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Intellectual Impairment (intellectual + impairment)
Selected AbstractsParticipation of children with cerebral palsy is influenced by where they liveDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 5 2004Donna Hammal MSc The study aimed to determine whether degree of participation of children with cerebral palsy (CP) is influenced by where they live, as predicted by the social model of disability. Ninety-two per cent children with CP resident in Northern England and born 1991-1996 were entered into the study. Participation was measured by the Lifestyle Assessment Score and its six component domain scores. Regression analysis was used to investigate variations in participation. There were 443 children (265 male, 178 female; mean age 4 years 8 months [SD1 year 1 month] at time of assessment) in the study. In the regression analysis the following factors remained significant with regard to level of participation: type of CP (167 with hemiplegia, and of those remaining 240 with bilateral spasticity); intellectual impairment (105 with IQ<50,113 with IQ 50 to 70, and 225 with IQ>70); presence of seizures (115 with active epilepsy); walking disability (114 unable to walk, 81 restricted and needing aids, 186 restricted but unaided, 62 unrestricted); communication problems (61 no formal communication, 51 use alternative formal methods, 126 some delay or difficulty, 205 no communication problems). After adjustment for these factors, there were significant variations with regard to level of participation in the Lifestyle Assessment Score by district of residence. The magnitude of these variations in Lifestyle Assessment Score between districts is similar to that accounted for by severe intellectual impairment. Similar models were obtained for four of the six domain scores. For one of these four, restriction of social interaction, the significant variation between districts was minimally influenced by the underlying type of CP, walking ability, or presence of seizures. Higher levels of participation among children with CP are associated with residence in certain districts. This is not attributable to variations in case-mix or functional capacity of the children. Participation of children with disability is partly a product of their environment. [source] Effects of nursing interventions within an integrated care pathway for patients with hip fractureJOURNAL OF ADVANCED NURSING, Issue 2 2007Lars-Eric Olsson Abstract Title. Effects of nursing interventions within an integrated care pathway for patients with hip fracture Aim., This paper reports a study to evaluate the contribution of nursing care within an integrated care pathway for patients with hip fracture. Background., There is growing interest in quality assurance in health care. Integrated care pathways are a method to achieve this goal, and are a multi-professional team approach where the requirement for nurses to work effectively within the team is important. However, the nurses' role and contribution within the team have not been well described. Method., A quasi-experimental, prospective study comparing an intervention group with a comparison group was carried out. One hundred and twelve independently living patients, aged 65 years or older and admitted to a Swedish hospital with a hip fracture, were consecutively selected. Pathological fracture and severe intellectual impairment (Pfeiffer's test <3 points) served as exclusion criteria. The intervention was designed to focus on patients' motivation and their prerequisites for rehabilitation and was based on the concept of transition. The main outcome measure was the number of patients restored to preoperative activities of daily living levels in 2003,2004. Findings., In the intervention group 21% were restored to activities of daily living to level A (independent) at discharge, whereas only 5% in the comparison group were restored to this level. No patients in the intervention group, admitted as independent, remained at activities of daily living level F (dependent), whereas 16% remained at level F in the comparison group (P = 0·003). Conclusion., When admitting older patients with a hip fracture, it is important to acquire good knowledge about each patient and their prerequisites and to offer them accelerated rehabilitation in accordance with their individual ability. By monitoring process indicators during the transition, serious deviations from the care plan can be avoided. [source] Predictors of academic attainments of young people with Down's syndromeJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 5 2008S. Turner Abstract Background Earlier studies of young people with Down's syndrome have investigated a relatively limited range of variables which may influence their academic attainment. The relative strength of such influences and how they may vary during the school career, has also been under-researched. Aims The aim of the paper is to identify the contemporary and antecedent predictors of the level of academic attainment achieved by a representative sample of young people with Down's syndrome. Sample The paper reports data from three studies of 71 young people with Down's syndrome and their families. Mean IQ at the time of the first study (t1) was 40.4. Mean chronological age was 9 years at t1, 14 at t2, and 21 at t3, when all the young people had left school. Methods The outcome measure was the 58-item Academic Attainments Index (AAI), comprising three sub-scales covering reading, writing and numeracy. Predictors of the outcome were derived from questionnaires and interviews from tutors, mothers and fathers. A path analysis approach was used to investigate the pattern of predictors of the outcome over the three studies. Results Factors predicting greater progress in this measure between t2 and t3 were lower chronological age and attendance at mainstream school. Progress from t1 to t2 was also associated with attendance at mainstream school, as well as with higher t1 mental age, mother's practical coping style and higher child attentiveness. Background factors predicting higher t1 AAI scores were higher mental age, attendance at mainstream school and father's internal locus of control. The path analysis model predicted 48% of the variance in t3 outcome scores. Severity of intellectual impairment was by far the most significant predictor. Conclusion Limitations to the study include evidence of attrition bias towards more able children, and the need to obtain the t3 outcome measure from tutors for some young people and parents for others. Parents may have over-estimated abilities. Results are broadly in agreement with other studies, and confirm the pattern reported earlier with this group. Mainstream school attendance had a modest beneficial effect on AAI scores throughout the school career of the children, independently of level of intellectual disability. Identification of predictors of attainment levels and of improvement over time may help parents, teachers and other professionals involved with families of children and young people with Down's syndrome optimise the attainment of such skills. [source] Self-determination, social abilities and the quality of life of people with intellectual disabilityJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 11 2007L. Nota Summary Background The international literature has documented that self-determination is impacted by environmental factors, including living or work settings; and by intraindividual factors, including intelligence level, age, gender, social skills and adaptive behaviour. In addition, self-determination has been correlated with improved quality of life (QoL). This study sought to contribute to the growing literature base in this area by examining the relationship among and between personal characteristics, self-determination, social abilities and the environmental living situations of people with intellectual disabilities (ID). Methods The study involved 141 people with ID residing in Italy. Healthcare professionals and social workers who had known participants for at least 1 year completed measures of self-determination, QoL and social skills. Analysis of variance was conducted to verify whether different levels of intellectual impairment were associated with different degrees of the dependent variables. The Pearson product,moment correlation was used to examine any relationships among dependent variables and IQ scores. Finally, discriminant function analysis was used to examine the degree to which IQ score, age, self-determination and social abilities predicted membership in groups that were formed based on living arrangement, and on QoL status (high vs. low). Results The anova determined, as expected, that participants with more severe ID showed the lowest levels of self-determination, QoL and social abilities. Discriminant function analysis showed that (a) individuals attending day centres were distinguished from those living in institutions in that they were younger and showed greater autonomy of choice and self-determination in their daily activities; (b) basic social skills and IQ score predicted membership in the high or low QoL groups; and (c) the IQ score predicted membership in the high or low self-determination groups. A manova conducted to examine gender- and age-level differences on self-determination found gender differences; women had higher self-determination scores than men. Conclusions These findings contribute to an emerging knowledge base pertaining to the role of intraindividual and environmental factors in self-determination and QoL. In general, the study replicated findings pertaining to the relative contribution of intelligence to self-determination and QoL, added information about the potential contribution of social abilities, and pointed to the potentially important role of opportunities to make choices as a particularly important aspect of becoming more self-determined, at least in the context of residential settings. [source] Intellectual and adaptive behaviour functioning in pantothenate kinase-associated neurodegenerationJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 6 2007K. Freeman Abstract Background Pantothenate kinase-associated neurodegeneration (PKAN), an extremely rare autosomal recessive disorder resulting in iron accumulation in the brain, has a diverse phenotypic expression. Based on limited case studies of one or two patients, intellectual impairment is considered part of PKAN. Investigations of cognitive functioning have utilized specific neuropsychological tests, without attention to general intellectual skills or adaptive behaviour. Methods Sixteen individuals with PKAN completed measures of global intellectual functioning, and participants or care providers completed measures of adaptive behaviour skills and day-to-day functional limitations. Clinicians provided global ratings of condition severity. Results Testing with standardized measures documented varied phenotypic expression, with general cognitive skills and adaptive behaviour ranging from high average to well below average. Age of disease onset correlated with measures of intellectual functioning, adaptive functioning and disease severity. Conclusions Findings support previously described clinical impressions of varied cognitive impairment and the association between age of onset and impairment. Further, they add important information regarding the natural history of the disease and suggest assessment strategies for use in treatment trials. [source] Performance of young people with Down syndrome on the Leiter-R and British picture vocabulary scalesJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 4 2005S. Glenn Abstract Background The British picture vocabulary scales (BPVS-II) and the Leiter international performance scales (Leiter-R), both restandardised in 1997, are often used in experimental studies to match individuals with intellectual impairment. Both provide a brief measure of mental age, and cover a wide ability range using a simple format. The BPVS-II assesses verbal comprehension and the Leiter nonverbal abilities. The issue is which to choose. People with Down syndrome (DS), for example, have particular problems in language and so the BPVS may provide an underestimation of ability. Method The present study investigated this by comparing the performance of 46 young people with DS (21 females, 25 males, mean age 19 years 10 months) on the BPVS-II (verbal mental age , VMA) and the Leiter-R brief IQ (nonverbal mental age , NVMA). Results Contrary to expectations VMAs were significantly higher than NVMAs (6 years 6 months and 5 years 2 months, respectively). There was a significant correlation of 0.61 between the VMA and NVMA, and both discriminated participants at all levels of ability. However, the Leiter-R brief IQ scores provided poor discrimination at the bottom end of the IQ range (IQ 36). Conclusion Both the BPVS-II and the Leiter-R provide mental age equivalent scores that are useful for plotting developmental progress, although absolute mental ages may differ. [source] Blockheads, roundheads, pointy heads: Intellectual disability and the brain before modern medicineJOURNAL OF THE HISTORY OF THE BEHAVIORAL SCIENCES, Issue 2 2005C. F. Goodey Recent work on the conceptual history of intellectual disability has pointed to a discontinuity in the seventeenth century, identifying the concept as essentially modern in a more radical sense than mental illness or physical disability. However, Galenist accounts of intellectual impairment were clearly connected (via anatomy) to neurology, which could be taken as prima facie evidence that Galenism shares with modern medicine one of its basic explanatory approaches to intellectual disability. Close textual examination does not bear out this counter-claim, at least as far as the conceptual apparatus itself is concerned. However, it does reveal a degree of continuity in the medical mind-set as discourses of monstrosity were transposed from the domain of anatomy to that of post-Cartesian psychology. © 2005 Wiley Periodicals, Inc. [source] Periventricular leukomalacia, inflammation and white matter lesions within the developing nervous systemNEUROPATHOLOGY, Issue 3 2002Payam Rezaie Periventricular leukomalacia (PVL) occurring in premature infants, represents a major precursor for neurological and intellectual impairment, and cerebral palsy in later life. The disorder is characterized by multifocal areas of necrosis found deep in the cortical white matter, which are often symmetrical and occur adjacent to the lateral ventricles. There is no known cure for PVL. Factors predisposing to PVL include birth trauma, asphyxia and respiratory failure, cardiopulmonary defects, premature birth/low birthweight, associated immature cerebrovascular development and lack of appropriate autoregulation of cerebral blood flow in response to hypoxic-ischemic insults. The intrinsic vulnerability of oligodendrocyte precursors is considered as central to the pathogenesis of PVL. These cells are susceptible to a variety of injurious stimuli including free radicals and excitotoxicity induced by hypoxic-ischemic injury (resulting from cerebral hypoperfusion), lack of trophic stimuli, as well as secondary associated events involving microglial and astrocytic activation and the release of pro-inflammatory cytokines TNF-, and IL-6. It is yet unclear whether activated astrocytes and microglia act as principal participants in the development of PVL lesions, or whether they are representatives of an incidental pathological response directed towards repair of tissue injury in PVL. Nevertheless, the accumulated evidence points to a pathological contribution of microglia towards damage. The topography of lesions in PVL most likely reflects a combination of the relatively immature cerebrovasculature together with a failure in perfusion and/or hypoxia during the greatest period of vulnerability occurring around mid-to-late gestation. Mechanisms underlying the pathogenesis of PVL have so far been related to prenatal ischemic injury to the brain initiated within the third trimester, which result in global cognitive and developmental delay and motor disturbances. Over the past few years, several epidemiological and experimental studies have implicated intrauterine infection and chorioamnionitis as causative in the pathogenesis of PVL. In particular, recent investigations have shown that inflammatory responses in the fetus and neonate can contribute towards neonatal brain injury and development-related disabilities including cerebral palsy. This review presents current concepts on the pathogenesis of PVL and emphasizes the increasing evidence for an inflammatory pathogenic component to this disorder, either resulting from hypoxic-ischemic injury or from infection. These findings provide the basis for clinical approaches targeted at protecting the premature brain from inflammatory damage, which may prove beneficial for treating PVL, if identified early in pathogenesis. [source] Effects of polydipsia,hyponatremia on seizures in patients with epilepsyPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 3 2007MITSUTOSHI OKAZAKI md Abstract Aggravation of seizures due to hyponatremia was investigated in five patients with epilepsy and polydipsia,hyponatremia. They experienced marked increases in the frequency of their complex partial seizures with a decrease in the serum sodium level to 118,127 mEq/L. In all cases, the serum sodium level returned to normal through restriction of fluids, and the clinical seizures improved. All patients had shown intellectual impairment and/or psychotic episodes, and all had been given antipsychotics. Hyponatremia caused by polydipsia appears to be a risk factor for aggravation of habitual seizures in patients with epilepsy. [source] Elbow flexion response as another primitive reflexPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 2 2002Kazumasa Sudo MD Abstract In daily clinical practice we noticed that patients with intellectual impairment spontaneously flex the elbow within a few seconds of the forearm being manipulated during routine examination of spasticity of the muscles in the upper extremities. We termed this phenomenon elbow flexion response (EFR), and prospectively studied it in 229 patients who underwent in-hospital rehabilitation following brain damage. Evaluation of each patient included EFR, patient profile, ability to communicate, scores on three parameters from various intelligence tests, scores on seven parameters testing primitive reflexes, and scores on three parameters describing personality. We investigated for relationships among these parameters. Consequently, although EFR rarely have a statistical association with the varied profiles of patients, patients with bilateral lesion or bilateral paresis demonstrated significantly more marked EFR than those with unilateral lesion or unilateral paresis. Patients with involvement of the frontal lobe showed significantly more marked EFR than those without damage in this area. Elbow flexion responses occurred significantly more frequently in relation with lower scores on intelligence and occurred with significantly higher frequency in conjunction with the more marked appearance of conventional primitive reflexes. Therefore, we conclude that EFR have a strong association with intelligence and with the existence of frontal lobe lesion, and their mode of clinical presentation parallels that of primitive reflexes particularly that of the grasp reflex. We propose that EFR could be referred as a variation of the grasp reflex occurring in the more proximal or axial part of the body. [source] The Impact of Personal Characteristics of People with Intellectual and Developmental Disability on Self-determination and Autonomous FunctioningJOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 4 2003Michael L. Wehmeyer Background, Many people assume that the presence of an intellectual disability precludes a person from becoming self-determined. Recent research, however, has suggested that the environments in which people live, learn, work or play may play a more important role in promoting self-determination then do personal characteristics of the person, including level of intelligence. Methods, This study examined the self-determination and autonomous functioning of 301 adults with intellectual disability or a developmental disability without concomitant intellectual impairments (e.g. persons with cerebral palsy, epilepsy and spina bifida) as a function of personal characteristics of individuals. Results, Intellectual capacity was not a significant contributor to either self-determination or autonomous functioning for this group. Opportunities to make choices, however, contributed significantly and positively to greater self-determination and autonomy. Intelligence scores did, however, predict whether the person worked or lived in more or less restrictive settings, though for the latter, both self-determination and autonomous functioning also contributed significantly. Conclusions, These findings are discussed with regard to the role of personal characteristics, particularly intelligence level, in promoting self-determination and more positive adult outcomes. [source] Offering choices to people with intellectual disabilities: an interactional studyJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 12 2008C. Antaki Abstract Background At the level of policy recommendation, it is agreed that people with intellectual impairments ought to be given opportunities to make choices in their lives; indeed, in the UK, the Mental Capacity Act of 2005 enshrines such a right in law. However, at the level of practice, there is a dearth of evidence as to how choices are actually offered in everyday situations, which must hinder recommendations to change. Method This qualitative interactional study, based on video recordings in British residential homes, combines ethnography with the fine-grained methods of Conversation Analysis. Results We identify six conversational practices that staff use to offer choices to residents with intellectual disabilities. Conclusions We describe the unwanted consequences of some of these practices, and how the institutional imperative to solicit clear and decisive choice may sometimes succeed only in producing the opposite. [source] | ||||||||||