2. Definition
Fetal alcohol syndrome refers to the growth,
mental, and physical problems that may occur in a
baby when a mother drinks alcohol during
pregnancy.
4. Possible causes:
• The cause of FAS is when a women consumes alcohol
while she is pregnant. The severity of FAS is based on
the amount of alcohol consumed and when it is
consumed while the women is pregnant.
• Larger amounts of alcohol and consuming the
alcohol while in the first 3 months of pregnancy (1st
trimester), appear to increase the problems.
5. Is there a safe amount of
alcohol you can drink when
your pregnant?
6. There is no safe
number of alcoholic
drinks you can
consume when you
are pregnant.
7. Symptoms:
• Failure to thrive due to being
premature
• Developmental delays
• Organ dysfunction
• Epilepsy
• Poor growth while the baby
is in the womb and after birth
• Decreased muscle tone and poor coordination
8. • Heart defects
• Structural problems with the face
• Difficulties with their respiratory system
9. Characteristics:
• low birth weight
• small head circumference
• poor coordination/fine motor
skills
• poor socialization skills
• Learning difficulties
• Behavioural problems
10. Characteristics continued
• Structural problems with the face:
- Narrow, small eyes with large epicanthal
folds
- Small head
- Small upper jaw
- Smooth groove in upper lip
- Smooth and thin upper lip
11.
12.
13.
14. Diagnosis:
• Diagnosis is multidisciplinary—must involve at
least the first two of the following:
• Paediatrician
• Psychologist
• Optimally, also may include
– Speech-language therapist
– Occupational therapist
– Physiotherapist
– geneticist
15. Cognitive Development
• Developmental delays/
Learning difficulties:
- poor memory
- Inability to understand concepts
such as time and money
- Poor language comprehension
- Poor problem-solving skills
18. Brain Function
• When psychologists assess a person with FASD, they
look at a number of “functional domains.”
• These overlap somewhat, but all contribute to how
we understand and identify brain damage which is
not visible.
19. Seven Domains
• Cognition
• Adaptation
• Executive function
• Memory
• Communication (Language and a bit more)
• Attention
• Achievement
20. Cognition
• IQ is a very unreliable predictor of functional
ability among people with FASD
• Possible exception: very low IQs
• IQ can vary from severe intellectual disability
to high average.
21. Subdomains
• IQ is not a single entity--different areas of
intelligence are tested.
• Verbal abilities
• Nonverbal abilities
• Speed of processing
• Working memory
22. • In most people, subdomains are more or
less even
• Among people with FASD, there tends to be
a discrepancy among subtest scores.
• Areas of strength don’t necessarily predict
other areas. This leads to
misunderstandings.
23. Adaptation: How Does the Person
Use Intelligence for Daily Living?
• Among most of the population IQ and
adaptation are pretty much comparable
• Among populations with FASDs, adaptation is
much lower than would be predicted by IQ
• It can vary within itself as well.
24. Executive Function
• The ability to organise one’s skills. Planning,
working memory, organisation, inhibition,
initiation…
• The ability to evaluate one’s own behaviour
and change in response to that evaluation.
(self-regulation)
25. Executive functions
• Sequencing and planning—how to initiate a task,
what steps are involved in completion, when to quit
• Flexibility-how to shift tasks smoothly, accept
change, deal with transitions
• Impulse control—
• The ability to keep one’s self and materials organized,
in order, predictable, etc.
26. Memory
• Not a single factor
• Short-term/long-term/working memory
• Storage/retrieval
• Verbal/nonverbal
• Abstract/concrete
• Procedural memory
27. • Memory can be intermittent—here today,
gone tomorrow
– Reteach, keep calm
– Look for multi-tasking—is the situation the same
as it was yesterday? In what respects?
– Implications regarding generalisation
– Implications regarding use of consequences to
change behaviour
28. Communication
• Language impairments are very common among
alcohol-affected children and adults.
• They are often very talkative.
• Expressive language is often apparently more
developed than receptive language.
• “Norbert is so controlling! Everything has to be
his way..conversation topics, play, routine…”
30. Hearing impairments
• Can be either problems of acuity or
perception.
• Hypersensitive hearing (hyperacousis) is
common.
• Otitis media (glue ear).
31. Hypersensitivity
• Children may be very uncomfortable with being
touched or held
• Toothbrushing can be a real battle
• Certain foods (temperature or texture) can be very
distressing
• Textures of fabric in clothing can be distressing.
• Children can’t explain what’s troubling them.
32. Hyposensitivity
• Dangerously high pain threshold
• Insensitivity to extremes of hot and cold
• May seek physical stimulation and feedback by
touching or banging on things
• May sniff things, people
• Find socially acceptable ways for student to meet
sensory needs
33. Social and emotional
Poor socialization skills:
- Difficulty building and maintaining friendships and
relating to groups
Behavioural problems:
- Hyperactivity
- Inability to concentrate
- Social withdrawal
- Stubbornness
- Impulsiveness
- Anxiety
35. Structural Modifications
A child with FAS physical development is
mostly aesthetic, their muscle tone is
Increased, the structure of their head
and face are altered; yet their motor skills
are not usually effected.
For this reason there are no need for
additional structural modifications.
36. • Language and literacy:
Ensure the centre includes books of all levels to be
laid out, through out the centre. When these books
are read in groups times, allow these group times to
be optional. Have a trained professional- teachers
aid- to teach the child with FAS language and literacy
skills.
• Music times:
Music times will be planned the same, yet with
alterations to take place if needed. These alterations
can be to have a staff member present to accompany
the child with staying focused in a group.
37. • Outdoor play:
The environment is the key issue here. The
environment needs to be spacious, so the child with
FAS can run with out obstacles in the way. The
outdoor planning can stay the same.
• Play with others:
Due to one of the symptoms being poor socialization
skills, the child may need assistance in building and
maintaining friendships. This will be every staff
members duty, yet it will be the child’s PCG focus.
• Routines:
The planning of routines will be the same. Routines
will not be at set times, they will be intertwined with
the rest of the programme through out the day. This
allows for flexibility and freedom through out the
day, for every child.
38. Ways to educate and inform parents
about FAS:
• You could place pamphlets in the foyer stating the
dangerous effects of consuming alcohol and drugs
while pregnant.
• These pamphlets will have information about
organisations from the community, that can help
families with issues surrounding FAS.
• These pamphlets and any other relevant information,
could come from your local medical community
centre
39. WE NEED TO :
• Focus on taking positive steps forward in
supporting the child’s development
• In order to do this we need to stop focusing
on what the parents have done and start
focusing on what we can do for the parent’s
and their child; right now.
41. DEFINITION:
• disorder caused by the incomplete closing of
the embryonic neural tube.
• Some vertebrae overlying the spinal cord are
not fully formed and remain unfused and
open.
• If the opening is large enough, this allows a
portion of the spinal cord to protrude through
the opening in the bones.
42. INCIDENCE:
• Spina bifida is one of the most common birth
defects, with an average
worldwide incidence of one to two cases per
1000 births, but certain populations have a
significantly greater risk.
• .
43. CAUSES:
• Maternal diabetes
• Family history
• Obesity
• Increased body temperature from fever or external sources
such as hot tubs and electric blankets may increase the
chances of delivery of a baby with a spina bifida.
• Medications such as some anticonvulsants.
• Pregnant women taking Valproic acid have an increased risk
of having children with spina bifida
• Genetic basis.
• Folic acid deficiency
44. EMBRYOLOGY:
• Spina bifida is caused by the failure of
the neural tube to close during the first month
of embryonic development (often before the
mother knows she is pregnant).
• Under normal circumstances, the closure of
the neural tube occurs around the 23rd
(rostral closure) and 27th (caudal closure) day
after fertilization.
45.
46. TYPES:
• Spina bifida malformations fall into three
categories:
spina bifida occulta
spina bifida cystica with meningocele
spina bifida cystica with myelomeningocele.
47.
48. Spina bifida occulta:
• In occulta, the outer part of some of the
vertebrae is not completely closed.
• The splits in the vertebrae are so small
that the spinal cord does not protrude.
• The skin at the site of the lesion may be
normal, or it may have some hair growing
from it; there may be a dimple in the skin,
or a birthmark.
49. Meningocele:
• The least common form of spina bifida is a
posterior meningocele
• In this form, the vertebrae develop normally,
but the meninges are forced into the gaps
between the vertebrae.
50.
51. Myelomeningocele:
• In individuals with myelomeningocele, the
unfused portion of the spinal column allows
the spinal cord to protrude through an
opening.
• The meningeal membranes that cover the
spinal cord form a sac enclosing the spinal
elements.
• Spina bifida with myeloschisis is the most
severe form of myelomeningocele. In this
type, the involved area is represented by a
flattened, plate-like mass of nervous tissue
with no overlying membrane.
52.
53. CONTD…
• The protruded portion of the spinal cord and
the nerves that originate at that level of the
cord are damaged or not properly developed.
• As a result, there is usually some degree
of paralysis and loss of sensation below the
level of the spinal cord defect.
54. CLINICAL MANIFESTATIONS:
Physical Signs:
• Orthopedic abnormalities (i.e., club foot, hip
dislocation)
• Bladder and bowel control problems, including
incontinence, urinary tract infections, and poor renal
function.
• Pressure sores and skin irritations
• Abnormal eye movement
• 68% of children with spina bifida have
an allergy to latex
• Paralysis
55. CONTD…
• Scoliosis
• Back pain
• Partial or complete lack of sensation
• Weakness of the hips, legs, or feet of a newborn
• Other symptoms may include:
• Hair at the back part of the pelvis called the sacral area
• Dimpling of the sacral area
• Difficulty swallowing, which can lead to choking.
• Hoarseness.
• Breath-holding and problems breathing during sleep.
• Below-average intelligence.
56. Neurological complications:
• Many individuals with spina bifida have an
associated abnormality of the cerebellum,
called the Arnold Chiari II malformation. In
affected individuals, the back portion of the
brain is displaced from the back of the skull
down into the upper neck.
57. Executive function:
• Specific areas of difficulty in some individuals
include planning, organizing, initiating,
and working memory. Problem-
solving, abstraction, and visual planning may
also be impaired.
• Children with spina bifida and shunted
hydrocephalus have higher rates of ADHD.
58. Academic skills:
• Individuals with spina bifida may struggle
academically, especially in the subjects
of mathematics and reading. In one
study, 60% of children with spina bifida
were diagnosed with a learning disability.
59. Social complications:
• Compared to typically developing children,
youths with spina bifida may have fewer
friends and spend less time with peers.
60. DIAGNOSTIC EVALUATION:
• Pregnancy screening:
Neural tube defects can usually be detected
during pregnancy by testing the mother's blood
(AFP screening) or a detailed fetal ultrasound.
Increased levels of maternal serum alpha-
fetoprotein (MSAFP) should be followed up by
two tests - an ultrasound of the fetal spine
and amniocentesis of the mother's amniotic fluid
(to test for alpha-
fetoprotein and acetylcholinesterase).
61. PREVENTION:
• Dietary supplementation with folic acid has been
shown to be helpful in reducing the incidence of
spina bifida. Sources of folic acid include whole
grains, fortified breakfast cereals,
dried beans, leaf vegetables and fruits.
• It is recommended that any woman considering
becoming pregnant take 0.4 mg of folic acid a
day. Pregnant women need 1 mg per day.
62. TREATMENT:
• There is no known cure for nerve damage caused
by spina bifida.
• The spinal cord and its nerve roots are put back
inside the spine and covered with meninges.
• In addition, a shunt may be surgically installed to
provide a continuous drain for the excess
cerebrospinal fluid produced in the brain, as
happens with hydrocephalus.
• Shunts most commonly drain into
the abdomen or chest wall.
63. Physical/Health Educator Considerations
• Try to include students in all activities.
• Be aware of the students abilities and
limitations.
• Plan for their needs.
• Make sure activities are age appropriate.
• Allow opportunities for self directed learning
and experimentation.
64. Special Considerations
– Be aware that there may be some times where the child
can cause distractions and you will need an aid to help
control the class.
– Be sensitive to bowel and bladder problems, these can
cause embarrassing situations.
– Make sure students are involved because it is often that
children with this condition become over weight.
– Focus on upper body activities because of the little or no
mobility in the legs.
– Development depends largely on environmental factors
and setbacks that may disrupt functioning such as lengthy
hospital stays, dependence, and poor self esteem.
65. Exercise
• A comprehensive program of physical activity
is needed to maintain a healthy life
• Intervention should occur as early as possible.
• Home based programs are needed to teach
parents how to exercise their baby’s feet and
legs so they can walk with crutches, braces,
and exercise is also important for use of a
wheel chair.
66. Activities and Exercise
• Body Awareness
• Group Play
• Parachute activities
• Upper body activities
• Strength training
• Aquatics
• Flexibility
• Relays
• Wheel chair activities
67. Goals of Intervention
• Teaching gross motor and spatial skills to facilitate
coordination.
• Developing and maintaining fitness and flexibility to
emphasize self sufficiency.
• Encouraging movement and fitness to overcome susceptibility
to obesity.
• Developing physical skills that generalize to activities of daily
living and vocational skills.
• Promoting social development in recreational and group play
activities, such as aquatics.
• Providing appropriate social outlets for enjoyment and self
satisfaction on an individual basis as well as with family or
peers within the community.
68. COMPLICATIONS:
• Difficult delivery with problems resulting from
a traumatic birth, including cerebral palsy and
decreased oxygen to the brain
• Frequent urinary tract infections
• Hydrocephalus
• Loss of bowel or bladder control
• Meningitis
• Permanent weakness or paralysis of legs
