Term
| Learning Disabilities: Definitions |
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Definition
No consistent definition exists, but the
core feature is, “an intrinsic cognitive
difficulty that results in academic
achievement at a level less than expected
for the individuals’ intellectual potential” |
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Term
| Auditory processing disorders |
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Definition
| neural deficit resulting in CNS dysfunction when processing sound |
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Term
| Language processing disorders |
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Definition
| difficulty understanding what you hear and expressing what you want to voice |
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Term
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Definition
| difficulty with calculations |
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Term
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Definition
difficulty in learning to read, specifically
matching letters with sounds
• Approximately 20% of the population |
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Term
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Definition
difficulty with written expression including
spelling, poor handwriting, or putting thoughts onto paper |
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Term
| Learning Disabilities are what |
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Definition
• Neurologically-based processing disorder
resulting in problems learning, language,
and/or motor function depending on
location of cortex affected
• Can make it difficult to: listen, think, speak,
read, write, spell, or perform mathematical
calculations |
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Term
Learning Disabilities
• Prevalence: |
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Definition
• Prevalence difficult to determine because
diagnostic criteria is varied
• Two times as common in children with chronic
health conditions
• 2013–2014 data from the US DOE shows that
students with learning disabilities account for
4.5% of the total student population
• Percentage varies by source
• Reading and written expression are the most
common forms |
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Term
| learning disability inc prevalence in who |
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Definition
With family history of LD
• Who live in poverty and under-stimulating
environments
• Who were born prematurely
• With other developmental and mental health
conditions
• With neurologic conditions
• With chromosomal disorders
• With chronic medical conditions
• History of CNS infection or traumatic brain injury |
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Term
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Definition
• Learning disabilities and ADHD are two of
the leading causes of poor school
performance
• Approximately 5–10% of children have a
learning disability
• Approximately 3–5% of children have ADHD
• Early recognition and intervention is key |
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Term
| Learning Disabilities: Presentation |
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Definition
- Become apparent at different times in
education, but overarching presentation is
struggling with completing school work
and possibly failing grades
• “It is so difficult for him to complete his
homework”
• “I feel like we spend so much time studying
together and she is still falling behind”
Easy to blame the victim -> Lazy, unmotivated
- Parents complain of:
• Poor school performance
• Low grades
• Acting out
• Avoiding homework
- What not to do/say:
• “Don’t worry, he will outgrow it”
• “It will fade with time”
• “Let’s wait until his next checkup and see”
Early identification and early intervention
-> improved patient outcomes
- Presentation varies so you need to know the right
questions to ask |
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Term
| - Reading: 5–12% of school-age children questions |
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Definition
• Is reading something you like to do or have to do?
• How well do you read?
• Do you have trouble sounding out each word?
• Do you understand what you read?
• Do you ever skip words or lines or read the same lines twice?
• Do you get to the end of the page or chapter and not know what
you have read?
• Do you find that you have misread questions or instructions after
completing assignments? |
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Term
| Writing: 7–15% of school-age children questions |
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Definition
• How is your handwriting?
• Do you find that you cannot write as fast as
you can think?
• When you look at your writing, do you find
spelling, grammar, punctuation, or
capitalization errors?
• Can you take notes as quickly as you
need to? |
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Term
| Math: 3–6% of school-age children questions |
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Definition
Do you understand what your teaching is
presenting?
• Do you mistake 12 for 21 or put numbers in
the wrong columns?
• Do you have a problem with word problems? |
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Term
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Definition
• Ask the months of the year
- Do they have to start over when a mistake is made
or can they pick up where the error was made?
• Do you have difficulty remembering the
alphabet when searching in the dictionary?
• Abstraction:
- Do you understand jokes?
- Do you not always understand what people say?
• Organization:
- How do you manage your notebooks? Desk?
Locker?
- Do you often lose things?
• Memory:
- Do you remember what you learned at school
when you get home?
- Do you learn best by listening or reading? |
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Term
| Learning Disabilities: Diagnosis |
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Definition
• Primary diagnosis is typically made through
psychometric testing performed by educators or
psychologists
• Primary care providers responsible for ruling out
any medical, neurologic, and/or behavioral
conditions that may be related
• Information gained through history taken at the
primary care level
• Know where to refer -> think back to the unit on
disabilities in term II |
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Term
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Definition
• Most children with learning disabilities
have a normal physical exam
• Learning disability is rarely the first
manifestation of these disorders |
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Term
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Definition
- Every Student Succeeds Act (ESSA)
• Fully implemented September 2017
• Governs all general education services including specialized
services for students who are neglected, delinquent, or at risk,
ESL learners, etc.
- Section 504 of the Rehabilitation Act
• Civil rights law
• Prohibits discrimination on the basis of disability in programs or
activities receiving financial assistance
• Ensures individuals with disabilities have the right to equal
access to many different services
• Reports from health care providers are frequently used, although
not required, to gain accommodations |
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Term
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Definition
• The goal is habilitation
• Involve occupational and/or speech
therapy
• Connect with school resources
• Individualized Education Plan (IEP)
- Describes areas of difficulty, how each area
will be specifically assessed, and how
progress will be measured at each stage
- Signed by school and parents |
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Term
| Multiple Sclerosis Defined |
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Definition
• Heterogeneous demyelinating disease of
the CNS with variable clinical and
pathologic features
- Demyelinating: acquired, usually inflammatory
- Dysmyelinating: usually genetic, abnormal
myelin formation
• Inflammation, demyelination, axonal
degeneration -> clinical manifestations
• Unknown cause
• Theory: begins as inflammatory immune-mediated
disorder characterized by autoreactive
lymphocytes -> microglial activation
and chronic neurodegeneration
-Breakdown of myelin -> interrupted signal
transmission |
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Term
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Definition
• Characteristic neuropathologic finding:
- Focal demyelinated plaques within the
CNS
- Variable degrees of inflammation and gliosis
- Partial preservation of axons
• Demyelinating lesions commonly found in:
- Optic nerves, spinal cord, brainstem,
cerebellum, juxtacortical and periventricular
white matter |
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Term
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Definition
• Most frequent (nontrauma) cause of
permanent disability in young adults
• Women > men (2.3:1)… and increasing
• Mean onset: 28–31 years of age (15–45
years of age)
- Typically earlier for women than men
- Relapsing-remitting: 25–29 years of age
- Secondary progressive: 40–49 years of age
- Primary progressive: 39–41 years of age |
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Term
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Definition
- Presence of other autoimmune disease
- Genetic link:
• >100 associated polymorphisms
• Strongest known association: HLA-DRB1 locus • Vitamin D response element (VDRE)
• Sibling risk: 3–5%, monozygotic twin risk: 20–
40%
• No clear pattern of inheritance
- Environmental influence:
• Viral infections: may cause immune system
related trigger
• Current focus: link to EBV
• Other areas of research: HBV, VZV, CMV
• Increased risk with childhood obesity and
tobacco use |
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Term
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Definition
• Prevalence increases with geographic latitude,
incidence does not (2010 review)
Inverse relationship between sun exposure,
ultraviolet radiation exposure or serum vitamin D
levels, and risk or prevalence of MS (higher risk w less sunlight) |
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Term
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Definition
• Neuromuscular changes:
- Numbness, paresthesia, weakness, spasticity
• Eye abnormalities:
- Optic neuritis, voluntary gaze abnormalities,
nystagmus
• Bowel and bladder dysfunction:
- Urgency is most common, incontinence with
progression
• Cognitive impairment
• Depression
• Fatigue
• Heat sensitivity
• Sensory symptoms
- Vibratory sense impairment, decreased sharp/light touch
• Sleep disorders
- Restless leg syndrome, nocturia
• Sexual dysfunction
- Decreased libido, decreased sensation |
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Term
| Suggestive features: of MS |
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Definition
Relapses and remissions
• 15–50 years of age
• Optic neuritis
• Lhermitte’s sign
• Internuclear
ophthalmoplegia
• Fatigue
• Heat sensitivity (Uhthoff
phenomenon) |
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Term
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Definition
• Steady progression
• <15 years of age, >50
years of age
• Cortical deficits
• Rigidity, sustained
dystonia
• Dementia
• Rapid onset (minutes) |
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Term
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Definition
| The internuclear ophthalmoplegia is this would be where you get the inability to abduct. So you can't abduct. And so this will be a left-eye lesion on this patient here. And it's creating the inability for the right to abduct. |
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Term
| 2 main initial presentations of MS |
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Definition
sensory in limbs, visual loss
(Typically present over hours to days, remit over weeks to months) |
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Term
An otherwise healthy 25-year-old female
presents to your clinic complaining of
visual changes over the past few days.
She states that everything out of her left
eye appears “foggy.” Upon further
questioning, you also learn that she has
felt lower extremity weakness and
difficulty balancing. She denies previous
similar symptoms. |
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Definition
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Term
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Definition
• History and physical exam are most
important aspect of diagnosis
• MRI -> supporting evidence
- Cerebral or spinal plaque(s) that represent
discrete regions of demyelination
- McDonald criteria: CNS lesions disseminated
in time and space • Time: asymptomatic gadolinium-enhancing and nonenhancing lesions at any time • Space: 4 MS-typical regions of CNS |
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Term
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Definition
So when we're looking at this image here, you can see-- again, I don't expect you to be able to interpret MRIs. But we want to be able to see the different lesions.
And if you look at letter C here, you can see that typically these lesions do appear at a right angle to the cerebral cortex there. I'm sorry. To the corpus callosum. So you see the enhancing lesions at a right angle there to the corpus callosum.
And this is actually called the Dawson fingers when this effect happens, when this phenomenon happens. And you can see them linking up there almost like fingers out of the corpus callosum there on the center on C. And that would be one way.
You can see these different lesions appearing, these highlighted or enhancing lesions that are appearing in different locations. And that would be our time and our space.
MRI is limited, though. If we have a patient who's over 50, it's extremely limited, because sometimes these lesions that we see, these plaques that we're diagnosing MS with, are also seen with ischemic lesions. And so they can look very similar on an MRI. |
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Term
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Definition
• Ischemic lesions mimic MS lesions -> less
reliable for patients >50 years of age
• Sensitivity and specificity vary greatly
depending on number of locations required
and the exact locations included in criteria
• Spinal cord lesions can be used in increase
sensitivity compared to brain MRI alone
• “Black holes” vs. enhancing lesions |
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Term
| MS Diagnosis CSF analysis |
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Definition
• Not required, cannot use as diagnostic criteria
• Normal appearance
• Normal pressure
• Usually normal leukocyte count
• Usually normal protein (albumin)
• Increased oligoclonal bands
- 95% of clinically definite MS
• Increased IgG index
- 90% of clinically definite MS |
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Term
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Definition
As far as classification goes, we see increasing disability, and then our lesions over time here. So we have benign multiple sclerosis. This is going to be where we have just small relapses and we go back to baseline. This is very rare that this actually occurs.
The relapsing and remitting multiple sclerosis, we have the-- you are at baseline. You have a relapse. You get better, but you're not at baseline. And then you have a relapse, and then you get better, but that better is now still worse than where you were before that next relapse. And so every time you relapse, even though you remit, you're remitting to a slightly more higher level of disability.
The secondary progressive type is where you're going to have these periods of the normal relapsing, remitting, relapsing, remitting. And that baseline is going to get to a slightly higher level of disability each time. And then eventually, usually in your 40's to 50's, it just progresses. So you're not going to have relapses and remissions any more. It's just chronic progressive at that point.
Then the other type that you can get, which is much more rare-- only 10% to 20% of patients-- is going to be primary progressive. These are people who start from the beginning. They never have relapses and remissions. They just continuously, progressively, slowly, chronically get worse. |
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Term
| MS Clinically isolated syndromes: |
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Definition
• First attack of MS-compatible disease
• MRI lesions present at baseline à 60% longterm
chance of MS
• MRI lesions absent at baseline à 20% longterm
chance of MS |
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Term
| Relapsing-remitting MS (RRMS) |
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Definition
• Clearly defined relapses with full, or close to
full, recovery
• 85–90% of all cases |
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Term
| Secondary progressive MS (SPMS): |
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Definition
• Starts as RRMS à gradual worsening à minor remissions
• No set criteria for when RRMS becomes SPMS (retrospective
diagnosis)
• Typically 10–20 years after symptom onset |
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Term
| Primary progressive MS (PPMS): |
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Definition
• Progressive accumulation of disability, possible minor plateaus
• Diagnosis on patient history alone, no changes in imaging
• 10% of cases at onset
• Older at diagnosis, even male vs. female, worse prognosis |
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Term
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Definition
• Seldom fatal
• Approximately seven year reduction in life expectancy
• Quality of life:
- Approximately 1/3 have no persistent disability
- Largest deficit is ambulation
• Higher risk of more severe disease if initial symptoms:
- Present >40 years of age
- Affect multiple body systems
- Affect mental functioning, urinary, or motor control
• Pregnancy appears protective, higher rates of relapse
postpartum |
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Term
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Definition
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Term
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Definition
No cure, goal is symptom relief
• Disease modifying therapy (DMT)
(immunomodulatory agents):
- Interferon beta preparations (1a, 1b)
- Glatiramer acetate
- Monoclonal antibody therapy (-mAbs)
• Acute relapses: glucocorticoids
• Spasticity: baclofen and diazepam
• Monitoring: Disability scale q three months, brain
MRI a 12 months |
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