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Handicapped children and Handicapped children and medical problemsmedical problems
Prof. Saad S Al-AniProf. Saad S Al-AniSenior Pediatric ConsultantSenior Pediatric Consultant
Head of Pediatric departmentHead of Pediatric departmentKhorfakkan HospitalKhorfakkan Hospital
03/02/200903/02/2009 22
Definition Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.
The WHO definition include three specific dimensions of health The physical health The mental health The social health
Recently a fourth dimension has been included that is spiritual health.
World Health organization (WHO)
03/02/200903/02/2009 33
1 .The Physical HealthIt is a state in which every cell and every organ is functioning at optimum capacity and perfect harmony with the rest of the body.
2. The Mental Health
Mental health is not mere absence of mental illness it is defined as.A state of balance between the individual and the surrounding world, a state of harmony between oneself and others.
3. The Social Health
Defined as the quantity and quality of an individual’s interpersonal ties and extent of involvement with the community.
4. The Spiritual Health
Refer to that part of individual, which reach out and strive for meaning and purpose of life.
World Health organization (WHO)
03/02/200903/02/2009 44
Changing TerminologyChanging Terminology
• Crippled childrenCrippled children
• Handicapped childrenHandicapped children
• Disabled childrenDisabled children
• Children and youth with special Children and youth with special health care needshealth care needs
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Definition ofDefinition of“Children with Special Health Care “Children with Special Health Care Needs”Needs”
• ““Children with special health care Children with special health care needs are those who have or are at needs are those who have or are at increased risk for a chronic physical, increased risk for a chronic physical, developmental, behavioral, or developmental, behavioral, or emotional condition and who also emotional condition and who also require health and related services of require health and related services of a type or amount beyond that a type or amount beyond that required by children generally.” required by children generally.” (McPherson, Arango, Fox, et al., 1998)(McPherson, Arango, Fox, et al., 1998)
03/02/200903/02/2009 66
The common types of The common types of disabilitiesdisabilities
• Cerebral palsy Cerebral palsy
• Muscular dystrophy Muscular dystrophy • Spina Bifida Spina Bifida
• Brain injury Brain injury
• Others: Hydrocephalus, epilepsy, Others: Hydrocephalus, epilepsy, brittle bone, congenital heart brittle bone, congenital heart disease, tumor, burns, congenital disease, tumor, burns, congenital abnormalitiesabnormalities
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Major problemsMajor problems
• Impaired motor controlImpaired motor control
• In-coordination problemsIn-coordination problems
• Tonal problemsTonal problems
• Joint contractures & deformitiesJoint contractures & deformities
• Skeletal malformationSkeletal malformation
• Muscle weaknessMuscle weakness
03/02/200903/02/2009 88
Associated problemsAssociated problems• Cognitive impairmentCognitive impairment
• Visual / auditory problemsVisual / auditory problems
• Oral motor dysfunctionOral motor dysfunction– Communication problems (speech Communication problems (speech
problems)problems)– DroolingDrooling– Feeding problemsFeeding problems
• Behavioral problemsBehavioral problems
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Continuum of Chronic Continuum of Chronic ConditionsConditions
13%
6%
Children with Chronic Conditions
Children with Special Health Care Needs Children with
Disabilities
30%
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Needs of the ChildNeeds of the Child
SocialSocialPlaying with others
Group playTeam games
ImaginativeImaginativeRole PlayCreating
Pretending
SkilfulSkilfulDexterity
ManipulationConstruction
ExploratoryExploratoryMotivation
Interest
IntellectualIntellectualClassifyingLanguage
Development
PhysicalPhysicalAgility
Co-ordination
Needs of the ChildNeeds of the Child
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Disability & DevelopmentDisability & Development
• 1/10 - as many as 600 million people 1/10 - as many as 600 million people worldwide - live with a physical, worldwide - live with a physical, sensory (deafness, blindness), sensory (deafness, blindness), intellectual, or mental health intellectual, or mental health impairment significant enough to impairment significant enough to make a difference in their daily lives make a difference in their daily lives
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Disability & Development Disability & Development (cont.)(cont.)
• 80% of people with disabilities live in 80% of people with disabilities live in the developing world where it impacts the developing world where it impacts the lives of family members and the lives of family members and communities.communities.
03/02/200903/02/2009 1313
Cerebral PalsyCerebral Palsy
• Cerebral palsy is one of the most Cerebral palsy is one of the most common congenital (existing before common congenital (existing before birth or at birth) disorders of childhood. birth or at birth) disorders of childhood.
03/02/200903/02/2009 1414
Cerebral PalsyCerebral Palsy
• Cerebral palsy affects muscle control Cerebral palsy affects muscle control and coordination, so even simple and coordination, so even simple movements — like standing still — are movements — like standing still — are difficult. difficult.
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Cerebral Palsy (cont.)Cerebral Palsy (cont.)
• Other vital functions that also involve Other vital functions that also involve motor skills and muscles — such as motor skills and muscles — such as breathing, bladder and bowel control, breathing, bladder and bowel control, eating, and learning — are also affected eating, and learning — are also affected when a child has CP. Cerebral palsy does when a child has CP. Cerebral palsy does not get worse over time.not get worse over time.
03/02/200903/02/2009 1616
Spastic diplegic CPSpastic diplegic CP
• 27% have seizure disorders27% have seizure disorders
• 30% have mental retardation30% have mental retardation
• 43% have strabismus 43% have strabismus
• 10-15% have hearing impairments10-15% have hearing impairments
• oral motor dysfunction in 90%oral motor dysfunction in 90%
03/02/200903/02/2009 1717
failure to
thrive
maladaptive behaviors
oraldysphagia
GERD
Eating
constipation
dental caries
pain
environment
03/02/200903/02/2009 1818
What does this population actually What does this population actually look like?look like?
• Cerebral PalsyCerebral Palsy 0.2 to 0.5%0.2 to 0.5% Lipkin 91Lipkin 91
– 10% to 37%10% to 37% have drooling problems significant have drooling problems significant enough to interfere with daily global functionenough to interfere with daily global function
Ekedahl et.al. 74, Sochaniwskj 82, Blasco 92, Nunn Ekedahl et.al. 74, Sochaniwskj 82, Blasco 92, Nunn 20002000
• Severe/Profound Mental Severe/Profound Mental RetardationRetardation 0.2% to 0.7%0.2% to 0.7%– An An unknown percentageunknown percentage of these children are of these children are
further handicapped by droolingfurther handicapped by drooling Harris and Purdy 87, Crysdale and White 89, Limbrock Harris and Purdy 87, Crysdale and White 89, Limbrock
et al 90et al 90
03/02/200903/02/2009 1919
ASSESSMENTASSESSMENTAnterior Drooling represents Anterior Drooling represents only one element in the only one element in the continuum of oral performance continuum of oral performance impairmentimpairment• SialorrheaSialorrhea
• Speech problemsSpeech problems
• Feeding and swallowing difficultiesFeeding and swallowing difficulties
• Structural and motor problemsStructural and motor problems
• Upper respiratory congestionUpper respiratory congestion
• AspirationAspiration
03/02/200903/02/2009 2020
Goal of RehabilitationGoal of Rehabilitation
• Help children with physical Help children with physical disabilities improve FUNCTION and disabilities improve FUNCTION and PARTICIPATE more fully in family, PARTICIPATE more fully in family, social, educational and recreational social, educational and recreational activities.activities.
03/02/200903/02/2009 2121
Multifactorial challengesMultifactorial challenges
• Constipation contributes to anorexia and Constipation contributes to anorexia and irritability.irritability.
• GERD causes pain and food refusals.GERD causes pain and food refusals.• Hip subluxation and spasms are painful. Hip subluxation and spasms are painful. • Pain increases spasticity and negative Pain increases spasticity and negative
behaviors.behaviors.• Mother frustrated with food refusals and Mother frustrated with food refusals and
opts for GT feedings rather than oral opts for GT feedings rather than oral feedings.feedings.
03/02/200903/02/2009 2222
• Evaluation and management of Evaluation and management of reflux and constipation to reduce reflux and constipation to reduce mealtime discomfort and improve mealtime discomfort and improve appetite.appetite.
• Selective dorsal rhizotomy to reduce Selective dorsal rhizotomy to reduce spasticity that hinders mobility, spasticity that hinders mobility, causes pain and adds additional work causes pain and adds additional work of postural support during meals.of postural support during meals.
How can we help?How can we help?
03/02/200903/02/2009 2323
Other ideas…Other ideas…
• Behavioral feeding strategies Behavioral feeding strategies directed at bringing Davis back into directed at bringing Davis back into family mealtimes.family mealtimes.
• Respite services and parenting Respite services and parenting resources to support single mom. resources to support single mom.
• Reinforce successes with praise and Reinforce successes with praise and positive reinforcement. positive reinforcement.
03/02/200903/02/2009 2424
Cerebral Palsy (cont.)Cerebral Palsy (cont.)
A child can begin therapy for:A child can begin therapy for:
• movementmovement
• learninglearning
• speechspeech
hearinghearing
• social and emotional development.social and emotional development.
• In addition, medication, surgery, and In addition, medication, surgery, and braces can help improve muscle braces can help improve muscle function. function.
03/02/200903/02/2009 2525
Mental RetardationMental Retardation
• Mental RetardationMental Retardation– Mild / IntermittentMild / Intermittent– Moderate / LimitedModerate / Limited– Severe / ExtensiveSevere / Extensive– Pervasive / ProfoundPervasive / Profound
• Basic skills:Basic skills:– Social, academic, local environmentSocial, academic, local environment
• Transition programmingTransition programming
03/02/200903/02/2009 2626
EpilepsyEpilepsy
• Epilepsy is a brain disorder that Epilepsy is a brain disorder that causes people to have recurring causes people to have recurring seizuresseizures..
• They may have violent muscle They may have violent muscle spasms or lose consciousness.spasms or lose consciousness.
03/02/200903/02/2009 2727
03/02/200903/02/2009 2828
03/02/200903/02/2009 2929
03/02/200903/02/2009 3030
03/02/200903/02/2009 3131
03/02/200903/02/2009 3232
03/02/200903/02/2009 3333
03/02/200903/02/2009 3434
03/02/200903/02/2009 3535
03/02/200903/02/2009 3636
03/02/200903/02/2009 3737
Communication with Communication with ChildrenChildren
• Introduce yourself and give the reasonIntroduce yourself and give the reason for you are being there.for you are being there.
• Call the child by nameCall the child by name when giving when giving direction or interacting with the child.direction or interacting with the child.
03/02/200903/02/2009 3838
Communication with Children Communication with Children (Cont.)(Cont.)
• When meeting or interacting with the When meeting or interacting with the
child, child, bend or stoopbend or stoop so that you are on so that you are on eye level with the child.eye level with the child.
• When speaking to a child, When speaking to a child, use words and use words and tone of voicetone of voice that will help the child feel that will help the child feel confident and reassured. confident and reassured.
03/02/200903/02/2009 3939
Communication with Children Communication with Children (Cont.)(Cont.)
• ListenListen to the childto the child. . RespectRespect the the child’s response and view.child’s response and view.
• ObserveObserve the child carefully. Body the child carefully. Body language will tell you a lot about language will tell you a lot about the child’s mood or fears.the child’s mood or fears.
•
03/02/200903/02/2009 4040
Communication with Children Communication with Children (Cont.)(Cont.)
• Always rememberAlways remember that the child may have that the child may have
misunderstanding or worries that you may not misunderstanding or worries that you may not have thought about.have thought about.
• Each child will be different withEach child will be different with special special interests, likes or dislikesinterests, likes or dislikes. . You will need to You will need to find out the child’s interest to help you find out the child’s interest to help you communicatecommunicate..
• The least lovable child needs the most The least lovable child needs the most love.love.
03/02/200903/02/2009 4141
Do ......Do ......
• Give a child a choiceGive a child a choice when there is a when there is a choice.choice.
• Allow child to be independentAllow child to be independent with with minimal help. Give verbal minimal help. Give verbal encouragement and make sure he or she encouragement and make sure he or she has opportunity to try.has opportunity to try.
03/02/200903/02/2009 4242
Do ......(Cont.)Do ......(Cont.)
• Give positive reinforcementGive positive reinforcement..• State suggestion or direction in a positiveState suggestion or direction in a positive
rather than a negative form. (refrain rather than a negative form. (refrain from saying don’t)from saying don’t)
• When setting limit, When setting limit, clearly defineclearly define what what you mean and be consistent.you mean and be consistent.
03/02/200903/02/2009 4343
Don’t ......Don’t ......
• Avoid using negative attitudeAvoid using negative attitude as tool as tool for redirecting behavior. Never use words for redirecting behavior. Never use words which make the child feels less respect which make the child feels less respect such as blaming, shaming or making him such as blaming, shaming or making him feel guilty, e.g. “only babies cry, be good.”feel guilty, e.g. “only babies cry, be good.”
• Do not promiseDo not promise a child anything you are a child anything you are not absolutely sure will happen. If you not absolutely sure will happen. If you make a promise, be sure you are able to make a promise, be sure you are able to do it.do it.
03/02/200903/02/2009 4444
Don’t ......(Cont.)Don’t ......(Cont.)
• Be professional.Be professional. Do not discussDo not discuss the the
child in front of another child. Do not child in front of another child. Do not discuss the child in public place.discuss the child in public place.
• When commenting on child’s When commenting on child’s creativity,creativity, avoid wordsavoid words like “what is like “what is it?” Instead use words like “what it?” Instead use words like “what beautiful color you used?”beautiful color you used?”
03/02/200903/02/2009 4545
Some suggestion on Some suggestion on adapting for specific adapting for specific disabilitiesdisabilitiesPhysical Physical
handicappedhandicapped• Positive reinforcementPositive reinforcement
• Breaking down tasks to achieveBreaking down tasks to achieve
reinforcementreinforcement
• Materials and equipment Materials and equipment adaptationadaptation
Mental handicappedMental handicapped • Positive reinforcementPositive reinforcement
• Breaking down tasks into Breaking down tasks into sequencesequence
• SShowing, guiding throughout thehowing, guiding throughout the
activityactivity
• MMay require some physical ay require some physical adaptationadaptation
03/02/200903/02/2009 4646
Some suggestion on Some suggestion on adapting for specific adapting for specific disabilities (Cont.)disabilities (Cont.)Visual impairmentVisual impairment • Positive reinforcementPositive reinforcement
• Guiding throughout the actionGuiding throughout the action
• Descriptive instructionDescriptive instruction
• Equipment / material adaptationEquipment / material adaptation
Hearing Hearing impairmentimpairment
• Positive reinforcementPositive reinforcement
• Breaking down the tasksBreaking down the tasks
• Facing the child while talkingFacing the child while talking
• Using sign languageUsing sign language
• Physical adaptationPhysical adaptation
Emotional Emotional impairmentimpairment
• Positive reinforcementPositive reinforcement
• Keep a small groupKeep a small group
• Arrange activity that are Arrange activity that are short in short in length and easy-to-succeedlength and easy-to-succeed so that so that the child does not become frustratedthe child does not become frustrated
03/02/200903/02/2009 4747
Strategies that HelpStrategies that Help
• 1. Physically handicapped children long to 1. Physically handicapped children long to be normal and be seen as normal as be normal and be seen as normal as much as possible. much as possible.
• 2. Find out what the child's strengths are 2. Find out what the child's strengths are and capitalize on them. These children and capitalize on them. These children need to feel as successful too! need to feel as successful too!
03/02/200903/02/2009 4848
Strategies that Help Strategies that Help (cont.)(cont.)
• 3. Keep your expectations of the 3. Keep your expectations of the physically handicapped child high. This physically handicapped child high. This child is capable of achieving. child is capable of achieving.
• 4. Never accept rude remarks, name 4. Never accept rude remarks, name calling or teasing from other children. calling or teasing from other children. Sometimes other children need to be Sometimes other children need to be taught about physical disabilities to taught about physical disabilities to develop respect and acceptance. develop respect and acceptance.
03/02/200903/02/2009 4949
Strategies that Help (cont.)Strategies that Help (cont.)
• 5. Compliment appearance from time to 5. Compliment appearance from time to time. (new hair cut, a new outfit). time. (new hair cut, a new outfit).
• 6. Make adjustments and 6. Make adjustments and accommodations whenever possible to accommodations whenever possible to enable this child to participate. enable this child to participate.
• 7. Never pity the physically handicapped 7. Never pity the physically handicapped child, they do not want your pity. child, they do not want your pity.
03/02/200903/02/2009 5050
Strategies that Help (cont.)Strategies that Help (cont.)
• 8. Take the opportunity when the child is 8. Take the opportunity when the child is absent to teach the rest of the class absent to teach the rest of the class about physical handicaps, this will help about physical handicaps, this will help foster understanding and acceptance. foster understanding and acceptance.
• 9. Take frequent 1 on 1 time with the 9. Take frequent 1 on 1 time with the child to make sure that he/she is aware child to make sure that he/she is aware that you're there to help when neededthat you're there to help when needed
03/02/200903/02/2009 5151