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Dr.Sarkawt S.Kakai FKBMS(Ortho.& Trauma) Physical Disability What is Disability? A disability is any condition of the body or mind (impairment) that makes it more difficult for the person with the condition to do certain activities (activity limitation) and interact with the world around them (parti...

Dr.Sarkawt S.Kakai FKBMS(Ortho.& Trauma) Physical Disability What is Disability? A disability is any condition of the body or mind (impairment) that makes it more difficult for the person with the condition to do certain activities (activity limitation) and interact with the world around them (participation restrictions). There are many types of disabilities, such as those that affect a person’s: Vision Movement Communicating Thinking Hearing Remembering Mental health Learning Social relationships According to the World Health Organization, disability has three dimensions: Activity limitation, such as difficulty seeing, hearing, walking, or problem solving. Participation restrictions in normal daily activities, such as working, engaging in social and recreational activities, and obtaining health care and preventive services. Disability can be Related to conditions that are present at birth and may affect functions later in life, Including cognition (memory, learning, and understanding), mobility (moving around in the environment), vision, hearing, behavior, and other areas. These conditions may be Disorders in single genes (for example, Duchenne muscular dystrophy); Disorders of chromosomes (for example, Down syndrome); and The result of the mother’s exposure during pregnancy to infections (for example, rubella) or substances, such as alcohol or cigarettes Associated with developmental conditions that become apparent during childhood (for example, autism spectrum disorder and attention-deficit/hyperactivity disorder or ADHD) Related to an injury (for example, traumatic brain injury or spinal cord injury). Associated with a longstanding condition (for example, diabetes), which can cause a disability such as vision loss, nerve damage, or limb loss. Progressive (for example, muscular dystrophy), static (for example, limb loss), or intermittent (for example, some forms of multiple sclerosis What is impairment? Impairment is an absence of or significant difference in a person’s body structure or function or mental functioning. For example, problems in the structure of the brain can result in difficulty with mental functions, or problems with the structure of the eyes or ears can result in difficulty with the functions of vision or hearing. Structural impairments Are significant problems with an internal or external component of the body. Examples of these include a type of nerve damage that can result in multiple sclerosis, or a complete loss of a body component, as when a limb has been amputated. Functional impairments Include the complete or partial loss of function of a body part. Examples of these include pain that doesn’t go away or joints that no longer move easily. What is the difference between activity limitation and participation restriction? The World Health Organization (WHO) published the International Classification of Functioning, Disability and Health (ICF) in 2001. The ICF provides a standard language for classifying body function and structure, activity, participation levels, and conditions in the world around us that influence health. This description helps to assess the health, functioning, activities, and factors in the environment that either help or create barriers for people to fully participate in society. According to the ICF: Activity is the execution of a task or action by an individual. Participation is a person’s involvement in a life situation. The ICF includes the following in the categories of activities and participation: Learning and applying knowledge Managing tasks and demands Establishing and managing interpersonal relationships and interactions Engaging in major life areas (education, employment, managing money or finances) Engaging in community, social, and civic life Visual Disabilities “Legally Blind” describes an individual who has 10% or less of normal vision. Only 10% of people with a visual disability are actually totally blind. The other 90% are described as having a “Visual Impairment.” Common causes of vision loss include: Cataracts (cloudy vision – treatable) Diabetes (progressive blindness) Glaucoma (loss of peripheral vision) Retinal Detachment (loss of vision) Hearing Disabilities “Deaf” describes an individual who has severe to profound hearing loss. “Deafened” describes an individual who has acquired a hearing loss in adulthood.. “Hard of Hearing” describes an individual who uses their residual hearing and speech to communicate. The Canadian Hearing Society Awareness Survey of 2001 states that almost 1 in 4 (23%) of Adult Canadians report having a hearing loss. Mental Health Disabilities Mental health disabilities can take many forms, just as physical disabilities do. Unlike many physical illnesses though, all mental illnesses can be treated. They are generally classified into six categories: Schizophrenia – The most serious mental illness Mood Disorders (Depression and Manic Depression) Anxiety Disorders. They include phobias and panic disorder as well as obsessive-compulsive disorder. Eating Disorders – They include anorexia nervosa and bulimia Personality Disorders. People with these disorders usually have a hard time getting along with other people. They are the most difficult disorders to treat. Organic Brain Disorders Intellectual Disabilities Characterized by intellectual development and capacity that is significantly below average. Involves a permanent limitation in a person’s ability to learn. Causes of Intellectual (or Developmental) Disabilities include: Any condition that impairs development of the brain before birth, during birth, or in childhood years Genetic conditions Illness affecting the mother during pregnancy Childhood diseases Learning Disabilities A learning disability is essentially a specific and persistent disorder of a person’s central nervous system affecting the learning process. This impacts a person’s ability to either interpret what they see and hear, or to link information from different parts of the brain. Having a learning disability does not mean a person is incapable of learning; rather that they learn in a different way. Many people with a learning disability develop strategies to compensate for or to circumvent their difficulties. Burn Injuries DR.SARKAWT S.KAKAI FKHMS(ORTHO. &TRAUMA) Introduction The skin is the largest organ of the body, and the most frequently injured structure in burns. The outer layer, which is typically first to be injured, is called the epidermis. Beneath the epidermis lies the dermis. This layer provides nutrition and structural support. Elastic fibers allow the skin to tolerate pressure and shearing forces. Functional presentation The depth or thickness of the injury is considered very important. Starting it includes superficial (epidermis), superficial partial (extending into dermis), deep partial (epidermis and most of dermis, with impaired healing and high risk of scarring), and full thickness (not expected to heal). Percentage of total body surface area (TBSA) involved is also critical. The “Rule of 9s” allocates 9% to the head and each upper extremity, 18% to anterior trunk, posterior trunk, and each lower extremity, and 1% to the perineum. Other organ systems may be injured during burns and associated trauma. Respiratory involvement after inhalation of smoke or fumes may be the most critical. Damage to the gastrointestinal tract may hinder the critical process of providing nutritional support to allow healing. Electrical injuries may cause cardiac damage. Nerve injuries are of particular importance. Nerve endings may be damaged in partial thickness burns, causing neuropathic pain while reducing useful sensation. Full thickness injuries destroy nerves, taking away protective sensation. Electrical injuries, burns covering over 15% TBSA, and stays over 20 days in intensive care are associated with a particularly high risk of neuropathy Post-burn management Can span from inception to the hospital to several months or years, depending on the severity of the injury. Stages of rehabilitation can be divided into early and later stages although there is no clear cut time frame for each as they are both thought to overlap. Early stage Also known as wound healing phase. Essentially, the aims of this stage are as follows: Respiratory care. Chest clearance can be achieved by raising the head and chest region. Physiotherapy techniques such as deep breathing exercises, v ibrations, percussion, postural drainage, coughing and suctioning can be employed to clear excess secretions. Prevention of deep vein thrombosis can be achieved by encouraging early ambulation. Prevention of contractures and stiffness Splinting and proper positioning will help achieve this aim. Also performing active or passive range of motion (ROM) exercises, depending on the patient's level of consciousness is crucial in the prevention of these complication. Immobilisation is only allowed when a part of the body has just been grafted. Even then, the area must be kept in an anti-deformity position Edema Edema (accumulation of fluid in soft tissues with swelling) may be significant. Use of elastic dressings, elevation, and mobilization may be employed for edema control. In severe cases involving burns around the circumference of a limb, nerves may be injured and flow through blood vessels may be compromised, even to a degree leading to amputation. Compartment syndrome may require surgical intervention. Pressure garments are commonly used on grafted burns or those that take longer than 14 days to heal. These are intended to reduce hypertrophic (overgrown) scarring, perhaps by reducing rates of blood flow to the scar Splinting is a standard procedure to preserve range of motion or protect a healing wound. Lightweight plastic materials are popular. The clinical challenge is to provide a device that will achieve goals of protecting range of motion and preserving joint function without causing undue discomfort to the patient. Pain Pain management is a critical part of patient care. Patients with poorly Burn Injuries controlled pain will have difficulty complying with the rigors of acute care and rehabilitation. Nerve endings that were painfully stimulated in the initial injury may be further stimulated by inflammatory processes, and by mechanical stresses during wound care and therapies. Resulting pain syndromes can be associated with significant functional and psychological morbidity Location of Burn Contracture Tendency Anti-Contracture Positioning and/or Typical Splint Anterior elbow Flexion Elbow extension splint in 5-10 degrees of flexion Dorsal wrist Wrist extension Wrist support in neutral Volar wrist Wrist flexion Wrist cockup splint in 5-10 degrees of flexion Dorsal hand Claw hand deformity Functional hand splint with MP joints at 70-90 degrees, IP joints fully extended, first web space open, thumb in opposition Volar hand Palmar contracture Cupping of hand Palm extension splint MP’s in slight hyperextension Anterior hip Hip flexion Prone positioning, Weights on thigh in supine Knee immobilizers Knee Knee flexion Knee extension positioning and/or splints Prevent external rotation, which may cause peroneal nerve compression Foot Foot drop Ankle at 90 degrees with foot board or splint Watch for signs of heel ulcers Later Stage This stage, also known as the post-healing stage, focuses more on the following: An improvement in muscle strength, endurance, balance and coordination owing to prolonged bed immobilization. Scar management Ambulation with little or no assistance Engaging in functional activities Integration into society PSYCHOLOGICAL AND VOCATIONAL IMPLICATIONS Recovery from moderate to major burns can be very stressful. Depression and post-traumatic stress disorders (PTSD) are common sequellae. Psychological interventions appear to effectively reduce burn patient psychological morbidities. Psychological interventions significantly reduce the risk of depression, anxiety, and hospital stay compared to usual care. Treatment It is critical to seek emotional support from professionals and other survivors to help with your psychological distress. Get sufficient sleep and eat healthy foods. Avoid tobacco, illicit drugs and/or excessive use of alcohol because they can make matters worse. Medications Depression (e.g., low mood, low energy, irritability towards self and others). Anxiety (e.g., worry, recurring and disturbing memories). Sleep (e.g., nightmares, difficulty relaxing). Developmental disabilities Lec.3 Dr.Sarkawt S.Kakai KHCMS (Ortho. & Trauma) Developmental Disabilities Are a diverse group of severe chronic conditions that are due to mental and/or physical impairments. People with developmental disabilities have problems with major life activities such as language, mobility, learning, self-help, and independent living. The prevalence of DDs is increasing. From 1997 to 2008 Autism prevalence increased by 289.5 percent while ADHD prevalence increased by 33 percent. Developmental disabilities (DD) includes conditions such as Attention deficit hyperactivity disorder (ADHD) Autism Intellectual disability Learning difficulties (e.g. developmental coordination disorder (DCD) / dyspraxia, auditory processing disorder) Blindness Cerebral palsy Moderate to profound hearing loss Seizures Causes Genetic or chromosome abnormalities. These cause conditions such as Down syndrome. Prenatal exposure to substances. For example, drinking alcohol when pregnant can cause fetal alcohol spectrum disorders. Certain infections in pregnancy Preterm birth Developmental Milestones Birth to 4 months Includes smiling, and bringing hands to mouth. 6 months. Includes playing with others, sitting without support, and rolling over. 9 months. Includes making sounds like "mama" and "dada," understanding the word "no," crawling, and pulling to a stand. 1 year. Includes playing peekaboo, following simple directions, and walking while holding on to furniture. 18 months. Includes speaking and understanding several words, eating with a spoon, walking, and walking up and down stairs. 2 to 3 years. Includes recognizing labels and colors, naming pictures of common objects, getting dressed and undressed, and walking and running easily. Screening test The American Academy of Pediatrics (AAP) recommends developmental and behavioral screenings for all children during regular well-child checkups at the following ages:9, 18 and 30 months Ages and Stages Questionnaire Parents' Evaluation of Developmental Status Modified Checklist for Autism in Toddlers (M-CHAT) Intellectual disability A term used when there are limits to a person’s ability to learn at an expected level and function in daily life. Levels of intellectual disability vary greatly in children. Children with intellectual disability might have a hard time letting others know their wants and needs, and taking care of themselves. are generally assessed through the use of standardized individually administered IQ tests. Signs sit up, crawl, or walk later than other children learn to talk later, or have trouble speaking find it hard to remember things have trouble understanding social rules have trouble seeing the results of their actions have trouble solving problem Classification Heber (1959, 1961) linked his description of “retardation in measured intelligence” to the following IQ scores: “borderline”(IQ range of 70–84), “mild” (IQ range of 55–69), “moderate” (IQ range of 40– 54), “severe” (IQ range of 25–39), and “profound” (IQ below 25). Definition and Examples of Intensities of Supports Intermittent Supports. Supports on an “as needed basis.” Characterized by episodic nature, person not always needing the support(s). Limited Supports. An intensity of supports characterized by consistency over time, time-limited but not of an intermittent nature Extensive Supports. This is characterized by regular involvement (e.g., daily) Pervasive Supports. This is characterized by their constancy and high intensity, provided across environments, potentially life-sustaining in nature. Attention Deficit Hyperactivity Disorder Is a neurodevelopmental disorder that affects the functioning of the brain. It seems to be due to abnormalities in the dopamine system and a change in frontal lobe development. While its cause is unknown, it is considered a genetic disorder, with environmental factors (e.g. diet, physical and social environments) playing a small role in its etiology. The following factors can increase the risk of ADHD: Very low birth weight Premature birth Exceptional early adversity ADHD is diagnosed based on reported behaviors or psychiatric assessment. The primary symptoms associated with ADHD are inattentiveness, hyperactivity and impulsiveness. However, fine and gross motor skills are affected in around 30 to 50 percent of children with ADHD, particularly in the predominantly inattentive and combined ADHD group. These motor problems are often ignored due to behavior difficulties, but children typically struggle with: Dressing, Handwriting, Learning to ride a bicycle and Tying shoelaces Autism Leo Kanner (1943) described a group of 11 children who displayed a similar pattern of specific symptoms that were significantly different from those of other childhood behavior disorders. Kanner called this form of childhood psychopathology “early infantile autism” Autism Spectrum Disorder (ASD), is a different way of thinking involving a neurological developmental difference that changes the way a person relates to the environment and people around them. A person with autism sees, experiences and understands the world in a different manner Etiology/Epidemiology ASD is a neurobiological disorder influenced by both genetic and environmental factors affecting the developing brain. Currently, no single universal cause has been identified but research is ongoing to discover potential etiologic mechanisms in ASD. ASD (according to some research) is becoming more prevalent. This finding is questioned, possibly be attributed to increased awareness, overdiagnosis, or overinclusive diagnostic criteria. Its prevalence is reported to be 1 in 68. Diagnoses based on combined clinician observation and caregiver reports are consistently more reliable than those based on either observation or reports alone. Later diagnoses often occur in presence of co-occurring problems such as anxiety, hyperactivity, or mood disorders that might have triggered the ASD, along with the same factors that play a part in delayed diagnoses in younger children. There is a need for clinical follow-up and reassessments of children diagnosed with ASDs, especially during the preschool years Diagnosis