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Mental Retardation, Special Olympics, and the INAS-FMH

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Title: Mental Retardation, Special Olympics, and the INAS-FMH


1
Mental Retardation, Special Olympics, and the
INAS-FMH
  • Chapter 21

2
INAS-FID Perspective
  • INAS-FID
  • Part of Paralympic movement
  • Provides competition at elite levels for
    individuals with mild mental retardation

3
Special Olympics Perspective
  • Special Olympics
  • 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

4
The Name Dilemma
  • Imbeciles/idiots
  • Mental deficiency
  • Mental retardation
  • Intellectual disabilities

5
The Definition Dilemma
  • Determines eligibility for services
  • Upper limit of IQ - 70 or 75
  • Adaptive functioning

6
Current Definitions of MR
  • Key concepts in each definition include
  • Intellectual functioning
  • Adaptive behavior
  • Age of onset

7
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
    childs educational performance

8
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

9
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.

10
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

11
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

12
The Supports Paradigm
  • Emphasizes the interaction of supports with the
    dimensions of intellectual disabilities
  • Support intensities vary
  • Intermittent
  • Limited
  • Extensive
  • Pervasive

13
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

14
Level of Severity vs. Needed Supports
  • IQs specify four levels of MR function
  • Mild Moderate
  • Severe Profound
  • 1992 - two classifications of MR
  • Mild Severe
  • 2002 - supports-based classification system
  • Fix the environment rather than the person

15
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

16
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

17
Chromosomal Abnormalities
  • Chance errors in cell division
  • Autosomal chromosome disorders
  • Sex-linked chromosome disorders - tend to be more
    frequent and less severe

18
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

19
Other Syndrome Disorders
  • Apert syndrome
  • Cornelia de Lange syndrome
  • Neurofibromatosis
  • Tuberous sclerosis
  • Sturge-Weber disease
  • Prader-Willi syndrome

20
Metabolism and Brain Formation Disorders
  • Inborn errors of metabolism
  • Phenylketonuria Galactosemia
  • Hurlers syndrome Tay-Sachs disease
  • Unknown prenatal influences cause brain and head
    size anomalies
  • Anencephaly Microcephalus
  • Hydrocephalus Craniostenosis

21
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

22
Conditions Caused by Other Toxins, Infections,
and Traumas
  • Use of drugs
  • Premature births Small head circumference
  • Low weight Delayed motor development
  • Failure to thrive
  • Sexually transmitted diseases
  • Traumas that injure the brain or oxygen
    deprivation

23
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

24
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

25
Physical Appearance
  • Unique clinical features (over 100)
  • 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

26
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

27
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

28
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

29
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

30
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

31
Visual and Hearing Concerns
  • Visual problems limit development of hand-eye 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

32
Heart and Lung Problems
  • 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

33
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

34
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

35
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

36
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

37
MR With Associated Medical Conditions
  • More severe a disability - more likely there are
    associated conditions that affect motor behavior
  • Seizures
  • Pain insensitivity and indifference
  • Dual diagnosis
  • Cerebral palsy
  • Pervasive developmental disorders

38
Communication and Self-Direction
  • 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

39
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

40
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

41
Cognitive Ability Related to Motor Learning
  • Attention
  • Memory or retention
  • Feedback
  • Task analysis, repetition, and generalization

42
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

43
Memory and Retention
  • Long-term memory equal to peers
  • Short-term memory deficits
  • Rehearsal strategies must be taught
  • Modeling
  • Verbal rehearsal
  • Self-talk
  • Imagery

44
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

45
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

46
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

47
Motor Development and Delays
  • Delays in use of righting, propping, and
    equilibrium postural reactions
  • Delays in processing classroom instructions

48
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

49
Obesity and Overweight Problems
  • 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

50
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

51
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

52
Programming Requiring Few Supports
  • Enhancement of inclusion
  • Preparation for the mainstream
  • Keep up with classmates
  • Develop some physical activity strengths
  • Work on weaknesses
  • Accept limitations

53
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

54
Special Olympics Sports Skills Programs
  • 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

55
Special Olympics Competition and Unified Sports
  • 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

56
Stepping Out for Fitness Model
  • Adolescents and adults with MR
  • Use of music in all lessons
  • Five components in the instructional model
  • Assessment
  • Objectives
  • Task analysis
  • Implementation
  • Postevaluation

57
Programming for Young Children with MR
  • PREP Play Model
  • I CAN Preprimary
  • Language-Arts-Movement-Programming

58
PREP Play Model
  • Task analysis with recommended physical prompts
    for instruction of 3 to 12 year olds in
  • Locomotion Large play equipment
  • Small play equipment Play vehicles
  • Interaction in group-teaching and 1 to 1
  • Several modes of assessment
  • Includes knowledge of body parts and actions

59
Other Models for Young Children
  • I CAN Preprimary - utilizes play as a vehicle
    for learning
  • Locomotion Body control
  • Object control Play equipment
  • Play participation Health-fitness
  • Includes a home activities program
  • LAMP - teaching movement and language concurrently

60
Programming Requiring Extensive Supports
  • 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

61
Programming Requiring Extensive Supports
  • 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

62
Sensorimotor Models
  • Goals focus on
  • Increasing body awareness
  • Improving prelocomotion movement skills
  • Improving object manipulation skills
  • Developing posture and locomotion skills and
    patterns

63
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

64
Special Olympics Motor Activities Training Program
  • Focuses on four types of activities
  • Warm-up activities
  • Strength and conditioning activities
  • Sensory-motor awareness activities
  • Motor activities
  • Supplement to existing programs and curricula

65
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
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