1. Alterations in Sensorimotor Function
By Nataliya Haliyash, MD, BSN

2. Alterations in sensory function can have a profound effect on the child's ability to achieve normal growth and development.
Early identification of hearing, vision, and communication defects enables early intervention to assist the child and family to achieve optimal growth and developmen

3. Lecture Objectives
Nursing care of the child with sensory or cognitive impairment:
Impaired vision
Impaired hearing
Mental retardation
Down syndrome
Nursing care of the child with neuromuscular dysfunction:
The child who is paralyzed
Quadriplegia: special needs
The child with cerebral palsy
Nursing care of the child with musculoskeletal alterations:
The child with a fracture
Congenital hip dysplasia
Congenital acute clubfoot
Legg-Calvé-Perthes disease (coxa plana)
Duchenne muscular dystrophy

4. EAR Structure And Age Peculiarities
Three main sections:
the outer ear,
the middle ear,
the inner ear
The eustaehian tube connects the middle ear with the nasopharynx. It allows fluid to drain into the nasopharynx and equalizes pressure between the outer and middle ear.
Infants and young children have shorter, more
horizontal, and more flaccid eustaehian tubes, predisposing
them to middle ear infections.

5. EAR Structure And Age Peculiarities
Infants and young children:
eustaehian tubes are shorter, more horizontal, and more flaccid
Predisposing factor to middle ear infections.
0-3 mo:
Soothed by parent's voice
Gives a startled response to loud sudden noises
3-6 mo:
Looks to see where sounds come from
Becomes frightened by an angry voice
Smiles when spoken to
Wakes up when spoken to or when a loud noise is made nearby

6. 6-12 mo:
Stops for a minute when someone says "no-no," "bye-bye," and own name
Looks at objects or pictures when someone talks about them
Enjoys rattle and similar toys for their sounds
12-18 mo:
Sings and hums spontaneously
Discriminates between sounds such as doorbell, telephone, barking dog, and so forth
"Dances" and makes sounds to music
18-24 mo:
Brings objects to others when asked
Hears and identifies sounds coming from another room

7. Hearing impairment
Disability that may range in severity from mild to profound.
Deafness is a hearing impairment that is so severe that the child is impaired in processing linguistic information through hearing, with or without amplification

8. Hearing impairment
Hard-of-hearing – residual hearing, with a hearing aid, sufficient to enable successful processing of linguistic information through audition

9. Incidence of hearing loss
The incidence of hearing loss in newborns is 1 in 1,000, and is one of the most common infant disabilities in the United States.
Each year 4,000 children are born profoundly deaf,
4,000 others have some degree of hearing loss
One to two additional children per 1,000 become deaf during childhood

10. Hearing impairment Classification:
Congenital
Acquired
Pathophysiological types of hearing loss:
Conductive hearing loss (middle-ear) – interference with transmission of sound to the middle ear, can be temporary or permanent
Sensorineural hearing loss (perceptive or nerve deafness)
results from damage or malformation of the inner ear and/or auditory nerve.
Can be a congenital defect or consequence of infection, exposure to loud noises or ototoxic drugs, and prematurity.
Sounds are distorted, severely affecting discrimination and comprehension

11. Hearing impairment Mixed conductive-sensorineural hearing loss:
Interference with transmission of sound in the middle ear and along neural pathways
Frequently results from recurrent otitis media and its complications
Central hearing loss:
All hearing losses that do not demonstrate defects in the conductive or sensorineural structures
Is caused by damage that interrupts sound transmission between the brainstem and the cerebral cortex,
difficulty in sound discrimination, auditory association of meaning to sound, auditory memory, and being able to differentiate sound from its background.