PEARLS

■ Most adults with early-onset disabilities are healthy with aging. Significant or acute loss of function should not be expected, and evaluation must ensue.

■ Adults with early-onset disabilities view themselves as healthy, although this is dependent on the num­ber of health conditions.

■ Urinary/renal issues for adults with childhood-onset SCD are of primary concern. However, management of pressure ulcers and lymphedema can be most problematic.

■ Consider newer tone management options to manage pain or improve function, with concomitant therapy. With decreased tone, additional focused therapy can improve function.

■ Pain is common in adults with childhood-onset disabilities. All pain is not arthritis, and there can be many etiologies. Never miss the oppor­tunity to question, evaluate, diagnose, and treat. Although most pain is musculoskeletal in origin, if there is no improvement, consider neurologi- cally based etiologies, such as stenosis, tethering, or entrapments.

■ Exercise can improve performance, and any per­son with a disability can participate, with modifi­cations. Do not just consider therapy—home- and community-based programs can be effective.

Best Resources

Alexander LM, Bullock K, Maring JRPT. Challenges in the recognition and management of age-related con­ditions in older adults with developmental disabili­ties. Topics in Geriatric Rehabilitation: Aging With a Developmental Disability. 2008;24:12-25.

Dicianno BE, Kurowski BG, Yang JM, et al. Rehabilitation and medical management of the adult with spina bifida. American Journal of Physical Medicine & Rehabilitation. 2008;87:1027-1050.

Field MJ and Jette A, eds, Institute of Medicine (IOM).

Janicki MP, Davidson PW, Henderson CM, et al. Health characteristics and health services utilization in older adults with intellectual disability living in community residences. J Intellect Disabil Res. 2002;46:287-298.

Kemp BJ, Mosqueda L, eds. Aging with a Disability: What the Clinician Needs to Know. Baltimore, MD: The Johns Hopkins University Press;2004.

American Paraplegia Society. J of Spinal Cord Med. 2002;24(4).

Tosi L, Maher N, Moore DM, Goldstein M, Aisen ML (editors). Adults with cerebral palsy: papers pre­sented at a workshop to define the challenges for treating and preventing the secondary musculoskel­etal and neuromuscular complications in this rap­idly growing population. Developmental Medicine & Child Neuro. 2009;51(Suppl. 4).

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