Post on 10-Dec-2015
DOWN’S SYNDROMEDefinition- also called trisomy 21 because of a chromosomal mutation resulting in a 3rd chromosome 21 - a chromosomal disorder resulting in 47 chromosomes instead of 46- results from faulty cell division affecting the 21st pair of chromosomes
Etiology- Increases in the frequency of thyroid autoantibodies- Most translocations consist of centric fusions between No. 21 and a D chromosome; ~1/2 of these are inherited.- Viral infection that disturbs chromosome segregation for infants following epidemics of infectious hepatitis.- Advanced maternal age
Epidemiology- Approximately 4000 infants with Down syndrome are born annually in the United States with an incidence of 1 in 800 to 1000 live births.
Pathophysiology & Clinical Manifestations The extra chromosome 21 affects almost every organ system and results in a wide spectrum of phenotypic consequences. Two hypotheses to explain the mechanism of gene action in Down Syndrome Developmental instability (loss of chromosomal balance)
1. Neuropathologya) Brain weight is 76% of normal b) Micrrocephalyc) Brain is abnormally rounded and short with a
decreased anterior =-posterior diameter (mircorbrachycephaly)
d) Number of secondary sucli is decreasede) Paucity of small neuronsf) Migrational defect involving small neuronsg) Decresed synaptogenesis owing to altered
synaptoc morphologyh) Structural abnormalities in the dendritic spines in
the pyramidal tracts of the motor cortexi) Lack of myelinationj) 8% of children with down syndrome also have
some form of seizure diorder
2. Sensory Deficitsa) Visual and hearing deficitsb) Hearing speechc) Can have cataracts, farsightedness, strabismus,
and nystagmus
3. Musculoskeletal Differencesa) Lineaar growtth deficitsb) Decrease in normal velocity of growth in staturec) Led length reductiond) 10-30% reduction in metacarpal and pahalangeal
lengthe) Absent palmaris longus and supernumerary
forearm flexorsf) Lack of differentiation of distinct mm bellies for
the zygomaticus major and minor and the levatr labii superioris
g) Hypotonia and ligamentous laxityh) Hip subluxation is commoni) Deficiency in grip strength, isometric strength and
ankle strength
4. Cardiopulmonary pathologiesa) 40% are born with congenital heart defecrs, most
commonly atrioventricular canal defects and ventriculoseptal defects
5. Physical Characteristicsa) Brachycephalyb) Fontanesl are frequently larger than normal and
take longer to closec) Aeas of hair lossd) Skin is often dry and mottled in infancy and gets
rough when child gets oldere) Face has flat contourf) Underdeveloped facial bones and mm and a small
noseg) Eyes are characterized by narrow, slightly slanted
eyelids, with the corners marked by epicanthal folds
h) Mouth is small, palate is narrow and tongue if furrowed shape in later childhood
i) Dentition is often delayed and may be spottyj) Abdomen may be slightly protuberantk) Chest may have an abnormal shapel) 90% have umbilical herniam) Hands and feet tend to be small and 5th finger is
curved inwardn) 50 % have a single crease across the aplm in one
or both hands
o) Toes are unusually shortp) Majority has a wide space between the 1st and 2nd
toes with a crease running between them on the sole
Table 299-1. Some Complications of Down Syndrome*SYSTEM DEFICIT
CardiacCongenital heart disease, most often VSD and AV canal Increased risk of mitral valve prolapse and aortic regurgitation
CNS
Cognitive impairment (mild to severe) Gross motor and language delay Autistic behavior Alzheimer's disease
GIDuodenal atresia or stenosis Hirschsprung's disease Celiac sprue
EndocrineHypothyroidism Diabetes
EENT
Ophthalmic disorders (eg, congenital cataracts, glaucoma, strabismus, refractive errors) Hearing loss Increased incidence of otitis media
GrowthShort stature Obesity
HematologicHematologic disorders (eg, neonatal polycythemia, transient leukemia, acute megakaryoblastic leukemia, acute lymphoblastic leukemia)
Musculoskeletal Atlantoaxial and atlanto-occipital instability*Not all are present in a given patient, but incidence is increased compared with unaffected population. AV = atrioventricular; EENT = eyes, ears, nose, and throat; VSD = ventricular septal defect.
DiagnosisA doctor can make an initial diagnosis at birth based on the looks of the baby. The baby may hear aheart murmur when listening to the baby‘s chest with a stethoscope.- X-rays- CT Scan- Amniocentesis- Chorionic villus sampling- Blood test- Echocardiogram- ECG- Prenatal amniocentesis with karyotype analysis
- Sometimes neonatal karyotype analysis (if prenatal diagnosis not done)
Differential Diagnosisa. Trisomy 18 (Edward syndrome) an extra copy of chromosome 18 usually severe mental retardation and heart problems sometimes stomach, digestive tract, reproductive
organ & urological tract problems fatal in infancy and childhood
b. 47XXY (Kleinfelter syndrome) most common chromosomal disorder with an extra X
chromosome mild mental deficiency, infertility, small testis,
gynecomastia, antisocial behaviour
c. XXX (Trisomy X) chromosomal disorder with an extra X chromosome female, mild mental deficiencies, psychosis, menstrual
abnormalities
Multiple X chromosomes male infants born with one or more additional X
chromosome in each cell no. of chromosome beyond normal total of 46 mental IQ and distinct facial appearance and speech,
skeletal, and coordination Problems
Prognosis In most cases, prognosis for Down‘s syndrome has
been favorable.\ Life expectancy has increased substantially, reaching
the age of 50 or over 50 years 80% survive to the age of 5years Risk for other medical conditions that affects nearly
every system of the body. underlying disorder cannot be treated Treatment depends on specific manifestations Later in life, approximately 75% of adults over 60
years with Down Syndrome show signs & symptoms of Alzheimer’s disease
PT Managementa. Objectives of careGeneral Goal: Anticipate gross and fine motor delay and provide interventions and weightBearing
b. Appropriate interventions and its rationale1. Utilize positioning and handling activities throughout early infancy and childhood –to promote anti-gravity control and weight bearing2. Facilitate anti-gravity extension in prone and weight shifting within and as transitionfrom prone.3. In supine and supported sitting, encourage midline orientation, anti-gravitybimanual activities including eye-hand coordination, and anterior neck and trunkanti-gravity activities – to promote anti-gravity muscle strength4. Emphasize trunk extension and extremity loading – to increase axial musclestrength5. Encourage emergence of righting and postural reactions through use of rotationwithin and during movement.6. Allow for dynamic rather than static exploration of movement.7. Introduce developmental milestones when chronologically appropriate, includingsupported sitting and standing, when trunk control and alignment are able to beestablished.8. Anticipate delay in postural control responses and provide functional opportunitiesto enhance development in areas of cognition, language, and socialization.9. Teach parents and other team members activities and position choices that willenhance the child‘s overall development.
c. Relevant health teaching(s) to patient & familySupport group that would help the individual with Down‘s syndrome be comfortable withhis/her life. Behavioral training can also help people with Down‘s syndrome and their families deal with the frustrations, anger and compulsive behavior that often occur. Parents or caregivers should learn to help a person with Down‘s syndrome deal with frustration. At the same time, it is also important to encourage independence
References Tecklin, Jan S., Pediatric Physical Therapy, 4th ed, pp. 368, 370 Behram, Kliegman, Jenson , Nelson Textbook of Pediatrics, 17th ed
THE MERCK MANUAL OF DIAGNOSIS AND THERAPY - 19th Ed. (2011)
Crepeau, Elizabeth B. , Cohn Ellen, Schell, Barbara A. , Occupational Therapy Willard & Spackman’s
MENTAL RETARDATION or INTELLECTUAL DISABILITY
Definition (TECKLIN)- is a disability characterized by significant limitations in both intellectual functoning and adaptive behavior expressed in conceptual, social, and practical adaptive skills.
-In order to be classified as mental retardation,onset of this disability occurs before age 18
- According to DSM- IV -TR 4th ed, essential feature of mental retardation is significantly subaverage general intellectual functioning, accompanied by significant limitations in adaptive functioning in at least two of the following applicable adaptive skill areas: communication, self-care, home living, social/ interpersonal skills, use community resources, self-direction, health and safety, functional academic skills, leisure, and work
- a condition existing in an individual that is described by the specific performance of the individual not due to a specific trait- performance state in which functioning is impaired
DEFINITION (MERCK) - Intellectual disability (ID, previously called mental retardation) is characterized by significantly sub-average intellectual functioning (often expressed as an intelligence quotient < 70 to 75) combined with limitations of > 2 of the following: communication, self-direction, social skills, self-care, use of community resources, and maintenance of personal safety. Management consists of education, family counseling, and social support.
CLASSIFICATIONLEVELS OF RETARDATION (Merck Manuals)
LEVEL IQ RANGE
Ability at Preschool Age (Birth - 6 years)
Ability at School Age (6-20 years)
Ability at Adult Age (21 years and older)
Mild 52-68
Can develop social and communication skills, muscle coordination is slightly impaired, often not diagnosed til later age
Can learn up to about the 6th-grade level by late teens, can be guided toward social conformity, can be educated
Can usually achieve enough social and vocational skills for self support, but may need guidance and assistance during times of unusual social or economic crisis
Moderate 36-51
Can talk or learn to communicate; social awareness is poor; muscle coordination is fair; profit from self-training in self-help
Can learn some skills and occupational skills; progression beyond 2nd-grade level in schoolwork is unlikely; may learn to travel alone in familiar training
May achieve self-support by performing unskilled or semiskilled work under sheltered conditions; need supervision and guidance when under mild social or economic stress
Severe 20-35
Can say a few words; able to learn some self-help skills; have few or no expressive skills; muscle coordination is poor
Can talk or learn to communicate; can learn simple health habits; benefit from habit training
May continue partially to self-care under complete supervision, can develop some useful self-protection skills in controlled environment
Profound 19 or below
Extremely retarded; little muscle coordination; may need nursing care
Some muscle coordination; unlikely to walk or talk
Some muscle coordination and speech; may achieve very limited self-care, need nursing care
TECKLIN CLASSIFICATION- key elements in the definition of MR are :
capabilities, environment and function- previously used terms of mildly, moderate severely,
or profoundly retarded are no longer wildly used
- Current classification carries with it an application of new diagnostic criteria directly correlated to need for support
-Four intensities of support: intermittent, limited, extensive, and pervasive
-Support services may come to child with MR from 4 sources: the individual child, other people, technology,
or habilitation services
IQ 50-55 to 7035-40 to
50-5520-25 to
35-40<20-25
Preschool
Often appears
unimpaired; develops functional social and
communication skill
Impaired social skills;
can communicate; may need supervision
Severely impaired
communication;
impared motor skills
Requires full-support;
dependent for care; limited
sensorimotor development
School-aged
Academic skills of 6th
grade are possible; special
education support is needed for
Can develop up to 4th
grad academic skills with
special traiming/
modification
May learn to
communicate; basic personal health habits, limited
Some motor development contines to
be dependdent
for care;limited success with
trainin
secondary school
academic skills
AdultCan learn
social skills and
vocational skills
Unskilled or semiskilled
vocation
Needs complete support
and supervision for any self-
support activity
Limited motor ability
and communication; continued dependency
for care
ETIOLOGY- Most cases of mental retardation the cause is unknown-several conditions during a woman’s pregnancy can cause or contribute to mental retardation in her child
Use of certain drugs Excessive consumption of alcohol Radiation therapy Poor nutrition and certain viral conditions (German measles
or rubella) Chromosomal abnormalities: Down Syndrome
ETIOLOGIC CLASSIFICATION OF MRETIOLOGY EXAMPLES
Prenatal Onset Examples1. Chromosomal Disorder Downturner or Klinefelter’s syndrome
2. Syndrome disorders Neurofibromatosis, myotonic muscular dystrophy. Prader-Willi, Tuberous sclerosis
3. Inborn errors of metabolism Phenylketonuria carbohydraate disorders, Lesch - Nyhan syndrome
4. Developmental disordeers of brain formation
Anencephaly, hydrocephalus, porencephaly, microcephaly
5. Environmental influences Intrauterine malnutrition, drugs, toxins, alcohol, narcotics, maternal dss
Perinatal Causes Examples6. Intrauterine disorders Placental insufficiency, maternal sepsis,
abnormal labor or delivery7. Neonatal disorders Intraventricular hemorrhage, maternal
sepsis, abnormal labor or deliveryPostnatal Causes Examples8. Head injuries Intracranial hemorrhage, contusion,
concussion9. Infections Encephalitis, meningitis, viral infections10. Demyelinating disorders Post-infections and post-immunization
disorders
11.Degenerative disorders Syndromic disorders, poliodystrophies, basal gangliadisorders, leukodystrophies
12.Seizure disorders Infantile spasms, myoclonic epilepsy13. Toxic-metabolic disorders Reye‘s syndrome, lead intoxication,
metabolic disorders14. Malnutrition Protein-calorie, prolonged IV
alimentation15.Environmental deprivation Psychosocial disadvantage, child abuse/
neglect
Prenatal drug and toxin exposure cause ID. Fetal alcohol syndrome is the most common of these conditions. Anticonvulsants , chemotherapy drugs, radiation exposure, lead, and methylmercury are also causes. Severe undernutrition during pregnancy may affect fetal brain development, resulting in ID.
Perinatal: Complications related to prematurity, CNS bleeding, periventricular leukomalacia, breech or high forceps delivery, multiple births, placenta previa, preeclampsia, and perinatal asphyxia may increase the risk of ID. The risk is increased in small-forgestational-age infants; intellectual impairment and decreased weight share the same cause. Very low- and extremely low-birth-weight infants have variably increased chances of having ID, depending on gestational age, perinatal events, and quality of care.
Postnatal: Undernutrition and environmental deprivation (lack of physical, emotional, and cognitive support required for growth, development, and social adaptation) during infancy and early childhood may be the most common causes of ID worldwide. Viral and bacterial encephalitides (including AIDS-associated neuroencephalopathy) and meningitides, poisoning (eg, lead, mercury), and accidents that cause severe head injuries or asphyxia may result in ID.
INCIDENCE 3% of population of US is assumed to have mental
retardation, only 1% to 1.5% are actually diagnosed.
80% of cases , the cause is unknown (4x) M.> W 75%- mild form
20%- moderate form5%- severe or profound form
Down Syndrome - one fo the most prevalent form ( 1 in 800 to 1000 in live births
PATHOPHYSIOLOGY1. Depending on the cause; early diagnosis and prompt treatment may be particularly important in cases involving an identifiable and possibly correctable cause, such as phenylketonuria, malnutrition, or child abuse.2. Diagnosis usually is made after a period of suspicion. Diagnosis may be made at birth from recognition of a specific syndrome, such as Down syndrome. Diagnosis and classification are based on standard IQ test scores.
CLINICAL MANIFESTATION
COMMON MANIFESTATIONS OF MENTAL RETARDATION by AGE
Age Area of ConcernNewborn Dysmorphisms
major organ system dysfunction (feeding & breathing)
Early infancy (2-4mo) Failure to interact with the environmentConcerns about vision and hearing impairments
Later infancy (6-8mo) Gross motor delayToddlers (2-3yr) Language delays or difficultiesPreschool (3-5yr) Language difficulties or delays
Behavior difficulties, including playDelays in fine motor skills: cutting, coloring, drawing
School age (over 5yr) Academic underachievementBehavior difficulties
COMPLICATIONS (TECKLIN)1. Neuromotor Impairments
- most neuromuscular impairments are present as a result of primary pahtology in the CNS
- secondary impairments then include deficits in motor control, coordination, postural control, force production, flexibility, and balance
2. Learning Impairment- Impaired ability to utilize advanced cognitive
processes, manage simultaneous or multiple demands, and successfully organize complex information, with subsequent effects on task performance as well as task mastery
Diagnosis
Table 304-5. Tests for Some Causes of Intellectual Disability (MERCK)
SUSPECTED CAUSE INDICATED TESTS
Single major anomaly or multiple minor anomalies Family history of cognitive disability
Chromosome analysis Chromosomal microarray analysis Cranial CT and/or MRI*
Failure to thrive Idiopathic hypotonia Genetic metabolic disorders
HIV screening in high-risk infants Nutritional and psychosocial history Urine and/or blood amino acid and enzyme studies for storage diseases or peroxisomal disorders Muscle enzymes SMA 12 (includes albumin, alkaline phosphatase, AST, total bilirubin, BUN, Ca, cholesterol, creatinine, glucose, P, total protein, and uric acid) Bone age, skeletal x-rays
Seizures
EEG Cranial CT, MRI*, or both Blood Ca, P, Mg, amino acids, glucose, and lead levels
Cranial abnormalities (eg, premature closure of the sutures, microcephaly, macrocephaly, craniostenosis, hydrocephalus) Cerebral atrophy Cerebral malformations CNS hemorrhage Tumor Intracranial calcifications due to toxoplasmosis, cytomegalovirus infection, or tuberous sclerosis
Cranial CT, MRI*, or both TORCH screening Urine culture for virus Chromosome analysis Chromosomal microarray analysis
*After neurologic consultation. SMA = sequential multiple analyzer; TORCH = toxoplasmosis, rubella, cytomegalovirus, herpes.
Diagnosis of MR is based on the criteria embodied within the definition reflecting intellectual functioning level and adaptive skill level (TECKLIN)
Assessment of Intellectual FunctioningStandardized intelligence test
- administered by a psychologist-determine a child’s inteelectual functioning on the basis of an IQ of 70 or 75 below- Instruments commonly used:
Stanford-Binet Intelligence Scale, 5th ed, One of tthe Wechsler Scales, such as Wechsler Intelligence Scale for Children-IV or Wechsler Preschool and Primary Scale of Intelligence II, and the Kaufman Assessment Battery for Children
Assessment of Adapive Skill levelImpairments in adaptive function are usuallt
the presenting symptoms in individuals with MR. Adaptive skills are those skills considered to be central to successful life functioning and are frequently related to the need for supports for persons with mental retardation
DIFFERENTIAL DIAGNOSIS
AutismBorderline intellectual functioningChild Abuse & Neglect, Posttraumatic Stress DisorderChildhood Disintegrative DisorderCognitive DeficitsLearning Disorder, ReadingLearning Disorder, Written ExpressionMathematics Learning DisorderPediatric DepressionPervasive Developmental DisorderRett SyndromeSevere communication/language disorders
Prognosis
Many people with mild to moderate ID can support themselves, live independently, and be successful at jobs that require basic intellectual skills. Life expectancy may be shortened, depending on the etiology of the disability, but health care is improving long-term health outcomes for people with all types of developmental disabilities. People with severe ID are likely to require life-long support. The more severe the cognitive disability and the greater the immobility, the higher the mortality risk.
PT MANAGEMENT
A. Objectives of care Analyze not only what the child can do, but also the
process underlying the observed skills and behaviors Perform an evaluation with as many functional
aspects as is reasonable Identify not only the disability, but also the child’s
abilites, however minimal Understand by what means, or even whether, the
child is perceiving the world, including yo, before continuing with the evaluation
B. Appropriate interventions and its rationaeAssess all children for all signs of developmental delays1. Sensory examination and intervention VISUAL: Stimulation and practice in both focusing and
tracking AUDITORY: Vesitubular stimulation to enhance
auditory integration TACTILE : Heavy touch and pressure or weight-
bearing-
Decrease tactile hypersensitivity and promoting proximal joint stability
VESTIBULAR: vestibular activities- improve balance , stimulate experience of movement, activate mm contraction, promote awareness and eye contact , and increase spatial awareness and perception
2. Intervention to limit cognitive impairment Present concepts using meaningful and concrete
directions Repetition of activities (long term memory use) Meaningful tasks using the thrapeutic tools to
improve transfer of learning
3. Intervention to limit physical impairments and functional limitations
Activities deesigned to limit musculoskeletal, neuromuscular and cardiopulmonary impairments; reduce functional limitations; prevent secondary impairment
C. Relevant health teaching(s) to patient and familyEncourage the prevention of mental retardation
ReferencesTecklin, Jan S., Pediatric Physical Therapy, 4th ed, pp. 368, 370,Muscari, M.E. (2005). Pediatric nursing, 4th edition, Lippincott William & Wilkins.Behram, Kliegman, Jenson , Nelson Textbook of Pediatrics, 17th ed, pp. 140-142THE MERCK MANUAL OF DIAGNOSIS AND THERAPY - 19th Ed. (2011)
LEARNING DISABILITIES
(MERCK)
Learning disabilities are conditions that cause a discrepancy between potential and actual levels of academic performance as predicted by the person's intellectual abilities.
Learning disabilities involve impairments or difficulties in concentration or attention, language development, or visual and aural information processing.
Etiology Usually present from birth, although it may go
undetected until later in life. Genetic predisposition
Chromosomal abnormalities Single abnormal gene Multi-factorial Perinatal injury Other medical conditions
Infection, trauma, environmental toxins
EpidemiologyThe number of children with learning disabilities is unknown, about 5% of the school-age population in the US receives special educational services for learning disabilities. Among affected children, boys outnumber girls 5:1.
PathophysiologyLearning disabilities may be congenital or acquired. No single cause has been defined, but neurologic deficits are evident or presumed. Genetic influences are often implicated. Other possible causes include
• Maternal illness or use of toxic drugs during pregnancy• Complications during pregnancy or delivery (eg, spotting, toxemia, prolonged labor, precipitous delivery)• Neonatal problems (eg, prematurity, low birth weight, severe jaundice, perinatal asphyxia, postmaturity, respiratory distress)
Potential postnatal factors include exposure to environmental toxins (eg, lead), CNS infections, cancers and their treatments, trauma, undernutrition, and severe social isolation or deprivation.-- Structural changes involving frontal/striatal system and intra- and interhemispheric white matterProjections
Clinical Manifestations Children with learning disabilities typically have at
least average intelligence, although such disabilities can occur in children with lower cognitive function as well.
Symptoms and signs of severe disabilities tend to manifest at an early age. Mild to moderate learning disabilities are usually not
recognized until school age, when the rigors of academic learning are encountered.
Affected children may have trouble learning the alphabet and may be delayed in paired associative learning (eg, color naming, labeling, counting, letter naming).
Speech perception may be limited, language may be learned at a slower rate, and vocabulary may be decreased.
Affected children may not understand what is read, have very messy handwriting or hold a pencil awkwardly, have trouble organizing or beginning tasks or retelling a story in sequential order, or confuse math symbols and misread numbers.
Disturbances or delays in expressive language or listening comprehension are predictors of academic problems beyond the preschool years.
Memory may be defective, including short-term and long-term memory, memory use (eg, rehearsal), and verbal recall or retrieval
Some children with learning disabilities have difficulty following social conventions (eg, taking turns, standing too close to the listener, not understanding jokes); these difficulties are often components of mild autism
Difficulties with impulse control, non-goal-directed behavior and overactivity, discipline problems, aggressiveness, withdrawal and avoidance behavior, excessive shyness, and excessive fear may occur. Learning disabilities and attention-deficit/hyperactivity disorder (ADHD) often occur together.
Diagnosis
Cognitive evaluation typically includes verbal and nonverbal intelligence testing and is usually done by school personnel. Psychoeducational testing may be helpful in describing the child's preferred manner of
processing information (eg, holistically or analytically, visually or aurally). Neuropsychologic assessment is particularly useful in children with known CNS injury or illness to map the areas of the brain that correspond to specific functional strengths and weaknesses. Speech and language evaluations establish integrity of comprehension and language use, phonologic processing, and verbal memory.
Behavioral assessment and performance evaluation by teachers' observations of classroom behavior and determination of academic performance are essential. Reading evaluations measure abilities in word decoding and recognition, comprehension, and fluency. Writing samples should be obtained to evaluate spelling, syntax, and fluency of ideas. Mathematical ability should be assessed in terms of computation skills, knowledge of operations, and understanding of concepts.
Medical evaluation includes a detailed family history, the child's medical history, a physical examination, and a neurologic or neurodevelopmental examination to look for underlying disorders. Although infrequent, physical abnormalities and neurologic signs may indicate medically treatable causes of learning disabilities. Gross motor coordination problems may indicate neurologic deficits or neurodevelopmental delays. Developmental level is evaluated according to standardized criteria.
Psychologic evaluation helps identify ADHD, conduct disorder, anxiety disorders, depression, and poor self-esteem, which frequently accompany and must be differentiated from learning disabilities. Attitude toward school, motivation, peer relationships, and self-confidence are assessed.
Prognosis A learning disability can‘t be cured or fixed A lifelong issue No treatment available with the right support and intervention, however,
children with learning disabilities can succeed in school and go on to successful, often distinguished careers later in life.
Without proper support, people with learning disabilities adapting and coping up with psychological and social adjustments in both working and non-working environments
Complicationsa. Learning disabilities in reading (dyslexia)Signs of reading difficulty include problems with: Letter and word recognition Understanding words and ideas Reading of speed and fluency General vocabulary skills
b. Learning disabilities in math (dyscalculia) A child with a math-based learning disorder may struggle with memorization andorganization of numbers, operation signs, and number Children with math learning disorders might also have trouble with counting principles (such as counting by 2s or counting by 5s) or have difficulty telling time.
c. Learning disabilities in writing (dysgraphia)Symptoms of a written language learning disability revolve around the act of writing. Theyinclude problems with: Neatness and consistency of writing Accurately copying letters and words Spelling consistency Writing organization and coherence
Table 304-3. Common Learning DisabilitiesDISABILITY MANIFESTATIONDyslexia Problems with readingPhonologic dyslexia
Problems with sound analysis and memory
Surface dyslexia
Problems with visual recognition of forms and structures of words
Dysgraphia Problems with spelling, written expression, or handwritingDyscalculia Problems with mathematics and difficulties with problem-solvingAgeometria Problems due to disturbances in mathematical reasoning
AnarithmiaDisturbances in basic concept formation and inability to acquire computational skills
DysnomiaDifficulty recalling words and information from memory on demand
PT Managementa. Objectives of care Improve the quality of life and ability through learning Improve functional abilities Improve health
b. Appropriate interventions and its rationaleExercises should address these three and should be meaningful and relevant for the
patient1. Cognitive – show them pictures of storytelling then make them recall thesequence of the pictures shown or remember parts of the story2. Perceptual speed – flash cards to an individual with a learning disability forhim/her to recognize things3. Psychomotor – imagery
c. Rationale of intervention1. To improve their cognitive functioning like for memory and processing.2. To be able to know objects or people in the pictures as fast as they can totest the individual‘s speed3. For the individual to sychronize one‘s action with one‘s imagination that thephysical therapist shall visually cue
d. Relevant health teaching(s) to patient & family- Teach family to be supportive, kind and patient. They should understand the situation of theirchild and they should be show him/her love and care.
ReferencesKeltner, N. L., Schwecke, L.H., & Bostrom, C.E. (2007). Psychiatric nursing, 5th edition, p. 637. Singapore: Mosby ElsevierBehram, Kliegman, Jenson , Nelson Textbook of Pediatrics, 17th ed, pp. 100-106Rose, Nicholas D., Essential Psychiatry¸2nd ed, 168, 170-181.Tecklin Jan, Pediatric Physical therapy 4th ed pp. 367-381Molnar, Grabriella, Pediatric rehabilitation 3rd ed p. 61Rennie J. Learning Diability, Physical therapy,, Treatment and Management, 2nd ed. THE MERCK MANUAL OF DIAGNOSIS AND THERAPY - 19th Ed. (2011)