INTERNSHIP Notes 27102021

 1.AUDIOLOGY/SPEECH LANGUAGE PATHOLOGY-Ashi Susan Kuriakose

linguistics online class 

humanities student underging online class- vocational hogher secondary- achievemnt of 7 th grade- wrote SSLC WITH THE HELP OF SCRIBE -" wll not live if failed in the exam "- 

LD - academic issue - problems in reading writing- maths- ; life skills ok , ignorant of letters , "ka" "ma"-in Malaayalam- confusion with joined letters, symbols - problems with letters in English also- 

INTERVENTIONS-

goalsetting important-training in sound production- spelling errors corrected with the help of phonics - exceptions - try seperately- 

2.CLINICAL PSYCHOLOGY-Jayasree KG

3.NUROLOGY-Jasni. M P ,

Math Clinic  OSERVATIONS- 

EVALUATION TOOL USED-games used -tangrams

maths evaluation tool- diagnostic test-5% cut off - test of arithmetic ability-NIMHANS(INDIAN NORMS)

QNS- 1.count the number in each box 2. comparing the number  in each box -3.read the numbers and copy it in numerals ( the doc takes the paper back without any courtesy while I was  noting down a few ideas -seemed not interested in sharing this information- licensed property)

PATIENT 1 

2 1/2 years autistic child - home activities mother - find out what toy he is interested- note the book he is demanding - 1 1/2 minutes provision of preference - find comfortable  place - take an appointment on Monday-look for repeated activities- be calm ,slow and clearcut in giving instrucions-shows a board game with colourful  icons

IQ test can only be purchased by professionals

PATIENT 2 

A GIRL IN 5 STD-english medium school-Parents complains about being agressive -no emotional expressions- rigid attitude - not cryng when pained - not expressing  even when hurt-academically brilliant -reads selective books -fictional stories of Sudha Murthi , Anne Frank -spends most of time on TV , mobile, likes foreign culture, western culture , basically luxury loving , does not accept reality . 

DOC INTERACTION WITH THE PARENTS with the help of evaluation tool 

any friends - no comfort zone - no social mingling- reserved-prefers to sit at home _one of the class toppers- leadership in school activities -draws a bit -COVID induced inactivity-comfrtable at home - does not like sharing-not intereested in class schedule-not attending "Kuran" classes- recently backward in Maths--no doubts-microfamily only recent- thinks expressing emotions something inferior- attentiondeficit-not planning everything- last minute rush-highly skilled- goood orator-parents worried that it seems academic performance apparently going down- says excuses for not doing things on time-intentional or not - can not identify-whether she is lying- gadget friendly-

how long ? screen time toolong - no game - blogging - web series- fictional- not reading now -recent changes for the last 2 1/2 years - pushing by  mother- not accepting  time schedule for routine - conflict with sibling ( 6years old )  - does not  show affinity to the little child - no problem with the cousins  - not reaching to the cousins - screaming  aloud " Why am I scared ? Who should I fear ?  About friends- Nisha is highly selective , every body is rude to me , obsessed , craves for attention , serves friends deliberately,

Doc :  stubborn   ? likes travels ? luxury foods ? gifts ? likes foods ? living in flat ?

PARENTS : compares herself to cousin WHO IS FINANCIALLY better.- does not help parents- not responding properly-acts smart before visitors- highly eccentric recently-

DOC : analyses : TV PREFERNCE-thyroid issues- pregnancy issues- does not like milk- fits nil- breast feeding - 9 months -feeding pattern -eats  a lot foody - attitude -

milestones k ? -conversation / communication issues- relationship with father and mother- do you value her feelings- 

Father- "when I am busy , I cannot"

Dislikes physical activity - not much , plays cards with cousin rarely.

finishes schedules but not on time -shouts @ her little brother - a recent dislike for schools - like walks alone - not interested in maths- keeps things safe

ready to do paid services - keeps secrets-afraid of ghost stories- it prolific ? 

Doc comments to the parents

Positives  - no problem in behaviour - emotional ,highly selective, 

Negatives-she can not balance her expressions - may be taxing for mother and father- upskillilng is required- needs interaction with the child - no friends connection- feels attention lack from my mother - now she feels a need but no skill in creating friends - she always waits positive reponses-need not reveal herself easily- need  a half day session with the child - restless is not a serious problem -blogging is creativity- she is not able to finish other chores because she is lost in writing - 

final observation : must do other tests for evaluation 

INTERACTION WITH THE CHILD 

 -Asks the child many questions about her  school- holy angels - CBSE - vanchiyoor-5th grade - asks about the class room- how to reach the class from the office room-( likes books -library- period of reading - like schools - extra curricular / enojys PE / practses DANCE -study related activity / assembly / role in assembly as monitor/ house wise charge / about play ground / about teachers / some of them hard / phy puishment / yes / 4 students in a bench / I like my hindi teacher/ some teachers allow to place the bag on the desks.others dont.she likes her hindi teacher- friend Neelima-enjoyed the trip from the school to magic planet - she liked the shows - describes vividly- mother often intervenes to correct the child- the child likes her cousin because he is protective and sharing-this session ends - There will be a detailed session next Monday

The child leaves with the parents .

Gen evaluation by the doctor

- She has not much problems- She articulates well - but there is a need of a detailed evaluation session-

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4.PHYSICAL MEDICINE AND REHABILITATION UNIT-.Preethy.S.L 

PAEDETRIC ASSESSMENT 

PATIENT 1 : severely spastic - CP-14 years boy- birth complication ,prologed labour-

The doc hands over a copy of the evaluation tools and allows us to ask about the tool-i askked about DTR reflexes - DTR FOR deep tender reflexes-( SPASTIC-EXAGGERATED RELEXES,PLACIDITY-SLUGGISH RELEXES;NORMAL-JERKY RFLEXES)

REHBILITATION PROCESS- 

SPASTIC - slow movement , placid -fast movement 

PATIENT - 2

A CHILD with no neck and roll movement- CP -no movements

Therapy- Activities

-neck wedge - trunk balance nil-spine strengthening-sitting-bed -pillow-crosslegged position-bog basin sitting-standing exercises-half knee standing (മുട്ടിൽ നിറുത്തുക ) 

DISCUSSION -GROWTH AND DEVELOPMET-NECK MUSCLES

3-6 MONTHS :critical period

rises neck @ 3 months , neck tightens @4months, turns aound and lies down with face raised  within 2-2 1/2 years , rrely before 5 years,

causes of delay : look for Down Syndrome - comorbidities -heart problems 

PATIENT : 3

A LEAN girl of 4 1/2 yrs age - one of twins -talkative , meaningful responses -spastic- delay in growth (self note :Spasticity is a condition in which muscles stiffen or tighten, preventing normal fluid movement. The muscles remain contracted and resist being stretched..)- parents being nurses-growth issues identified very early and therapy initiated on time -born early, 33 WEEKS - BW 1.100 kg-memory normal- language normal-uses past tense -slight issue in eye coordination-IQ normal-has disrathria-leg slightly curved 

THERAPY ACTIVITIES

-mobilisation and stretching  MS,(rhythmic rotation RR,sustained stretchingSS,PNF,),weight bearing WB, activating weak and antagonistic muscles, orthotics and assistive devices ,aquatic therapyAT, teach and prompte proper positioning,practice functional skills,facilitate normal patterns of movement 

1.LEFT HAND MS,RR,SS

 2.LEFTSHOULDER MS,RR,SS

3.HELPS  to turn whole body  to right side - a painful monoveure-neck movement not easy-cano sit alone- bowed posture- feels like falling- gives a bog doll( a dog named Kalyani) to hold on -

4.repeats with the right side

5.sits with crossed legs for trunk balance-tries to make her crawl -teaches the sequnec of movements for crawling - reinfocement , a kiss to the doll for each movement

6. make her sit on gym ball-make her lie with face upwards, make her lie with face downwards,makes her look upwards,make her try to stand by herself -holds her hand and compels her to walk - tells mothre to try the same activity again- advises to do the activity at home 

7. therapy for scissoring gate ( W sitting )- ball exercises- other activities tol to the mother in earlier sessions-

Discussion- the curved in the leg may become normal after 4  1/ 2 years ...hydro theraly at home will do good - if scissoring gate exisits even after learning to walk , surgery is an option-

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Patient 3 : A kid with emotional outbursts.......3 years 6 months old boy ...referral from CD C, - treatment @ICCONS  for 1 years 6 months ....hydrocephalism-ventricles affected-placid muscles-can not walk properly- alernate stepping not possible -can climb starirs up, but panicky while stepping down

THERAPY ACTIVITIES 

- keeps him lying back and makes kim kick in the air , make him sit , makes him walk slowly

 -rotating movements-practising walking up a ramp, with fans switched off to get maximum resistence -strenthening activities-has wide stepped gait-flat foot -has got training at home  to walk in sand - the doc uses loud complimets like "very good" , "good boy"

DOCTOR COMMENTS : Hyposis - protruded abdomen - language delay(making him lie, make him stand)- IQ seems not normal- can imitate- crosslegged position slightly difficult for the child , just for 5-10minutes-the child has just started walking-lingustic training to be intiated soon- 

ACTIVITY- MAKES HIM SIT IN CROSSLEGGED POSITION-balanced walking again- MAKES HIM CLAP - helps him step down slowly

5.SPECIAL EDUCATION SCHOOL-Sulochana P.S.-Leader 

6.ACADEMIC SESSIONS

A brief  discussion on L D  

with the help of ppt presentation 

-technical issues with  screen presention- 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 woth 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 compasssion-harassment in many private schools - students who reprt 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  reprting at the ICCONS- THE Y WANT TO LEARN TO READ - 

MOTHER ready to cooperate with the dos and donts -But  father not cooperative 

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-experienc is most important - autistic students may have talents in other fields- a yoube savvy boy with autism could read a word at accidetal glane- group therapy- no right based approch- no one refered to RPWD ACT 2016-

Registration Process

details- register- form filled- patient taken to varioes departments- spl education -5 years- therapy , date will be given in advance - nuroligy 2 days a week - fee depeds on oncome  -ranges from 100-250/-- no NRI FEES NOW - fee for therapy - 40,60,80

no residential classes now.online corses and classes

LANGUAGE AND LINGUISTICS

ABIDAS NOTES

INTERNSHIP NOTES 26102021

 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.)

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

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

INTERNSHIP NOTES 25 10 2021

 NOTES:

                                      SCHEDULE FOR 25,26 AND 27 TH OF OCTOBER 2021

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.

ABIDA 'S NOTES 

RADHAKRISHNAN'S   NOTES 

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

TOOLS FROM PHYSIOTHERAPY-

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

Internship at ICCONS-PREPARATIONS

 CLICK HERE TO READ ABOUT 

ICCONS-The Institute for Communicative and Cognitive Neuro Sciences (ICCONS)

LOCATION MAP -ICCONS

ICCONS Thiruvananthapuram is near to Chest hospital Pulayanarkotta Thiruvananthapuram phone 0471 2440232 . ( It is by the side of the bypass road from Ulloor Jn to Akkulam road ) 

The contact Person @ ICCONS Thiruvananthapuram will be Mr. AnilKumar(Psychologist) :anilkumar64@gmail.com Phone 9946923555.

ONLINE THERAPY REGISTRATION

PREPARATION FOR INTERNSHIP 25 26 27

PLS take leadership  in the sessions and be  familiarised with the topics assigned against your name and be ready with at least 5 questions on these topics every day . Other team memebers can prvide more doubts and questions as far as possible. The leaders can suggest one more team member to help you .

1.Radhakrishnan C K ( ASSIGNED AS TEAM LEADER)

2.Jasni. M P , Leader ,NUROLOGY sessions

3.Ashi Susan Kuriakose-Leader, SPEECH AND LANGUAGE sessions

4. Jayasree KG-Leader,PSYCHOLOGY sessions

5.Abidamol P-Leader ,LINGUISTICS sessions

6.Preethy.S.L -Leader ,PHYSIOTHERAPY sessions

7.Sulochana P.S.-Leader , SPECIAL EDUCATION sessions

8.ARYA   (not contacted me)- Leader ,ACADAMIC SESSIONs

9.ASHWARYA (not contacted me)- Joint  Leader, Team Internship

Pls suggest mutual changes of topics if required.

2.The participants may reach at the centre at 9.00 am on every day of the internship and report at the head of the institution. Your business hours will be 9am-4pm. 

3. For each session and each centre we have to nominate a Leader so as to take the leadership of the programme for the smooth functioning and all are requested to go along with the leader nominated. This also may be sent to you on Monday. 

4. The nominated leader may contact all the others in the group and make proper arrangements for the effective functioning of the programme.

 5. On the first day, submit the authorisation letter from the SRC. The letter may be forwarded on Monday to the group and all of you have to take a print out of the same and fill in your name at the place offered and submit at ICCONS. Please bear the ID Card of the SRC DMLD Course all time in the institute. Those students without identity cards of the DMLD course please carry the ID card of CMLD Course or any other ID cards like voters ID or Aadhaar card.

5. Please take with you the Covid vaccination certificates and follow strict Covid Protocol during your journey and all time at ICCONS. 

6.Keep hand sanitizers also with you. 

On the last day submit to the authorities of ICCONS the filled up format of the Certificate of Internship and get it signed by the Director/ Head in- charge (See the format in the following pages). Copy of this has to be included in your Report. (Try to get this Certificate in the letter head of the ICCONS )

MODEL SCHEDULE

DOCS TO BE kept @hand

1. DMLD ID CARD 

2. AUTHORISATION LETTER FROM THE DIRECTOR,SRC(TAKE A PRINTED COPY)

3. Rs.1000 as fees

4. Lunch Parcel Everyday

5.Covid Vaccination Certificate

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Go through the texts and study once again about 

1. The details OF Learning disabilities, and other relevant disorders. 

2. The procedures of the assessment and 

3.Management of learning disabilities and other disorders

 like ASD, 

Speech and Language disorders, 

Motor disabilities,

 Perceptual disabilities, 

ADHD, ADD, SCD, ID etc. 

4. The DSM 5 and ICD 10 categorizations of the disorders also.

Focus mainly on psychological aspects , physio therapy, of AUTISM / ASD/ ADHD/ CP

DEPTS REALATED 

 Department of nurology ,psychology ,physioptherapy,special education,ASD/ADHD, 

WORK DEVISION 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,ARYA   - Leader ,ACADAMIC SESSIONs

3.NUROLOGY-Jasni. M P , Leader ,NUROLOGY sessions,ASHWARYA (not contacted me)- 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

Radhakrishnan C K 

INTERNSHIP REPORT 

 The outline of the project is with this letter and the report should have minimum 50 pages and maximum 70 pages. 

. The following points may be included in the observation Report besides the first part, 

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

*****

DMLD TEXT UNIT 1

Devolpment  Charts

COMMENTS ON INTERNSHIP

We have successfully completed  the Internship. They were very serious in conducting and imparting knowledge to us. We were taken care of by all the departments and the deputed professionals. Dr. Sanjiv Thomas, Director took class today and provided seating arrangements by his side during his OP session which was extended till 2pm. He explained each case to us in detail. In all other departments also they seated us to observe the psychological examinations and counseling. As students SRC we got high respects and service from all there.

Other points: They are providing all their facilities and staff in between their hectic routine. So we felt there should be sufficient candidates in a batch.

Unit end questions and answers-UNIT 1 DMLD

 Define and describe the Growth and Development

Growth is the progressive increase in the size of a child or parts of a child.

Development is the progressive acquisition of various skills (abilities) such as head support, speaking, learning, expressing the feelings etc...

Child development refers to the natural growth and learning that occurs in all children from birth to adulthood, including physical, intellectual, and social-emotional growth

.Let us see the difference between the ‘Growth’ and ‘Development’

Growth refers to an increase in size, height, weight etc. ./.Easily measured and observed /It is limited / Starts with birth to reach the maximum at maturity /  Concerned with various aspects and parts of body and behaviour as a whole / Quantitative change 

Development refers to improvement in the functioning of the body process / Cannot be measured easily’/A continuous unending process all through life /Limited to specific areas / Qualitative and Quantitative change .

Human development constitutes the development of different areas such as physical, motor, language and speech, emotional, social and cognitive developments. By the time the child reaches adulthood, the development of major areas will be completed. But the development of these areas of a person with learning disabilities can be affected or distorted. 

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What are the areas of development of a child ?

Areas of Development Human development constitutes the development of different areas such as physical, motor, language and speech, emotional, social and cognitive developments. By the time the child reaches adulthood, the development of major areas will be completed. But the development of these areas of a person with learning disabilities can be affected or distorted.

 a. Physical development: Physical development means changes in height and weight and associated changes in size and shape and the functioning of the body. Physical development influences child’s behaviour directly by determining what they can do and indirectly by influencing their attitudes towards self and others. Physical development provides children with the abilities they need to explore and interact with the world around them. 

b. Motor development: Motor development means the development of control over bodily movements through the coordinated activity of the nerve centres, the nerves and the muscles. It includes the Gross motor abilities and fine motor abilities which is crucial in the education process — writing, drawing, speech etc. Motor development is partially responsible for overcoming the helplessness of new-born infants. 

 c. Language and speech development: Language development is the process by which children come to understand and communicate language during early childhood. The thoughts and feelings can be communicated in any form of language (gestures, emotional expressions, speech or written language), but it is most commonly and most effectively done by speech. 

Speech development is the ability to use meaningful ideas through spoken words. Speech is a motor-mental skill. d. Emotional Development: Emotions are complex psychological and biological responses to internal and external stimuli. 

d.Emotional development can be defined as the ability to express, control, understand and accept one's emotions. All emotions play an important role in children’s lives through the influence they have on children’s personal and social adjustments. 

e. Social Development: It is the acquisition of the ability to behave in accordance with social expectations — control emotions, waiting patiently, making friends, sharing toys, taking care of others etc. The change of children into social, nonsocial or antisocial person depends mainly on learning, not on heredity. Young children develop these abilities in small increments over time. 

f. Cognitive or intellectual development: Cognitive development is the sum total of sensation, perception and cognition. Sensation means sensing something through sense organs. Perception gives additional meaning to sensing. Cognition is the process of thinking and knowing. 

The intellectual or cognitive development helps a person to memorize, imagine, communicate, perceive and to solve problem. It develops from birth until adulthood.

3.Specify the Stages of child Development with reference to children with birth defects or disabilities

In pregnancy, each part of the baby’s body forms at a specific time. During these times, the body can be very sensitive to damage caused by medications, alcohol or other harmful exposures. We call this specific time the “critical period of development” for that body part.

 The CPD (critical period of development) for the central nervous system is from the 3rd week to the 16th week of fetal growth.The development period for the heart is 3-6 weeks of fetal growth.Arms develop from the 4th to the 6th week of fetal growth.The CPD for the eyes is from the 4 1/2 week to the 8th week of fetal growth.The cpd for the legs is from the initial day of the 4th week to the the initial days of the 7th week of fetal growth. The CPD for teeth is 6th to 8th and for the palate ,it is the 6th to the initial days of the 12th week of fetal growth.The critical development period for the external genitala is the second half of the 8 th week to the first 3 quarters of the 12 the week.The CPD of the ears is from the 4th week ti the first half of the fetal growth.

In general, major defects of the body and internal organs are more likely to occur between 3 to 12 embryo / fetal weeks.Minor defects and functional defects including those affecting the brain are  likely to occur even later in pregnancy.

Evaluate a child’s development after birth

Postnatal and later periods of life have been classified in to various stages or planes by different experts. Commonly used terms and classifications are given below: 

 Neonatal ( newborn baby ) period: ages 0–4 weeks; 

 Infant: ages 4 weeks – 1 year/ (Infancy means the speechless period or before walking. So for some children, it may be extended up to 2 years )

  Toddler: ages 1–3 years -The word is derived from "to toddle", which means to walk unsteadily, like a child of this age. 

The toddler years are a time of great cognitive, emotional and social development.

  Preschooler: / Early childhood: ages 3–6 years; 

 Middle childhood: ages 6-8 years; 

 Later childhood: ages 8-12 years; 

(‘Childhood’ is the development stage between infancy and puberty)  Adolescent: ages 12–20 years; 

 Adult stage; ages 20- 45 years;

 Middle age stage: 45 -65 years; 

 Old age stage: ages 65 and above

The development of communication and language in a child is as follows : The child during the early stages of infancy cries when wet or hungry, coos when comfortable (3 months ), makes simple sounds by 6 months , uses sound for different things by 9 months, begins to use simple single words by one year , begins to use words together by 2 years, uses simple sentences to express ideas by 3 years to 5 years. If the child lags behind during any one of  these stages, parents should take steps to support the child without delay. Measures like speaking and singing to the child, consulting experts like speech therapists without delay is advocated.

MCQ 2 UNIT 1 DMLD

 MCQ 2 UNIT 1 DMLD

1. .......is the progressive acquisition of various skills (abilities) such as head

support, speaking, learning,...( Growth, Development,Heredity)

2.Human growth and behaviour is determined by the interaction of two factors—(heredity

and environment., growth  and development, heredity and development.)

3.Development proceeds from heteronomy to autonomy:(Yes / No)

4.Development occurs at the same rates for different parts of the

body.(Yes / No)

5.A trait is often determined by only one gene.(Yes / No)

6.In humans, mutations in FOXP2 cause the severe .......................

 disorder ( writing, reading ,speech and language)

7.CNS (Central Nervous System) develops generally from the ........week( 3rd, 4th,16th)

8.There is a ‘Baby Centre’ Mobile App to track the ........... growth

9.The development pattern of the prenatal child and postnatal

development. (monthly, daily, weekly)

10. Teeth develops only after the child is born. (yes / no)

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MCQ 1 QUESTIONS

MCQ2 ANSWERS.

Human growth and behaviour is determined by the interaction of two factors—heredity

and environment.

Development proceeds from heteronomy to autonomy:

Development occurs at different rates for different parts of the

body:

In humans, mutations in FOXP2 cause the severe speech and language disorder

CNS develops generally from the 3rd week.

There is a ‘Baby Centre’ Mobile App to track the weekly growth

development pattern of the pre natal child and post natal

development.

Teeth develops from the 6th  to 8th week of the Embryo.

Development is the progressive acquisition of various skills (abilities) such as head

support, speaking, learning,...