Client with Mental Retardation

[Phillygryl, LPN]

I have a case with a client who has Soto's Syndrome and Mental Retardation. I do not know why, but this client gets very agitated and bites the back of his hands (knuckles) and his lower arms. Is there anything that would help prevent this. I don't know if the mother would be amenable to him wearing gloves. I suggested today that we bandage his knuckles and I did not get a favorable response. What can I do?

[leslie :-D]

intellectual impairment with behavioral problems, is all too common amongst this population.

http://en.wikipedia.org/wiki/Sotos_syndrome

what type of meds is he on?

leslie

[txredheadnurse, BSN, RN]

I've worked with DD clients for a long time and have seen just about every type of SIB (self injurious behavior) you can imagine. The hand and arm biting are sometimes learned behaviors to solicit attention and/or express frustration, anxiety or irritability. The trick with any SIB is discovering what needs aren't being met such as hunger, pain, need to go to the bathroom, etc. or anxiety over a change in routine and surroundings or painful stimuli. Then you need to address those needs and, hopefully, there will be a decrease in the SIB. Please remember all behavior serves a purpose; the challenge lies in discovering the purpose.

It can also be a self stimulatory behavior in the same fashion that I will play with a paper clip or twirl a pen if I am working on a problem or feeling a bit anxious. And, frequently, it serves multiple purposes at once. The reality is SIB is nearly impossible to totally extinguish. The goal is decrease the frequency and severity by behavioral interventions and meeting the needs the client is attempting to communicate to their caregivers. Medications can also help decrease the SIB but only by inducing sedation will meds stop them. By sedation I mean to such an extent that the person is basically "knocked out".

Applying mittens or rigid arm splints are generally a last resort since they tend to increase the level of agitation. I have only used those when the only remaining options were constant 1 to 1 supervision with physical blocking (which is nerve wracking for both caregiver and client) or sedation. I know it can be a frustrating issue to deal with but try to view it as a clue to an unmet need(s). I sometimes felt my direct care staff were much more stressed out by head banging or hand/arm biting than the client doing the SIB was. It is a flawed method of communication but it is not a random act.

[Flare, ASN, BSN]

to add to what the pp wrote, learning what promps the SIB is the overall goal, but it can be a lorg journey getting there, especially if your client isn't verbal or has limited verbal skills. Redirection to a known soothing activity can be helpful. Gloves, slpints ect can cause agitation. Before you go that route for aversion therapy, consider trying an aversive substance - perhaps a lotion that leaves an undesired after taste or an a and d ointemnt that leaves the skin smooth - as some may be biting hands to try and fix the jagged patched from previous SIB.