Mental Retardation and its Treatment

Mental Retardation is a condition diagnosed before the age of 18 that includes below average general intellectual function and a lack of the skills necessary for daily living. It is characterized by significantly impaired cognitive functioning and deficits in two or more adaptive behaviors”.

It can be defined as,

“Sub-average of Intellectual functioning that results from injury, disease or any Abnormality before the Age of 18 years”

It has historically being defined as “intellectual quotient” scores under 70. Mental Retardation is a sub type of “intellectual disability” although that term is now preferred by most advocates in most English countries.

PREVALENCE RATE OF MENTAL RETARDATION

The prevalence rate of mental retardation is 2% to 3% of population.

IQ CLASSIFICATION IN MENTAL RETARDATION

In mental retardation, the IQ (Intellectual Quotient) can be classified as the following.

Sr. No. CATEGORY OF MR IQ
1 Borderline 70 – 80
2 Mild Mental Retardation 55 – 70
3 Moderate Mental Retardation 40 – 55
4 Severe Mental Retardation 40 – 25
5 Profound Mental Retardation below 25

CATEGORIES / LEVELS OF MENTAL RETARDATION

There are four categories / levels of mental retardation to DSM – IV – TR as defined the following.

  1. Mild Mental Retardation
  2. Moderate Mental Retardation
  3. Severe Mental Retardation
  4. Profound Mental Retardation

MILD MENTAL RETARDATION

There are 75 to 85% cases of mild mental retardation. They are slow in all areas. They may have no unusual physical signs. They are educate-able. They have useful reading and math skills up to grade 3 to 6 level. They can acquire practical skills. They can conform socially. Their mental age is usually 8 years to 12 years.

MODERATE MENTAL RETARDATION

There are 10% to 25% cases of moderate mental retardation. They have notice-able delays, especially in speech. They may have some unusual physical signs. The self help can be developed through training. The reserved supervision is required for these persons. They can learn simple communication, health and safety habits. They also learn and modify their behavior through reward and punishment techniques. They have poor social awareness.

SEVERE MENTAL RETARDATION

There are 4% to 10% cases of severe mental retardation. They are marked obvious delays. They may walk late. They have little or no communication skills. They have some understanding of speech and show some response. They need direction and supervision and no vocational training. They may be trained in simple self-care. They follow routine frame work.

PROFOUND MENTAL RETARDATION

They are 1% to 2% cases of profound mental retardation. They are marked delays in all areas. They are needed close supervision. The congenital abnormalities often present in these children. These children have some motor development. They may response to regular physical activity and social stimulation.

TREATMENT / MANAGEMENT OF MENTAL RETARDATION

The management / treatment of mental retardation is done to eliminate or reduce the conditions that lead to development of the disorders associated with mental retardation. Some useful management plans of mental retardation are as defined the following.

  1. Primary Prevention
  2. Secondary & Tertiary Prevention
  3. Special Education for Child
  4. Different Therapies
  5. Family Counseling
  6. Community Services
  7. Individualized Education Plan (IEP)
  8. Individualized Therapy Plan (ITP)
  9. Play Therapy

PRIMARY PREVENTION

The primary prevention concerns actions taken to eliminate or reduce the conditions that lead to development of the disorders associated with mental retardation. Such manners include education to increase the general public’s knowledge and awareness of mental retardation, continuing efforts of health professional to ensure and upgrade public health policies, legislation to provide optimal maternal and child health care and eradication of the know disorders associated with central nervous system damage.

SECONDARY & TERTIARY PREVENTION

The disorder associated with mental retardation should be treated to shorten the cause of the illness (secondary prevention) and to minimize the consequent disabilities (tertiary prevention). Mentally retarded children frequently have emotional and behavioural difficulties requiring psychiatric treatment.

SPECIAL EDUCATION FOR CHILD

Special Educational settings for children who are mentally retarded should include a comprehensive program that addresses adaptive skills training, social skill training and vocational training.

DIFFERENT THERAPIES

There are different therapies that may be considered very effective for the management / treatment of mental retardation as defined the following.

  1. Group therapy
  2. Cognitive therapy
  3. Behavioural therapy
  4. Relaxation Exercise
  5. Play Therapy
  6. Psychodynamic Therapies
  7. Occupational Therapies

Group Therapy

The group therapy has often been a successful format, in which mentally retarded children can learn and practice hypothetical real life situations and receive supportive feedback.

Cognitive Therapy

The cognitive therapy is applied to the children who are mentally retarded. In this situation, the cognitive therapy dispels false beliefs of these mentally retarded children.

Behavioral Therapy

The behaviour therapy has been used for many years to shape and enhance social behaviours and to control and minimize aggressive and destructive behaviours. Positive reinforcement for desired behaviours and benign punishment for objectionable behaviours have been helpful.

Relaxation Exercise

The relaxation exercise with self instructions is recommended for mentally retarded persons who can follow the instructions.

Play Therapy

Special Olympics International is the largest recreational sports program geared for this population. The sports are assigned to these children to develop their physical fitness. Different types of toys, music and colors are selected in play therapy for these children.

Psycho-dynamic Therapies

The psychodynamic therapy has been used with patients and their families to decrease conflicts about expectations that result in persistent anxiety, rage and depression.

Occupational Therapies

The children with mental retardation are also assigned different types of occupational therapies to enhance their abilities of professions.

FAMILY COUNSELING

The family counseling is often addressed to the family of mentally retarded patient about ways to enhance competence and self esteem while maintaining realistic expectations for the patient.

COMMUNITY SERVICES

One of the most prevalent problems among persons who are mentally retarded is sense of social education and social skills deficits. Thus, improving the quantity and quality of social competence is a critical part of their care. Special Olympic also enhances social interactions, friendships and general self esteem.

INDIVIDUALIZED EDUCATION PLAN (IEPs)

The individualized education plan (IEP) is designed to educate the children with mental retardation.

INDIVIDUALIZED THERAPY PLAN (ITPs)

The individualized therapy plans (ITPs) are also designed for the management of the mentally retarded children.

Related Articles:

Brain Tumor Types and Treatment Facilities in USA

Brain tumor is a mass of abnormal growth of cell in the brain. It occurs when abnormal cells form within the brain. Brain tumor represents a group of neoplasm arising from brain tissues, each with their own unique biology, prognosis and treatment. Many different types of brain tumor exist. Some brain tumor are non cancerous (benign), and some brain tumors are cancerous (malignant) brain tumor can begin in your primary brain tumor, or cancer can begin in other parts of your body and spread to your brain Secondary and Metastatic brain tumor. How quickly a brain tumor growth can vary greatly.

Types of brain tumors

Brain TumorAll types of brain tumor may produce symptoms that vary dependent on the part of the brain involved. These symptoms may include headache, seizures, problem vision, vomiting and mental changes. The headache is classically worse in the morning and goes away with vomiting. More specific problems may include difficulty in walking, speaking and with sensation. As the disease progresses unconsciousness may occur. The brain is divide into lobes and each lobes or area has its own function tumor in any of these lobes may affect the areas performance. The location of tumors is often linked to the symptoms experienced but each person may experience something different.

Frontal lobe tumors may contribute to poor reasoning, inappropriate social behavior, personality changes, poor planning, lower inhibition and decrease production of speech (Broca’s area).

Temporal lobe tumor may contribute to poor memory loss of hearing, difficulty in language comprehension (Wernicke’s area).

Parietal lobe tumors here may result in poor interpretation of language, decreased sense of touch and pain, poor spatial and visual perception.

Occipital lobe tumor is damage to this lobe may result in poor or loss of vision. Cerebellum tumor in this area may cause poor balance muscle movement and posture.

Brain stem tumors on this can affect blood pressure, swelling and heart beat.

Brain Tumor TypesPrimary brain tumor originates in the brain itself or in tissues close to it, such as in the brain-covering membranes (meninges), cranial nerves, pituitary glands and pineal glands. Primary brain tumor begins when normal cells acquire errors (mutation) in their DNA. These mutations allow cells to grow and divide at increased rate and to continue living when healthy cells would die. The result is a mass of abnormal cells, which forms a tumor. Primary brain tumor is much less common than are secondary brain tumor in which cancer begins elsewhere and spreads to the brain. Many different types of primary brain tumors exist.

Gliomas: This tumor begins in brain or spinal cord and includes strocytomas, ependymoma, glioblastomas, oligoastrocytomas and oligodenrogliomas.

Meningiomas: A meningiomas is a tumor that arise from the membrane that surrounds your brain and spinal cord (meninges).Most maningiomas are non cancerous.

Acoustic neuromas (schwannomas): These are benign tumors that develop on the nervous that control balance and hearing leading from your inner ear to your brain.

Pituitary adenomas: These are mostly benign tumors that develop in the pituitary glands t the base of the base.

Medullablastomas: These are the most common cancerous brain tumor in children. a medulloblastomas starts in the lower back part of the brain and tends to spread to the spinal fluids. It is less common in adults.

PNETs primitive neuroectodermal tumors (PNETs) are rare cancerous tumors that start in embryonic cells in the brain. They can occur anywhere in the brain.

Germ cell tumors: Germ cell tumors may develop during childhood where the testicles or ovaries will form.bur sometime germ cells tumors moves to other parts of the body such as the brain.

Craniopharyngiomas: These rare non cancerous starts near the brain’s pituitary gland, which secrets hormones that control may many body functions.

Secondary metastatic brain tumors are tumors that results from cancer that starts elsewhere in your body and then spreads (metastasizes) to your brain. Secondary brain tumor most often occurs in people who have a history of cancer. But in rare cases metastatic brain tumor may be the firs sign of cancer that begin else where in your body. Secondary brain tumor are far more common than are primary brain tumor. Any cancer can spread to the brain, but the most common types include:

  • Breast cancer
  • Colon cancer
  • Kidney cancer
  • Lung cancer
  • Melanoma

Brain Tumor Treatment Facilities in USA

Treatment for a brain tumor depends on size, type and location of the tumor, as well as your overall health and your preferences. When a brain tumor is diagnosed, a medical team will be formed to assess the treatment options presented by the region to the patients and his/her family. In America there are lots of treatments are used to treat the brain tumor. In brain tumor different types of doctors’ works together to create patient’s overall treatment plan that combines different types of treatment. This is called multidisciplinary team.

However, research in the past 20 years has helped to significantly lengthen the lives of people with brain tumors. More refined surgeries, a better understanding of the types of tumors that respond to chemotherapy, and more targeted delivery of radiation therapy have lengthened lives and improved the quality of life for many people diagnosed with brain tumor. Some of the symptoms of a brain tumor can be severe and have an enormous impact on a patient’s life. However they can often be managed with the use of certain medication.

Drug called corticosteroids are used to lower swelling in the brain which can lessen pain from the swelling without need for prescription pan medications. These drugs may also help improve neurological symptoms by decreasing the pressure from the tumor and swelling in the healthy brain tissue.

Antiseizure medication helps to control seizure. There are several types of drugs available and they are prescribed by your neurologist.

Surgery is the removal of the tumor and some surrounding healthy tissues during an operation. It is usually the first treatment used for a brain tumor and is often the only treatment needed for low-grade brain tumor. Removing the tumor can improve neurological symptoms, provide tissue for diagnosis, help make other brain tumor treatments more effective, and, in many instanced, improve the prognosis of the person with the brain tumor. Surgery to brain requires the removal of a part of the skull, a procedure called craniotomy. After the surgeon removes the tumor the patient’s own bone will be used to cover the opening in the skull. There is rapid advancement in surgery including the use of computer based techniques, Image Guided Surgery (IGS).

Radiation therapy is to use of high-energy x-rays or other particles to destroy tumor cells. It is used to slow the growth of tumor. It is done after surgery and along with chemotherapy. The most common radiation treatment is called external-beam radiation therapy in which radiation given outside the body. When a radiation treatment is given using implants it is called internal radiation therapy or brachytherapy.

External beam radiation therapies are directed as follows.

  • Conventional radiation therapy in certain situation, such as whole brain radiation therapy for brain metastases, this technique is appropriate.
  • 3-dimensional conformal radiation therapy(3d-crt) this model can be used to aim the radiation beams directly at the tumor, sparing the healthy tissue from high doses of radiation therapy
  • Intensity modulate radiation therapy IMRT is a type of 3D-CRT that can more directly target a tumor. In this radiation broken up in to small beams and the intensity of each of these smaller beams can be changed.
  • Proton therapy proton therapy is type of external-beam radiation therapy that uses protons rather than x-rays.at higher energy protons can destroy tumor cells.
  • Stereotactic radio surgery is the use of single high dose of radiation given directly to the tumor and not healthy tissue it can be used when a person has more than 1 metastatic brain tumor
  • Fractioned stereotactic radiation therapy is delivered with stereotactic precision but divided into small daily dose called fraction given over several weeks, in contrast to the 1-day radio surgery.

Chemotherapy is the use of drug to destroy tumor cells, usually by stopping the cancers cells’ ability to grow and divide. The goal of chemotherapy can be to destroy tumor cells remaining after surgery, slow tumors growth, or reduce symptoms. Chmemotherapy is given by medical oncologists’ doctor who specializes in treating tumors with medications. Systematic chemotherapy gets into bloodstream to reach tumor cells throughout the body. Common ways to give chemotherapy include pills that is swallowed (orally), or by intravenous (IV) injection placed into vein by needle it can also be given through catheter.

Targeted therapy is a treatment targets the tumor’s specific genes, proteins, or the tissue environment that contributes to a tumor’s growth and survival. This type of treatment blocks the growth and spread of tumor cells while limiting the damage to healthy cells.

Alternating electrical field therapy this type of treatment uses a noninvasive portable device that interferes with parts of a cell that are needed for the tumor cells to grow and spread it is given by placing electrodes that produces an electric field on the outside of a person’s head. The available device is called Optune.it is used for Glioblastoma.

Tumor treating Fields a wearable device locally or regionally delivered treatment that produces electric field to disrupt the rapid cell division exhibited by cancer cells by creating alternating, “wave-like” electric fields.

Focused ultrasound therapy is early stage on invasive therapeutic technology with the potential to improve quality of life and decrease the cost of care for patients with brain tumor. It is also to reduce the toxicity and side effects, and/or promote anti-tumor responses.

Clinical trials many clinical trials focus on new treatments researcher want to know that if there treatments are effective or safe they do clinical; trials. In which some they do ways to relieve symptoms and side effects during treatment. In the beginning of clinical trial patient are given safety and informed consent.

Palliative treatments vary widely and often include medications, nutritional changes relaxation exercise emotional support and other therapies.

Tubular Retractor System help neurosurgeon perform minimally invasive surgery to address brain aneurysm, stroke, blood clots, and brain tumors.

GLIADEL wafer is a new treatment approach of Glioblastoma, which involves controlled release delivery of Carmustine from biodegradable polymer wafers.

GliaSite Radiation Therapy System These therapies for malignant brain tumors are developed by researchers in John Hopkins Comprehensive brain Tumor Center, and now this treatment are used in nationwide.

Nutrition Therapy Malnourishment may interfere with your ability to heal by interrupting or delaying treatment. In America registered dietitian are available to work with patients including your gastroenterologist and naturopathic clinician, throughout treatment.

Pain Management those with advance brain tumor are most likely to have severe pain most of pain associated with cancer comes from the tumor itself, y pushing on nerves bones or organs which lead to significant discomfort and pain. Medical experts manage these pains with several therapies.

Oncology Rehabilitation Treatment brain cancer may cause cognitive and physical impairment (e.g. motor sensory language etc).rehabilitation involves wide range of therapies. Physical therapy, occupational therapy, speech and language therapy, manual therapy, auriculotherapy

Advance Surgical Recovery Program (ASURE) it is important to resume their daily activities that are why Cancer care center designed this program to heal quickly. Typically provide physical therapy within 24 hours after surgery. It is designed to reduce fatigue and post surgery complications.

Spiritual Support for faith based individuals spiritual support is a fundamental aspect of their treatment at cancer treatment centers.

Adults survivor-ship program cancer care does not end when cancer end. The Adult Survivor-ship Program at Tufts Medical Center in Boston, MA offers ongoing care to individuals who have completed active treatment for cancer. Preventions, surveillance for cancer, intervention for treatment coordination among specialist are included in this program.

Integrative Therapies the most common brain tumor is Malignant, HIGH Grade Glioma (HGG), whose treatment begins with surgical resection of the tumor, followed by combined chemo, radiation regimen with the drug Temadol.

Read more on our Health and Treatment blog.

Author Bio:

Irsha Ikram,
Writer, Psychologist
Msc Psychology
Lahore, Pakistan

Virtual Live Brain Cell Research Database in Seattle

First official open database for brain research is created in Seattle USA. Scientists took a live part of human brain flesh which was put aside during an operation in local hospital. The Allen Institute for Brain Science last week shed some light on these virtual human brain cells. These cell are not real but stimulating close to real. Their functions are also stimulating electrical signals that are generated in mind. Idea of creating open database is great for opening doors to new scientists and data sharing. Below is video which briefly describe virtual human cells.

This brain structure theory is started by The Allen Institute for Brain Science and further collaborated by neurosurgeons from Seattle USA including leading scientist Christof Koch. Human brain is very complicated and all latest research includes experiments on animals like dogs, pigs etc. Christof Koch said that if we want to treat human diseases then research should be on living human cells. So a discarded sample of live human brain is taken for experiment. This led to open new doors of research. Human brain has many mysterious diseases which are still not cured in medical science like Alzheimer’s, schizophrenia and depression. Last week I wrote an article on depression treatment using magic mushrooms which was great news for depresses patients.

Brain NeuronsNeurosurgeons started to take sample cells from patients of brain tumors, epilepsy etc. These samples are taken time to time for regular improvement in 3D brain structures. But neurosurgeons recommend that live human samples would also be required for refining virtual structures. Although it is tough to get live human samples but definitely required from outer layer of brain which includes memory, consciousness details of human. Such samples are necessary because mostly discarded pieces of brain are diseased, waste or not usable.

The Allen Cell Types Database is open for all scientists. Chief scientist Christof Koch said that database is ready with data collection from 300 live neurons of various patients. Much data is already available in database about mouse brain. Scientists have made around hundred plus 3-D structures of cells. But still research is going on in positive phase. Lot has to learn yet.

Allen Institute has received grants from NIH (National Institute of Health) of $100 million over five years. This research grant will help fund database, pay salaries and invest on buying new equipment so that fruitful results can be obtained from research.

Live Brain SamplesNoble prize winners of 1906 Camillo Golgi and Santiago Ramon y Cajal started the journey towards new direction in understanding brain cells. They were first to depict the actual layout of brain cells and their anatomy with neurons. Neurons is first step towards understanding what brain does. It is consisted on a nuclei, axons and dendrites. Nuclei is central part which is responsible for transmitting data to and from other brain cells. Axons are used to transmit signals whereas dendrites are reserved for incoming signals towards nuclei. Each neuron is connected with many others. Neuro scientists are satisfied that single human brain contains around 84 billion neurons. These further connect with each other and make more than 101 trillion neuron connections.

Human Brain by Allen InstituteAllen Institute scientists are breaking these enormous number of brain cells into simpler form. An expert from Allen says that considering 80 billion plus neurons is complicated and much tough to understand. So it is necessary to categorise this huge number into types of cells. If we conisder a single brain cortex that around 100 types of cells would be found. So it will become lot easier if we break these into smaller chunks. In the above picture you will see types of brain neurons in various colors for better understanding by Allen Institute.

Chandelier Cell by Allen InstituteAllen Institute is considering to ease working of brain cells. Allen scientists are putting their fine details in 3D computer format. This will provide finer level of understanding at better scale. If a scientists want to cure Alzheimer’s or autism then working at such fine level of computer structure would be lot easier. If we know types of neurons then differentiating is lot easier.

Team of this brain research includes Jonathan Ting, Hamilton, Christof Koch, Ed Lein and many more. Hamilton says that samples of live human cells lasts much longer than mouse brain cells. So it is quit easy to stimulate real functions of brain. Each brain cell has a history that scientists are trying to decode using various methods. Ed Lein is quit positive about getting such research on board and funded at state level.

Neun FemaleThis is picture of Neun taken from live samples of 60 years old female. She is facing epilepsy since 18 years. Her background is white ethnic. This Neun sample is very rare. It is helpful for understanding basic details of epilepsy disease. If Allen Institute becomes successful in grading human cells or neurons then classification of discarded cells would be lot easier.

Read more on our Health and Treatment blog.