Causes, complications, and consequences of neurodevelopmental disorders: encountered in a cohort of adults with childhood-onset brain dysfunction who are institutionalized.Introduction: In their 1997 article, Carl Tyler and Claire Bourguet discussed the national trend to deinstitutionalize de·in·sti·tu·tion·al·ize tr.v. de·in·sti·tu·tion·al·ized, de·in·sti·tu·tion·al·iz·ing, de·in·sti·tu·tion·al·iz·es 1. To remove the status of an institution from. 2. adults with intellectual disabilities and place them in community residential settings. As a result, community based primary care physicians (PCPs) would assume care for this new patient population. In their research, the authors gathered information on 21 adults at the time of deinstitutionalization de·in·sti·tu·tion·al·i·za·tion n. The release of institutionalized people, especially mental health patients, from an institution for placement and care in the community. and subsequently obtained follow-up data over the next three years from their new community based PCP PCP abbr. 1. phencyclidine 2. primary care physician Pneumocystis carinii pneumonia (PCP) . At deinstitutionalization, each patient had an average of 2.0 diagnoses related to chronic conditions with an average of 2.1 long-term medications. After one year of community care, they had an average of 2.9 diagnoses with an average of 1.7 long-term medications. Fifty percent of these diagnoses (which included hepatitis B Hepatitis B Definition Hepatitis B is a potentially serious form of liver inflammation due to infection by the hepatitis B virus (HBV). It occurs in both rapidly developing (acute) and long-lasting (chronic) forms, and is one of the most common chronic , dysphagia dysphagia /dys·pha·gia/ (-fa´jah) difficulty in swallowing. dys·pha·gia or dys·pha·gy n. Difficulty in swallowing or inability to swallow. , acid peptic peptic /pep·tic/ (pep´tik) pertaining to pepsin or to digestion or to the action of gastric juices. pep·tic adj. 1. Relating to or assisting digestion. 2. disease, GERD GERD gastroesophageal reflux disease. GERD abbr. gastroesophageal reflux disease GERD , absence seizures absence seizure n. A brief, sudden loss of consciousness symptomatic of petit mal epilepsy. , primary degenerative de·gen·er·a·tive adj. Of, relating to, causing, or characterized by degeneration. Degenerative Degenerative disorders involve progressive impairment of both the structure and function of part of the body. dementia, bronchiectasis bronchiectasis Abnormal expansion of bronchi in the lungs. It usually results when preexisting lung disease causes bronchial inflammation and obstruction. Bronchial wall fibres degenerate, and bronchi become dilated or paralyzed, preventing removal of secretions, which , and idiopathic idiopathic /id·io·path·ic/ (id?e-o-path´ik) self-originated; occurring without known cause. id·i·o·path·ic adj. 1. Of or relating to a disease having no known cause; agnogenic. iridocyclitis) were newly formulated by the PCP. In addition, some patients who had chronic conditions while institutionalized in·sti·tu·tion·al·ize tr.v. in·sti·tu·tion·al·ized, in·sti·tu·tion·al·iz·ing, in·sti·tu·tion·al·iz·es 1. a. To make into, treat as, or give the character of an institution to. b. no longer presented with them in community-based practice. For example, one-third of patients previously diagnosed with chronic constipation constipation, infrequent or difficult passage of feces. Constipation may be caused by the lack of adequate roughage or fluid in the diet, prolonged physical inactivity, certain drugs, or emotional disturbance. did not present with this in the community. Similar results were seen with glaucoma glaucoma (glôkō`mə), ocular disorder characterized by pressure within the eyeball caused by an excessive amount of aqueous humor (the fluid substance filling the eyeball). , schizophrenia schizophrenia (skĭt'səfrē`nēə), group of severe mental disorders characterized by reality distortions resulting in unusual thought patterns and behaviors. , dextrocardia, and cerebral palsy cerebral palsy (sərē`brəl pôl`zē), disability caused by brain damage before or during birth or in the first years, resulting in a loss of voluntary muscular control and coordination. . After one year of community-based practice, none of the patients had to be re-admitted to institutions. Although there were no quantitative comparisons made, many patients showed functional improvement in activities of daily living (most notably a patient who was wheelchair bound while institutionalized gained the ability to ambulate am·bu·late intr.v. am·bu·lat·ed, am·bu·lat·ing, am·bu·lates To walk from place to place; move about. [Latin ambul and previously incontinent in·con·ti·nent adj. 1. Lacking normal voluntary control of excretory functions. 2. Lacking sexual restraint; unchaste. patients gained urinary urinary /uri·nary/ (u´ri-nar?e) pertaining to, containing, or secreting urine. u·ri·nar·y adj. 1. Relating to urine and its production, function, or excretion. 2. continence continence /con·ti·nence/ (kon´tin-ens) the ability to control natural impulses.con´tinent con·ti·nence n. 1. Self-restraint; moderation. 2. ). The average weight of these patients increased by eight pounds with some gaining as much as 34 pounds. Other issues in care noted by the new PCPs included lack of immunization immunization: see immunity; vaccination. records in 38 percent of the patients, lack of cholesterol testing Cholesterol Test Definition The cholesterol test is a quantitative analysis of the cholesterol levels in a sample of the patient's blood. Total serum cholesterol (TC) is the measurement routinely taken. in 24 percent, and adverse health effects due to the use of cigarettes as rewards while institutionalized. Based on their findings, the authors discuss six main recommendations that should be heeded in order to better care for this patient population, whether institutionalized or not. First, it is important for physicians to attempt to identify the cause of a patient's mental retardation mental retardation, below average level of intellectual functioning, usually defined by an IQ of below 70 to 75, combined with limitations in the skills necessary for daily living. so that one can be vigilant for syndrome-specific health complications that may occur. Second, look for conditions commonly seen in persons with mental retardation, such as hepatitis B, dysphagia, aspiration aspiration /as·pi·ra·tion/ (as?pi-ra´shun) 1. the drawing of a foreign substance, such as the gastric contents, into the respiratory tract during inhalation. 2. , and seizures In counterdrug operations, includes drugs and conveyances seized by law enforcement authorities and drug-related assets (monetary instruments, etc.) confiscated based on evidence that they have been derived from or used in illegal narcotics activities. . Third, think of geriatric geriatric /ger·i·at·ric/ (jer?e-at´rik) 1. pertaining to elderly persons or to the aging process. 2. pertaining to geriatrics. ger·i·at·ric adj. 1. syndromes (incontinence incontinence Inability to control excretion. Starting and stopping urination relies on normal function in pelvic and abdominal muscles, diaphragm, and control nerves. Babies' nervous systems are too immature for urinary control. Later incontinence may reflect disorders (e.g. , falls, immobility immobility standing still and disinclined to move, as in an animal suddenly blinded; responds to other stimuli unless immobility is part of a dummy syndrome when all stimuli are ignored. , cognitive decline, osteoporosis osteoporosis (ŏs'tēō'pərō`sĭs), disorder in which the normal replenishment of old bone tissue is severely disrupted, resulting in weakened bones and increased risk of fracture; osteopenia ) that may emerge at an earlier age in this population. Fourth, identify and treat secondary disabilities or consequences that may occur as a result of a patient's primary complications. Fifth, apply medication reduction strategies. Lastly, preventative health care strategies are essential and should be implemented in this population. In the years following Tyler and Bourget's work, other studies have been published discussing the issues faced by patients with neurodevelopmental disorders Neurodevelopmental disorders such as fragile X syndrome are severe disabling conditions often associated with life-long impairment. History These disorders are now recognized to be the result of abnormalities in brain development due to both genetic and . Baxter, et al. performed a similar study in Wales Wales, Welsh Cymru, western peninsula and political division (principality) of Great Britain (1991 pop. 2,798,200), 8,016 sq mi (20,761 sq km), west of England; politically united with England since 1536. The capital is Cardiff. in which patients with "intellectual disabilities" (i.e. the cognitive complication complication /com·pli·ca·tion/ (kom?pli-ka´shun) 1. disease(s) concurrent with another disease. 2. occurrence of several diseases in the same patient. com·pli·ca·tion n. of a neurodevelopmental disorder) were encouraged to see a primary care practitioner. Their data showed that of those patients that followed up, more than half had new health concerns diagnosed (63 percent had one concern, 25 percent had two, and 12 percent more than two). Henderson, et al., performed a study of patients with Down syndrome Down syndrome, congenital disorder characterized by mild to severe mental retardation, slow physical development, and characteristic physical features. Down syndrome affects about 1 in every 730 live births and occurs in all populations equally. and reported that certain medical conditions See carpal tunnel syndrome, computer vision syndrome, dry eyes and deep vein thrombosis. occur more frequently in this group of adults. However, they discovered that follow-up of common complications that occur in individuals with Down syndrome is infrequent in·fre·quent adj. 1. Not occurring regularly; occasional or rare: an infrequent guest. 2. . About half of adults with Down syndrome had not seen a doctor in the previous 12 months and one-third had not visited a doctor in the previous three years. It was with this work in mind that the following research project was begun. In order to be able to effectively care for patients with neurodevelopmental disorders, Tyler and Bourget's six recommendations should be considered for each individual. In the following research, a small cohort cohort /co·hort/ (ko´hort) 1. in epidemiology, a group of individuals sharing a common characteristic and observed over time in the group. 2. of patients at Hunterdon Developmental Center Hunterdon Developmental Center is a developmental center in Clinton, NJ. It is a 650 bed residential facility for adults with neurodevelopmental disorders complicated by cognitive dysfunction (mental retardation). was followed and, with the above framework in mind, screened for different medical complications and consequences of their neurodevelopmental disability. Patients with NDDs are a very heterogeneous group with various causes, complications, and consequences of their NDD NDD Norton Disk Doctor (Norton Utilities) NDD National Direct Dialing NDD Nature Deficit Disorder NDD Next-Day Delivery NDD Non-Decision Directed (digital communications) NDD Narcotics Detection Dog . With regards to causes, there are three main categories: unknown, genetic, and acquired. As seen in Table 3, genetic causes include metabolic syndromes metabolic syndrome n. See syndrome X. Metabolic syndrome A group of risk factors for heart disease, diabetes, and stroke. (e.g. PKU PKU: see phenylketonuria. ), structural disorders (e.g. tuberous sclerosis tuberous sclerosis n. An inherited disease characterized by hamartomas of the brain, retina, and viscera, as well as epileptic seizures, mental retardation, and skin nodules of the face. Also called Bourneville's disease. ), and chromosomal chromosomal, adj relating to chromosome, or a configuration within the cell's nucleus that contains a linear thread of DNA that conveys genetic data. chromosomal emanating from or pertaining to chromosome. abnormalities (e.g. Down syndrome). Acquired causes can be subdivided into prenatal prenatal /pre·na·tal/ (-na´tal) preceding birth. pre·na·tal adj. Preceding birth. Also called antenatal. prenatal preceding birth. (e.g. congenital rubella syndrome congenital rubella syndrome A malformation complex in a fetus infected in utero with rubella; the defects reflect the embryologic stage at the time of infection, with developmental arrest affecting all 3 embryonal layers, inhibiting mitosis, causing delayed and ), perinatal perinatal /peri·na·tal/ (-na´t'l) relating to the period shortly before and after birth; from the twentieth to twenty-ninth week of gestation to one to four weeks after birth. per·i·na·tal adj. (e.g. traumatic brain injury Traumatic brain injury (TBI), traumatic injuries to the brain, also called intracranial injury, or simply head injury, occurs when a sudden trauma causes brain damage. TBI can result from a closed head injury or a penetrating head injury and is one of two subsets of acquired brain of birth), and postnatal postnatal /post·na·tal/ (-na´t'l) occurring after birth, with reference to the newborn. post·na·tal adj. Of or occurring after birth, especially in the period immediately after birth. disorders (e.g. lead encephalopathy lead encephalopathy n. A rapidly developing encephalopathy caused by the ingestion of lead compounds and seen particularly in early childhood, marked by convulsion, delirium, hallucination, and other cerebral symptoms related to chronic lead poisoning. ). Regardless of the cause of NDD, these patients may display various combinations of four main complications: cognitive dysfunction dysfunction /dys·func·tion/ (dis-funk´shun) disturbance, impairment, or abnormality of functioning of an organ.dysfunc´tional erectile dysfunction impotence (2). (e.g. mental retardation), motor dysfunction (e.g. spasticity spasticity /spas·tic·i·ty/ (spas-tis´i-te) the state of being spastic; see spastic (2). spas·tic·i·ty n. 1. A spastic state or condition. 2. Spastic paralysis. ), behavioral issues (e.g. impulsivity), and seizures. Lastly, these four "complications" can result in numerous "consequences." For example, GERD is a consequence that can result from scoliosis Scoliosis Definition Scoliosis is a side-to-side curvature of the spine. Description When viewed from the rear, the spine usually appears perfectly straight. , which itself is a consequence of a motor complication. Therefore, the purpose of this study is to show that NDD patients do not simply have an isolated condition, but rather a broad spectrum of complications and consequences that are related to the initial cause of dysfunction (i.e. the neurodevelopmental disorder). Methods: A retrospective chart review was completed on 43 patients currently residing in two inpatient inpatient /in·pa·tient/ (in´pa-shent) a patient who comes to a hospital or other health care facility for diagnosis or treatment that requires an overnight stay. in·pa·tient n. units (referred to in this paper as Unit 1 and Unit 2) at the Hunterdon Developmental Center located in Clinton, NJ. The Hunterdon Developmental Center is a 650-bed residential facility for adults with neurodevelopmental disorders, complicated by cognitive dysfunction (mental retardation). In addition to cognitive dysfunction, roughly 30-40 percent of the residents of HDC (Hard Disk Controller) See disk controller. HDC - Disk Controller receive psychotropic psychotropic /psy·cho·tro·pic/ (si?ko-tro´pik) exerting an effect on the mind; capable of modifying mental activity; said especially of drugs. psy·cho·tro·pic adj. medication for a variety of severe destructive behaviors, 30 percent demonstrate complex seizures, and 30 percent demonstrate neuromotor dysfunction as well. A precise and accurate neurodevelopmental diagnosis has been established for approximately 30-40 percent. Established diagnoses include Down syndrome, Fragile X syndrome Fragile X Syndrome Definition Fragile X syndrome is the most common form of inherited mental retardation. Individuals with this condition have developmental delay, variable levels of mental retardation, and behavioral and emotional difficulties. , Trisomy trisomy /tri·so·my/ (tri´so-me) the presence of an additional (third) chromosome of one type in an otherwise diploid cell (2n + 1). See also entries under syndrome. triso´mic tri·so·my n. 8 mosaic syndrome, Trisomy 13 syndrome, William Syndrome, Velo-cardio-facial syndrome, Rubenstein-Taybi syndrome, Rett syndrome Rett syndrome is a neurodevelopmental disorder that is classified as a pervasive developmental disorder by the DSM-IV. Many [1] argue that this is a mis-classification just as it would be to include such disorders as fragile X syndrome, tuberous sclerosis, or Down , Angelman syndrome, Smith Magenis syndrome, PKU, tuberous sclerosis, neurofibromatosis Neurofibromatosis Definition Neurofibromatosis (NF), or von Recklinghausen disease, is a genetic disease in which patients develop multiple soft tumors (neurofibromas). These tumors occur under the skin and throughout the nervous system. , Sturge Weber syndrome, congenital rubella syndrome, the syndrome of hypoxic/ischemic perinatal brain injury, lead encephalopathy, hydrocephalus hydrocephalus (hī'drəsĕf`ələs), also known as water on the brain, developmental (congenital) or acquired condition in which there is an abnormal accumulation of body fluids within the skull. , prosencephaly, schizencephaly, and other diagnoses. The Center is operated by the NJ Division of Developmental Disabilities developmental disabilities (DD), n.pl the pathologic conditions that have their origin in the embryology and growth and development of an individual. DDs usually appear clinically before 18 years of age. , under the auspices aus·pi·ces 1 n. Plural of auspex. auspices Noun, pl under the auspices of with the support and approval of [Latin auspicium augury from birds] Noun of the New Jersey Department of Human Services, with funding provided through state appropriation The designation by the government or an individual of the use to which a fund of money is to be applied. The selection and setting apart of privately owned land by the government for public use, such as a military reservation or public building. and federal programs (ICF/MR ICF/MR Intermediate Care Facility for the Mentally Retarded ). Hunterdon Developmental Center employs a large staff, including nine full time physicians. A 70-bed infirmary infirmary /in·fir·ma·ry/ (-ah-re) a hospital or place where the sick or infirm are maintained or treated. in·fir·ma·ry n. is located in the center of the campus. The Center also provides skilled nursing, staff EMT's, 24-hour care and medical services, and a comprehensive rehabilitation program Noun 1. rehabilitation program - a program for restoring someone to good health program, programme - a system of projects or services intended to meet a public need; "he proposed an elaborate program of public works"; "working mothers rely on the day care for physical therapy, speech therapy, audiology audiology /au·di·ol·o·gy/ (aw?de-ol´ah-je) the study of impaired hearing that cannot be improved by medication or surgical therapy. au·di·ol·o·gy n. , and occupational therapy. In addition to routine medical services provided by staff physicians, board certified board certified, adj the status of a dental specialist such as an orthodontist who has become a board diplomate by successfully completing the certification program of the recognized certification board in that area of practice. specialists offer regular clinics in psychiatry psychiatry (səkī`ətrē, sī–), branch of medicine that concerns the diagnosis and treatment of mental, emotional, and behavioral disorders, including major depression, schizophrenia, and anxiety. , neurology neurology (n  rŏl`əjē, ny–), study of the morphology, physiology, and pathology of the human nervous system. , epileptology, dermatology dermatology (dûrmətŏl`əjē), branch of medicine concerned with diagnosis and treatment of diseases and disorders of the skin. , gynecology gynecology (gīn'əkŏl`əjē), branch of medicine specializing in the disorders of the female reproductive system. Modern gynecology deals with menstrual disorders, menopause, infectious disease and maldevelopment of the ,
ENT ENT ears, nose, and throat (otorhinolaryngology). ENT abbr. ear, nose, and throat ENT ear, nose and throat. ENT Ears, nose & throat; formally, otorhinolaryngology , orthopedics orthopedics (ôrthəpē`dĭks), medical specialty concerned with deformities, injuries, and diseases of the bones, joints, ligaments, tendons, and muscles. , ophthalmology ophthalmology (ŏf'thălmŏl`əjē), branch of medicine specializing in the anatomy, function and diseases of the eye. Ophthalmologists specialize in the medical and surgical treatment of eye disorders, vision measurements for , and genetics. Collaborations with Warren Community Hospital and Hunterdon Medical Center provide for acute Hospital care when needed. The medical staff of Hunterdon Developmental Center also provides for regular teaching activities in developmental medicine for residents, fellows, and medical students affiliated with the Robert Wood Johnson Medical School Robert Wood Johnson Medical School (often abbreviated RWJMS) is one of eight schools that comprise the University of Medicine and Dentistry of New Jersey (UMDNJ). RWJMS operates three campuses in New Jersey, in Piscataway, New Brunswick and Camden. . Information obtained from each patient's chart included a diagnosis (if available), occurrence of the four main complications of NDD (i.e. cognitive, motor, seizure Forcible possession; a grasping, snatching, or putting in possession. In Criminal Law, a seizure is the forcible taking of property by a government law enforcement official from a person who is suspected of violating, or is known to have violated, the law. , behavior), and occurrence of certain common health consequences. This data was then statistically analyzed an·a·lyze tr.v. an·a·lyzed, an·a·lyz·ing, an·a·lyz·es 1. To examine methodically by separating into parts and studying their interrelations. 2. Chemistry To make a chemical analysis of. 3. to observe the prevalence of specific etiologic e·ti·ol·o·gy also ae·ti·ol·o·gy n. pl. e·ti·ol·o·gies 1. a. The study of causes or origins. b. The branch of medicine that deals with the causes or origins of disease. 2. a. neurodevelopmental diagnoses and the complications and consequences of those NDDs in this population. Results: The population being studied in this report consisted of 43 males whose ages varied from 27-75 years with a mean of 49. Table 1 shows the prevalence of the main "complications" of NDD in this population. Overall, 100 percent of patients had a cognitive dysfunction, 91percent had a motor dysfunction, 84 percent had seizures, and 51 percent had behavioral issues. Unit 1 patients had an average of 3.2 complications where Unit 2 patients had an average of 3.3. Motor dysfunction and seizures were more prevalent in Unit 2, whereas, behavioral issues were more common in Unit 1. Table 2 shows the prevalence of certain common "consequences". Overall, pneumonia pneumonia (n mōn`yə), acute infection of one or both lungs that can be caused by a bacterium, usually Streptococcus pneumoniae , GERD, scoliosis, polypharmacy, dental problems, and visual
deficits were seen in over 50 percent of the population. When examining
each consequence individually, certain trends were observed. Pneumonia
was evident in 93 percent of the patients in Unit 1 but was only seen in
57 percent of Unit 2 patients. Similarly, chronic lung disease lung disease Pulmonary disease Pulmonology Any condition causing or indicating impaired lung function Types of LD Obstructive lung disease–↓ in air flow caused by a narrowing or blockage of airways–eg, asthma, emphysema, chronic bronchitis; (47
percent vs. 18 percent), oropharyngeal oropharyngeal /oro·pha·ryn·ge·al/ (-fah-rin´je-al)1. pertaining to the mouth and pharynx. 2. pertaining to the oropharynx. dysfunction (73 percent vs. 11 percent), feeding tube feeding tube n. A flexible tube that is inserted through the pharynx and into the esophagus and stomach and through which liquid food is passed. placement (53 percent vs. 4 percent), constipation (73 percent vs. 25 percent), and urinary tract infections urinary tract infection (UTI), n infection in one or more of the structures that make up the urinary system. Occurs more often in women and is most commonly caused by bacteria. (40 percent vs. 21percent) had prevalence rates that were much higher in Unit 1. Scoliosis (47 percent vs. 68 percent) and dental problems (20 percent vs. 68 percent) were the only two consequences seen at much higher rates in Unit 2. Table 3 shows the prevalence of various causes of NDDs. As a group, genetic disorders The following is a list of genetic disorders and their origins. Beside most disorders is a code that indicates the type of fertilization and the chromosome involved.
Discussion: After reviewing the charts of these 43 patients, it is clear how NDDs present as a constellation Constellation, ship Constellation (kŏnstĭlā`shən), U.S. frigate, launched in 1797. It was named by President Washington for the constellation of 15 stars in the U.S. flag of that time. of complications and consequences. Hunterdon Developmental Center provided for a sample size with a variety of NDD causes. The specific etiologic origins of NDDs were not evenly divided with 42 percent having unknown causes, 23 percent having genetic causes, and 35 percent having acquired causes. Also, patients in this study were found to average 3.3 complications of NDDs. With regards to secondary consequences, pneumonia, GERD, scoliosis, polypharmacy, dental concerns, and visual deficits were the most common ones in this population. The differences in the complications and consequences observed in Unit 1 versus Unit 2 can be explained by the manner in which Hunterdon divides their patients. For the most part, patients at this facility are assigned to a unit based on their functional abilities. Unit 1 is located in the Health Services health services Managed care The benefits covered under a health contract Residence building and consists of patients with severe complications and medical consequences. This can be noted by the fact that this unit has a high incidence of pneumonia, chronic lung disease, oropharyngeal dysphagia, and feeding tube placement. In contrast, Unit 2 consists of patients who are non-ambulatory and more prone to seizures. Therefore, these patients had a higher number of motor and seizure complications but fewer consequences that required immediate medical attention. The primary limitation of this study was its small sample size (n=43). Also, the charts reviewed were those of patients who were more medically ill (Unit 1) or more likely to be non-ambulatory (Unit 2) than a typical NDD patient, which introduced selection bias into this study. In addition, this was a retrospective study retrospective study, a study in which a search is made for a relationship between one phenomenon or condition and another that occurred in the past (e.g. so it was subject to the bias of the original charting physician and staff. For future studies, it would be advised to perform a cohort study A cohort study is a form of longitudinal study used in medicine and social science. It is one type of study design. In medicine, it is usually undertaken to obtain evidence to try to refute the existence of a suspected association between cause and disease; failure to refute consisting of the entire Hunterdon Developmental Center population. This would give a better indication of the prevalence of NDD causes, complications, and consequences in the average patient. Despite the study's limitations, its underlying message should be clear: a patient's childhood-onset brain dysfunction always has an underlying medical cause that should be sought. With this mindset mind·set or mind-set n. 1. A fixed mental attitude or disposition that predetermines a person's responses to and interpretations of situations. 2. An inclination or a habit. , members of the healthcare community would be better able to anticipate and treat the resulting complications and consequences. References May P: The 5 Essential Concepts of Developmental Medicine: A New Medical Paradigm for Persons with Developmental Disabilities. Developmental Medicine and Dentistry dentistry, treatment and care of the teeth and associated oral structures. Dentistry is mainly concerned with tooth decay, disease of the supporting structures, such as the gums, and faulty positioning of the teeth. Reviews & Reports; June 2006. Tyler CV, Bourguet C: Primary Care of Adults with Mental Retardation. Journal of Family Practice. 1997; 44(5): 487-494. Baxter H, Lowe K, Houston H, Jones G, Felce D, Kerr M: Previously unidentified morbidity morbidity /mor·bid·i·ty/ (mor-bid´it-e) 1. a diseased condition or state. 2. the incidence or prevalence of a disease or of all diseases in a population. mor·bid·i·ty n. in patients with intellectual disability. British Journal of Gen Pract. 2006; 56(523): 93-98. Henderson A, Lynch SA, Wilkinson S Noun 1. Wilkinson - English chemist honored for his research on pollutants in car exhausts (born in 1921) Sir Geoffrey Wilkinson , Hunter M: Adults with Down's Syndrome: the prevalence of complications and health care in the community. British Journal of Gen Pract. 2007; 57(534): 50-55. Andy Rodriguez, Medical Student III, UMDNJ--Robert Wood Johnson Medical School Piscataway, New Jersey
Table 1: Patient Diagnoses and Complications
Patient # Age/Gender Diagnosis Cognitive
Unit 1
1 60 M Down Syndrome P
2 46 M Arrested Hydrocephalus P
3 64 M Peripartum Ischemic Encephalopathy P
4 71 M Down Syndrome P
5 36 M Skull Fracture with Subdural Hematoma P
6 44 M Angelman Syndrome P
7 70 M Prematurity P
8 60 M Coffin-Lowry Syndrome P
9 66 M Unknown P
10 58 M Down Syndrome P
11 72 M Unknown P
12 47 M FG Syndrome P
13 35 M Unknown P
14 26 M Unknown P
15 54 M Unknown P
Unit1 Totals: 15
Unit1 Percentages: 100%
Unit 2
1 52 M Prematurity P
2 44 M Anoxemia at Birth P
3 51 M Cerebral Migration Defect P
4 43 M Unknown P
5 50 M Smith-Magenis Syndrome P
6 44 M Unknown P
7 39 M Angelman Syndrome P
8 43 M Unknown P
9 40 M Unknown P
10 45 M Postnatal Viral Encephalitis P
11 74 M Prematurity P
12 40 M Unknown P
13 41 M Unknown P
14 44 M Postnatal Meningitis P
15 35 M Cytomegalic Inclusion Disease P
16 45 M Primary Cranial Defect P
17 45 M Prematurity P
18 44 M Unknown P
19 37 M Down Syndrome P
20 43 M Unknown P
21 46 M Unknown P
22 36 M Unknown P
23 54 M Tuberous Sclerosis P
24 59 M Primary Intracranial Neoplasm P
25 75 M Mechanical Injury at Birth P
26 44 M Postnatal Anoxemia P
27 27 M Fetal Distress Syndrome P
28 43 M Unknown P
Unit 2 Totals: 28
Unit 2 Percentages: 100%
Overall Totals: 43
Overall Percentages: 100%
Diagnosis Motor Seizure
Down Syndrome
Arrested Hydrocephalus P
Peripartum Ischemic Encephalopathy P
Down Syndrome P P
Skull Fracture with Subdural Hematoma P P
Angelman Syndrome P P
Prematurity P
Coffin-Lowry Syndrome P P
Unknown P P
Down Syndrome P
Unknown P P
FG Syndrome P P
Unknown P P
Unknown P P
Unknown P P
Unit1 Totals: 13 11
Unit1 Percentages: 87% 73%
Prematurity
Anoxemia at Birth P P
Cerebral Migration Defect P P
Unknown P P
Smith-Magenis Syndrome P P
Unknown P P
Angelman Syndrome P P
Unknown P P
Unknown P P
Postnatal Viral Encephalitis P P
Prematurity P P
Unknown P P
Unknown P P
Postnatal Meningitis P P
Cytomegalic Inclusion Disease P P
Primary Cranial Defect P
Prematurity P P
Unknown P P
Down Syndrome P P
Unknown P P
Unknown P P
Unknown P P
Tuberous Sclerosis P P
Primary Intracranial Neoplasm P P
Mechanical Injury at Birth P
Postnatal Anoxemia P P
Fetal Distress Syndrome P P
Unknown P
Unit 2 Totals: 26 25
Unit 2 Percentages: 93% 89%
Overall Totals: 39 36
Overall Percentages: 91% 84%
Diagnosis Behavior Total
Complications
Down Syndrome P 2
Arrested Hydrocephalus P 3
Peripartum Ischemic Encephalopathy P 3
Down Syndrome 3
Skull Fracture with Subdural Hematoma 3
Angelman Syndrome 3
Prematurity 2
Coffin-Lowry Syndrome P 4
Unknown P 4
Down Syndrome P 3
Unknown 3
FG Syndrome P 4
Unknown 3
Unknown P 4
Unknown P 4
Unit1 Totals: 9 3.2
Unit1 Percentages: 60%
Prematurity P 2
Anoxemia at Birth 3
Cerebral Migration Defect P 4
Unknown P 4
Smith-Magenis Syndrome P 4
Unknown 3
Angelman Syndrome 3
Unknown 3
Unknown P 4
Postnatal Viral Encephalitis 3
Prematurity P 4
Unknown 3
Unknown 3
Postnatal Meningitis 3
Cytomegalic Inclusion Disease 3
Primary Cranial Defect P 3
Prematurity P 4
Unknown 3
Down Syndrome P 4
Unknown 3
Unknown P 4
Unknown 3
Tuberous Sclerosis 3
Primary Intracranial Neoplasm P 4
Mechanical Injury at Birth P 3
Postnatal Anoxemia P 4
Fetal Distress Syndrome 3
Unknown 2
Unit 2 Totals: 13 3.3
Unit 2 Percentages: 46%
Overall Totals: 22 3.3
Overall Percentages: 51%
Table 2: Consequences of Neurodevelopmental Dysfunction
Unit 1
Patient Number 1 2 3
Pneumonia [check] [check] [check]
Chronic Lung Disease [check]
Oropharyngeal Dysfunction [check] [check] [check]
Feeding Tube [check] [check]
GERD [check] [check]
Barrett's Esophagus [check]
Constipation [check]
Scoliosis
Osteoporosis [check]
Fractures [check]
Polypharmacy [check] [check] [check]
Decubiti [check]
Bladder Dysfunction
UTI [check] [check] [check]
Dental Problems
Visual Deficits [check] [check]
Hearing Deficits
Hepatitis B Carrier [check] [check]
Hypothyroidism [check]
Hypertension
Hyperlipidemia
Unit 1
Patient Number 4 5 6
Pneumonia [check] [check] [check]
Chronic Lung Disease [check]
Oropharyngeal Dysfunction [check] [check] [check]
Feeding Tube [check] [check]
GERD [check] [check] [check]
Barrett's Esophagus [check]
Constipation [check] [check] [check]
Scoliosis [check] [check]
Osteoporosis [check] [check]
Fractures [check] [check] [check]
Polypharmacy [check] [check] [check]
Decubiti
Bladder Dysfunction
UTI
Dental Problems [check]
Visual Deficits [check] [check]
Hearing Deficits [check]
Hepatitis B Carrier
Hypothyroidism [check]
Hypertension
Hyperlipidemia [check]
Unit 1
Patient Number 7 8 9
Pneumonia [check] [check]
Chronic Lung Disease [check]
Oropharyngeal Dysfunction [check]
Feeding Tube [check]
GERD [check]
Barrett's Esophagus [check]
Constipation [check] [check]
Scoliosis [check] [check] [check]
Osteoporosis [check] [check]
Fractures [check] [check] [check]
Polypharmacy [check] [check] [check]
Decubiti
Bladder Dysfunction
UTI [check]
Dental Problems [check]
Visual Deficits [check] [check]
Hearing Deficits
Hepatitis B Carrier
Hypothyroidism
Hypertension [check] [check]
Hyperlipidemia [check] [check]
Unit 1
Patient Number 10 11 12
Pneumonia [check] [check] [check]
Chronic Lung Disease [check]
Oropharyngeal Dysfunction [check] [check]
Feeding Tube [check]
GERD [check] [check]
Barrett's Esophagus
Constipation [check] [check]
Scoliosis [check] [check]
Osteoporosis [check]
Fractures [check]
Polypharmacy [check] [check]
Decubiti [check]
Bladder Dysfunction [check]
UTI [check] [check]
Dental Problems [check]
Visual Deficits [check] [check] [check]
Hearing Deficits
Hepatitis B Carrier
Hypothyroidism [check]
Hypertension [check]
Hyperlipidemia [check]
Unit 1
Patient Number 13 14 15
Pneumonia [check] [check] [check]
Chronic Lung Disease [check] [check] [check]
Oropharyngeal Dysfunction [check] [check]
Feeding Tube [check] [check]
GERD [check] [check]
Barrett's Esophagus [check]
Constipation [check] [check] [check]
Scoliosis
Osteoporosis [check]
Fractures [check]
Polypharmacy [check] [check] [check]
Decubiti
Bladder Dysfunction
UTI
Dental Problems
Visual Deficits [check] [check]
Hearing Deficits
Hepatitis B Carrier
Hypothyroidism
Hypertension
Hyperlipidemia
Unit 1
Patient Number Total # Total %
Pneumonia 14 93%
Chronic Lung Disease 7 47%
Oropharyngeal Dysfunction 11 73%
Feeding Tube 8 53%
GERD 10 67%
Barrett's Esophagus 4 27%
Constipation 11 73%
Scoliosis 7 47%
Osteoporosis 7 47%
Fractures 9 60%
Polypharmacy 14 93%
Decubiti 2 13%
Bladder Dysfunction 1 7%
UTI 6 40%
Dental Problems 3 20%
Visual Deficits 11 73%
Hearing Deficits 1 7%
Hepatitis B Carrier 2 13%
Hypothyroidism 3 20%
Hypertension 3 20%
Hyperlipidemia 4 27%
Unit 2
Patient Number 1 2 3
Pneumonia [check] [check] [check]
Chronic Lung Disease
Oropharyngeal Dysfunction [check]
Feeding Tube [check]
GERD [check] [check]
Barrett's Esophagus [check]
Constipation
Scoliosis [check]
Osteoporosis [check]
Fractures [check] [check]
Polypharmacy [check] [check]
Decubiti
Bladder Dysfunction [check]
UTI [check] [check]
Dental Problems [check] [check] [check]
Visual Deficits [check] [check]
Hearing Deficits [check]
Hepatitis B Carrier
Hypothyroidism
Hypertension [check]
Hyperlipidemia
Unit 2
Patient Number 4 5 6
Pneumonia [check] [check]
Chronic Lung Disease [check]
Oropharyngeal Dysfunction
Feeding Tube
GERD [check]
Barrett's Esophagus [check]
Constipation [check] [check]
Scoliosis [check] [check] [check]
Osteoporosis [check]
Fractures [check]
Polypharmacy [check] [check] [check]
Decubiti
Bladder Dysfunction
UTI
Dental Problems [check] [check] [check]
Visual Deficits [check] [check] [check]
Hearing Deficits
Hepatitis B Carrier
Hypothyroidism [check]
Hypertension
Hyperlipidemia
Unit 2
Patient Number 7 8 9
Pneumonia [check] [check] [check]
Chronic Lung Disease
Oropharyngeal Dysfunction [check]
Feeding Tube
GERD [check] [check]
Barrett's Esophagus
Constipation [check] [check]
Scoliosis [check] [check]
Osteoporosis
Fractures [check]
Polypharmacy [check] [check] [check]
Decubiti
Bladder Dysfunction
UTI [check]
Dental Problems [check] [check] [check]
Visual Deficits [check] [check] [check]
Hearing Deficits
Hepatitis B Carrier
Hypothyroidism
Hypertension
Hyperlipidemia
Unit 2
Patient Number 10 11 12
Pneumonia [check] [check]
Chronic Lung Disease [check]
Oropharyngeal Dysfunction
Feeding Tube
GERD [check] [check] [check]
Barrett's Esophagus [check] [check]
Constipation [check]
Scoliosis [check] [check] [check]
Osteoporosis
Fractures [check]
Polypharmacy [check] [check] [check]
Decubiti
Bladder Dysfunction
UTI
Dental Problems [check] [check]
Visual Deficits [check] [check] [check]
Hearing Deficits
Hepatitis B Carrier [check]
Hypothyroidism
Hypertension
Hyperlipidemia [check]
Unit 2
Patient Number 13 14 15
Pneumonia [check]
Chronic Lung Disease [check]
Oropharyngeal Dysfunction
Feeding Tube
GERD [check]
Barrett's Esophagus
Constipation
Scoliosis [check] [check] [check]
Osteoporosis
Fractures
Polypharmacy [check] [check] [check]
Decubiti
Bladder Dysfunction [check]
UTI [check]
Dental Problems [check]
Visual Deficits [check] [check] [check]
Hearing Deficits
Hepatitis B Carrier
Hypothyroidism
Hypertension
Hyperlipidemia
Unit 2
Patient Number 16 17 18
Pneumonia [check] [check]
Chronic Lung Disease [check]
Oropharyngeal Dysfunction
Feeding Tube
GERD [check] [check]
Barrett's Esophagus [check]
Constipation [check]
Scoliosis [check]
Osteoporosis [check] [check] [check]
Fractures [check] [check]
Polypharmacy [check] [check]
Decubiti [check] [check]
Bladder Dysfunction
UTI
Dental Problems [check] [check]
Visual Deficits [check]
Hearing Deficits
Hepatitis B Carrier
Hypothyroidism [check]
Hypertension
Hyperlipidemia
Unit 2
Patient Number 19 20 21
Pneumonia [check] [check]
Chronic Lung Disease
Oropharyngeal Dysfunction
Feeding Tube
GERD [check]
Barrett's Esophagus [check]
Constipation
Scoliosis [check]
Osteoporosis [check] [check]
Fractures [check] [check]
Polypharmacy [check] [check] [check]
Decubiti
Bladder Dysfunction
UTI
Dental Problems [check] [check]
Visual Deficits [check]
Hearing Deficits
Hepatitis B Carrier
Hypothyroidism [check]
Hypertension
Hyperlipidemia [check]
Unit 2
Patient Number 22 23 24
Pneumonia
Chronic Lung Disease
Oropharyngeal Dysfunction [check]
Feeding Tube
GERD [check] [check] [check]
Barrett's Esophagus [check]
Constipation [check]
Scoliosis [check] [check]
Osteoporosis
Fractures [check]
Polypharmacy [check] [check]
Decubiti
Bladder Dysfunction [check]
UTI [check]
Dental Problems [check] [check]
Visual Deficits
Hearing Deficits
Hepatitis B Carrier
Hypothyroidism
Hypertension
Hyperlipidemia
Unit 2
Patient Number 25 26 27
Pneumonia
Chronic Lung Disease [check]
Oropharyngeal Dysfunction
Feeding Tube
GERD
Barrett's Esophagus
Constipation
Scoliosis [check] [check]
Osteoporosis
Fractures [check]
Polypharmacy [check] [check] [check]
Decubiti [check]
Bladder Dysfunction
UTI [check]
Dental Problems [check]
Visual Deficits [check]
Hearing Deficits [check] [check]
Hepatitis B Carrier [check]
Hypothyroidism [check]
Hypertension [check]
Hyperlipidemia
Unit 2
Patient Number 28 Total # Total %
Pneumonia [check] 16 57%
Chronic Lung Disease 5 18%
Oropharyngeal Dysfunction 3 11%
Feeding Tube 1 4%
GERD 15 54%
Barrett's Esophagus 7 25%
Constipation 7 25%
Scoliosis [check] 19 68%
Osteoporosis [check] 8 29%
Fractures [check] 12 43%
Polypharmacy 24 86%
Decubiti 3 11%
Bladder Dysfunction 3 11%
UTI 6 21%
Dental Problems 19 68%
Visual Deficits 17 61%
Hearing Deficits 3 11%
Hepatitis B Carrier 2 7%
Hypothyroidism 4 14%
Hypertension 2 7%
Hyperlipidemia 2 7%
Unit 2
Patient Number Total # Total %
Pneumonia 30 70%
Chronic Lung Disease 12 28%
Oropharyngeal Dysfunction 14 33%
Feeding Tube 9 21%
GERD 25 58%
Barrett's Esophagus 11 26%
Constipation 18 42%
Scoliosis 26 60%
Osteoporosis 15 35%
Fractures 21 49%
Polypharmacy 38 88%
Decubiti 5 12%
Bladder Dysfunction 4 9%
UTI 12 28%
Dental Problems 22 51%
Visual Deficits 28 65%
Hearing Deficits 4 9%
Hepatitis B Carrier 4 9%
Hypothyroidism 7 16%
Hypertension 5 12%
Hyperlipidemia 6 14%
Table 3: Causes of Neurodevelopmental Dysfunction
Unit 1
Causes of Brain
Dysfunction Number Percentage
Unknown Cause 5 33%
Genetic Disorders 6 40%
- Metabolic Disorders 0 0%
- Structural Malformations 0 0%
Tuberous Sclerosis 0 0%
- Chromosomal Abnormalities 6 40%
Down Syndrome 3 20%
Angelman Syndrome 1 7%
Coffin-Lowry Syndrome 1 7%
FG Syndrome 1 7%
Smith-Magenis Syndrome 0 0%
Aquired Disorders 4 27%
- Prenatal Disoders 1 7%
Arrested Hydrocephalus 1 7%
Prenatal Infection 0 0%
- Perinatal Disorders 2 13%
Prematurity 1 7%
Peripartum Ischemic
Encephalopathy 1 7%
Fetal Distress Syndrome 0 0%
- Postnatal Disorders 1 7%
Anoxemia at Birth 0 0%
Postnatal Infection 0 0%
Mechanical Injury at Birth 1 7%
Primary Neoplasm 0 0%
TOTAL 15
Unit 2
Causes of Brain
Dysfunction Number Percentage
Unknown Cause 13 46%
Genetic Disorders 4 14%
- Metabolic Disorders 0 0%
- Structural Malformations 1 4%
Tuberous Sclerosis 1 4%
- Chromosomal Abnormalities 3 11%
Down Syndrome 1 4%
Angelman Syndrome 1 4%
Coffin-Lowry Syndrome 0 0%
FG Syndrome 0 0%
Smith-Magenis Syndrome 1 4%
Aquired Disorders 11 39%
- Prenatal Disoders 1 4%
Arrested Hydrocephalus 0 0%
Prenatal Infection 1 4%
- Perinatal Disorders 4 14%
Prematurity 3 11%
Peripartum Ischemic
Encephalopathy 0 0%
Fetal Distress Syndrome 1 4%
- Postnatal Disorders 6 21%
Anoxemia at Birth 2 7%
Postnatal Infection 2 7%
Mechanical Injury at Birth 1 4%
Primary Neoplasm 1 4%
TOTAL 28
Overall
Causes of Brain
Dysfunction Number Percentage
Unknown Cause 18 42%
Genetic Disorders 10 23%
- Metabolic Disorders 0 0%
- Structural Malformations 1 2%
Tuberous Sclerosis 1 2%
- Chromosomal Abnormalities 9 21%
Down Syndrome 4 9%
Angelman Syndrome 2 5%
Coffin-Lowry Syndrome 1 2%
FG Syndrome 1 2%
Smith-Magenis Syndrome 1 2%
Aquired Disorders 15 35%
- Prenatal Disoders 2 5%
Arrested Hydrocephalus 1 2%
Prenatal Infection 1 2%
- Perinatal Disorders 6 14%
Prematurity 4 9%
Peripartum Ischemic
Encephalopathy 1 2%
Fetal Distress Syndrome 1 2%
- Postnatal Disorders 7 16%
Anoxemia at Birth 2 5%
Postnatal Infection 2 5%
Mechanical Injury at Birth 2 5%
Primary Neoplasm 1 2%
TOTAL 43
|
|
||||||||||||||||||||
Printer friendly
Cite/link
Email
Feedback
Reader Opinion