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Definition: A neurodevelopmental disorder that is diagnosed on behavioral and developmental characteristics. Can have deficits in social interaction and social communication. Also restricted, repetitive patterns of behavior, interests, or activities

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Genetics: Rate of autism in siblings is at 1 in 80 chance of having ASD. Researchers are unsure of how/what genes play into the disorder, but estimates are from 4-20. Also, different manifestations of ASD have different genetic factors.

Neurological Structure and Development: About half of children with ASD have abnormal electroencephalograms. Have smaller and fewer Purkinje cells (noticeably in cerebellum). Cells are less densely packed in the limbic systems. Frontal cortex made of smaller and more isolated cells.

Environmental Factors: Some studies show that biomedical treatments have rid the child's body of toxins and have cured them of autism. But, the more severe the autism, the less likely for these treatments to work. Environmental factors can lead to better or worse prognosis, it is not the cause of the disorder.

The Study to Explore Early Development (SEED) is the largest U.S. study looking at factors that put children at risk.

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Social interactions and the ability of the person to accept and adapt to changes in the environment are affects of ASD. There are 5 diagnostic criteria.

1. Persistent deficits in social communication and social integration: Social-emotional reciprocity, nonverbal communication behaviors used in social interactions, developing, maintaining and understanding relationships.

2. Restricted, repetitive patterns of behavior, interests, or activities with the presence of at least 2 observation categories: stereotyped or repetitive motor movements, use of objects, or speech; insistence on sameness, inflexible adherence to routines, or ritualized patterns of behavior; highly restricted, fixated interests of abnormal intensity or focus; or hyper- or hypo-reactivity to sensory input.

3.Symptoms are present during early development.

4. Symptoms cause significant functional impairment.

5. Ruling out other possible explanations for the symptoms.

3 Severity levels:
Level 1: Requires support. Social communication: noticeable impairments in initiating and maintain social interactions. Inflexible behaviors interfere with functioning in one or more situations.

Level 2: Requires substantial support. Social communication: deficits apparent even when support systems in place. Restricted, repetitive behaviors are significant. Distress caused when change is required.

Level 3: Requires very substantial support. Severe deficits in social communication: very limited initiation and minimal response to others. Restricted, repetitive behaviors are extremely inflexible.

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Common: epilepsy, sleep disorders, hyperactivity, anxiety, and depression.

Sensory processing dysfunctions: 3 types.
1. Sensory over-responsivity: the brain not able to inhibit sensations effectively. Melt-downs are regular because they cannot control how their brain responds to stimuli

2. Sensory under-responsivity: React less intensely to sensory info than normally developing individuals. Takes more neural activity to have a response to something.

3. Sensory seeking: need more intense sensory input. Exhibit high levels of self-stimulation.
Most with ASD have a mixed sensory processing disorder.

Cognitive impairment: people with ASD are visual learners. Because of this they often times process information slowly.

Self-injurious behavior: any behavior that is self-inflicted and causes physical injury to the individual.

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Joint attention intervention: teaching a child to respond to the nonverbal bids of others or to initiate joint attention interactions ( pointing to objects, showing items to someone, following eye gaze).

Schedules: Use lists to complete activities. Mode of communication can be verbal, written, or visual.

Self-management: promote independence by training individuals to regulate their own behavior by recording occurrence/non-occurrence or the target behavior and using self-selected motivational strategies for achievement.

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Definition: Exhibiting significant sub-average intellectual functioning, existing concurrently with deficits in adaptive behavior, manifested during the developmental period. *Most common type of developmental disability*

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5 general categories:
1. Genetic conditions: chromosome abnormalities, errors in the combining or grouping of genes, damage to genetic material during pregnancy because of overexposure to X-rays or other factors.

2. Problems during pregnancy: malnutrition, illness.

3. Problems at birth: oxygen deprivation, birth injuries, low birth weight, prematurity.

4. Problems after birth: lead or mercury poisoning, head injuries, diseases.

5. Poverty and cultural deprivation: greater risk for malnutrition and disease, exposure to environmental hazards.

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Effective Recreational Therapy Interventions for ID

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Effective Recreational Therapy Interventions for ID

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Functional Skills: A child with ID, severe and profound ID - Addressing normal physical growth and developmental patterns (head control, upper extremity coordination, sitting balance, object manipulation). A person with moderate cognitive impairment - activities that develop coordination (strength, find motor skills). A person with mild ID - social skills training during community integration.

Social skills should be addressed through recreational activity (role modeling and practice, rehearsal techniques).

Education, Training, and Counseling: Allow the client to pick recreation activities that they enjoy, Activity and task analysis should be used for ease of skill development and instruction. Encourage the client to explore surroundings and make decisions about what they can do, who they can ask to join in, how they can secure necessary equipment and supplies, and how to identify the best location. To maximize levels of independence individuals with ID benefit from training in activities of daily living.

Community Integration: encourage to develop the skills necessary to negotiate the community with the greatest possible amount of independence. TRS should make sure client knows of recreation resources in their community, activity rules and equipment, costs associated with activity participation, appropriate clothing and apparel, as well as knowledge of how to access facilities.

Health Promotion: physical exercise has show improvement in physical, mental, and emotional functions in people with ID. People with ID lack motivation so the TRS should help encourage them to get involved.

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Definition: A group of conditions due to an impairment in physical, learning, language, or behavior areas.

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Importance of Timing of a Diagnosis of a Sensory Impairment

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Importance of Timing of a Diagnosis of a Sensory Impairment

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Congenital: present at birth.

Acquired: appears later in life.

A persons social and emotional aspects of their life can be effected. For example, if someone who has been able to hear all their lives starts losing hearing as they get older can feel isolated when they do not understand what their friends are saying. A child who was born with hearing loss could struggle learning how to communicate without the help of an interpreter or a cochlear implant.

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Caused by noise, aging, disease, and heredity. Illness and certain medications can also cause hearing loss.

For about 25% of babies born with a hearing loss the cause is unknown. Another 25% is due to maternal infections during pregnancy, complications after birth and head trauma. For about 50% it is due to genetics (such as Down or Usher).

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Types:
1) Conductive Hearing Loss - caused by something that stops sounds from getting through the outer or middle ear. Can be treated with medicine or surgery.

2) Sensorineural Hearing Loss - occurs when there is a problem in the way the inner ear or hearing nerve works.

3) Mixed Hearing Loss - includes both a conductive and a sensorineural hearing loss.

4) Auditory Neuropathy Spectrum Disorder - occurs when sounds enters the ear normally, but because of damage to the inner ear or the hearing nerve, sound isn't organized in a way that the brain can understand.

Degrees:
1) Mild Hearing Loss - a person may hear some speech sounds but soft sounds are hard to hear.

2) Moderate Hearing Loss - a person may hear almost no speech when another person is talking at a normal level.

3) Severe Hearing Loss - a person will hear no speech when a person is talking at a normal level and only some loud sounds.

4) Profound Hearing Loss - a person will not hear any speech and only very loud sounds.

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Functional Skills: focus on communication, social skills and relationships, and use of assistive technology. For communication skill development - expressive and receptive skills, increased awareness of environmental needs. Social skills and relationships may include increasing vocabulary, increasing ways to communicate. For technology - training in selection or use of devices.

Education, Training and Counseling: Programs used - domestic life skills, money management, job skills, communication and social and interpersonal skills, advanced self-care skills, leadership, leisure skills, meal preparation and cooking, communication awareness and reintegration.

Community Integration: Municipal parks and recreation departments can helps. Schools and community recreation providers can collaborate to meet the needs of children. Allowing a person to not have constraints in physical education programs can enhance activity involvement.

Health Promotion: Minimizing exposure can help. Examples are decreasing recreational noise exposure, decreasing problems from job-related hearing loss, and targeting the use of portable entertainment devices. Among people with hearing loss there is a need for help with behavioral health. Do not overlook mental health in a person with hearing loss. Just because a person can not communicate how they are feeling does not mean they are not struggling.

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Normal eyesight has a visual acuity of 20/20, which means that an individual with normal vision can see small details at 20 feet away. A person with a visual acuity of 20/50 can see the same detail at 20 feet away that a person with normal eyesight can see from 50 feet away. The definition of legal blindness is a visual acuity of 20/200.

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Ocular visual impairments: caused by diseases or conditions affecting the eye.

Cortical visual impairments: caused by injury or structural differences in the brain. Diagnosed when there is and eye exam that is either normal or cannot explain the degree of diminished functional vision, a history of significant congenital or acquired brain injury or neurologic disorder, and the presence of the unique visual behaviors associated with CVI.

Common eye diseases that cause visual impairment and blindness: Refractive Errors (near-sightedness, farsightedness, distorted vision at all distances, loss of close vision), Age-Related Macular Degeneration (retinal eye disease that results in damaged sharp and central vision), Cataract (clouding of the eye's lens), Diabetic Retinopathy (leading cause of blindness in US, progressive damage to the blood vessels of the retina), Glaucoma (occurs with either normal eye pressure or a rise in the normal fluid pressure resulting in damage to the optic nerve), Amblyopia (the brain and eye do not work together, "lazy-eye"), Strabismus ( imbalance in the positioning of the 2 eyes causes a lack of coordination between the eyes), Diplopia (double vision, monocular and binocular), Visual Field Impairment (lack of awareness of one side of the environment or loss of vision in a specific area of the visual field), Quality of Vision Impairments (night blindness, hypersensitivity to daylight, color blindness, floaters, stray lights, seeing stars or flashes).

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Functional Skills:
Orientation and mobility - provide people with effective descriptive information about various environments, or use the sighted guide technique.
Self-care - developing adaptive skills and behaviors.
Communication - put hand out first to shake hands, work on eye contact like following the person's voice.
Reading - different forms may be needed like large print, Braille, audio, or digital formats.
Facilitators and barriers - identification of environment facilitators, physical environment, support and relationships, attitudes, services, systems, and policies.

Education, Training, and Counseling:
Americans with Disabilities Act - provide education to facilitate awareness of civil and legal rights regarding access to facilities and programs.
Leisure counseling - provided as needed to facilitate psychosocial adjustment and optimal participation that promotes health and quality of life.
Lifestyle - education about physical inactivity patterns and obesity are important.
Adaptive technology - teach effective use of assistive technology products to facilitate participation and independence in home, work and community settings.
Compensatory strategies - training for visual impairments, like labeling the color of clothing for color vision impairment.
Assertiveness training - facilitates asking for assistance, seeking directions and responding effectively to diverse people and situations.

Community Integration:
Community functioning - teach clients how to move around, ask for directions, access goods and services, problem solving, and use of assistive technology.
Transportation - address the client's skill and comfort level with accessing and using transportation.
Safety - teach clients how to deal with emergencies and safety issues.
Equipment - provide information and training for equipment to facilitate independence in the community, example would be a long cane, GPS unit, or cell phone.

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Basic Information Regarding Duchenne's Muscular Dystrophy 

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Basic Information Regarding Duchenne's Muscular Dystrophy 

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MD is a group of diseases caused by defects in a person's genes.

Over time, muscles weakness decreases mobility and makes the tasks of daily living difficult.

MD can run in the family, but may not.

In 2007 15 out of every 100,000 males aged 5-24 were affected by DMD.

Males are more likely to be affected by DMD.

DMD muscle weakness normally begins before the age of 5.

Upper arms and upper legs show muscle weakness first in DMD.

Brain, throat, heart, diaphragm/chest muscles, stomach, intestines, spine can all be affected by DMD.

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Basic Information Regarding Cerebral Palsy 

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Basic Information Regarding Cerebral Palsy 

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A group of symptoms and neurological disorders that appear in early childhood and infancy.

The effects of CP vary in each person depending on the severity of the damage to the brain.

There are 4 types of CP:
Spastic CP - muscles are stiff and can be permanently contracted, muscles are tight and tone is increased.
Athetoid or Dyskinetic CP - slow, uncontrolled movements usually in extremities and face; low muscle tone; frequently dysarthria; intelligence is rarely affected.
Ataxic CP - balance and depth perception most affected; poor coordination; unsteady side-based gait.
Mixed - combination of any of the above types; combination of high and low tone or stiffness and involuntary movements.

One of the most common motor disability affecting children.

Systems affected will vary depending on the severity of CP and the location of the brain injury.

Systems affected include: nervous system, skeletal system, muscular system, digestive system, respiratory system, urinary system.

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Difficult to diagnose due to variations that occur in milestone achievement.

Typically diagnosed in the early developmental years, normally by 18 months but sometimes up to 3 years.

Primary observed indication of CP include developmental delays, like the inability to grasp, sit up, or crawl.

Other signs include changes in muscle tone from low (hypotonia) to high (hypertonia), abnormal posture, and retained early childhood reflexes.

About 70-80% of CP cases occur prenatally and are caused by genetic conditions, infection, maternal bleeding or seizures, abnormal brain development, lack of oxygen, stroke and intrauterine growth restriction.

New research is showing a link between CP and abnormalities with the placenta.

Less than 10% occur during birth. Causes are breech position, infections, lack of oxygen, stroke, multiple births, and jaundice.

The remaining cases occur within the 1st years of life due to head injury, viral or bacterial infections affecting the central nervous system, seizures, motor vehicle accidents, and child abuse.

Children born prematurely ( earlier than 37 weeks) or with a low birth weight (3.5 pounds or less) are at the greatest risk for CP.

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Additional disabilities commonly occur with CP. They include:
Intellectual Disability - the most common secondary disability in CP.
Epilepsy or Seizures - 35-50% with CP also have epilepsy or seizures.
Both Intellectual Disability and Seizure Disorder - occurs in about 25% with CP.
Behavioral Problems - about 25% with CP including attention-deficit/hyperactivity disorder, dependency, oppositional defiance disorder, and general hyperactivity.
Learning Disabilities - about 40% with CP.
Sensory Impairments - 15-62% children with CP have vision impairments, about 6% have a hearing impairment and 75% develop strabismus (lazy eye). Adults 25-39% have vision problems and 8-18% have hearing problems.
Feeding Difficulties and/or Malnutrition - includes choking, long feeding time, need for gastric tube, underweight, sucking problems, swallowing, and silent aspiration.
Lung Problems - about 35% experience a pulmonary infection in a 6 month period.
Chronic Pain - back, foot, ankle, knee and shoulder pain, as well as headaches.
Autism - about 9% of the CP population.
Inadequate or Low Levels of Physical Fitness
Balance Issues
Fatigue and Cardiovascular Disease - may be related to low fitness levels.
Musculoskeletal Problems - weakness, contractures, arthritis, kyphosis, osteoporosis, scoliosis, osteopenia, decreased range of motion.
Difficulty Processing Stimulation - including over or under-response to auditory, tactile, and visual stimuli; impacting ability to manipulate objects.
Incontinence
Speech Difficulties - most common being dysarthria.
Drooling - due to swallowing disorder.
Breathing Difficulties - due to impaired postural control.
Skin Breakdown
Contractures
Problems with Spatial Awareness - due to decreased sense of position of a part of their body.
Depression or Distress

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Functional Skills:
Exercise/Stretching/Fitness
Aquatic Therapy
Hippotherapy - the use of a horse as part of an integrated treatment strategy performed by health professionals.
Therapeutic Horseback Riding - conducted by non-therapist riding instructors and assistants based upon their training and knowledge of the riders' disabilities and of methods for safely using therapy-trained horses.
Therapeutic Massage

Education, Training, and Counseling:
School Setting - developing friendships, improving self-concept and/or self-esteem, transitioning from school to community or workforce, enhancing communication skills, reinforcing daily living skills, developing social skills, utilizing decision making skills, reinforcing motor skills, facilitating coping skills, and providing opportunities for self expression.
Adaptive Sports
Community Integration Skills and Resources - accessibility (playgrounds, parks, public buildings, community programs, transportation, and activity adaptation), advocacy (inclusive environments, accessible facilities, and increased opportunities for participation), and removal of barriers.
Mobile Devices as Adaptive Equipment - iPad, Apps.
Leisure and Health Education
Relaxation and Coping Skills

Community Integration and Inclusion:
Social Skills and Inclusion
Participation and Inclusion
Advocacy Skills

Health Promotion:
Adaptive Sports - downhill skiing, basketball, swimming, archery, dance, biking, yoga.
Animal Assisted Therapy
Volunteerism
TR Camping Program

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Diplegia: only legs are impacted.

Hemiplegia: only half of the body is impacted, usually one side of the body in both extremities.

Quadriplegia: both upper and lower extremities are impacted; may also include facial and trunk muscles.

Ataxia: poor muscle coordination.

Dysarthria: difficulty coordination the muscles needed for speech.

Spasticity: muscles are continuously contracted.

Contractures: shortening and hardening of muscles, tendons, or other tissue.

Osteopenia: low bone density.

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Basic Information Regarding Spinal Cord Injury

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Basic Information Regarding Spinal Cord Injury

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A SCI occurs when the spinal cord is damaged as a result of trauma, disease, or disorder. When the spinal cord is damaged, communication is interrupted and can result in temporary or permanent loss of movement and/or sensation.

Damage to the spinal cord or nerves is what is meant by SCI, not damage to the vertebrae.

Primarily affects younger adults, but can affect any age.

Causes:
Trauma (main cause), Tumor, Transverse Myelitis, Guillain-Barre Syndrome.

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Classified by level of injury and type of injury.

Level of Injury:
To determine the level of injury, several tests are performed to asses the vertebral column and spinal cord including x-rays, computerized tomography scan, and magnetic resonance imaging. Followed by a neurological exam to determine the level of injury and type of impairment.
To determine motor function, the individual is instructed to actively move each limb or joint in all possible ranges to determine motor function deficits. While assessing the range of motion, the evaluator also asses the strength of muscles using a modified Manual Muscle Exam (MME). The scoring criteria is - Normal (N or 5) 100% functionality, Good (G or 4) 75% functionality, Fair (F or 3) 50% functionality, Poor (P or 2) 25% functionality, Trace (T or 1) 10% functionality, Zero (0) 0% functionality.

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Type of Injury:
The neurologic exam is the primary method to determine the extent of spinal cord impairment (complete or incomplete). If no motor or sensory function below the level of injury, it is referred to as a complete SCI. Some motor and/or sensory function below the level of injury, it is referred to as an incomplete SCI. An incomplete SCI can be the result of a contusion to the spinal cord, a displaced bone, or edema. If the source of the pressure is identified early than surgery and/or traction can be used. Recovery is unpredictable and varies widely. The ASIA Impairment Scale provides further classification of type of injury and provides 5 impairment grades. Complete SCI = ASIA A with no motor or sensory function below the injury level. Incomplete SCI = ASIA B (has sensory but no motor function below injury level), C (has motor function below injury level and more than half of key muscles have a muscle grade of 0-2), D (has a motor function below injury level and at least half or more of key muscles have a muscle grade of 3 or more) depending on functional presentation. A client who had previous motor and/or sensory deficits but now exhibits no deficits is an ASIA E.

Types of Paralysis and Related Function:
SCI is primarily divided into 2 types: tetraplegia which results from injury C1-C8, and paraplegia which results from injury to T1-S5. Both can be broken down into complete and incomplete.

Clinical Syndromes:
Anterior Cord Syndrome - Damage to the anterior portion of the spinal cord or a reduction in the vascular supply to the anterior portion of the spinal cord, resulting from compression, dislocation of a vertebra, or a cervical disk protrusion. Results in loss of pain sensation, temperature sensation, and motor strength; proprioception, vibration, and the sense of touch are preserved.
Central Cord Syndrome - Damage in the central area of the spinal cord, result of hyperflexion injuries in the cervical spine, congenital injuries, or degenerative narrowing of the spinal canal. Characterized by greater neurological impairments in the upper extremities than the lower extremities.
Posterior Cord Syndrome - Damage to the posterior portion of the spinal cord and/or its vascular supply, commonly resulting from posterior impact injuries where the cord is compressed as a result of forces from hyperextension. Results in loss of proprioception, as well as the sense of vibration and deep touch.
Brown-Sequard Syndrome - Damage to one lateral side of the spinal cord, frequently caused by a stab or gunshot wound, which results in the loss of voluntary motor control, sensation and decreased reflexes at the same dermatome level on the side of the damage to the cord. May display a lack of superficial reflexes, clonus, and a positive Babinski sign. Contra-lateral side of the SC may display a loss of pain and temperature sensation for several dermatome segments below the LOI.

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Autonomic Dysreflexia or Hyperreflexia - During an episode the presence of a negative stimulus triggers a sympathetic response surge that cannot be moderated by the parasympathetic system secondary to the damage caused by the SCI. Symptoms include pounding headache due to high blood pressure, stuffy nose, profuse sweating, goose bumps, change in vision, feeling flushed. Can suffer a stroke or death if the source of irritation is not alleviated. Most common cause is a bladder issue. Others include impacted bowel, irritation to the skin, sunburn, a pressure sore, ingrown toenail, pressure from sharp object.

Pressure Ulcers - Since most individuals with SCI have impaired sensation below the LOI, the brain cannot tell the body to move and relieve pressure from body parts and restoring blood flow. Can result in a life threatening bone infection. There are 4 stages:
1. a red spot or discoloration at the site of the sore, no break in skin.
2. open sore created by the breaking of top layer of skin.
3. wound continually deepens, breaks through second layer of skin to underlying fat tissue.
4. breakdown reaches fat tissue to the underlying muscle and can affect the bone.

Respiratory Complications - injuries to the upper thoracic and cervical spinal cord impact the respiratory muscles that aide in taking deep breaths and in coughing, leading to a wide occurrence of respiratory complications in individuals with SCI. Pneumonia and atelectasis are complications.

Spasticity or Spastic Hypertonia - interruption of messages to the reflex center of the brain may result in the overcompensation of the spinal cord reflex system, leading to spasticity.

Temperature Regulation - a complete SCI will be impacted by thermoregulation issues. SCIs above T6 will be most impacted.

Heterotopic Ossification - the growth of new bone in soft tissue areas. Most likely to occur in the hips, knees, and shoulders. Can decrease rang of motion and contractures.

Deep Vein Thrombosis - occurs when a blood clot forms in a vein, most commonly in the lower extremities. If not treated, can travel to the lungs.

Orthostatic Hypotension - a decrease in systolic blood pressure of more than 20 mm Hg and/or a decrease in diastolic blood pressure of more than 10 mm HG when changing from the supine to an upright position. Can result in dizziness, lightheadedness, possible fainting or brief loss of consciousness, fatigue, headache, nausea, pallor, perioral and facial numbness and blurred vision.

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Tetraplegia: paralysis of all four limbs. Formally called quadriplegia.

Paraplegia: paralysis of the legs and lower body.

Complete vs. Incomplete Injury: Complete =  no motor or sensory function below the level of injury. Incomplete = some motor and/or sensory function below the level of injury.

Autonomic Dysreflexia: a life threatening rise in blood pressure that can occur in individuals with a LOI at or above T6 when there is a negative stimulus within or outside of the body below the level of injury.

Pressure Ulcer: the result of pressure build up on the skin in a particular area, haltering the flow of blood to that area causing the skin to die

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Pressure Ulcer: also known as bed sores. Wounds caused by unrelieved pressure on the skin.

Incontinence: lack of control over urination or defecation. 5 categories - continent, usually continent, occasionally incontinent, frequently incontinent, total dependence.

Delirium: onset is rapid (hours or days) and can fluctuate during the day, can be traced to another acute medical condition, and the patient often returns to pre-delirium functioning after the condition is resolved. Deficit in attention and an additional deficit in cognition found in any of the other domains.

Dementia: a group of symptoms that interferes with daily living.

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Predominant Age: early onset - before 65 years old, late onset - after 65 years old. Early onset is uncommon.

Causes: characterized by plaques forming in the brain. They destroy brain cells, creating progressive deterioration of higher cognitive functioning in the areas of memory, problem solving, and thinking. An inability to carry out everyday tasks or perform instrumental activities of daily living. Can be caused from other medical conditions, genetics, biological and environmental risk factors, age, lifestyle factors (alcohol abuse, smoking, high fat diet), lack of social support, lack of mental stimulation, stress, depression.

Systems Affected:
Complex Attention: mild case - the patient takes longer than they used to for tasks. May need to double check more often, find thinking easier when there are fewer other things competing for attention. Major deficits - being easily distracted by other events to the extent of not being able to function. Input needs to be simplified to be understood. Simple information may not be remembered. Mental calculations are not possible and all thinking takes longer.
Executive Function: mild NCD is diagnosed when the person requires increased effort to complete multistage projects; has trouble resuming a task after and interruption; requires extra effort to organize, plan, pr make decisions; and/or finds large social gatherings more taxing because of increased effort required to follow shifting conversations. Major NCD - abandon complex projects, need to focus on one task at a time, and rely on others to plan instrumental activities of daily living or make decisions.
Learning and Memory: mild NCD - trouble recalling recent events, increased reliance on list making, trouble keeping track of characters in a movie or novel, some repetition of stories within a couple of weeks. Major NCD - repeats within the same conversation, cannot keep track of even a short list of items when shopping, requires frequent reminders to stay with the task at hand. Except in severe forms of NCDs, the person's early memories and implicit memory are preserved.
Language: mild - noticeable word finding difficulty and general terms are substituted for specific terms, may not use the names of acquaintances, subtle grammatical errors in articles, prepositions and auxiliary verbs. Major - significant difficulties with both expressive and receptive language, general terms are often used and general pronouns are used instead of names, names of close family and friends are forgotten, may stop speaking.
Perceptual-motor Abilities: mild - relies more on maps and directions to get places, can get lost more easily, has problems with spatial tasks. Major - present more of the same kind of difficulties to the point where previously familiar activities become a problem, confusion can increase at dusk when the light levels change perceptions.
Social Cognition: mild - subtle changes in personality, behaviors, or attitudes. There is less ability to read facial expressions or recognize social cues. Also changes in the way the person relates to others, often with less inhibition. Major - behavior clearly outside of acceptable range, can include insensitivity to dress, religious views, or sexual behaviors. An inability to react appropriately to cues from others during discussion or when doing things with them. Safety in not a consideration in decisions, has little insight into the changes that have taken place.

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Lewy Body Neurocognitive: An umbrella term for Parkinson's Disease NCD and NCD with Lewy Bodies.

2 Related Diagnoses:
Parkinson's disease NCD: Requires the criteria for a major or mild NCD and an insidious onset and rapid progression. Must also be associated with established Parkinson's disease.

NCD with Lewy Bodies: requires the criteria for a major or mild NCD and an insidious onset and gradual progression. Likely to be fluctuating cognition with pronounced variations, recurrent visual hallucinations, spontaneous features of parkinsonism that show up after the onset of cognitive decline, rapid eye movement sleep disorders, and/or severe neuroleptic sensitivity.

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Programs are designed while considering therapeutic goals, the person's age and personality style, stage of the disease, cognitive and physical function, behavioral problems, and the individual's leisure interests and skill level. People with NCDs will benefit the most from self-selected activities that promote a sense of personal expression. People with NCDs usually have a low rate of participation in activities partially due to their physical and cognitive decline. To increase participation consider past and current leisure interests. The Farrington Leisure Interest Inventory is commonly utilized. Past interests may be too difficult. Focus on personality style since this influences interests. Social and creative experiences may benefit those who are more extroverted. Cooking, gardening, and reading programs may be better for introverted people. The Neurodevelopmental Sequencing Program describes the processes of intervention programs for people with NCDs, including the design, the resources needed to deliver it and the implementation procedures. The purpose of the NDSP is to improve the quality of life of individuals with NCDs through the enhancement of physical and psychosocial abilities as they relate to recreation participation. The results of the treatment need to be measured to know how effective the program was.

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Can cause a large amount of stress on family members.

Can cause strain on their physical well-being, financial status, and emotional well-being.

Family may gain patience.

If family can help increase the family member with NCD quality of life, then the family's quality of life can increase.

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PTSD: Classified as Trauma- and Stressor-Related Disorders. The essential feature of post-traumatic stress disorder is the development of characteristic symptoms following exposure to one or more traumatic events.

Causes: Can include surviving a traumatic event or injury, witnessing other persons being injured or killed, the sudden unexpected death of a loved on

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Mood and ability to cope effectively with ongoing stressful events, even events that most people would not experience as stressful.

Diminished interest in significant activities, recurring distressing recollections and/or dreams of the event, feeling separate from others, negative beliefs concerning the future.

Can affect a person's social functioning.

Cognitive difficulties can be poor concentration and focus.

Can affect the brain structure known as the limbic system (may account for difficulties concerning emotional learning).

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Increased risk for agoraphobia, obsessive-compulsive disorder, social phobia, specific phobia, MDD, somatization disorder, substance-related disorders.

80% more likely than those without PTSD to have symptoms of at least one other mental disorder.

At risk for panic disorder and suicidal feelings and thoughts.

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5 Categories of Symptoms for Schizophrenia 

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5 Categories of Symptoms for Schizophrenia 

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1. Delusions: Several types include Persecution (belief that someone or some organization intends to harm the client), Referential (belief that certain gestures or environmental cues are directed at the client), Grandiose (belief he/she has exceptional abilities), Erotomanic (belief that someone is in love with him/her), Nihilistic (belief in impending destruction), Somatic (belief about health).

2. Hallucinations: Auditory is the most common. Hallucinations that occur when falling asleep or waking are considered normal. May also be normal in some religious contexts.

3. Disordered Thinking and Speech: To be disordered the speech must be disordered enough to substantially impair communication. Some aspects are switching topics in ways that the listener can't follow and giving answers that are not related to the questions that are asked. Aspects of disordered thinking can be memory deficits, delayed recall, difficulty accessing vocab, difficulty to plan, impairments in organizing info, problems attending to single or multiple tasks.

4. Motor Behavior: Diagnosed when the behavior interferes with activities of daily living or other goal-directed behaviors.  Catatonia includes behaviors such as resistance to instructions, rigid or bizarre postures, lack of response, purposeless and stereotyped movements (grimacing, staring, echoing of speech).

5. Negative Symptoms: Something seems to be missing from the person with SSD. Diminished emotional expression (demonstrated when their is less emotion than normal in interactions with others; also called flattened affect) and avolition (decrease in or a lack of motivation). Other negative symptoms include alogia, asociality, anhedonia.

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No known cause for SSD.

Genetics play a role in development  of SSD.

Structure and chemical composition of the brain contribute as well. More likely to have enlarged ventricles, possibly related to tissue deterioration,  and less activity in frontal cortex. Chemical imbalances, specifically dopamine.

Environmental factors like living in environmentally stressful settings (urban settings). Low SES have high rates of SSD. Immigrants also have high rates of SSD.

Psychosocial factors like families with deviant styles of communication and express emotion frequently.

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Cognitive Functioning: Symptoms of delusion and disordered thinking and speech. Impairments in receiving, processing, and initiating conversation. Planning, problem solving, initiating tasks, managing multiple tasks, organizing info, and fine motor skills.

Perceptual Functioning: Most common area of functional impairment. Positive symptoms like sensory hallucinations. Can be experienced in all 5 sensory areas.

Emotional Functioning: Negative symptoms involve blunted or flattened affect. Anhedonia may be experienced as well.

Social Functioning: Asociality (another negative symptom) affects the individuals ability to empathize with others. Amotivation in social situations affects an individual's motivation and ability to initiate behavio

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Hallucination: Vivid perceptions of something that is occurring in the real world, even though nothing is causing the perception.

Delusion: Beliefs that the client will not change even though they are contradicted by evidence in the current situation.

Psychosis: Thought and emotions are so impaired that contact is lost with external reality.

Anhedonia: Inability to experience pleasure.

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Definition and Symptoms of Major Depressive Disorder 

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Definition and Symptoms of Major Depressive Disorder 

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Can occur as a single episode or as a recurrent condition and range in intensity from mild to severe. MDD is a pervasive disorder, and even when the onset is triggered by situational factors, the person with MDD displays symptoms that are more severe than would be expected by such triggers.

Symptoms: MDD lasts at least 2 weeks while manifesting at least 5 of the following symptoms
1. Depressed mood
2. Diminished interest or pleasure in most or all activities
3. Significant unintentional increase or decrease in weight or appetite.
4. Lack of sleep or sleeping excessively
5. Psychomotor changes noticed by others
6. Fatigue and/or loss of energy
7. Feelings of guilt and/or worthlessness
8. Diminished cognitive abilities
9. Recurrent thoughts of death

Subtypes: Psychotic Features; Catatonic Features (immobility, extreme agitation, extreme negativism, peculiarities of voluntary movement, echolalia or echopraxia); Melancholic Features; Atypical Features; Seasonal Patterns

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Significant diminish in quality of life, and lost work productivity, cognitive and emotional impairment.

Symptoms can negatively impact short-term and long-term relationships, as well as existing social supports.

MDD can disrupt daily activities through symptoms of amotivation and lethargy, less energy for dealing with issues, and low self-efficacy.

Basic self-care can be neglected, weight gain or loss may also occur as a result.

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Frequently co-occurs with many physical and mental health conditions. Seen at higher rates among people with chronic pain, illness, disability, and cardiovascular disorders.

Co-occur with anxiety, substance abuse, eating disorders, dementia, and personality disorders.

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Definition of Generalized Anxiety Disorder

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Definition of Generalized Anxiety Disorder

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Characterized by excessive and uncontrollable worry about everyday things more days than not for at least six months. The anxiety also manifests in physical symptoms including muscle tension, sweating, nausea, gastrointestinal problems, jumpiness, fidgeting, trembling, inability to relax, being easily startled, trouble sleeping, and feeling on edge.

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Affects the mental functions of the person including mood, cognition (trouble concentrating, difficulty learning new info and behaviors, misperception of events an situation, poor short-term memory, difficulty with abstract thinking), and social functioning.

Also affects various systems in the body through the influence of the client's emotional state. Motor functioning is affected and causes shakiness, restlessness, headaches, gastrointestinal system, cardiovascular system, heart palpitations, respiratory systems, shortness of breath, autonomic nervous system, excessive sweating.

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Why is Gambling Disorder considered an Addictive Disorder?

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Why is Gambling Disorder considered an Addictive Disorder?

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Gambling Disorder is considered to be an addictive disorder because evidence suggests that gambling affects the brain reward system in a way that is similar to substance abuse.

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Behaviorally Conditioned Problem Gamblers: recalling first big win and then become conditioned to "chase losses", cycle continues. Creates a belief that the person has control over the outcome or viewing losses as near wins so there is a want to keep trying.
Experience anxiety, depression, and substance use and abuse.
Tend to have lower levels of gambling problems and are more likely to comply with treatment than those in the other 2 subgroups.

Emotionally Vulnerable Problem Gamblers: often develops similarly to the behaviorally conditioned group.
Differs by being characterized by pre-existing vulnerabilities, such as anxiety and/or depression, poor coping, and problem-solving skills, as well as negative family experiences and life events.
Attracted to gambling to meet psychological needs and reduce emotional states.
More likely to have other mental health disorders including addictive behaviors and affective disorders.
Less likely to respond to treatment and are unlikely to be able to gamble in non-problematic ways.

Antisocial, Impulsive Problem Gamblers: more likely to have predisposing psychological and biological factors.
Believed to have neurological and neurochemical dysfunctions, as well as features of impulsivity, attention deficit disorder and antisocial personality.
Tend to have more psychopathology.
More likely to report parents with substance abuse and antisocial problems.
More likely to report early exposure to substance and gambling behaviors.
Unlikely to seek treatment options and does not comply with treatment.

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Systems Affected and Secondary Problems of Gambling Disorder

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Systems Affected and Secondary Problems of Gambling Disorder

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Systems Affected: Preoccupation with gambling activity, often to the extent of interfering with occupational and/or social functioning.
"Chasing behavior" - betting larger sums of money or taking greater risks in order to undo or make up for previous losses.
Cognitive processes become irrational, believe they have control over gambling behavior and outcomes.
Thoughts become preoccupied with various elements of gambling. Can impact all other domains of life (self, family and work).
Impacts relationships (lying, stealing, fraud, forgery, embezzling).
Emotional difficulties (depression, inability to cope, feeling of spiraling out of control).
Substance misuse.

Secondary Problems: Social/relationship difficulties (separation and divorce), occupational difficulties, criminal behavior, antisocial behavior, financial troubles, affective and/or substance-related disorders, suicide

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Anorexia Nervosa: Refusal to maintain body weight at or above a minimally normal weight for height, body type, age and activity level; intense fear of weigh gain or being fat; feeling fat or overweight despite dramatic weight loss; extreme concern with body weight and shape; and loss of menstrual periods in girls and women post-puberty.

Bulimia Nervosa: Recurrent episodes of eating large quantities of food in short periods of time, often secretly, without regard to feelings of hunger or fullness, and to the point of feeling out of control while eating; following those binges with some form of purging or compensatory behavior to make up for excessive calories taken in (self-induced vomiting, laxative or diuretic abuse, fasting, exercise).

Binge-Eating Disorder: Similar to bulimia nervosa including frequent episodes of eating large quantities of food in short periods of time without regard to feeling of hunger or fullness; feeling out of control during binges; eating large quantities of food rapidly without really tasting the food; eating along; feelings of shame, disgust, or guilt after a binge; NO purging or compensatory behaviors.

Pica: Persistent eating of nonfood or nonnutritive substances that is developmentally inappropriate and is not supported by any particular cultural or social practice.

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Genetics: tend to run in families. Estimated that 50-80% of eating disorders are caused by genetics.

Biological Issues: Serotonin may be an influence of eating behaviors. Restricting food intake, bingeing, purging have been shown to alter brain structure, metabolism, and neurochemistry.

Psychological or Interpersonal Issues: May develop or be triggered as a result of searching for control, coping with stress or trauma, personality factors, family issues, low self-esteem, feeling of inadequacy, or lack of control in life, depression, anxiety, anger, stress, loneliness, troubled personal relationships, difficulty expressing emotions and feelings, a history of being teased or ridiculed based on size or weight, or history of physical or sexual abuse.
May have pre-existing psychological and emotional problems.
May be triggered by an inability to mourn and/or cope with death, loss, or abandonment.

Social/Societal Issues: Peer pressure and what people see in the media may cause a want for thinness. This occurs often among young girls.

Cultural Issues: Cultures that glorify "thinness" or muscularity place a high value on obtaining the "perfect body," have narrow definitions of beauty that include only specific body weights and shapes.

Obesity Prevention Programs: 30% of parents of children aged 6-14 who participated in a school-based childhood obesity prevention program observed behaviors in their children that are commonly seen in eating disorders.

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Nutritional Issues: nutritional and caloric intake, eating patterns, eliminated or taboo foods, food rituals, using food inappropriately to deal with a crisis.

Cognitive Issues: denial of illness, severe body image issues, perfectionism, challenges with the need for control, issues with escape or avoidance thoughts and behaviors.

Emotional Challenges: anxiety, depression, decreased self-esteem and self-worth, inability to express or cope with anger.

Physical Challenges: dehydration, low blood pressure, osteoporosis, stomach and digestive complications, arrhythmias, tearing of the esophagus.

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Medical Issues: cardiac arrhythmia, cardiac arrest, brain damage, osteoporosis, infertility, and death.

Almost 50% of people with an eating disorder meet the criteria for depression.

Women who are pregnant and have a eating disorder are at increased risk for premature labor, low birth weight babies, cardiac irregularities, stillbirth or fetal death, gestational diabetes, miscarriage, preeclampsia, complications during labor, respiratory difficulties, abnormal fetal growth, increased risk of cesarean birth, difficulties breast-feeding, postpartum depression, anxiety or panic attacks,low self-esteem, poor body image, suicidal ideations, withdrawal or social isolation, lack of enjoyment in hobbies or activities, marital or family conflicts.

Medical Issues that co-occur with AN: bone loss, difficulties with temperature regulation, loss of menstrual periods, low heart rate, low blood pressure, anxiety, depression, social  isolation, perfectionism.

Medical Issues that co-occur with BN: electrolyte imbalance, esophageal ulcers, tooth decay, anxiety, depression, substance use, difficulties with impulse control.

Medical Issues that co-occur with BED: gastric problems, obesity, obesity-related conditions, anxiety, depression, substance use.

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Familial, Social, or Cultural Factors: Problems with substance use is more likely when a person's primary family, social, and/or cultural network tolerates, approves, and/or models substance abuse and related behaviors. Shifts from family to friends during adolescence and early adulthood.

Personality Factors: More likely in those experiencing depression, high levels of stress, challenges in self-regulating behavior, and/or having poor coping skills.

Cognitive Factors: Substance use produces a positive effect that reinforces the continued or increased use of substances, particularly if the individual also has positive expectancies related to the effects of the substance.

Genetic Factors: A person who has a parent with a substance use problem is at a greater risk for developing a substance use problem even when social factors are controlled for.

Biological Factors: Particular neurotransmitters (dopamine and serotonin) affect the reward pathways of the brain. Substance use can artificially influence the function of the neurotransmitters to the extent that it becomes difficult for the reward system of the brain to be stimulated naturally.

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Systems Affected by Substance Related Disorders

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Systems Affected by Substance Related Disorders

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Substance use exists on a continuum. Hazards and consequences of use are not universal and harmful involvement with one substance does not necessarily lead to harmful involvement with another.

All substances have different effects.

Physical Health Concerns: illness, injuries, hyperactivity of the autonomic nervous system, physical damage to the body.

Mental Health Concerns: anxiety, depression, loss of motivation, anger, agitation, irritability.

Social Health Concerns: strained or unhappy relationships with the possibility of a breakdown, as well as problems at work or school.

Cognitive Health Concerns: short-term confusion, learning problems, memory loss. In rare cases hallucinations, and delusions are possible.

Additional Problems: poor impulse control, poor judgement, poor sleep quality with frequent disruptions, insomnia.

Lifestyle Issues: financial instability, unemployment, homelessness, traffic accidents, conflict with the law, food insecurity, poor nutritional intake, poor dental hygiene.

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Secondary Problems of Substance Related Disorders

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Secondary Problems of Substance Related Disorders

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Others Affected: May impact those around them, including family, friends, co-workers and classmates. Can include personal, physical, or emotional harm. May experience isolation, social life restrictions, dissatisfying relationships, public embarrassment, a disruption of routines or family celebrations, feelings of shame, anger and resentment, the burden of multiple roles or changing roles, depression, guilt or responsibility, changes in physical health, financial instability, violence.

Concurrent Disorders or Dual Diagnosis: More than 50% of those seeking help for their substance use also have a mental illness. Treatment for those experiencing concurrent disorders can be complicated and complex; frequent relapse and reoccurring crises tend to be the norm. Also may experience higher rates of unemployment, relationship difficulties, social anxiety, poverty, homelessness, social marginalization and conflict with the law.

Other Disorders Associated with Substance Use: anxiety disorders, attention-deficit/hyperactivity disorder, mood disorders (MDD, bipolar disorder, dysthymia, cyclothymia), psychosis (schizophrenia).

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Disease that affects the arteries in and around the brain

Occurs when a blood vessel that carries oxygen and nutrients to the brain ruptures or is blocked by a clot

Lack of oxygen causes brain cells in parts of the brain affected to die

The damage results in neurological impairments. Impairments depend on the part of the brain damaged

Delay in treatment can create more severe damage

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Helps us remember the signs of a CVA

Face drooping - one side of the face can become numb or droop. Ask the person to smile to determine if face is drooping

Arm weakness - one arm may be weak or numb. Have them lift both arms and pay attention to if one starts drifting down

Speech difficulty - slurred speech or being unable to speak. Ask the person to repeat a simple sentence like "the sky is blue"

Time to call 911 - if a person is exhibiting any of these signs call 911 and get them to the hospital asap

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The side of the brain that is damaged bu the CVA affects the symptoms that the client shows

Left CVA - right hemiplegia, language deficits, slow and cautious behavior style

Right CVA - left hemiplegia, visual deficits, quick and impulsive behavior style

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1 or more of the following 3 problems with the vascular system are the primary causes of strokes:
1. may be caused by a blood clot that develops in the brain and blocks blood flow (called thrombosis and is main cause of ischemic strokes)
2. blood clot may originate elsewhere in the vascular system and travel to the brain, becomes lodged and blocks blood flow (called an embolism and is another main cause of ischemic strokes)
3. blood vessel breaks or ruptures, causes bleeding in the brain (called a hemorrhage and causes intracerebral hemorrhagic strokes and subarachnoid hemorrhage strokes)

Common strike risk factors: hypertension, high cholesterol, heart disease, sleep apnea, smoking, alcohol use, heart rhythm disorders, drug use, and body weight above the recommended BMI

Risk factors for women: pregnancy and post-menopause

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Main systems affected are an individual's motor, sensory, cognitive, language, and visual functions

Motor Impairments: hemiplegia, motor planning, muscle power, muscle tone, reflexes, balance, gait, apraxia, and coordination. Most common impairments. Most often seen in face, arms, and/or legs

Sensory Impairments: decreased sensory awareness, numbness, tingling, astereognosis, agraphia, and processing problems

Cognitive Impairments: decreases in consciousness functions, calculation abilities, attention, concentration, problem solving, organizing, perception, orientation, time management, planning, judgement, and safety

Language Impairments: dysphasia in comprehension, reading, writing, decrease in expression and reception of language

Visual Impairments: double vision, depth perception problems, field cuts

Can also affect emotions, personality, sexual function, bowel and bladder function

Common post-stroke physical effects include seizures, paralysis, incontinence, spasticity, pain, dysphagia, fatigue

Common post-stroke emotional effects include depression, reflex crying, memory challenges, one-side neglect

Common post-stroke cognitive effects are dementia, aphasia, apraxia, diminished short-term and long-term memory

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Secondary Problems Associated with a Stroke

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Secondary Problems Associated with a Stroke

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More common secondary problems and limitations include inactivity, lack of independence and participation, post-stroke depression, emotional lability

Inactivity can affect an individual's work performance, academic performance, community involvement, and social relationships

Post-stroke depression is identified as irritability, trouble sleeping, low self-esteem, fatigue, and withdrawal

Emotional lability is the rapid transition from emotional highs to emotional lows with no apparent provocation

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A form of acquired brain injury that occurs from a direct trauma to the brain.

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Classified as mild, moderate, or severe depending on the extent of damage to the brain.

Mild TBI is also called concussion or minor brain injury. Occurs when an impact or forceful motion of the head results in a brief alteration of mental status, such as confusion or disorientation, loss of memory for events immediately before or after the injury, or brief loss of consciousness. Individuals are classified as having a mild TBI if they have a Glasgow Coma Scale score of 13-15 and have symptoms of headache, fatigue, sleep disturbance, irritability, sensitivity to noise or light, balance problems, decreased concentration or attention, decreased speed of thinking, memory problems, nausea, blurry vision, dizziness, depression, anxiety, emotional mood swings, and/or seizures. Frequently people who sustain a mild TBI fail to recognize the potential severity of their injury and do not receive medical care at the time of injury. Symposiums may persist days, weeks or months after the injury.

Individuals are classified as having a moderate TBI when there is a loss of consciousness, along with persistent confusion and functional impairments in 1 or more of the cognitive, physical, emotional, or behavioral domains, along with a GCS score of 8-12.

Individuals are classified has having a severe TBI when there is a prolonged unconscious state or coma with a GCS score less than 8.

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Primary system affected is the brain.

Common impairments can include:

Physical changes - weakness, muscle tone and coordination problems, full or partial paralysis, balance difficulties, and/or fatigue

Cognitive changes - impairments in arousal and attention, initiation, memory, problem solving, judgment, organization and planning, time management, abstract reasoning, insight, reading, writing, language, communication, new learning, confabulation

Emotional and behavioral changes - difficulty with social skills, such as an inability to empathize with others or poor pragmatics, inappropriate or self-centered behavior, disinhibited behavior, irritability, agitation, frustration, flat affect, depression, anxiety

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Anoxic Injury - results from an absence of oxygen to the brain

Hypoxic Injury - results from a decrease of oxygen to the brain

Cranial Nerve Dysfunction - injury to 1 or more of the 12 cranial nerves after a TBI causing impairments in taste, smell, visual, auditory, or vestibular function

Edema - swelling and excess fluid in the brain

Hematomas - collection or pooling of blood that can increase intracranial pressure. 3 types: 1. subdural hematoma (blood vessels rupture between the brain and the dura) 2. epidural or extradural hematoma (blood vessels rupture between the dura and the skull) 3. intracerebral or intraparenchymal hematoma (bleeding within the brain itself)

Hydrocephalus - occurs when cerebral spinal fluid accumulates in the brain resulting in dilation of the cerebral ventricles and an increase in intercranial pressure

Heterotopic ossification - formation of bone where bone does not usually form in soft tissues

Seizures - post-traumatic, recurrent, and epilepsy are known complications of TBI. May develop immediately, within 24 hours, or more than one week after the injury

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Diabetes: complex disease that occurs when insulin production is too low or when the body is unable to effectively use the insulin it produces because of defects in the insulin receptors.

Type 1: Insulin dependent diabetes mellitus and juvenile-onset diabetes are called T1D. The immune system destroys the pancreatic beta cells that make insulin.

Type 2: Non-insulin dependent diabetes mellitus and adult-onset diabetes are T2D. Most common form. The body does not produce enough insulin or the cells cannot use the insulin properly so there is a build-up of glucose in the bloodstream.

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Type 1: caused by an autoimmune disease, predominantly hereditary, that attacks and destroys beta cells in the pancreas. Viruses, infections, and foods are thought to trigger the autoimmune reaction.

Type 2: triggered by a combination of genetic, personal, and environmental factors. Heredity seems to play a role. Personal factors include obesity, being middle-aged, physical inactivity, high blood pressure, bad cholesterol levels, polycystic ovary syndrome, prediabetes, acanthosis nigricans, history of cardiovascular disease, lack of physical activity.

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Hypoglycemia: blood sugar becomes too low. Symptoms include shakiness, dizziness, sweating, hunger, headache, pale skin color, sudden moodiness or behavior changes, clumsy or jerky movements, seizure, difficulty paying attention, confusion, and tingling sensations around the mouth. Clients are taught to test their blood sugar levels and to eat something that will help raise their glucose levels.

Hyperglycemia: blood glucose becomes too high. Can be caused by injection of too little insulin or when the body isn't using insulin effectively. Signs and symptoms include high levels of sugar in the urine, frequent urination, and increased thirst.

Ketoacidosis: a serious condition where excess ketones and acidosis develop because of faulty carbohydrate metabolism. When carbohydrates can't be used for fuel, the body metabolizes proteins instead. Mostly occurs in clients who have T1D and can rarely occur in clients with T2D. Occurs slowly, but when vomiting occurs, the condition can develop within a few hours. Symptoms start with thirst, a very dry mouth, frequent urination, high blood glucose levels, high levels of ketones. Increased symptoms include constantly feeling tired, dry or flushed skin, nausea, vomiting, abdominal pain, difficulty breathing, fruity odor on the breath, a hard time paying attention, or confusion.

Hyperosmolar Hyperglycemic Nonketotic Syndrome: Can take days or weeks to develop. Most common in T2D but can also occur in T1D. Usually brought on b illness or infection. Blood glucose levels rise and the body tries to get rid of the excess glucose through the urine. First the body makes a lot of urine and later the amount of urine becomes less and very dark. Drink lots of water to make sure you don't get dehydrated.

Hypertension: 2/3 of adults with diabetes have high blood pressure.

Heart Disease and Stroke

Blindness

Kidney Disease

Nervous System Disease

Amputation

Dental Disease

Complications of Pregnancy

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Multiple Sclerosis: an autoimmune disease that causes chronic inflammation of the central nervous system. The body's own defense system attacks myelin. As damage occurs, the myelin covering of the nerves becomes inflamed, swollen, and detached from the fibers. The myelin is destroyed. Scare tissue forms over the nerve fibers in place of the myelin

Myelin: fatty substance that surrounds and protects the nerve fibers of the brain, optic nerves and spinal cord.

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Relapsing-Remitting (RRMS): the most common type of MS. Symptoms flare up and then subside. Flare ups usually last several days to several weeks. Person may have total or only partial recovery between flare ups. 85% of people with MS initially begin with this course.

Secondary-Progressive (SPMS): When flare ups become steadily progressive and only partial recoveries are achieved with each flare up, the course of the disease i SPMS. Disease-modifying medications have become available and lowered the percentages of people who develop SPMS.

Primary-Progressive (PPMS): a steady progression of symptoms without signs of remitting, and occurs in about 10% of individuals with MS.

Progressive-Relapsing (PRMS): steady progression of symptoms with obvious acute attacks. 5% of people with MS appear to have PRMS.

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Any system that is directly related to the CNS has the possibility of being affected. MS varies for everyone.

Primary symptoms are the direct result of demyelination: weakness, numbness, tingling, tremor, visual problems (double and/or blurry vision), pain, paralysis, poor balance, bowel and bladder dysfunction, slurred speech, decline in cognitive function (including reasoning, memory, and processing), dysphagia.

Symptoms can be aggravated by external variables including -
Heat: sunbathing, hot tubs, opening the oven door, a hot shower, hot weather. Heat and humidity cause the myelin sheath to conduct electricity less efficiently.
Fatigue: one of the major complaints of MS making it both a symptom and something that makes the other symptoms worse. Extreme fatigue that affects motivation and the ability to perform daily activities. Unique to people who have MS. Occurs every day and worsens throughout the day.
Stress: Stressful event and poorly controlled stress levels can lead to flare ups in MS symptoms.

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Heart Disease: an umbrella term that includes a range of medical conditions tat involve the heart in one way or another.

Blood Vessel Diseases (cardiovascular disease): Narrowed, blocked, or stiffened blood vessels that impair circulation.

Heart Arrhythmia: An abnormal heartbeat, which can be quick, slow, or irregular.

Congenital Heart Defect: Structural problems of the heart or major blood vessels. Over 18 types of congenital heart defects are recognized.

Cardiomyopathy: Thickening and stiffening of the heart muscle.

Heart Infections: There are 3 types of heart infections. 1) Pericarditis: infection of tissue surrounding the heart. 2) Myocarditis: infection of the muscular middle layer of the heart walls. 3) Endocarditis: infection of the inner membrane that separates the chambers and heart valves.

Valvular Heart Disease: Functions of one or more heart valves are damaged leading to stenosis (narrowing), regurgitation (leaking), or prolapse (improper closing).

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Secondary Problems Related to Heart Disease

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Secondary Problems Related to Heart Disease

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Will vary depending on the type of heart disease.

Physical, developmental, or cognitive disorders can occur.

Anxiety disorders, particularly panic attacks and phobias; mood disorders, predominantly depressive episodes, minor depression, or dysthymia.

Back problems from being overweight or deconditioning from lack of physical activity.

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Cancer: the genetic name given to a group of more than 100 diseases where abnormal cells divide and grow out of control. As cancer advances, the cancer cells can invade other parts of the body, spreading to nearby tissue or moving through the blood or lymphatic system.

The location where the cancer originated dictates the name of the cancer.

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Secondary Problems Related to Cancer Treatment

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Secondary Problems Related to Cancer Treatment

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Surgery complications: pain, a partially collapsed lung, blood clots, fatigue, muscle atrophy, anesthesia effects, confusion or delirium, and infection.

Chemotherapy effects: nausea, vomiting, loss of appetite, hair loss, mouth sores, and low blood cell counts that increase risk for infection, bleeding, bruising, and anemia.

Radiation effects: skin irritation, fatigue.

Individuals with advanced caner often experience a greater number of physical, emotional, and spiritual symptoms including pain, dypnea, constipation, fatigue, poor sleep, anxiety, depression, and grief.

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Stage 0: Carcinoma in situ (early cancer that is present only in the layer of cells in which it began)

Stage I, II, III: Higher numbers indicate more extensive disease, as seen by larger tumor size and spread of the cancer beyond the organ in which it first developed to nearby lymph nodes and/or tissues or organs adjacent to the location of the primary tumor.

Stage IV: The cancer has spread to distant tissues or organs

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Chronic Obstructive Pulmonary Disease (COPD): a condition that makes it difficult to breathe.

Chronic bronchitis: chronic inflammation of the bronchial tubes with an increase in mucus and mucus secreting cells. Coughing to try to clear the mucus and becomes short of breath with exertion. Smoking is the most common cause.

Emphysema: the walls of the alveoli begin to break down and the lung loses its elasticity.

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Primary cause is smoking, accounts for approximately 85-90% of COPD cases.

Only small amount of people develop COPD from other air allergens, such as prolonged exposure to fumes, chemicals, or secondhand smoke.

In rare cases, COPD can be caused by alpha 1 antitrypsin deficiency, gene related disorder. Leads to deterioration of the lung.

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Limits work ability, physical ability, household chores, social activities, sleeping, family activities.

More susceptible to respiratory infections, pulmonary hypertension, heart problems, lung cancer, depression.

May have poor nutrition, poor muscle strength, poor endurance, skeletal disease like decreased bone density, psychosocial issues including anxiety, learned helplessness, loss of internal locus of control, sensory problems.

Many of these problems are due to frequent hospitalizations, decreased activity level, deconditioning, medications, lack of sufficient oxygen, poor adjustment and coping strategies.

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Rheumatoid arthritis: a chronic disease that involves inflammation of the lining of the joints, causing joint damage, chronic pain, loss of function, and possibly permanent disability. Considered an autoimmune disorder.

3 stages:
1) the swelling of the synovial lining, causing pain, warmth, stiffness, redness, and swelling around the joint.
2) the rapid division and growth of cells, which causes the synovium to thicken.
3) the inflamed cells release enzymes that may digest bone and cartilage, often causing the involved joint to lose its shapes and alignment leading to increased pain and loss of movement

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Don't know exactly what causes RA, but research has identified some factors.

Genetic Factors: specific genes may play a role in if a person develops RA and how severe it may be. However, some people may possess these genes and don't develop RA, while others don't have these genes and develop RA.

Environmental Factors: Virus, bacterium, or mycobacterium may trigger the disease process. The exact agent is unknown.

Hormones: Deficiencies or changes in certain hormones may promote the development of RA in genetically susceptible clients who have been exposed to environmental triggering agent

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Systems Affected by Rheumatoid Arthritis 

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Systems Affected by Rheumatoid Arthritis 

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Predominantly affects the musculoskeletal system, though sensory changes, involvement of other organs, lower energy levels and psychological issues may be present.

Primarily affects wrist joints and finger joints closest to the hand.

Can also affect the neck, shoulders, elbows, hips, knees, ankles, and feet.

Presents in a symmetrical pattern, affects the same joints on the right and left sides.

Clients complain of feeling pain and stiffness that lasts for more than 30 minutes in the morning or after a long rest.

Joints become swollen, reddened, and painful during and after excessive use.

Additional symptoms and problems: anemia, depression, fatigue, fundamental limitations, impaired range of motion, inflammation, joint deformity, malaise, neck pain, rheumatoid nodules, fever, dry eyes and mouth.

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Secondary Problems of Rheumatoid Arthritis

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Secondary Problems of Rheumatoid Arthritis

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Bone Loss: women are at an increased risk. Medications for RA can trigger bone loss.

Cardiopulmonary Endurance: decreased involvement in cardiopulmonary conditioning due to the primary symptoms and secondary symptoms often results in compromised endurance.

Muscle Atrophy: loss of muscle strength due to decreased activity levels.

Life Tasks: joints become tender and painful causing low ability to perform tasks.

Psychological Changes: Depression, anxiety, and feeling of helplessness.

Sexual Dysfunction: desire to participate in sexual activity decreases.

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Epilepsy:a medical condition that affects brain neurons and causes abnormal signals.

Seizures:Abnormal signals cause a brief, strong surge of electrical activity that affects a portion or all of the brain. Can last for a few seconds to a few minutes.

Having a seizure does not necessarily mean that a person has epilepsy. Only when a person has had two or more unprovoked seizures is s/he diagnosed with epilepsy.

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Difference Between Focal Seizures and Generalized Seizures

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Difference Between Focal Seizures and Generalized Seizures

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Focal Seizures (partial seizures): begin in a localized area of the brain. Frequently labeled by the area of the brain in which they originate. 1) Simple Focal Seizure: remain conscious but experience unusual feelings or sensations. 2) Complex Focal Seizure: altered consciousness, may experience a dreamlike experience that lasts a few seconds. May display strange, repetitious behaviors called automatisms such as blinks, twitches, or mouth movements.

Generalized Seizures: a result of abnormal neuronal activity that occurs in more than one area of the brain. May cause loss of consciousness, falls, or muscle spasms. 1) Absence Seizures: a momentary loss of consciousness of just a few seconds. Also referred to as petit mal seizures. 2) Tonic Seizures: cause stiffening of the back, leg and arm muscles. 3) Clonic Seizures: cause repetitive, rhythmic jerks that involve both sides of the body at the same time. 4) Myoclonic Seizures: jerks or twitches of the upper body, arms, or legs are typical of these seizures. 5) Atonic Seizure: cause a loss of normal muscle tone, which often results in a fall. 6) Tonic-Clonic Seizures: stiffening of the body and repeated jerks of the arms and/or legs as well as loss of consciousness. Also known as grand mal seizures.

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Status Epilepticus: a potentially life-threatening condition in which a person either has an abnormally prolonged seizure or does not fully regain consciousness between seizures. A prolong seizure lasts longer than 5 minutes.

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Here is the link to Netflix for the trailer. If you scroll down it will bring you to the episodes.
https://www.netflix.com/title/80191036

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Marroquin, B., Nolen-Hoeksema, S. (2017). Abnormal Psychology, Seventh Edition. New York City, NY: McGraw-Hill Education.

NAMI. (n.d.). Retrieved December 16, 2018, from https://www.nami.org/Learn-More/Mental-Health-Conditions/Bipolar-Disorder/Overview

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Mania: A persistent elevated mood for at least 1 week.

Bipolar i Disorder: Full manic and major depressive episodes

Bipolar ii Disorder: Hypomanic and major depressive episodes

Hypomania: Involves the same symptoms as mania, but the symptoms are not severe enough to interfere with daily functions, do not involve hallucinations or delusions, and last at least 4 consecutive days

Cyclothymic Disorder: Similiar symptoms to i and ii but is milder

Rapid Cycling Bipolar Disorder: 4 or more mood episodes that meet criteria for manic, hypomanic, or major depressive episode within 1 year lead to a diagnosis of rapid cycling bipolar disorder

Disruptive Mood Dysregulation Disorder: Child aged 6 and younger must show severe temper outbursts that are grossly out of proportion in intensity and duration to a situation and inconsistent with developmental level

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Genetics: high prevalence rates in identical twins.

Neurotransmitters: low seratonin "opens the door" to mood disorder and norepinephrine activity defines its form.

Stress: example is a sudden death in the family.

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Switching between major depressive episodes to high manic episodes.

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Manic Symptoms:  Must show 3 of the following symptoms - 1)inflated self-esteem or grandiosity. 2) Decreased need for sleep. 3) More talkative than usual or pressure to keep talking. 4) Flight of ideas or racing thoughts. 5) Distractibility to irrelevant external stimuli. 6) Increase in goal-directed activity or psychomotor agitation. 7) Excessive involvement in pleasurable activities with high potential for painful consequences.

Depressive Symptoms: Sadness, anhedonia, change in appetite and/or weight, sleep problems, psychomotor agitation, fatigue, feelings of worthlessness or excessive guilt, problems concentrating or making decisions, suicidal ideation, with or without plan or attempt.