1.AUDIOLOGY/SPEECH LANGUAGE PATHOLOGY-Ashi Susan Kuriakose-Leader, SPEECH AND LANGUAGE sessions,Abidamol P-Leader ,
LINGUISTICS sessions
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-
2.CLINICAL PSYCHOLOGY-Jayasree KG-Leader,PSYCHOLOGY sessions,
SHANTHI V S
PATIENT 1 - behavioural training
BOY OF 4yrs 6 months - mild autism- restless - does not know letters- lacking attention- being trained with building blocks - repeating rhymes - reached here afteroccupational theraly from NISH -
training in LETTER IDENTIFICATION done @ICCONS -
ACTIVITY 1
learns placing letters back in their positions on a tray / letters with different colours used -
ACTIVITY 2 : THE doctor sings ABCD and places the letters cuttings in the same order. the child is encouraged to do the same .
ACTIVITY 3 : COLOURING LETTERS ON PAPER with outline of letters given-different colours used -training with oral commands like "wait" , "stop" "no"-sometimes the teacher has to compel to paint - the DOCTOR holds his hand and make him draw/paint
ACTIVITY 4 : drawing at his own will- exercises to join lines , draw over, dotted lines
ACTIVITY 5 : ALLOW THE CHILD TO DO SOMETHING IN THE ROOM AT HIS OWN PREFERENCE - he goes to a shelf in a cornes -picks upa bottle with small sphere inside he bottle - the child goes on shaking the bottle ( repetitive actions charecteristic of ASD)
ACTIVITY 6 : SHOWS an alphabet book with large fonts and very large figures( comment : the child has got a similia book at home , he has a habit of turning over the pages repeatedly- eses his preferences to effect learning )
ACTIVITY 7 : PAINTS the child's fingertips and directs to thouch a circle drawn on paper, encourages to sing rhymes , the boys seems fond of rhymes and rhythmic movements
( self obeservation- use of musical instruments may facilitate learning here)
-after 40 minute training the DOCTOR permit the boy to go out- says "goodbye"-the boy lets pouta scream of joy and goes out
3.NUROLOGY-Jasni. M P , Leader ,NUROLOGY sessions, Joint Leader, Team Internship
RADHAKRISHNAN 'S NOTES
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.)
- 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.)
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
DR SAJEEV'S OP
OBSERVATION NOTES
PATIENT 1
CHILD screming , accompanied by mother-delayed development woth attention deficit, srated walking 1 year 4 months
The doc reades out patient files aloud in English
-early birth@240th day,born as twins -low birthweight-1.700kg- responses only by gestures-social maturity of i year 8 months ( psychological evaluation)- now scheduled for nurological assessment , linguistic assessment-restless - speaks only about 5-6 words-poor imitation skills-delay in socialisation - receptive language-8-12 months ; conceptual age , chronlogical age , developmental age ,; six months after the previous therapy-EEG- no traits of fits
comments by the doc
-growth is regrassinve -training may be effective- presence of a twin brother can be useful-must continue therapy-if the child does not retain learning, repeat instructions - parents must give training at home coninually- take care to see the boy does not get affected by fever or epidemics-must give balanced nutrion ( explains the constituents )
-discusses the weight of the child at varius stages - 6 months ,10 kg ; 1y 6 months 5 kg, 2yrs 1 month-12 kg ; bone growth - give milk for calcium intake-
- observes his gait and walk-makes him sit forcefully and allow to stand at will - comments - seems no issues in walking-
doctor comments : the child had therapy in walking like sand walking- had strage eating habits like eating paper, paint, mud
(observation-the child is with the father now and comparatively calm.)
doctor comments - therapy is done every 2 days per week , the remaing done at home ,consults with paedetrician- instructs to come back after 6 motnhs-
mother-when the boy has fever , the pill for fits is also given
doc comments : had fits along with fever in March 2021)-treatment start from SAT-MOTHER also had fits upto 8 years of age .-she had taken the pill VALPALINE - 2 pills once a day-taken pill continously for more than a year- stppped tking pills during pregnancy- first preganacy resulted in abortion as the child was withour heartbeat-now after treatment the mother does not have fits for 2 years-checks EEG and no symptoms of fits now
Discussion- normal birth weight of a child
PATIENT : 2
Hyperactive- fidgets-8 years old - writes letters as in sts 1- from a govt school in kollam dt-typical LD- the child had burns after toching the hot silencer cover of a bika parked at home.
grunts-moves aorund noisely-but responds to the doctors greetings-shows a colour picture and asks the child who draw it ? " no answer "
comments by the dctor : attention seeking behviour- consults here since 2016- undergoes occuptional therapy- UNDERGOES special education classes -
PARENT COMMENT :- sensitive to sounds - spends a lot of tome with pets like goats-
keeps schedules- replies to instructions very rarely- agressive at alight workload - cannot bear the sound od bikes -
DOC COMMENT :- HE HAS sensation fear./affinity- habituation approach is the treatment- the child must get used to the sounds- -need no medicines now-must try to increase his attention span-
PATIENT 3 :
A screaming child arrives -5year old -referred from Poona-parents NRI - child doesnot speak properly-repeats only a few sounds-parents rarely use Malayalam
CASE HISTORY : normal delivery-38th week-no health complaints to the mother- no pregnancy/delvery problems...
child cry normal at birth- scissorian section-BW 3.6 KGS-parents not diabetic-no previous pregnancy failure- -no ICU TREATMENT-discaharged after 3 days
GROWTH AND DEVELOPMENT :
missed certain mile stones like turning uoside down- sat directly- walkd between 6 months-1 years-motor skills of 3 years - emotions normal- uttered words @1 year age , two wods like pappa an mamma @18 months ; speech lock @2years- continues crying a lot ,can not stop crying(PARENT doubts ASD )
DOC COMMENTS (CASE HISTORY)
immunisation done- selective hearing- sleep habits abnormal- sleep pattern changes - 14 kd @2yrs, 15 hg @5 years, downwards shift in weight/asthama/ dry skin/ cold breathing/ dry cough
hearing test not done - not minding others reponses-
PARENT COMMENTS - watches cartoons on tv- responds to cartoons-
DOC COMMENT : hearing test must be done - may be irriatted by higer frequencies -(hopes he cooperates with the test !)
DOC ANALYSIS : - NOT USING MOTHER TOUNGUE - depends on the amount of language used @home -not moving away/ moving ears away even if the phone sound is louder -no problems with vision- shows learning capacity- hearing assessment to be done -
MOTHER COMMENTS : the child does not use verbs . - does not use mlayalam much 2home - a mixed use-
DOC PRESCRIPTIONS :
Speech and langauge assessment- developmental assessment- cognitive assessment - psychological evaluation- next appointment after taking these tests within a week
FATHER COMMENTS
- NOT HAPPY ABOUT the time lag @ the hospital and loopholes in covid protocol
PATIENT 4-
A grown up (45 years old) man acccompanied by his doctor brother- referral case from Sree Chithra-under treatment for more than 7 years - pervious consutation march 21-hypothyroid-passive posture- hand movement problems-extra temporal behaviour-severe headache- memory issues-nausia-postoral headache-metabolism affected- generalised epilepsy -
DOCTOR ANALYSIS
any recent issues od fits ? / sleep ?/ addicted to watching tv / PREVIOUS fit on dec2019-EEG DONE JAN 2019-MRI scan done - generally passive - low resposes- may be medicine induced -psychosis-hallucinations- side effect of medicine ?
DOCTOR ADVICE
-SERVES GOOD- HE IS ok now- split the dose into 3 tomes daily-pushing sodium might do good -(to the patients's doctor brother )need much depend on google info
PATIENT 5
A restless girl-pancky-extends her hand towards the doc expecting injection-pinches her mother-
-delay in growth- marginal ASD- group therapy-speech therapy interrupted by lockdown- cant write- less sounds produced-language delay-inattention-referral from CDC-
PREGNANCY DETAILS-
scissarion section -BW 2.45-2.75 -sat / walked @9months-1 yrs- no speech even @ 1 years- started saying " vellam " ( malayalam word for water) , more gestures , more movements ,proper immunisation -eye test in KMS -NORMAL-hearing @birth normal - not decipher words - no retention of learning- colour concepts- reconised and matched-
Discussion on CASE HISTORY
no link between dialogues and action- analysis : network connectivity not right - help provided by special education- do not remeber the sequence of events
Effect of therapy
-use of cartoons-started verbal communication -no social issues- concentrate on language issues-mapping domain , physical development assessment , psycho cognitive assessment , language assessment -BLOOD COUNT /THYROID /
PATIENT 6 :
kid - 2 1/2 years old- wt 10.500kg,-SECOND APPOINTMENT- more obstinate -attack of its
MOTHER -Ph.D holder , FATHER - TECHEE
EEG - test for fits- electrical sparks creates fits-
sedation - obstinate more -can not rule out epilepsy-
Mother says -Child started using more words after an attack of fits-
( DOC-fits may subside within first 6 years, antihistamines cause fits for eg VICKS )
PATIENT 7
A lean boy-5years 2 months- respones like that of a bird-ko,ko-points out at the door-laughs without provocation-language devpt 1 year 11 months- meditative, curious eye coordination
CASE HISTORY
EEG NORMAL-continued attack of Rubella-acute language problem- poor language output-language therapy for two years- obstinate- uncontrolled emotions- frustrations-
growth not satisfactory-genetic tests from CDC normal-
DOC ADVICE
-letter to pediatrician to check growth- endocrine deficiency
PATIENT 8
3YEARS boy continuing therapies-4 times unsuccessful attempt for EEG - EEG done recently- repeats sounds- no proper replies-
CASE HISTORY
-ASD ? -attention problems - hyper active
speech language tests
more tests,VSMs,SFPs,CARs
DOC COMMENT- vaccination done - Rubella can affect brain and heart -
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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
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