Occupational Therapy

Parkinson's Disease

2009-10-21T18:29:00.000-07:00

Parkinson's Disease

Parkinson's disease is a common condition of the brain that typically begins in the middle to later part of life. It is a progressive condition, meaning that it continues to get worse with time. Parkinson's disease has probably existed for thousands of years. Its symptoms and potential therapies were mentioned in the Ayurveda (the system of medicine practiced in India as early as 5000 B.C.) and in the first Chinese medical text (Nei Jing), which appeared 2,500 years ago.

Parkinson's disease occurs when certain nerve cells (called neurons) in an area of the brain known as the substantia nigra die or become impaired. Normally, these neurons produce an important brain chemical known as dopamine. Dopamine is a chemical messenger responsible for transmitting signals between the substantia nigra and the next "relay station" of the brain, the corpus striatum, to produce smooth, purposeful muscle movement.

A loss of dopamine causes the nerve cells of the corpus striatum to fire out of control, leaving people unable to direct or control their movements in a normal manner. Parkinson's research studies have shown that people with the condition have lost 80 percent or more of the dopamine-producing cells in the substantia nigra.

But why this nerve death or impairment happens is still unknown, although significant findings by research scientists continue to yield fascinating new clues and several theories about Parkinson's disease causes.

Current Theories for the Cause of Parkinson's Disease

Current theories regarding the cause or causes of Parkinson's disease include:

Environmental factors
Genetic factors
Free radicals
Normal age-related wearing down
A combination of some or all of these theories.

Common Parkinson's Disease Symptoms

Common Parkinson's disease symptoms include:

Tremors
Rigid limbs
Slow movement (bradykinesia)
A shuffling gait
An inability to move (akinesia)
A stooped posture
Reduced facial expressions
A soft speaking voice.

Tremors

Tremors are one of the most common symptoms of the disease. The tremor associated with the condition has a characteristic appearance. Typically, it takes the form of a rhythmic back-and-forth motion of the thumb and forefinger at three beats per second. This is sometimes called "pill rolling." Tremors usually begin in a hand, although sometimes, a foot or the jaw is affected first. It is most obvious when the hand is at rest or when a person is under stress. In three out of four people, the tremor may affect only one part or side of the body -- especially during the early stages of the disease. Later it may become more general. Tremors are rarely disabling, and they usually disappear during sleep or improve with intentional movement.

Rigidity

Rigidity, or a resistance to movement, is aParkinson's disease symptom seen in most people with this condition. A major principle of body movement is that all muscles have an opposing muscle. Movement is possible, not just because one muscle becomes more active, but also because the opposing muscle relaxes. In Parkinson's disease, rigidity comes about when, in response to signals from the brain, the delicate balance of opposing muscles is disturbed. The muscles remain constantly tensed and contracted so that the person aches or feels stiff or weak. The rigidity becomes obvious when another person tries to move the affected person's arm, which will move only in ratchet-like or short, jerky movements known as "cogwheel" rigidity.

Bradykinesia

Bradykinesia, or the slowing down and loss of spontaneous and automatic movement, is a particularly frustrating symptom of Parkinson's disease because it is unpredictable. One moment the person can move easily. The next moment, he or she may need help. This may well be the most disabling and distressing symptom of the disease because the person cannot rapidly perform routine movements. Activities once performed quickly and easily -- such as washing or dressing -- may take several hours.

Postural Instability

Postural instability, or impaired balance and coordination, causes a person to develop a forward or backward lean and to fall easily. When bumped from the front or when starting to walk, a person with a backward lean has a tendency to step backwards, which is known as retropulsion.

Postural instability can cause a person to have a stooped posture, in which the head is bowed and the shoulders are drooped. As the disease progresses, walking may be affected. A person may halt in mid-stride and "freeze" in place, possibly even toppling over. Or, he or she may walk with a series of quick, small steps as if hurrying forward to keep balance. This is known as festination.

Other symptoms of Parkinson's disease can include:

Depression
Emotional changes
Dementia
Difficulty swallowing and chewing
Speech impairments
Urinary problems
Constipation
Skin problems
Sleep disturbances
Sexual difficulties.

Depression

Depression is a common problem and may appear early in the course of the disease, even before other symptoms are noticed. Depression may not be severe, but it may be intensified by the drugs used to treat other Parkinson's disease symptoms. Fortunately, depression can be successfully treated with antidepressant medications.

Emotional Changes

Some people with Parkinson's disease become fearful and insecure. Perhaps they fear they cannot cope with new situations. They may not want to travel, go to parties, or socialize with friends. Some lose their motivation and become dependent on family members. Others may become irritable or uncharacteristically pessimistic. Memory loss and slow thinking may occur, although the ability to reason remains intact. Whether people actually suffer intellectual loss (also known as dementia) from Parkinson's disease is a controversial area still being studied.

Difficulty With Swallowing and Chewing

The muscles used in swallowing may work less efficiently in later stages of Parkinson's disease. In these cases, food and saliva may collect in the mouth and back of the throat, which can result in choking or drooling. Medications can often alleviate these problems.

Speech Changes

About half of all people with Parkinson's disease have problems with speech. They may speak too softly or in a monotone voice, hesitate before speaking, slur or repeat their words, or speak too fast. A speech therapist may be able to help these people reduce some of these problems.

Urinary Problems or Constipation

In some people with Parkinson's disease, symptoms affecting the bladder and bowel can occur due to the improper functioning of the autonomic nervous system. The autonomic nervous system is responsible for regulating smooth muscle activity. Some people may become incontinent, while others have trouble urinating.

Others may experience constipation because the intestinal tract operates more slowly. Constipation can also be caused by inactivity, eating a poor diet, or drinking too little fluid. It can be a persistent problem and, in rare cases, can be serious enough to require hospitalization. People should not let constipation last for more than several days before taking steps to alleviate it.

Skin Problems

In Parkinson's disease, it is common for the skin on the face to become oily, particularly on the forehead and at the sides of the nose. The scalp may become oily, too, resulting in dandruff. In other cases, the skin can become quite dry. These problems are also the result of an improperly functioning autonomic nervous system. Standard treatments for skin problems can be help helpful. Excessive sweating, another common symptom, is usually controllable with the medications used forParkinson's disease treatment.

Sleep Problems

Parkinson's disease symptoms can also include sleep problems. These include difficulty staying asleep at night, restless sleep, nightmares and emotional dreams, and drowsiness during the day. It is unclear if these symptoms are related to the disease or to the medications used to treat Parkinson's disease. People with Parkinson's should never take over-the-counter sleep aids without consulting their healthcare providers.

Stages of Parkinson's Disease

Stage I (Beginning Stage of Parkinson's)

Stage I is considered the beginning stage of the disease. A person is categorized with stage I if the following are present:

Signs and symptoms are only on one side of the body
Symptoms are mild
Symptoms are inconvenient but not disabling
Usually has tremors in one limb
Friends have noticed changes in posture, locomotion, and facial expression.

Stage I is also known as early-stage Parkinson's disease.

Parkinson's Disease Stage II

A person is categorized as stage II if the following are present:

Symptoms occur on both sides of the body
Minimal disability
Posture and gait are affected.

Parkinson's Disease Stage III (Moderate Parkinson's Disease)

Stages III, IV, and V are when a person develops significant disability from Parkinson's disease. A person in stage III is considered to have moderate Parkinson's disease.

A person is categorized with stage III if the following are present:

Significant slowing of body movements
Early impairment of equilibrium when walking or standing
Generalized dysfunction that is moderately severe.

Stage IV (Advanced Parkinson's Disease)

A person is categorized with stage IV of the disease if the following are present:

Severe symptoms
The person can still walk to a limited extent
Rigidity and bradykinesia are present
Person is no longer able to live alone
Tremor may be less than earlier stages.

This stage is considered advanced Parkinson's disease.

Stage V Parkinson's Disease

A person is said to be in stage V if the following are present:

Cachectic stage (general reduction in vitality and strength of body and mind)
Invalidism complete
Person cannot stand or walk
Requires constant nursing care.

Diagnosing Parkinson's Disease

Parkinson's disease may be difficult for healthcare providers to diagnose because early symptoms may be vague, and they can mimic other conditions or even be dismissed as normal aging.

In order to make a Parkinson's disease diagnosis, a healthcare provider will begin by asking a number of questions (known as a medical history). Some of these may include questions about:

Your current symptoms
Other medical conditions you have
Medications you may be taking.

He or she will also perform a physical exam to look for signs and symptoms of Parkinson's disease.

Tests and Procedures for Diagnosing Parkinson's Disease

Parkinson's disease can also be hard to diagnose early on because there are no tests or procedures that can definitely diagnose the condition. Your healthcare provider may recommend several tests and/or procedures to help rule out other conditions that can cause similar symptoms. This may involve blood tests or a brain scan. However, brain scans (such as a CT scan or an MRI) generally appear normal in a person with Parkinson's disease.

Is the Diagnosis Parkinson's Disease or Another Condition?

Several medical conditions can share similar symptoms with Parkinson's disease, especially during the early stages. Your healthcare provider will consider these before making a Parkinson's disease diagnosis.

Some of these conditions fall under a group of disorders with similar features called Parkinson syndromes, or parkinsonism. These disorders share several symptoms, and all are the result of the loss of dopamine-producing brain cells. Parkinson's is also called primary parkinsonism or idiopathic Parkinson's disease. Idiopathic is a term describing a disorder for which no cause has yet been found. In the other forms of parkinsonism, either the cause is known or suspected, or the disorder occurs as a secondary effect of another, primary neurological disorder.

Besides Parkinson's disease, other forms of parkinsonism include:

Postencephalitic parkinsonism
Drug-induced parkinsonism
Striatonigral degeneration
Ateriosclerotic parkinsonism
Toxin-induced parkinsonism (such as carbon monoxide or cyanide)
Lewy body dementia
Accompanying other conditions, such as:

Shy-Drager syndrome (sometimes called multiple system atrophy)
Progressive supranuclear palsy
Wilson's disease
Huntington's disease
Hallervorden-Spatz syndrome
Alzheimer's disease
Creutzfeldt-Jakob disease
Olivopontocerebellar atrophy
Post-traumatic encephalopathy.

Parkinson's Disease Treatment

Currently, there is no cure for Parkinson's disease. Also, there is no treatment that has been shown to slow down or stop the progression of the disease. However, there is treatment for Parkinson's disease that provides dramatic relief from the symptoms.

Before recommending a specific treatment, your healthcare provider will consider several factors, including your:

Current Parkinson's disease symptoms, along with how much the symptoms disrupt your life
Mental and emotional state
Current medications.

Based on these factors, your healthcare provider will recommend one or several different treatment options. Some of these treatment options can include:

Medications
Lifestyle changes and support
Surgery.

Medications for Treating Parkinson's Disease

Not everyone who is diagnosed with Parkinson's disease will immediately require medicine. Many people are only mildly affected and do not require medications for several years after the initial diagnosis.

When Parkinson's treatment does become necessary, healthcare providers often begin with one or more of the less powerful Parkinson's disease medications. This includes such drugs as:

Selegiline (Eldepryl^®, Zelapar^®, Emsam^®)
An anticholinergic
A dopamine agonist, such as pramipexole (Mirapex^®) orropinirole (Requip^®).

This allows healthcare providers to save the most powerful treatment (specifically, levodopa) for the time when people need it most.

When Parkinson's disease symptoms become severe, healthcare providers usually prescribe levodopa combined with carbidopa. Carbidopa-levodopa products are available as the brand-name medicinesSinemet^®, Sinemet^® CR, Parcopa^®, or as a generic. Carbidopa is used with levodopa because it delays the conversion of levodopa into dopamine (a chemical messenger) until it reaches the brain. Nerve cells can use levodopa to make dopamine and replenish the brain's dwindling supply of this neurotransmitter.

Lifestyle Changes and Support Groups

Lifestyle changes are an important part of any treatment for Parkinson's disease. This includes exercise and diet. Support groups also can be helpful.

Exercise

Because movements are affected in Parkinson's disease, exercising may help people improve their mobility. Some healthcare providers prescribe physical therapy or muscle-strengthening exercises as a part of Parkinson's disease treatment. This is intended to tone muscles and to put underused and rigid muscles through a full range of motion. Exercises will not stop Parkinson's disease from progressing, but they may improve body strength so that the person is less disabled.

Exercises also improve balance, helping people overcome gait problems, and can strengthen certain muscles so that people can speak and swallow better. Physical activity can also improve the emotional well-being of people with Parkinson's by giving them a feeling of accomplishment.

Although structured exercise programs help many people, more general physical activity is also beneficial. Some examples include:

Walking
Gardening
Swimming
Calisthenics
Using exercise machines.

Diet

Eating a well-balanced, nutritious diet can be beneficial for anybody. However, to prevent or cure Parkinson's disease, there does not seem to be any specific vitamin, mineral, or other nutrient that has any therapeutic value for Parkinson's disease treatment. In fact, a high-protein diet may limit the effectiveness of levodopa.

Despite some early optimism, recent studies have shown that tocopherol (a form of vitamin E) does not delay Parkinson's disease. This conclusion came after a carefully conducted, five-year study that examined the effects of both selegiline and vitamin E on early symptoms of Parkinson's disease. While selegiline was found to slow down the early progression of the disease and delay the need for levodopa, there was no evidence of any therapeutic benefit from vitamin E.

Support Groups

One of the most demoralizing aspects ofParkinson's disease is how completely a person's world changes. The most basic daily routines may be affected -- from socializing with friends and enjoying normal and congenial relationships with family members, to earning a living and taking care of a home. Faced with a very different life, people need encouragement to remain as active and involved as possible. That's when support groups can be a valuable part of Parkinson's disease treatment, not only to the person affected, but to their families and caregivers as well.

Surgery as a Part of Treatment

Surgery for Parkinson's disease was once a common practice. However, after the discovery of levodopa, surgery was restricted to only a few cases. Currently, surgery is reserved for people who have failed to respond satisfactorily to drugs.

One of the procedures used as part of Parkinson's disease treatment, called cryothalamotomy, requires a supercooled metal probe tip to be surgically inserted into the thalamus (a "relay station" deep in the brain). This destroys the area of the brain that produces tremors. This and related procedures, such as thalamic stimulation, are coming back into favor for people who have severe tremors or have Parkinson's only on one side of the body.

A therapy called deep brain stimulation (DBS) has now been approved by the U.S. Food and Drug Administration (FDA) for treating Parkinson's disease. In DBS, electrodes are implanted into the brain and connected to a small electrical device, called a pulse generator, that can be externally programmed. DBS can reduce the need for levodopa and related drugs, which, in turn, decreases the involuntary movements (dyskinesias) that are a common side effect of levodopa. It also helps to:

Alleviate fluctuations of symptoms
Reduce tremors, slowness of movements, and gait problems.

DBS requires careful programming of the stimulator device in order to work correctly.

Parkinson's Disease Research

There has been considerable progress made within Parkinson's research in recent years. Ongoing studies aim to discover better ways of relieving the symptoms of Parkinson's disease and ultimately preventing or halting the disease. New Parkinson's disease research is focusing on many areas, including brain anatomy, dopamine, environmental factors, genetics, mitochondria, and cell transplantation.

ALS

2009-10-20T18:16:00.000-07:00

Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease, is a rapidly progressive, invariably fatal neurological disease. This disease attacks the nerve cells (neurons) responsible for controlling voluntary muscles. ALS belongs to a group of disorders known as motor neuron diseases, which are characterized by the gradual degeneration and death of motor neurons.

If a person has amyotrophic lateral sclerosis (ALS) and one or more immediate family members also has the disease (for example, a parent, sibling, or grandparent), then the condition is considered familial amyotrophic lateral sclerosis.

Motor neurons are nerve cells located in the brain, brainstem, and spinal cord. These nerve cells serve as controlling units and provide vital communication links between the nervous system and the voluntary muscles of the body. Messages from motor neurons in the brain (called upper motor neurons) are transmitted to motor neurons in the spinal cord (called lower motor neurons). From here, they are transmitted to particular muscles.

Because amyotrophic lateral sclerosis affects only motor neurons, the disease does not impair a person's:

Mind
Personality
Intelligence
Memory.

Nor does it affect a person's ability to:

See
Smell
Taste
Hear
Recognize touch.

People with this condition usually maintain control of eye muscles and bladder and bowel functions.

ALS Symptoms

The early symptoms of ALS (amyotrophic lateral sclerosis) are frequently overlooked because the disease is so subtle in its early stages. When present, the earliest ALS symptoms may include:

Muscle stiffness, twitching, or cramping
Weakness affecting an arm or leg
Slurred and nasal-sounding speech
Difficulty chewing or swallowing.

These general symptoms then develop into more obvious weakness or atrophy (loss of muscle tissue) that may cause a doctor to suspect ALS.

The body parts that early ALS affects will depend on which muscles are damaged first. In some cases, one of the legs is affected and the person experiences awkwardness when walking or running -- or he or she begins to trip or stumble more often. In other cases, the person experiences problems with a hand or arm and has difficulty with simple tasks requiring manual dexterity, such as buttoning a shirt, writing, or turning a key in a lock. Other people may experience speech problems as their first symptom of ALS.

Regardless of where the ALS symptoms first appear, muscle weakness and atrophy will spread to other parts of the body as the disease progresses.

Eventually, people who have ALS will experience increased problems with:

Moving
Swallowing (dysphagia)
Speaking or forming words (dysarthria).

Those with ALS symptoms are aware of their progressive loss of function because this disease generally does not affect a person's thinking or mental capacities. Therefore, people with this condition may experienceanxiety and/or depression. Also, a small percentage of people may experience problems with their memory or decision-making abilities, and there is growing evidence that some people may develop a form ofdementia.

In the later stages of ALS, the person will experience the following symptoms:

Difficulty breathing as the muscles of the respiratory system weaken
Loss of the ability to breathe on his or her own (must depend on ventilator support for survival)
An increased risk of pneumonia.

It's important for people with ALS (and their loved ones) to talk to their healthcare provider about the course of the disease and the options fortreatment of ALS. This can help the patient make informed decisions in advance.

Causes of ALS

The cause or causes of ALS (amyotrophic lateral sclerosis) are not known, and scientists do not yet know why ALS strikes some people and not others.

ALS research scientists are looking at a number of possible ALS causes, including:

Genetics
Glutamate
Autoimmune responses
Environment.

Gene Mutations

An important step toward finding the causes of ALS came in 1993, when research scientists discovered that mutations in the gene that produces the superoxide dismutase 1 (SOD1) enzyme were associated with some cases of familial ALS.

The SOD1 enzyme is a powerful antioxidant that protects the body from damage caused by free radicals. Free radicals are highly reactive molecules that are produced by cells during normal metabolism. If these free radicals are not neutralized, they can accumulate and cause random damage to the DNA and proteins within cells.

Although it is not yet clear how the SOD1 gene mutation leads to motor neuron degeneration, researchers have theorized that an accumulation of free radicals may result from the faulty functioning of this gene. In support of this theory, animal studies have shown that motor neuron degeneration and deficits in motor function accompany the presence of the SOD1 mutation.

Glutamate

Studies have also focused on the role of glutamate in motor neuron degeneration. Glutamate is one of the chemical messengers or neurotransmitters in the brain.

Scientists have found that, compared to healthy people, ALS patients have higher levels of glutamate in the serum and spinal fluid. Laboratory studies have demonstrated that neurons begin to die off when they are exposed over long periods to excessive amounts of glutamate.

Autoimmune Responses

Autoimmune responses -- which occur when the body's immune system attacks normal cells -- have been suggested as one possible cause for ALS. Some scientists theorize that antibodies may directly or indirectly impair the function of motor neurons, interfering with the transmission of signals between the brain and muscles.

Environmental Factors

In searching for possible ALS causes, researchers have also studied environmental factors, such as exposure to toxic or infectious agents, and examined the possible role of dietary deficiency or trauma. However, as of yet, there is insufficient evidence to implicate these factors as possible ALS causes.

ALS Diagnosis

There is no single test used to make an ALS diagnosis. An ALS diagnosis is typically based on a person's symptoms, such as spasticity and muscle weakness. Tests used to rule out other diseases before making an accurate ALS diagnosis include magnetic resonance imaging and electromyography. In order for your doctor to make a definitive ALS diagnosis, he or she will also need your full medical history and will conduct a neurological exam.

Treatment of ALS

Scientists have not found a cure for ALS (amyotrophic lateral sclerosis). However, the U. S. Food and Drug Administration (FDA) has approved the first drug treatment for ALS, which is called riluzole.

Riluzole is believed to:

Reduce damage to motor neurons by decreasing the release of glutamate
Prolong survival by several months (mainly in those with difficulty swallowing)
Extend the time before a patient needs ventilation support.

Riluzole does not reverse the damage that has already occurred to the motor neurons, and patients taking riluzole must be monitored for liver damage and other possible side effects.

Team Effort for Treatment of ALS

Other treatments of ALS are designed to relieve ALS symptoms and improve the quality of life for patients. Multidisciplinary teams of healthcare professionals are available to provide supportive care, including:

Physicians
Pharmacists
Physical, occupational, and speech therapists
Nutritionists
Social workers
Home care and hospice nurses.

These teams can design an individualized ALS treatment plan of medical and physical therapy, and provide special equipment aimed at keeping patients as mobile and comfortable as possible.

ALS Research

Scientists studying ALS are hoping to discover what causes it and to develop more effective treatment methods, among other things. To that end, ALS research scientists are trying to better understand apoptosis (programmed cell death) and examining the disease in families. Investigators are optimistic that research studies will eventually lead to better treatments for ALS.

Dysphagia

2009-10-19T19:01:00.000-07:00

Dysphagia

Dysphagia, or trouble swallowing is a symptom that accompanies a number of neurological disorders. The problem can occur at any stage of the normal swallowing process as food and liquid move from the mouth, down the back of the throat, through the esophagus and into the stomach. Difficulties can range from a total inability to swallow, to coughing or choking because the food or liquid is entering the windpipe, which is referred to as aspiration. When aspiration is frequent a person can be at risk of developing pneumonia. Food may get "stuck" in the throat or individuals may drool because they cannot swallow their saliva. Neurological conditions that can cause swallowing difficulties are: stroke (the most common cause of dysphagia); traumatic brain injury; cerebral palsy; Parkinson disease and other degenerative neurological disorders such as amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig's disease), multiple sclerosis, progressive supranuclear palsy, Huntington disease, and myasthenia gravis. Muscular dystrophy and myotonic dystrophy are accompanied by dysphagia, which is also the cardinal symptom of oculopharyngeal muscular dystrophy, a rare, progressive genetic disorder.

Signs and symptoms of dysphagia:

Pain when swallowing

Inability to start the swallowing process
Persistent coughing or choking while swallowing
Low-grade fevers
Sensation of food stuck in the throat or chest
Frequent heartburn
Lack of interest in eating or taking much longer than normal to finish a meal
Coughing overnight

Children show similar signs and symptoms but have unique indicators also:

Being distracted during meals
Tensing their bodies
Taking more than 30 minutes to finish their meal
Leaking or spitting foods or liquids
Coughing or gagging during meals
Losing weight

Prognosis

The prognosis depends upon the type of swallowing problem and the course of the neurological disorder that produces it. In some cases, dysphagia can be partially or completely corrected using diet manipulation or non-invasive methods. In others, especially when the dysphagia is causing aspiration and preventing adequate nutrition and causing weight loss, it may require aggressive intervention such as a feeding tube. For those with progressive degenerative neurological disorders, dysphagia will be only one in a cluster of symptoms and disabilities that have to be treated.

Diagnosing swallowing problems

Physical exam. Todd Levine, MD, asks his patients to drink water and then say their names. If their voice sounds wet, there is a problem as the water is trapped at the top of the esophagus near the vocal chords. Doctors might also examine your head, neck and tongue; test your gag reflex; and x-ray your lungs.
Modified barium swallow or videofluoroscopy. Patients swallow a barium solution that coats the inside of the esophagus and allows a doctor or speech-language pathologist to see the entire swallowing process and find where the problem occurs.
Flexible endoscopic evaluation. A small flexible scope is passed through the nose to the back of the throat, base of the tongue and larynx to look directly at these areas for potential problems.

Treatments for dysphagia

Changing a person's diet by adding thickeners helps many people, as does learning different ways to eat and chew that reduce the risk for aspiration. Occasionally drug therapy that helps the neurological disorder can also help dysphagia. In a few persons, botulinum toxin injections can help when food or liquid cannot enter the esophagus to get to the stomach. More severely disabled individuals may require surgery or the insertion of feeding tubes.

What research is being done?

National Institutes of Health conduct research related to dysphagia in their clinics and laboratories and support additional research through grants to major medical institutions across the country. Much of this research focuses on finding better ways to treat dysphagia.

Down Syndrome

2009-10-18T19:36:00.000-07:00

What Is Down Syndrome?

Down syndrome is a chromosomal disorder caused by an additional (third) chromosome 21 or "trisomy 21." t is not usually hereditary in the conventional sense. That is, it is not inherited; it does not "run in families." The condition is usually the result of a random event that occurs during the formation of reproductive cells (eggs and sperm). One exception is Down syndrome caused by a balanced translocation. is associated with mental retardation, a characteristic facial appearance, and poor muscle tone (hypotonia)This syndrome occurs in one out of 800 live births, in all races and economic groups. It is the most frequent genetic cause of mild to moderate mental retardation and associated medical problems. As far as we know, it is not caused by any behavioral activity of the parents or environmental factors.

Risk Factors for a Down Syndrome Baby

There are several established risk factors for this condition, including:

Having a Down syndrome baby previously
Increasing maternal age
Carriers of a balanced translocation.

Characteristics of Down Syndrome Symptoms

There are estimated to be over 100 characteristics of Down syndrome. Common characteristics of Down syndrome can include:

A flat facial profile
An upward slant to the eye
A short neck
Abnormally shaped ears
White spots on the iris of the eye (called Brushfield spots)
A single, deep transverse crease on the palm of the hand
Smaller than average size
Exaggerated space between the first and second toe
Poor muscle tone (called hypotonia)
Joint looseness
Broad feet with short toes
Learning disabilities.

Besides the physical characteristics, people with Down syndrome are also at increased risk of developing certain medical conditions that come with their own set of symptoms. Some of these conditions can include:

Thyroid problems
Hearing problems
Congenital heart disease
Eye problems
Seizure disorders
Bone, muscle, nerve, or joint problems
Leukemia and other cancers
Immune system problems
Developmental delay
Mental retardation
Premature aging
Alzheimer's disease.

Because of these medical conditions and their complications, a person with Down syndrome is at increased risk of premature death. Regular checkups are very important. Checkups help ensure that any changes in health are noted and treated if necessary.

Down Syndrome Diagnosis

Tests used to make a Down syndrome diagnosis include amniocentesis, chorionic villus sampling (CVS), and percutaneous umbilical blood sampling (PUBS). To confirm the diagnosis, the doctor may request a blood test called a chromosomal karyotype. The doctor may also make a Down syndrome diagnosis shortly after birth, based on the presence of possible characteristics of the disorder. This blood test goes by several names, including:

Multiple marker screening test
Maternal blood screening test
Triple screen
Quad screen.

Treatment for Down Syndrome

Because it is a problem with the chromosomes, there are no cure , the goals of Down syndrome treatment are to control symptoms and manage any resulting medical conditions. This includes regular checkups and screenings, medications, and surgery. Counseling and support groups are also aspects of treatment for those who need help in coping with emotional and practical aspects of Down syndrome.

Down Syndrome Research
Scientists conducting research on Down syndrome are investigating new prenatal diagnostic techniques and methods to improve understanding of the developmental consequences of the disorder. This research has led to many advances, such as preimplantation diagnosis. Couples who join research studies have the first chance to benefit from treatments that have shown promise in earlier research.

STROKE (CVA)

2009-10-17T16:50:00.000-07:00

What Is a Stroke?

A stroke (known medically as a cerebrovascular accident or CVA) is a sudden episode that may affect consciousness, sensation, and movement, which results from a blockage or rupture of a blood vessel in the brain. It causes symptoms that last for at least 24 hours.There are two main types -ischemic and hemorrhagic.

Ischemic Stroke

The most common type of stroke is an ischemic stroke. Up to 80 percent of stroke cases are ischemic strokes. With this stroke, not enough essential oxygen- and nutrient- rich blood is able to get to certain parts of the brain for a long enough period of time that brain tissue is damaged. This lack of blood supply occurs because a blood vessel becomes severely narrowed or blocked.

There are several reasons why a blood vessel in the brain may become severely narrowed or blocked. The two most common causes are an embolism and thrombosis.A blood vessel can also become narrowed or blocked through stenosis.

Embolism

A blood clot or other tissue in the blood, such as fat or air, from a part of the body other than the brain can travel through blood vessels and become wedged in a smaller brain artery. This free-roaming clot or tissue is called an embolus (plural: emboli). Emboli often form in the heart. They also commonly form in the neck arteries or within the aorta. A stroke caused by an embolus is called an embolic stroke.

Several conditions can increase a person's chances for developing an embolus. Some of the most common include atrial fibrillation, sick sinus syndrome, and other irregular heart rhythms. These conditions can cause poor blood flow, which allows harmful clots to form. Emboli are also more likely to form in people:

With heart valve diseases, such as endocarditis, mitral valve prolapse, or rheumatic heart disease
Who have had a recent heart attack
With sickle cell disease
With systemic lupus erythematosus (lupus or SLE for short)
With other conditions that can cause inflammation of blood vessels, such as temporal arteritis, syphilis, or HIV/AIDS.

Thrombosis

A blood clot can also form in one of the brain arteries (called cerebral arteries); however, instead of breaking free, the clot remains attached to the artery wall until it grows large enough to block blood flow. This type of stroke is known as a thrombotic stroke.

Most of the time, a thrombus occurs within an area of the brain damaged by atherosclerosis. In atherosclerosis (also known as hardening of the arteries), deposits of plaque (a mixture of fatty substances, includingcholesterol and other lipids) build up along the inner walls of large- and medium-sized arteries, causing thickening, hardening, and loss of elasticity of artery walls and decreased blood flow. This increases the risk that a thrombus will form, causing severe narrowing or complete blockage of the affected blood vessel.

Stenosis

A third ischemic stroke cause involves a type of artery narrowing known as stenosis. This narrowing most often occurs from the buildup of plaque from atherosclerosis. Over time, this narrowing can completely block a brain artery.

Hemorrhagic Stroke

Bleeding into the brain (or the spaces surrounding the brain) causes the second main type of stroke, called a hemorrhagic stroke. In a healthy, functioning brain, cells do not come into direct contact with blood. If an artery in the brain breaks, blood moves out into the surrounding tissue, causing damage. Hemorrhagic strokes account for approximately 20 percent of all strokes.

Common hemorrhagic stroke causes include:

Blood vessel breakage
Aneurysm
Arteriovenous malformation
Trauma
Tumor or cancer.

Blood Vessel Breakage

Bleeding can also occur when arterial walls break open. Plaque-encrusted artery walls eventually lose their elasticity and become brittle, thin, and prone to cracking. Hypertension, commonly known as high blood pressure, increases the risk that a brittle artery wall will give way and release blood into the surrounding brain tissue. In fact, high blood pressure is the most common underlying cause of hemorrhagic stroke.

Aneurysm

A bleeding aneurysm is a weak or thin spot on an artery wall. Over time, these weak spots stretch or balloon out under high blood pressure. The thin walls of these ballooning aneurysms can rupture and spill blood into the space surrounding brain cells.

Arteriovenous Malformation

A person with an arteriovenous malformation (AVM) also has an increased risk of hemorrhagic stroke. AVMs are a tangle of defective blood vessels and capillaries within the brain that have thin walls, which can rupture.

Trauma

Any type of head trauma can cause bleeding in the brain and result in a stroke.

Tumor or Cancer

Certain types of tumors and cancer are known to cause hemorrhagic strokes. These include:

Stroke Risk Factors That You Cannot Change:

Growing older (the risk of stroke tends to increase with age)
Being male (however, women are more likely than men to die from a stroke)
Being African American
Having a family history of stroke
Having a history of a stroke, TIA, or heart attack.

TIA

A transient ischemic attack (TIA) is a transient stroke, or "mini-stroke" that lasts only a few minutes. A TIA occurs when the blood supply to part of the brain is briefly interrupted. TIA symptoms, which usually occur suddenly, are similar to those of stroke symptoms but do not last as long. Most symptoms of a TIA disappear within an hour, although they may persist for up to 24 hours.

Stroke Risk Factors That You Can Change or Control:

High blood pressure(hypertension)
Smoking
High cholesterol(hypercholesterolemia)
Atrial fibrillation
Certain heart diseases
Diabetes
Carotid artery disease
Sleep apnea
Heavy consumption of alcohol
Drug abuse.

Stroke Symptoms

For a person having a stroke, the symptoms may vary depending on which part of the brain is affected. Examples of specific symptoms can include:

Sudden numbness or weakness of face, arm, hand, or leg (especially on one side of the body)
Sudden confusion
Sudden trouble speaking or understanding speech
Sudden trouble seeing in one or both eyes (such as double vision, blurred vision, or blindness)
Sudden dizziness, lightheadedness, or trouble walking
Sudden loss of balance or coordination
Sudden severe headache with no known cause
Vomiting
Loss of consciousness
Spinning sensation (vertigo)
Sudden collapse
Seizures (in a small number of cases).

There are now effective therapies for stroke that need to be administered at a hospital; however, they lose their effectiveness if they are not received within the first three hours after stroke-related symptoms appear.

Also, keep in mind that it is common for a stroke victim to protest or deny that he or she is having a stroke. If you notice a person exhibiting any of the possible symptoms of a stroke discussed above, get help right away.

Stroke Treatment

For Ischemic Stroke (Restore Blood Flow)

The main treatments used to restore blood flow to the heart involve thrombolytic drugs.

Healthcare providers may prescribe thrombolytic ("clot-busting") drugs to dissolve blood clots that are blocking blood flow to the brain. When given soon after an ischemic stroke begins, these drugs can limit or prevent permanent damage to the brain by dissolving the blood clot. In treating a stroke that has just occurred, every minute counts. Get a person who has had a stroke to the hospital as soon as possible afterstroke symptoms start so he or she may be evaluated and receive treatment as soon as possible.

A thrombolytic drug known as tissue plasminogen activator (t-PA, Activase^®) can be effective for treating a stroke if a person receives it within three hours after his or her stroke symptoms have started. Because thrombolytic drugs can increase bleeding, doctors only use t-PA when they are certain that the person has suffered an ischemic stroke and not a hemorrhagic stroke.

For Hemorrhagic Stroke (Stop the Bleeding)
In people with a hemorrhagic stroke, treatment options will depend on what is causing the bleeding. The key with this type of treatment is to stop the bleeding as quickly as possible. Surgery may be one option. For example, in people with a brain aneurysm that that has bled, healthcare providers may recommend a technique called "clipping." Clipping involves clamping off the aneurysm from the blood vessel, which reduces the chance that it will burst and bleed.

The detachable coil technique is a new therapy for treating high-risk intracranial aneurysms, or aneurysms that occur inside the skull. Doctors insert a small platinum coil through an artery in the thigh and thread it through the arteries to the site of the aneurysm. They then release the coil into the aneurysm, where it triggers an immune response from the body. This immune response causes a blood clot to form inside the aneurysm, strengthening the artery walls and reducing the risk of rupture. Once the aneurysm is stabilized, a neurosurgeon can clamp it off with less risk of bleeding and death to the patient.

Medications Used for Treating a Stroke
In addition to treatments to restore blood flow in people who have suffered anischemic stroke, healthcare providers may use other medications or therapies as part of stroke treatment to reduce complications or the chances of another stroke. Some of these medicines can include:

Anticoagulants
Antiplatelets.

Anticoagulants
Anticoagulants reduce the risk of another stroke by decreasing the ability for blood to clot and also prevent existing clots from growing. These drugs are particularly useful in preventing the formation of clots in people with atrial fibrillation. The most commonly used anticoagulants for stroke treatment include warfarin (Coumadin^®), heparin, and enoxaparin (Lovenox^®).

Antiplatelets
Antiplatelet drugs prevent clotting by decreasing the activity of platelets, which are blood cells that help blood clot. By reducing the risk of blood clots, these drugs lower the risk of ischemic stroke. In the case of stroke treatment, doctors prescribe antiplatelet drugs mainly for prevention of another stroke. The most widely known and used antiplatelet drug is aspirin. Other antiplatelet drugs include:

Clopidogrel (Plavix^®)
Ticlopidine (Ticlid^®)
Dipyridamole (Persantine^®)
Aspirin and dipyridamole (Aggrenox^®)
.

The Hospital Stay
The length of your hospital stay after a stroke depends on factors such as:

Your condition
Your response to the stroke treatment
Tests doctors recommend to find the stroke cause.

Most people spend several days in the hospital after a stroke. While in the hospital, healthcare providers will monitor your condition, and you will receive treatment for any complications that may arise.

Treatment During the Recovery Period

Treatment for a stroke does not end when a person leaves the hospital. In fact, leaving the hospital is when treatment really begins in many cases. For a lot of people who have had a stroke, treatment is a lifelong process.

When it is time to leave the hospital, you will likely receive:

Specific dietary and rehabilitation instructions
Discharge instructions concerning driving, activity level, and medication
Any other restrictions.

Stroke Rehabilitation

Rehabilitation is designed to help stroke survivors become as independent as possible. It helps stroke survivors relearn the skills they lose as a result of brain damage. Another aspect of rehabilitation for stroke survivors involves teaching them how to compensate for any residual disabilities. Rehabilitation often begins 24 to 48 hours after the stroke at an acute-care hospital and may continue at inpatient, outpatient, or nursing facilities -- or at home.

Professionals Involved With Rehabilitation

Professionals involved with rehabilitation after a stroke include:

Physicians
Rehabilitation nurses
Physical therapists
Occupational therapists
Recreational therapists
Speech-language therapists
Vocational therapists
Mental health professionals.

Physicians

Physicians have the primary responsibility for managing and coordinating the long-term care of stroke survivors, including recommending which rehabilitation programs will best address individual needs. Physicians are also responsible for caring for the stroke survivor's general health and providing guidance aimed at preventing a second stroke, such as:

Controlling high blood pressure
Controlling diabetes
Eliminating risk factors such as cigarette smoking, excessive weight, a high-cholesterol diet, and high alcohol consumption.

Rehabilitation Nurses

Nurses specializing in stroke rehabilitation help survivors relearn how to carry out the basic activities of daily living. Rehabilitation nurses also educate survivors about routine healthcare, such as:

How to follow a medication schedule
How to care for the skin
How to manage transfers between a bed and a wheelchair
Special needs for people withdiabetes.

These nurses also work with survivors to reduce risk factors that may lead to a second stroke, and provide training for caregivers.

Nurses are closely involved in helping stroke survivors manage personal care issues, such as bathing and controlling incontinence. Most stroke survivors regain their ability to maintain continence, often with the help of strategies learned during rehabilitation. These strategies include strengthening pelvic muscles through special exercises and following a timed voiding schedule. If problems with incontinence continue, nurses can help caregivers learn to insert and manage catheters and to take special hygienic measures to prevent other incontinence-related health problems from developing.

Physical Therapists

Physical therapists specialize in treating disabilities related to motor and sensory impairments. They are trained in all aspects of anatomy and physiology related to normal function, with an emphasis on movement. Physical therapists can:

Assess the stroke survivor's strength, endurance, range of motion, gait abnormalities, and sensory deficits to design individualized rehabilitation programs aimed at regaining control over motor functions.

Help survivors regain the use of stroke-impaired limbs, teach compensatory strategies to reduce the effect of remaining deficits, and establish ongoing exercise programs to help people retain their newly learned skills. Disabled people tend to avoid using impaired limbs, a behavior called learned non-use. However, the repetitive use of impaired limbs encourages brain plasticity and helps reduce disabilities.

Encourage the use of impaired limbs. Selective sensory stimulation such as tapping or stroking, active and passive range-of-motion exercises, and temporary restraint of healthy limbs while practicing motor tasks.

Use a new technology, transcutaneous electrical nerve stimulation (TENS), which encourages brain reorganization and recovery of function. TENS involves using a small probe that generates an electrical current to stimulate nerve activity in stroke-impaired limbs.

In general, physical therapy emphasizes practicing:

Isolated movements

Repeatedly changing from one kind of movement to another

Rehearsing complex movements that require a great deal of coordination and balance, such as walking up or down stairs or moving safely between obstacles.

People who are too weak to bear their own weight can still practice repetitive movements during hydrotherapy (water provides sensory stimulation as well as weight support) or while being partially supported by a harness. A recent trend in physical therapy emphasizes the effectiveness of engaging in goal-directed activities, such as playing games, to promote coordination. Physical therapists frequently employ selective sensory stimulation to encourage use of impaired limbs and to help survivors regain awareness of stimuli on the neglected side of the body.

Occupational and Recreational Therapists

Like physical therapists, occupational therapists are concerned with improving motor and sensory abilities during rehabilitation. Occupational therapists help survivors relearn skills that are needed for performing self-directed activities, such as personal grooming, preparing meals, and housecleaning.

Occupational therapists can teach some survivors how to:

Adapt to driving and provide on-road training. They can teach people to divide a complex activity into its component parts, practice each part, and then perform the whole sequence of actions. This strategy can improve coordination and may help people with apraxia relearn how to carry out planned actions.

Develop compensatory strategies and how to change elements of their environment that limit activities of daily living. For example, people with the use of only one hand can substitute Velcro closures for buttons on clothing.

Make changes in their homes to increase safety, remove barriers, and facilitate physical functioning, such as installing grab bars in bathrooms.

Recreational therapists help people with a variety of disabilities to develop and use their leisure time to enhance their health, independence, and quality of life.

Speech-Language Pathologists
Speech-language pathologists can help stroke survivors with aphasia relearn how to use language or develop alternative means of communication. Speech-language pathologists can also help people improve their ability to swallow and work with patients to develop problem-solving and social skills to cope with the aftereffects of a stroke.

Many specialized therapeutic techniques have been developed to assist people with aphasia, and some forms of short-term therapy can improve comprehension rapidly.

Intensive exercises form the cornerstone of language rehabilitation. These intensive exercises can include:

Repeating the therapist's words
Practicing following directions
Doing reading or writing exercises.

Conversational coaching and rehearsal, as well the development of prompts or cues to help people remember specific words, are sometimes beneficial. Speech-language pathologists also help stroke survivors develop strategies for overcoming language disabilities. These strategies can include the use of symbol boards or sign language. Recent advances in computer technology have spurred the development of new types of equipment to enhance communication.

Speech-language pathologists use noninvasive imaging techniques to study swallowing patterns of stroke survivors and identify the exact source of their impairment. Difficulties with swallowing (also known as dysphagia) may be caused by several different things, including:

A delayed swallowing reflex
An inability to manipulate food with the tongue
An inability to detect food remaining lodged in the cheeks after swallowing.

Once they have identified the cause of the swallowing problems, speech-language pathologists will work with the individual to devise strategies to overcome or minimize the deficit. Sometimes, simply changing body position and improving posture during eating can bring about improvement. The texture of foods can be modified to make swallowing easier; for example, thin liquids, which often cause choking, can be thickened. Changing eating habits by taking small bites and chewing slowly can also help alleviate dysphagia.

Vocational Therapists
Approximately one-fourth of all strokesoccur in people between the ages of 45 and 65. For most people in this age group, returning to work is a major concern. Vocational therapists perform many of the same functions that ordinary career counselors do. They can help people:

With residual disabilities
Identify vocational strengths
Develop resumes that highlight those strengths
Identify potential employers
Assist in specific job searches
Provide referrals to stroke vocational rehabilitation agencies.

Most important, vocational therapists educate disabled individuals about their rights and protections as defined by the Americans with Disabilities Act of 1990. This law requires employers to make "reasonable accommodations" for disabled employees. Vocational therapists frequently act as mediators between employers and employees to negotiate the provision of reasonable accommodations in the workplace.

Mental Health Professionals
Addressing a stroke survivor's mental and emotional health can be an important part of stroke rehabilitation. For example, stroke survivors often experience depression (see Stroke and Depression). Treatment for such depression may shorten the rehabilitation process and lead to a more rapid recovery.

Mental health professionals that may be involved in the rehabilitation process include:

Psychologists
Psychiatrists
Clinical social workers.

Stroke Effects

There are many possible effects of a stroke, including paralysis, pain, and problems using or understanding language. A person who has had a stroke may also have incontinence, difficulty swallowing, and numbness. Other possible effects can involve problems with thinking and memory, as well as emotional disturbances (such as clinical depression).

Stroke Research

In the case of stroke, research currently under way includes work being done to better understand the impact of high blood pressure and other risk factors on a person's chances of having a stroke. Researchers are also studying the causes of stroke at a cellular level to find information that will help improve diagnosis, treatment, and prevention of stroke. Ongoing stroke research also includes an evaluation of constraint-induced movement therapy to improve motor function in stroke survivors.

ADHD

2009-10-16T19:06:00.000-07:00

ADHD

ADHD (attention deficit hyperactivity disorder) is one of the most frequently occurring childhood psychiatric disorders. Symptoms include not staying focused on a task, having trouble sitting still, and acting without thinking. These symptoms usually become evident in preschool or early elementary years, and can continue into adolescence and even adulthood. In many cases, the most effective treatments for ADHD include medications and behavioral therapies.

If left untreated, ADHD can have long-term effects on a child's ability to make friends or do well at school or work. Over time, children with the condition may develop depression , poor self-esteem, and other emotional problems.

A child with ADHD faces a difficult but not insurmountable task ahead. In order to achieve his or her full potential, the child should receive help, guidance, and understanding from:

Parents
Guidance counselors
The public education system.

ADHD Symptoms

In many cases, ADHD symptoms appear over the course of several months, often with symptoms of impulsiveness and hyperactivity preceding those of inattention, which may not emerge for a year or more. Specific symptoms include having trouble organizing activities, fidgeting, and excessive talking. Many normal children can have symptoms of this condition, but at lower levels, so it is important to get an accurate diagnosis by a qualified professional.

There are three subtypes of ADHD recognized by professionals based on symptoms of ADHD. These types are:

Predominantly hyperactive-impulsive type (that does not show significant inattention)
Predominantly inattentive type (that does not show significant hyperactive-impulsive behavior), sometimes called ADD -- an outdated term for this entire disorder
Combined type (that displays both inattentive and hyperactive-impulsive symptoms).

Progression of ADHD Symptoms

Symptoms of ADHD typically appear over the course of many months, often with the symptoms of impulsiveness and hyperactivity preceding those of inattention, which may not emerge for a year or more.

Different symptoms of ADHD may appear in different settings, depending on the demands the situation may pose for the child's self-control. A child who "can't sit still" or is otherwise disruptive will be noticeable in school, but the inattentive daydreamer may be overlooked. The impulsive child who acts before thinking may be considered just a "discipline problem," while the child who is passive or sluggish may be viewed as merely unmotivated. Yet both may have different types of ADHD.

What Are Not ADHD Symptoms?

All children are sometimes restless, sometimes act without thinking, and sometimes daydream the time away. When the child's hyperactivity, distractibility, poor concentration, or impulsivity begin to affect performance in school, social relationships with other children, or behavior at home, ADHD may be suspected. Because ADHD symptoms vary so much across settings, however, ADHD may not be easy to diagnose. This is especially true when inattentiveness is the primary symptom.

Because many normal children may have these possible symptoms, but at a low level (or the symptoms may be caused by another disorder), it is important that the child receive a thorough examination and appropriate ADHD diagnosis by a well-qualified professional.

Causes of ADHD

The exact causes of ADHD are unclear, although many people mistakenly believe that the disorder arises from social factors or child-rearing methods. Through research, scientists are refining their theories about the possible causes, some of which include environmental agents and genetics. Brain injury, food additives, and sugar are no longer thought to cause ADHD.

Possible Environmental Causes

There is little compelling evidence at this time that ADHD can arise purely from social factors or child-rearing methods. Most of the possible causes of ADHD appear to be related to neurobiology and genetics. This is not to say that environmental factors cannot influence the severity of ADHD, and especially the degree of impairment and suffering the child may experience, but that such factors do not seem to cause the condition by themselves. Knowing this can remove a huge burden of guilt from parents, who might blame themselves for their child's behavior.

Studies have shown a possible correlation between the use of cigarettes and alcohol during pregnancy and risk for ADHD in the child. As a precaution, it is best to refrain from both cigarette and alcohol use during pregnancy.

Another environmental agent that may be associated with a higher risk of ADHD is high levels of lead in the bodies of young preschool children. Since lead is no longer allowed in paint and is usually found only in older buildings, exposure to toxic levels of lead is not as prevalent as it once was. Children who live in old buildings where lead still exists in the plumbing or in lead paint that has been painted over may be at risk.

Genetic Causes

Attention disorders often run in families, so there are likely to be genetic influences. Studies indicate that 25 percent of the close relatives of children with ADHD also have it, whereas the rate is about 5 percent in the general population. Many studies of twins now show that the disorder has a strong genetic influence.

ADHD Brain Changes

Researchers are studying different areas of the brain to better understand the potential causes of ADHD. Children with ADHD are known to have a 3 percent to 4 percent smaller brain volume in all areas of the brain. Of these children, those who have not been treated with ADHD medications also show an abnormally small volume of white matter -- the part of the brain responsible for transmitting information. It is hoped that by better understanding these ADHD brain changes, newer and more effective treatments can be developed.

ADHD Treatment

As soon as a thorough, accurate diagnosis is made, ADHD treatment can begin. No single treatment is the answer for every child. Several factors are involved in determining which option is best, such as the child's needs, personal and medical history, and research findings. In many cases, a plan to treat ADHD consists of a combination of medications and behavior therapy.

Some of the therapy options used to treat ADHD include:

Psychotherapy
Behavior therapy
Social skills training
Support groups
Parenting skill training
Behavioral interventions.

Medications Used to Treat ADHD

Research has shown that treating ADHD with certain medications (stimulants, in most cases) and behavior therapies help children with this condition control their activity level and impulsiveness, pay attention, and focus on tasks. A few of the stimulants commonly prescribed for ADHD include:

Despite data showing that stimulant medications are safe, there are widespread misunderstandings about the safety and use of these drugs for ADHD treatment, and some healthcare practitioners are reluctant to prescribe them. Like all medications, those used for ADHD do have side effects and need to be closely monitored.

Suggestions for Parents

Below are some suggestions for parents to help their child with ADHD and school:

Learn about ADHD. The more you know, the more you can help yourself and your child.
If your child has shown symptoms of ADHD from an early age and has been evaluated, diagnosed, and treated with either behavior modification or medication (or a combination of both) when your child enters the school system, let his or her teachers know. They will be better prepared to help your child come into this new world away from home.
If your child enters school and experiences difficulties that lead you to suspect that he or she has ADHD, you can either seek the services of an outside professional or you can ask the local school district to conduct an evaluation. Some parents prefer to go to a professional of their own choice.

However, it is the school's obligation to evaluate children whom they suspect have ADHD or some other disability that is affecting not only their academic work but their interactions with classmates and teachers as well.

If you feel that your child has ADHD and isn't learning in school as he or she should, you should find out who in the school system you should contact. Your child's teacher should be able to help you with this information. Then you can request -- in writing -- that the school system evaluate your child.

The letter should include the date, your and your child's names, and the reason for requesting an evaluation. Keep a copy of the letter in your own files.

Until the last few years, many school systems were reluctant to evaluate a child with ADHD. However, recent laws have made clear the school's obligation to the child suspected of having ADHD that is adversely affecting his or her performance in school.

If the school persists in refusing to evaluate your child, you can either get a private evaluation or enlist some help in negotiating with the school. Help is often as close as a local parent group. Each state has a Parent Training and Information (PTI) center as well as a Protection and Advocacy (P&A) agency.

Once your child has been diagnosed with ADHD and qualifies for special education services, the school, working with you, must assess the child's strengths and weaknesses and design an Individualized Educational Program (IEP). You should be able to periodically review and approve your child's IEP.

Each school year brings a new teacher and new schoolwork, a transition that can be quite difficult for children with ADHD. Your child needs lots of support and encouragement at this time.

Praise your child when he or she does well. Build your child's abilities. Talk about and encourage his or her strengths and talents.
Be clear, be consistent, and be positive. Set clear rules for your child. Tell your child what he or she should do, not just what they shouldn't do. Be clear about what will happen if your child does not follow the rules. Have a reward program for good behavior; praise your child when correct behaviors are shown.
Learn about strategies for managing your child's behavior. These include valuable techniques such as: charting, having a reward program, ignoring behaviors, natural consequences, logical consequences, and time-out. Using these strategies will lead to more positive behaviors and cut down on problem behaviors.
Talk with your doctor about whether ADHD medication will help your child.
Pay attention to your child's mental health (and your own!). Be open to counseling; it can help you deal with the challenges of raising a child with ADHD. It can help your child deal with frustration, feel better about himself or herself, and learn more about social skills.
Talk to other parents whose children have ADHD. Parents can share practical advice and emotional support.
Meet with the school and develop an educational plan to address your child's needs. Both you and your child's teachers should get a written copy of this plan.
Keep in touch with your child's teacher. Tell the teacher how your child is doing at home. Ask how your child is doing in school and offer support.

Suggestions for Teachers

Below are some suggestions for teachers:

Learn more about ADHD.
Figure out what specific things are difficult for the student. For example, one student with ADHD may have trouble starting a task, while another may have trouble ending one task and starting the next. Each student needs different help.
Post rules, schedules, and assignments. Clear rules and routines will help a student with ADHD. Have set times for specific tasks, and be sure to call attention to changes in the schedule.
Show the student how to use an assignment book and a daily schedule. Also teach study skills and learning strategies, and reinforce these regularly.
Help the student channel his or her physical activity (e.g., let the student do some work standing up or at the board). Provide regularly scheduled breaks.
Make sure directions are given step by step and that the student is following the directions. Give directions both verbally and in writing. Many students with ADHD also benefit from doing the steps as separate tasks.
Let the student do work on a computer.
Work together with the student's parents to create and implement an educational plan tailored to meet the student's needs. Regularly share information about how the student is doing at home and at school.
Have high expectations for the student, but be willing to try new ways of accomplishing tasks. Be patient, and maximize the student's chances for success.

School and ADHD: A Final Thought

Never forget the cardinal rule -- you are your child's best advocate.

Alzheimer's Disease

2009-10-15T10:34:00.000-07:00

What is Alzheimer's Disease?

Dementia is a brain disorder that seriously affects a person's ability to carry out daily activities. The most common form of dementia among older people is Alzheimer's disease (also known simply as Alzheimer's). This condition initially affects parts of the brain that control thinking, memory, and language.

Alzheimer's is named after Dr. Alois Alzheimer, a German doctor. In 1906, Dr. Alzheimer noticed changes in the brain of a woman who had died of an unusual mental illness. Within the brain tissue, he found abnormal clumps (now called amyloidplaques) and tangled bundles of fibers (now called neurofibrillary tangles). Today, these plaques and tangles in the brain are considered signs of Alzheimer's disease.

Amyloid plaques, which are made up of fragments of a protein called beta-amyloid peptide mixed with a collection of additional proteins, remnants of neurons, and bits and pieces of other nerve cells.
Neurofibrillary tangles (NFTs), found inside neurons, are abnormal collections of a protein called tau. Normal tau is required for healthy neurons. However, in AD, tau clumps together. As a result, neurons fail to function normally and eventually die.
Loss of connections between neurons responsible for memory and learning. Neurons can't survive when they lose their connections to other neurons. As neurons die throughout the brain, the affected regions begin to atrophy, or shrink. By the final stage of AD, damage is widespread and brain tissue has shrunk significantly.

Stages of Alzheimer's Disease

Alzheimer's Disease develops slowly and causes changes in the brain long before there are obvious changes in a person's memory, thinking, use of words, or behavior. There are three Alzheimer's stages: mild, moderate and severe . Each of the three stages is characterized by different symptoms.

Mild Alzheimer's Disease

A person with mild Alzheimer's disease may:

Lose zest for life.

Lose recent memory without a change in appearance or casual conversation.

Lose the ability to make judgments concerning money.

Have difficulty with new learning and making new memories.

Have trouble finding words. He or she may substitute or make up words that sound like or mean something like the forgotten word.

May stop talking to avoid making mistakes.

Have a shorter attention span and less motivation to stay with an activity.

Easily lose his or her way going to familiar places.

Resist change or new things.

Have trouble organizing and thinking logically.

Ask repetitive questions.

Withdraw, lose interest, or become irritable. He or she may not be as sensitive to others' feelings or become uncharacteristically angry when frustrated or tired.

Avoid making decisions. For example, when asked what he or she wants to eat, says, "I'll have what she is having."

Take longer to do routine chores, becoming upset if rushed or if something unexpected happens.

Forget to pay, pay too much, or forget how to pay. For instance, he or she may hand the checkout person a wallet instead of the correct amount of money.

Forget to eat, eat only one kind of food, or eat constantly.

Lose or misplace things by hiding them in odd places or forget where things go. For example, the person may put clothes in the dishwasher.

Hoard things of no value.

Moderate Alzheimer's Disease

Common symptoms in this stage of Alzheimer's disease can include:

Changes in behavior, concern for appearance, hygiene, and sleep (which become more noticeable).

Inability to identify close relatives (such as thinking a son is a brother or that a wife is a stranger).

Poor judgment (This creates safety issues when the person is left alone -- he or she may wander and risk exposure, poisoning, falls, self-neglect, or exploitation.).

Difficulty recognizing familiar people and objects. The person may take things belonging to others.

Repetition of stories, favorite words, statements, or motions (such as tearing tissues).

Engaging in restless, repetitive movements in late afternoon or evening (such as pacing, trying doorknobs, or fingering draperies).

Inability to organize thoughts or follow logical explanations.

Difficulty completing tasks.

Telling stories to fill in gaps in memory.

Inability to formulate the correct response to a written request.

Inappropriate behavior (such as kicking, hitting, biting, screaming, cursing, or grabbing).

Becoming sloppy or forgetting manners.

Sensing things that are not there.

Making accusations (such as accusing a spouse of an affair or family members of stealing).

Frequent napping (or waking up at night and believing it is morning).

Difficulty positioning the body to use the toilet or sit in a chair.

Thinking that a mirror image is following him or television story is happening to her.

assistance to find the toilet, use the shower, remember to drink, and dress for the weather or occasion.

Inappropriate sexual behavior, such as mistaking another individual for a spouse. A person with Alzheimer's disease may forget what is considered private behavior and may disrobe or masturbate in public.

Severe Alzheimer's Disease

Common symptoms in this Alzheimer's stage can include:

Inability to recognize self or close family
Speaking gibberish or acting mute
Refusing to eat; choking or forgetting to swallow
Repetitively crying out; patting or touching everything
Loss of bowel and bladder control
Weight loss
Skin that becomes thin and tears easily
Becoming uncomfortable or crying out when transferred or touched
Forgetting how to walk (or being too unsteady or weak to stand alone)
Seizures, frequent infections, or falls
Groaning, screaming, or loud mumbling
Sleeping more
Requiring total assistance for all activities of daily living.

Diagnosing Alzheimer's Disease

Diagnosing Alzheimer's disease in the early stages will offer the best opportunity to treat related symptoms. An early diagnosis will also help patients and their families plan for the future while the patient is still able to participate in the decision-making process. Tests that doctors use when diagnosing Alzheimer's include memory tests, medical tests, and brain scans.

Causes of Alzheimer's Disease

While there are no known causes of Alzheimer's disease, there are factors that can increase a person's risk for developing this condition. Risk factors that may contribute to the causes of Alzheimer's disease include age, family history, and certain genes. Scientists are currently studying other possible risk factors and causes of Alzheimer's disease, such as: high blood pressure, high cholesterol, and low levels of the vitamin folate.
Alzheimer's disease risk factors include:
Age
Family history
Certain genes.

Age
Age is the most important known risk factor for Alzheimer's disease. The number of people with the disease doubles every 5 years beyond age 65.

Family History
Family history is another risk factor. Scientists believe that genetics may play a role in many cases of Alzheimer's disease. For example, familial Alzheimer's disease (a rare form of Alzheimer's disease that usually occurs between the ages of 30 and 60) is inherited.

Certain Genes
The more common form of Alzheimer's disease is known as late-onset Alzheimer's. It occurs later in life, and no obvious inheritance pattern is seen in most families. However, several risk factor genes may interact with each other and with non-genetic factors to cause the disease.

The only risk factor gene identified so far for late-onset Alzheimer's disease is a gene that makes one form of a protein called apolipoprotein E (ApoE). Everyone has ApoE, which helps carry cholesterol in the blood. Only about 15% of people have the form that increases the risk of Alzheimer's disease. It is likely that other genes may also increase the risk of Alzheimer's disease or protect against Alzheimer's disease, but they remain to be discovered.

Is there any Treatment?
Alzheimer's Disease is a slow disease that starts with mild memory problems and ends with severe brain damage. The course the disease takes and how fast changes occur vary from person to person. On average, patients with Alzheimer's disease live from 8 to 10 years after they are diagnosed, although some people may live with the condition for as long as 20 years.
Currently, there is no Alzheimer's treatment that can stop Alzheimer's disease. However, there are medications available to help with related symptoms.

Alzheimer's Treatment for Mild to Moderate Disease
For some people in the early and middle stages of Alzheimer's disease, there are medications that may prevent some Alzheimer's symptoms from becoming worse for a period of time. These medications include:
Tacrine (Cognex^®)
Donepezil (Aricept^®)
Rivastigmine (Exelon^®)
Galantamine (Razadyne^®, previously known as Reminyl^®).
Scientists do not yet fully understand how cholinesterase inhibitors work to treat Alzheimer's disease, but current research indicates that they prevent the breakdown of acetylcholine -- a brain chemical believed to be important for memory and thinking. As Alzheimer's disease progresses, the brain produces less and less acetylcholine. Therefore, cholinesterase inhibitors may eventually lose their effect.
Currently, there are no published studies that directly compare these drugs. Therefore, because all four medications work in a similar way, it is not expected that switching from one of these drugs to another will produce significantly different results. However, a person with Alzheimer's disease may respond better to one drug than another. It is important to note that Cognex^® (tacrine) is no longer actively marketed by the manufacturer

Treating Moderate to Severe Disease
Donepezil is also approved to treat severe Alzheimer's disease. Another drug,memantine (Namenda^®), has also been approved to treat moderate to severe Alzheimer's disease, although it also is limited in its effects. Combining memantine with other Alzheimer's medications may be more effective than any single therapy. One controlled clinical trial found that patients receiving donepezil plus memantine had better cognition and other functions than patients receiving donepezil alone.

Dose and Side Effects of Alzheimer's Disease Medication

For Alzheimer's disease medication, doctors usually start patients at low drug doses and gradually increase the dosage based on how well a patient tolerates the drug. There is some evidence that certain patients may benefit from higher doses of the cholinesterase inhibitor medications. However, side effects are more likely to occur if the dose is higher. The recommended effective dosage of Namenda is 20 mg/day after the patient has successfully tolerated lower doses.

Patients may be drug sensitive in other ways, and they should be monitored when a drug is started. Patients or their caregivers should:

Report any unusual symptoms to the prescribing doctor right away
Let the doctor know before adding or changing any medications
Follow the doctor's instructions when taking any medication, including vitamins and herbal supplements.

Prevent Alzheimer's

Until there is a cure or the causes of the disease are identified, actions that may help prevent Alzheimer's include: lowering cholesterol, lowering high blood pressure levels, controlling diabetes, exercising regularly, and engaging in intellectually stimulating activities. Although this does not guarantee Alzheimer's will not occur, it may help delay the disease's development. Before trying anything that promises to prevent Alzheimer's, check it out with your doctor first.

Current Focus of Research on Alzheimer's
Alzheimer's research scientists are studying various aspects of the disease. Recent research studies, including those currently under way, are focused on the following areas:

Genetics
Mild cognitive impairment
Neuroimaging
Inflammation
Medications
Antioxidants
Ginkgo biloba
Estrogen.
Alzheimer's research scientists are currently testing a number of drugs to see if they:

Prevent Alzheimer's disease
Slow down the disease
Help to reduce symptoms.

Some ideas that seem promising turn out to have little or no benefit when they are carefully studied in a clinical trial. Researchers undertake these trials to learn whether treatments that appear promising in observational and animal studies are actually safe and effective in people.

Pervasive Developmental Disorder

2009-10-14T10:04:00.000-07:00

What is Pervasive Developmental Disorder ?

Pervasive developmental disorder is an umbrella term for a group of disorders in which people have delays in the development of socialization and communication skills. Autism is perhaps the best known type. Other types include Asperger syndrome, childhood disintegrative disorder, and Rett syndrome. Symptoms of this disorder vary, but include problems relating to others and difficulty with changes in routine.

Pervasive Developmental Disorder Symptoms:

Pervasive developmental disorder symptoms encompass problems with social skills, speech and language, and development. Symptoms vary in type and intensity, and no two people will have the symptoms. A few of the more common pervasive developmental disorder symptoms include avoiding eye contact, repeating what is said (echolalia), and speaking in a flat-sounding voice.

Pervasive developmental disorder symptoms related to social skills can include:

Not interacting with others the way most people do, or not being interested in other people at all
wanting to be alone
Trouble understanding other people's feelings or talking about their own feelings
Not wanting to be held or cuddled, or only cuddling when they want to
Not noticing when other people try to talk to them
Being very interested in people, but not knowing how to talk, play, or relate to them.

Other pervasive developmental disorder symptoms related to speech, language, and communication can include:

Speaking with a flat-sounding voice
Inability to control how loudly or softly they talk
Standing too close to the people they are talking to
Sticking with one topic of conversation for too long
Speaking well and knowing a lot of words, but having a hard time listening to what other people say.
Talking a lot about something that they really like, rather than having a back-and-forth conversation with someone.

Children with pervasive developmental disorder might also learn a hard skill before they learn an easy one. For example, a child might be able to read long words, but not be able to tell you what sound a "b" makes. A child might also learn a skill and then lose it. For example, a child may be able to say many words, but later stop talking altogether.

Education and Treatment for Pervasive Developmental Disorder

Early and intensive education can help children with the condition grow and learn new skills. The goal of these efforts is to help with the more difficult symptoms of pervasive developmental disorder in a child and to improve the child's skills that help him or her talk, interact, play, learn, and care for his or her needs.

Medicines can relieve symptoms and are helpful for some people, but structured teaching of skills (often called behavioral intervention) is currently the most effective treatment for pervasive developmental disorder.

The treatment your doctor recommends will depend on the type of pervasive developmental disorder your child has and his or her needs.

Options to treat pervasive developmental disorder can include:

Therapy
Specialized education
Social support
Medications.

Cerebral Palsy

2009-10-13T18:02:00.000-07:00

What is Cerebral Palsy?

The term cerebral palsy refers to any one of a number of neurological disorders that appear in infancy or early childhood and permanently affect body movement and muscle coordination but don’t worsen over time. Even though cerebral palsy affects muscle movement, it isn’t caused by problems in the muscles or nerves. It is caused by abnormalities in parts of the brain that control muscle movements. The majority of children with cerebral palsy are born with it, although it may not be detected until months or years later. The early signs of cerebral palsy usually appear before a child reaches 3 years of age. The most common are a lack of muscle coordination when performing voluntary movements (ataxia); stiff or tight muscles and exaggerated reflexes (spasticity); walking with one foot or leg dragging; walking on the toes, a crouched gait, or a “scissored” gait; and muscle tone that is either too stiff or too floppy. A small number of children have cerebral palsy as the result of brain damage in the first few months or years of life, brain infections such as bacterial meningitis or viral encephalitis, or head injury from a motor vehicle accident, a fall, or child abuse.

What is the prognosis?

Cerebral palsy doesn’t always cause profound disabilities. While one child with severe cerebral palsy might be unable to walk and need extensive, lifelong care, another with mild cerebral palsy might be only slightly awkward and require no special assistance. Supportive treatments, medications, and surgery can help many individuals improve their motor skills and ability to communicate with the world.

Is there any treatment?

An occupational therapist may work within the community, the hospital, school or a special unit. Within local authority social services departments, occupational therapists are responsible for the assessment and provision of suitable equipment and for major adaptations to an existing or new environment at home, school or work to enable an individual to be as functionally independent as possible.

Occupational therapy plays a large role in the development of a child with Cerebral Palsy. The job of an occupational therapist is to hone the ability of the fine-motor skills and small muscles, which include hands, feet, mouth, fingers and toes. These therapists also teach daily living skills such as dressing, eating, and everyday mobility. It is also one of their jobs to make sure children are properly positioned in wheelchairs, standing frames, etc to maximize benefit and minimize positions that could contribute to more spasms or other uncontrolled movements. They may also teach your child better or easier ways to write, draw, cut with scissors and brush their teeth. Occupational therapists will also help your child find the right special equipment to make everyday jobs a little easier, such as modified spoons and cups for easier feeding, toys that are easily held and that will help the development of motor skills and seats, wheelchairs, pushchairs, standing frames, walking frames and side lying boards that will help improve your child’s mobility, posture, etc. The occupational therapist may try to develop certain physical and learning skills using special play equipment and advise on equipment to help mobility such as tricycles and trolleys.

It is also the job of an occupational therapist to help make your home and community accessible to your child. Many adaptations may needs to be accommodated in order for your child to reach his maximum level of independence. For instance, because children with Cerebral Palsy often have problems with their posture and muscle tension, a chair may need to be adapted with creative use of foam in order for the child to sit comfortably. Things such as the Rifton Corner Seat aid in a child’s ability to sit on the floor while playing, without stressing the leg muscles and while keeping the child’s posture upright.

Occupational therapists will look at the best posture and seating for the child. When you and your occupational therapist are considering your child’s seating needs, it is important to obtain a clear idea of what final outcome you are looking to achieve. “Some seating is very bulky. Many special seats have trays in front of them, which means that the child is unable to join the rest of the family at the dinner table. Many chairs available on the market depend on numerous straps to hold the child in place. I don’t think I would have been very comfortable as a child if several parts of my body were strapped down every time I sat in a chair. On the other hand, chairs that do not rely on straps probably require the child to put in some effort to keep their posture correct. Thus, sitting down becomes an activity rather than an act of relaxation. If your child clearly needs special seating it might be worth considering the option of more than one chair, perhaps one for relaxing and one for active sitting.”

In addition to helping your child find comfortable seating, depending on the degree of disability of the child, the therapist may be interested in the walking pattern or gait of the child. Even if the child can not walk or stand on his or her own, it is important that your child stand for a portion of the day. While movement is necessary to stop muscles from becoming atrophied, for children with Cerebral Palsy standing takes the weight from the hips to the feet, allowing the hip joint to develop more regularly. Hip dislocation is a common problem in children with Cerebral Palsy, and allowing the joint to develop adequate strength will help to avoid such dislocations. If a child is unable to stand on his own, there are many standing frames available. If a child is not able to stand on his own but can manage with an adult’s assistance, purchasing a standing frame may not be necessary. Activities such as holding your child’s hips and supporting him in a standing position while he leans against a sofa or low table can be just as effective in allowing your child’s joints to grow healthfully. Toilet seats can be specialized to help children with Cerebral Palsy develop this independent function without the need of assistance.

In instances where mobility is very limited, special computers that can be used by touching the screen, by speaking the commands, or other modifications make it possible for individuals with Cerebral Palsy to accomplish tasks they would otherwise be unable to do on their own. For example, computers can help people turn on a light switch with the blink of an eye or open a door with a nod of the head.

Occupational Therapists are also trained to evaluate the child’s sensory system to determine whether a primary sensory deficit is present or whether a child has difficulty processing sensory information. Sensory Integration refers to the ability to evaluate the relative importance of all sensory inputs acting on the body, on the basis of a child’s current posture, previous movement experiences and movement expectations. A child with Cerebral Palsy may experience sensory integration dysfunction as a result of central nervous system damage, or sensory integration dysfunction might develop secondary to the limited sensory experiences that these children have as a result of their limited motor abilities.

Occupational therapy will help determine your child’s abilities and will help to form reasonable goals to help your child reach.

What occupational therapists cannot do

Therapists cannot cure cerebral palsy; they can only help reduce disabling effects. Through therapy, disabled people can achieve improvement in communication and movement, and can become more independent. Every person with cerebral palsy is different, however, and not everyone will achieve the same results.

What research is being done?

Researchers are investigating the roles of mishaps early in brain development, including genetic defects, which are sometimes responsible for the brain malformations and abnormalities that result in cerebral palsy. Scientists are also looking at traumatic events in newborn babies’ brains, such as bleeding, epileptic seizures, and breathing and circulation problems, which can cause the abnormal release of chemicals that trigger the kind of damage that causes cerebral palsy. To make sure children are getting the right kinds of therapies, studies are also being done that evaluate both experimental treatments and treatments already in use so that physicians and parents have valid information to help them choose the best therapy

Autism

2009-10-12T22:10:00.000-07:00

Autism is a brain disorder that affects a person's ability to communicate, form relationships with others, and respond appropriately to the external world. People with the condition often exhibit repetitive behavior or narrow, obsessive interests. Other characteristics of autism include problems with verbal and nonverbal communication and social interaction. Scientists aren't certain what causes the disorder, but it's likely that both genetics and environment play a role.
Autism varies widely in its severity and symptoms. Because of this, early signs may go unrecognized, especially in mildly affected children or when it is masked by more debilitating handicap

Autism Symptoms
Distinctive autism signs and symptoms include difficulties with social interaction, problems with communication, and repetitive behaviors. A baby with symptoms may be unresponsive to people or focus intently on one item to the exclusion of others for long periods of time. Symptoms may include engaging in repetitive movements, such as rocking and twirling, or in self-abusive behavior, such as biting or head-banging.

There are three distinctive symptoms of autism:
Difficulties with social interaction
Problems with verbal and nonverbal communication
Repetitive behaviors or narrow, obsessive interests.
Autistic children can also develop symptoms that include reduced sensitivity to pain but increased sensitivity to sound, touch, or other sensory stimulation. Symptoms can range from mild to disabling.

Symptoms of Autism: Social Interaction
The hallmark symptom of autism is impaired social interaction. Parents are usually the first to notice possibly symptoms in their child.
As early as infancy, a baby with autism symptoms may be unresponsive to people or focus intently on one item to the exclusion of others for long periods of time.
A child with autism may appear to develop normally and then withdraw and become indifferent to social engagement.

Autism Symptoms: Verbal and Nonverbal Communication
The second most common symptom of autism is problems with verbal and nonverbal communication.
Children with autism may fail to respond to their name and often avoid eye contact with other people. They have difficulty interpreting what others are thinking or feeling because they can't understand social cues, such as tone of voice or facial expressions, and don't watch other people's faces for clues about appropriate behavior. They lack empathy.

Autism Symptoms: Repetitive Behaviors or Narrow, Obsessive Interests
Many children with symptoms of autism engage in repetitive movements, such as rocking and twirling, or in self-abusive behavior, such as biting or head-banging. They also tend to start speaking later than other children and may refer to themselves by name instead of "I" or "me."
Children with autism don't know how to play interactively with other children. Some speak in a sing-song voice about a narrow range of favorite topics, with little regard for the interests of the person to whom they are speaking.

Autism Symptoms: Sensitivity
Many children with autism have a reduced sensitivity to pain, but are abnormally sensitive to sound, touch, or other sensory stimulation. These unusual reactions may contribute to behavioral symptoms, such as a resistance to being cuddled or hugged.

Symptoms of Autism and Other Medical Conditions
Children with autism symptoms appear to have a higher-than-normal risk for certain coexisting conditions, including:
Fragile X syndrome (which causes mental retardation)
Tuberous sclerosis (in which tumors grow on the brain)
Epileptic seizures
Tourette syndrome
Learning disabilities
Attention deficit disorder (ADD).
For reasons that are still unclear, about 20 to 30 percent of children with autism develop epilepsy by the time they reach adulthood.
While people with schizophrenia may show some autistic-like behavior, their symptoms usually do not appear until the late teens or early adulthood. Most people with schizophrenia also have hallucinations and delusions, which are not found in autism.

Progression of Autism Symptoms
For many children, symptoms of autism improve with treatment and with age. Some children with the condition grow up to lead normal or near-normal lives. Children whose language skills regress early in life, usually before the age of three, appear to be at risk of developing epilepsy or seizure-like brain activity. During adolescence, some children with autism may become depressed or experience behavioral problems. Parents of these children should be ready to adjust treatment for their child as needed.

Some people with the condition can function at a relatively high level, with speech and intelligence intact. Others have serious cognitive impairments and language delays, and some never speak.
In addition, individuals with autism may seem closed off and shut down, or locked into repetitive behaviors and rigid patterns of thinking. An infant may avoid eye contact, seem deaf, and abruptly stop developing language. The child may act as if unaware of the coming and going of others, or physically attack and injure others without provocation. Infants with autism often remain fixated on a single item or activity, rock or flap their hands, seem insensitive to burns and bruises, and may even mutilate themselves.

A Team Approach to Making a Diagnosis
Autism is a complex disorder. A comprehensive evaluation requires a multidisciplinary team including a psychologist, neurologist, psychiatrist, speech therapist, and other professionals experienced in diagnosing autism. The team members will conduct a thorough neurological assessment and in-depth cognitive and language testing.
Because hearing problems can cause behaviors that could be mistaken for autism, children with delayed speech development should also have their hearing tested. After a thorough evaluation, the team usually meets with parents to explain the results of the evaluation and present the diagnosis.

What Causes It?
Scientists aren't certain what causes autism, but it's likely that both genetics and environment play a role.

Family Factors
Recent studies strongly suggest that some people have a genetic predisposition to autism. In families with one autistic child, the risk of having a second child with the disorder is approximately 5 percent, or one in 20. This is greater than the risk for the general population.
Researchers are looking for clues about which genes contribute to increased susceptibility. In some cases, parents and other relatives of an autistic child show mild impairments in social and communicative skills or engage in repetitive behaviors. Evidence also suggests that some emotional disorders, such as manic depression, occur more frequently than average in the families of people with autism.
The theory that parental practices are responsible for autism has now been disproved.

Neurotransmitters
Some studies suggest that people with autism have abnormal levels of serotonin or other neurotransmitters in the brain. These abnormalities suggest that autism could result from the disruption of normal brain development early in fetal development caused by defects in genes that control brain growth and that regulate how neurons communicate with each other. While these findings are intriguing, they are preliminary and require further study.

Treatment for Autism
There is no single best treatment for autism. One point that most professionals agree on is that early treatment is important; another is that most individuals with autism respond well to highly structured, specialized programs.

Before you make decisions on your child's autism treatment, you will want to gather information about the various treatments that are available. Learn as much as you can, look at all the options, and make your decision on your child's treatment based on your child's needs. You may want to visit public schools in your area to see the type of program they offer to special needs children.

Autism Treatment: Questions to Ask
Guidelines used by the Autism Society of America include the following questions parents can ask about potential treatment for autism:

Are there assessment procedures specified?
Has the treatment been validated scientifically?
Will the treatment result in harm to my child?
How will failure of the treatment affect my child and family?
How will the treatment be integrated into my child's current program?

Do not become so infatuated with a given treatment that functional curriculum, vocational life, and social skills are ignored.

The National Institute of Mental Health suggests a list of questions parents can ask when planning for their child, including the following:

How successful has the program been for other children?
How are activities planned and organized?
Are there predictable daily schedules and routines?
How much individual attention will my child receive?
How is progress measured?
Will my child's behavior be closely observed and recorded?
Will my child be given tasks and rewards that are personally motivating?
Is the environment designed to minimize distractions?
Will the program prepare me to continue the therapy at home?
What is the cost, time commitment, and location of the program?
How many children have gone on to placement in a regular school and how have they performed?
Do staff members have training and experience in working with children and adolescents with autism?

Applied Behavior Analysis
Among the many methods available for treating autism and education of people with autism, applied behavior analysis (ABA) has become widely accepted as an effective treatment. Applied behavioral methods have been shown to reduce inappropriate behavior and increase communication, learning, and appropriate social behavior.

The basic research done by Ivar Lovaas and his colleagues at the University of California, Los Angeles, calling for an intensive, one-on-one child-teacher interaction for 40 hours a week, laid a foundation for other educators and researchers in the search for further effective early interventions to help those with ASD attain their potential.

The goal of behavioral management is to reinforce desirable behaviors and reduce undesirable ones.

Goals of Autism Treatment
An effective treatment program will:

Offer a predictable schedule
Build on the child's interests
Teach tasks as a series of simple steps
Actively engage the child's attention in highly structured activities
Provide regular reinforcement of behavior.

Parental involvement has emerged as a major factor in treatment success. Parents work with teachers and therapists to identify the behaviors to be changed and the skills to be taught. Recognizing that parents are the child's earliest teachers, more programs are beginning to train parents to continue the therapy at home.

Instruction Based on Age
As soon as a child's disability has been identified, instruction should begin. Effective programs will teach early communication and social interaction skills.

Younger Than Three
In children younger than 3 years, appropriate interventions usually take place in the home or a child care center. These interventions target specific deficits in learning, language, imitation, attention, motivation, compliance, and initiative of interaction. Included are behavioral methods, communication, occupational and physical therapy along with social play interventions.

Often the day will begin with a physical activity to help develop coordination and body awareness; children string beads, piece puzzles together, paint, and participate in other motor skills activities. At snack time the teacher encourages social interaction and models how to use language to ask for more juice. The children learn by doing. In teaching the children, positive reinforcement is used.

Older Than Three
Children older than 3 years usually have school-based, individualized, special education. The child may be in a segregated class with other autistic children or in an integrated class with children without disabilities for at least part of the day. These programs should provide a structure that will help the children learn social skills and functional communication. In these programs, teachers often involve the parents, giving useful advice in how to help their child use the skills or behaviors learned at school when they are at home.

Elementary School
In elementary school, the child should receive help in any skill area that is delayed and be encouraged to grow in his or her areas of strength. Ideally, the curriculum should be adapted to the individual child's needs. Many schools have an inclusion program in which the child is in a regular classroom for most of the day, with special instruction for a part of the day. This instruction should include such skills as learning how to act in social situations and in making friends.

Middle and High School
During middle and high school years, instruction will begin to address such practical matters as work, community living, and recreational activities. This should include work experience, using public transportation, and learning skills that will be important in community living. Collaboration between parents and educators is essential in evaluating your child's progress.

Adolescence is a time of stress and confusion; and it is no less so for teenagers with autism. Like all children, they need help in dealing with their budding sexuality. While some behaviors improve during the teenage years, some get worse. Increased autistic or aggressive behavior may be one way some teens express their newfound tension and confusion.

The teenage years are also a time when children become more socially sensitive. At the age that most teenagers are concerned with acne, popularity, grades, and dates, teens with autism may become painfully aware that they are different from their peers. They may notice that they lack friends. And unlike their schoolmates, they aren't dating or planning for a career. For some, the sadness that comes with such realization motivates them to learn new behaviors and acquire better social skills.

How Physical Therapy and Occupational Therapy Differ

2009-10-12T21:33:00.000-07:00

Although both types of therapy help kids improve the quality of their lives, there are differences. Physical therapy deals with the issues of pain, strength, joint range of motion, endurance, and gross motor functioning, whereas occupational therapy deals more with fine motor skills, visual-perceptual skills, cognitive skills, and sensory-processing deficits.

Occupational Therapy Practitioners

There are two professional levels of occupational practice — occupational therapist (OT) and occupational therapist assistant (OTA).

Since 2007, an occupational therapist (OT) is required to complete a master's degree program. Before 2007, only a bachelor's degree was required.

An occupational therapist assistant is only required to complete an associate's degree program. OTAs are able to carry out treatment plans developed by the occupational therapist but can't complete evaluations.

All occupational therapy practitioners must complete supervised fieldwork programs and pass a national certification examination. Most states also require a license to practice and require occupational therapy practitioners to take continuing education classes throughout their careers to maintain that licensure.

Occupational therapists work in a variety of settings, including:

hospitals
schools
rehabilitation centers
mental health facilities
private practices
children's clinics
nursing homes

What is Occupational Therapy

2009-10-11T22:07:00.000-07:00

Occupational therapy, often abbreviated as "OT", incorporates meaningful and purposeful occupation to enable people with limitations or impairments to participate in everyday life. Occupational therapists work with individuals, families, groups and populations to facilitate health and well-being through engagement or re-engagement in occupation. Occupational therapists are becoming increasingly involved in addressing the impact of social and environmental factors that contribute to exclusion and occupational deprivation.

The World Federation of Occupational Therapist defines occupational therapy as a profession concerned with promoting health and well-being through occupation. The primary goal of occupational therapy is to enable people to participate in the activities of everyday life. Occupational therapists achieve this outcome by enhancing the individual's ability to participate, by modifying the environment, adapting the activity to better support participation and/or facilitating physical or mental rehabilitation to maximize functional performance.

Occupational therapy relies on understanding the importance of an activity to an individual, being able to analyze the physical, mental and social components of the activity, and then adapting the activity, the environment, and/or the person to enable them to resume the activity. Occupational therapists address the question, "Why does this person have difficulties managing his or her daily activities (or occupations), and what can we adapt to make it possible for him or her to manage better and how will this then impact his or her health and well-being?”

Occupational therapy gives people the "skills for the job of living" necessary for "living life to its fullest."

Occupational therapy draws from the field of occupational science to provide an evidence base to practice and develop academic and practice links to other related disciplines such as social science and anthropology, and also utilizes a range of generic models to guide the practice of OT.

Who might need occupational therapy?

birth injuries or birth defects
sensory processing/integrative disorders
traumatic injuries (brain or spinal cord)
learning problems
autism
pervasive developmental disorders
juvenile rheumatoid arthritis
mental health or behavioral problems
broken bones or other orthopedic injuries
developmental delays
post-surgical conditions
burns
spina bifida
traumatic amputations
cancer
severe hand injuries
multiple sclerosis, cerebral palsy, and other chronic illnesses

One of the activities that occupational therapists can address to meet children's needs is working on fine motor skills so that kids can grasp and release toys and develop good handwriting skills. Occupational therapists also address hand–eye coordination to improve play skills, such as hitting a target, batting a ball, or copying from a blackboard.

An occupational therapist can also:

help kids with severe developmental delays learn some basic tasks, such as bathing, getting dressed, brushing their teeth, and feeding themselves
help kids with behavioral disorders learn anger-management techniques (i.e., instead of hitting others or acting out, the children would learn positive ways to deal with anger, such as writing about feelings or participating in a physical activity)
teach kids with physical disabilities the coordination skills required to feed themselves, use a computer, or increase the speed and legibility of their handwriting
evaluate each child's needs for specialized equipment, such as wheelchairs, splints, bathing equipment, dressing devices, or communication aids
work with kids who have sensory and attentional issues to improve focus and social skills