NOTES:
DAY 1 NOTES
WORK DIVISION IN PREPARING REPORTS
1.AUDIOLOGY/SPEECH LANGUAGE PATHOLOGY-Ashi Susan Kuriakose-Leader, SPEECH AND LANGUAGE sessions,Abidamol P-Leader ,LINGUISTICS sessions
2.CLINICAL PSYCHOLOGY-Jayasree KG-Leader,PSYCHOLOGY sessions,
3.NUROLOGY-Jasni. M P , Leader ,NUROLOGY sessions, Joint Leader, Team Internship
4.PHYSICAL MEDICINE AND REHABILITATION UNIT-.Preethy.S.L -Leader ,PHYSIOTHERAPY sessions,Radhakrishnan C K ( TEAM LEADER)
5.SPECIAL EDUCATION SCHOOL-Sulochana P.S.-Leader , SPECIAL EDUCATION sessions
URGENT MESSAGE :PLS SEND AN OUTLINE OF REPORTS mainly on the sessions allotted for you ( neatly handwritten/typed)on the FIRST DAY BEFORE 30-10-2021.
1.PSYCHOLOGY :
Postings for observations
Case 1:
Doctor ANIL and KARTHIK :4 years-babbles- does not focus -sits in a closed chair-typical autism--normal upto 3 years-the doctor keeps touching and holding the child by hand and speaks softly(to get him focussed)--uses bigger dolls and coloured rings - gives loud, clearcut emphatic instructions as if you were guding an elephant.-
starts playing with differently coloured rings placing back in around a an iron stick.- the boy loses attention intermittently- the doctor keeps touching and holding the child by hand and speaks softly(to get him focussed)-when the child finshes placinga ring the doctor says "good boy" as reinforcement/ compliment.The doc touches the rings and counts each ring seperately aloud .
GAME 2
2.SQURE BOXES REPLACEMENT GAME - placing and replacing the buliding squares of the same colour- the activities repeated with different colours
3.the doctor askas the boy to call his mother- the boy just looks at the door.( inattentive, yawns , shakes his knees and bables)
4. mother enters , the doc continues a game of throwning a ball with the child - mother seems to feel happy with the child )
doc - "yes . now he sits for a while and have started doing things "
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GEN ORIENATION -Jayasree,JASNI,those who
actually participated in the session.
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GEN ORIENTATION DONE BY DR MALINI ( Ph.D in Dyscalculia)
About ICCONS @TVM :
-started@1998 , services - provides clinical assessment , courses to create manpower, centre for research studis as continuation of the research wing @ SREECHITHRA .-initiated by DR.SURESH
***6-10 % OF children are having LD .
--nurological cae fo children -often neglected - are handled here.
---a multidisciplinary approach is used to normalise the children with autism / C P/ LD
---ICCONS @ shornur GIVES IMPORTANCE TO GENETIC RESEARCHES - UNDP project- started 2005-
courses @ ICCONS
- MEANT FOR (a) MINIMAL MANAGEMENT OF LD ,(b) for training resource persons (c) courses in BSC , MSC, ...affiliated to CUHAS
PATHOLOGY
works as a referral hospital
referred by hospitals like CDC, NISH , /PHCs...
- THE PATIENT is directed for evaluation and training at the psychology/ nurology/ speech pathology/ special education / linguistics department
-Diagnosis done according to ICD 10 / DSM format : criteria / symptoms / presentation
- testing ; various SCREENING DEVICES - tests adaptive funtioning
ON SCREENING TOOLS / PROCEDURE
-SLD - uses own material to assess and train---curriculum baesd tests also used - test of adaptive abiity (NIMHANS ) - REVISED
- WISC ( MATH MEMORY TEST)
-process of identification done to find out whether SLD or not - diagnostic tools - certification using NIMHANS INDEX-
-DSM-5 largely used
on different cases
service of nurologist employed -
to discriminate between thyroid / related disorders /
-describes how SLD IS DIFFERENT FROM other conditions
CASE BY CASE INTERVENTIONS EXAMPLES
1.LD-with primay , secondary behavioiral issues
2.ADHD-addressing restlessness ...behaviour therapy
Cognitive Retraining
profiling- problem identification-designing exercises- monitoring progress
Remedial teaching -eg: in reading comprehension
linguistics evaluation and training
SLD - parental counselling
autistic traits to be identified
case 1 : 35 % MR , AUTISTIC , tratment for 10 years without much improvement-life skill traing done-
work atmpshere :
collaborative- team work-
special education wing - LD CONSULTATION ON SATURDAYS-teaching in other work days - now online classes b/c covid restrictions .
reasearch realated -international conferences -
assessment is- based on experiences - parental involvement important-caseas from sreechithra referre to here- a recent awareness only of 10 years on SLD-
TRAINING PROGRAMMES FOR TEACHERS -
45 MINUTES POSTINGS SESSION INCLUDED IN THIS internship programme
- reference to MAGIC PALNET as a training programme for parents
- vocational traing can be done for autistic children eg ; how to run a shop
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2.SPEECH AND LANGUAGE PATHOLOGY-Ashi Susan Kuriakose,Abidamol P/ those who actually participated in the session.
CLASS BY MISS DIVYA ( MASTERS IN SPEEECH AND PATHOLOGY)
Errors in conversation- fluency errors and non fluency errors.
STUTTERING
approach towards accidental stutterring- need not highlight the occurancesstutterring -
normal stuttering - therapy technics used
- anxiety issues can be a cause for stuttering
- nurological reasions like stroke can induce stuttering
CLUTTERING
- just the opposite of stuttering-
- various kinds of speech sound disorders--(1 )പശു pronunced as പയു (2)cleft issues-(3) paletting ( cured by surgical procedures)(4) tongue tiedness ( surgical procedure)-after surgery therapy-pronunciation training- functional abnormalities like കൊഞ്ഞി പറയൽ
Developmental Disorders :
child language and disorders-
Autistic and ADHD-
LANGUAGE-age receptive, expressive
Those with behavioural issues are sent to psychological evaluation and procedures. only after the child becomes trainable , language training is effected.
-home training is important
issues related to ADHD /MR/ LANGUAGE / CP / DOWN SYNDROME are treated here.
aphasia-after a stroke/ verbal sounds which cannot be comprehended -auditory / fluency
aphasia battery test- one year assesment-
aphasia -difficult to cure
dysarthria - speech - dysphagia- swallowing therapy-adult after stroke : language issues: verbal , non verbal
adult stuttering-nurogenic stuttering- retardation -
LD ASSESSMENT- finds language age-tests in syntax, symanetics, pragmatics,coordiation of phonemens and graphemes...
begins with pronun.. of sounds, rhyming words, short sentences, ..
Testing audio
Audio meter- sound proof-hearing aid - sound recognition
children - by birth
voice disorders- breathy/harsh/hoarse( take breath- use actions -stand in the middle )--online training is done
3.LINGUISTICS-Ashi Susan Kuriakose,Abidamol P/those who actually participated in the session.
4.PHYSIOTHERAPY-Preethy.S.L ,Radhakrishnan C K /those who actually
NOTES BY CKR 26102021
LOCOMOTOR DISABILITY-The role of physiotherapy cases
cases : mainly due to CP/ injuries to spine / muscular dystrophy /
reasons : accidents / heredity / birth defects / lack of pegnancy care / feeding problems.
issues :balance and coordination problems.
Epilepsy can cause similiar issues.( The director of this centre has doctorate on Epilepsy)
follow up in fits may conttinue even after 20 years...
DYSPRAXIA-hand eye coordination issues,
fine motor coordination, gross motor coordination
equipments . methods used-
balance beam ,ramp walking, stepline, treadmill, sidevorad walking ,motorised tilting table , balance game
most cases - related to CP
CAUSES
BIRTH realated , pregnancy related,after meningitis , ....issues usually before 2 years of age
cases
severe spastic pregnancy....( incomplete sentences )
training methods- flag jumping, star jumping
sensory integration therapy:
: 8-12 weeks
westblot sensation test used - sensory integration problems in 30 % of autism cases- VARIOUS PHOBIAS present - tested using sensory integration protocol @NISH-
issues usually identified at schools -some children are tactile sensitive - like --dislike for wet objects , use of oil , visual issues,
Training Methods
- clay mixing, flour mixing, velvet touching
case examples - a 4 year boy with coordination trouble -treated for many years here- till his graduation -
-visual perception problems - colour / shape / taking letter cuttings / ..
-familiarising with traffic parks /obstruction created settings /..
expnais the use of gim ball / exercise ball
- used for trunk balancing for children with CP / USEFUL FOR SHAPING YOUR BODY
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ROLE OF PHYSIOTHERAPY
CP/ INJURIES OF SPINE /MD / heridety / birth defects / lack of pregnancy care / feeling problems / balance and coordination problems (1981-40%;1990- 49 %)
fits followup to 20 years
normal development : walking 11-15 months
skipping mle stones is a sgnof autism-grosss motors skills 3 to5 years
fine skills -cutting through a line
gross motor skills - 3 to 5 years
fine motor development - 2 years explained
certain students go back after 3 years ( regression = evident autism )
4 years -can a recognise a face drawn
Acquired autism by the use of negative factors like using uncontrolled TV USES / MOBILLE USES
5 YEARS-perception-propriosection
PROBLEM LIST
- can not build toy towers beyond 8 blocks
- can not hold a crayon / having problems with eating / sleepy or using bathroom / having trouble undressing / clumsy / hard to handle objects / shy ,agressive , anxious / not interested in playing with other children / overexcited / gloomy
Physiotherapy in Learning Disabilty area
dyspraxia/ IQ not affected / lacks in coordination skills / problem in learning to drive / poor eye hand coordination / problems in movement /coordination/ judgement/ cannot even wave a goodbye /problems in sensory recognition
EFFECT OF DYSPRAXIA
language problems
mind thought process
difficulty in planning a problem
problems in multiple tasks
HYPERACTIVITY
skippikng in reading / perceptional problems / w sitting positions /
less bilateral coordination , bye stepped , cross legged / side sitting / long sitting
Mobile reading posture -5 symptoms ( HARRY POTTER HERO had Dyspraxia )
1.SPIT 2. EASI 2021 NEWTES 4-12
DIAGNOSIS
devept test , assessment , 5 year growth development
Dyspraxia -identification
very early childhood ......../ early childhood-handwriting /childhood- colotuing construcion
**can not learn new cases / can be arranged through proper training / preschool age in adults
Treatment of dyspraxia
equine therapy /kinetic coordination/ different poses
5.SPECIAL EDUCATION /- Sulochana P.S. /Radhakrishnan C K /those who actually participated in the session.
Miss Sheeba :
all types handled-no spessial assessment here- after team evaluation, traing given based on learning issues- op on saturdays- therapy o for 45 minutes each- other days - regular classes and individual therapy- mostly autistic comorbidity also-
about the institiution- autonomus with govt aid-the patients here have reproted first in 1999 when the insttituition stated- of ages 30-45 years - no comprehesinve improvement during these years-kept mostly for the convenience of the parents-residential school about 2 years ago- no classes after COVID-6 children in one class - 2 male attendants
life long support centre @PALAKKAD
- Parents association working (named "Nishchintha") with the help of central government-all facilities -APARENT CAN LIVE WITH their child and get support and treatment from the community and the hospital-each prent builds a home and leaves it to the community after their demise-
back to TVM CENTRE
- vocational therapy is also part of special education-EG - FILE MAKING WITH THE HELP OF THE ATTENDERS-watering the garden-filling the pots-
+ regular schooling
Saturdays for special education
clinic op referrrals- 2-7 years; takes a marginal fee of 40-80 rupees daily
fine motor improvent -with the help of various equipments
gross motorimprovemnt - with the help of diffe type of exercises mostly bu compulsion-cannot hope fora speedy change -takes time
HYPERACTIVITY-belt +chair-45 minutes daily-
equipments observed-
fruits tray/specially shaped objects tray / tray with objects of different size , colour / models of vehicles / vegetables / number identification tray ./ boxes of numbers/ alphabets/ puzzles /
ACTIVITIES TO REDUCE HYPERACTIVITY
- mixing grains and told to seperate them
- practising writing letters
- making chains with beeds bigger sized to smaller sizes- small beeds +thread-
identifying colours- matching/ sorting/ identifying
- using picture books with giant pics
- parental support and home training is necessary to make any observable change
- eye: hand coordination activities - scribblng, tracing numbers and lines
READING ACTIVITIES
Identification of lettres -simple to complex- reading letters- writing them-
-Training in dialy life activities from simple to compex-(eg: brushing tooth: finding the brush)
-handling money upto Rs.200 / time ......
for elders >>> biodata making, list of phone numbers
--no checklists used - siblings may play a role in training
-- rate of achievement for each person is different
--vocational training is given after 18 years of age .but majic planet type training cant be done bc most of the students are autistic ( stds with down syndrome can be trained but stds with autsm can not be trained well -miss sheeba )
--- at the center 25 children belong to DALIT GROUP( 4 classes, 2 teachers, 2 attendants)
-- no special talent / abilitity observed in the present group
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ACADEMIC SESSIONS
Behavioural Aspects of LEARNING DISABILITIES
Slide presentation by Miss Malini Jayachandran
low self esteem,emotional problems,anxiety
inattention-
-not being secondary relation with parents
- comorbidities- ADHD,ODD
skill acquisition disorder-DSM-5APA2013
-cognitive remediation adjunct to medical training- clumsy , uncoordinated motor behaviour-mechanised writing
speech related behavioural issues
speech not organised,voice modulation,nonfluent,slow/fast rate of sound production
Social skill deficits of ststd less than 10 yrs
less insight/ concern for parents/anxiety in mingling with peers/rule breaking behaviour/ poor self concept
Social skill deficits of std above ,= 10 yrs
more insight/ concern for parents/anxiety in mingling with peers/rule breaking behaviour/ more self concept/ mood changes /frustration/ tolerance
Motivational aspects:school refusal / pessimistic outlook
METACOGNITIVE ASPECTS : YOUR understanding about your abilities -usually less for LD students- poor ....(awareness / planning/ ability to monitor)....inabilty to check one own ability or efficacy
COMORBID CONDITIONS
ADHD,- affects maths calcu...
prevalent in 4-10 % of population
careless mistakes / difficulty in sustaing in attention / often fails to listen / fails ti finish in school time
HYPERACTIVITY
Conduct Disorder : anti social behaviour / phy cruelty / persistent pattern of behaviour / violent / truancy
ODD
often loses temper / touchy and easily annoyed by others / anxiety disorders/ seperation anxiety disorder / persistent excessive worry /
MATHS ANXIETY
anxiety disorders / phobias ,panic attacks, social phobia , generalised anxiety disorder
DEPRESSIVE DISORDERS
dysphoric mood / suicidal ideations / low concentration
INTERVENTIONS
Individualisation - behaviour problem / cognitive processing problems -social skill training,group therapy,family therapy
Academic problems / remedial teaching
Therapy : behaviour psycho counselling
BEHAVIOUR THERAPY
Change and adaptive behaviours/ASSUMPTIONS/Behaviour can be unlearned
SOLUTIONS
assessing target behaviour/generalisation to real life settings/maintence over time
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6.SINGLE POSTINGS FOR VARIOUS DEPARTMENTS FOR OBSERVATION OF OP( write your personal experiences)
Childhood Locomotor Disorders (PHYSIOTHERAPY) sent by ASHI SUSAN KURIAKOSE
BRIEF REVIEWS:DAY 2
Today classes went well on schedule.Excellent cooperation from ICCONട.
DAY 2 NOTES
WORK DIVISION IN PREPARING REPORTS
1.AUDIOLOGY/SPEECH LANGUAGE PATHOLOGY-Ashi Susan Kuriakose-Leader, SPEECH AND LANGUAGE sessions,Abidamol P-Leader ,LINGUISTICS sessions
2.CLINICAL PSYCHOLOGY-Jayasree KG-Leader,PSYCHOLOGY sessions,
3.NUROLOGY-Jasni. M P , Leader ,NUROLOGY sessions
4.PHYSICAL MEDICINE AND REHABILITATION UNIT-.Preethy.S.L -Leader ,PHYSIOTHERAPY sessions,Radhakrishnan C K ( TEAM LEADER)
5.SPECIAL EDUCATION SCHOOL-Sulochana P.S.-Leader , SPECIAL EDUCATION sessions
1. PAEDIATRIC ASSMENT COLLECTED BY RADHAKRISHNAN
2.LINGUISTIC ASSESSMENT TOOL COLLECTED BY JASNI
3.SOCIO ECONOMIC SURVEY FORM ( USED @ REGN) COLLECTED BY ASHI SUSAN KURIAKOSE
BRIEF REVIEWS:DAY 2
4.30 hours interaction with the Director with Observation of 8 patients in his OP for Nurology. Interactive Sessions in OP section for Linguistics and psychology . Another fruitful day @ ICCON ട TVM
DAY 3 NOTES
WORK DIVISION IN PREPARING REPORTS
1.AUDIOLOGY/SPEECH LANGUAGE PATHOLOGY-Ashi Susan Kuriakose-Leader, SPEECH AND LANGUAGE sessions,Abidamol P-Leader ,LINGUISTICS sessions
2.CLINICAL PSYCHOLOGY-Jayasree KG-Leader,PSYCHOLOGY sessions,
3.NUROLOGY-Jasni. M P , Leader ,NUROLOGY sessions,
4.PHYSICAL MEDICINE AND REHABILITATION UNIT-.Preethy.S.L -Leader ,PHYSIOTHERAPY sessions,Radhakrishnan C K ( TEAM LEADER)
5.SPECIAL EDUCATION SCHOOL-Sulochana P.S.-Leader , SPECIAL EDUCATION sessions
SPEECH AND LANGUAGE NOTES 27/10/2021 SENT BY JAYASREE
SOCIO ECONOMIC SURVEY FORM ( USED @ REGN)
COLLECTED BY RADHAKRISHNAN
FINAL DISCUSSION ON LD PDF SENT BY JAYASREE
WRITING DISORDERS PDF SENT BY JAYASREE
BRIEF REVIEWS-DAY 3
The 3rd day of Internship wascompleted after 4 intensive sessions ,2 of them being OP observation in the physiotherapy dept , Math clinic and 2 academic sessions in the dept of Speech and Lang therapy and in the dept of Linguislics. The programme ended with a positive feed back from the director in charge .-CKR
