Essentials of Family Medicine Ch 13
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What are the levels of mental retardation?
- Mild: IQ 50-70. They are able to attain math and reading skills at a 3rd-6th grade level. They can conform socially, maintain employment, and can integrate quite well in society.
- Moderate: IQ 35-49. Can perform simple activities and basic self-care.
- Severe: 20-34. Require supervision and support, but may participate in simple, repetitive self care activities.
- Profound MR: IQ<20, not capable of self care.
What are the 4 subtypes of CP?
- 1. Spastic-most common. May occur as a diplegia involving only bilater lower extremities, a quadriplegia, or a hemiplegia. Muscles often become stiffly contracted.
- 2. Athetoid-uncontrolled, slow, writhing movements, dysarthria, drooling, and grimacing may occur.
- 3. Ataxic-Abnormalities in balance and depth perception, poor coordination, wide based gait and intention tremor
- 4. Mixed
What may be seen on physical exam in CP?
- Abnormalities in posture, oropharyngeal problems(tongue thrusts, swallowing), strabismus, increased or decreased muscle tone, abnormal evolution of primitive reflexes, or abnormal DTRs.
- Other conditions that often occur with CP include: seizures, refractive errors, hearing loss, MR, failure to thrive, learning disabilities, attention problems, and behavior problems.
What are causes of CP?
- Injury to developing brain, may occur during prenatal period, during labor and delivery(severe ashphyxia leading to hypoxic-ischemic encephalopathy), or in first few years of life. -Prenatal infection(rubella, cytomegalovirus, toxoplasmosis, and Rh histoimmuno incompatibility syndrome.
- Postnatal-CNS infection (bacterial meningitis or viral encephalitis), injury, stroke.
What are signs of CP?
- Motor abnormalities that are static and not progressive.
- A definitive diagnosis should not be made until after 1 year of life.
How should autistic children be managed?
Parental education and support, community services, occupational therapy, physicasl therapy, structured play, behavior management, and in some cases, medication.
What are some clues a practitioner should look for that may indicate an autistic child?
Aberrant social skills, abnormal eye contact, aloofness, failure to orient to name, failre to use gestures to point or show, lack of interactive play, or lack of interest in peers.
What are the subtypes of autistic spectrum disorder?
- Autistic disorder-severe end of spectrum
- Asperger's-milder, poor peer relationships, lack of empathy, and a tendancy to over focus on specific topics, often have normal intelligence and normal language skills.
- Pervasive developmental disorder NOS-children who don't meet criteria for autistic disorder, but have severe impairments.
- Rett's Syndrome-neurodegenerative, affects girls 1-3 years, following a period of normal development. Loss of hand skills, gross motor and coordination skills, language and cognitive skills, and social interaction skills.
- Disintegrative disorder-occurs after age 24 mo's, following a period of normal development. It results from profound losses in play, language, social and motor skills.
What is autistic spectrum disorder?
- A continuum of disorders of brain development involving impaired communication skills, impaired social interactions, and restricted, repetitive or stereotypical patterns of behavior.
- Strong genetic component
What is detected first in failure to thrive change in weight or height?
- Change in weight, then height, then head circumference.
- *In congenital, constitutional, familial, and endocrine causes of growth disturbance, length will decline before weight or proportionately to weight.
How is failure to thrive detected?
children are without weight gain in 2 months or children have dropped 2 percentile curves in less than 6 months.
*Always consider measurement or plotting error.
What is the immediate cause of failure to thrive?
malnutrition-may result b/c insufficient calories are offered, b/c of inability to take or retain sufficient calories, or b/c of increased caloric need secondary to increased metabolism.
Developmental delay refers to a disturbance in one or more of the three developmental streams which are...
- 1. Motor-abnormal fine or gross motor activity (CP)
- 2. Cognitive delays-language receptive, language expressive, problem solving, or visual-motor. (Mental retardation, learning disorders, communications disorders)
- 3. Social-adaptive- ADHD, autism, pervasive developmental delay, age sepcific issues such as sleep disorder or toileting problems.
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