Frailty And Process Outcomes
After adjusting for age, sex, and CURB-65, patients with greater frailty were more likely to require nasogastric tube feeding and prolonged hospitalization and be newly discharged to a long-term care institution . However, new psychoactive drug use or ICU stay did not significantly differ by frailty level after adjustment.
Types Of Flu Vaccines For People With Disabilities
There are several influenza vaccine options and your health care provider can recommend one that is appropriate for you. People with certain medical conditions or disabilities, such as those with weakened immune systems or cochlear implants, should not receive the nasal spray flu vaccine. Visit this page for more information.
Information about different types of flu vaccines can be found here.
Why Choose Children’s Hospital Colorado
The Developmental Pediatrics Program at Children’s Colorado has experienced physicians trained in developmental-behavioral pediatrics and neurodevelopmental disabilities. This means our experts have had additional training to evaluate children with a wide range of developmental problems.
We also have experienced licensed clinical psychologists, all of whom have doctoral degrees. Our psychologists have completed additional post-doctoral training in the area of children with intellectual and other developmental disabilities.
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Frequency Of Intellectual Disability In Cp
The 1999 to 2008 CP birth cohort comprised 1141 children, of whom 12% had missing data on intellectual status. Of the remaining 1005 children, 45% were recorded as having intellectual disability. The severity of impairment was unknown for nearly half the group with intellectual disability. Overall, there was little evidence for a difference in the frequency of intellectual disability according to birth gestation, although there was some evidence for a lower rate of intellectual disability in children born between 28 weeks’ and 31 weeksâ gestation relative to those born at term .
How Common Are Intellectual Disabilities
Approximately 6.5 million people in the United States have an intellectual disability. Approximately 1 3 percent of the global population has an intellectual disabilityas many as 200 million people.
Intellectual disability is significantly more common in low-income countries16.41 in every 1,000 people. Disabilities overall are more common in low-income countries.
The United Nations Development Program estimates that 80 percent of all people with disabilities live in low-income countries. While people with disabilities represent approximately one in 10 people worldwide, they are one in every five of the worlds poorest people.
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Research In Asthma Management For People With Intellectual Disability
This is a very neglected area, possibly due to difficulties in recruiting people with intellectual disability for research studies however, it can be done .
Diagnosis
The feasibility, repeatability and reproducibility of measuring airway resistance using the interrupter technique in lieu of spirometry has been studied in 67 people aged 50years or over with a mild, moderate or severe intellectual disability . Airway resistance during tidal breathing has a good correlation with forced expiratory volume in 1s, which is measured with spirometry and has been used successfully in children with cerebral palsy .
Self-management
Inhaler technique mastery has also been studied in people with mild intellectual disability, triangulating a qualitative examination of the training process in inhaler technique with established quantitative techniques to give the first insights into how individuals with intellectual disability actually use their inhalers . The study showed that prior to training, no participants correctly used any device. The most poorly use devices were pressurised metered-dose inhalers, with or without accessory devices . Inhalation steps were poorly performed across all devices. A number of barriers to correct inhaler use were identified including poor comprehension of breathing processes and poor dexterity.
Role of caregivers
Flow Of Inclusion Of General Items
shows the flow of inclusion of the general items in all three rounds. Originally, 82 general items were presented to the participants in the first round. The participants reached consensus on 44 general items. An overview of these items can be found in the Supplementary material. Six items were rejected in this round . Full agreement in both expert groups was reached during the first round on nine items: vision, hearing, gastro-oesophageal reflux disease , defecation , behaviour , smoking, alcohol and drug and sports . The GP experts fully agreed on dental care and weight loss/gain.
Flow of inclusion of general items throughout Delphi rounds one, two and three for the development of a health assessment instrument for people with ID . *See Supplementary Table S1, **See Supplementary Table S2, ***See .
In the second round, the remaining 32 general items with agreement of 5075% and 10 new general items were presented to both expert groups. Supplementary Table S2 shows the changes in agreement between the first and second rounds. The items with an asterisk were presented in the second round with additional information from the first round.
New health assessment items proposed by GPs and ID physicians in the Delphi study
Light grey indicates 100% in one expert group. Middle grey indicates > 75% GP expert group: inclusion. Dark grey indicates 100% in both expert groups.
aNew items presented in round 2 for the first time.
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What Causes Intellectual Disability
Anytime something interferes with normal brain development, intellectual disability can result. However, a specific cause for intellectual disability can only be pinpointed about a third of the time.
The most common causes of intellectual disability are:
- Genetic conditions. These include things like Down syndrome and fragile X syndrome.
- Problems during pregnancy. Things that can interfere with fetal brain development include alcohol or drug use, malnutrition, certain infections, or preeclampsia.
- Problems during childbirth. Intellectual disability may result if a baby is deprived of oxygen during childbirth or born extremely premature.
- Illness or injury. Infections like meningitis, whooping cough, or the measles can lead to intellectual disability. Severe head injury, near-drowning, extreme malnutrition, infections in the brain, exposure to toxic substances such as lead, and severe neglect or abuse can also cause it.
- None of the above. In two-thirds of all children who have intellectual disability, the cause is unknown.
Measurements Of Frailty Pneumonia Severity And Comorbidity Burden
A deficit-accumulation frailty index was calculated using 50 items from baseline assessment: 26 comorbidities, polypharmacy , self-reported ability to perform 21 activities listed above, weight loss> 5 kg in past year, body mass index< 21 kg/m2, and serum albumin< 3.5 g/L . MMSE was excluded from the FI calculation due to low completion rate . Based on FI , patients were classified into robust , pre-frail , mild-to-moderately frail , and severely frail categories. Pneumonia severity was calculated using CURB-65 score , which includes confusion, uremia, elevated respiratory rate, hypotension, and 65 years of age . The Gagne comorbidity index was used to quantify the comorbidity burden .
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Pain In Cognitive Impairment Not Dementia
9 July 2021
Translations
GLOBAL YEAR
This years theme focuses on increasing the awareness of clinicians, scientists, and the public of our growing pain knowledge and how it can benefit those living with pain.
Summary Autism Spectrum Disorder Vs Intellectual Disability
Autism spectrum disorder and intellectual disability are two developmental disorders seen in humans. Autism spectrum disorder causes significant social, communication, and behavioural challenges. In contrast, intellectual disability causes limitations in both intellectual functioning and in adaptive behaviour that cover many day-to-day social and practical skills. So, this is the key difference between autism spectrum disorder and intellectual disability.
Reference:
2. Intellectual Disability: Definition, Symptoms, Treatment, and More. Medical News Today, MediLexicon International.
Image Courtesy:
1. Signs of Autism By MissLunaRose12 Own work via Commons Wikimedia
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Depending On The Cause Of Intellectual Disability And Various Areas Of The Brain Involved The Motivational
Individuals with intellectual disability often display pain in unusual ways. Subtle changes in behavior and appearance may be indicators of pain, as expressions of pain may be variable and idiosyncratic . Depending on the cause of intellectual disability and various areas of the brain involved, the motivational-affective, cognitive-evaluative, and autonomic responses to pain can be affected . This creates a misconception that people with intellectual disability are a homogenous group who are less sensitive to pain and have a higher pain threshold .
Pain recognition in cognitive impaired
Pain management in cognitive impaired
In order to manage pain, an effective pain assessment and evaluation of pain sources is necessary. Conditions that cause nociceptive pain, for example fractures and dental problems, should be evaluated . Gastroesophageal reflux disease is a major cause of pain in intellectual disability and may be associated with vomiting, pneumonia, and dental problems. All of which are potentially painful . Validated tools are available to quantify symptom frequency and severity of gastroesophageal reflux and early detection and early treatment of gastroesophageal reflux is key to preventing pain and other symptoms. Besides nociceptive pain, neuropathic pain should be considered as a cause as well.
Key Points
REFERENCES
de Knegt N. and Scherder E. Pain in adults with intellectual disabilities. Pain.152:9714.
Abraham J. Valkenburg, MD, PhDDepartment of Anesthesiology
Why Is Respiratory Illness In Cerebral Palsy Important
The commonest cause of morbidity and mortality in people with CP is respiratory-related . Early mortality is more common in people with severe or profound intellectual disability, severe motor impairment, epilepsy, spasticity, and term birth . Compared to the general population, adults with CP have a 14-fold risk of death from diseases of the respiratory system . Although individuals with CP are surviving longer than previously , respiratory failure has been the leading cause of death in this population since the 1970’s .
More severely impaired children with CP are admitted to hospital more often and for longer , have more procedures and diagnoses per admission, and are more likely to die while in hospital.
Hospitalization and pain are the two strongest predictors of poor health-related quality of life in children with severe CP . As the commonest cause of medical admission to hospital in severe CP is respiratory illness, it follows that respiratory illness is a leading cause of reduced health-related QoL. There is also a significant increase in the frequency of hospitalizations in children with severe physical disability in the last 6 months of life . Therefore, referral to palliative care should be considered if the frequency of admissions increases.
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What Tests Are Used To Diagnose Intellectual Disability
The diagnosis of intellectual disability is made based on the results of cognitive testing to measure intelligence, as well as evaluating how a child functions in everyday activities to measure their adaptive skills.
To test for intellectual disability, a qualified psychologist tests children using standardized testing tools. In addition, either the psychologist or developmental pediatrician does tests to evaluate a child’s adaptive skill abilities. These tests are non-invasive and not painful to children. In fact, many of these tests seem like games.
What Are The Most Common Causes
The most common causes of intellectual disabilities are:
Genetic conditions. Sometimes an intellectual disability is caused by abnormal genes inherited from parents, errors when genes combine, or other reasons. Examples of genetic conditions are Down syndrome, Fragile X syndrome, and phenylketonuria .
Complications during pregnancy. An intellectual disability can result when the baby does not develop inside the mother properly. For example, there may be a problem with the way the babys cells divide. A woman who drinks alcohol or gets an infection like rubella during pregnancy may also have a baby with an intellectual disability.
Problems during birth. If there are complications during labor and birth, such as a baby not getting enough oxygen, he or she may have an intellectual disability.
Diseases or toxic exposure. Diseases like whooping cough, the measles, or meningitis can cause intellectual disabilities. They can also be caused by extreme malnutrition, not getting appropriate medical care, or by being exposed to poisons like lead or mercury.
We know that intellectual disability is not contagious: you cant catch an intellectual disability from anyone else. We also know its not a type of mental illness, like depression. There are no cures for intellectual disability. However, children with intellectual disabilities can learn to do many things. They may just need take more time or learn differently than other children.
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Research Setting And Ethics
This population-based, retrospective epidemiological study was undertaken at the Murdoch Children’s Research Institute within the Melbourne Children’s campus, Victoria, Australia. The protocol was approved by the Human Research Ethics Committee of the Royal Children’s Hospital, Melbourne. Data linkage with the National Death Index received ethics approval from the Australian Institute of Health and Welfare.
Frailty And Patient Outcomes At 30 Days
Among 147 patients who did not have the maximum disability on admission, 99 developed the primary outcome . The risk of primary outcome increased with the frailty level on admission, which remained statistically significant after adjusting for age, sex, and CURB-65 : 46.7% for robust group, 61.1% for pre-frail group , 83.8% for mild-to-moderate frailty group and 86.2% for severe frailty group . Similar patterns were observed for the individual outcomes of death and functional decline, but the association was not statistically significant for death due to low event rates.
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Why People With Intellectual Disabilities Are Dying Avoidable Deaths
Maureen McIlquham drifts between caressing memories and hellish grief when she thinks of her daughter, Michelle.
Michelle wanted to be a copy typist. She longed to have a boyfriend and fall in love, like her sister.
She loved to sing and would often skip off to her room, close the door and play Mariah Carey’s All I Want For Christmas Is You as she danced barefoot.
“I miss hearing her music coming through the bedroom wall. I miss her singing. I just miss Michelle,” Mrs McIlquham said.
Michelle Mcilquham died at 28.Credit:Wolter Peeters
Michelle died of meningitis on May 19, 2009, after a middle ear infection spread to her brain.
The 28-year-old’s condition was overlooked by medical staff who couldn’t see past her mild intellectual disability, a coronial inquest later found.
Michelle was “evidently in real pain”, the deputy coroner said. But her treating doctor wrote off her distress, crying and moaning as a “temper tantrum” after she’d suffered a seizure and was transferred by ambulance to Bankstown Hospital’s emergency department.
“She had a mind of her own like anyone else,” Mrs McIlquham said. “She was intelligent and bright and charming. She could speak for herself, but by the time we saw a doctor she wasn’t talking, she was in pain and so tired.”
Maureen McIlquham holds a photo of herself and her daughter, Michelle, who died of meningitis in 2009. Credit:Wolter Peeters
“I told the doctor she wasn’t always like this , but I don’t think they believed me.”
Upper Airway Obstruction And Sleep
Sleep disordered breathing and UAO are common in CP with severe motor impairment . Risk factors for sleep disordered breathing include UAO, brainstem dysfunction, epilepsy, chronic aspiration, chest wall deformity, and hypotonia. Treatment of sleep disordered breathing may improve seizure control, reduce lethargy, and improve alertness. However, it increases burden of care, GER, and aspiration risk, and is generally not tolerated. Although widely used, there is no evidence in CP that non-invasive ventilation prevents pneumonia or hospitalizations. A small study found bilevel positive pressure in acute care reduced length of stay .
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Reviewmortality In People With Intellectual Disabilities And Epilepsy: A Systematic Review
Reviews 16 studies on mortality in people with intellectual disabilities and epilepsy.
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People with intellectual disabilities and epilepsy have increased risk of mortality.
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Increased mortality risk evident mainly in those with ongoing seizures.
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Evidence base is small and further research is needed.
How Does An Intellectual Disability Happen
Intellectual disabilityformerly known as mental retardationcan be caused by injury, disease, or a problem in the brain. For many children, the cause of their intellectual disability is unknown.
Some causes of intellectual disabilitysuch as Down syndrome, Fetal Alcohol Syndrome, Fragile X syndrome, birth defects, and infectionscan happen before birth. Some happen while a baby is being born or soon after birth.
Other causes of intellectual disability do not occur until a child is older these might include severe head injury, infections or stroke.
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What Happens After The Tests
As a result of our findings, recommendations are made about the types of services that may benefit your child. Sometimes, those recommendations include additional medical testing to identify the cause of developmental issues or associated medical conditions.
Not all children require many tests. Some tests may affect the treatment of your child, while others may help identify a specific medical condition related to the diagnosis of intellectual disability. Additional referrals to other providers like, speech and language therapists, occupational therapists, geneticists and neurologists may also be recommended.
What To Expect From Cognitive Testing
Cognitive tests evaluate a child’s knowledge and problems solving skills and assess verbal and non-verbal skills. Different tests are used based on the child’s age and level of functioning. Tests may often appear like play or may seem similar to school work. Evaluation of a young child may take 2 to 3 hours, while evaluation of an older child may take 4 or more hours.
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What Other Services And Therapies Are Available
In addition to services that may be provided by the school system, different types of services and therapies may be provided in the community, including:
- Physical therapy to work on gross motor skills, particularly issues related to differences in muscle tone, strength, motor planning and coordination.
- Occupational therapy to address issues related to fine motor, self-help, sensory processing, and/or feeding skills.
- Speech and language therapy to address delays in speech sound production, understanding and production of language. Some children also may require special assistance in development of nonverbal communication skills. Therapy also may focus of feeding problems.
- Behavioral therapies may be used to work on behaviors that interfere with learning, social interactions and day-to-day functioning, such as problems with attention, mood, aggression or self-injurious behaviors.
There is no medication to treat intellectual disability, as it is a disability and not a disease. However, in some instances medication may also be useful for helping associated problems, such as sleep, attention or mood.