Handicapped children and medical problems


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Handicapped children and medical problems

  1. 1. Handicapped children and medical problems Prof. Saad S Al-Ani Senior Pediatric Consultant Head of Pediatric department Khorfakkan Hospital
  2. 2. <ul><li>Definition </li></ul><ul><li>Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity. </li></ul><ul><li>The WHO definition include three specific dimensions of health </li></ul><ul><li>The physical health </li></ul><ul><li>The mental health </li></ul><ul><li>The social health </li></ul><ul><li>Recently a fourth dimension has been included that is spiritual health. </li></ul>World Health organization (WHO)
  3. 3. 1. The Physical Health It is a state in which every cell and every organ is functioning at optimum capacity and perfect harmony with the rest of the body. 2. The Mental Health Mental health is not mere absence of mental illness it is defined as. A state of balance between the individual and the surrounding world, a state of harmony between oneself and others. 3. The Social Health Defined as the quantity and quality of an individual’s interpersonal ties and extent of involvement with the community. 4. The Spiritual Health Refer to that part of individual, which reach out and strive for meaning and purpose of life. World Health organization (WHO)
  4. 4. Changing Terminology <ul><li>Crippled children </li></ul><ul><li>Handicapped children </li></ul><ul><li>Disabled children </li></ul><ul><li>Children and youth with special health care needs </li></ul>
  5. 5. Definition of “Children with Special Health Care Needs” <ul><li>“ Children with special health care needs are those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally.” (McPherson, Arango, Fox, et al., 1998) </li></ul>
  6. 6. The common types of disabilities <ul><li>Cerebral palsy </li></ul><ul><li>Muscular dystrophy   </li></ul><ul><li>Spina Bifida </li></ul><ul><li>Brain injury </li></ul><ul><li>Others: Hydrocephalus, epilepsy, brittle bone, congenital heart disease, tumor, burns, congenital abnormalities </li></ul>
  7. 7. Major problems <ul><li>Impaired motor control </li></ul><ul><li>In-coordination problems </li></ul><ul><li>Tonal problems </li></ul><ul><li>Joint contractures & deformities </li></ul><ul><li>Skeletal malformation </li></ul><ul><li>Muscle weakness </li></ul>
  8. 8. Associated problems <ul><li>Cognitive impairment </li></ul><ul><li>Visual / auditory problems </li></ul><ul><li>Oral motor dysfunction </li></ul><ul><ul><li>Communication problems (speech problems) </li></ul></ul><ul><ul><li>Drooling </li></ul></ul><ul><ul><li>Feeding problems </li></ul></ul><ul><li>Behavioral problems </li></ul>
  9. 9. Continuum of Chronic Conditions
  10. 10. Needs of the Child Social Playing with others Group play Team games Imaginative Role Play Creating Pretending Skilful Dexterity Manipulation Construction Exploratory Motivation Interest Intellectual Classifying Language Development Physical Agility Co-ordination Needs of the Child
  11. 11. Disability & Development <ul><li>1/10 - as many as 600 million people worldwide - live with a physical, sensory (deafness, blindness), intellectual, or mental health impairment significant enough to make a difference in their daily lives </li></ul>
  12. 12. Disability & Development (cont.) <ul><li>80% of people with disabilities live in the developing world where it impacts the lives of family members and communities. </li></ul>
  13. 13. Cerebral Palsy <ul><li>Cerebral palsy is one of the most common congenital (existing before birth or at birth) disorders of childhood. </li></ul>
  14. 14. Cerebral Palsy <ul><li>Cerebral palsy affects muscle control and coordination, so even simple movements — like standing still — are difficult. </li></ul>
  15. 15. Cerebral Palsy (cont.) <ul><li>Other vital functions that also involve motor skills and muscles — such as breathing, bladder and bowel control, eating, and learning — are also affected when a child has CP. Cerebral palsy does not get worse over time. </li></ul>
  16. 16. Spastic diplegic CP <ul><li>27% have seizure disorders </li></ul><ul><li>30% have mental retardation </li></ul><ul><li>43% have strabismus </li></ul><ul><li>10-15% have hearing impairments </li></ul><ul><li>oral motor dysfunction in 90% </li></ul>
  17. 17. failure to thrive maladaptive behaviors oral dysphagia GERD Eating constipation dental caries pain environment
  18. 18. What does this population actually look like? <ul><li>Cerebral Palsy 0.2 to 0.5% Lipkin 91 </li></ul><ul><ul><li>10% to 37% have drooling problems significant enough to interfere with daily global function </li></ul></ul><ul><ul><ul><ul><ul><li>Ekedahl et.al. 74, Sochaniwskj 82, Blasco 92, Nunn 2000 </li></ul></ul></ul></ul></ul><ul><li>Severe/Profound Mental Retardation 0.2% to 0.7% </li></ul><ul><ul><li>An unknown percentage of these children are further handicapped by drooling </li></ul></ul><ul><ul><ul><ul><ul><li>Harris and Purdy 87, Crysdale and White 89, Limbrock et al 90 </li></ul></ul></ul></ul></ul>
  19. 19. ASSESSMENT Anterior Drooling represents only one element in the continuum of oral performance impairment <ul><li>Sialorrhea </li></ul><ul><li>Speech problems </li></ul><ul><li>Feeding and swallowing difficulties </li></ul><ul><li>Structural and motor problems </li></ul><ul><li>Upper respiratory congestion </li></ul><ul><li>Aspiration </li></ul>
  20. 20. Goal of Rehabilitation <ul><li>Help children with physical disabilities improve FUNCTION and PARTICIPATE more fully in family, social, educational and recreational activities. </li></ul>
  21. 21. Multifactorial challenges <ul><li>Constipation contributes to anorexia and irritability. </li></ul><ul><li>GERD causes pain and food refusals. </li></ul><ul><li>Hip subluxation and spasms are painful. </li></ul><ul><li>Pain increases spasticity and negative behaviors. </li></ul><ul><li>Mother frustrated with food refusals and opts for GT feedings rather than oral feedings. </li></ul>
  22. 22. <ul><li>Evaluation and management of reflux and constipation to reduce mealtime discomfort and improve appetite. </li></ul><ul><li>Selective dorsal rhizotomy to reduce spasticity that hinders mobility, causes pain and adds additional work of postural support during meals. </li></ul>How can we help?
  23. 23. Other ideas… <ul><li>Behavioral feeding strategies directed at bringing Davis back into family mealtimes. </li></ul><ul><li>Respite services and parenting resources to support single mom. </li></ul><ul><li>Reinforce successes with praise and positive reinforcement. </li></ul>
  24. 24. <ul><li>Cerebral Palsy (cont.) </li></ul><ul><li>A child can begin therapy for: </li></ul><ul><li>movement </li></ul><ul><li>learning </li></ul><ul><li>speech </li></ul><ul><li>hearing </li></ul><ul><li>social and emotional development. </li></ul><ul><li>In addition, medication, surgery, and braces can help improve muscle function. </li></ul>
  25. 25. Mental Retardation <ul><li>Mental Retardation </li></ul><ul><ul><li>Mild / Intermittent </li></ul></ul><ul><ul><li>Moderate / Limited </li></ul></ul><ul><ul><li>Severe / Extensive </li></ul></ul><ul><ul><li>Pervasive / Profound </li></ul></ul><ul><li>Basic skills: </li></ul><ul><ul><li>Social, academic, local environment </li></ul></ul><ul><li>Transition programming </li></ul>
  26. 26. Epilepsy <ul><li>Epilepsy is a brain disorder that causes people to have recurring seizures . </li></ul><ul><li>They may have violent muscle spasms or lose consciousness. </li></ul>
  27. 37. Communication with Children <ul><li>Introduce yourself and give the reason for you are being there. </li></ul><ul><li>Call the child by name when giving direction or interacting with the child. </li></ul>
  28. 38. Communication with Children (Cont.) <ul><li>When meeting or interacting with the child, bend or stoop so that you are on eye level with the child. </li></ul><ul><li>When speaking to a child, use words and tone of voice that will help the child feel confident and reassured. </li></ul>
  29. 39. Communication with Children (Cont.) <ul><li>Listen to the child . Respect the child’s response and view. </li></ul><ul><li>Observe the child carefully. Body language will tell you a lot about the child’s mood or fears. </li></ul>
  30. 40. Communication with Children (Cont.) <ul><li>Always remember that the child may have misunderstanding or worries that you may not have thought about. </li></ul><ul><li>Each child will be different with special interests, likes or dislikes . You will need to find out the child’s interest to help you communicate . </li></ul><ul><li>The least lovable child needs the most love. </li></ul>
  31. 41. Do ...... <ul><li>Give a child a choice when there is a choice. </li></ul><ul><li>Allow child to be independent with minimal help. Give verbal encouragement and make sure he or she has opportunity to try. </li></ul>
  32. 42. Do ......(Cont.) <ul><li>Give positive reinforcement . </li></ul><ul><li>State suggestion or direction in a positive rather than a negative form. (refrain from saying don’t) </li></ul><ul><li>When setting limit, clearly define what you mean and be consistent. </li></ul>
  33. 43. Don’t ...... <ul><li>Avoid using negative attitude as tool for redirecting behavior. Never use words which make the child feels less respect such as blaming, shaming or making him feel guilty, e.g. “only babies cry, be good.” </li></ul><ul><li>Do not promise a child anything you are not absolutely sure will happen. If you make a promise, be sure you are able to do it. </li></ul>
  34. 44. Don’t ......(Cont.) <ul><li>Be professional. Do not discuss the child in front of another child. Do not discuss the child in public place. </li></ul><ul><li>When commenting on child’s creativity, avoid words like “what is it?” Instead use words like “what beautiful color you used?” </li></ul>
  35. 45. Some suggestion on adapting for specific disabilities <ul><li>Positive reinforcement </li></ul><ul><li>Breaking down tasks into sequence </li></ul><ul><li>S howing, guiding throughout the </li></ul><ul><li>activity </li></ul><ul><li>M ay require some physical adaptation </li></ul>Mental handicapped <ul><li>Positive reinforcement </li></ul><ul><li>Breaking down tasks to achieve </li></ul><ul><li>reinforcement </li></ul><ul><li>Materials and equipment adaptation </li></ul>Physical handicapped
  36. 46. Some suggestion on adapting for specific disabilities (Cont.) <ul><li>Positive reinforcement </li></ul><ul><li>Keep a small group </li></ul><ul><li>Arrange activity that are short in length and easy-to-succeed so that the child does not become frustrated </li></ul>Emotional impairment <ul><li>Positive reinforcement </li></ul><ul><li>Breaking down the tasks </li></ul><ul><li>Facing the child while talking </li></ul><ul><li>Using sign language </li></ul><ul><li>Physical adaptation </li></ul>Hearing impairment <ul><li>Positive reinforcement </li></ul><ul><li>Guiding throughout the action </li></ul><ul><li>Descriptive instruction </li></ul><ul><li>Equipment / material adaptation </li></ul>Visual impairment
  37. 47. Strategies that Help <ul><li>1. Physically handicapped children long to be normal and be seen as normal as much as possible. </li></ul><ul><li>2. Find out what the child's strengths are and capitalize on them. These children need to feel as successful too! </li></ul>
  38. 48. Strategies that Help (cont.) <ul><li>3. Keep your expectations of the physically handicapped child high. This child is capable of achieving. </li></ul><ul><li>4. Never accept rude remarks, name calling or teasing from other children. Sometimes other children need to be taught about physical disabilities to develop respect and acceptance. </li></ul>
  39. 49. <ul><li>Strategies that Help (cont.) </li></ul><ul><li>5. Compliment appearance from time to time. (new hair cut, a new outfit). </li></ul><ul><li>6. Make adjustments and accommodations whenever possible to enable this child to participate. </li></ul><ul><li>7. Never pity the physically handicapped child, they do not want your pity. </li></ul>
  40. 50. <ul><li>Strategies that Help (cont.) </li></ul><ul><li>8. Take the opportunity when the child is absent to teach the rest of the class about physical handicaps, this will help foster understanding and acceptance. </li></ul><ul><li>9. Take frequent 1 on 1 time with the child to make sure that he/she is aware that you're there to help when needed </li></ul>
  41. 51. Thank you