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| Division of Occupational Therapy - OT Connect Mental Retardation
Mental retardation is the most common of the developmental disabilities and affects between .8% and 3% of the population. Physicians identify four degrees of mental retardation based on IQ and adaptive behavior. These are: mild, moderate, severe and profound. The labels are highly general and may not always reflect the functional abilities of the person in different environments. Common Symptoms/ Course of Disease
Additional problems can include: speech, ambulation, seizures, vision, non-responsiveness to physical contact, reduced alertness or spontaneous play, feeding, chronic conditions such as heart disease, diabetes, anemia, obesity, and dental problems. Early signs of impaired cognition can also include delays in neurologic soft signs, which include balance, motor symmetry, perceptual motor skills and fine motor skills. Age of Onset: These individuals are typically diagnosed before the age of 18 years old. Current Medical Treatment: Diagnosis is made after formal testing, usually done at school age. The formal testing includes IQ tests and tests of adaptive behavior that includes: basic reasoning, environmental knowledge, and developmentally appropriate daily living and self-maintenance skills (Case-Smith, 2001). The child is usually diagnosed with MR if they score 2 standard deviations below the normal range. There are some drugs prescribed to these individuals. “The most common class of drugs prescribed in this population is the psychostimulants because of the coexistence of attention deficit with or without hyperactivity disorder (ADHD/ADD) in as many as 50%” (Harum, 2001). After a formal diagnosis is made, other referrals are possibly made for psychological, educational, developmental, speech and hearing, occupational and physical therapy evaluations. The physician, other professionals, and parents then determine services. Today, the philosophy of inclusion is used with this population, beginning with early intervention. Inclusion is an educational and social approach that offers any special services needed within the classroom and play environment of typically developing peers. Services and programs include opportunities for these individuals to reach their maximal potential in the least restrictive environment (Case-Smith, 2001). Occupational Therapy Involvement Occupational therapy addresses functional and developmental skills. These can include dressing, feeding, toileting, self-care, cognition, fine and perceptual motor skills, balance, handwriting, safety issues and vocational training (Case-Smith, 2001). Some occupational therapists work as job coaches and service coordinators to support the transition from school to community environments. The occupational therapist also works closely with the family or caregiver and gives suggestions for the level of care needed at home and if home modifications are necessary. The occupational therapist can see individuals as adults or children with this disease. Evaluations used are typically functional performance evaluations like the Pediatric Evaluation of Disability Inventory, the School Function Assessment and the Assessment of Motor and Process Skills (Cronin, 2004). Skilled observation is also a tool the occupational therapist should use when evaluating the child. The treatment goals for all individuals who have cognitive impairment, focus on helping the individual become as independent as possible. The therapist helps the individual reach their maximal potential in life. The therapist also educates the family or caregiver on the proper way for caring for the individual, and explains what functions the therapist feels the client is capable of performing safely and adequately. The occupational therapist helps support the development of social skills and appropriate social behaviors. Assistive technology devices and device adaptations are a common approach used by occupational therapists to enhance the independent function of the client and maximize their potential for living and working independently as adults. References
How OT Makes a Difference: Evidence-Based Practice Tannous, C., Lehmann-Moch, V. et al. (1999). Beyond good practice: Issues in working with people with intellectual disability and high support needs. Australian Occupational Therapy Journal, 46, 24-35. Since the de-institutionalization of persons with intellectual disability, these persons are more prevalent within the community. This article interviewed twelve occupational therapists about what practices are most commonly used with this population and which ones benefited the client more. The study found that positive therapy outcomes were more common when other practices such as empowerment, changing perceptions, and the therapy relationship were incorporated with the hands on treatment. The Occupational Therapist needs to provide support while enabling the clients to participate as citizens within the community. The therapist needs to advocate for the client, and teach them their rights. The study found that when all of these interventions are used simultaneously, the client has an increased chance in reaching their therapy goals. Mr. J is a 36-year-old male with the diagnosis of Mental Retardation and is currently receiving Occupational Therapy. Mr. J lives in a group home, and for the purposes of this interview his primary caregiver was interviewed. Mr. J receives Occupational Therapy at an outpatient clinic. He receives this service one hour a week and also has speech therapy one hour a week. The reason he is receiving Occupational Therapy is because of decreased muscle tone in his right arm, decreased hand eye coordination, decreased cognition, decreased strength and endurance, and decreased functional independence. He has been receiving these services for a year. In therapy, Mr. J participates in activities to increase his independence in functional activities. Some of these activities include muscle strengthening, endurance activities, cognitive activities, handwriting, activities of daily living, puzzles, and social interaction. The therapist also incorporates activities that will increase the use of Mr. J’s right arm and hand. These include cutting bread, getting dressed, and tying his shoes. When asked if Mr. J’s needs and wants were considered in the treatment planning the caregiver felt that they were. She stated that the Occupational Therapist gives Mr. J homework, which he really enjoys. She also stated that the therapist always asks Mr. J what he would like to do, and that coming to therapy makes him feel special. She also feels that as Mr. J progresses, the treatments have progressed. She also stated that the each treatment session, that the therapist explains to her and Mr. J what they will be doing and why. When asked what she felt the major benefits of Occupational Therapy are, the caregiver stated he uses his right hand more and most importantly he talks and verbalizes his feelings more. He is more social and likes to tell and show others what activities he performed in therapy that day. She stated “The more he is in therapy, the better he does”. She also stated that if he misses an appointment, his functional performance declines. She feels the only recommendation is for Mr. J to receive therapy more than just one hour a week. She feels he could benefit from much more.
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