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172 Cards in this Set
- Front
- Back
Astereognosis
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Inability to recognize objects by touch *also called tactile agnosia
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Ataxia
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Inability to coordinate muscle activity during voluntary movement.
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Athetoid (dyskinetic)
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Resembling athetosis or repetitive involuntary, slow, sinous, writhing movements. Classification of cerebral palsy in which involuntary purposeless movement occurs when an individual attempts purposeful motion. The abnormal movements may not only occur in the limb being moved but also involve an "overflow" of activity to all other limbs with an exaggeration of reflexes
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Clonus
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Alternate involuntary muscular contraction adn relaxation in rapid succession
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Contracture
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Abnormal shortening of muscle tissue that renders the muscle highly resistant to stretching which can lead to permanent disability
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Deformity
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Distortion of any part or general disfigurement of the body
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Diplegia
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Paralysis of like parts on either side of the body. In cerebral palsy, diplegia describes involvment of the lower extremities predominately, with only mildy affected upper extremities
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Dysarthria
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imperfect articulation of speech caused by disturbances of muscluar control resulting from central or peripheral nervous system damage
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Graphesthesia
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The ability by which outlines, numbers, words, or symbols, traced or written on the skin are recognized
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Hemiplegia
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Paralysis of one side of the body, usually caused by a brain lesion, such as a tumor, or a CVA. Paralysis occurs on the side opposite the lesion, or infarct, because of decussation of most of the fibers in the motor tracts of the brain.
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Homonymous hemianopsia
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loss of one half of the visual field, on the same side in both eyes
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hypertonicity (spasticity)
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abnormal muscle tone felt as too much resistance to movement as a result of hyperactive reflexes and loss of inhibiting influences from higher brain centers
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hyperflexia
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overflexion of limb
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hypoxemia
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insufficient oxygenation of the blood
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kernicterus
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A form of hemolytic jaundice of the newborn.
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kinesthesia
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The ability and sense by which position, weight, and movement are perceived
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Quadriplegia
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Paralysis of all four limbs
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scoliosis
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lateral curvature of the vertebral column
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nystagmus
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Involuntary, rapid, rhythmic movement (horizontal, vertical, rotatory, or mixed, i.e., two types) of the eyeball
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primitive reflexes
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Innate primary reactions found in newborns and indicative of severe brain damage if present beyond their usual time of disappearance. Adult patients with closed head injury or stroke may manifest these signs; absence on reevaluation is a sign of progress in recovery. Examples include placing reactions, moro reflex, grasp reflex, rooting reflex, and sucking reflex.
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Strabismus
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Deviation of the eye in which the visual axes assume a position relative to each other different from that required by the psychological conditioning also called squint.
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Topagnosis
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Loss of ability to localize site of tactile sensations
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Stretch Reflex
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Reflex contraction of a muscle in response to passive longitudinal stretching.
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Ambiguous hand preference
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Absence of a dominant hand preference; the switching of hand within the same activity.
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Amygdala
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A structure that is part of the limbic system and is involved in the emotions of aggression and fear.
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Auditory Processing
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The process of the brain recognizing and interpreting sounds in the environment. This process is responsible for the comprehension of language.
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Autistic Disorder
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A neurobiologic disorder with an unknown etiology, characterized by significant delay or deviation in social interaction, communication, and repetitive or stereotyped behaviors
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Aspergergers disorder
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A neurobiologic disorder of unknown etiology in which cognitive and communicative skills develop normally or nearly normal during
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Casein
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A protein found in cows milk. A theory in the field of autism suggests that children with autism do not digest this protein appropriatly, leading to a buildup of morphine-like substances in the body and causing social withdraw and abnormal behaviors
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Cerebellum
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A region of the brain that is found at the rear of the head and is above the brainstem. It has been traditionally known for its role in the coordination of movement, but recent research suggests the cerebellum may also have a role in cognitive, sensory, language, and abstract-thinking skills
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Childhood Disintegrative Disorder
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A rare neurobiologic disorder that develops in children who had appeared completely normal during their first few years of life. Following its onset, language, social interaction, and self care skills are lost and autistic like symptoms appear
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Echolalia
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The automatic and meaningless repetition of anothers words or phrases. In autism this may be immediate or delayed
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Frontal Lobes
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Region of the brain located at the front of the cerebrum. This region is responsible for social behavior, spontaneous production of language, initiation of motor activity, processing sensory stimuli and then planning reaction as a result of the input, abstract thinking, problem solving, and judgement.
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Gastrointestinal Disorder
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disorder of the GI tract
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Gene
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a region of DNA that carries the instructions for cells
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Gluten
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A protein found in wheat products. A theory in the field of autism suggests that children with autism do not digest this protein appropriatly, leading to a buildup of morphine like substances in the body and causing social withdrawal and abnormal behaviors
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Hippocampus
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A structure that is part of the limboc system and is involved in long term memory functions
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Hyperlexia
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The ability to read words above age-level expectation. Usually children with this ability have difficulty understanding the meaning of the words they read
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Inferior Olive
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region of the brainstem that transmits error signals to the cerebellum
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Joint Attention
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the ability to use eye contact and gestures in order to share experiences with others
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Limbic system
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This group of subcortical structures is involved in various emotions and memory functions
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neurobiological
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Of or relating to the biologic study of the nervous system. The cause of autism is considered to be an abnormality in the structure or function of the brain
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neuron
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A nerve cell that is specialized in transmitting and receiving electrical signals to communicate information between different regions of the body
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purkinje cells
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cells that form a layer near the surface of the cerebellum and convey signals away from the cerebellum
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retts disorder
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A rare neurobiologic disorder that primarily affects females and is caused by a deviation on the methyl-CpG- binding protein 2 gene. This disorder has a distincitive course since early development in children is typical, followed by the deceleration of head growth, loss of purposeful hand movements, and appearnace of autistic like symptoms
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rote memory
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The process of memorizing and using language overheard from others rather than producing spontaneously generated language
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tactile defensiveness
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A type of sensory defensiveness in which a person overreacts or avoids touching certain textures
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theory of mind
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The ability to understand another persons thoughts feelings or intentions
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Mild MR
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IQ 50-70
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Moderate MR
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IQ 35-50
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Severe MR
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IQ 20-35
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Profound MR
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IQ Below 20
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5 Diagnostic Criterias for Autism Spectrum Disorder
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Autistic Disorder
Pervasive Developmental Disorder (PDD-NOS) Aspergers Retts Childhood Disintegrative Disorder |
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Hydrocephaly
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The abnormal accumulation of cerebrospinal fluid in the brain
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cortical tubers
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form on surface of brain
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subependymal nodules
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form in walls of the ventricles
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giant-cell astrocytomas
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tumor blocking flow brain fluids
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Classification of Mental Retardation 3 Compnents
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Significantly subaverage intellectual functioning
An impairment resulting from an injury, disease, or abnormality that existed before age 18 An impairment in adaptive abilities |
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Associated Impairments of Mental Retardation (4)
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Cerebral palsy
Seizure disorders Sensory impairments (vision, hearing, tactile etc.) Psychological / behavioral |
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Angelman Syndrome
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Chromosomal
Severe MR Speech impairment Ataxia, poor balance Behavior – laughter, smiling, apparent happy, excitable Poor attention Hand flapping, hypermotoric May have Small head, Seizures, Abnormal EEG, strabismus, tongue thrust/swallowing disorder, uplifted flexed arms when walking, prominent mandible, inc. sensitivity to heat, wide mouth, wide-spaced teeth, sleep disturbance, drooling, chewing/mouthing behaviors, flat back of hea |
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Cru-Du-Chat Syndrome
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chromosomal abnormality
learning difficulties (most severe, some only mildly affected 1:50 000 people world-wide cat cry = characteristic cry of newborns similar to mewing of a kitten |
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Cornelia de Lange Syndrome
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low birthweight (often under five pounds),
slow growth and small stature, and small head size (microcephaly). small hands and feet thin eyebrows which frequently meet at midline (synophrys), long eyelashes, short upturned nose and thin, downturned lips. Less common characteristics: excessive body hair (hirsutism), partial joining of the second and third toes, incurved fifth fingers, gastroesophageal reflux, seizures, heart defects, cleft palate, bowel abnormalities, feeding difficulties, and developmental delay missing limbs or portions of limbs, usually fingers, hands or forearms |
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Praeder-Willi Syndrome
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disorder of chromosome 15
Prevalence: 1:12,000- 15,000 (both sexes, all races) Major characteristics: hypotonia, hypogonadism, hyperphagia, cognitive impairment, difficult behaviors, small hands and feet, morbid obesity |
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Sotos Syndrome
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taller, heavier and have larger heads
sometimes called cerebral gigantism - distinctive head shape and size delayed motor, cognitive and social development low muscle tone speech impairment as child matures, many of these gaps narrow: the rate of growth slows down, muscle tone improves and with it speech and other motor skills improve. |
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Willliams Syndrome
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Characteristic facial appearance
Dev Delay, LD, ADD overly friendly (excessively social) musculoskeletal problems heart, blood vessel, kidney problems hypercalcemia , hyperacusis low birth-weight / low weight gain feeding problems irritability (colic during infancy) dental abnormalities , hernias |
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Trisomy 13
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severe MR
seizures microcphaly microphthalmia micrognathia scalp defects (absent skin) cleft lip and/or palate hypotelorism, iris defects low set ears simian crease on palms polydactyly hernias undescended testicle hypotonia limb skeletal abnormalities |
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Trisomy 18
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USUALLY DIE IN UTERO OR SHORTLY AFTER BIRTH
Heart defects: Kidney problems Intestinal problems Excess amniotic fluid (polyhydramnios) Clenched hands Pocket of fluid on the brain (choroid plexus cysts) Rocker bottom feet Delayed growth Small jaw (mycrognathia) Small head (microcephaly) Low-set ears Strawberry-shaped head Severe developmental delays Umbilical or inguinal hernia |
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Noonans Syndrome
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Developmental delay variable
Short stature Congenital heart defect Broad or webbed neck Unusual chest shape Apparently low-set nipples Cryptorchidism Ears low-set posteriorly rotated fleshy helices Eyes wide-spaced epicanthal folds thick or droopy eyelids Facial appearance striking in new born period & middle childhood, and more subtle in the adul |
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Turners Syndromw
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Only Females – one missing sex chromosome
Symptoms: Neck webbing, congenital edema, cardiac problems infertile, visual perceptual problems, short stature |
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Klinefelters Syndrome
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Males only - One or more extra x
chromosomes (XXY, XXXY, etc.) Symptoms: Learning disabilities Emotional and behavioral problems Tall, slim, hypogonadism, and infertile There is also an XYY syndrome Symptoms, may have: Mild MR, tremors, decreased coordination, radioulnar stenosis, behavior issues |
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What chromosome is 95% of the time affected in Down Syndrome
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Trisomy 21
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Tourettes Syndrome
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More common in boys than girls
Genetic (not completely understood) Neurologic and behavioral symptoms -may have: Involuntary vocal and motor tics (most characteristic symptom) Obsessive -compulsive behavior hyperactivity, distractibility, impulsivity |
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Tuberous Sclerosis
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rare genetic neurological disease
benign tumors in brain and other vital organs kidneys, heart, eyes, lungs, and skin other common symptoms include: seizures, mental retardation, behavior problems, and skin abnormalities may be present at birth, however can be subtle and full symptoms may take some time to develop three types of brain tumors associated : cortical tubers, form on surface of brain; subependymal nodules, form in walls of the ventricles; and giant-cell astrocytomas |
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Neurofibromatosis (von Recklinghausen’s disease
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Boys > girls
Causes multiple tumors (usually neurofibromas) on central and peripheral nerves, café au lait spots, and lesions in blood vessels and organs Symptoms: Mild MR or learning disabilities Speech disorders Hypertension, vision and hearing issues Musculoskeletal anomolies, short stature |
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Phenylketonuria (PKU)
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METABOLIC SYNDROME
Inability to metabolize phenylalanine Tested for at birth If untreated results in severe cognitive and behavioral disabilities Most common in Caucasian children |
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Tay-Sachs disease
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METABOLIC SYNDROME
Absence of enzyme, hexosaminidase A Common to Jewish people from Mediterranean region Results in death in childhood (can be tested for – both parents need to carry gene) |
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Galactosemia
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METABOLIC SYNDROMEI
nability to convert galactose into glucose Without treatment may result in reduced cognitive, perceptual problems, tremors, choreoathetosis, and ataxia |
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Lesch-Nyhan syndrome
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METABOLIC SYNDROME
Boys only – inability to metabolize purines Progressive neuromuscular condition resulting in MR, spasticity, and self mutilation |
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What are the four metabolic diseases?
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PKU
TAY SACHS DISEASE GALACTOSEMIA LESCH-NYHAN SYNDROME |
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Bayley Scale of infant development
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psychological test for IQ
Verbal, motor and behavior development 1 – 42 months |
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Stanford Binet Intelligent Scale
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psychological test for IQ
Verbal reasoning, visual reasoning, quantitative and short term memory. 11/2 years – adult |
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Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI – R)
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Information, similarities, arithmetic, vocabulary, comprehension, sentences, object assembly, picture completion, geometric design block design, animal pegs, mazes. Motor and processing.
3-7 years |
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Wechsler Intelligence Scale for Children – Third Ed (WISC –III
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Information, similarities, arithmetic, vocabulary, comprehension, digit span, picture completion, picture arrangement, block design, object assembly, symbol search, coding, mazes. Problem solving.
6 – 17 years |
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Leiter International Performance Scale – Revised (Leiter-R)
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Measures intelligence and cognitive abilities nonverbally
Removes language bias Shown not to have social or cultural bia |
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Anencephaly
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lack of developmentof brain in utero- baby does nor survive
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Encephalocele
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incomplete closure of the cranium resulting in the protrusion of the nervous tissue and meninges
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Dandy Walker Malformation
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Location of hydrocephalus
Progressive cystic enlargement of the 4th ventricle |
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Chiari II malformation
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Location of hydrocephalus
protrusion of cerebellar material into the foramen magnum |
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Syrinomyelia
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Location of hydrocephalus
Fluid filled cavity in the spinal cord |
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Symptoms of increased cranial pressure in infant and child
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infant: bulginf funtanelle and irritability
Child: headaches, vomitting, irritability, lethargy, strabismus, decreased vision |
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Treatment of Hydrocephalus
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implantation of a shunt
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OT treatment for hydrocephalus
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OT treats residual symptoms not the actual hydrocephalus and monitoring of the shunt for infections, clogging, kinking or displacement
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Spina Bifida
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Congenital defect of vertebral arches & spinal column
Most common in lower thoracic, lumbar, or sacral area |
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Symptoms fo spina bifida occulta
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Dimpling or pigmentation of skin or tufts of hair over lesion
Lipomas (soft moveable subcutaneous nodules) or tethering of the cord Mild motor impairment or bowel and bladder problems |
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Spina Bifida Cystica
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abnormality of the vertebra with protruding sac
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Meningocele
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meninges and CSF in sac occurs in spina bifida cystica
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Myelomeningocele
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nerve roots, meninges, and CSF in sac occurs in spina bifida cystica
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OT treatment for spina bifida
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Treatment of motor and sensory disturbances
Equipment and adaptations Skill training |
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A seizure is.... and its symptoms are....
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abnormal, unregulated electrical discharge that occurs within the brain‘s cortical gray matter and transiently interrupts normal brain function
Altered awareness / consciousness Abnormal sensations, Involuntary movements / convulsions |
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A generalized seizure....
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– involve both hemispheres and consciousness is usually lost
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Infantile spasms
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Last between 6 and 24 months. Result in developmental delay
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Absence seizure
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Momentary loss of awareness (may appear as blink, glazed look, abrupt cessation of an activity)
No aura or recovery period |
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Tonic-clonic seizure
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Aura or sensation followed by rigidity (tonic) then rhythmic contractions (clonic)
May last up to 5 minutes followed by sleep for few hours Usually incontinent |
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Atonic/akinetic seizure
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Loss of muscle tone
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Myoclonic seizure
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Contractions small groups
of muscles |
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OT treatment for seizures
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address resultant symptoms
education adn environmental modifications |
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Medical treatment of seizures
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medications
Ketogenic diet Surgery |
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Tachypnea
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Rapid breathing, often because of pulmonary congestion
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cardiomegaly
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enlarged heart
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cyanosis
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bluish discoloration of the skin, generally throughout the body, which indicates lack of oxygen
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congenital heart disease
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heart disease from birth
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acquired heart disease
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heart disease that develops later on in life
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Respiratory Distress syndrome
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Premature birth
Difficulty with O2 absorption Due to surfactant deficiency in babies born before 34 weeks |
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Bronchopulmonary dysplasia
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premature birth
Thickened airways and mucus production Usually due to mechanical ventilation needed at birth |
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hemophilia
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Prolonged clotting & excessive bleeding
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Osteogenises Imperfecta
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Hereditary collagen disorder resulting in brittle bones and loose joints (variation in severity)
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OT treatment for OI
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Protective equipment, splints
Education and lifestyle adjustment |
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Marfans Syndrome
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Excessive growth at the epiphyseal plates resulting in:
long thin arms, legs, fingers etc. Misalignment of joints and malformation of sternum Malformations of the aorta Ocular problems (myopia and detached retina |
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OT treatment for Marfans Syndrome
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OT treatment would be for
symptoms of poor coordination, postural stability, & scoliosis, as well as possible cardiac endurance issue |
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Achrondroplasia
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genetic form of dwarfism
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OT treatment for Achondroplasia
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OT treatment may be for pain associated with bone deformities or adaptations for independence in a taller world
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Arthrogryposis mutiples congenita
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Arthrogryposis means ‘curved or hooked joints’ & describes multiple joint contractures at birth
Abnormal development in womb caused by: Lack of movement Abnormal, nerve, muscle or connective tissue development Numerous fetuses A genetic disorder like spinal muscular atrophy or trisomy 18 |
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Most common form of arthrogryposis
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Amyoplasia
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Is cognition affected in arthrogryposis or amyoplasia
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No cognition is not affected
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OT treatment for Arthrogryposis
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Maintenance & increasing functional ROM & strength
Serial casts, surgery, splints, ROM exercises Adapted equipment & training for occupational performance in ADL’s, work, school, play and leisure |
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how do you dplint for congenital hip dislocation
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splinting in abducted and flexed position
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Congenital gip dislocation affects boys or girls more
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Girls
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A spica cast would be used for.....
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congenital hip dislocation
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Muscular Dystrophy
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Progressive degeneration of the surface and internal membranes of the muscle cells
Cause – genetic Symptoms – progressive muscle weakness |
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Most common muscular dystrophy and deadliest
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Duchennes
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Pseudohypertrophy
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large weak muscles due to fat deposits
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Beckers dystrophy
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mild form of duchennes muscular dystrophy
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OT treatment for Duchennes
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maintenance of function
compensatory and adaptations to maximize participation |
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Facioscapulohumeral muscular dystrophy
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Autosomal dominant
Usual onset between 7 and 20 years of age with slow progression (normal life expectancy) Is an infantile onset variety with rapid progression Symptoms – weakness of facial muscles and shoulder girdle Difficulty whistling, closing eyes and raising arms |
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OT treatment for Facioscapulohumeral muscular dystrophy
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maintenance of strength and function and compensation for weakness
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Emery-Dreifuss dystrophy
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Only males (females carrier)
Onset anytime before 20 Muscle weakness in biceps, triceps and distal leg muscles |
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Myotonic dystrophy
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Males and females
Onset adolescence or young adulthood Myotonia (delayed relaxation after muscle contraction), weakness facial and distal limb muscles |
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Congenital muscular dystrophy
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Any MD present at birth or first year
Usually present as ‘floppy’ baby |
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Developmental Coordination Disorder
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Also referred to in literature
Clumsy child syndrome Congenital maladroitness Specifically gross and fine motor problems No other primary diagnoses such as sensory or intellectual impairment May lead to secondary problems Academic Social Participation Often linked with speech and language disorders |
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Sensory Integrative Disorder
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Also known as Sensory Integrative Dysfunction or Sensory Integrative Problems
Hetrogeneous group of problems presumed to be due to subtle neural differences in using multisensory systems to produce an adaptive motor output Problems seen could involve skills in: Motor Sensory processing / modulation Behavior / Social Learning |
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Spasticity develops due to damage to the ?
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Motor cortex
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Spasticity
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Increased muscle tone
When attempt to move tend to use attractor patterns (primitive reflexes) Continued use of these patterns results in contractures in the agonists and weakness in the antagonists Maintain fixed stable postures but lack mobility |
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Ataxic
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Damage in cerebellum
Tremorous movements Have mobility but not stability Not usually at risk for contractures |
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hypotonia
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decreased muscle tone (floppy baby)
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Selective Dorsal Rhisotomy
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procedure for CP, surgical snipping of SOME of the sensory nerve roots
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OT treatment for CP
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Remedial and compensatory strategies for promoting maximum participation in areas of occupation including:
Development of sensorimotor skills Feeding Assistive technology ADLs, IADLs Family education and support |
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PT treatment for CP
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Remediation of sensorimotor skills
Mobility devices |
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Most common type of learning disorder
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Reading
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Most common neurobehavioral condition of childhood
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ADD/ADHD
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Symptoms of ADD
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Present before age 7
Present in 2 or more settings Causes impairment in functioning Not better accounted for by another mental disorder |
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Subtypes of ADD/ADHD
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Predominantly inattentive type
Predominantly hyperactive-impulsive type Combined type |
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Retts disorder affects males or females
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females only
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The hallmark sign of childhood disintegrative disorder
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Apparantly normal development for at least the first 2 yrs after birth then a significant loss of previously acquired skills before age 10
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ABA (applied behavioral analysis) therapy
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Intensive behavioral approach
One on one with trained worker Up to 40 hours per week Targets specific behavior – reward desired behavior Positives – literature shows success in training specific behaviors Criticisms – does not address socioemotional or sensory issues or generalize well |
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Developmental Individual-Difference, Relationship-Based Model (Floor Time)
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Goals of treatment are to develop social communication and emotional thinking
Developmental approach using interactive experiences, which are child directed in a low stimulus environment. Stages of Relating and communicating Engagement (Birth to 8 months) Two-way communication (6 to 18 months) Shared Meanings (18-36 months) Emotional Thinking (3 to 5 years) |
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SCERTS ModelSocial Communication, Emotional Regulation and Transactional Support
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Treatment goals
Social communication Enhance capacities for joint attention Enhance capacities for symbol use Emotional regulation Enhance capacities for self-regulation Enhance capacities for mutual regulation Enhance capacity to recover from dysregulation Transactional support Educational and learning supports Interpersonal supports Family support Support among professionals |
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TEACCH
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A structured teaching approach used in North Carolina school systems
Structured teaching strategies individualized according to the strengths, skills, interests and needs of each child Elements Physical structure Daily schedule Work systems Routines Visual structure |
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Miller Method Language and Cognitive Development Center (Boston, Mass.)
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Theorize children with ASD have system-forming disorders.
Development of body-world awareness combining motor cognitive and communicative strategies Treatment goals are to expand the child’s systems by keeping the child on task and transforming stereotypic behaviors into functional interactions Associated equipment = platforms, Swiss cheese boards and large swinging balls Use symbol accentuation reading program and American sign language to teach communication |
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Son-Rise ProgramOptions Institute
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Option process = loving as non-judgmental method for resolving unhappiness and discarding self-limiting beliefs
Institute offers training for families to provide home based program No scientific studies |
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Sensory Integration
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Intervention to improve nervous system function.
Provide the child with enhanced levels of sensory information during physical activities that are meaningful to the child and that elicit adaptive behaviors Key terms Artful vigilance Child-centered approach Adaptive response Just right challenge |
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Holding therapy
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Child is held by parent in attempts to make contact with child.
During holding attempts are made to make eye contact and verbal connections Child’s is held whether their response to the contact is positive or negative Has been criticized as traumatic |
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Facilitated Communication
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Hypothesis that individuals with ASD have a motor deficit that prevents them from expressing themselves but possess sophisticated symbolic language
Trained facilitators hold individual’s hand, wrist or arm to help them spell on message board or keyboard Peer-reviewed, empirically-based research studies have not supported this approach |
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Berard approach
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Auditory integration
retrain the auditory system by correcting hearing distortions Music modified and filtered Listening 30 minutes, twice/day for 10–12 days |
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Tomatis Approach
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Auditory integration
improve listening and communication skills directly Classical music and nature sounds Over 6-12 months, 100 hours in 8 hour ‘loops |
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Fast Forward
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Auditory integration
discrimination of phoneme differences at increasing speeds |
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Vision therapy
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Optometrists who practice vision therapy may use lenses, prisms, filters or occlusion to help with attention problems in focusing
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Educational KinesiologyBrain Gym
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Designed by Dr. Dennison (educator) to improve sensory function by enhancing neuropathways
Used in school setting by entire classes Drink lots of water Prescriptive exercise routines with names like: Brain buttons Cross crawls Hook ups |
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HigashiDaily Life Therapy
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Developed by Dr. Kitahara for school program for individuals with ASD in Japan
Focuses on physical exercise, arts and vocational training No known research studies |
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Interactive GuidingAffolter Approach
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Use of tactile and kinesthetic input (hand over hand guiding) to facilitate initiation of activities
Nonverbal Initiated and removed by therapist as needed |
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Priming
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Breaking down and practicing a task in advance of using it in a situation
Provides familiarity with tools and routines in advance to allow more attention to the salient features of the in class task |
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Picture Exchange Communication System (PECS)
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Augmentative communication system
Child hands an adult a picture of an object or activity they want. The physical handing of the picture is designed to develop communicative initiation No verbal prompts are given. However as the child hands the picture language is attached “oh you want a _______” |
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Token Systems
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Visual, tangible and predictable system of positive reinforcement
Can be modified for more immediate or delayed gratification |