Transcript Mental Retardation, Special Olympics, and the INAS-FMH Chapter 21

Mental Retardation, Special
Olympics, and the INAS-FMH
Chapter 21
INAS-FID Perspective
• INAS-FID
– Part of Paralympic movement
– Provides competition at elite levels for
individuals with mild mental retardation
Special Olympics Perspective
• Special Olympics
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Exclusively for people with MR
Year-round sports training and competition
Unified Sports
Separate from the Paralympics
Summer World Games - over 7,000 athletes
School systems utilize program as part of
adapted physical education
The Name Dilemma
• Imbeciles/idiots
• Mental deficiency
• Mental retardation
• Intellectual disabilities
The Definition Dilemma
• Determines eligibility for services
• Upper limit of IQ - 70 or 75
• Adaptive functioning
Current Definitions of MR
• Key concepts in each definition include
– Intellectual functioning
– Adaptive behavior
– Age of onset
Current Definitions of MR
• IDEA
– Significantly subaverage general
intellectual functioning existing
concurrently with deficits in adaptive
behavior and manifested during the
developmental period that adversely
affects a child’s educational performance
Current Definitions of MR
• AAMR - 1992
– Substantial limitations in certain personal
capabilities
– Manifested as significantly subaverage
intellectual functioning
– Exists concurrently with related disabilities in
two or more of 10 adaptive skill areas
– Begins before age 10
Current Definitions of MR
• AAMR - 2002
– A disability characterized by significant
limitations both in intellectual functioning and
in adaptive behavior as expressed in
conceptual, social, and practical skills. This
disability originates before age 18.
Current Definitions of MR
• Intellectual functioning - general capacity as
measured by standardized tests
• Adaptive behavior - skills learned by people
in order to function in everyday life
– Conceptual
– Social
– Practical
Current Definitions of MR
• Limitations in adaptive behaviors should
also be considered in light of the following
– Intellectual abilities
– Participation, interactions, and social roles
– Health - includes fine and gross motor skills
and ambulating
– Context
The Supports Paradigm
• Emphasizes the interaction of supports with
the dimensions of intellectual disabilities
• Support intensities vary
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Intermittent
Limited
Extensive
Pervasive
Using the Supports Paradigm
• Identify the relevant support areas
• Identify relevant support activities for each
support area
• Assess the level or intensity of support
needs
• Write an Individual Supports Plan
• Provide the supports and evaluate
Level of Severity vs. Needed
Supports
• IQs specify four levels of MR function
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– Severe
Moderate
Profound
• 1992 - two classifications of MR
– Mild
Severe
• 2002 - supports-based classification system
– Fix the environment rather than the person
Placement and Prevalence
• Third largest disability group
• Few persons live in residential facilities
– Multiple disabilities
– IQs less than 35
• Adults live in small-group homes
– In the community
– Received MH/MR services
Etiology of Mental Retardation
• Multiple factors
– Biological
– Environmental
• No clear etiology for 30 to 40%
• A number of predisposing factors
• Causes today are examined to prevent MR
Chromosomal Abnormalities
• Chance errors in cell division
• Autosomal chromosome disorders
• Sex-linked chromosome disorders - tend to
be more frequent and less severe
Fragile X Syndrome
• Inherited
• Gap or break in the long arm of the X
chromosome
• Frequently goes undiagnosed
• Mental function varies
• Various behaviors and physical indicators
Other Syndrome Disorders
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Apert syndrome
Cornelia de Lange syndrome
Neurofibromatosis
Tuberous sclerosis
Sturge-Weber disease
Prader-Willi syndrome
Metabolism and Brain Formation
Disorders
• Inborn errors of metabolism
– Phenylketonuria
– Hurler’s syndrome
Galactosemia
Tay-Sachs disease
• Unknown prenatal influences cause brain
and head size anomalies
– Anencephaly
– Hydrocephalus
Microcephalus
Craniostenosis
Fetal Alcohol Syndrome
• Most common condition within the
infection, toxin, and trauma etiologies
• Associated with parental drinking
• Various indicators including growth
retardation, microcephalus, altered facial
features, physical and behavioral problems,
and mental retardation
Conditions Caused by Other
Toxins, Infections, and Traumas
• Use of drugs
– Premature births
– Low weight
– Failure to thrive
Small head circumference
Delayed motor development
• Sexually transmitted diseases
• Traumas that injure the brain or oxygen
deprivation
Down Syndrome
• An autosomal chromosomal condition that
results in short stature, distinct facial
features, and physical and cognitive
differences that separate it from other
manifestations of MR
• Intellectual function varies
Types of Down Syndrome
• Trisomy 21 - failure of chromosome pair 21
to separate properly
• Translocation - portion of 21st chromosome
is transferred or fused with another
chromosome
• Mosaicism - chance error in nondisjunction
after fertilization - causes both normal and
trisomic cells
Physical Appearance
• Unique clinical features (over 100)
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Short stature, limbs, hands, and feet
Almond-shaped slanting eyes
Flattened facial features and back of skull
Small oral cavity
Hypotonic muscle tone
Joint looseness
• Wide variation from person to person
Strengths and Weaknesses
• Tend to function motorically lower than
most other persons with MR
• Benefit from sensorimotor programming
and intensive training in sports
• Function higher than others with MR in
rhythm
Hypotonia and Skeletal Concerns
• Muscular hypotonia at birth can be
decreased with large-muscle exercise
• Protruding abdomen and high incidence of
umbilical hernias
• Postural problems
• Lax ligaments affect function of foot
Motor Development Delays and
Differences
• Substantial delays in emergence of postural
reactions and motor milestones
• Development of manual control is also
different than in non-DS peers
• Vision problems, lack of motivation and
practice, and neural deficits contribute to
problems with hand-eye coordination
Balance Deficits
• Perform 1 to 3 years behind other persons
with same level of MR
• Basic movements are awkward
• Limits the learning of fundamental motor
skills and patterns
Left-Handedness and
Asymmetrical Strength
• Higher percentage of individuals with DS
than of non-DS peers are left-handed
– Need left-handed models
• Asymmetry of strength - limbs on left side
generally stronger than right
– Possible left cerebral hemisphere damage
– Uneven swimming strokes
– Awkwardness in using body parts
Visual and Hearing Concerns
• Visual problems limit development of handeye and foot-eye coordination
– Myopia, strabismus, nystagmus, and cataracts
are potential problems
• 50-65% have significant hearing problems
– Problems learning to speak, following
directions, and making and keeping friends
– Middle ear and respiratory infections
Heart and Lung Problems
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Congenital heart disease
Atrioventricular canal defect - early fatigue
Mitral valve prolapse or aortic regurgitation
Structural abnormalities in lungs, nasal
passages, airways, and chest may affect
breathing
• Avoid factors that cause respiratory infections
Fitness and Obesity Concerns
• Poor results on all motor and physical
fitness tests except the sit-and-reach test
• Dysfunction of the neuromuscular system
that affects strength development
• Obesity and high blood cholesterol
• Resting metabolism rate depressed
Health and Temperament
Concerns
• Average lifespan is over 50
• Many early deaths are associated with major
mobility and eating problems
• Susceptibility to upper respiratory infections
• Early-onset Alzheimer-type neuropathology
• Generally friendly, cheerful, mannerly, and
responsible
• Stubbornness may be related to CNS deficit
Atlantoaxial Instability
• Ligaments and muscles surrounding the
joint between the atlas and axis can slip out
of alignment and cause damage to the spinal
cord
• Absence of condition determined by X rays
• Restricted from activities that place pressure
on the head and neck muscles
MR Without DS
• No generalizations can be drawn
• Most individuals with MR pass as normal
once they leave school
• 90% have mild impairments and need few
adaptations
• May need intermittent or limited supports
• Self-concept and social acceptance problems
MR With Associated Medical
Conditions
• More severe a disability - more likely there
are associated conditions that affect motor
behavior
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Seizures
Pain insensitivity and indifference
Dual diagnosis
Cerebral palsy
Pervasive developmental disorders
Communication and SelfDirection
• Communication level decreases with
severity of MR
• Present instructions slowly and clearly
• Check for understanding
• Allow time for response
• Provide opportunities for choice-making
• Facilitate self-direction
Augmentative or Alternative
Communication (AAC)
• Manual sign language
• Communication board/device
• Teachers and some peers learn
communication skills
• ACC devices
– Picture boards
– Synthetic or digitized speech
Time Delay Interventions
• Amount of time individual needs to answer
a question or perform a requested act
• Maintain eye contact without prompting for
up to 10 seconds
Cognitive Ability Related to
Motor Learning
• Attention
• Memory or retention
• Feedback
• Task analysis, repetition, and generalization
Attention
• Overexclusive attention
• Overinclusive attention
• Reduce irrelevant cues - restricted
environment
• Emphasis on recognizing relevent cues and
blocking out irrelevant ones
• Utilize attention-getters USING NET
Memory and Retention
• Long-term memory equal to peers
• Short-term memory deficits
• Rehearsal strategies must be taught
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Modeling
Verbal rehearsal
Self-talk
Imagery
Feedback
• Do not use feedback as fully as peers
• Provide both passive and questioning
feedback about process and product
• Meaningful feedback leads to success
• Dependent on short-term memory
• Feedback must be received immediately
Task Analysis, Repetition, and
Generalization
• Need more trials than peers and smaller
chunks of instruction
• Difficulty in chaining parts into sequences
• Need explicit directions
• Periodic practice after learning
• Practice in variable environments to teach
and reinforce generalization
Motor Performance
• Developmental coordination disorder
• Below-average performance in games and
sports that increases as complexity of rules,
strategies, and motor demands increase
• Better performance in closed skills that
require no quick body adjustments than in
open skills that are much more
unpredictable
Motor Development and Delays
• Delays in use of righting, propping, and
equilibrium postural reactions
• Delays in processing classroom instructions
Influence of Physical Constraints
• Height and body composition explain some
differences in motor performance
• With adjustments for height and body
composition significant differences in some
aspects of motor performance disappear
• Reducing body fat may improve motor
performance
Obesity and Overweight
Problems
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Affects motor performance
Affects predisposition to physical activity
Higher prevalence in females
Higher prevalence in mild/moderate MR
than severe MR
• Living arrangements impact weight
Kelly-Rimmer Equation for
Computing Percent Body Fat
• Standard measures may not be appropriate
• Kelly-Rimmer Equation takes into account
measurements other than height and weight
• Development of weight programs
emphasizing nutrition, exercise, and
behavioral intervention
Physical Fitness and Active
Lifestyle
• Cardiovascular or aerobic fitness
• Understanding of the purpose of a distance
run, concepts of speed, and discomfort
related to exercise is limited
• Pacer shuttle run
• Considerations for congenital heart disease
• Increased exercise tolerance in severe MR
• Develop ecologically valid goals
Programming Requiring Few
Supports
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Enhancement of inclusion
Preparation for the mainstream
Keep up with classmates
Develop some physical activity strengths
Work on weaknesses
Accept limitations
The Knowledge-Based Model
• Emphasizes movement problem solving so
learners are actively involved
• Instruction in three component areas
– Procedural knowledge
– Declarative knowledge
– Affective knowledge
• Steps in problem solving are explicitly
taught and practiced
Special Olympics Sports Skills
Programs
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Illustrated guide of each sport
Mandatory training for instructors
Eight weeks of training before competition
Development of active lifestyle and access
Skills, social behavior, and functional
knowledge of rules can all be emphasized
Special Olympics Competition
and Unified Sports
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Underlying philosophy
Community based
Utilize reverse mainstreaming
Generalization to activities outside SO
Unified sports - persons with and without MR
No competition until age 8
Divisioning to equalize competition
Stepping Out for Fitness Model
• Adolescents and adults with MR
• Use of music in all lessons
• Five components in the instructional model
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Assessment
Objectives
Task analysis
Implementation
Postevaluation
Programming for Young Children
with MR
• PREP Play Model
• I CAN: Preprimary
• Language-Arts-Movement-Programming
PREP Play Model
• Task analysis with recommended physical
prompts for instruction of 3 to 12 year olds in
– Locomotion
– Small play equipment
Large play equipment
Play vehicles
• Interaction in group-teaching and 1 to 1
• Several modes of assessment
• Includes knowledge of body parts and actions
Other Models for Young Children
• I CAN: Preprimary - utilizes play as a
vehicle for learning
– Locomotion
– Object control
– Play participation
Body control
Play equipment
Health-fitness
• Includes a home activities program
• LAMP - teaching movement and language
concurrently
Programming Requiring
Extensive Supports
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Includes individuals in the severe category
Multiple disabilities
Lack of self-direction
Training of teacher aides, peer tutors, and
others to provide supports
• Mature slowly motorically and cognitively
• Focus on nonambulatory locomotor
activities and object control
Programming Requiring
Extensive Supports
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Social skills and communication goals
Social and recreational interests
Individual sports
Life-skills curriculum - age-appropriate,
functional activities taught in natural
environments and based on students’
preferences
Sensorimotor Models
• Goals focus on
– Increasing body awareness
– Improving prelocomotion movement
skills
– Improving object manipulation skills
– Developing posture and locomotion skills
and patterns
Data-Based Gymnasium Model
• Utilizes behavior management techniques of
cueing, consequating, shaping, fading, and
chaining
• Teaching approach is task analysis
• Clipboard of programming management
• Systematic plan for training and using volunteers
and parents
• Targets movement concepts, motor skills, physical
fitness, and leisure skills
Special Olympics Motor
Activities Training Program
• Focuses on four types of activities
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Warm-up activities
Strength and conditioning activities
Sensory-motor awareness activities
Motor activities
• Supplement to existing programs and
curricula
Special Olympics Motor
Activities Training Program
• Assessment and task analysis of skills
• Utilize behavior management techniques
like shaping and reinforcing
• Individual skills tests competition is also
available for this population in various
sports