THAARE ZEMIN PER: 14.The ideas got from the classes of experts and discussions

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