Students with Neuromuscular Disabilities and Brain Injury

Neuromuscular disabilities and brain injuriesEpilepsy Cerebral PalsyTraumatic Brain Muscular Dystrophy

Epilepsy- What is it? It is a condition that produces brief

disturbances in the electrical functioning of the brain, causing seizers. (Kuder, 2006)

Seizers happen without immediate cause and usually are repeated.

Epilepsy is broken down into two groups.◦Generalized epilepsy affects both

hemispheres of the brain.◦Partial epilepsy focuses on one side of the

brain.

Epilepsy

Types of Epilepsy Generalized Epilepsy Partial Epilepsy

Idiopathic (genetic causes)

- Childhood absence epilepsy- Juvenile myoclonic epilepsy- Epilepsy with grand-mal seizures on awakening Others

- Benign focal epilepsy of childhood

Symptomatic (cause unknown) or cryptogenic (cause unknown)

- West syndrome- Lennox-Gastaut syndrome- Others

- Temporal lobe epilepsy- Frontal lobe epilepsy Others

Epilepsy – Etiology Causes are unknown, unless it was

caused by an injury.Research has shown that epilepsy is

more prevalent in people that have experienced severe illness, brain damage, strokes, brain abscess, problems present at birth, tumors, kidney failure, low oxygen to the brain during birth and abnormal levels of blood sugar or sodium.

Epilepsy- Etiology cont. Researchers have said some

forms of epilepsy may be inherited.

Sometimes women experience spontaneous seizers because of changing in their hormones throughout their life. If females have to much estrogen it can cause more electrical discharge to the brain.

Epilepsy - SymptomsDuring seizures

◦ Unconsciousness ◦ Convolsions◦ Jerking of limbs

Usually each seizure is similar to the lastSocial communication problemsAn aura consisting of a strange sensation

(such as tingling, smelling an odor that isn't actually there, or emotional changes) occurs in some people prior to each seizure.

Severe epilepsy can cause aphasia which is memory loss after a seizure.

Epilepsy- DiagnosisNeurological examinationEGG (electroencephalograph)

exam which is reading of the electrical activity in the brain

Varies blood testing Eligible for services under IDEA

through other health impairments.

Epilepsy - TreatmentRemoval of tumor, abnormal

blood vessel.Medication called anticonvulsants

may reduce the number of seizures.

Brain surgery Vagal nerve stimulatorSpecial diets

Epilepsy- Interventions/ Services Intervene early Mnemonic devices Color coded notebooks to help

organize workRepetitive lesson strategies

throughout the unit.Therapies like yoga to relieve

stress

Cerebral Palsy- What is it?

A term describing a group of muscle and nerve disorders that affect a child’s ability to move.

Types: 1. Hypertonia(spasticity)2. Athetoid3. Ataxic4. Mixed

Cerebral Palsy- What is it? Continued.Hypertonia (spasticity)-Significant limitations

to range of motion. Muscles contracted, movements are slow and jerky. Muscular stiffness, over-reaction, and tightness, often due to oversensitive stretch reflexes

Athetoid- involuntary movement of limbs, lack of head control. Flailing of arms and legs. Writhing movements.

Ataxic- difficulty with balance and poor coordination

Mixed-combination of two or more types.*Of the children who have cerebral palsy, approximately 60%

have spasticity.

Cerebral Palsy- Etiology Prenatally(before birth) - Anoxia (lack of oxygen),

radiation exposure, drugs that harm the fetus, genetic disorder, fetal stroke, injury, infection of the uterus or kidney, toxemia, anemia, Rh factor, rubella.

Perinatally(during birth)- Anoxia, Rh factor, high bilirubin levels, injury.

Postnatally (after birth) - Anoxia; injury; infections such as toxoplasmosis, meningitis; other central nervous system disease.

Cerebral Palsy is non-progressive.

*For nearly 40% of all children with this disorder, we don't know what causes the damage.

Cerebral Palsy- SymptomsThings to look for:Delay in reaching motor milestones, such as

sitting or walking. Abnormal movement, muscle tone that is too

low (hypotonia) or too high (hypertonia). Unusual reflexes, such as a very active knee-

jerk; persistent primitive reflexes.Lethargy, or lack of alertness Irritability or fussinessAbnormal, high-pitched cryTrembling of the arms and legsAbnormal posture, such as the child favoring

one side of the body

Cerebral Palsy- DiagnosisCheck motor skills, muscle tone, and

postureCT (computed tomography).  Image

of the brain that can determine underdeveloped areas of brain tissue.

MRI (magnetic resonance imaging). Generates a picture of the brain to determine areas that may be damaged

Intelligence testing

Cerebral Palsy- Interventions/ServicesEarly InterventionAlternative Augmentative

CommunicationAssistive technology Speech Language Therapy Physical TherapyOccupational Therapy Eligible for services under IDEA

through Orthopedic Impairments Great Resource!

TBI- What is it?• Traumatic Brain Injury is caused by an

external physical force.

• Open-head injury: also known as localized. A visible injury that usually is confined to one portion of the brain. (example, gunshot wound)

• Close-head injury: caused by a rapid acceleration and deceleration of the head, during which the brain bounces around inside the skull. (example, car accidents, falls, and sports injuries)

TBI- Symptoms• Physical impairments: Speech, vision, hearing,

and other sensory impairment; headaches, problems with coordination; spasticity and/or paralysis

• Cognitive impairments: Memory difficulties; slowness in thinking; problems concentrating; problems with perception and attention; problems planning and sequencing

• Behavior and personality problems: Fatigue; mood swings; anxiety; depression; difficulty with emotional control

TBI- Testing• Glasgow Coma Scale: Scale that assesses the response

to stimuli in patients with craniocerebral injuries. This 15-point test helps a doctor or other emergency medical personnel assess the initial severity of a brain injury by checking a person's ability to follow directions and move their eyes and limbs. The coherence of speech also provides important clues. Abilities are scored numerically. Higher scores mean milder injuries.

• Types of responses that are looked at:• Eye opening response

• Verbal response

• Motor response

TBI- Treatment• In most cases, children with head injuries show

improvement over time, but there may be lasting effects that can have an impact on classroom performance.

There are three main types of treatments for TBI:

• Acute Treatment

• Subacute Treatment

• Chronic Treatment and Long-Term Rehabilitation

Acute Treatment of TBI• Immediately after the incident, patients are generally rushed to

the hospital for immediate acute treatment.

Things that are done during Acute Treatment:

• Check for and surgically remove life-threatening blood clots

• Clear patients' airways

• Medicate patients (to calm them, prevent seizures or otherwise prevent further injury)

• Monitor and surgically relieve high levels of intracranial pressure (the pressure caused by the buildup of excess brain fluid in the skull)

• Put patients on life support systems, if necessary

Subacute Treatment of TBI• Medical staff will fully evaluate the patient's impairments,

disabilities and probability of recovery.

• Doctors will outline a course of appropriate treatments, helping patients and their families build the right team of medical professionals necessary for rehabilitation and chronic TBI treatment.

• Although most traumatic brain injury patients enter subacute treatment centers in shock or a state of post-traumatic amnesia, they leave these facilities ready to live independently, live with home care or move onto to long-term care centers.

• Patients with mild to moderate TBI spend little, if no time in subacute treatment centers. In contrast, those with severe traumatic brain injury usually spend anywhere from 5 to 10 years getting critical care in subacute treatment facilities.

Chronic Treatment of TBI Because the complications of TBI can cause lifelong impairment, patients will

need ongoing treatment in the form of:

• Assistive technologies (These include any device, ranging from a wheelchair to a specialized keyboard, that facilitates perception, comprehension and/or mobility.)

• Counseling and/or therapy (physical and/or speech)• Medications

Patients' individual complications and conditions will vary depending on their:

• Age• Co-morbid conditions (other medical issues existing with the primary

condition)• Severity of TBI• Type of TBI

Short-term goals that help achievement may include:• Being able to socialize• Overcoming low self-esteem, depression or other emotional issues• Re-learning to speak and otherwise communicate

TBI- Interventions Prevention is the best intervention for head injuries. They

include:

• Wear seat belts, helmets, and appropriate sports equipment

Ten elements that should be part of an educational program for students with TBI:

• Maximally controlled environment• Low pupil-teacher ratio• Intensive and repetitive instruction• Emphasis on process• Behavioral programming• Integrated instructional therapies• Stimulation experiences• Cuing, fading, and shadowing• Readjustment counseling• Home-school liaison

Muscular dystrophy- What is it?

A group of inherited disorders that involve muscle weakness and loss of muscle tissue which gets worse over time

There are nine types of muscular dystrophy, all affecting different parts of the body and all being onset in different stages of life

There are also five motor neuron diseases including Spinal Muscular Atrophy, which is one of the most severe and least common forms of muscular dystrophy

The most common kind is Duchenne Muscular Dystrophy

Muscular Dystrophy- CausesAn absence of dystrophin, a

protein that helps keel muscle cells intact.

Duchenne is x-linked recessive and primarily affects boys. It is usually inherited from the mother. Most women who are carriers don’t have any types of symptoms.

Muscular Dystrophy- Symptoms

Generalized weakness and muscle wasting first affecting the muscles of the hips, pelvic area, thighs, and shoulders.

Calf pseudohypertrophy- enlarged calf muscles due to muscle tissue being destroyed and replaced by fat.

FatigueProgressive difficulty walkingTypical life expectancy is 25 years

Muscular Dystrophy- Diagnosis

Electromyography- a medical instrument that records the electrical waves associated with the activity of skeletal muscles

Genetic tests- techniques used to test for genetic disorders, involve direct examination of the DNA molecule itself.

Muscle biopsy- a procedure in which a piece of muscle tissue is removed from an organism and examined microscopically.

Serum CPK- a blood test where levels of creatine phosphokinase are measured

Muscular Dystrophy- Treatment

There is no known cure, but the treatments are meant to treat the symptoms

Treatments include activity such as physical therapy and steroids to prolong muscle strength.

Muscular Dystrophy- InterventionsGenetic counselingSince there is no cure it is had to

prevent this disease but they are trying to develop gene therapy.