Lecture 6

1. Lecture 6 Developmental Disabilities P020A

2. Course Objective #36 • Describe the cause and symptoms in the child suffering from the following types of malnutrition: • Kwashiorkor • Marasmus

3. Malnutrition • Body does not get enough nutrients.

4. Causes of Malnutrition • Inadequate diet • Problems with digestion or absorption • Medical conditions

5. Malnutrition Kwashiorkor Marasmus Rickets Pellegra -these are the most severe forms of malnutrition

6. Kwashiorkor • Not enough protein  in the diet.

7. KwashiorkorOccurrence World -Wide U.S.A. Weaning • Famine • Limited food supply • Low levels of education

8. Kwashiorkor • When kwashiorkor does occur in the United States, it is usually a sign of … • child abuse and severe neglect

9. Kwashiorkor Severe Mild △ skin pigment h muscle mass Diarrhea i grow Fatigue Hair △ • infections • Irritability • Hepatomegaly  Ascites • Lethargy • Dermatitis • Edema

10. KwashiorkorDx test • BUN • CBC • Creatinine clearance • Serum creatinine • Serum potassium • Total protein

11. KwashiorkorTreatment h Calories & protein • 1st • Calories • Slowly • 2nd • Protein • Lactose free

12. KwashiorkorPrognosis • “Children who have had this condition will never reach their full potential for height and growth” • May be permanent • Mental & physical problems

13. KwashiorkorPrevention • Diet • Carbohydrates • Fat • 10% total cal. • Protein • 12% total cal.

14. Marasmus • Overall calorie deficiency

15. MarasmusS&S • Tissue wasting • Stunted growth

16. MarasmusTreatment • Slowly h calories

17. What is the difference? Kwashiorkor Maramus i protein and calories • iprotein

18. Ricketts • Deficiency of Vitamin D

19. RickettsS&S • Bone deformities

20. RickettsTreatment • Vitamin D • Sunlight

21. Pellagra • i Niacin • (B complex vitamin)

22. PellagraS&S • Scaly dermatitis • Inflamed mucosa • Mental disturbances

23. Pellagra • + Niacin into diet

24. Course Objective #37 • Differentiate between the following forms of cerebral palsy: • Spastic • Dyskinetic • Ataxic • Mixed

25. Cerebral Palsy • Disorder of movement, balance and posture • Results from a non-progressive lesion in the • Cerebellum

26. Cerebral Palsy (CP) • Motor problems • May also have… • cognitive impairments, • seizures • sensory loss

27. Cerebral Palsy (CP) • h in neonatal care  • h survival of very low birth weight babies • > risk of CP

28. Cerebral Palsy (CP) • ~ ½ of all CP is found in birth weights less than 5 ½ lbs.

29. Cerebral Palsy (CP) • most often attributed to perinatal injury • Prenatally • Postnatally

30. Causes of CP: Prenatal: -infections -exposure to teratogens -maternal-fetal blood incompatibilities -faulty implantation of ovum

31. Causes of CP: Perinatal: -asphyxia* -intra-cranial bleeding

32. Causes of CP: Postnatal: -infection -brain abscess -head trauma -kernicterus

33. Types of CP Classified by variations in motor symptoms Spastic* Dyskinetic Ataxic Atonic Mixed

34. Spastic CP • -#1 • lesion located in pyramidal tract • “spasticity” • movement is slow, effortful, restricted • occasionally jerky and explosive

35. Spastic CP Further sub-typed by limbs affected: -all four limbs = quadriplegia -two like limbs, mostly legs = diplegia -three limbs = triplegia -legs only = paraplegia -limbs on one side only = hemiplegia -one limb = monoplegia

36. Spastic CPclassified by severity • Mild: May lack only fine motor movements, have awkward gait, arms out for balance • Moderate: problems with fine and gross motor and speech • Severe: unable to walk, use hands, or speak

37. Extrapyramidal CP -AKA Dyskinetic CP • Refers to one of the two nerve tracts in the brain that control movement • Impairment in muscle tone and a variety of abnormal motor patterns and postures

38. Extrapyramidal CP --movements are uncontrolled and without purpose -movements disappear with sleep and increase with stress

39. Extrapyramidal CP Types of movement: • Athetosis* • slow, wormlike, writhing. • If movements are jerky • choreic & choreoathetoid

40. Extrapyramidal CP Subtypes • Rigidity • Movement is impeded • Resistance

41. Extrapyramidal CP Subtypes • Tremor • Rhythmic & pendulum-like

42. Ataxic CP • 7% of all CP • disorder of balance / incoordination • lesion is in the cerebellum

43. Ataxic CP -gait is unsteady -wide-based gait -

44. Ataxic CP -hand movements awkward with tendency to under or over reach -difficulty with repetitive finger movements or rapid turning

45. Atonic (Hypotonic) CP -Usually hypotonic at birth and persists beyond 2-3 yrs. -usually develops incoordination, ataxia, difficulty with rapid movements -cognitive impairment can be severe -can also develop into athetoid form by age 3

46. Mixed Form CP -combination of movement disorders -most common mix is spasticity and athetosis -less common is ataxia and athetosis

47. CP Associated Disorders • Speech Impairment may be the most disabling aspect of the disorder ~ 2/3 of people with CP are speech impaired

48. CP Associated Disorders 2) Intellectual Impairment -assessment of intelligence is difficult due to impairment in movement -ataxia & athetoid types less affected -spastic type more affected -mixed type greatest affected

49. CP Associated Disorders 3) Perceptual Disorders • visual, visual-motor, tactile, auditory • ADD / ADHD

50. CP Associated Disorders 4) Health Problems • seizures • orthopedic deformities • UTI • Respiratory difficulties • Eye abnormalities • hearing loss