Diagnostic Groups in Therapeutic Recreation by

What is ASD?

jeranek_amy — 2019-09-19 16:22:00 UTC

DSM-5 includes autism, Asperger's Disorder, Childhood Disintegrative Disorder, and Pervasive Developmental Disorder Not Otherwise Specified. The DSM-IV had these all as separate diagnoses.

A neurodevelopmental disorder; diagnosed on behavioral and developmental characteristics, not just medical

Wide levels of functioning, from high to low

What is a Developmental Disability?

jeranek_amy — 2019-09-19 16:26:35 UTC

Diverse group of chronic conditions

Physical or mental impairments that arise before adulthood; arise during any part of development but usually last through a person's lifespan

May affect a person's everyday living

What is an Intellectual Disability?

jeranek_amy — 2019-09-19 16:29:40 UTC

Characterized by significant limitations in intellectual functioning as well as adaptive behavior

Below average intelligence and life skills before the age of 18

Causes of ASD

jeranek_amy — 2019-09-19 17:07:36 UTC

Unknown but three areas show promise in explaining disorder

Genetics: identical twins are more likely than fraternal twins to share autism; siblings in general are more likely to have autism; specific genes are unknown

Neurological structure and development: children with autism are more likely to develop epilepsy than those without; children with autism usually have abnormal EEG's (no autism-specific pattern, just abnormalities); differences in cells in children with autism

Environmental factors: little evidence for direct environmental causes; there are bio-medical treatments that can help but these are not the cause of autism

Systems Affected

jeranek_amy — 2019-09-19 17:14:37 UTC

Affects social interactions and adaptability

5 diagnostic criteria: deficits in social communication and interaction; repetitive patterns of behavior; symptoms present in early stages of development; symptoms cause significant functional impairments; cannot explain symptoms using other explanations/diagnoses

3 levels of functioning: requires support; requires substantial support; requires very substantial support

Common Secondary Conditions

jeranek_amy — 2019-09-19 17:20:38 UTC

Epilepsy, sleep disorders, hyperactivity, anxiety, and depression

Most common is sensory processing disorders (sensory over-responsivity, sensory under-responsivity, and sensory seeking)

Cognitive impairments: deficits or surpluses of intelligence (tend to visually process, so linguistics don't necessarily make the most sense)

Self-injurious behaviors: common behaviors include biting, scratching, hitting, head banging, pinching, eye gouging (remember these are harm to themselves not others-harm towards others happens but not as common)

Effective Treatments

jeranek_amy — 2019-09-19 17:25:14 UTC

No one single approach is best, but early intervention is important

Behavioral package: designed to teach alternative behaviors in place of undesirable behaviors; taught through basic principles of behavior change (ex: task analyses)

Comprehensive behavioral treatment for young children: for children under the age of 8; interventions are comprehensive, intense, and used for all settings and behaviors

Peer training package: focuses on teaching peers (friends or siblings) without disabilities strategies for play and social interactions with children with ASD (ex: Circle of Friends)

Causes of Intellectual Disabilities

jeranek_amy — 2019-09-19 17:36:17 UTC

Genetic conditions (such as down syndrome)

Problems during pregnancy (anything that can affect fetal brain development)

Problems during childbirth (usually if baby is deprived of oxygen)

Illnesses (like meningitis) or injuries (like a TBI)

Other-in most cases, the cause is unknown

Effective TR interventions for intellectual disabilities

jeranek_amy — 2019-09-19 17:40:31 UTC

Activity schedules and visual cues: this helps people with intellectual disabilities to visualize what needs to be done and how to do the task; also effective in helping with transitions

Behavioral interventions: designed to positively reinforce ideal behaviors and help to recognize what could possibly trigger a behavior

Also important to consider timing, location, and the professional who will work with the client

My TR Takeaway

jeranek_amy — 2019-09-19 18:23:01 UTC

Importance of Timing of Diagnosis

jeranek_amy — 2019-09-26 16:46:26 UTC

Acquired hearing loss: sudden onset can be a drastic, difficult change; with age, the loss is gradual

Congenital hearing loss: a person is born deaf or hard of hearing; has not developed functional communication yet

Visual impairment/blindness: can affect any age, but most common in adults 40 and older with the frequency much high in adults 65 and older

Timing of diagnosis can affect treatment plans; later diagnosis means there is less that can be done; early diagnosis has treatment options to prevent worsening of impairment

Causes of Hearing Loss

jeranek_amy — 2019-09-26 16:57:18 UTC

Noise, aging, disease, heredity, illnesses, and certain medications

Cause is unknown for ~25% of babies born with a hearing impairment; another 25% is believed to be caused by maternal infections during pregnancy; the other 50% is due to genetics

Types of Hearing Loss

jeranek_amy — 2019-09-26 17:16:13 UTC

Conductive hearing loss: something isn't allowing sounds to pass through outer or middle ear

Sensorineural hearing loss: problems with how the inner ear or hearing nerve works

Pre-lingual hearing loss: hearing loss before learning how to speak

Asymmetrical hearing loss: hearing loss is different in each ear

Degrees of Hearing Loss

jeranek_amy — 2019-09-26 17:19:45 UTC

Mild hearing loss: may hear some sounds but soft sounds are hard to hear

Moderate hearing loss: may hear little to no speech when another person is talking at a normal volume

Sever hearing loss: hear no speech when someone is talking at a normal volume and only some loud sounds

Profound hearing loss: does not hear any speech and only very loud sounds

Visual Acuity

jeranek_amy — 2019-09-26 17:22:26 UTC

Normal acuity is recognized as 20/20; meaning a person with normal vision can see small details at 20 feet away

Example: a person with visual acuity of 20/70 can see the same detail at 20 feet that a person with normal vision could see at 70 feet

Legal blindness: visual acuity of 20/200 or less

Low vision: visual acuity between 20/70 and 20/200 that is not correctable

Causes of Visual Impairments

jeranek_amy — 2019-09-26 17:26:30 UTC

Ocular visual impairments: caused by diseases or conditions affecting the eyes

Cortical visual impairments: caused by injury or structural differences in brain

Refractive errors: nearsightedness (myopia), farsightedness (hyperopia), astigmatism, and loss of close vision (presbyopia)

Age-related macular degeneration (AMD); eye disease that results in damaged sharp and central vision

Cataract: clouding of the eye's lens; can occur at any age; leading cause of blindness in the world

Recreational Therapy Interventions for Hearing Loss

jeranek_amy — 2019-09-26 17:33:53 UTC

Depends on setting and primary problem; usually choose a smaller group or individual interventions for people with hearing impairments

Choose interventions that will be available for client when discharged; focus on enhancing adaptions for communication

Functional skills for persons with hearing impairments: focus on communication, social skills and relationships, and use of assistive technology

Domestic and life skills, money management, job skills, advanced self-care skills, leadership skills, leisure skills, meal prep and cooking, communication awareness and reintegration, community integration, and health promotion

Recreational Therapy Interventions for Visual Impairments

jeranek_amy — 2019-09-26 17:45:58 UTC

Currently little research on efficacy of interventions specific to this population

Functional skills for persons with visual impairments: focus on problem solving; specific skills can be worked on later

Some specific skills: orientation and mobility, self-care, communication, reading, leisure skills, and barriers

Education (such as teaching about the ADA), leisure counseling, lifestyle alterations, adaptive technology, compensatory strategies, assertiveness training, community integration and health promotion

My TR Takeaway

jeranek_amy — 2019-09-26 17:52:12 UTC

Duchenne's Muscular Dystrophy (DMD)

jeranek_amy — 2019-10-05 16:24:00 UTC

Muscular dystrophies: a group of muscle diseases caused by mutation's in a person's genes

Duchenne muscular dystrophy:
-most commonly affected: males between the ages of 5-24
>symptoms usually appear before the age of 5
-upper legs and upper arms usually show symptoms first
-other parts of the body that may be affected: heart, lungs, throat, stomach, intestines, and spine

Cerebral Palsy (CP)

jeranek_amy — 2019-10-05 16:49:18 UTC

Cerebral palsy: describes a group of symptoms and neurological disorders that appear in early childhood and infancy
-cerebral refers to the brain
-palsy refers to muscle problems or weakness

Neurological problems result from non-progressive damage to areas of the brain that control movement and coordination
-also affects: muscle tone, endurance, strength, and speech

One of the most common motor disability affecting children

Prevalence: lower in Hispanic children than black or white children; incidences of CP in babies of low birth weight and premature birth

Difficult to diagnose before birth or during early development; typically diagnosed in early developmental years usually by 18 months but sometimes not until 3 years

Diagnose by focusing on motor skills to evaluate delays while ruling out other disorders that may cause these delays

Symptoms and Causes of CP

jeranek_amy — 2019-10-05 16:58:38 UTC

-Ataxia: poor muscle coordination
-Poor muscle control
-Spasticity or tight muscles
-Atypical gait
-Drooling
-Swallowing/eating difficulties
-Speech impairments: clarity and articulation
-Difficulty with fine motor skills
-Toe walking
-Atypical muscle tone (too high or low)
-Involuntary movements and tremors

-70-80% of cases occur prenatally
-Caused by genetic conditions, infection, maternal bleeding or seizures, abnormal brain development, lack of oxygen, stroke, and intrauterine growth restriction
-New research: link between CP and abnormalities with the placenta
-Less than 10% occur during labor/delivery
-Causes occurring during birth: breech position, infections, lack of oxygen, stroke, multiple births, and jaundice
-Remaining cases occur during first years of life from head injury, viral or bacterial infections affecting CNS, seizures, motor vehicle accidents, and child abuse
-Children born prematurely or at low birth weight (3.5 pounds or less) are at greatest risk for CP

Secondary Problems of CP

jeranek_amy — 2019-10-05 17:05:39 UTC

Secondary disabilities:
-Intellectual disability (40-67%)
-Epilepsy or seizures (35-50%)
-Both intellectual disability and seizure disorder (25%)
-Behavioral problems (25%)
-Learning disabilities (40%)
-Sensory impairments (15-62%)
-Feeding difficulties and/or malnutrition (57% sucking problems, 38% swallowing problems, 80% fed via tube, 50% underweight or overweight)
-Lung problems (33%)
-Chronic pain (28% of adults)
-Autism (9%)

Secondary complications
-inadequate or low levels of physical fitness
-balance issues
-fatigue and cardiovascular disease
-musculoskeletal problems
-difficulty processing stimulation including over- or under-response to auditory, tactile, and visual stimuli
-incontinence
-speech difficulties
-drooling due to swallowing disorder
-breathing difficulties
-skin breakdown
-contractures
-problems with spatial awareness
-depression or distress

RT Interventions for CP

jeranek_amy — 2019-10-05 17:12:38 UTC

Functional skills
-exercise/stretching/fitness
-aquatic therapy
-hippotherapy (the use of horse as part of an integrated treatment strategy; performed by health professionals)
-therapeutic horseback riding (THBR; conducted by non-therapist riding instructors)
-massage therapy

Education, Training, and Counseling
-Adaptive sports
-Community integrations skills and resources (accessibility, advocacy, removal of barriers)
-Mobile devices as adaptive equipment
-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 (ex: downhill skiing, basketball, swimming, etc)
-animal-assisted therapy
-volunteerism
-camping programs

Additional Important Terms

jeranek_amy — 2019-10-05 17:20:16 UTC

-Congenital: present from birth
-Dyplegia: paralysis of corresponding parts on both sides of the body
-Hemiplegia: paralysis of one side of the body
-Quadriplegia: paralysis of all four limbs
-Ataxia: loss of full control of bodily movements
-Dysarthria: difficult or unclear articulation of speech that is otherwise linguistically normal
-Spasticity: a condition in which certain muscles are continuously contracted
-Contractures: a condition of shortening or hardening of muscles, tendons, or other tissues; often leading to deformity and rigidity of joints
-Osteopenia: reduced bone mass of lesser severity than osteoporosis

Spinal Cord Injury (SCI)

jeranek_amy — 2019-10-05 17:31:35 UTC

Spinal cord injury: occurs when the spinal cord is damaged as a results of trauma, disease, or disorder; when the spinal cord is damaged, communication is interrupted and results in temporary or permanent loss of movement/sensation

Primarily affects younger adults, but can affect any person of any age; average age for SCI is 41

Causes:
-trauma: main cause; primary methods are motor vehicle accidents, falls, violence, and sports related injuries
-tumor: grows on or close to spinal cord, pressure placed on cord (as well as edema), may cause damage to spinal cord
-transverse myelitis (TM): an acute inflammatory process typically resulting from infectious agent causing damage to neural tissues
-Guillan-Barre syndrome (GBS): results from acute inflammatory process, demyelinates nerves in PNS

Classifications of SCI

jeranek_amy — 2019-10-05 17:52:50 UTC

Classified by level and type of injury; when applicable, a syndrome is added to the classification

Level of injury (LOI): cervical, thoracic, lumbar, sacral, and coccygeal
-SCI refers to the actual spinal cord not the vertebrae, but to classify the area of spinal cord or nerve impairment, the vertebra level is identified
-LOI is determined through a series of test such as CT scans, MRI's, x-rays, and a variety or neurological exams

Types of SCI

jeranek_amy — 2019-10-05 18:00:10 UTC

Type of Injury: complete (exhibits no motor/sensory function below LOI) or incomplete (exhibits some motor/sensory function below LOI)

Types of Paralysis: primarily divided into two types-tetraplegia which results from injury C1-C8 and paraplegia which results from injury T1-S5 (which can be further broken down)
-complete and incomplete tetraplegia
-complete and incomplete paraplegia

Secondary Problems of SCI

jeranek_amy — 2019-10-05 18:03:10 UTC

Autonomic dysreflexia or hyperreflexia (AD): life threatening rise in blood pressure occurs in individual with LOI at/above T6

Pressure ulcers (decubitus ulcers, skin sores): too much pressure builds up on skin in a particular area, flow of blood is stopped, skin begins to die

Respiratory complications: injuries to upper thoracic and cervical spinal cord affects respiratory muscles (diaphragm, abdominal muscles, etc) that help take deep breaths and cough

Spasticity or spastic hypertonia: interruption of messages to reflex center results in overcompensation of spinal cord reflex system, resulting in spasticity

Temperature regulation: individuals with complete SCI's have thermoregulation issues, especially individuals with SCI's at T6 and above

Heterotopic ossification (🤬): growth of new bone in soft tissue areas

Deep vein thrombosis (DVT): occurs when blood clots form in veins, mostly lower extremities

Orthostatic (postural) hypotension: a decrease in systolic blood pressure and/or a decrease in diastolic blood pressure when changing from a laying to upright position

Additional Important Terms

jeranek_amy — 2019-10-05 18:12:28 UTC

-tetraplegia: paralysis of all four limbs
-paraplegia: paralysis of legs and lower body
-complete vs incomplete injury: complete injury patients exhibit NO motor or sensory function below the injury while incomplete injury patients exhibit SOME motor or sensory function below the injury
-autonomic dysreflexia: a condition in which our involuntary nervous system overreacts to external or bodily stimuli
-pressure ulcers: localized damage to skin and/or underlying tissue as a result of long-term pressure or pressure in combination with shear or friction

My TR Takeaway

jeranek_amy — 2019-10-05 18:19:39 UTC

Post Traumatic Stress Disorder (PTSD)

jeranek_amy — 2019-10-17 19:45:43 UTC

Essential feature of PTSD: the development of characteristic symptoms following exposure to one or more traumatic events

Some possible causes include rape, abuse, natural disaster, being in a war zone, or exposure to a terrorist attack
-threatened or actual: physical assault, sexual violence
-being kidnapped or held hostage
-torture, being a prisoner of war, natural or human-made disasters, severe car accidents
-traumatic medical incidents: waking up during surgery, anaphylactic shock
-some first responders may develop PTSD

Systems affected by PTSD

jeranek_amy — 2019-10-17 19:46:54 UTC

Affects a person's mood and ability to cope effectively (esp. with ongoing stressful events)

Affects a person's social functioning (detached; avoid people, places, activities that remind them of their trauma)

Cognitive difficulties: poor concentration and focus
-limbic system affected (may affect emotional learning and emotional dysregulation)

Secondary problems of PTSD

jeranek_amy — 2019-10-17 19:54:09 UTC

Increased risk for agoraphobia, obsessive-compulsive disorder, social phobia, specific phobia, major depressive disorder, somatization disorder, and substance-related disorders

Increased risk for panic disorder and suicidal feelings and/or thoughts

A significant overlap between PTSD and fibromyalgia

48% of cases of PTSD co-occur with traumatic brain injuries

Ability to continue education and find employment

Children are more likely to display symptoms of separation anxiety and oppositional defiant disorder

Schizophrenia-categories of symptoms

jeranek_amy — 2019-10-17 19:58:37 UTC

Delusions, hallucinations, disordered thinking or speech (must substantially impair communication), grossly disorganized or abnormal motor behavior (interfering with ADL's), and negative symptoms (something seems to be missing like diminished emotional expression)

Causes of Schizophrenia

jeranek_amy — 2019-10-17 20:01:21 UTC

No known cause

Genetics appear to play a role in development

Structure and chemical composition of the brain: enlarge ventricles, less activity in frontal cortex, chemical imbalances (research suggests a correlation)

Environmental factors: stressful settings (impoverished neighborhoods, lower SES, immigrants have higher incidence rates possibly because of abrupt cultural change)

Birth complications and cannabis abuse (predicts earlier onset)

Psychosocial factors: research suggests a biological condition that prevents people with SSD from developing and integrated sense of self; stressful situations often trigger a psychotic relapse; poor information processing, attention, coping mechanisms, and social skills may experience more stress

Systems affected by Schizophrenia

jeranek_amy — 2019-10-17 20:06:30 UTC

Cognitive functioning: delusions and disordered thinking and speech

Perceptual functioning: positive symptoms (e.g. sensory hallucinations); misinterpretation of external stimuli

Impairments in receiving, processing, initiating conversation, planning, problem solving, initiating tasks, managing multiple tasks, organizing information, and fine motor skills

Structural composition of the brain: decreased activity of frontal lobe (which is responsible for speech fluency, understanding, language use)

Emotional functioning: negative symptoms (involves blunted or flattened affect); anhedonia

Social functioning: asociality (negative symptom) affects ability to empathize with others; amotivation

Important terms (Schizophrenia)

jeranek_amy — 2019-10-17 20:11:33 UTC

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

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

Psychosis: a severe mental disorder in which thought and emotions are so impaired that contact is lost with external reality

Anhedonia: the inability to experience pleasure

Major Depressive Disorder (MDD)

jeranek_amy — 2019-10-17 20:15:45 UTC

Axis I disorder; may manifest with somewhat diverse symptomology and occur as a single or recurrent episode; ranges in intensity from mild to severe; pervasive disorder and onset is triggered by situational factors; lasts at least two weeks while manifesting at least 5 symptoms

Symptoms: depressed mood most of the day, nearly every day; diminished interest or pleasure in most or all activities, nearly every day; significant unintentional increase or decrease in weight or appetite; lack of sleep or sleeping excessively, nearly every day; psychomotor changes noticed by others (agitation or sluggishness), nearly every day; fatigue and/or loss of energy, nearly every day; feelings of guilt and/or worthlessness, nearly every day; diminished cognitive abilities, nearly every day; recurrent thoughts of death

Systems affected by MDD

jeranek_amy — 2019-10-17 23:30:05 UTC

Diminished quality of life, lost work productivity, cognitive and emotional impairment, and the leading cause of years lived with disability

Potentially negatively impact short- and long-term relationships, and alter ones appraisals of existing social supports

Can disrupt daily activities through symptoms of amotivation and lethargy, and low self-efficacy

Basic self-care can be neglected; weight gain or loss may also occur

Secondary problems of MDD

jeranek_amy — 2019-10-17 23:36:15 UTC

Frequently co-occurs with many physical and mental health conditions

Seen at higher rates among persons with chronic pain, illness, disability, and cardiovascular disorders

Co-occurs with anxiety, substance abuse, eating disorders, dementia, and personality disorders (cause is not always clear)

Generalized Anxiety Disorder (GAD)

jeranek_amy — 2019-10-17 23:41:18 UTC

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, GI problems, jumpiness, fidgeting, trembling, inability to relax, being easily startled, trouble sleeping, and feeling on edge)

People who have GAD feel like they are losing control of themselves and/or situations during extreme periods of anxiety

Negative and anxious thinking also heighten somatic symptoms which increases anxiety until feedback between the way the body feels and the anxiety it causes spirals out of control

Systems affected by GAD

jeranek_amy — 2019-10-17 23:49:31 UTC

Affects mental functions of the patient including mood, cognition (trouble concentrating, difficulty learning new information and behaviors, misperception of event and situations, poor shot-term memory, difficulty with abstract thinking), and social functioning

Affects various systems in the body through the influence of client's emotional state

Affects motor functioning by causing shakiness, restlessness, and headaches

GI system with diarrhea, constipation, pain, nausea, feeling of "butterflies"

Cardiovascular system: heart palpitations

Respiratory system: shortness of breath

Autonomic nervous system: excessive sweating

My TR Takeaway

jeranek_amy — 2019-10-18 00:04:19 UTC

Geriatric Syndromes

jeranek_amy — 2019-10-18 23:23:25 UTC

Pressure ulcer: injuries to skin and underlying tissue resulting from prolonged pressure on the skin; most often develop on skin that covers bony areas

Incontinence: lack of voluntary control over urination or defecation

Delirium: an acutely disturbed state of mind that occurs in fever, intoxication, and other disorders and is characterized by restlessness, illusions, and incoherence of thought and speech

Dementia: a chronic or persistent disorder of the mental processes caused by brain disease or injury and marked by memory disorders, personality changes, and impaired reasoning

Alzheimer's Disease

jeranek_amy — 2019-10-18 23:30:04 UTC

Requires the criteria for a major or mild neurocognitive disorder with an insidious onset and gradual progression in one or more of the cognitive domains

Probable Alzheimer's is diagnosed when there is evidence of a genetic component from genetic testing or family history; also if there is evidence of a decline in memory, learning, and at least one other cognitive domain, decline steady without extended plateaus

Possible Alzheimer's is diagnosed when the conditions for probable Alzheimer's are not met, but the decline is steady without plateaus

Early onset is before 65 years of age and older Alzheimer's is after the age of 65

Caused by plaques forming in the brain (destroy brain cells which creates progressive deterioration of higher cognitive functioning in the areas of memory, problem solving, and thinking); characterized by an inability to carry out everyday tasks or perform instrumental ADL's

Lewy Body NCD

jeranek_amy — 2019-10-18 23:36:36 UTC

An umbrella term for two related diagnoses: Parkinson's and NCD with Lewy bodies

Requires 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 onset of cognitive decline, REM sleep disorders, and/or severe neuroleptic sensitivity

RT Approaches

jeranek_amy — 2019-10-18 23:41:02 UTC

Consider therapeutic goals, person's age, personality, stage of the disease, cognitive and physical function, behavioral problems, and the individual's leisure interests and skill level

Meaningful activities promote well-being and prevent excess disability; people with NCDs will benefit the most from self-selected activities that promote a sense of personal expression

Consider past and current leisure interests (cooking, gardening, reading programs, etc.)

Results of treatment need to be measured in order to obtain essential feedback about the effectiveness of the intervention

NCD affecting families

jeranek_amy — 2019-10-18 23:44:12 UTC

NCDs are devastating; progressively steal a person's happiness, relationships, dignity, and any potential contributions to family and community

Can be difficult for families and friends to interact with their loved ones after an NCD diagnosis

My TR Takeaway

jeranek_amy — 2019-10-18 23:51:00 UTC

Attention Deficit Hyperactivity Disorder

jeranek_amy — 2019-10-30 21:12:05 UTC

Neurodevelopmental disorder; interferes with social and academic/occupational functioning or development

Clients have markedly decreased inattention (not to due to defiance or comprehension deficits);
-ex: difficulty staying on task and lack of perseverance, organization, and focus
AND/OR
have an age-inappropriate level of hyperactivity/impulsivity (ex. of hyperactivity includes excessive motor activity and talkativeness; ex. of impulsivity includes hasty decisions that may cause harm)

Symptoms must be present before age of 12 and last for at least 6 months

May be identified as predominantly hyperactive/impulsive, predominantly inattentive, or combined

Potential Risk Factors

jeranek_amy — 2019-10-30 21:17:15 UTC

Neurobiological basis; heredity has a strong influence

Deficit in inhibitory control is an underlying symptom (theory)
-deficit affects executive functioning, resulting in broad range of dysfunctional behaviors

Environmental exposure (ex. high lead concentrations in blood), brain injury, prenatal exposure to tobacco/alcohol, low birth weight, or difficulties during pregnancy are all potential risk factors

Psychosocial factors (ex. prolonged emotional deprivation)
-stressful psychological events during childhood may be a symptom (PTSD may be a better diagnosis)

Child's temperament and demands of society to adhere to routine (behaviors and performance)

Systems Affected

jeranek_amy — 2019-10-30 21:22:38 UTC

Decreased cognitive processing ability related to decreased attention span and impulsivity
-multiple studies: functional abnormalities found in cognitive and attention networks in brain

Part of prefrontal cortex increases efficiency of decision making and execution; part of prefrontal cortex is involved in selective and divided attention, attention shifting, behavioral inhibition, etc.

Parietal cortex supports attention and spatial processing; striatum supports executive and motor functions; cerebellum controls motor, somatosensory, language, executive functioning, etc.

Central nervous system involvement can be observed within activity performance (causes activity limitation and participation restrictions)

Emotional health affected (increased incidences of depression and interpersonal problems-either organic problems or indirect result of other's responses)

Secondary Problems

jeranek_amy — 2019-10-30 21:30:55 UTC

Emotional impairment
-difficulty moderating or suppressing emotional reactions and show more extreme emotional reactions
-co-existing mental health conditions (ODD or CD are common)
-higher risk of dysthymia, major depressive disorder, and anxiety disorders

Social impairment
-impaired social skills (due to not learning through observation or incidence learning)
-behavioral issues (inability to delay gratification, unpredictable mood, etc.)
-problems fitting in with peers (due to lack of age-appropriate social skills)
-dislike for school (which can lead to antisocial behaviors and self-defeating behaviors)
-impaired sense of self (most have average or high IQs and can understand something is "different" about them which can lead to impaired self-esteem, self-confidence, and self-image)

Physical activity deficits
-perceptual motor deficits and general coordination deficits (making it difficult for participation in sports and other physical activities)

RT Interventions

jeranek_amy — 2019-10-30 21:40:58 UTC

Behavioral parent training (BPT): 8-12 week training for parents involving discussion, coaching, and role-play
-teaches parents how to alter, influence, and change their child's behavior through behavior modification

Behavioral classroom management (BCM): point systems, time outs, reward programs, etc. to be used by teachers in the classroom
-findings show that, for example, brief time outs work better than longer ones, and response cost programs are more effective than reward programs

Behavioral peer interventions (BPI): summer intensive sessions are more beneficial; focus on behavioral interventions for peer problems in recreational settings

Anger management programs to teach appropriate expression of anger for kids with ADHD

Limit environmental stimuli that could increase distraction, create enriching experiences to increase motivation and maintain motivation

Provide structure and consistency!
-clear expectations and understandings of acceptable/unacceptable behaviors

Oppositional Defiant Disorder (ODD)

jeranek_amy — 2019-10-30 21:50:01 UTC

An ongoing pattern of disobedient, hostile, and defiant behavior toward authority figures which goes beyond the bounds of normal childhood behavior

Behaviors are persistent for at least 6 months and are clearly disruptive to the family and home or school

Some symptoms that may be present are losing their temper, arguing with adults, deliberately annoying others, being angry and negative, malicious or vindictive behavior, and blaming others for all that goes wrong

Possible Causes

jeranek_amy — 2019-10-30 21:53:42 UTC

May be a combination of inherited and environmental factors

Factors may include: a child's natural disposition, limitations or developmental delays in a child's ability to process thoughts and feelings, and imbalance of certain brain chemicals, lack of supervision, inconsistent or harsh discipline, and abuse or neglect

Familial problems (harsh parenting styles, lack of structure and guidance, frequent disputes between parents, and lack of emotional and physical availability)

RT Interventions

jeranek_amy — 2019-10-30 21:56:39 UTC

Functional skill development
-changing distorted thinking patterns (cognitive behavioral approach)
-communication (provision of programs and activities that focus on communication)

Education, training, and counseling
-basic social skills (teaching how to initiate and develop healthy relationships with other people)
-interpersonal relationship activities
-anger management (providing healthy opportunities to vent feelings of anger through relaxation techniques, journaling, structured recreational sports, etc.)
-relaxation and stress reduction
-leisure education (educate about benefits of participating in recreational activities)

Community integration
-recreation and leisure (engaging in non-competitive but expressive and cooperative recreational programs)

My TR Takeaway

jeranek_amy — 2019-10-30 22:02:28 UTC

Eating Disorders

jeranek_amy — 2019-11-08 02:37:33 UTC

Anorexia nervosa: lack or loss of appetite for food; an emotional disorder characterized by an obsessive desire to lose weight by refusing to eat

Bulimia nervosa: an emotional disorder involving distortion of body image and an obsessive desire to lose weight, in which bouts of extreme overeating are followed by depression and self-induced vomiting, purging, or fasting

Binge-eating disorder: a severe eating disorder characterized by recurrent episodes of eating large quantities of food; a feeling of a loss of control during the binge; experiencing shame, distress or guilt afterwards

Pica: an eating disorder that involves eating items that are not typically thought of as food and that do not contain significant nutritional value

Causes of Eating Disorders

jeranek_amy — 2019-11-08 02:42:20 UTC

Genetics: eating disorders tend to run in families

Biological factors: evidence that serotonin plays a role; neurochemistry makes it difficult for individuals to discontinue the behavior; eating disorder behaviors can alter brain chemistry

Psychological or interpersonal issues: may develop as a result of searching for control, coping with stress or trauma, personality factors, family issues, low self-esteem, feelings of inadequacy or lack of control in life, depression, anxiety, anger, stress, loneliness, troubled personal relationships, difficulty expressing emotions and feeling, a history of being teased or ridiculed base on size or weight, or a history of sexual abuse

Social/societal and cultural issues: today's culture desires thinness which influences self-esteem and self-worth; cultural norms emphasize outer beauty rather than inner beauty

Obesity prevention programs: parents reported eating disorder characteristics in their children after participating in an obesity prevention program

Systems Affected by Eating Disorders

jeranek_amy — 2019-11-08 02:50:36 UTC

Socially: individuals are often withdrawn and socially isolated; may stop participating in social activities

Nutritionally: problems including nutritional and caloric intake, eating patterns, eliminated or taboo foods, food rituals, and using food appropriately to deal with crisis

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

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

Physically: dehydration, low blood pressure, stomach and digestive complications, arrhythmias, and tearing of the esophagus

Causes of Substance Related Disorders

jeranek_amy — 2019-11-08 02:55:25 UTC

5 areas identified
Familial, social, or cultural factors: when primary networks tolerates, approves, and/or models substance abuse and related behaviors

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: produces a positive effect that reinforces the continued or increased use of substances

Genetic factors: a person who has a parent with a substance use problem has an increased risk of developing a substance use problem; genetically vulnerable individuals inherit a greater sensitivity to positive effects

Biological factors: particular neurotransmitters affect the reward pathways in the brain; substance use can artificially influence the function of these neurotransmitters

Systems Affected by Substance Related Disorders

jeranek_amy — 2019-11-08 03:02:04 UTC

The type, quantity, frequency, and route of administration of a substance influence the impact
-individual mental, emotional, physical health, and level of tolerance also has an impact

Physical health: illness, injuries, hyperactivity of ANS, and physical damage to body

Mental health: anxiety, depression, loss of motivation, anger, agitation, and irritability

Social health: strained or unhappy relationships

Cognitive health: short-term confusion, learning problems, and memory loss; possible hallucinations and delusions

Poor impulse control, judgement, and sleep quality

Secondary Problems of Substance Related Disorders

jeranek_amy — 2019-11-08 03:06:29 UTC

A person's substance use can impact family, friends, co-workers, and classmates; could experience isolation, social life restrictions, dissatisfying relationships, and public embarrassment

Concurrent disorders: mental health concerns (anxiety, ADHD, mood disorders, psychosis, personality disorders)

My TR Takeaway

jeranek_amy — 2019-11-08 03:09:22 UTC

Definition of CVA

jeranek_amy — 2019-11-14 18:16:43 UTC

A disease that affects the arteries in and around the brain; a blood vessel carrying oxygen and nutrients to the brain ruptures or is blocked by a clot then parts of the brain don't receive necessary oxygen and brain cells in that area die

F.A.S.T.

jeranek_amy — 2019-11-14 18:19:41 UTC

F.A.S.T. is an acronym to recognize sudden signs and symptoms of a person having a stroke

Face drooping (ask person to smile and examine asymmetries)

Arm weakness (ask to raise both arms and one starts to drop)

Speech difficulty (ask to repeat a simple sentence)

Time to call 9-1-1 (if any of the above are present, call 9-1-1, get to hospital ASAP)

Left vs Right CVA

jeranek_amy — 2019-11-14 18:22:11 UTC

Left and right refers to the side of the brain in which the cerebrovascular accident is occurring or did occur; we are able to tell based on some dysfunctions that may be present

Left CVA: means right hemiplegia (affects right side of body), language deficits, slow or cautious behavior style

Right CVA: means left hemiplegia (affects left side of body), visual deficits, quick or impulsive behavior style

Causes of CVA

jeranek_amy — 2019-11-14 18:25:42 UTC

There are 3 primary causes:
1. blood clot that develops in the brain and blocks blood flow; this is known as 'thrombosis' which is a common cause of ischemic strokes

2. blood clot originates elsewhere in vascular system and travels to the brain, becomes lodged, and blocks blood flow; this is known as an 'embolism' which is another common cause of ischemic strokes

3. blood vessel breaks or ruptures and causes bleeding in the brain; this is known as a 'hemorrhage' which is most often caused by weakened blood vessels and high blood pressure

Systems Affected by CVA

jeranek_amy — 2019-11-14 18:28:22 UTC

Brain damage is the significant system affected by a CVA
-primarily motor, sensory, cognitive, language, and visual functions

Muscular system: brain is responsible for controlling body, which can cause paralysis in one side of the body

Respiratory system: part of brain that controls swallowing may be affected which can have a variety of effects on the respiratory system; if muscles can't direct food properly, they may go down wrong and settle in the lungs which can lead to serious infection

Secondary Problems of CVA

jeranek_amy — 2019-11-14 18:33:11 UTC

Most secondary problems are related to inactivity, which may result from lack of mobility, poor coping skills, and barriers to rec and leisure

Inactivity, lack of independence and participation, post-stroke depression, and emotional liability (emotional outbursts)

Numbness, fatigue, balance and coordination problems, urinary or bowel incontinence, speech problems, memory problems, difficulty recognizing limitations

Definition of Traumatic Brain Injury (TBI)

jeranek_amy — 2019-11-14 18:37:48 UTC

An acquired brain injury resulting from direct trauma to the brain

Brain dysfunction caused by an outside force, usually a violent blow to the head

A disruption in the normal function of the brain that can be caused by a bump, blow, or jolt to the head, or penetrating head injury

Different Classifications of TBI

jeranek_amy — 2019-11-14 18:39:46 UTC

Most common form of classification if classification by severity which uses the Glasgow Coma Scale (GCS)
-GCS has 3 components which are eye opening, verbal response, and motor response; these scores are added together to produce total score

Mild: concussion or minor brain injury; occurs from forceful motion of head, resulting in temporary alteration of mental status; reports of headaches, fatigue, sensitivity to light, etc.
-GCS score of 13-15

Moderate: loss of consciousness, persistent confusion and functional impairments
-GCS score of 8-12

Severe: prolonged unconscious state; come
-GCS score <8

Classification by outcome can be determined by examining neuropsychological functioning and mood as well as using the Glasgow Outcome Scale
-original 5 categories were dead, vegetative state, severe disability, moderate disability, and good recovery

Classification by prognosis is not used as often but examines how long (number of days) that post-traumatic amnesia lasts

Systems Affected by TBI

jeranek_amy — 2019-11-14 18:53:14 UTC

The structure of the brain is the most significant system affected, which can lead to a wide variety of dysfunctions

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

Cognitive changes: arousal and attention, initiation, memory, problem solving skills, judgement, organization and planning, time management, abstract reasoning, insight; changes in reading, writing, learning, and communication and language may also be noticed

Emotional and behavioral changes: difficulty with social skills (such as lacking the ability to empathize), inappropriate or self-centered behaviors, other emotional-behavioral issues such as irritability, agitation, frustration, depression, and anxiety

Secondary Problems of TBI

jeranek_amy — 2019-11-14 18:56:49 UTC

Secondary problems causing further damage to structure of the brain
-anoxic injury: absence of oxygen to brain
-hypoxic injury: decrease of oxygen to brain
-cranial nerve dysfunction: senses and vestibular function impaired
-edema: swelling and excess fluid to brain
-hematoma: pooling of blood in brain which leads to increased intracranial pressure
-hydrocephalus: cerebrospinal fluid build-up leading to dilation of ventricles in brain, which increases intercranial pressure

Other secondary problems
-heterotopic ossification (🤬): formation of bone in soft tissue
-seizures: develop within 24 hours-1 week post-injury

My TR Takeaway

jeranek_amy — 2019-11-14 19:11:05 UTC