Table 1.

Tips for physical examinations and investigations in patients with IDD

PrepareAsk caregivers to outline the steps of the procedure in advance by using a picture schedule or other communication tool
DesensitizeDesign protocols (eg, a home kit including a tourniquet, alcohol swab) to safely practise some of the steps of a procedure. Include parts of a basic physical examination in every office visit to build familiarity with procedures
ModelModel the desired physical examination movement and encourage the patient to imitate it. Alternatively, replicate the desired movement indirectly by having the patient reach for a favourite object or mimic a known routine (eg, arms up to take off a shirt)
De-stress the environmentMake sensory-calming items available to the patient and minimize common sensory insults such as loud noises or fluorescent lighting. Allow time to accommodate to the clinic room before entering
Use sedation mindfullySedation, such as low-dose sublingual lorazepam, can facilitate examination or investigations. Complete a trial dose at home some time before the actual procedure. Owing to lack of understanding and anticipation of the sedative effect, patients with IDD might be alarmed at the feeling of sedation and react with agitation before becoming calmer. If a general anesthetic is planned for one reason (eg, an eye examination), consider trying to do bloodwork and other tests at the same time
Use alternativesUse alternative tests when positioning of the patient is an obstacle. For example, use arm span to estimate height measurement for a patient who is unable to stand or distal one-third radius bone density for a patient with hip contractures or scoliosis who cannot have testing at femoral and lumbar sites
  • IDD—intellectual and developmental disabilities.