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Toilet Training Children with Moderate-Severe Disability PowerPoint Presentation

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Published on : Aug 03, 2021 | Views : 1223 | Downloads : 0

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Slide 1-

Toilet Training Children with Moderate-Severe Disability Lisa Samson-Fang MD University of Utah and Salt Lake City School District
Slide 2-

Objectives Background/ literature Practical programming Supportive equipment Adolescent issues
Slide 3-

Can This Child Be Toilet Trained? Case I 5 year old autism no functional verbalizations assistance for ADLs. finger feeds. Social quotient (Vineland Social Matuirty Scale) 0.36. Case II 7 year old total body involved CP cognitive impairments Communication: differential cries and eye gaze.
Slide 4-

Is this an important goal? Impacts on independence caregivers
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Impacts In the institutional setting. Incontinence reduced Decreased linen usage Work load minimally decreased. Therapeutic vs. Custodial role Positive impacts in other areas of self care Not studied in the home or school setting.
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Important? Removes negative impacts on social interactions Increased freedom in more environments Privacy
Slide 7-

Who’s Job Is It??
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The child with disability Not just an adaptation of the process used for “the typical toddler”
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Cognitive Impairments Understanding goal Attention Initiation Impulse control Generalization
Slide 10-

Birth Cohort Follow-up Wendt et al. Information available on 105 of 132 individuals with mental retardation. Bowel continence. 70% by age 7 and 80% by age 20. Bladder continence. 63% by age seven, 83% by age 20.
Slide 11-

Autism Social motivation Language Sequencing/attending Routine changes The diaper is a routine Sensory Sensation – function Sensory overload Enjoyment of product
Slide 12-

Survey of Parents Dalrymple et al. Overall results Training required urine 1.6 yrs bowel 2.1 years Start at 4-5 years 95% successfully trained 78% self initiated Common issues Regression Night incontinence Constipation Behavioral concerns
Slide 13-

Cerebral Palsy Motor Issues Mobility Safety Upper extremity function Medical issues Chronic constipation Neurogenic bladder
Slide 14-

Preschool children with CP Shaw Population n = 27 2.5 - 4 years old Results 6 dry at entry 7 immediately dry 12 achieved 2 wet Factors in success Higher expectations Routine Shared aim w/ peers More appropriate toilets Access to PT/OT advice
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CP: Neurogenic Bladder McNeal et.al. 30% prevalence of symptoms Enuresis Stress incontinence Urgency Frequency Dribbling Difficulty urinating History of a UTI.
Slide 16-

Urologic Findings Decter et al. Referred population for symptoms Significant findings - 86% Uninhibited contractions Detrusor-sphincter dyssynergia Small capacity bladder Bladder hypertonia Periodic relaxation of the external sphincter Improved w/ treatment - 78%
Slide 17-

Constipation Bowel training difficult unpleasant. Affects bladder Lower volume Uninhibited contractions Optimize treatment Monitor for recurrence
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Multi-modal Treatment Nickel and Desch Positioning and seating Behavioral issues Dietary changes Cleanout procedure Maintenance medications Emptying program
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Note: The behavioral protocols discussed are not intended for the achievement of continence in individuals who lack bowel and bladder control (e.g., individuals with spinal cord lesions).
Slide 20-

The Literature Populations: Cognitive disability, autism, physical disability Settings: Institutional, school, home Designs: Case studies/ small cohorts
Slide 21-

The Literature Methods: Timed and Regular Group vs. Individual Goal: Trained vs. Conditioned Degree of independence Attainment of “sub-skills” Generalize to other situations
Slide 22-

Most Replicated Azrin and Foxx Induce frequency Timed toilet sitting Positive reinforcement Dry pants checks Minimal assistance/prompt for dressing/ faded Modeling Pants and potty alarm devices Verbal reprimand-cleanliness training
Slide 23-

Comparing Methods Smith Individualized regular potting Monitor child’s rhythms Toilet when high probability Stimulus to void is full bladder Arbitrary timed potting: Set schedule Stimulus to void is toileting routine
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Slide 25-

Comparing Methods
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Preschool Setting Richmond Frequent potting (q15minutes faded to q 2 hours over 1 month) Praise, liquid rewards Brief reprimand and simple correction Self initiation not a goal 4 children 4.5 hours / day No equipment Otherwise no change in classroom routine
Slide 27-

Weekly Accident Rates
Slide 28-

Is continuity important Dunlap et.al. 3 children with Autism (5-7 yrs) 1 new to toileting, 2 w/ 2 years of no success Baseline training program in 1 environment vs. training in ALL environments.
Slide 29-

Results
Slide 30-

Alarms
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