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PPT ON MENTALLY CHALLENGED CHILDREN OR MENTAL RETARDATION IN CHILDREN

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PPT ON MENTALLY CHALLENGED CHILDREN OR MENTAL RETARDATION

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PPT ON MENTALLY CHALLENGED CHILDREN OR MENTAL RETARDATION IN CHILDREN

  1. 1. BY M. Sandeep kumar MSC NURSING 2ND YEAR SVIMS, TIRUPATI. MENTALLY CHALLENGED Thursday, January 28, 2016 1
  2. 2. INTRODUCTION……  Challenged condition makes the normal function of individual very difficult and leads to dependency. These conditions are increasing day by day due to changing lifestyle and complicated environment.  Challenged children is one who deviated from normal health status either physically, mentally or socially and requires special care, treatment and education. Thursday, January 28, 2016 M. Sandeep kumar 2
  3. 3. CONCEPT OF CHALLENGED…….  According to WHO the sequence of events leading to disability and handicapped OR challenged conditions are as follows. M. Sandeep kumar INJURY OR DISEASE IMPAIRMENT DISABILITY CHALLENGED OR HANDICAPPED Thursday, January 28, 20163
  4. 4. IMPAIRMENT….?  It is defines as any loss or abnormality of psychological, physiological or anatomical structure or function, e.g. Loss of vision, loss of hearing, etc. Primary impairment may leads to secondary impairment e.g. Defective hearing results in learning difficulties and poor school performance.  Impairment leads to disability. Thursday, January 28, 2016 M. Sandeep kumar 4
  5. 5. DISABILITY….?  It develops as the consequence of impairment. E.g. Loss of limbs results in inability to walk. Disability is the inability to carry out certain activities which are considered as normal for the age and sex. Thursday, January 28, 2016 M. Sandeep kumar 5
  6. 6. HANDICAPED OR CHALLENGED..? Handicap is defined as a disadvantage for a given individual resulting from an impairment or a disability, that limits and prevents the fulfillment of a role which is normal for that individual, depending, on age, sex, social and cultural factors. primary handicap may lead to secondary handicap condition e.g. Blindness leads to economical handicapped situation. Thursday, January 28, 2016 M. Sandeep kumar 6
  7. 7. Classification….. Thursday, January 28, 2016 M. Sandeep kumar 7
  8. 8. 1. Physically challenged  physically challenged children can be grouped according to affected part of the body. These include orthopedically handicapped, sensory handicapped, neurologically handicapped and handicapped due to systemic diseases. Thursday, January 28, 2016 M. Sandeep kumar 8
  9. 9. 2. Mentally challenged  Mentally challenged is now used for the condition mental retardation. At least 2 - 3 percent of Indian population are mentally handicapped in any one form. Cognitive impairment is also used as synonym for mentally challenged or mental retardation. Thursday, January 28, 2016 M. Sandeep kumar 9
  10. 10. 3. Socially challenged  Socially challenged children are having disturbed opportunities for healthy personality development due to social factors leading to non- achievement of full potentialities. Social disturbances are found in the form of broken family, parental inadequacy, loss of parents, poverty, lack of educational opportunities, environmental deprivation and emotional disturbances as lack of tender loving care. Thursday, January 28, 2016 M. Sandeep kumar 10
  11. 11. Mentally challenged…,  Intellectual disability (ID), also called intellectual development disorder (IDD) and formerly known as mental retardation (MR). Mental retardation (MR) is a developmental disability that first appears in children under the age of 18. It is characterized as a level of intellectual functioning (as measured by standard intelligence tests ) that is well below average and results in significant limitations in the person's daily living skills (adaptive functioning).  The term MR as offensive and the term intellectual disability or intellectually challenged is now preferred by most advocates in most english speaking countries. M. Sandeep kumar Thursday, January 28, 201611
  12. 12. Definition:-  Mental retardation refers to significantly sub average general intellectual functioning (BELOW 70) resulting in or associated with concurrent impairments in adaptive behavior and manifested during the developmental period. - American association on mental deficiency,1983. Thursday, January 28, 2016 M. Sandeep kumar 12
  13. 13. KEY WORDS………….  Significant sub average is defined as an intelligence quotient (IQ) of 70 or below on standardized measures of intelligence.  Adaptive behavior is defined as the degrees with which the individual meets the standards of personal independence and social responsibility expected of his age and cultural group. The expectations of adaptive behavior vary with the chronological age. Thursday, January 28, 2016 M. Sandeep kumar 13
  14. 14. Adaptive skill areas.? Thursday, January 28, 2016 M. Sandeep kumar 14
  15. 15. The deficient in adaptive behavior 1. During infancy and childhood  Sensory and motor skill development  Communication skill (including speech and language)  Self-help skills.  Socialization. 2. During childhood and adolescent  Application of basic academic skill to daily life activities.  Application of appropriate reasoning and judgment in the mastery of the environment.  Social skill. 3. During late adolescent  Vocational and social responsibilities and performance.  Note:- developmental period is defined as the period of time between conception and the 18th birth day. Thursday, January 28, 2016 M. Sandeep kumar 15
  16. 16. Epidemiology…….?  3 % of the world population is estimated to be mentally retarded.  In India 5 out of 1000 children are mentally retarded (Indian express 13th march 2001). More than 20 million children are suffering with mental retardation.  Mental retardation is more common in boys than girls.  Mortality is high in severe or profound mental retardation due to associated physical condition.  Common in the age group of 2 -3 years. Peak in 10–12 years of age. Thursday, January 28, 2016 M. Sandeep kumar 16
  17. 17. Etiology Genetic factors 1. Chromosomal abnormalities:-  Down’s syndrome  Fragile X syndrome  Trisomy X syndrome  Turner’s syndrome M. Sandeep kumar Thursday, January 28, 201617
  18. 18. Down syndrome.  About one-half of all cases of mental retardation are caused by known biological abnormalities like Down syndrome.  The cause of Down syndrome is the presence of an extra chromosome.  In general, children and adults with Down syndrome function within the moderate to severe range of mental retardation. M. Sandeep kumar Thursday, January 28, 201618
  19. 19. Fragile-X syndrome  Fragile-X syndrome, is the most common known genetic cause of mental retardation.  Fragile-X syndrome is indicated by a weakening or break on one arm of the X sex chromosomes, and it is transmitted genetically.  Not all children with the fragile-X abnormality have mental retardation.  As in fragile-X syndrome, abnormalities of the sex chromosomes are particularly notable. Thursday, January 28, 2016 M. Sandeep kumar 19
  20. 20. Etiology 2. Metabolic disorders:- Phenylketonuria Wilsons syndrome Galactosemia M. Sandeep kumar Thursday, January 28, 201620
  21. 21. Phenylketonuria…..  PKU is caused by abnormally high levels of the amino acid phenylalanine, usually due to the absence of or an extreme deficiency in phenylalanine hydroxylase, an enzyme that metabolizes phenylalanine.  Children with PKU have normal intelligence at birth.  However, as they eat foods containing phenylalanine, the amino acid builds up in their system.  This phenylketonuria produces brain damage that eventually results in mental retardation.  Retardation typically progresses to the severe to profound range.M. Sandeep kumar Thursday, January 28, 201621
  22. 22. Etiology 3. Cranial malformation Hydrocephaly Microcephaly 4. Gross diseases of brain Tuberous sclerosis Neurofibromatosis Epilepsy Thursday, January 28, 2016 M. Sandeep kumar 22 Etiology
  23. 23. Etiology Prenatal factors:- Infections:- [ STORCH ]  Rubella  Cytomegalovirus  Syphilis  Toxoplasmosis  Herpes simplex. Endocrine disorders:-  Hypothyroidism  Hypo parathyroidism  Diabetes mellitus M. Sandeep kumar Thursday, January 28, 201623
  24. 24. INFECTIONS….  Rubella (German measles) is a viral infection that may produce few symptoms in the mother but can cause severe mental retardation and even death in the developing fetus.  The human immunodeficiency virus (HIV) can be transmitted from an infected mother to a developing fetus.  The effects on the child are profound, including mental retardation, visual and language impairments, and eventual death. M. Sandeep kumar Thursday, January 28, 201624
  25. 25. INFECTIONS….  Syphilis is a bacterial disease that is transmitted through sexual contact. syphilis produces a number of physical and sensory handicaps in the fetus, including mental retardation.  Another sexually transmitted disease, genital herpes, can be transmitted to the infant during birth and result in mental retardation.  Two infectious diseases that occur after birth, encephalitis and meningitis, can cause mental retardation. M. Sandeep kumar Thursday, January 28, 201625
  26. 26. Etiology Thursday, January 28, 2016 M. Sandeep kumar 26 Physical damage and disorders:-  Injury  Hypoxia  Radiation  Hypertension  Anemia  Emphysema Intoxication:-  Lead  Certain drugs  Substance abuse
  27. 27. Etiology Placental dysfunction:- Toxemia of pregnancy Placenta previa Cord prolapse Nutritional growth retardation Thursday, January 28, 2016 M. Sandeep kumar 27
  28. 28. Etiology Perinatal factors:- Birth asphyxia Prolonged and difficult birth Prematurity (due to complications) Kernicterus Instrumental delivery (resulting in head injury, intraventricular hemorrhage) M. Sandeep kumar Thursday, January 28, 201628
  29. 29. Etiology Postnatal factors:- Infections:- Encephalitis, Measles, Meningitis, Septicemia. Accidents. Lead poisoning Thursday, January 28, 2016 M. Sandeep kumar 29
  30. 30. Etiology Pregnancy and birth complications  One major complication is Rh incompatibility.  Another pregnancy and birth complication that can cause intellectual deficits is premature birth.  particularly anoxia, or oxygen deprivation; severe malnutrition; and the seizure disorder epilepsy. M. Sandeep kumar Thursday, January 28, 201630
  31. 31. Etiology Environmental and social-cultural factors:-  Cultural deprivation  Low socio-economic status  Inadequate caretakers  Child abuse Thursday, January 28, 2016 M. Sandeep kumar 31
  32. 32. PREDISPOSING FACTORS  Low socioeconomic strata or poverty.  Low birth weight of children.  Advanced maternal age.  Consanguinity.  Extreme malnutrition.  Lack of stimulating environment Poor sensory experience.  Poor sensory experience Thursday, January 28, 2016 M. Sandeep kumar 32
  33. 33. PREDISPOSING FACTORS  Defective low standard education due to defective scholastic environment.  Psychological disadvantage. E.g. poor health practices, poor housing, disuse of language, etc.  Parental deprivation  Prolonged isolation of care takers during developmental period.  Sensory deprivation and social deprivation. Thursday, January 28, 2016 M. Sandeep kumar 33
  34. 34. Classification…….;  Intelligent quotient is the ratio between mental age (MA) and chronological age (CA). while chronological age is determined from the date of birth , mental age is determined by intelligence test. Thursday, January 28, 2016 M. Sandeep kumar 34
  35. 35. TYPES OF MENTAL RETARDATION Type IQ range in mental retardation 1. Mild (Educable) 50 - 70 2. Moderate (Trainable) 35 - 50 3. Severe (Dependent retarded) 20 - 35 4. Profound (Life support) < 20 Thursday, January 28, 2016 M. Sandeep kumar 35
  36. 36. Mild retardation (Educable) (IQ 50-70):-  85-95% of total mental retardation cases belong to mild mental retardation.  Environmental influences, psycho social deprivation, restrictive child rearing practices, malnutrition, low-socio-economic class are the causes for mild mental retardation.  They have deficient in intellectual skills, studies up to 6-8th standard, problem in reading and writing, difficult in academic school work, normative living skills, walking, talking, toilet training, language abilities, and development of domestic skill, behavior, social and emotional adjustment like a normal person.  Can fully adjust educable, finds difficulty in complex ideas, drawing generalization, can learn motor skills better than verbal skill and writing, emotionally they are stable, overactive, temper tantrum is common, can understand simple terms, they can be trained in special school.  In adult life most of them lead independent life in normal surroundings. Thursday, January 28, 2016 M. Sandeep kumar 36
  37. 37. Moderate retardation (Trainable) (IQ 35-50)  10% of mental retardation cases belong to moderate mental retardation.  Children can be trainable, aimed at self-help skills, they can speak and support themselves, able to perform semi-skilled or unskilled work under supervision can learn few basic skills.  Communication skills develop much slowly, limited progress in scholastic work, studies up to 2nd grade, unaware of needs, have less neuro pathological complications, partially depends on others for their care. Thursday, January 28, 2016 M. Sandeep kumar 37
  38. 38. Severe retardation (Dependent) (IQ 20-35)  7% of total mental retardation cases, belong to severe MR.  Slow motor development in preschool years, trainable for normal living activities, allow them to do daily living activities under supervision, contributes partially to self-maintenance, some children may learn social behavior , able to communicate in simple way , engaged in limited activities, delayed speech and communication skills. Thursday, January 28, 2016 M. Sandeep kumar 38
  39. 39. Profound retardation (Life support) (IQ < 20)  1-2% of mental retardation cases are profound type.  considerable organic pathology, nervous system is noticed, associated conditions are; blindness, deafness, seizures are common, delayed milestones, motor impairment, totally dependent, cannot do anything on their own.  Death may occur due to variety of problems or complications. Thursday, January 28, 2016 M. Sandeep kumar 39
  40. 40. Mental Retardation Symptoms of Mental Retardation.. However, all definitions generally agree on the three major criteria for mental retardation: 1) significant limitations in intellectual functioning, 2) significant limitations in adaptive functioning, and 3) onset before age 18 years. M. Sandeep kumar Thursday, January 28, 201640
  41. 41. SIGNS AND SYMPTOMS  Failure to achieve developmental milestones.  Deficiencies in cognitive functioning such as inability to follow commands or directions.  Reduced ability to learn or to meet academic demands.  Expressive or receptive language problems.  Psychomotor skill deficits. M. Sandeep kumar Thursday, January 28, 201641
  42. 42. SIGNS AND SYMPTOMS  Difficulty performing self-care activities.  Neurologic impairment  Medical problems such as seizures  Low self-esteem, depression and labile moods  Irritability when frustrated or upset  Acting-out behavior  Lack of curiosity Thursday, January 28, 2016 M. Sandeep kumar 42
  43. 43. Diagnosing MR……./  The diagnosis of mental retardation is usually made after a period of suspicion by professionals or family members that the child’s developmental progress is delayed.  In some cases it is conformed at birth because of recognition of district syndrome.  Routine developmental screening can assist in early identification. Thursday, January 28, 2016 M. Sandeep kumar 43
  44. 44. Diagnosing MR…….//  Multidisciplinary evaluation should be individually tailored to the child. A team of professionals like pediatric neurologist, developmental pediatrician, psychologist, social scientist, speech therapist, physical therapist, special educator, social worker and nurse will evaluate the child.  Complete history is collected from family members and care takers. Thursday, January 28, 2016 M. Sandeep kumar 44
  45. 45. Diagnosing MR…….///  Mental history  Physical examination to exclude physical illness.  Neurological assessment  Assessment of mile stones like intellectual levels, cognitive ability, language pattern and communication skills, hearing, conative behavior. Thursday, January 28, 2016 M. Sandeep kumar 45
  46. 46. Diagnosing MR…….//// Investigations,,,,,,  Urine and blood examination for metabolic disorders.  Hormonal studies- T3, T4, TSH when cretinism is suspected.  Culture for cytogenic and biochemical studies.  EEG to exclude seizures.  MRI, CT scan to study the structural abnormality of brain for example tuberous sclerosis. Thursday, January 28, 2016 M. Sandeep kumar 46
  47. 47. Diagnosing MR…….///// Investigations,,,,,,  Antibodies for diagnosing infections, LFT in Wilson’s disease.  Sensory test – assessment for vision, hearing.  Amniocentesis for pregnant mothers to detect chromosomal abnormalities, chorionic villi sampling, chromosomal analysis.  Education evaluation- reading, writing, regularity in schooling, living learning skills, daily living skills, social abilities. Thursday, January 28, 2016 M. Sandeep kumar 47
  48. 48. Diagnosing MR…….//////  Psychological investigation includes Stanford Binet intelligence tests (mental abilities) 2 years and more. Wechler’s intelligence scale for children WISC (above 6 years)  Through the psychological testing the mental age of the child estimated. The intelligence quotient is then determined using the formula. Thursday, January 28, 2016 M. Sandeep kumar 48
  49. 49. Early behavioral signs suggestive of MR 1) Dysmorphic features (e.g. down syndrome, fragile X syndrome). 2) Irritability or unresponsiveness to contact. 3) Abnormal eye contact during feeding. 4) Gross motor delay. 5) Decreased alertness to voice or movement. 6) Language difficulties or delay 7) Feeding difficulties. Thursday, January 28, 2016 M. Sandeep kumar 49
  50. 50. Treatment modalities for MR……  Behavior management.  Environmental supervision.  Monitoring the child’s developmental needs and problems.  Programs that maximize speech, language, cognitive, psychomotor, social, self-care, and occupational skills.  Ongoing evaluation for overlapping psychiatric disorders, such as depression, bipolar disorder, and ADHD. Thursday, January 28, 2016 M. Sandeep kumar 50
  51. 51. Treatment modalities for MR  Family therapy to help parents develop coping skills and deal with guilt or anger.  Early intervention programs for children younger than age 3 with mental retardation  Provide day schools to train the child in basic skills, such as bathing and feeding.  Vocational training. Thursday, January 28, 2016 M. Sandeep kumar 51
  52. 52. PREVENTION:- PRIMARY PREVENTION SECONDARY PREVENTION TERTIARY PREVENTION Thursday, January 28, 2016 M. Sandeep kumar 52
  53. 53. PRIMARY PREVENTION ……… Preconception:-  Genetic counseling,  Immunization for maternal rubella.  Blood tests for marriage licenses can identify the presence of venereal disease.  Adequate maternal nutrition can lay a sound metabolic foundation for later childbearing.  Family planning in terms of size, appropriate spacing and age of parents can also affect a variety of specific causal agents. Thursday, January 28, 2016 M. Sandeep kumar 53
  54. 54. PRIMARY PREVENTION …… During gestation:-  Prenatal care:-  Adequate nutrition, fetal monitoring and protection from diseases.  Avoidance of teratogenic substances like exposure to radiation and consumption of alcohol and drugs.  Analysis of fetus for possible genetic disorder:-  By amniocentesis, fetoscopy, fetal biopsy and ultrasound. Thursday, January 28, 2016 M. Sandeep kumar 54
  55. 55. PRIMARY PREVENTION ……… At delivery:-  Delivery conducted by expert doctors and staff, especially in cases of high risk pregnancy.  Apgar scoring done at 1 to 5 minutes after the birth of the child.  Injection of gamma globulin, to protect the child not to get Rh- incompatability. Thursday, January 28, 2016 M. Sandeep kumar 55
  56. 56. PRIMARY PREVENTION …… Childhood:-  Proper nutrition throughout the developmental period and particularly during the first 6 months after birth.  Dietary restriction for specific metabolic disorders until no longer needed.  Avoidance of hazards in the child’s environment to avoid brain injury from causes such as lead poisoning, ingestion of chemicals, or accidents. Thursday, January 28, 2016 M. Sandeep kumar 56
  57. 57. SECONDARY PREVENTION……  Early detection and treatment of preventable disorders. For example phenylketonuria, hypothyroidism can be effectively treated at an early stage by dietary control or hormone replacement therapy.  Early recognition of presence of mental retardation. A delay in diagnosis may cause unfortunate delay in rehabilitation.  Psychiatric treatment for emotional and behavioral difficulties. Thursday, January 28, 2016 M. Sandeep kumar 57
  58. 58. TERTIARY PREVENTION……  This includes rehabilitation in vocational, physical and social areas according to the level of challenged.  Rehabilitation is aimed at reducing disability and providing optimal functioning in a child with mental retardation. Thursday, January 28, 2016 M. Sandeep kumar 58
  59. 59. CARE AND REHABILITATION OF MR  The prevention and early detection of mentally handicaps.  Regular assessment of the mentally retarded persons attainments and disabilities.  Advice, support, and practical measures for families.  Provision for education, training, occupation, or work appropriate for each handicapped person.  Housing and social support to enable self-care.  Medical, nursing, Psychiatric and psychological services those who require them as outpatients, day patients or inpatients. Thursday, January 28, 2016 M. Sandeep kumar 59
  60. 60. GENERAL PROVISIONS……  The family doctor and pediatrician are mainly responsible for early detection and assessment of mental retardation and assessment of mental retardation.  The team providing continuing health care also includes psychologists, speech therapists, nurses, occupational therapists and physiotherapists. Thursday, January 28, 2016 M. Sandeep kumar 60
  61. 61. Mildly retarded….  A few mildly retarded children require fostering, boarding schools placement or residential care, but usually specialist services are not required.  Mildly retarded adults may need help with housing, employment or with the special problems of old age. Thursday, January 28, 2016 M. Sandeep kumar 61
  62. 62. Severely retarded……..  In case of severely retarded may require special services throughout their lives, which may include a setting services, day respite during school holidays, or overnight stays in a foster family or residential care.  The main principle now guiding the provision of resources is that the retarded person should be use the usual community services rather than to provide specialist segregate services. Thursday, January 28, 2016 M. Sandeep kumar 62
  63. 63. Education and training…….  The aim is that as many mentally retarded children as possible are educated in ordinary schools either in normal classes or in special classes.  There is now an increasing use of more specialists teaching and a variety of innovative procedures for teaching language and other methods of communication.  Before leaving school, these children require reassessment and vocational guidance. Thursday, January 28, 2016 M. Sandeep kumar 63
  64. 64. HINTS FOR SUCCESSFUL TRAINING…  Divide each training activity into small steps and demonstrate.  Give repeated training in each activity.  Give the training regularly and systematically.  Starts the training with what the child already knows and then proceed to the skill that needs to be trained. By this the child will have a feeling of success and achievement.  Rewards his efforts even if the child attains near success.  Use the training material which is appropriate, attractive and locally available. Thursday, January 28, 2016 M. Sandeep kumar 64
  65. 65. HINTS FOR SUCCESSFUL TRAINING…  Remember children will learn better from children of the same age.  Remember there is no age limit for training a mentally retarded person.  Assess the child periodically preferably once in a four or six months.  Remember a mentally retarded child learn very slowly. Tell the parents not to be dejected at the slow progress, nor feel threatened Thursday, January 28, 2016 M. Sandeep kumar 65
  66. 66. VOCATIONAL TRAINING………  Vocational activities include in vocational training are work preparation, selective placement, post placement and follow up. For example:- MITRA special school and vocational training center for the mentally retarded , Bengaluru, Karnataka. Thursday, January 28, 2016 M. Sandeep kumar 66
  67. 67. HELP FOR FAMILIES……..  Help for families is needed from the time that the diagnosis is first made.  When the child starts school the parents should not only be kept informed about this progress, but should feel involved in the planning and provision of care.  Families are likely to need extra help when their child is approaching puberty or leaving school.  Stages in parent counseling… Thursday, January 28, 2016 M. Sandeep kumar 67
  68. 68. Stages in parent counseling…..  Stage-I:- impart information regarding condition of the mentally retarded child. Avoid giving misleading information or building false hopes in the parents.  Stage-II:- help the parents develop right attitude towards their mentally retarded child (to prevent overprotection, rejection, pushing the child too hard). Handle guilty feelings in parents.  Stage-III:- create awareness in parents regarding their role in training the child. Thursday, January 28, 2016 M. Sandeep kumar 68
  69. 69. Can I ask some questions…..?  Is mental retardation same as mental illness?  No , mentally retarded persons are not mentally ill. The mentally retarded persons are just slow in their development.  Is mental retardation curable?  No. mental retardation is a condition which cannot be curable. But timely and appropriate intervention can help mentally retarded person learn several skills.  Is it true that the mentally retarded persons cannot be taught anything?  No. mentally retarded persons can be taught many things, but they need to be trained systematically. They can perform many jobs under supervision. Thursday, January 28, 2016 M. Sandeep kumar 69
  70. 70. Can I ask some questions…..?  Can marriage solve the problems of mentally retardation?  No. many people think that after marriage, the mentally retarded person will become active and responsible or sexual satisfaction will cure the person. That is not so. Marriage will only further complicate the problem. When it is known that a mentally retarded person cannot be totally independent, it will not be possible to look after his family. Thursday, January 28, 2016 M. Sandeep kumar 70
  71. 71. Can I ask some questions…..?  Do mentally retarded persons become normal, as they grow older ?  No. the mentally retarded persons mental development is slower than that of a normal person. Therefor when their actual age increases with time, the mental development does not occur at the same pace to catch up with the actual age.  Is mental retardation an infectious disease?  No. Interaction between mentally retarded children and normal children on the other hand, helps in the improvement of mentally retarded children. Thursday, January 28, 2016 M. Sandeep kumar 71
  72. 72. NURSING MANAGEMENT:- Assessment:-  Assessment of early infant behavior for cognitive disability include non-responsiveness to contact, poor eye contact and during feeding, slow feeding, diminished spontaneous activity, decreased responsiveness to surroundings, decreased alertness to voice or movement, and irritability.  Documentation of daily living skills.  A careful family assessment for information on  The family’s response to the child.  Presence of other members with impaired cognition in the family.  Degree of independence encouraged at home.  Stability of the family unit. Thursday, January 28, 201672
  73. 73. NURSING MANAGEMENT:- INTERVENTION:-  The long term goals for these children are highly individualized and are dependent on the level of mental retardation . parents should be involved in establishing realistic goals for their child. Some of these goals can be:  The child dresses himself  The child maintains continence of stool and urine  The child demonstrate acceptable social behavior  The adolescent participates in a structured work program. Thursday, January 28, 2016 M. Sandeep kumar 73
  74. 74. NURSING MANAGEMENT:-  Early intervention programs are essential to maximize the potential development.  The nurse can participate in programs that teach infant stimulation, activities of daily living and independent self-care skills. A successful technique in treatment of the mentally retarded is called operant conditioning.  In addition learning social skills and adaptive behavior assists the child in building a positive self-image. For older children and adolescent assistance is needed to prepare them for a productive work life. Thursday, January 28, 2016 M. Sandeep kumar 74
  75. 75. MR REHABILOITATION CENTERS IN INDIA ……..  V.D. Indian Society for mentally retarded. Mumbai  The Association for the Welfare of Persons with a Mental Handicap in Maharashtra (A.W.M.H. Male). Mumbai 400 023  NATIONAL INSTITUTE OF MENTALLY HANDICAPPED has three regional centers located at New Delhi, Kolkata, & Mumbai,  MITRA special school and vocational training center for the mentally retarded , Bengaluru, Karnataka. Thursday, January 28, 2016 M. Sandeep kumar 75
  76. 76. MR REHABILOITATION CENTERS IN AP…….. 1. Thakur Hari Prasad Institute of Research & Rehabilitation for the Mentally Handicapped, Hyderabad . 2. National Institute for the Mentally Handicapped Manovikas Nagar,P.O. Secunderabad . 3. RASS College of Special Education, Rashtriya Seva Samiti, Seva Nilayam, Tirupati . 4. B.S.R. College of Special Education for Mentally Retarded, Anantapur. Thursday, January 28, 2016 M. Sandeep kumar 76
  77. 77. Thursday, January 28, 2016 M. Sandeep kumar 77

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