Physical Health of Adults with Intellectual Disabilities (Int. Assoc. for the Scientific Study of Intellectual Disabilities)

304 Pages·2002·2.27 MB·English

by  Vee Prasher

Physical Health of Adults with
Intellectual Disabilities

Physical Health of Adults
with Intellectual
Disabilities
Edited by
Vee P. Prasher
Monyhull Hospital, Kings Norton, Birmingham
and
Matthew P. Janicki
University ofIllinoisat Chicago
#2002byBlackwellPublishingLtd Firstpublished2002
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To
Dr Trevor Parmenterwho, through his leadershipof theIASSID and thoughtful
guidancetothoseofuswiththeWorldHealthOrganization,providedtheimpetus
for the development of this book
and
Suman, Monisha andAaran,whose support and patience were very
much appreciated

Contents
Contributors xii
SeriesForeword xiv
Foreword xv
Preface xvii
1 Epidemiological Issues 1
Helen Beange
Introduction 1
Definitionof intellectualdisability (mental retardation) 1
Age-specific prevalence of intellectual disability 2
Risk factors for ill-health 2
Prevalence ofhealthproblems 4
Age distribution of health problems 5
Sex distribution of healthproblems 6
Distribution ofhealthproblems accordingto level of intelligence 6
Mortality 7
Morbidity 7
Individual health problems 8
Conclusion 13
References 14
2 Assessing Physical Health 21
Gerard J.Kerins

Introduction 21
History taking 22
Review ofsystems 24
Physical examination 28
Investigations 31
Conclusions 33
References 33
3 Physical Health and ClinicalPhenotypes 35
Gregory O’Brien,Louise Barnard, Joanne Pearson andLisa Rippon
Introduction 35
Life expectancy 36
Morbidity andmortality 36
viii Contents
Chronicphysical deteriorating conditions 40
Majorspecific disorders 41
Mucopolysaccharidoses(MPS) 55
Sex chromosome aneuploidies 57
Other aneuploidies 58
Conclusion 59
References 60
4 Cerebral Palsy 63
Clyde E. Rapp and Margarita Torres
Introduction 63
Epidemiology 64
Etiology 65
History 68
Clinicalissues 70
Diet and nutrition 76
The physical examination 76
Diagnosis 81
Conclusion 83
References 83
5 Visual Impairment 88
Mette Warburg
Introduction 88
Definitionsof visual impairment 89
Prevalence of visual impairment 92
Errorsofrefraction 94
Medical causes ofvisual impairment 95
Cerebralvisual impairment 99
Ocular disorders in adults with Down syndrome 101

Cost of treatment 104
Coping 104
Prevention 105
Conclusion 106
References 107
6 Hearing Impairment 111
Sybil Yeates
Introduction 111
Prevalence of hearingloss 112
Tests ofhearing 113
Causesofhearing impairment in peoplewith intellectual
disabilities 119
Contents ix
Management ofhearing loss 127
Conclusion 129
References 130
7 Epilepsy 133
Stephen Brown
Introduction 133
What isepilepsy? 133
Definitionsand classification 134
Types of seizures and syndromesseen in peoplewith
intellectual disabilities 135
Status epilepticus 138
Epidemiology 139
Diagnosisanddifferentialdiagnosis 140
Behavioral consequences 141
The special issue of Down syndrome 141
Management 143
When to start drug treatment 146
Choice of anti-epileptic drugs 147
Generalprinciplesof using anti-epileptic drugsinpeople
withintellectualdisabilities 152
Conclusion 152
References 153
8 Endocrinological Issues 160
Aidan McElduff
Introduction 160
Clinical issues 161
Lifelong care and appropriate stepping(mile) stones 162
Risk factors for endocrine problems 162

Endocrine and related disorders 164
Screening 175
Therapeutic approaches 176
Accesstohealthcare in theusual paradigm of health
care delivery 176
Conclusion 178
References 178
9 Dentition andOral Health 181
Hans Malmstrom, Rosemeire R. Santos-TeachoutandYang-Fang Ren
Introduction 181
Epidemiology 181
Intellectual disabilities and edentulism 182
x Contents
Nutrition and dentures 183
Common oral diseasesinadults with intellectual disabilities 184
Oral infectiousdiseases 188
Oral facial tumors 189
Benigntumours 190
Premalignant lesions 190
Malignant lesions 191
Other oral problems 192
Interrelationshipsbetweenoral diseasesandsystemic diseases 195
Coordination of oral care 198
Conclusion 199
References 200
10 Nutritionand PhysicalHealth 204
Dawna Torres Mughal
Introduction 204
Role of nutrition in health 205
Food, health andculture 205
Dietary guidelines for healthfuldiets 207
Nutritional needs 213
Conclusion 225
References 226
11 Health Promotion and Disease Prevention 230
Nicholas Lennox
Introduction 230
What is health promotionand disease prevention? 230
The continuum of health promotion 231
Why isthe health promotionof peoplewith intellectual
disabilities important? 234

What affects health for peoplewith intellectual disabilities? 235
How do we engage in healthpromotion for peoplewith
intellectualdisabilities? 243
Systemicinterventions to improve the health ofadults with
intellectualdisabilities 244
Conclusion 247
References 247
12 Barriersto Health Care Servicesand theRoleof
thePhysician 252
Helen Baxter andMichael Kerr
Introduction 252
Accessibility,mobility andsensory impairment 253