Category Archives: Symptoms

Traumatic Brain Injury

Traumatic Brain Injury and Closed Head Injury commonly occur due to motor vehicle collisions. Injuries can range from a loss of consciousness of less than five minutes to being comatose for many months. Any level of injury can cause an increase in pre-injury bad driving behaviors or create new, unsafe driving issues. These issues can stem from problems with vision, accuracy and speed of eye movements, speed of response, attention, memory, problem solving, judgment and/or loss of physical skills. It can spare one skill and wipe another skill completely from memory. It commonly makes learning new information difficult and may keep a survivor from quickly learning from their mistakes. All of the above can result in unsafe driving encounters, unpredictable driving actions or repeat collisions for the survivor.If someone you know has been in an accident or has had a TBI, look for the following warning signs:

Inappropriate driving speeds
Is slow to identify and avoid potentially hazardous situations
Needs help or instruction from passengers
Doesn’t observe signs or signals or speed limits
Leaves out important road, traffic or warning information
Slow or poor decisions to traffic or road changes
Easily frustrated or confused
Pattern of getting lost, even in familiar areas
Collisions or near misses
Blames their driving mistakes on the behavior of other drivers

If you or those that drive with you notice any of the above warning signs and need a driving evaluation, give us a call at 508-697-6006 and we can, help you with with knowledge about medical conditions, and help with a comprehensive evaluation and determine your ability to drive.

Visual Perception
Functional Ability
Reaction Time
Behind-the-wheel evaluation

April is National Autism Awareness Month

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What is autism?

Autism spectrum disorder (ASD) is a range of complex neurodevelopment disorders, characterized by social impairments, communication difficulties, and restricted, repetitive, and stereotyped patterns of behavior. Autistic disorder, sometimes called autism or classical ASD, is the most severe form of ASD, while other conditions along the spectrum include a milder form known as Asperger syndrome, and childhood disintegrative disorder and pervasive developmental disorder not otherwise specified (usually referred to as PDD-NOS). Although ASD varies significantly in character and severity, it occurs in all ethnic and socioeconomic groups and affects every age group. Experts estimate that 1 out of 88 children age 8 will have an ASD (Centers for Disease Control and Prevention: Morbidity and Mortality Weekly Report, March 30, 2012). Males are four times more likely to have an ASD than females.

What are some common signs of autism?

The hallmark feature of ASD is impaired social interaction. As early as infancy, a baby with ASD may be unresponsive to people or focus intently on one item to the exclusion of others for long periods of time. A child with ASD may appear to develop normally and then withdraw and become indifferent to social engagement.

Children with an ASD may fail to respond to their names and often avoid eye contact with other people. They have difficulty interpreting what others are thinking or feeling because they can’t understand social cues, such as tone of voice or facial expressions, and don’t watch other people’s faces for clues about appropriate behavior. They may lack empathy.

Many children with an ASD engage in repetitive movements such as rocking and twirling, or in self-abusive behavior such as biting or head-banging. They also tend to start speaking later than other children and may refer to themselves by name instead of “I” or “me.” Children with an ASD don’t know how to play interactively with other children. Some speak in a sing-song voice about a narrow range of favorite topics, with little regard for the interests of the person to whom they are speaking.

How is autism diagnosed?

ASD varies widely in severity and symptoms and may go unrecognized, especially in mildly affected children or when it is masked by more debilitating handicaps. Very early indicators that require evaluation by an expert include:

no babbling or pointing by age 1
no single words by 16 months or two-word phrases by age 2
no response to nameA
loss of language or social skills
poor eye contact
excessive lining up of toys or objects
no smiling or social responsiveness.

Later indicators include:

impaired ability to make friends with peers
impaired ability to initiate or sustain a conversation with others
absence or impairment of imaginative and social play
stereotyped, repetitive, or unusual use of language
restricted patterns of interest that are abnormal in intensity or focus
preoccupation with certain objects or subjects
inflexible adherence to specific routines or rituals.

Health care providers will often use a questionnaire or other screening instrument to gather information about a child’s development and behavior. Some screening instruments rely solely on parent observations, while others rely on a combination of parent and doctor observations. If screening instruments indicate the possibility of an ASD, a more comprehensive evaluation is usually indicated.

A comprehensive evaluation requires a multidisciplinary team, including a psychologist, neurologist, psychiatrist, speech therapist, and other professionals who diagnose children with ASDs. The team members will conduct a thorough neurological assessment and in-depth cognitive and language testing. Because hearing problems can cause behaviors that could be mistaken for an ASD, children with delayed speech development should also have their hearing tested.

Children with some symptoms of an ASD but not enough to be diagnosed with classical autism are often diagnosed with PDD-NOS. Children with autistic behaviors but well-developed language skills are often diagnosed with Asperger syndrome. Much rarer are children who may be diagnosed with childhood disintegrative disorder, in which they develop normally and then suddenly deteriorate between the ages of 3 to 10 years and show marked autistic behaviors.

What causes autism

Scientists aren’t certain about what causes ASD, but it’s likely that both genetics and environment play a role. Researchers have identified a number of genes associated with the disorder. Studies of people with ASD have found irregularities in several regions of the brain. Other studies suggest that people with ASD have abnormal levels of serotonin or other neurotransmitters in the brain. These abnormalities suggest that ASD could result from the disruption of normal brain development early in fetal development caused by defects in genes that control brain growth and that regulate how brain cells communicate with each other, possibly due to the influence of environmental factors on gene function. While these findings are intriguing, they are preliminary and require further study. The theory that parental practices are responsible for ASD has long been disproved.

What role does inheritance play?

Twin and family studies strongly suggest that some people have a genetic predisposition to autism. Identical twin studies show that if one twin is affected, there is up to a 90 percent chance the other twin will be affected. There are a number of studies in progress to determine the specific genetic factors associated with the development of ASD. In families with one child with ASD, the risk of having a second child with the disorder is approximately 5 percent, or one in 20. This is greater than the risk for the general population. Researchers are looking for clues about which genes contribute to this increased susceptibility. In some cases, parents and other relatives of a child with ASD show mild impairments in social and communicative skills or engage in repetitive behaviors. Evidence also suggests that some emotional disorders, such as bipolar disorder, occur more frequently than average in the families of people with ASD.

Do symptoms of autism change over time?

For many children, symptoms improve with treatment and with age. Children whose language skills regress early in life—before the age of 3—appear to have a higher than normal risk of developing epilepsy or seizure-like brain activity. During adolescence, some children with an ASD may become depressed or experience behavioral problems, and their treatment may need some modification as they transition to adulthood. People with an ASD usually continue to need services and supports as they get older, but many are able to work successfully and live independently or within a supportive environment.

How is autism treated?

There is no cure for ASDs. Therapies and behavioral interventions are designed to remedy specific symptoms and can bring about substantial improvement. The ideal treatment plan coordinates therapies and interventions that meet the specific needs of individual children. Most health care professionals agree that the earlier the intervention, the better.

Educational/behavioral interventions: Therapists use highly structured and intensive skill-oriented training sessions to help children develop social and language skills, such as Applied Behavioral Analysis. Family counseling for the parents and siblings of children with an ASD often helps families cope with the particular challenges of living with a child with an ASD.
Medications: Doctors may prescribe medications for treatment of specific autism-related symptoms, such as anxiety, depression, or obsessive-compulsive disorder. Antipsychotic medications are used to treat severe behavioral problems. Seizures can be treated with one or more anticonvulsant drugs. Medication used to treat people with attention deficit disorder can be used effectively to help decrease impulsivity and hyperactivity.
Other therapies: There are a number of controversial therapies or interventions available, but few, if any, are supported by scientific studies. Parents should use caution before adopting any unproven treatments. Although dietary interventions have been helpful in some children, parents should be careful that their child’s nutritional status is carefully followed.

Spina Bifida

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Spina Bifida is a congenital defect in which part of one or more vertebrae (the bone structure that surrounds the spinal column), fail, to develop completely, leaving part of the spinal cord exposed. It can occur anywhere on the spine but is most common in the lower back. The severity of the condition depends on how much nerve tissue is exposed. Frequently special adaptations on a vehicle are necessary for independent driving. The person with Spina Bifida may also have impairments in the ~areas of vision, perception (how the brain interprets what the eyes see) or learning. Adaptive driving equipment is frequently used for physical problems. A spinner knob and hand controls can be used if a person is unable to use either foot for gas or brake. Specialized modifications can also allow a person to transfer to the driver’s seat or drive from the wheelchair in a van or minivan.

Common factors that can affect safe driving:

Limited range of motion and strength
Difficulty with coordinated movements
Visual impairments (poor acuity)
Trouble visually scanning or tracking quickly
Learning difficulties
Impaired judgment in complex situations
Slow processing and reaction time

A driver rehabilitation evaluation will examine the strengths and weaknesses of each individual as related to the driving task. The goal is independent, safe driving. No modifications or vehicle selection should be made until the person has completed a driver evaluation.

Visual Perception
Functional Ability
Reaction Time
Behind-the-wheel evaluation

Pass on the Ribbon & Help Spread Rett Syndrome Awareness

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Rett syndrome is a rare, severe, “girls only” form of autism. It’s usually discovered in the first two years of life, and a child’s diagnosis with Rett syndrome can feel overwhelming. Although there’s no cure, early identification and treatment may help girls and families who are affected by Rett syndrome.

Who Gets Rett Syndrome?
Rett syndrome is an autism spectrum disorder that affects girls almost exclusively. It’s rare — only about one in 10,000 to 15,000 girls will develop the condition.

In most cases of Rett syndrome, a child develops normally in early life. Between 6 and 18 months of age, though, changes in the normal patterns of mental and social development begin.

What Are the Symptoms of Rett Syndrome?
Although it’s not always detected, a slowing of head growth is one of the first events in Rett syndrome. Loss of muscle tone is also an initial symptom. Soon, the child loses any purposeful use of her hands. Instead, she habitually wrings or rubs her hands together.

Around 1 to 4 years of age, social and language skills deteriorate in a girl with Rett syndrome. She stops talking and develops extreme social anxiety and withdrawal or disinterest in other people.

Rett syndrome also causes problems with muscles and coordination. Walking becomes awkward as girls develop a jerky, stiff-legged gait. A girl with Rett syndrome may also have uncoordinated breathing and seizures.

What Causes Rett Syndrome?
Most children with Rett syndrome have a mutation in a particular gene on the X chromosome. Exactly what this gene does, or how its mutation leads to Rett syndrome, isn’t clear. It’s believed that the single gene may influence many other genes involved in development.

Although Rett syndrome seems to be genetic, the faulty gene is almost never inherited from the parents. Rather, it’s a chance mutation that happens in the girl’s own DNA. No Rett syndrome risk factors have been identified, other than being female. There is no known method for preventing Rett syndrome.

When boys develop the Rett syndrome mutation, they die shortly after birth. Because boys have only one X chromosome (instead of the two girls have), the disease is more serious, and quickly fatal.

How Is Rett Syndrome Diagnosed?
A diagnosis of Rett syndrome is based on a girl’s pattern of symptoms and behavior. The diagnosis can be made on these observations alone. Discussions between a doctor and a girl’s parents will help determine important details, such as when symptoms started.
Genetic testing can help confirm the diagnosis in 80% of girls with suspected Rett syndrome. It’s possible that genetic testing can help predict severity.

Treatments for Rett Syndrome
There are treatments available for Rett syndrome that focus on helping a girl live the best life she can with the condition. Physical therapy can help improve mobility; speech therapy may help somewhat with language problems; and occupational therapy helps girls perform daily activities — like bathing and dressing — independently.

Experts believe that therapy can help girls with Rett syndrome and their parents. Although a “normal” life may not be possible, some improvement can be expected with therapy. Participating in activities — including school — and improved social interaction are sometimes possible.

Medicines can treat some of the problems with movement in Rett syndrome. Medication can also help control seizures. Unfortunately, there is no cure for Rett syndrome.

What to Expect With Rett Syndrome
Many girls with Rett syndrome can be expected to live at least into middle age. Researchers are still following women with the disease, which was only widely recognized in the past 20 years.

Symptoms of Rett syndrome don’t usually improve over time. It is a lifelong condition. Often, there is a very slow worsening of symptoms, or symptoms remain stable. Girls and women with Rett syndrome will rarely be able to live independently.

Keep Calm It’s Only An Extra Chromosome

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keep calm its only extra chromosome - Down Syndrome Awareness Month

Despite the incredible number of medical advances which have enriched and extended the lives of people with Down syndrome, Trisomy 21 continues to be extremely misunderstood. Many people look at Down syndrome through the lens of outdated stereotypes and misconceptions.

Down Syndrome Awareness Month, celebrated each October, is one way to change that. The goal of Down Syndrome Awareness Month is, of course, to spread awareness, to educate about Down syndrome, and to celebrate people who have Down syndrome, and their abilities and accomplishments.

Facts about Down syndrome:

What is Down syndrome?
Trisomy 21, or Down syndrome, is a genetic disorder which is caused by a full or partial third copy of the 21^st chromosome. There are three types of Down syndrome. Trisomy 21, or nondisjunction, is the most common kind, seen in 95% of Down syndrome cases. The extra chromosome is present in every cell in the body. Translocation Down syndrome occurs in about 4% of Down syndrome cases and is caused by a partial copy of the 21^st chromosome breaking off and attaching to another chromosome (usually the 14^th chromosome). Finally, Mosaic Down syndrome is the rarest case, seen in about 1% of Down syndrome cases. Mosaic Down syndrome happens when the nondisjunction of an extra chromosome is present in some, but not all, of the body’s cells. Some cells will have 47 chromosomes, while the rest will have the typical 46 chromosomes.

Is Down syndrome rare?
No, Down syndrome is not rare. It is the most commonly occurring genetic disorder or birth defect. One out of every 691 babies born in the United States will have Down syndrome, and there are over 400,000 people who have Down syndrome living in the United States. Down syndrome occurs in all races, and while women are at a greater risk of conceiving a child with Down syndrome as they get older, the majority of babies with Down syndrome are born to younger mothers.

What are the effects of having Down syndrome?
People with Down syndrome usually have hypotonia, or low muscle tone, and developmental delays. Early intervention programs and therapies are able to help children with Down syndrome reach the same milestones as typical children, albeit at a slightly longer pace. The rate at which the person with Down syndrome reaches these milestones, as well as the developmental delays he or she has, will be highly individual. There usually are cognitive delays as well, ranging from mild to moderate. It is important to remember, though, that each person with Down syndrome is different, just like typical people. People with Down syndrome are also at increased risk for various medical conditions, such as heart defects, hearing problems, thyroid conditions, childhood leukemia, and Alzheimer’s. However, medical advances have made most of these issues highly treatable, to the point where people with Down syndrome have life expectancies similar to those of people with typical chromosomes.

What are the physical characteristics of Down syndrome?
There are common markers for Down syndrome, which include almond-shaped eyes, a single crease in the palm, flat facial features, small ears, and extra space between the big toe and second toe. However, each person with Down syndrome is an individual, so some people may exhibit many of these characteristics, while others will not have any.

Can people with Down syndrome lead normal, fulfilling lives?
People with Down syndrome often do work and make contributions to society. They also get married, as well as have friendships and other meaningful relationships. Unfortunately, most men with Down syndrome cannot have children, or have a lower fertility rate than typical men. About 50% of women with Down syndrome are able to have children. Thirty-five to fifty percent of children born to a mother with Down syndrome will also have Down syndrome, or other developmental delays. Most importantly, people with Down syndrome do lead happy, fulfilling lives. Studies have consistently shown that people with Down syndrome overwhelmingly report being happy with themselves, their lives, and how they look.

Are people with Down syndrome always happy?
No. People often refer to people with Down syndrome as always happy, or as constantly full of love and joy, but this does a disservice to people with Down syndrome. They experience the full range of emotions, just like everyone else. Reducing them to one emotion or one feeling reduces them to less of a person. They feel happiness, along with sadness, anger, frustration, and countless other feelings, and they deserve to have those feelings acknowledged.