis (ABA) is one of the widely used evidence-based approaches (66). ABA
interventions operate under the principle of re-conditioning target behavior. The main principle is
breaking down specific skills or activities into small elements, and teaching these in a progressive and
systematic manner through reinforcement. It has shown substantial improvements in language, IQ, and
academic skills. Discrete Trial Training (DTT), Early Intensive Behavioral Interventions (EIBI), Pivotal
Response Training (PRT), and Verbal Behavioral Intervention (VBI) are different types of ABA intervention
 THE DENVER MODEL,

• The Denver model is one of the most studied developmental models developed initially by Rogers et al.
(76). Therapists focus on deficit areas, particularly at the level of imitation, understanding and sharing
emotions, theory of mind, and social perception but follow the developmental sequence of normally
developed children. Interventions aim at creating a warm environment and positive relationship between
children and adults. Teaching mainly occurs in naturalistic settings, involving parents as co-therapists. As
the vital role of early intervention is widely acknowledged and the benefits of the Denver Model
appreciated, the model has been adapted to toddlers and preschoolers, giving way to the ESDM.
Significant improvements in adaptive behavior, language, and IQ were identified in randomized control
trials
 THE DEVELOPMENTAL INDIVIDUAL DIFFERENCE (DIR)

• DIR was developed by Dr. Greenspan in the 1980s and his focus was on ‘floor time’ and ‘child-led’ play. DIR
also focuses on the child’s development. It comprises a series of strategies to enhance relationships and
social/emotional communication to support cognitive and emotional development. Instead of identifying
deficits, it focuses on meeting the child at his/her developmental levels (e.g., in terms of shared attention and
self-regulation, engagement and relating, back and forth interactions and communications, play and symbolic
thinking). It also acknowledges the different sensory and motor profiles of the individual by assessing and
working on motor planning and sequencing, sensory processing (visual, auditory, proptioceptual), and
modulation. Finally, it leverages the children’s strengths by establishing relationships and environments that
support such strengths to develop emotional, social, and cognitive capabilities. Growing evidence seems to
support this approach
 THE RELATIONSHIP DEVELOPMENTAL INTERVENTION
(RDI)
• RDI focuses on activities that facilitate interactive behavior and positive engagement in social
relationships to motivate the child to learn social skills and sustain social relationships (74). The program
is based on the assumption that autistic children lack flexible thinking, and so it helps them develop
dynamic intelligence to cope with changes and new information. RDI has six objectives: emotional
referencing, social coordination, declarative language, flexible thinking, relational information processing,
foresight and hindsight. Evaluations of this approach seem promising, showing reductions in autistic
symptoms and increased mainstream placement (79).
• Skill-based developmental training” are also available. These include PECS (Picture Exchange Communication System) and
PBS (Positive Behavior Support). PECS is used in children who are non-verbal as it is an augmentative communication system
based on exchanging flashcards with images (replacing or integrating speech). It is based on the ABA principles of prompt,
reinforce, reward success/correct, and error. Evidence supporting this approach is accumulating (80), but more evidence is
needed (81). PBS is a comprehensive intervention that include ABA, normalization/inclusion movements, and person-centered
values (82). The main goal is to help the children become more autonomous and less dependent on family members and
therapists. One of the distinguishing features of this approach is the idea that changes must occur in the social system and the
surrounding environment in which the individual is in, rather than the individual alone (83). This more ‘humanistic’ approach to
treatment tries to focus on manipulating antecedent triggers to maladaptive behavior rather than showing the adverse effects
of such behavior. Two PBS techniques have been developed: one is called the antecedent-based techniques (84) and
involves the use of visual schedules to build activity patterns and offer choice (84), and the other focuses on understanding the
problem behavior and developing educational strategies and reinforcements to improve lifestyle
 SENSORY INTEGRATION THERAPY

• Sensory integration therapy focuses on the neurophysiological processing of sensory information, which
is known to be different in autistic individuals. The goal is not to teach a skill or correct behavior but to
allow the child to interact with an environment in an adaptive way, thus developing a coping mechanism
to correct the underlying sensory-motor dysfunctions (86). The treatment involves engagement of full
body movements in environments designed to offer tactile, proprioceptive, gravitational, auditory, visual,
and vestibular stimulation.
 AUDITORY INTEGRATION THERAPY

• Auditory integration therapy is based on sensory abnormalities and language disorders often associated
with auditory issues. Treatment involves exposing children to filtered and modulated music (in terms of
volume and pitch). It is based on the assumption that continued exposure to modulated sounds can
functionally modify the central auditory processing system, thus impacting language and behavior
 ANIMAL-BASED THERAPY

• Animal-based therapy is another intervention that has generated enthusiasm (88). There are several types of
animal-based intervention, involving dogs, horses, and dolphins. For example, dolphin-therapy consists of
interacting with dolphins in captivity (51). It is believed that these animals can help humans communicate better
with one another. Horse-riding therapy is another animal-based intervention based on the idea that it involves
multiple functioning domains, including social, cognitive, and gross motor (89). It is also believed that the
movements during riding help children self-regulate and demonstrate improvements in distractibility, attention,
and social motivation (90). Horse-riding is also called exercise intervention (along with jogging, martial arts,
swimming, or yoga/dance), which can result in improvements in numerous behavioral outcomes, including
stereotypical behavior, social-emotional functioning, cognition, and attention
 MUSIC THERAPY

• Music therapy is based on the assumption that certain processes in musical improvisation and
coordination with other music players may help autistic individuals develop social interaction and
communicative skills. Music therapy may help in the emotional and motivational responses of the
involved individuals, though conclusive results are still lacking
 PHARMACOLOGICAL AND DIETARY INTERVENTIONS

• The most commonly prescribed drugs for individuals with ASD are Abilify (aripiprazole) and Risperdal
(risperidone). While the FDA has approved these drugs for use in individuals with ASD, they have not been
developed specifically to treat ASD. For example, aripiprazole is an atypical antipsychotic (93). In addition,
comorbidities such as gastrointestinal problems (reflux, chronic constipation, and diarrhea) occur in 46–85% of
children with ASD (94, 95). Seizures occur in 11–39% of ASD cases (96). Sleep problems, depression,
emotional reactions and behaviors, sinusitis, headaches, mood swings and bipolar disorders are other
observed comorbidities (97). Melatonin could effectively treat sleep disturbance and insomnia by improving
sleep onset (98–101). Pediatric insomnia is also treated using antihistamines, alpha-2-agonists,
benzodiazepines, and chloral hydrate (102). In addition, valproic acid has been used to treat mood swings
and bipolar disorders and seizures in people with ASD (103). Another drug for seizures is dimethylglycine
(104).
 CONCLUSION

• ASD is a lifelong condition that may result from different genetic and environmental factors. ASD
phenotypes vary considerably from one person to another, complicating the diagnosis and treatment
strategies. Although significant results have been achieved in the ASD diagnosis, there are no consistent
ASD biomarkers at the moment. Over the years, the diagnostic tools have increased. Early identification
of children with ASD allows selecting a suitable treatment to improve communication, social and living
skills, and reduce maladaptive behaviors and comorbidities. Although significant progress has been
made, the therapeutic options to treat individuals with ASD remain limited.
•Best food for Autism [Link]
search_query=autism+spectrum+disorder+patient
•Caring for patients with ASD [Link]
•Calming strategies for Autism [Link]
•Working with people with autism: the professionals [Link]
watch?v=QG6A5c8_1YY
•OT and ASD [Link]
EPILEPSY
• Epilepsy is a condition that causes seizures, temporary episodes that often include twitching and
convulsions. These seizures happen when the brain's electrical impulses act abnormally and send
erratic signals. Think of it as your brain getting confused by these haywire messages, and the result is a
seizure.
• Epilepsy can make driving, walking across the street, or cooking dinner a dangerous activity because
you never know when a seizure may strike.
• Epilepsy usually begins in young people, often between ages 5 and 20, although it can affect anyone
 Introduction to epilepsy
•Epilepsy is caused by a sudden, brief change in the brain’s electrical
activity.
•When brain cells are not working properly, actions, movement, or
consciousness may be altered for a short time. These physical
changes are referred to as epilepsy, or recurrent seizures.
•A person experiencing a seizure can appear dreamlike, or be
staring ahead and unresponsive. Depending on the part of brain
involved during the seizure, they may also experience abnormal
motor movement (uncontrolled muscle contractions) in the body.
 CNT

•A person experiencing a seizure can appear dreamlike, or be

staring ahead and unresponsive. Depending on the part of
brain involved during the seizure, they may also experience
abnormal motor movement (uncontrolled muscle contractions)
in the body.
• generalized epilepsy
• focal epilepsy
• combined generalized and focal epilepsy
• unknown epilepsy
 Generalized epilepsy

• Generalized epilepsy usually starts during childhood. However, it can also affect adults.
• People with this type of epilepsy have generalized seizures. These affect both the left and right sides of the brain.
Additionally, these seizures may be either motor, which involve physical movement, or non-motor, which do not.
If someone has a motor seizure, they may experience:
• jerking movements
• weakness or limp limbs
• tense, rigid muscles
• muscle twitching
• full-body epileptic spasms.
Generalized seizures. This type of seizure tends to involve all the parts of your brain. There are six kinds of generalized
seizures:
• Absence seizures happen mostly in children and involve small movements such as lip smacking or eye blinking.
• Tonic seizures make you stiffen the muscles in your arms, legs, back and sometimes fall down as a result.
• Atonic seizures take away your muscle control. They’re also called drop seizures, because they can make you
collapse onto the floor.
• Clonic seizures often make you repeat jerking movements in your neck, face, and arms.
• Myoclonic seizures involve short, twitching and jerking motions in your arms and legs.
• Tonic-clonic seizures, which used to be called grand-mal seizures, can make you lose consciousness, stiffen your whole
body, and shake. You may also bite your tongue or lose control of your bladder.
Non-motor seizures are also called absence seizures. Symptoms may include:
• staring into space
• a sudden stop in movement
• brief twitches
• fluttering eyelids
 Focal epilepsy
• People with focal epilepsy have focal seizures. Unlike generalized seizures, focal seizures only affect one part of the brain. They can
start in one area and move to others.

• These seizures can begin with an aura, which are minor symptoms signifying the seizure’s onset. This can feel like an uneasy feeling in
the stomach, similar to the feeling of riding a rollercoaster.

• As the seizure progresses, a person can experience motor and non-motor symptoms. Some motor symptoms of focal seizures include:

• muscle twitching

• jerking

• spasms

• repeated movements, like clapping or chewing

Non-motor symptoms do not affect how someone moves. However, they may cause confusion or changes in emotions. Some non-motor
symptoms of focal seizures include:

• waves of hot or cold

• goosebumps
• Focal seizures. These seizures involve abnormal activity in just one part of your brain. You may lose
consciousness, or you may stay alert when you have them.
• Without loss of consciousness. These seizures may just change your emotions, or alter your sense of
sight, smell, taste, or sound. You might also jerk an arm or a leg without meaning to, or feel tingling,
dizziness, or see flashing lights.
• With loss of consciousness. During these seizures, you aren’t quite aware of your surroundings as usual.
You may stare into space, or move repetitively by chewing, rubbing your hands, or walking in circles.
 Combined generalized and focal epilepsy

• Someone with combination epilepsy has both generalized seizures and focal seizures. Therefore, they
can experience a mixture of the symptoms discussed above.

• Combined epilepsy is linked to Dravet syndrome, which is a rare, lifelong form of epilepsy. It is usually
caused by a mutation in the SCN1A gene.
 Unknown epilepsy
• If doctors do not know where seizures originate, they will diagnose a person with unknown
epilepsy.
People with unknown epilepsy can have a combination of motor and non-motor symptoms.
Motor seizures often present as tonic-clonic (previously referred to as “grand-mal”). These
seizures can have the following symptoms:
• stiffening and loss of consciousness
• rapid, rhythmic jerking and convulsing
• bluish face from lack of oxygen
• loss of bladder and/or bowel control
These seizures usually last 1–3 minutes.
These seizures usually last 1–3 minutes.
Unknown epilepsy also presents with non-motor symptoms. These can include:
• a sudden stop in movement
• vacant staring
• stillness
 SYMPTOMS OF EPILEPSY
The primary symptom of epilepsy is a seizure.
Symptoms of epilepsy vary greatly between individuals and depend on the type of seizure. Symptoms can be mild to
severe in form. Some of the symptoms include
Euphoria during aura (before the episode)
Temporary confusion
Episodes of staring blankly, Sudden stillness
Convulsions/ Uncontrollable jerking movements or twitching of the face, arms and legs
Loss of consciousness or awareness
Psychological symptoms such as fear and anxiety
Affected speech, Temporary loss of control of your bladder or bowels
Most seizures only last for a few minutes or even just a few seconds.
 Causes of epilepsy

This abnormal activity could result from:

• Epilepsy results from abnormal activities in the brain and can affect any area of the brain.
• Genetic changes that run in families
• Trauma or injury to head
• Medical conditions that affect the brain, for example, brain tumor or stroke
• Infectious diseases of the brain such as meningitis
• Damage or injury to the brain during birth
• Developmental disorders of the brain such as autism
 Causes of seizures

• Missing medication doses

• Heavy alcohol use
• Cocaine, ecstasy, or other illegal drugs
• Lack of sleep/ tiredness
• Dehydration
• Other medicines that interfere with seizure medications
• Flashing lights, images, and repetitive patterns may cause seizures in persons with photosensitive seizure
disorder.
 Complications

If untreated for a prolonged period it may lead to

• Injuries or death due to falls
• Drowning during swimming
• Increased risk of accidents when driving a vehicle
• Complications during pregnancy
• Psychological problems such as depression, anxiety, and suicidal tendencies
• Frequent and recurrent seizures without regaining consciousness, a condition known as status epilepticus
• Sudden unexpected death in epilepsy (SUDEP), a rare but life-threatening complication
 DIAGNOSIS

• Although epilepsy is a seizure disorder, this does not mean that every seizure is a sign of epilepsy.
• A person can have provoked seizures, which are seizures due to a cause other than epilepsy. Some examples of things that could induce a seizure
are:
• abnormality in blood sugar
• fever
• infection
• head injury
• stroke
• brain trauma
• withdrawal from drugs or alcohol
• allergic reaction to medicine
• However, if none of these possibilities prompted the seizure, the person may have epilepsy. To make an
epilepsy diagnosis,
• determine whether a person meets the diagnostic criteria through medical history details, EEG tests,
blood tests, and brain imaging tests such as a CT scan or MRI.
• An electroencephalogram (EEG) to measure the electrical activity of the brain
• A spinal tap to collect spinal fluid for analysis
• Imaging tests, like an MRI or CT scan, of the head
These blood tests are also commonly used to help diagnose epilepsy or rule out other disorders:
• Tests of liver and kidney function
• Blood glucose tests
• Complete blood count and chemistry of the blood
• Tests to diagnose or rule out any infectious diseases
 CNT
•Some people can experience a seizure and not have epilepsy.
•For example, febrile convulsions that are result from high fevers are not
classified as epilepsy.
•Other types of seizures not classified as epilepsy include those caused by
an imbalance of body fluids or chemicals, or by alcohol or drug withdrawal.
Seizures of this nature can, in certain instances, develop into epilepsy if they
continue to recur in the absence of the initial cause.
 MANAGEMENT

• Medications
• Some people have drug-resistant epilepsy. This means they cannot control their epilepsy using the first two medications prescribed.
Around 33% of adults and 20–25% of children with epilepsy do not respond to their first-line treatment and must consider other options.
• A doctor will discuss various treatments a person can try. These may include:
• Surgery: This option typically works best for people who have seizures originating from one part of the brain. It involves safely removing
the focal point, or the part of the brain where the seizures start.
• Dietary changes: Some diets may help control seizures. Recommended diets include the modified Atkins diet, ketogenic diet, and low
glycemic diet. These diets should be carried out with support from a registered dietitian.
• Vagus nerve stimulation (VNS): This therapy treats people with focal seizures. It works by sending mild electrical pulses through the
vagus nerve, which leads to the brain. Over time, it changes how brain cells work.
• Other options, like behavioral therapy and CBD oil, may help with treating drug-resistant epilepsy.
• The goal of any treatment is to prevent or reduce seizure activity, with as minimal side effects as possible.
The most common treatment for epilepsy is the use of anti-epileptic drugs (AEDs), which successfully
control seizures in up to 70% of people.
 PREVENTION

• Although there is no way to prevent epilepsy, you can take steps to help prevent seizures:
• Don't drink alcohol, use illegal drugs, or smoke.
• Protect your head with a helmet during any sport or activity that could result in a head injury.
• Get plenty of sleep every night.
• Do your best to avoid getting a cold or the flu.
• Talk with your doctor about all of your prescription medications to be sure they won't aggravate seizures.
• Always take all of your epilepsy medications as prescribed.
• Find healthy ways to cope with stress.
 Prognosis of epilepsy

•Treatment for epilepsy is aimed at controlling the seizures as well as

treating any known underlying cause of them. in the majority of instances,
seizures can be partially or completely controlled by anticonvulsant
medication. certain types of seizures are difficult to control despite
medication.
•Epilepsy [Link]
•How to deal with tonic clonic seizure [Link]
v=olArThAgUd8
•The difference between seizures and epilepsy [Link]
watch?v=x6KQ8IyCzpM
•Types of seizures [Link]
•New epilepsy management guidelines [Link]
v=6gdnwUa4o7Q
DOWN SYNDROME/ TRISOMY 21
 Introduction to down syndrome

•Down Syndrome (DS) is a condition in which a person has an extra

chromosome. Chromosomes determines how a baby’s body forms and functions
as it grows during pregnancy and after birth. Typically, a baby is born with 46
chromosomes.
•Babies with down syndrome have an extra copy of chromosome 21 which
changes how the baby’s body and brain develop, and can cause both mental
and physical challenges for the baby..
 TYPES OF DOWN SYNDROME

• Trisomy 21 (Nondisjunction)
• Down syndrome is usually caused by an error in cell division called “nondisjunction.” Nondisjunction
results in an embryo with three copies of chromosome 21 instead of the usual two. Prior to or at
conception, a pair of 21st chromosomes in either the sperm or the egg fails to separate. As the embryo
develops, the extra chromosome is replicated in every cell of the body. This type of Down syndrome,
which accounts for 95% of cases, is called trisomy 21.
• Translocation
• Translocation accounts for about 4% of all cases of Down syndrome. In translocation, part of
chromosome 21 breaks off during cell division and attaches to another chromosome, typically
chromosome 14. While the total number of chromosomes in the cells remains 46, the presence of an
extra part of chromosome 21 causes the characteristics of Down syndrome.
• Mosaicism
• Mosaicism occurs when nondisjunction of chromosome 21 takes place in one – but not all – of the
initial cell divisions after fertilization. When this occurs, there is a mixture of two types of cells, some
containing the usual 46 chromosomes and others containing 47. Those cells with 47 chromosomes
contain an extra chromosome 21. Mosaicism accounts for about 1% of all cases of Down syndrome.
Research has indicated that individuals with mosaic Down syndrome may have fewer characteristics of
Down syndrome than those with other types of Down syndrome. However, broad generalizations are
not possible due to the wide range of abilities people with Down syndrome possess.
 Physical features of ds
a flattened face, especially the bridge of the nose
almond-shaped eyes that slant up
a short neck, small ears, small hands and feet
a tongue that tends to stick out of the mouth
tiny white spots on the iris (colored part) of the eye
a single line across the palm of the hand (palmar crease)
small pinky fingers that sometimes curve toward the thumb
poor muscle tone or loose joints
shorter in height as children and adults
 Health problems associated with DS

•Hearing loss
•Obstructive sleep apnea (a condition where the person’s breathing
temporarily stops while asleep)
•Ear infections
•Eye diseases
•Heart defects present at birth
 Diagnosis

The American College of Obstetricians and Gynecologists recommends offering the option of screening
tests and diagnostic tests for Down syndrome to all pregnant women, regardless of age.
• Screening tests can indicate the likelihood or chances that a mother is carrying a baby with Down
syndrome. But these tests can't tell for sure or diagnose whether the baby has Down syndrome.
• Diagnostic tests can identify or diagnose whether your baby has Down syndrome.
 Screening tests during pregnancy

• Blood test. This blood test measures the levels of pregnancy-associated plasma protein-A (PAPP-A) and
the pregnancy hormone known as human chorionic gonadotropin (HCG). Abnormal levels of PAPP-A
and HCG may indicate a problem with the baby.
• Nuchal translucency test. During this test, an ultrasound is used to measure a specific area on the back
of your baby's neck. This is known as a nuchal translucency screening test. When abnormalities are
present, more fluid than usual tends to collect in this neck tissue.n
 Diagnostic tests

• that can identify Down syndrome include:

• Chorionic villus sampling (CVS). In CVS, cells are taken from the placenta and used to analyze the fetal
chromosomes. This test is typically performed in the first trimester, between 10 and 13 weeks of pregnancy.
The risk of pregnancy loss (miscarriage) from a CVS is very low.
• Amniocentesis. A sample of the amniotic fluid surrounding the fetus is withdrawn through a needle inserted into
the mother's uterus. This sample is then used to analyze the chromosomes of the fetus. Doctors usually perform
this test in the second trimester, after 15 weeks of pregnancy. This test also carries a very low risk of
miscarriage.
• After birth, the initial diagnosis of Down syndrome is often based on the baby's appearance. But the
features associated with Down syndrome can be found in babies without Down syndrome, so your
health care provider will likely order a test called a chromosomal karyotype to confirm diagnosis. Using
a sample of blood, this test analyzes your child's chromosomes. If there's an extra chromosome 21 in all
or some cells, the diagnosis is Down syndrome.
 MANAGEMENT

• Early intervention for infants and children with Down syndrome can make a major difference in improving
their quality of life. Because each child with Down syndrome is unique, treatment will depend on
individual needs. Also, different stages of life may require different services.
• Primary care pediatrician to coordinate and provide routine childhood care, Pediatric cardiologist,
Pediatric gastroenterologist, Pediatric endocrinologist, Developmental pediatrician, Pediatric neurologist,
Pediatric ear, nose and throat (ENT) specialist, Pediatric eye doctor (ophthalmologist), Audiologist,
Speech pathologist, Physical therapist, Occupational therapist
• Physical therapy:Includes activities and exercises that help to build motor skills, increase muscle strength,
and improve posture and balance.
• Speech and language therapy:To help children with Down syndrome improve their communication skills
and use language more effectively.
• Occupational therapy:To find ways to adjust everyday tasks and conditions to match a person's needs
and abilities.
• Cognitive behavior therapy:To manage behaviors and other mental health problems.
 MEDICATION

• Drug therapy is not currently a component of the standard of care for Down syndrome. Medications are
indicated only for symptomatic treatment of pain.
•What is down syndrome [Link]
•Down syndrome [Link]
•Why do people with down syndrome look alike? [Link]
com/watch?v=_nJTIgl5OSI
•Down syndrome management [Link]
v=BLaXwdiRu5Y
GENERAL MANAGEMENT OF INTELLECTUAL
AND DEVELOPMENTAL DISABILITIES
 Management of IDD
•The principle universally accepted in the management of IDD is; early
diagnosis and use of coordinated multidisciplinary early intervention
procedures.
•As the population of people with Intellectual And Developmental
Disabilities is heterogeneous and present a complex set of needs, a
multidisciplinary team is essential to the support system available to
people "within this population".
 MULTIDISCIPLINARY TEAM
Client, caregivers, teachers, employers
Consultant physician, pediatrician
Occupational Therapist
Physiotherapist
Social Worker, Psychologist
Speech And Language Therapist, Audiologist, Eye specialist
Nutritionist
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•Each discipline in the multidisciplinary team, contributes its unique knowledge
that together provides holistic care to the clients and their families.
•However, since the intervention process focuses to a large part on a
functional occupational perspective, Occupational Therapists have a
significant role in [Link] this population
•What is occupational therapy? [Link]
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 INTERVENTION PROCESS FOR INTELLECTUAL AND
DEVELOPMENTAL DISABILITIES

•Intervention-
intervention Review
Assessment Re- Discharge
Referral Screening
/ evaluation
planning and
evaluation planning
and follow
implementatio up
n
 REFERRAL
•A Self-referral is where a client decides to seek services without someone
else’s advice.
•A Third party referral is where a client seek services due to advice or
persuasion from a friend, relative or well-wisher.
•A Professional referral where another healthcare professional recommends
a particular service to a client s/he suspect or has ascertained to be having
IDD.
 SCREENING
•Screening involves gathering information for the sole purpose of determining
whether the referral for a particular service is appropriate and necessary
•Activities involved in screening vary, and may include conducting interviews with
a parent, teacher, physician or referral source, obtaining reports from other
professionals (medical or educational personnel) who have seen the client,
conducting specific screening tests, reviewing medical or educational records, or
administering a standardized tool designed as a screening
instrument.
 ASSESSMENT/ EVALUATION
•Every individual with IDD have a unique combination of individual
and contextual characteristics therefore, careful planning, sound
clinical reasoning and critical thinking are crucial for making quality
decisions throughout the evaluation process
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•Each discipline have different evaluation procedures: Psychologists administer
tests of intellectual functioning, learning skills and styles, and verbal and non-
verbal cognitive skills, Special educators may administer tests related to
academic skills and achievement, Speech and language pathologists may
focus on communication and language, and related cognitive skills,
Physiotherapists may assess the motor skills whereas Occupational Therapists
might focus on the client’s occupational profile
AREAS OF ASSESSMENT IN INTELLECTUAL
AND DEVELOPMENT DISABILITIES
 ECOLOGICAL EVALUATIONS
•Context and environment include the cultural, personal, temporal, virtual, physical
and social conditions within and surrounding the client that impact their
occupational performance.
•Ecological evaluations examine the interaction patterns, and fit between
individuals and their respective environments
•Evaluation of the social context and environment is addressed by noting the
number and characteristics of the people in the setting, expectations for socially
relating to others, and communicating, sharing, and developing and fostering
relationships with others.
 CLIENT FACTORS
•Client factors includes values, beliefs and spirituality, body functions and
structures that resides within the client that influence one’s ability to engage in
the various performance skill areas.
•Body functions refer to the physiological and psychological functions of the
human body such as respiratory, cardiovascular, sensory and cognitive
functions.
•Body structures refer to the anatomical parts of the body such as bones,
blood vessels, lungs, and the brain.
 PERFOMANCE SKILLS
Performance skills are observable, goal-directed, behaviors that are
necessary to engage successfully in one’s occupations.
Occupational performance skills include;
Motor (gross and fine motor) skills includes gross motor coordination,
laterality, crossing the midline, bilateral integration, motor control, praxis,
dexterity, visual-motor integration, oral-motor control among others
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Sensory skills includes tactile, olfactory, gustatory, auditory, vestibular, visual

and proprioceptive skills;
Perceptual skills includes body scheme, right left discrimination, position in
space, depth perception, pain response, spatial relations, topographical
orientation, figure-ground, visual-closure, stereo-gnosis, kinesthesia among
others;
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Cognitive skills includes level of arousal, attention span. Memory, sequencing,
orientation, spatial operation, categorization, recognition, generalization,
initiation of activity, concept formation, problem solving, learning among
others;
Neuro-musculoskeletal skills includes reflexes, Range of Motion, muscle tone,
muscle strength, muscle endurance, postural control, postural alignment and
soft tissue integrity;
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Psychological skills includes self-concept skills; values, interests and needs;
Social skills includes role performance, interpersonal (communication) skills,
and self-expression skills;
Self-management skills includes coping skill, self-control and time
management skills.
INTERVENTION
 INTERVENTION PLANNING
•Intervention planning is complex task that requires the health care providers
to draw on all aspects of clinical reasoning to select and use various
specific frames of reference, theories and models in making intervention
decisions.
•Intervention plan must be Specific, Measurable, Achievable, Realistic, Time
bound-SMART.
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•Following the synthesis of evaluation data, and identification of the client’s
strengths, challenges and areas that would benefit from intervention, the
healthcare providers in the Multidisciplinary team must collaborate with the
clients and caregivers to develop an intervention plan that will address the
identified needs.
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•Some factors other than the assessment data need to be considered when
making intervention planning decisions including the level of research evidence
supporting the interventions, client preferences, available equipment and
materials, service delivery options, and the healthcare provider’s own skill level.
 DOCUMENTATION
•Documentation is a crucial and necessary process in care delivery process.
•Each member of the MDT will need to share their results with other professionals
who work with the client, the referral source, and the parents and, when
applicable, the client.
•After every session with a client the care provider should document at a minimum
the time they spent with the client, a summary of the evaluation/ intervention
activities that they completed, and their next plan of action.