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Moderate:10% (IQ of 36-51)Severe:3-4% (IQ of 20-35)Profound:1-2% (IQ of 19 & Bellow) identified early b/c baby’s developmental benchmarks Principles of supported employment:job coaching is faded to minimal levels,Stable at 20% of work hours per month for 2 months.Visual impairments:functional disturbances in vision affecting field of vision, color perception.Persons with visual acuity from 20/70 to 20/200. Legally blind 20/200 in best eye with corrected vision,or <20% visual field (norm is 140 – 160).causes of visual impairment:Diabetic retinopathy:#1 cause in U.S. 80% juvenile diabetes experience diabetic retinopathy w/in 15 yrs. Glaucoma:increased intraocular pressure from a malformation/malfunction of eye’s drainage struc. Vision loss progressive and permanent. Macular degeneration:hardening of the arteries that nourish the retina,common cause of vision loss in ppl 50 & older.Adjusting to loss of vision(braille)easier at young age.Adaptation difficulties w/ some sight vs totally blind due to:Embarrassment (trying to pretend to see)tripping/odd behavior,Fear of further sight loss. Treatment of PTSDAnti-anxiety/antidepressants, Narrative exposure therapy, electric therapy, emotional focus therapy(talk about trauma) Cognitive therapy,to treat avoidance.Prolonged exposure helps person confront and learn to cope with it. Increase PTSD risk: Living through traumas (natural disasters,war, assault,abuse, rape).Women are 4x more likely to develop PTSD, b/c increased risk of experiencing violence, trauma. Characteristics of PTSD:Re-experiencing (Flashbacks, Intrusive Memories),Avoidance and Emotional Numbing,Hyper-arousal,Negative thoughts and beliefs.Two specifications:Dissociative Specification: experiences high levels of either of 1)Depersonalization.Experience of being an outside observer of or detached from oneself (feeling in a dream).2)Derealization.Experience of unreality, distance, or distortion (e.g., “things are not real”). Delayed Specification:at least six months after the trauma(s), although onset of symptoms may occur immediately.PTSDAbout 7-8 out of every 100 people (7-8% of pop) will have PTSD.8 million adults have PTSD. 10/100 women (or 10%) PTSD.4/100 men (or 4%). Women are less likely to experience trauma than men. 1 in 3 women will experience a sexual assault. sex assault higher 4 women. Women more likely to see trauma.Vets health care:23/100 women (23%) report sex assault in military.55/100 women (55%) and 38/100 men (38%)experience sex harass in military.More men Vets than fem. Half of all Vets with military sexual trauma are men.Criterion A:1 stressorperson exposed to death, serious injury, sex violence:Criterion B intrusion symptoms 1:traumatic event is persistently re-experiencedCriterion C: 1 avoidance:Avoidance of trauma:Criterion D: 2 negative alterations in cognitions and mood:Negative thoughts worsened after traumaCriterion E:2 alt in arousal/reactivity(difficulty sleeping/concentrating, destructive behavior)Criterion F: duration(required)Symptoms last more than 1 month.Criterion G: (required)functional significance:Symptoms create distress or functional impairment (e.g., social, occupational).Criterion H: (required) exclusion:Symptoms are not due to medication, substance use, or other illnessAmputation:Disarticulation:through the joint.Closed amputation:create a stump that can be effectively used for prosthesis.Minor amputations:on foot below the ankle joint(toes,bones in foot)Major amputations:above the level of either the wrist or ankle.Shoulder disarticulationAbove elbow.Elbow disarticulation:Below elbowWrist disarticulation:Partial handHemi corpectomy (above hip)Hip disarticulationAbove the kneeKnee disarticulationBelow the kneeSyme (ankle)Partial footCauses of amputationDiabetes,Vascular disease or vascular accident,cardiovascular disease,Bone cancer and tumors (osteogenic sarcoma)Trauma leading to amputation (corn husking/ corn belt),Combat,Vehicle AccidentsElderly people falls/disease InfectionCongenital AbnormalitiesRisk factors for amputationEdema(swelling),Ulceration,Bony overgrowth,,Neuromas (nervefibers),Hyperesthesia:extreme sensitivity of the stump.Prosthetics:Durability, weight, speed vs strength,Lack of sensory feedback,Energy used,lasts about 2-5 years depending on activity level and rate of grown for youths,More proximal amputation the more difficult to fit/control. Heavier is more debilitating.more distal the amputation site, doesn’t’mean more utility, Tech malfunctionadjustment to amputation,Ages 20-50 most likely to work, Education, Prior work history,Adjustment, Males more likely to return to work than females,Higher levels of amputation less likely to return to work,Lower limb amputation ~ 66% return to work rate,Kids adjust better than adults,Living with a Unilateral amputation easier to live/work with than a Bilateral amputation