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