Alterations in Alterations in Sensorimotor FunctionSensorimotor Function

Alterations in Alterations in Sensorimotor FunctionSensorimotor Function

By Nataliya Haliyash, MD, BSNBy Nataliya Haliyash, MD, BSN

• Alterations in sensory function can have a profound effect on the child's ability to achieve normal growth and development.

• Early identification of hearing, vision, and communication defects enables early intervention to assist the child and family to achieve optimal growth and developmen

Lecture ObjectivesLecture Objectives• Nursing care of the child with sensory or

cognitiveive impairment:– Impaired vision– Impaired hearing– Mental retardation– Down syndrome

• Nursing care of the child with neuromuscular dysfunction:

– The child who is paralyzed– Quadriplegia: special needs– The child with cerebral palsy

• Nursing care of the child with musculoskeletal alterations:

– The child with a fracture– Congenital hip dysplasia– Congenital acute clubfoot– Legg-Calvé-Perthes disease (coxa plana)– Duchenne muscular dystrophy

EARStructure And Age Peculiarities• Three main sections:

– the outer ear, – the middle ear, – the inner ear

• The eustaehian tube connects the middle ear with the nasopharynx. It allows fluid to drain into the nasopharynx and equalizes pressure between the outer and middle ear.

• Infants and young children have shorter, more

• horizontal, and more flaccid eustaehian tubes, predisposing

• them to middle ear infections.

EARStructure And Age

Peculiarities• Infants and young children:

– eustaehian tubes are shorter, more horizontal, and more flaccid

– Predisposing factor to middle ear infections.

• 0-3 mo:– Soothed by parent's voice– Gives a startled response to loud sudden noises

• 3-6 mo:– Looks to see where sounds come from– Becomes frightened by an angry voice– Smiles when spoken to– Wakes up when spoken to or when a loud noise is

made nearby

• 6-12 mo:– Stops for a minute when someone says

"no-no," "bye-bye," and own name– Looks at objects or pictures when

someone talks about them– Enjoys rattle and similar toys for their

sounds• 12-18 mo:

– Sings and hums spontaneously– Discriminates between sounds such as

doorbell, telephone, barking dog, and so forth

– "Dances" and makes sounds to music• 18-24 mo:

– Brings objects to others when asked– Hears and identifies sounds coming from

another room

Hearing impairment• Disability that may range in

severity from mild to profound. • DeafnessDeafness is a hearing impairment

that is so severe that the child is impaired in processing linguistic information through hearing, with or without amplification

Hearing impairment

• Hard-of-hearingHard-of-hearing – residual hearing, with a hearing aid, sufficient to enable successful processing of linguistic information through audition

Incidence of hearing loss

• The incidence of hearing loss in newborns is 1 in 1,000, and is one of the most common infant disabilities in the United States.

• Each year 4,000 children are born profoundly deaf,

• 4,000 others have some degree of hearing loss

• One to two additional children per 1,000 become deaf during childhood

Hearing impairment– Classification:

• Congenital• Acquired

– Pathophysiological types of hearing loss: • Conductive hearing loss (middle-ear) –

interference with transmission of sound to the middle ear, can be temporary or permanent

• Sensorineural hearing loss (perceptive or nerve deafness)

– results from damage or malformation of the inner ear and/or auditory nerve.

– Can be a congenital defect or consequence of infection, exposure to loud noises or ototoxic drugs, and prematurity.

– Sounds are distorted, severely affecting discrimination and comprehension

Hearing impairment• Mixed conductive-sensorineural hearing loss:

– Interference with transmission of sound in the middle ear and along neural pathways

– Frequently results from recurrent otitis media and its complications

• Central hearing loss:– All hearing losses that do not demonstrate defects

in the conductive or sensorineural structures– Is caused by damage that interrupts sound

transmission between the brainstem and the cerebral cortex,

– difficulty in sound discrimination, auditory association of meaning to sound, auditory memory, and being able to differentiate sound from its background.