Case: Cerebral Palsy
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- Merryl Houston
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1 Case: Cerebral Palsy A.W. is a 48 y.o. AA female with diplegic Cerebral Palsy(CP) Dysphagia, coughing, with solid foods X 3 mo. Vague generalized abdominal pain intermittently, 3 lb wt loss Seizure disorder Foot pain Moved in with sister one year ago after father died. Sister is legal guardian. Post-menopausal
2 Cerebral Palsy: Physical Exam New findings: Generalized abdominal tenderness, 8 pound loss Severe dysarthria but near normal cognition Ambulates with cane, unsteady gait, clumsy hand movements Dental caries Scoliosis, Flat feet Left hand contracture
3 Cerebral Palsy Case D/Dx: GERD, strictures, web, Schatzki s ring, PUD, aspiration Evaluation and Treatment: EGD: mild esophagitis Swallowing study: mild aspiration BMD: osteoporosis Vitamin D deficiency noted Referred to speech therapy Podiatry for foot inserts Walker obtained Orthopedics for scoliosis
4 Cerebral Palsy Second to ID as the most frequent cause of DD in children 30% of children with CP have ID non-progressive, motor impairment syndromes secondary to lesions of the brain arising in the early development CP itself is not progressive but many age-related changes occur earlier in persons with CP
5 Common Medical Problems in Adults with Cerebral Palsy Dysphagia/Aspiration: Increased in quadraparesis & gastrostomy Gastroesophageal Reflux Disease Constipation Osteopenia: noted in childhood Osteoporosis : risk increases with age, earlier than general population Vitamin D deficiency Obesity
6 Adults with Cerebral Palsy DJD and resulting chronic pain Spasticity and weakness may lead to contractures Scoliosis : 25-64% of institutionalized patients Decubitus ulcers Seizures : 30% of all individuals with CP UTIs, incontinence
7 Adults with Cerebral Palsy Intellectual Disability(ID) variable in predicting survival Strauss et. al Mobility and feeding skills were strong predictors to survival Most common cause of death: Aspiration pneumonia ID contributed little to predicting survival Blair, et. al 2001 ID strongest predictor of survival Immediate cause of death in 59 % respiratory problems
8 Common Medical Problems in Adults with Down Syndrome Cardiovascular : MVP and AR higher prevalence Echocardiogram at baseline then follow clinically Endocrine : 40% have thyroid dysfunction; screen annually Hearing Loss Overall 40 50% ;screening every 2 years Atlanto-Axial Instability Increased mobility at C1 & C2: 15 % of patients C-spine films prior to special Olympics or intubation.
9 Common Medical Problems in Adults with Down Syndrome Overweight/Obesity Mobility restrictions: Foot deformities, scoliosis, early DJD Constipation : overall 30% Obstructive sleep apnea due to upper airway obstruction Seizures: Lifetime incidence 5% Intellectual decline/alzheimer s dementia
10 Common Medical Conditions in Adults with Developmental Disabilities Overweight/Obesity Mobility Issues Premature Aging Constipation Visual and Hearing impairments Cardiac abnormalities in genetic disorders Seizure disorder Mental health disorders Need for multi-disciplinary care
11 Evaluation of Adults with Developmental Disabilities ADLs/functional capacity Day program/workshop Home setting : family, group home, independent Homecare services Need for respite care for family members Guardianship
12 Multidisciplinary Evaluation of Adults with Developmental Disabilities Durable medical equipment needs: wheelchair, walker, cane Occupational/Physical Therapy services Coordinated care with subspecialists: Mental health: psychiatry Neurology : seizure disorder orthopedics : contractures, DJD Vision/Dental evaluation
13 Case: C.B. Mr. C.B. is a 52 y.o. African American male with CP Using a wheelchair since early childhood, has hand contractures, neurogenic bladder, rare UTIs. Severe dysarthria, contractures of both hands, no decubiti He is obese (BMI 35), has hypertension, diabetes, and hypercholesterolemia He is accompanied by his brother for routine follow-up. His brother asks about colonoscopy.
14 A woman with Cerebral Palsy who died of inoperable cervical cancer after never having had a pap smear or pelvic exam despite annual physicals recorded by her assigned primary physician Doostan & Wilkes 1999
15 Quality of Life and Disabilities (QOL) Individuals with disabilities can accurately assess their QOL Key to self report of QOL among people with disabilities: Accurate modified instrumentation : Self-Rated Quality of Life Scales for People with an Intellectual Disability: A review ( R. Cummins, 1997) Methodological Issues in Interviewing and Using Self-Report Questionnaires with People with Mental Retardation (Finlay & Lyons 2001)
16 Quality of Life and Disabilities Public Opinion Non-disabled people believe that the QOL of people who live with disabilities is extremely low When disabled people report about their own QOL, they rate it as only slightly lower than when non-disabled people self-report their own QOL (Amundson 2010, pp ) Professional Opinion Healthcare professionals judge QOL of people with disabilities to be even lower (Albrecht & Devlieger 1999)
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