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group_3_presentation_2_-_fetal_alcohol_spectrum_disorder_fasd [2016/11/04 18:00] sharms64 |
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| There has been no clear-cut mechanism of action for the development of FAS, but there have been many different proposed mechanisms that have been tested. Proposed biochemical issues have included abnormal prostaglandin metabolism, chromosomal alterations, placental dysfunction, hypoxia, interference with protein synthesis, alter growth signaling, interferences with neurotransmitter production which can result in neuroendocrine abnormalities and modification of enzymes with control glycogen synthesis and degradation.<sup>[14]</sup> | There has been no clear-cut mechanism of action for the development of FAS, but there have been many different proposed mechanisms that have been tested. Proposed biochemical issues have included abnormal prostaglandin metabolism, chromosomal alterations, placental dysfunction, hypoxia, interference with protein synthesis, alter growth signaling, interferences with neurotransmitter production which can result in neuroendocrine abnormalities and modification of enzymes with control glycogen synthesis and degradation.<sup>[14]</sup> | ||
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| + | {{:venn_dia.jpg|}} | ||
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| + | **Figure 4**: The effects of alcohol on the fetus | ||
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| ===== Growth of Fetus and Malnutrition ===== | ===== Growth of Fetus and Malnutrition ===== | ||
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| - | **Figure 4**: Immunofluorescence showing the effect of pre- natal exposure to ethanol on intermediate filaments of radial glial in primary culture (A) control cells; (B) cell prenatally exposed to alcohol. As shown, exposure to ethanol alter both the intermediate filament pattern (shown with arrows) and the morphological transformation of radial glial cells into astrocytes. | + | **Figure 5**: Immunofluorescence showing the effect of pre- natal exposure to ethanol on intermediate filaments of radial glial in primary culture (A) control cells; (B) cell prenatally exposed to alcohol. As shown, exposure to ethanol alter both the intermediate filament pattern (shown with arrows) and the morphological transformation of radial glial cells into astrocytes. |
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| ===== Neural Development ===== | ===== Neural Development ===== | ||
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| Ethanol has multiple cellular targets in the nervous system, which is one of the reason for many different proposed mechanisms.<sup>[16]</sup> Ethanol exposure causes oxidative injury, induction of apoptosis, suppression of neurogenesis, and disruption of cell-cell interactions.<sup>[16]</sup> There are certain areas of the developing central nervous system that appear to be more susceptible to defects caused by prenatal alcohol exposure. These areas include the ocular system, corpus callosum, basal ganglia and cerebellum. Ethanol causes damage to the neural stem cell progenitor pools that produce neurons and the supporting glial cells in the CNS. Defects to these cell can result in a decrease in their volumes leading to the structural abnormalities which affects the developing CNS.<sup>[15]</sup> | Ethanol has multiple cellular targets in the nervous system, which is one of the reason for many different proposed mechanisms.<sup>[16]</sup> Ethanol exposure causes oxidative injury, induction of apoptosis, suppression of neurogenesis, and disruption of cell-cell interactions.<sup>[16]</sup> There are certain areas of the developing central nervous system that appear to be more susceptible to defects caused by prenatal alcohol exposure. These areas include the ocular system, corpus callosum, basal ganglia and cerebellum. Ethanol causes damage to the neural stem cell progenitor pools that produce neurons and the supporting glial cells in the CNS. Defects to these cell can result in a decrease in their volumes leading to the structural abnormalities which affects the developing CNS.<sup>[15]</sup> | ||
| Oxidative stress is one of the proposed mechanism that plays a part in ethanol-induced cell damage, cell death and nervous system dysfunction that is observed in FAS.<sup>[17]</sup> Studies have shown that ethanol produces and increase in oxidative stress in the developing brain through two mechanisms: the inductions of reactive oxygen species generations, and decreasing the amount of efficient endogenous-antioxidant systems. | Oxidative stress is one of the proposed mechanism that plays a part in ethanol-induced cell damage, cell death and nervous system dysfunction that is observed in FAS.<sup>[17]</sup> Studies have shown that ethanol produces and increase in oxidative stress in the developing brain through two mechanisms: the inductions of reactive oxygen species generations, and decreasing the amount of efficient endogenous-antioxidant systems. | ||
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| + | <box width classes round white centre| **The effects of ethanol**> {{:{{{{:blah_the_return.jpg|}}</box| Figure 6: The figure illustrates how ethanol will affect the brain development.> | ||
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| Glial cells and their connections with neurons play an essential role during the development of the nervous system. Experimental evidence has shown that in utero ethanol exposure causes structural and functional defects in gliogenesis and in glial-neuronal interactions. This suggests glial cells having a potential role in alcohol- induced abnormalities in the developing brain.<sup>[18]</sup> Data from Guerri et al. demonstrated that in utero ethanol exposure affects the morphology of radial glia in culture and significantly depresses the expression of glial fibrillary acidic protein in fetal brain development. Other research has helped to support the conclusion that radial glial is among the primary targets for ethanol toxicity. With regards to the structures of the brain, the corpus callosum is initially formed by radial glial that support the growth of axons from one side of the brain to the other. The alterations in the radial glial caused by ethanol exposure would explain the structural abnormalities found in the corpus callosum and why it is one of the areas high susceptible to ethanol toxicity.<sup>[18]</sup> | Glial cells and their connections with neurons play an essential role during the development of the nervous system. Experimental evidence has shown that in utero ethanol exposure causes structural and functional defects in gliogenesis and in glial-neuronal interactions. This suggests glial cells having a potential role in alcohol- induced abnormalities in the developing brain.<sup>[18]</sup> Data from Guerri et al. demonstrated that in utero ethanol exposure affects the morphology of radial glia in culture and significantly depresses the expression of glial fibrillary acidic protein in fetal brain development. Other research has helped to support the conclusion that radial glial is among the primary targets for ethanol toxicity. With regards to the structures of the brain, the corpus callosum is initially formed by radial glial that support the growth of axons from one side of the brain to the other. The alterations in the radial glial caused by ethanol exposure would explain the structural abnormalities found in the corpus callosum and why it is one of the areas high susceptible to ethanol toxicity.<sup>[18]</sup> | ||
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| - | ====== Types of Treatment ====== | + | ====== Other Types of Treatment ====== |
| - | * There are generally five categories of treatment for patients that have FASD, including: medical care, medication, behaviour and education therapy, parent training, and alternative approaches. | + | |
| + | ===== Introduction ===== | ||
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| + | Similar to many other disorders those with FASD will be affected very differently thus treatments will have to be very specific to that person. Therefore, a treatment that may have worked for one patient with FASD may not necessarily work for another patient. As of today, there is still no treatment that will cure FASD however, through research it has been found that early intervention treatment services can help with a child’s improvement in development.<sup>[22]</sup> Early intervention services, such as therapy, are designed to help children at risk or with FASD from birth to 3 years of age, to help the child speak, walk, and interact with others.<sup>[23]</sup> | ||
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| + | ===== Protective Factors ===== | ||
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| + | Through studies it has been shown that there are protective factors which help to reduce the effects of FASD and also allow those affected by FASD to reach their full potential.<sup>[22]</sup> These factors include: | ||
| + | * early diagnosis | ||
| + | * involvement in special education and social services | ||
| + | * having a loving, nurturing, and stable home environment | ||
| + | * absence of violence | ||
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| + | All of these factors provide benefits such as: being able to better understand the child, allowing the child and their family to have more positive experiences, and prevent the child from developing secondary conditions (e.g. criminal behaviour, lack of education, and unemployment).<sup>[22]</sup> | ||
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| + | * There are generally five categories of treatment for patients that have FASD, including: medical care, medication, behaviour and education therapy, parent training, and alternative approaches.<sup>[22]</sup> | ||
| + | </style> | ||
| ===== Behaviour and Education Therapy ===== | ===== Behaviour and Education Therapy ===== | ||
| - | * Good Buddies: an intervention that uses a group setting to teach children with FASD appropriate social skills for their age group. | + | * Good Buddies: an intervention that uses a group setting to teach children with FASD appropriate social skills for their age group.<sup>[23]</sup> |
| - | * Families Moving Forward (FMF): an intervention intended to provide support for children displaying more severe and significant behaviour problems. | + | * Families Moving Forward (FMF): an intervention intended to provide support for children displaying more severe and significant behaviour problems.<sup>[24]</sup> |
| - | * Math Interactive Learning Experience (MILE): an intervention that helps to improve the child’s mathematical knowledge and skills because it is a consistently reported deficit of children with FASD. | + | * Math Interactive Learning Experience (MILE): an intervention that helps to improve the child’s mathematical knowledge and skills because it is a consistently reported deficit of children with FASD.<sup>[25]</sup> |
| - | * Parents and Children Together (PACT): an intervention that focuses on improving behaviour regulation and executive functions which include planning, organizing, and understanding. | + | * Parents and Children Together (PACT): an intervention that focuses on improving behaviour regulation and executive functions which include planning, organizing, and understanding.<sup>[26]</sup> |
| - | o Although there are multiple therapies these have been scientifically studied and have been effective in children. | + | |
| + | Although there are multiple therapies these have been scientifically studied and have been effective in children. | ||
| ===== Parent Training ===== | ===== Parent Training ===== | ||
| - | * This is often a program offered by therapists to educate parents about their child’s disability and providing different approaches to interact, engage, and teach their children. | + | * This is often a program offered by therapists to educate parents about their child’s disability and providing different approaches to interact, engage, and teach their children.<sup>[22]</sup> |
| - | * Some tips include: concentrating on the child’s strength, being consistent with everything, and accepting the child’s limitations. | + | * Some tips include: concentrating on the child’s strength, being consistent with everything, and accepting the child’s limitations.<sup>[22]</sup> |
| ===== Alternative Approaches ===== | ===== Alternative Approaches ===== | ||
| - | These are untested therapies that are also provided to assist with FASD. | + | These are untested therapies that are also provided to assist with FASD.<sup>[22]</sup> |
| * Biofeedback | * Biofeedback | ||
| * Auditory Training | * Auditory Training | ||
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| [21] Wozniak, J. R., Fuglestad, A. J., Eckerle, J. K., Fink, B. A., Hoecker, H. L., Boys, C. J., ... & Zeisel, S. H. (2015). Choline supplementation in children with fetal alcohol spectrum disorders: a randomized, double-blind, placebo-controlled trial. The American journal of clinical nutrition, 102(5), 1113-1125. | [21] Wozniak, J. R., Fuglestad, A. J., Eckerle, J. K., Fink, B. A., Hoecker, H. L., Boys, C. J., ... & Zeisel, S. H. (2015). Choline supplementation in children with fetal alcohol spectrum disorders: a randomized, double-blind, placebo-controlled trial. The American journal of clinical nutrition, 102(5), 1113-1125. | ||
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| + | [22] CDC. (2016, October 04). Fetal Alcohol Spectrum Disorders (FASDs). Retrieved from http://www.cdc.gov/ncbddd/fasd/treatments.html | ||
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| + | [23] O’Connor MJ, Frankel F, Paley B, et al. A controlled social skills training for children with fetal alcohol spectrum disorders. J Consult Clin Psychol. 2006;74(4):639–648. | ||
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| + | [24] Carmichael Olson H, Leavitt S. Families Moving Forward. Platform Presentation on October 23, 2010. FASD Fall Conference at Emory University, Atlanta, GA | ||
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| + | [25] Kable JA,Coles CD,Taddeo E. Socio-cognitive habilitation using the math interactive learning experience program for alcohol affected children. Alcohol Clin Exp Res. 2007; 31: 1425-1434. Bertrand J, Floyd L, Chasnoff I, Wells A, Bailey G, et al. Interventions for children with fetal alcohol spectrum disorders (FASDs): Overview of findings for five innovative research projects. Res Dev Disab. 2009;30(5):986–1006. | ||
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| + | [26] Wells, A.M., Chasnoff, I.J., Schmidt, C.A., Telford, E., & Schwartz, L. (2012). Neurocognitive habilitation therapy for children with fetal alcohol spectrum disorders: An adaptation of the Alert Program®. American Journal of Occupational Therapy, 66, 24-34. | ||
