1. Physical Disabilities Affecting Mobility Part I
September 29, 2005

2. Mobility Disabilities
Congenital.
Before, during, or immediately after birth.
Cerebral palsy.
Spina Bifida.
Congenital Osteogenesis Imperfecta.
Arthrogryposis.
Dwarfism.
Amputation.

3. Mobility Disabilities
Acquired Disabilities
Impact mobility later in life.
Traumatic Brain Injury
Stroke
Amputations
Muscular dystrophy
Rheumatoid Arthritis
Multiple Sclerosis
Myasthenia Gravis
Spinal Cord Injury

4. Congenital Mobility Disabilities
Cerebral palsy
More than 700,000 cases in America
Injury to the brain at birth or during birth
Bleeding in the brain
Lack of oxygen
Can be acquired due to brain damage, infections, meningitis.

5. Cerebral Palsy
Cerebral palsy is the most common physical disability in childhood. It is estimated 2 to 3 people out of every 1000 will have cerebral palsy. This condition is not hereditary and there is no cure. Many causes of cerebral palsy are still not known or understood.
©Copyright 2002 cerebral palsy league of Qld

6. Cerebral Palsy (Cont) Areas of the brain that govern motor control.
Voluntary muscle systems
Spasticity – tense, contracting muscles.
Athetosis – constant uncontrolled motion of limbs, head, and eyes.
Ataxia – poor muscle control, balance , coordination.
Changes in mental processes and perception.

7. Spina Bifida
Condition resulting from the neural tube not closing completely during the first four weeks of fetal development.
One in 2000 babies born in the US
Myelomeningocele – accompanied by hydrocephalus
Meningocele – meninges protrude from the opening in the vertebral column.

8. Spina Bifida Spina Bifida Occulta Incomplete vertebral development
Meninges are closed around the spinal cord.
Usually normal function not effected.

10. Spina Bifida Paralysis Use of braces, crutches, and wheelchairs
Bowel and bladder function may be affected.
Higher risk for obesity
Learning problems
Latex allergies
Folic acid

11. Congenital Amputation
Infants born without a limb, or with a significantly changed limb, twice the amount of those who lose a limb by accident, disease, or violent crime.
transverse deficiency or amelia
Congenital amputation resulting in the complete absence of a limb beyond a certain point (and leaving a stump).

12. Congenital Amputation
Longitudinal deficiencies
When a specific part of a limb is missing; for example, when the fibula bone in the lower leg is missing, but the rest of the leg is intact.
Phocomelia
The condition in which only a mid-portion of a limb is missing, as when the hands or feet are attached directly to the trunk.

13. Traumatic Brain Injury
Acquired damage to the brain that results when the head is hit, strikes a stationary object, or is shaken violently
#1 killer of people under age 34 in the U.S.
One of the leading causes of death & disability among children & adolescents

14. Traumatic Brain Injury
Occurs most frequently between ages 15-24
Males 4x more prevalent than females
MVA accidents (especially motorcycles) are the leading cause
500,000 new cases per year; 95% survival rate

15. Traumatic Brain Injury
Impact may range from mild physical disability to pervasive physical, behavioral, & cognitive deficits
Lifelong cost to an individual is said to exceed $4.5 million

16. Traumatic Brain Injury
Tentative conclusions re: psychosocial adaptation to TBI
Emotional difficulties, psychological reactions & personality changes result from a complex interplay of changes in neurological structure, pre-existing behavior patterns, & alterations of social supports

17. TBI: psychosocial adaptation - continued
Great variability in adaptation
Increased anxiety, denial of impairment, depression, anger & hostility.
Is it psychosocial reaction to personal losses vs. biological changes due to injury? Can’t really determine.
Display inability to accurately appraise the extent & severity of impairments & consequent psychosocial risk

18. TBI: psychosocial adaptation - continued
Follow-up studies suggest, people with TBI seldom attain satisfactory adaptation to their disability
No support to suggest severity of disability is related to severity of emotional and behavioral problems
Age of injury MAY affect adaptation/response; thought adolescence & young adults may have greater difficulty

19. Muscular Dystrophy
Irreversible change of muscle tissue in structure and strength.
Four common types of muscular dystrophy
Duchenne (most common)
Becker
Facioscapulohumeral
Myotonic

20. Duchenne Muscular Dystrophy
85% of all MD types are this type
Caused by the deficiency of the muscular protein dystophin
Diminished ambulation leading to wheelchair use by early adolescence
Gradual limitation on eating, dressing, and personal hygiene

21. Duchenne Muscular Dystrophy
Steadily failing respiratory ability resulting in death usually by the age of 20 years.
Intellectual development may be limited.
Depression and anxiety common reactions among children and adolescents with MD
Liveneh & Antonak, 1997
Rare inherited condition
Muscles replaced by fat and connective tissue.

22. Duchenne Muscular Dystrophy
Early symptoms begin at ages 2 to 5 years
Extensive accommodations usually needed by adolescence such as electric wheelchairs, leg braces.