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Neurological Disorders Affecting Developmental Delays

Youth development
by

Pablo Davila

on 1 May 2014

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Transcript of Neurological Disorders Affecting Developmental Delays

Normally diagnosed in early childhood
May be diagnosed when person exhibits both multiple motor & one or more vocal tics (need not be concurrent)
Based on observations and family history
Diagnosis
Identification
Neurological Disorders Affecting Developmental Delays
Reviewing the Nervous
System

Neurological Disorders
The brain, spinal cord, and nerves are susceptible if compromised or disrupted by:

Genetic disorders
Congenital abnormalities
or disorders
Infections
Traumatic injury to the
brain, spinal cord, or nerves
Environmental problems, such as malnutrition
Causes of
Neurological Disorders
Sudden, repetitive, non-rhythmic (motor tics) and utterances (phonic tics), that involve discrete muscle groups. Motor tics are movement-based tics, while phonic tics are involuntary sounds produced by moving air through the nose, mouth, or throat.
Gilles de la
Tourette Syndrome
(Tourette's)
Two or more involuntary epileptic seizures,

in which the brain has an irregular electrical discharge, identified by the periodic sudden loss or impairment of consciousness, often accompanied by muscle spasms (convulsions).

Epilepsy
A collection of motor impairments (paralysis or palsy) that affects voluntary movement and posture.
Cerebral Palsy
and Spasticity

A condition in which there is an excessive amount of cerebrospinal fluid (CSF) in the brain.
Previously known as "water on the brain."
Excessive amount of CSF abnormally widens cerebral ventricles, which creates potentially harmful pressure on brain tissue.
Causes: congenital or acquired
Hydrocephalus
By: Pablo Davila, Bich Do, Ellen Garibaldi, Matthew Pasillas

Berg, A. (2011) Epilepsy, cognition and behavior: the clinical
picture. Epilepsia, 52, 7-12.

Centers for Disease and Control, National Center for Chronic Disease Prevention and
Health Promotion. (2011)

Decoufle P, Autry A. Increased mortality in children and adolescents
with developmental disabilities. Pediatr Perinat Epidemiol. 2002;16:375-382.

Essner, B. S., & Holmbeck, G. N. (2010). The impact of family, peer, and school contexts
on depressive symptoms in adolescents with spina bifida. Rehabilitation Psychology, 55(4), 340-350. doi:10.1037/a0021664

F.Parkes, J., & Hill, N. (2010). The needs of children and young
people with cerebral palsy. Paediatric Nursing, 22(4), 14-19.

Freeman, J.M., Vining, E. P., G., & Pillas, D. J., (2002). Seizures and Epilepsy in
Childhood A Guide (3rd ed.). Baltimore: The John Hopkins University Press.

Helder, E. J., Austria, E., Lacy, M., & Frim, D. M. (2011). Behavioral outcome in
congenital shunted hydrocephalus without spina bifida. Journal Of Pediatric Neurology, 9(1), 41-47.

Sillanpaa M, Jalava M, Kaleva O, Shinnar S. Long-term prognosis of
seizures with onset in childhood. N Engl J Med. 1998;338:1916-1918.

U.S. Department of Health and Human Services, National Institutes of Health, National
Institute of Neurological Disorders and Stroke. (2007). Spina Bifida Fact Sheet (NIH Publication No. 07-309). Retrieved from http://www.ninds.nih.gov/disorders/spina_bifida/ detail_spina_bifida.htm

U.S. Department of Health and Human Services, National Institutes of Health, National
Institute of Neurological Disorders and Stroke (2008). Hydrocephalus Fact Sheet (NIH Publication No. 08-385). Retrieved from http://www.ninds.nih.gov/disorders/ hydrocephalus/detail_hydrocephalus.htm

U.S. National Library of Medicine, National Institutes of Health, National Center for
Biotechnology Information, PubMed (2011). Hydrocephalus (A.D.A.M. Medical Encyclopedia). Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002538/
References
Chapman University
Identification & How it Delays Development
Educational Relevance & School-Based Interventions
Spina Bifida
Muscular Dystrophy
Exact cause unknown
Majority of Tourettes are inherited
Exact mode of inheritance unknown
(motor)
-eye blinking
-grimacing
-head jerks
-foot stamps
-shoulder popping

(vocal)
-throat clearing
-making clicking sounds
-repeated sniffing
-yelping
-shouting

Therapy can help people with TS deal with what's going on, and cope with stress
Relaxation techniques (OT)
Involvement in sports, exercise & hobbies to focus mental and phsical energy
Continuing education for teachers to undertand the challenges of TS
TS makes it hard for children and teens to carry conversations or pay attention in class
Able to suppress for short time, but tension builds up eventually needs to be released
a genetic disorder that weaken the muscles that help the body move. It is characterized by progressive skeletal muscle weakness, defects in muscle protein, and the death of muscle cells and tissue.
Infants
Unusually large head or rapidly increased head circumference
Stretched or swollen veins
Vomiting
Drowsiness
Irritability
Eyes that gaze downward ("sunsetting")
Seizures
Older Children
Their skulls cannot expand to accommodate CSF in the way infants can.
Headaches
Vomiting
Shrill or high-pitched cry
Blurred or double vision
"Sunsetting" of the eyes
Excessive sleepiness
Lethargy
Irritability and changes in personality
Loss of bladder control
Muscle spasms
Problems with balance and coordination
Memory loss
Slowing or loss of developmental progress
Intellectual disability
Treatments
1. Shunt System
Surgical operation in which a shunt, a plastic tube, diverts the flow of CSF to another part of the body (often the abdominal cavity) where it can be absorbed.
May require a number of operations throughout lifetime, due to maintenance or infection.
2. Endoscopic Third Ventriculostomy
Limited number of individuals
Surgery that makes a small hole in third ventricle to allow CSF to flow to absorbing area around the surface of the brain.
Estimated to affect 1 in every 500 births in the U.S. (National Institutes of Health, 2008)
Children with hydrocephalus have varying degrees of delays in cognitive, physical, speech, and social-emotional development.
Vision problems, impaired memory and executive controls, learning difficulties.
Special Education or General Education with modifications.
Speech and Language Therapy
Physical Therapy and Adaptive P.E.
Occupational Therapy
Targeted interventions in writing, reading, math
Behavioral Therapy
Counseling
A neural tube defect caused by the failure of the fetus's spine to close properly during the first month of pregnancy.
Infants born with spina bifida may have an open lesion on their back where significant damage to the spinal cord and nerves has taken place.
This damage can result in varying degrees of paralysis in the lower limbs
Exact causes of spina bifida are unknown, but current research indicates low levels of folic acid before and during early pregnancy may play a role.
Identification & How
it Delays Development
Epileptic Seizures
Different types:
Mylomeningocele
Closed neural tube defects
Meningocele
Occulta
When the baby is born:
Protrusion of the spinal cord or meninges
Redness, patch of hair, or dimple at the back of the pelvis
Loss of sensation
Partial or full paralysis of lower limbs
Bowel and bladder complications
Abnormal feet or legs (e.g., a clubfoot)
Hydrocephalus
Meningitis
Later in life:
Difficulty breathing
Frequent urinary tract infections
Sleep disorders
Treatments
There is no cure for spina bifida as the nerve damage has already taken place in the womb.
Surgery should be performed within 24-72 hours after birth to close the spinal opening and minimize the chance of infection.
Surgery while the baby is in the womb to close the spinal opening. Hope is to stop or minimize nerve damage. Experimental and may lead to complications such as premature birth.
Other treatments include surgeries, medication, and physical therapy.
Children with paralysis may need wheelchairs, crutches, leg braces, catheters or other bladder assistance tools.
Seizures vary in type, severity and intensity

Alters consciousness, movement, sensation, or behavior

People can have seizures and not be diagnosed with epilepsy.
Educational Relevance
& School-Based Interventions
Estimated that between 1,500 to 2,000 babies are born with spina bifida each year in the U.S. (National Institutes of Health, 2007)
Many children born with spina bifida have typical cognitive development and average intelligence.
504 plan due to physical and self-care constraints
Children with both spina bifida and hydrocephalus may have significant delays in cognitive, physical, language, and social-emotional development
Physical Therapy and Adaptive P.E.
Behavioral Therapy
Counseling
Disordered movement and posture.
Non-progressive brain lesion or malformation.
Involvement of the immature or developing brain.
Brain lesion or malformation that may result in an altered clinical presentation over time
Diagnosis
Congenital
Acquired
Development Delay
Motor impairment and significant physical disability in childhood.
Educational Relevance
Severity of the disorder will determine level of assistance.
The child with treatment and support might improve the capabilities, increasing motor function and independence.
School Based Interventions
For full support and better prognosis.
Physical therapy
Medication
Speech therapy
Counseling
Special education
Classifying Epileptic Seizures
Generalized
Seizures
Focal Seizures
Tonic-Clonic (Grand-mal):
Goes stiff, jerks, falls, convulsions
Excessive saliva, possible loss of bowels

Tonic:
Goes stiff and falls

Clonic:
Jerking movements of arms and leg
Myoclonic: jerks of muscle group (neck, shoulders, upper arms)

Absence (Petit-mal):
Typical: 10-20 seconds of staring or blinking, unaware of surroundings
Atypical: 5-30 seconds of blinking or jerking of the lips

Atonic:
Sudden loss of muscle strength
Anywhere from eyelids drooping to falling to the ground
Neurons
Electrical and chemical signals received by dendrites passed along the axon, fueled by myelin and passed to the synapse to other cells
Neurotransmitters
Deficient neurons
Temporal lobe:
Most common type of focal seizure
Change in feelings, emotions, and thoughts

Frontal lobe:
Weakness in certain muscles
Usually occurs during sleep

Occipital lobe:
Visual symptoms: rapid eye blinking, seeing patterns, flashing lights and colors

Parietal lobe:
"Sensory seizure"
Sensations such as tingling or warmness (often on one side of the body)
Educational Relevance
Delaying Development
Physical:
Brain injury
Motor/fine motor loss/impairment
Speech Language loss/impairment
Muscle loss/impairment

Emotional:
8-48% prevalence of depression (CDC, 2011)
52.3% affected by anxiety disorders (CDC, 2011)
Fear of when and where the next seizure will occur

Cognitive:
One out of four children with epilepsy will have a learning disability (Berg, 2011)
Cognitive dysfunction (difficulties with memory, attention, processing, concentration)
School Based Interventions
The Nervous System is made up of two parts: the central nervous system, which includes the brain and the spinal cord; and the peripheral nervous system, which includes the nerves.
Evolution of the brain
Lesions in the brain, malformations, insufficient oxygen.
When the body's nervous system (brain, spinal cord, or nerves) experiences structural, biochemical, or electrical abnormalities.

Common symptoms include paralysis, muscle weakness, loss of sensation, seizures, confusion, pain, and varying levels of consciousness.
Symptoms
According to the Centers for Control and Prevention (2011):

Epilepsy affects about 2.3 million Americans

Estimated 10% of people will experience a seizure in their lifetime

Of the 10% experiencing seizures, 1 in 26 will be diagnosed with epilepsy

Causes are unknown in 2 out of 3 people, but some known conditions and events that may lead to epilepsy are:
oxygen deprivation, brain infections, traumatic brain injury or head injury, stroke, brain tumors, some genetic disorders.
Causes
Educational Relevance
Interventions
1. Epilepsy Management
Classroom plan: Ensure students understand
facts and plan to help students with epilepsy
Nurses: Administering Ketogenic diet,
Antiepileptic drugs, Emergency plan

2. Learning and Behavioral Interventions
Special Education, Phsyical Therapy, Occupational Therapy, Speech/Language Therapy, Visual Impairment Teacher, Adaptive PE

3. Whole-school Psychosocial Interventions
Extension of Project Uplift
A program for preventing depression
Take Charge of the Facts
An epilepsy awareness program and curriculum
designed to educate [pre]teens 11-18.
Deal or no Deal...
(But You Have to Choose Deal!!!!)
SYMPTOMS

-progressive muscle wasting
-poor balance
-drooping eyelids
-atrophy
-scoliosis
-inability to walk
-frequent falls
-calf deformation
-limited range of movement
-respiratory difficulty
-joint contractures
-cardiomyopathy
-arrhythmias
-muscle spasms
CAUSES

-generally inherited
-mutations of the dystrophian gene and nutritional defects at the prenatal stage are also possible in about 37% of people with MD
DIAGNOSIS

-based on the results of muscle biopsy, increased creatine phosphokinase, electromyography, electrocardiography
EDUCATIONAL RELEVANCE

-young men with MD experience planning and organizational difficulties
-children with MD experience emotional and behavioral problems
-weakening of certain muscles and joints make communication difficult in classroom environment
-teens with MD face challenge of wanting independence while simultaneously becoming more physically dependent
SCHOOL INTERVENTIONS

-supportive seating
-transportation services
-physical and occupational therapy
-counseling
-speech therapy
-adaptive P.E. services
-assistive technology
-note taking (recording, computer)
-extra time between classes
-assistive aide
EASYSTAND BANTAM
While seizures may begin at any age, children and the elderly are most susceptible.
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