CONCEPT OF NEUROLOGICAL IMPAIRMENT

CONCEPT OF NEUROLOGICAL IMPAIRMENT

Neurological impairments are a group of disorders that primarily relate to the central nervous system comprised of the brain and spinal cord.

A neurological disorder is any disorder of the body nervous system. Structural, biochemical or electrical abnormaltyies in the brain, spinal cord or other nerves can result in a range of symptoms. Examples are includes paralysis, muscle weakness, poor coordination, loss of sensation, seizures, confusion, pain and altered levels of consciousness. There are many recognised neurological disorders, some relatively common, but many rare. They may be assessed by neurological examinations, and studied treated within the the specialties of neurology and clinical neuropsychology.

Neurological impairment also refers to a broad group of disorders in which the central nervous system does not function properly and leads to some form of physical and mental problems. The type of impairment which affects the brain or spinal cord, can have affect a wide range of different capabilities, from motor skills to memory. However, not all neurological impairment are present from birth.

Intervention for neurological dsiorders include preventative measures, lifestyle changes, physiotherapy or other therapy, neurorehabilitation, pain managemnent, medication or operation performed by neurosurgeon. The world health organisation estimated in 2006 that neurological disorders and their sequelae {direct consequences} affect as many as one billion people world wide, and identified health inequalities and social stigma, discrimination as major factors contributing to the associated disability and suffering.

Among the more common diagnostic categories and conditions are cerebral palsy, epilepsy, brain injury, multiple sclerosis, tourette’s syndrome.

Neurological impairments are categorised into three major types: childhood aphasia which primarily affects speech and language abilities’, minimal brain dysfunction that affects learning and behavioural abilities; and learning disabilities that primarily affects understanding or the ability to process language.

A nuerological impairement can be acquired as a result of some form of brain or spinal cord injury. Often, the result are very similar, the only difference is the way in which a given part of the brain becomes damaged.

The capacity of the nervous system is limited or impaired with difficulties exhibited in one or more of the following areas: the use of memory, the control and use of cognitive functioning, sensory and motor skills, speech, language, organizational skills, information processing, affect, social skills, or basic life functions. The term includes students who have received a traumatic brain injury.

CAUSES OF NEUROLOGICAL IMPAIRMENT

There are many factors responsible for neurological impairment. Although, the brain and spinal cord are surrounded by tough membranes, enclosed in the bones of the skull and and spinal vertebrae, and chemically isolated by the so called blood brain barrier, they are very susceptible if compromised.

The specific causes of neurological problems vary, but can include:

genetic disorders

Congenital abnormalties

Infections

Lifestyle or environmental health problems including malnutrition and brain injury, spinal cord injury or nerve injury.

The problem may start in another body system that interact with the nervous system. For example, cerebrovascular disorders involved brain injury due to problems with the blood vesels (cardiovascular system) supplying the brain; autoimmune disorders involve damage causes by the body’s own immune system; lysosomal storage diseases such as niemann pick disease can lead to neurological deterioration.

In a substancial minority of cases of neurological symptoms, no neral cause can be identified using current testing procedures, and such ‘’idiopathic’’ conditions can invite different theories about what occuring.

THE MOST COMMON CAUSES OF NEUROLOGICAL IMPAIRMENT

The major neurological impairment are: cerebral palsy. Epilepsy, spinal bifida, spinal cord injuries, head injuries, multiple sclerosis.

I.                   CEREBRAL PALSY: cerebral palsy represents the most prevalent orthopaedic impairment and locomotive disability in school age children throughout the world. It is the most common cause of physical impairment in children occuring at the rate of between 1.5 and 5 new cases per 1,000 births (Hill, 1999). It may also be defined as a condition involving disabilities in movement and posture that result from damage to the brain before or during birth or in infancy (Fraser, Hensinger and Philips, 1990). In the term, cerebral palsy, where the word ‘cerebral’ signifies the presence of a causative lesion or damage to the brain, ‘palsy’ indicates the consequence of such a lesion in term of loss in impairment in motor functioning. Cerebral palsy is also a disorder of movement and posture resulting from a permanent damage to or defect in the immature brain.

CAUSES OF CEREBRAL PALSY

The most common cause of cerebral paly was once thought to be birth trauma, but now it is known to be due to damage associated with the lack of oxygenated blood to the brain (ischaemia), inadequate oxygenation of the cells of the body (hyposia) or lack of oxygen in the body (asphysia) in either premature infants with low birth weight or full term infant who developed problems during the prenatal period (Pellegrino2002).

TYPES OF CEREBRAL PALSY

On the basis of the area of the brain that is damaged, there are four primary forms of cerebral palsy. These are:

i.                    Spastic or pyramidal cerebral palsy: This result from damage to the cerebral cortex (motor area), is characterized by exaggerated muscle tone in selected muscle groups, which results in the limb muscle being excessively tight. Spastic cerebral palsy is the most common form of cerebral palsy and it account for about 60% of all cases (Haskell and Barrett, 1993).

ii.                  Athetosis (also known as dyskinetic or extrapyramidal CP) results from damage to the basal ganglia in the middle portion of the brain. It is characterised by inability to execute voluntary movement. This may also affect the tongue and mouth, thus making feeding and speaking difficult. Also common is the rotary, twisting, movement of the arm and legs. This form of cerebral palsy account for about 5% of all cases.

iii.                Ataxia or cerebellar cerebral palsy result from a defect in the cerebellum or its pathway and is characterised by the inability to coordinate voluntary movements. This leads to difficulty or inability maintain equilibrum or balance. This form of cerebral palsy account for 1 to 10 percent of all cases.

Mixed type cerebral palsy result from extensive damage to the various part of the brain and it is characterised by a combination of the type of motor impairment.

IDENTIFICATION OF CEREBRAL PALSY

Cerebral palsy is a condition characterised by paralysis weakness uncoordination and other motor dysfunction. Cerebral palsy is believed to account for more than half of children with physical impairment. It is non progressive brain damage that occurs before or during birth or in early childhood.

EDUCATIONAL IMPLICATION OF CEREBRAL PALSY

When the b rain is damaged, sensory abilities, cognitive function and emotional responsiveness as well as motor performance are usually affected. Educational probplem of cerebral palsy children as highlighted by OSATUYI (1996) are as many as their disabilities. Not only must special equipment and procedures be provided because they have physical disabilities, but also the same special education procedure and equipment required to teach children with vision, hearing or speech and language disorders, learning disabilities, behavioural disorder or mental retardation are often needed. Continous educational assessment of the individual is important. Teaching the cerebral palsy child according to Zadig (1983) demends competence in many aspects of special education and experience in working with a variety of disabling conditions in multi disciplinary settings.

II.                SPINAL BIFIDA: spina bifida is  birth defect of the spinal column (back bone). The cause is unknown but a developing foetus may fall victim of this serious backbone defect within one month of pregnancy. As a matter of definition it can be said that “spina bifida” is a general term for a congenital defect in the vertebrae that enclose the spina cord. As a result, a portion of the spinal cord and the nerves that normally control muscles and feeling of the lower part of the body fail to develop normally” (Heward, 2000, p 448), for causing defects, one or more vertebrae may push the spinal contents out, but can also at any point along the spine. Depending upon the nature of the defects and severity of impairment, spina bifida may be classified into the following main types:

i.                    Occulta: it is the mildest form of the spine bifida. There is no protrusion of the spinal cord. There occur only a slightly defect in the  form of mlformation of a few vertebrae, usually in the lower spine. It does not usually cause leg numbness and mild loss of bladder control in adulthood.

ii.                  Meningocele: it represent the moderate form of the spine bifida. Here, meninges (the flexible covering) that surrounds the spinal cord bulges through an opening in the back of the child at birth.

iii.                Meningomyelocele: it represents the most common and most severe form of spine bifida. Here a sac like structure that contain spimnal cord membranes spinal fluid and a portion of the spinal cord protudes over the spinal column. The condition carries a high risk of paralysis and infections as the broken area of the spinal cord possesses no skin to protect it. Surgery is needed soon after the birth to close the spinal opening and to prevent further danmage and possible infection, but this cannot help in repiaring the nerve damage. A meningomyelocele is often destined to have the paralysis of the lower limbs like legs of the anal and bladder sphineters because of the nerve damage.

CAUSES OF SPINA BIFIDA

The causes of spinal bifida is not known as at now. But it is possible that viruses or other yet unidentified noxious agents could be responsible for such abnomality.

IDENTIFICATION OF SPINA BIFIDA

The defect may occur anywhere from the back of the head to the lower end of the spine. The resulting damage to the nerves generally causes paralysis and/or lack of sensation below the site of the defect.

EDUCATIONAL IMPLICATION OF SPINA BIFIDA

Undoubtedly, some of the children will walk independently, whereas some will need braces and yet, others will have to use wheelchair. Some may have acute medical problems that require repeated hospitalization for surgery or treatment. Lack of bowl and bladder control in some children require periodic catheterization.

It may be argued that children with perpetual and motor problems will have difficulty in subjects which required good eyes hand coordination and visuospatial skillls contructional work in mathematics, art and craft, making of diagrams and graphs in geography, handling laboratory and workshop and wood work equipments (Lewis, 1991; Osatuyi, 1996)

III.             EPILEPSY OR (SEIZURE DISORDERS): a seizure may be defined as a neurological condition of an individual when he is subjected to a spontaneous abnormal discharge of electrical impulses in certain brain cells, abd the discharge spreads nearby cell causing a disturbance of movement, sensation, behaviour and consciousness. It becomes a disorder named as seizure disorder or more commonly known as epilepsy when seizures occur chronologically and repeatedly. The cases of epilepsy are usually found in early childhood and old age and can be apparently caused by any kind of damage to the brain as a result of infections, supply of insufficient oxygen to the brain cells, physical trauma or brain Injury. The most common types of epilepsy are psycho motor seizure, petil mal seizure, and grand mal seizure.

i.                    Psychomotor seizure: It is the least severe than the other two types. Petil mal and grand mal in terms of physical consequences. It may last from 2 to 5 minutes. During this brief period, the child may be found to act out or do things with no purpose, e.g. crying or shouting unnecessarily, walking around purposelessly, smacking his lips, e.t.c. while doing these, he is almost unconscious of his unusual behaviour.

ii.                  Petit mal seizure: Now named as absence seizure, petit mal falls mid way between the psychomotor and grand mal in terms of the severity of disorder. Each petit mal seizure accompined essentially with loss of conciousness lasts for a few seconds (10 to 20). During this brief period, the child may exhibit unsual behaviour like staining blankly, flithing or blinking of eye lids, rolling of the eyes, slighthy moving his/her mouth or dropping things in the hands.

iii.                Grand mal seizures: Also known as tonic-clonic seizure, it is the most severe form of epilepsy than the other two mentioned above. It generally lasts for several minutes. In such type episode,  a child may be found to exhibit the symtoms like the following:

1.      Falling on the ground suddenly with a loud vocal cry nd stiffening of his muscles accompanised with the loss of consciousness.

2.      Violent shaking of the entire body in account of the contration and relax action of the muscles.

3.      Possibility that the saliva may be forced from the mouth, legs and arms may jerk, the bladder and bowels may be emptived, tougue bitting, laboured breathing and blue to purple colouring of the skin may result.

On account of the severity of the disorder grand mal seizures require move attention and care of the part of the care givers and class teachers particularly in the forms of knowledge and trianing required to provide first aid to the suffering children.

CAUSES OF EPILEPSY

Recurrent seizure commonly called epilepsy can be caused by almost any kind of damage to the brain. The most common causes of epilepsy are stated by Hallahan and Kauffman (1991) are lack of sufficient oxygen (anoxia), low blood sugar (hypoglycemia), infections and physical trauma.

IDENTIFICATION OF EPILEPSY

Epilepsy, a central nervous system disorder is marked by brief period of loss of consciousness, convulsion movement twitching and deep sleep. Fronting or foaming in the mouth is common. There are two major type of seizures Generalized and partial.

A generalize seizure involves the discharge of cell in a large part of the brain, while a partial seizure begins in a localize area that only a small part of the brain is involved. There are many sub type of generalized and partial seizures. Generalized or partial seizure may take many forms which may differ in duration, frequency, onset, movement, causes, associated disability and control.

EDUCATION IMPLICATION OF EPILEPSY

It may be argued that most people with seizure disorder are able to function normally, except when having seizure. Intelligence  is not directly affected by seizure disorder, so educational procedure consist cheifly of attaining knowledge of the disorder allow to manage seizures, as well as commitment to help dispel the ignorance and fear connected with seizures.

For thee rest epileptic seizure having learning and behavioural problems may result from the damage of the brain that causes other disability as well. The problems may also be side effect of anticunvulsant medication or the result of mismanagement by parent and teachers. Seizures of any type may interfere with the childs attention or continuity of his/her education. Seizure may require the teacher to repeat instruction or allow the child extra time to respond. Whereas frequent major seizure may prevent even a bright child from achieving at the usual rate (Ysseldyke and Algozzine, 1990).

IV.             HEAD INJURIES: the term head injuries represents a wide spectrum of acquired injury into the brain caused through direct blow to the head by external physical force or other causes affecting the mechanism of the brain. These may include the injuries like brain stem injury, closed head injury, cerebral hemorrhage, depressed skull fracture, injury caused by external objects like bullet, anoxia and post operative infections, e.t.c. In sever cases, they may lead to paralysis and paresis or even death on the spot. Depending upon the severity of injury. The child may get his brain damage or have excessive swellings inside the head. Since all the locomotive functions are directly related with the normal functioning of the brain, any damage to it may result into serious neurological impairment and physical disabilities.

V.                MULTIPLE SCLEROSIS: The term multiple sclerosis is referred to as an incurable progressive disease of the central nervous system that results into the destruction of the insulating material covering nerve fibres. As a consequence, it creates disturbances and defects in the message carrying mechanism to and from the brain. The physical disabilities and locomotive impairment caused by multiple sclerosis thus may include the condition like difficulty in walking, talking, seeing and grasping objects poor muscle control, weakness and fatigue, intolerance of heat and cold, e.t.c. it is one of the most common neurological disorder found in the children after 9 to 10 years of age, that is responsible for creating serious neurological impairment and disabilities. 

PREVENTIVE MEASURES FOR NEUROLOGICAL IMPAIRMENT

As a general rule, nobody like to be impaired or disabled in any way. The cases of impairment  and disabilities should be checked and controlled from their very onset and eruption. So that we can save our children from their consequences. Which among other preventive measures includes the following:

1.      For avoiding inheritance of defective psychie structure or disease responsible for the development of neurological impairment, community awareness education to be conducted to prevent consanquineous marriages.

2.      There should be adequate arrangement, public awareness and timely care of newborns, infants and children and preventive vaccines like polio doses to be administered to avoid later impairments.

3.      Health and hygiene should be properly emphasized among the children and their parents.

4.      General public should also be made conscious of the need for avoiding contamination, infection and virus spreading diseases responsible for neurological impairments.

5.      The cases of accident due to negligence, alcohol consumption and others should be minimized by following traffic rules and taking all possible preventive measures to save the children from the possible spinal cord, head, bone fractures and amputation. e.t.c.

6.      Proper care of the mother should be taken during pregnancy, at the time of delivery for preventing congenital malformation and disabilities.

7.      There should not be any delay in providing first aid, diagnostic measures or necessary medical treatment to the cases of head and spinal cord injuries, fractures of the bones, viral diseases and illness, so that the further damage of any kind may be avoided or minimized to possible extent.

CONCLUSION

As it has been stated at the start of this paper, that Neurological impairments are a group of disorders that primarily relate to the central nervous system comprised of the brain and spinal cord. This is because, the brain is regarded as the control centre of the body. It is believed that when something goes wrong with the brain, undoubtedly, something happens to the physical, emotional or mental functions of the organism.

         However, it is also a decided fact that whatever prevention we take, the cases of neurological impairment cannot be altogether ruled out, but can only be minimized. Since they are bound to exist, we have to seek possible alternatives and measures for their adequate treatment, education and welfare for controlling and reducing their disabilities, providing them adequate educational opportunities and help them in their adjustment to the world of work and living.