xiv. The ideas got from the classes of experts and discussions
GEN ORIENTATION DONE BY DR Nandhini Jayachandran ( Ph.D in Dyscalculia)
Dr. NANDHINI JAYACHANDRAN gave a brief desciption about ICCONS @TVM .She said that the institution started@1998 . The important services available here include providing clinical assessment , running courses to create manpower, a centre for research studies as continuation of the research wing @ SREECHITHRA hospital initiated by DR.SURESH.
***6-10 % OF children are having LD .
--neurological care 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 PLANET as a training programme for parents
- vocational traing can NOT be done for autistic
********CKR 25 10 2021
1.AUDIOLOGY / SPEECH LANGUAGE PATHOLOGY-
Speech and Language Disorders-
.........with the help of ppt .......
SPEECH ASSESSMENT
- Assessment- ALDM-MAIN CAUSES-CP / AUTISM / M.R
CLICK HERE TO WATCH THE PPT.
BASE LNE PLAN- IEP
TOOLS- ASSESMENT OF LANGAUAGE DEVELOPMENT- PLAN-experience is most important - autistic students may have talents in other fields- a you tube savvy boy with autism could read a word at accidental glance- group therapy- no right based approach- no one referred to RPWD ACT 2016-
LANGUAGE AND LINGUISTICS
ABIDA’S NOTES(image)
2.LINGUISTICS-
Online classes going on - FACULTY 1 takes classes for BSC speech
@Shoranur ICCONS -2ND SEM
FACULTY 2( BINDUKALA S, BSC HOME SCIENCE , DIPLOMA IN LINGUISTICS,
MA ) - TAKING CLASSES FOR AN LD student-classes from 2nd grade- did not know
letters- mildly MR -a boy of 14 years- now in 9th class- hyper active -had
undergone psycho therapy- have life skills-the student is reading a malayalam
text aloud in the online class-
process of patient evaluation - special education -identification-
linguistics-sessioss- saturday meetings (group), school day sessions
(individual)-classes gonven in the role of parents- generally cooperative- a
few parents are not cooperative
studets reaching here belong to different types- ignorant of all
letters/ ignorant od a few letters/ words/ a few words / can not make sentences
/
"EXPERIENCE IS WHAT COUNTS IN ASSESSMENT AND MONITORING"-
On fees for classes
- children will have to pay a minimal
fee for classes -Rs.30-80 for 40m class-
MISS DIVYA ( MASTERS IN
SPEEECH AND PATHOLOGY) NOTES BY CKR
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.CLINICAL PSYCHOLOGY-
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
4.NUROLOGY and GEN MEDICINE : Dr,Sanjeev .V.Thomas ( Director)Kerala Registry of
Epilepsy and Pregnancy, Department of Neurology, Sree Chitra Tirunal Institute
for Medical Sciences and Technology, Trivandrum, India. sanjeev.v.thomas@gmail.com
Interaction with the Director for 4.30 hours with
Observation of 8 patients in his OP for Nurology. Interactive Sessions in
OP section for Linguistics and psychology .
The director took a class on LEARNING PROCESS AND INVOLVEMENT OF
BRAIN.
LEARNING-2types invoved
1. knowledge learning ----(memory related)
2. skill learning ----(memory not related)
skills are related the functioning of nurons in the cortex-
learning ability related to the
front lobe
BRAIN DEVELOPMENT :A RESULT OF CELL MIGRATION
explains the growth of brain nurons with a diagram -a nuron gets formed
inside the flux of the brain and migrates to the surface layer-postion 1; a
second nuron migrates just above the first nuron on the surface - postion 2;
this continues upto the sixth nuron . thus the frontal lobe has six
layers of nurons where a network is formed for receiving and expressing
messages.
The human frontal lobe is important for social behavior and executive
function.
NUROLOGICAL CELL MIGRATION DISORDERS-microscopic changes, can not be
found in investigation
**in certain cases when nurons can not reach their intended postions ,
the network gets affected and abnormal responses are intiated - termed as
epilepsy
**this can be analysed with the help of EEG (self notes -Although
most patients do not have seizures when the EEG is being recorded, they often
have abnormal brain activity in the EEG (spikes or sharp waves) that indicates
they have a tendency to have seizures. The location of this activity allows the
physician to determine whether patients have partial or generalized seizures.)
Causes of epilepsy
·
a stroke.
·
a brain tumour.
·
a severe head injury.
·
drug abuse or alcohol misuse.
·
a brain infection.
·
a lack of oxygen during birth.
(self notes :The frontal lobes are involved
in motor function, problem solving, spontaneity,
memory, language, initiation, judgement, impulse control, and social and sexual
behavior.
The frontal lobes are extremely vulnerable to
injury due to their location at the front of the cranium, proximity to the
sphenoid wing and their large size. MRI studies have shown that the frontal
area is the most common region of injury following mild to moderate traumatic
brain injury .....
click
here to read more about this ; Widespread neuronal
migration into the human frontal lobe continues for several months after birth.
Young neurons express markers of cortical inhibitory interneurons and originate
outside the cortex, likely in the ventral forebrain. The postnatal recruitment
of large populations of inhibitory neurons may contribute to maturation and
plasticity in the human frontal cortex. Defects in the migration of these
neurons could result in circuit dysfunctions associated with neurodevelopmental
disorders ;
The first few months after birth, when a child begins to interact with
the environment, are critical to human brain development. The human frontal
lobe is important for social behavior and executive function; it has increased
in size and complexity relative to other species, but the processes that have
contributed to this expansion are unknown. Our studies of postmortem infant
human brains revealed a collection of neurons that migrate and integrate widely
into the frontal lobe during infancy. Chains of young neurons move tangentially
close to the walls of the lateral ventricles and along blood vessels. These
cells then individually disperse long distances to reach cortical tissue, where
they differentiate and contribute to inhibitory circuits. Late-arriving
interneurons could contribute to developmental plasticity, and the disruption
of their postnatal migration or differentiation may underlie neurodevelopmental
disorders.-CKR)
LEARNING DISABILITY
ATTENTION SPAN CHECKING, MEMORY , RETIRIEVAL
COGNITIVE FUNCTIONING
read, write , recognisinga face
INTERVENTIONS
medical / physical training, strengthening other
means of communication
story- king visiting a football match- ordering 11
blls -each ball to be given to every player
alexia- inability to read
agraphia- inability to write
mathematical LD
Discussion-
BROCA'S AREA AND
WERNICA'S AREA
Brocas area - speech
production
wernicas area-
comprehension
refers to wernicas
aphasia- brain cell damage is permanent- if not recovered within six months ,
nurons would not degenerate
sensory onputs may
help to reoganise other parts- other parts of the brain will compensate for
shortages
- example of Helen
Keller's life -she understood coneversation by touching the throat of the
speaker - analysig the vibrations-
On physiotherapy
do not ignore the
affected parts - forced attempts- pressurising areas
Can we change IQ by
training ?
PERFORMANCE CAN BE
IMPROVED - use of IQ depends on the purpse of the use( EG -boatmen of Andaman
islands managing tsunami waves in a better way -They
saw the disturbed marine life, listened to the cries of the sea birds and
interpreted that some great danger was coming. A natural methodolgy, perfected
over centuries of kinship with the elements. So they got off the beaches and
retreated into the woods. And survived the tsunami, intact.Those who were in
the sea went away from the sea shore ,over rode the waves and
kept themselves safe out of the reach of the killer waves in far away sea
.....click
here to read more about this ....)
- better IQ doesnt
ensure success in life .
IQ was first used
as screening tool for selection into army -
tools used for
measuring IQ
1.Weschelers scale
-NORMATIVE DATA FOR DEVELOPD SOCIETY)
·
(Stanford-Binet Intelligence Scale.
·
Universal Nonverbal Intelligence.
·
Differential Ability Scales.
·
Peabody Individual Achievement Test.
·
Wechsler Individual Achievement Test.
·
Wechsler Adult Intelligence Scale.
·
Woodcock Johnson III Tests of Cognitive Disabilities.)
RESEARCH EXPERIENCES
checking IQ at various stages -epilepsy -heredity plays a close
connection- longitudinal spell- mothers with eplipsy are likely to have child
with epilepsy- 20 years of research studies reveal that certain medicines
during pregnancy are not safe for children , may result in epilepsy--
RESERCH ACTIVITIES
UNDERTAKEN CLICK HERE
SELF NOTES : RESEACH FINDINGS BY SANJEEV V THOMAS :There are close to one and
half million women with epilepsy (WWE) in reproductive age group in India. WWE
have several unique gender-specific problems in the biological and social
domains. Women experience more social stigma from epilepsy and have more difficulty
with education and employment. They have more difficulty to get married and
sustain successful family life. Reproductive hormones like estrogen and
progesterone have opposing effect on seizure threshold. WWE have increased risk
of infertility. About 10% of their babies may have major congenital
malformations. Most of the adverse biological outcomes for WWE are related to
adverse effects of antiepileptic drugs (AEDs). Traditional
AEDs like phenobarbitone and sodium valproate are probably
associated with increased risk of fetal malformations or other adverse fetal
outcomes. Polytherapy and use of high dose of any AED is associated with higher
risk fetal complications. It is very important that all WWE have a
preconception evaluation done by a neurologist, when the need to continue AEDs
or possibility of reducing AED load could be assessed. All WWE need to take
folic acid 5 mg daily during preconception period and pregnancy. They should
undergo a detailed screening for fetal malformations between 12 and 18 weeks of
pregnancy. The neurologist, gynecologist, imageologist and pediatrician need to
work as a team while managing pregnancy in WWE. It is important to reassure WWE
and their relatives that pregnancy is safe in WWE and their children are
healthy in more than 90% instances.
According
to Dr Sanjeev, 70 per cent of epileptic cases are curable. He added that there
are 10 epileptic cases per 1000 people in India and the male to female ratio is
the same.
MORE... VIDEO https://www.youtube.com/watch?v=38kEgSbl-xI
Live a happy life with epilepsy
5.PHYSICAL MEDICINE AND REHABILITATION UNIT-
LOCOMOTOR DISABILITY-The
role of physiotherapy 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
******************************
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
GOLD STD TEST FOR DISPRAXIA
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
6.SPECIAL EDUCATION SCHOOL-
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
***************
7.ACADEMIC SESSIONS
A brief discussion on
L D
with the help of ppt
presentation
-technical issues with
screen presentation- says technician on leave !-
Discussion- What is a language
disorder ---- types of disorders-challenges-samples of writing problems -eg of
mirror writing - dysgraphia- association of sound worth letters- proper
accomodations -
CLICK HERE FOR THE PPT-LD WHO ?
Reasons for writing disorders ppt
MAIN CHALLENGE :
Reading issues - boys more
susceptible- intervention by teachers with compassion-harassment in many
private schools - students who report here are mainly from Vallakadavu,
BEEMAPALLI- DEPENDS on how parents treat their wards- the craze for A+
GRADE disorder -
lack of consensus in the
family-eg a mother and the child reporting at the ICCONS- THE Y WANT TO
LEARN TO READ -
MOTHER ready to cooperate with
the do’s and don’ts -But father not cooperative
i. Introduction
ii. About the ICCONS
iii. The departments of ICCONS and the facilities
iv. Registration of patients/ cases
v. Case taking/ file Keeping
vi. Clinical and other examinations
vii. Procedure of Assessment at various departments / tests
viii. Identification of problems/ disorders/ disabilities
ix. Treatment/therapies/interventions and advice
x. Management / Rehabilitation process
xi. The types of cases came on the observation days
xii. The Parents’/ escorts’ roll during and after the treatment sessions
xiii. The improvements of the cases
xiv. The ideas got from the classes of experts and discussions
xv. My own observations
xvi. Conclusion
