1. MMR Patient with special challenge Dr. Miada Mahmoud Rady

2. MMR Care of Patients with Cognitive, Sensory, or Communication Impairment

3. MMR Developmental disability Definition: Defined by CDC as a diverse group of severe chronic conditions due to mental and/or physical impairments. Characteristic : 1.Impairments appear prior to age 22. 2.Usually continue throughout lifetime. 3.Numerous human attributes are adversely impacted.

4. MMR 4.Certain conditions have uncertain causes (autism, for example).

5. MMR Developmental Delay Definition : failure of child or an infant to reach a particular developmental milestone by the expected time. Signs of problems may be in one developmental area or in multiple areas. Delays are linked to many causes of developmental disabilities. Depending on causes, delays may persist into adulthood or resolve as medical or social situation improves

6. MMR Down syndrome Definition : An inherited genetic disorder known as trisomy 21characterized by : A.Developmental delay B.Cognitive impairment C.Unusual physical features ( Flattened face and nose,Short neck, Upward slanting eyes, Protruding tongue and Single crease on hand palms ).

7. MMR Risks include: 1.Sibling or mother with Down syndrome. 2.Older maternal age at time of conception. May have a shorter life expectancy Cognitive deficits range from barely noticeable to profound impairment. May function relatively independently or require constant assistance with basic tasks

8. MMR Chromosomal abnormality in down may cause: 1.Structural heart defects 2.Seizures 3.Numerous gastrointestinal problems 4.Speech alterations 5.Hearing loss

9. MMR Mental retardation Definition : Cognitive disorder appearing during childhood, accompanied by lack of adaptive behaviors including Ability to live and function independently and Interact successfully with others. A variety of tests are available, but intelligence quotient (IQ) below 70 is a defining characteristic.

10. MMR Autism A condition involving developmental delay. Increased rates of diagnosis is possibly due to: 1.Better awareness and screening. 2.Actual increase in occurrence. May be completely nonverbal throughout their lifetime or during periods of stress Developmental regression with no other cause should raise concern.

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14. Management A.Patients may react bizarrely or aggressively to commotion and excess stimuli. B.Physical contact should be: 1.Preceded with careful explanation. 2.Done from distal to proximal. C.Questions to the patient should be repeated in a variety of ways to ensure consistent response.

15. MMR D.Patients may show minimal reactions to pain or great discomfort to minor physical contact or injuries. E.Helpful to include caregivers in: Assessment Treatment Transport

16. MMR Hearing impairment Can be congenital or acquired.

17. MMR Congenital 1.Genetic factors cause 50% of congenital hearing loss in children. 2.Remaining 50% of congenital hearing loss is caused by: Maternal infection Rh incompatibility Hypoxia Maternal diabetes Pregnancy-induced hypertension

18. MMR Acquired hearing loss A.Majority of acquired hearing loss is from excessive exposure to loud noise. B.Other causes include: 1.Various infections (otitis media and viral infections) 2.Tumors (acoustic neuroma) 3.Ototoxicity of many medications 4.Diseases such as Meniere disease 5.Degenerative processes of aging

19. MMR Complication 1.Inhibit communication. 2.Limit social interaction. 3.Interfere with infant development. 4.Render many safety and warning devices ineffective

20. MMR Types of hearing loss 1.Conductive hearing loss: inability of sound to travel from outer ear through to the inner ear 2.Sensorineural hearing loss: problems with uptake of sound through tiny hairs within the ear and subsequent conduction of nerve impulses.

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