chapter 4 rehab

causes for MR

1. Genetics -some implications inherited from parents (where the baby was born with mental retardation there is nothing that could have been done); 2. Fetal Alcohol Syndrome (FAS) - where the mother used alcohol during pregnancy, which makes this a preventable form of retardation; 3. Birth complications- where the child experienced anoxia (no oxygen) or hypoxia (not enough oxygen) during birth, which resulted in mental retardation; 4. Trauma to the head- where damage occurred or severe illness such as meningitis may also cause mental retardation.

life skills for MR

: Mental retardation cannot be cured--however, in a nurturing environment, children and young adults can often learn important skills such as communication, reading, and hygiene behaviors. • There are different levels of severity in retardation. Some people are able to have more independence than others. • Most have difficulty with their self-confidence and well-being. o Resources: There are programs and information that assist people with mental retardation to live a fulfilling life. o Example: schools are required to develop an Individual Education Plans (IEPs) for children. o Family, friends, and teachers can also teach social rules and self-care (dressing, oral hygiene, etc.) through the use of educational practices and games

physical function probs and solutions

Chronic difficulties in physical functioning are frequently related to a) injuries (i.e., falls, car accidents, etc.) or b) diseases and disorder of the musculoskeletal (i.e., bones, skeletal muscles), connective tissues (i.e., ligaments, tendons, cartilage) and neuromuscular systems. • Injuries resulting in permanent difficulties in physical functioning --may be of traumatic onset or due to repetitive motion injuries. • Spinal Cord Injury (SCI) resulting in paralysis and loss of extremities function - usually has a sudden onset due to a major trauma (i. e., vehicle accident, diving in shallow water). • Mobility (use of legs and sometimes legs & arms) is affected. While the consequences are significant and life-long lasting individuals with SCI have a healthy, productive long life. Wellness and prevention of secondary conditions are key for quality of life. • SCI is defined by the level of the injury- the higher the cord is traumatized the more extensive are the effects on physical functioning. • • Lower level SCI injury -- is classified as paraplegia (T level) affecting mobility and other body functions (depending on the level)-hips, abdominal muscles, legs, feet, as well as bowel and bladder functioning. • Higher level SCI injury -- is classified as quadriplegia or tetraplegia (C level) affecting arms, hands and legs and compromised respiratory function including other body functions. Assistive Technology (AT) -- can help the person to compliment compromised abilities such as: walking, speaking, breathing, activities of daily living (ADLs) and many types of barriers to human functions.

hearing impairment

Definition Hard-of-hearing: A hard-of-hearing person is one whose hearing is impaired (usually 35-69 dB) such that it is difficult, but not impossible, to understand speech through the ear alone, with or without a hearing aid. • This is one of the categories that have the most changes under the new classification of disabilities. Once encompassing all levels of hearing loss, it is now broken up into three areas. • Hearing impairment affects a person's educational performance, but this condition is not included under the definition of deafness, which is a hearing impairment that is so severe that the person is impaired in hearing and understanding speech. Causes: The most common cause of hearing loss in children is an infection of the middle ear called otitis media. Others acquired their hearing loss due to factors such as noise, drugs and toxins. Some acquired hearing loss may be a result of heredity Life Skills: It is important to observe the way the individual uses their hearing and assist them in building their listening skills through encouragement and rewards (Moss, 2005). • In some cases, adaptive hearing devices can help with hearing impairment --but even with these devices a person cannot necessarily hear at the same level as others without a hearing impairment. • Every effort should be made to ensure a positive and meaningful experience for the person. • When necessary, an interpreter should be provided. Integrating sign language (ASL) into the educational & rehabilitation plan can also improve the learning experience. Resources: Each state defines the degree of hearing loss which determines a student's eligibility for special education services and for adult's levels of rehabilitation services. • In addition, to be eligible for special education services and Rehabilitation services the hearing loss must affect the student's educational performance. For rehabilitation services for adults the ability to obtain and retain employment must be impaired.

multiply disabilities

Definition: A combination of disabilities, such as mental retardation and orthopedic impairment that cannot be served in programs for either individual disability alone. Causes: The causes can vary greatly. Sometimes they may be the result of the Same things - Such as a genetic issue, illness, or accident, other times, they may be unrelated. Life Skills: Once assessments have been completed to determine the capabilities of the individual, life skills should set realistic goals that will assist the disabled in having success and increased confidence in their capabilities. Resources: Any resources in addition to standard state, local and national agencies and local special education professionals will likely vary depending on disabilities.

developmental disability

Definition: A developmental disability is a SEVERE mental or physical disability that occurs BEFORE age 22 --and causes challenges with major life activities such as speaking, mobility, taking care of oneself ADL and living independently. Causes: Causes of developmental disability vary-- but are more likely a result of experiences previously mentioned disabilities such as mental retardation, autism, or cerebral palsy. However, not everyone who has a disability has a developmental disability. The distinction is important because some services are only available to people with developmental disabilities. Life Skills: People with DD are expected to need some type of help with daily living for their whole lives. Assessments are needed to determine the individual's capabilities and the setting of realistic goals. Resources: The majority of people experiencing developmental disabilities require a combination of types of services, such as speech therapy, special education and counseling. • These services will be needed over a long period of time and must be planned for the individual. When this definition is applied young children from birth to age 5 -- they have many developmental delays with a large probability of other disabilities if services are not given at this age.

speech or language impairment

Definition: Communication or language disorders that affect communication and/or oral functioning that affects speech. These range from sound substitution or inability to produce certain sounds to the inability to understand language or produce speech that can be understood. The two types of speech disorders are: 1. Articulation disorder-- is when a person has a problem making the sounds necessary for speech such as stuttering or a lisp; 2. A phonological disorder-- is when a person has trouble with her actual voice when trying to make sounds. Causes: There are a variety of causes for speech and language disorders-- such as hearing loss, autism, cerebral palsy, neurological disorders, brain injury and mental retardation. • Physical problems such as cleft palate or lip (where the lip is split) may also cause the impairment. • A language disorder is when a person cannot understand and/or communicate with other people because of some type of malfunction of in the brain, accident or disease. • Individuals with language disorders may have trouble with matching a word with its meaning, creating sentences, or comprehending what someone is saying. Life Skills: Speech-language pathologists work directly with the person, family and teacher to improve a child or individual's speech. The therapist can develop a therapeutic plan that may involve vocal exercises to work on certain sounds. The therapist can work with the student and teacher about ways to help the child communicate in the classroom. There are also technologies -- such as computers with a speech function and speech augmentation -- that may be able to use to communicate better. Resources: Language disorders tend to be complex because they often involve cognitive problems, or problems with the brain. Because the early years of a child's life are when language skills are developing, it is important that these disorders be caught as early as possible in order to begin treatment and work on overcoming or dealing with the disorder. Speech therapists can be valuable depending on the impairment. For adults --rehabilitation services with speech pathology can help the person to make improvements

traumatic brain injury

Definition: Damage to the brain caused by illness or accident. Also known as intracranial injury, occurs when an external force traumatically injures the brain. Brain injury is the most common cause of death and disability in children. A person with a mild traumatic brain injury may lose consciousness or memory at the time of the accident. They may look all right on the outside but have lasting changes in their personality or thinking. Other times, the effects can be even more serious causing mental retardation, learning disabilities, loss of vision or speech, inability to remember new things and number of other complications. Causes: Traumatic Brain Injury (TBI) usually occurs due to an accident such as automobile or fall accidents During an accident, the brain literally bounces back and forth inside the skull, often hitting in both the front and the back of the brain. Brain injury can also occur due to hypoxia (not enough oxygen) or anoxia (no oxygen). This occurs in drowning, suffocation and sometimes due to problems at birth. Life Skills: Some people who suffer from a traumatic brain injury recover. In other cases, the damage can be permanent. It is important to know that healing from a brain injury takes a long time. People recovering from a TBI get tired more easily than they did before. An individual with TBI and those around him/her often have difficulty with the fact that someone who looks the same, walks the same as always is now different. Counseling can be beneficial. In addition, the patient will likely need assistance with his/her daily life- making the necessary adjustments to aid in living. These adjustments will vary depending on the severity of the injury. Resources: There are a number of local and state resources. • The first source to go to for information on TBI is generally a physician, ideally one that specializes in neuroscience. • Schools at all levels must provide services for individuals with TBI.

deafness

Definition: Deafness-- is a category of its own that means a hearing impairment that is so severe that the person is impaired in hearing and understanding speech. An individual who is "deaf' is one whose hearing is disabled (usually 70 dB or greater) such that understanding conversational speech through the ear alone is precluded, with or without use of a hearing aid. If deafness is from birth the person may not be able to speak - but speech therapy is possible. Causes: The most common is an infection of the middle ear or otitis media. • Individuals may also acquire their deafness due to factors such as noise, drugs and toxins. Some may be a result of heredity. Life Skills: Communication is a major issue with deafness. An interpreter (American Sign Language) should be provided and integrating sign language can also improve the learning and rehabilitation services experience. Resources: Each state defines the degree of hearing loss which determines the person's eligibility for special education services or any type rehabilitation services. • Deafness is usually defined as a hearing loss of 70 decibels or greater in the better ear.

specific learning disability

Definition: Learning disability is defined by law as "an imperfect ability to read, write, speak, or perform mathematical calculations - which is not due to physical, sensory or emotional impairment, mental retardation or socio-cultural disadvantage." Causes: A learning disability is not, by any means, a measure of a person's intelligence. • In the legal definition -- it specifically states that children with mental retardation are not included in this category. • However, students with learning disabilities experience certain obstacles that do not allow them to be educated in the usual way. • One of the most well-known and misunderstood type of learning disability is probably Dyslexia. • Definition of Dyslexia: Developmental reading disorder that occurs when the brain does not properly recognize and process certain symbols. • Dyslexia causes difficulty processing letters, numbers and other symbols. The most familiar characteristic of dyslexia is letter reversal, writing or reading "d" for "b", for example, or "p" for "q. "For numbers is 6 for 9 or 6 for 8. Life Skills: rehabilitation programs for achieving basic academic and social skills, vocational training, and specific college programs are available only within educational institutions. Resources: Because learning disabilities are primarily identified and diagnosed in educational environments -- they are the best resource for local, state, and national resources.

other health impairments

Definition: Other health impairments cover a variety of diseases and disorders. This category that refers to people who have limited strength, energy or alertness that affects their ability to learn. Causes: Some of these disorders are present at birth, such as sickle cell anemia, asthma, hemophilia, epilepsy, etc. Other impairments are caused by acquired conditions such as lead poisoning, rheumatic fever, HIV, or Cancer. Over 15% of all students are diagnosed with other health impairments. Life Skills: Once assessments have been completed to determine the capabilities of the individual, life skills should set realistic goals that will assist the disabled in having success md increased confidence in their capabilities. Resources: In deciding if all individual has a health impairment, a series of steps should be taken. For rehabilitation services -- a medical exam needs to be provided, taking into account the person's medical history. For education: the school needs to decide if a student is able to receive special education services by giving intelligence, achievement, behavior and other assessment tests -- as well as reviewing medical md other background information. Depending on the result of these tests, the school or VR will decide if the child is able to receive special education services. If the school decides they are not able to receive these services, it is still possible for students to receive services under the Rehabilitation Act.

developmental delay

Definition: The term developmental delay means that the individual or child is just behind their peers in development. Special services are granted for a short time or for their entire school/life or adult experience. Causes: According to CDC, 2005 ... developmental delay can have many different causes, such as genetic causes (like Down syndrome), or complications of pregnancy and birth (like prematurity/ or infections) ... Some causes can be easily reversed if caught early enough, such as hearing loss from chronic ear infections, or lead poisoning. Life Skills: Deciding who needs special education and rehabilitation services and how they are going to get them has always been a serious issue. The question is how can we be fair and equal to those requiring the services? If they are identified too early they may be labeled incorrectly and then only perform at the level that is expected -- which could lead to otherwise "average" children being taught at a slower rate simply because they had not developed as quickly as others. On the other hand -- if we wait too long to decide who needs services --those children/individuals may be set back further because they needed help way before it was given. Resources: The Individuals with Disabilities Education Act (IDEA) of 1975 mandated states to provide all disabled or special needs children/individuals with a fair education. • The goal is -- to be sure that special needs children anywhere in the country would get the same education and services because they would be tested the same way and labeled correctly the same way. • Depending on the definition children as young as 3 and as old as 9 can be classified as having a developmental delay. Even though some of the practices, rules, and labels vary by State -- the spirit of the law remains the same: help children with disabilities get the education that they need.

visual impairment

Definition: The terms partially sighted, low vision, legally blind, and totally blind - are used to describe students with visual impairments. They are defined as: I. Partially sighted - indicates some type of visual problem has resulted in a need for special education; 2. Low vision- generally refers to a severe visual impairment- not necessarily limited to distance vision. It applies to all individuals with sight who are unable to read print at a normal viewing distance even with the aid of eyeglasses or contact lenses; 3. Legally blind- means that a person has less than 20/200 vision in the better eye or a very limited field of vision (20 degrees at its -widest point); and 4. Totally blind- students learn via braille or other non-visual media. Causes: Congenital blindness may be hereditary or be the result of infection at birth; Other diseases may also result in blindness such as: amblyopia; diabetic retinopathy; glaucoma; macular degeneration; and trachoma (Teens Health, 2004). Life Skills: Emphasis on learning basic ADL skills is given for the visually impaired. Because the majority of the learning process comes through sight, recognized learning strategies should be employed (Lichman, 2002). Resources: Assessment is the first step to accessing resources for the individual. The severity of visual impairment must first be realized before the type of resources can be determined.

serious emotional disorder

Definition: These are behavior disorders or mental illnesses -- that persist over a long period of time and affect educational performance, vocational training and other forms of rehabilitation services. • This includes Attention Deficit/Hyperactive Disorder (ADHD), depression, bipolar disorder, conduct disorders and eating disorders -- to name a few. Causes: Genetics, environment and a combination of the two can all contribute to these disorders. • Behavior disorders may be inherited -- due to a chemical imbalance in the brain or occur as a result of brain injury. • The person's surroundings/environment is also important. If the person has been exposed to abuse, extreme stress, a death or loss in the family, and/or violence, he/she is more likely to develop these emotional disorders. Life Skills: In some cases, medication can be used to treat the disorder. • In all cases, people with emotional disorders and their families can be helped by understanding of the disorder and through families/communities working together to support the person. • Teaching a person how to overcome this disorder is a time consuming process, but often in conjunction with therapeutic intervention and medication, it is possible. Resources: In deciding if a person has a disorder that would fall into this category- medical and psychological evaluations should take place. • A physician/pediatrician should always be consulted in these cases as should a therapist, psychologist or psychiatrist. Rehabilitation programs, teachers and schools should accommodate students with these disturbances by providing a specialized education plan and intervention treatment

Autism

Definition: This category includes people with all levels of pervasive development disorder -the most known of which is Autism. Asperger's Syndrome (difficulty communicating and socializing), Rett's Syndrome (affects mostly girls-causes a progressive inability to use muscles for eye and body movement and speech) and Childhood Disintegrative Disorder are also classified under DD. All of them have common deficits in social interaction and communication. Often, people with these disorders show very little interest in other people. They have a limited number of interests in activities. They also tend to have difficulty with change and find comfort in repetition and structure. Causes: Although the number of children diagnosed with autism has risen dramatically in the last 30 years-- still no one knows what causes autism. There are many theories, but none have been scientific proven to date. Life Skills: Autistic individuals may have average or above average intelligence, however, their autism can keep them from achieving many goals. Because the two main facets of autism are issues with social interaction and communication-- these are areas that need to be worked on to help people with this disorder to function in society. Resources: Many for training and rehabilitation. ORTHOPEDIC IMPAIRMENT Definition: These conditions can be related to any physiological disorder or condition, cosmetic disfigurement, or anatomical loss affecting one or more body systems such as neurological or muscular-skeletal. Causes: Causes for physical disabilities range from birth defects such as Cerebral Palsy or Spina Bifida to impairment resulting from degenerative or progressive diseases such as muscular dystrophy. Accidents are another cause. Life Skills: Regardless of the physical disability, life skills should focus on assisting the individual with gaining the skills to increase their quality of life and independence. Skills should be broad, problem solving, age appropriate, and useful to the learner (Information Center on Disabilities & Gifted Education, 2005). Resources: Physical disabilities affect motion and motor skills that we depend on every day of our lives. • Depending on the disability and the age of the disabled person, most states have resources available through elementary, high school, colleges, and employment offices

deaf-blindness

Definition: This category was previously grouped with hearing impairments and deafness, but now it stand on its own. Deaf-blindness: is a combination of hearing and visual impairment. Its condition requires specialized education and vocational rehabilitation programs. Causes: Illness, accident or genetics can result in deaf-blindness. o Hereditary causes can include Usher Syndrome and Down Syndrome. o Other causes are issues that result from problems associated with premature birth, rubella and meningitis. Life Skills: Emphasis on ADL skills. The person can become isolated from the world around them if not trained properly. Establishing a method of communication is key and several such methods exist. • One method is tactile signing...communication based on standard sign system in which the receiver's hand is placed lightly upon the hands of the signer. Teaching individuals how to be self-sufficient should also be a point of focus for education and rehabilitation services. Resources: Accommodated in special education programs or with special education services that are specifically target toward deaf-blindness. • State and local resources will include schools, special education professionals, rehabilitation counseling and medical professionals

new initiatives

Healthy People 2010- formulated by the Office of Disease Prevention and Health Promotion, within the U.S. Department of Health and Human Services; implemented: o A 10-year plan intended to encourage and guide federal, state and local community health promotion and wellness activities and policies to improve the health of Americans. Compare with non-disabled population --people with disabilities have less participation in health promotion and preventative health activities such as: • less preventive use of health-care systems ( oral health exams, mammograms) • higher rate of chronic conditions (elevated blood pressure, depression and obesity) • lower rates of social participation (high school completion, employment) • lower rates of health behaviors ( stopping smoking, cardiovascular activities, etc.). People with disabilities are experiencing more health related problems that are often unrelated or secondary to their underlying disability: • Preventable secondary condition (e.g. pressure sores, fractures, etc.) • High rates of emergency room visits and hospital stays -- and • Early deaths from comorbidity or presence of two chronic conditions at the same time (e.g., diabetes, cardiovascular disease associated to obesity, poor nutrition, etc.). A crucial contribution of rehabilitation professionals is helping individuals to optimize function, utilize resources and eliminate environmental and attitudinal barriers. Part of the new health initiative is to include health promotion and prevention within the rehabilitation services plan.

categories of disabilities

It is much easier for rehabilitation professional to effectively design rehabilitation interventions by focusing on what each person needs to enhance functioning. It is important to understand the functioning impact of disability. You may have two individuals with the same diagnosis and their functional situations may not be alike at all. Each person's sychosocial circumstance, personal, education and vocational/occupational skills may not be alike. Most chronic medical conditions impact more than one aspects of functioning -- as well as a primary impact on the physical, sensory, cognitive, emotional and psychosocial functioning of the person

disability

Legal term: o .. a physical or mental impairment that substantially limits one or more major life activities ... (ADA, 1990) It is always good to clarify whether the disability appears to be temporary or permanent. A disability may be congenital or acquired. • Congenital Disability- health condition present at or about the time of birth. • Acquired Disability- occur any time after birth due to a variety of reasons The age of onset is very important when working with PWD, because any given disability or condition can have very different effects upon a person's education, employment, and lifestyle, depending on age of onset.

stats for disabilities

Population Highlights of Americans with disabilities: Approximately 56.7 million people (19 %) of the 303.9 million in the civilian non- institutionalized population had a disability in 2010. (U.S. Census Bureau, 201 0)

definitions of disabilities

What is a disability?" -- in some cases definition varies by agency and even as in the case of children and adolescents. (Refer to ADA definition of disability- a physical or mental impairment that substantially limits one or more major life activities) Past --there were eight categories of disability that qualified a student for special education services under federal law. Present: Now there are thirteen categories. A person with a developmental disability is entitled to a much wider array of services than students in special education without developmental disabilities. Developmental disabilities (DD) -- is not one of the thirteen categories -it is an umbrella term for various disabilities. There are other types under different categories client may be eligible for rehabilitation services at one agency but not at others if the agency is defined by disability type and expertise. • For children and adolescents --federal law identifies thirteen types of disabilities to include: These definitions or diagnosis stay with the person through their adult life as well. • Mental Retardation • Specific Learning Disabilities • Serious Emotional Disturbance • Visual Impairment • Speech or Language Impairment • Autism • Orthopedic Impairment • Traumatic Brain Injury • Multiple Disabilities • Other Health Impairments

mental retardation

client may be eligible for rehabilitation services at one agency but not at others if the agency is defined by disability type and expertise. • For children and adolescents --federal law identifies thirteen types of disabilities to include: These definitions or diagnosis stay with the person through their adult life as well. • Mental Retardation • Specific Learning Disabilities • Serious Emotional Disturbance • Visual Impairment • Speech or Language Impairment • Autism • Orthopedic Impairment • Traumatic Brain Injury • Multiple Disabilities • Other Health Impairments

living with a disability

o With medical and technological advances disability is not necessary a cause of premature death. o Once the disability or condition has been stabled and closely monitored and the person learns how to manage it- the person should not be considered to be "sick." o A person's life does not have to be defined by the disability. o Some changes do take place such as: their perception of self, may face financial difficulties, limited life activity and changes in relationships with family and friends. o Coping with a chronic condition or disability- the person resorts either to healthy adaptation or unhealthy adjustment and psychological deterioration. o Chronic illness and disability differ in their impact- not in terms of severity- but in how much they disrupt lives. o Individuals with chronic conditions and/or disabilities can live their life more in terms of obtaining satisfying levels of-- emotional, spiritual, social and physical health more so than concentrating on the diagnosed condition; o learning as much about the condition and preventive methods to avoid complications

diseases that impact physical disabilities

• Arthritis (rheumatoid and osteoarthritis) are examples of a disorder that impact physical functioning. • • Arthritis refers to inflammation of a joint and includes a variety of autoimmune (the body fighting itself) conditions that affects the joints, cartilage, and bones. • Rheumatoid arthritis is an immune disease directed against the persons own body-tissues (fingers, hands, wrists) -causes pain and lack of mobility. • Osteoarthritis- is a degenerative joint disease- with loss of cartilage with physical impact in weight-bearing joints (knees, hips). • Chronic back-pain -is another example that could be due to injury or degenerative disease like osteoporosis. • Carpal Tunnel Syndrome- disorder caused by pressure on the median nerve that runs down the forearm to the thumb, index finger, middle, and half the ring finger of the hand.