Dr. Mansoor Alam's Guide to Children with Special Needs

Dr. Mansoor Alam
Consultant Developmental Specialist
Institute for Child Development
New Delhi, India


 Crippled Children
 Lunatic Children
 Handicapped Children
 Disadvantaged Children
 Differently abled Children
 Specially Challenged Children
 Disabled Children
Children with Special
Needs


 High Risk Infants
 Developmental Delay
 Global Developmental delay
 Delayed Milestones
 Developmental Disorders
 Developmental Disabilities
 Developmental Regression
 Deviated Development
Needs


 Impairments
 Disabilities
 Handicap
 Person with Disability(PWD)
 Children with Complex Needs
Needs


Impairment
Impairment is any visible structural/anatomical loss of
physical or sense organs in an individual. The loss of a little
finger is an impairment.
Missing or defective body part, an amputated limb, paralysis
after polio, restricted pulmonary capacity, diabetes, near-
sightedness, mental retardation, limited hearing capacity,
facial disfigurement or other abnormal condition.
Impairments are generally not recognized until they interfere
in the performance of daily activities by an individual.
Needs


Disability
Disability, usually a consequence of impairment, is the
functional inability of an individual to perform any activity
in the manner or within the range considered ‘normal’ for
any human being. It is a restriction of activities as a result of
an impairment. Disability interferes in the performance of
daily activities by an individual.
As a result of an impairment may involve difficulties in
walking, seeing, speaking, hearing, reading, writing,
counting, lifting, or taking interest in and making one’s
surrounding.
Needs


Temporary Total Disability
Period in which the affected person is totally unable to work.
During this period, he may receive orthopaedic, ophthalmological,
auditory or speech any other medical treatment.
Temporary partial Disability
Period when recovery has reached the stage of improvement so
that person may began some kind of gainful occupation.
Permanent Disability
Permanent damage or loss of use of some part/parts of the body
after the stage of maximum improvement [from any medical
treatment] has been reached and the condition is stationary.
Needs


Handicap
Handicap is a disadvantage resulting from, or the consequence of,
impairment as well as disability. It is the manifest limitation that
prevents fulfilment of the social role expected for the age, sex or
cultural background of an individual (WHO, 1980)
A disability becomes a handicap when it interferes with doing
what is expected at a particular time in one’s life.
A person may lose a limb and still not face any impediments at his
job. Thus, he is physically impaired but not handicapped
Needs


Person with Disability
A person suffering from not less than forty percent of
any disability as certified by a medical authority.
Needs


The magnitude of impairments, disabilities and
handicaps has been estimated differently in different
counties. A WHO report suggests that 5.21 per cent of
the population of developing countries is disabled. This
comes to, roughly, a colossal 50 million persons with
disabilities in India.
In India 16.15 million people are affected with one or
the other of the four major types of disabilities (Old
Record)
Magnitude


 1. Physical/Locomotor Disabilities
 2. Visual Disabilities
 3. Hearing Disabilities
 4. Mental Disabilities
 5. Learning Disabilities
 6. Multiple Disabilities
Different types of Disability


Physical/Locomotor handicaps occur due to impairment of
the limbs or extremities. It involves an inability to execute
distinctive activities associated with moving the self or other
objects from one place to another. The inability results from
an affliction of the muscular-skeletal and/or nervous system.
The cause of physical/locomotor handicap may be
Congenital or developmental (cerebral palsy),
Acquired or infective (tuberculosis of the spine, chronic
osteomyelitis or leprosy),
Physical/Locomotor Disabilities


Traumatic (amputations, sports injuries or accidents),
Metabolic (rickets, vitamin B12 deficiency or gout),
Degenerative (motor neuron disease, multiple sclerosis
or Parkinson’s disease), etc.
Cerebral (cerebro-vascular accidents),
Spinal (traumatic paraplegia),
Nerve lesions (peripheral nerve injury),
Muscular lesions (muscular dystrophy),
Skeletal (fractures and dislocations), etc.


For the purpose of government benefits and
concessions, persons with locomotor handicaps are
graded under various severity levels, viz., mild (less
than 40 per cent), moderate (40 to 74 per cent), severe
(75 to 99 per cent) and profound (100 per cent).


 Cerebral Palsy
 Amputation
 Deformities and Contractures
 Spina Bifida
 Muscular Dystrophy
 Post Polio Residual Paralysis
Common Physical/Locomotor Disabilities


Cerebral Palsy is a
Non Progressive Neurological Disorder
Disorder of Posture and Movement
Consequence of pre-natal, peri-natal and post-
natal brain insult
Prevalence
1 in 250-400 Live Birth Worldwide
Cerebral Palsy


CP is classified in many ways to understand and deal
the condition
* Based on the site of insult to the brain
* Based on involvement of body parts
* Based on severity of the damage to the brain
Cerebral Palsy


Spastic Rigidity
Dyskinetic Floppy
Ataxia Mixed
Classification
Based on site of insult of the brain


Quadriplegia
Triplegia
Diplegia
Hemiplegia
Monoplegia
Newer Classification
Unilateral CP
Bilateral CP: Symmetrical / Asymmetrical
Classification
Based on involvement of body parts


Mild
Moderate
Severe
Profound
No longer used in practice
Classification
Based on extent of damage in the brain


 Gross Motor Ability Classification- GMFCS
GMFM, FMS,
 Manual Ability Classification-MACS
HABIT, CIMT, BMIT
 Visual Ability Classification-VFCS
Functional Vision Assessment


 Gross Motor Function Classification System
GMFCS


 Communication Ability Classification-CFCS
REEL
 Eating and Drinking Ability Classification-EDACS
ADL Assessment
5 Levels of Ability: Level V (5) to Level I (1)
Level-V: Least Ability
Level-1: Highest Ability


 Muscle tone variations: Hypertonic (too stiff /
presence of tightness), hypotonic (too floppy / low
muscle tone) or Fluctuate tone (Combination of high
and low muscle tone)
 Presence of tremors or involuntary movements
(Dyskinetic)
 Presence of slow, writhing movements (athetosis)
 Lack of muscle coordination (ataxia)
 Presence of lead pipe stiffness-Rigidity
Signs and Symptoms of Cerebral Palsy


 Milestones delays in reaching gross motor and fine
motor both
 Using only one side of the body (Hemiplegia)
 Gait disorders-Walking on toes, a crouched gait, a
scissors-like gait or a wide based gait
 Presence of excessive drooling
 Difficulty with swallowing, sucking and chewing
solid foods
 Delays or difficulties in communication skill
/speaking


 Presence of seizures / epilepsy / convulsion
 Problems with teething /dental problems
 Sensory dysfunction / hyper or hyposensitive
 Vision difficulties such as squint, optic atrophy,
nystagmus, etc
 Hearing difficulties or deficits
 Urinary incontinence / poor bladder and bowel
control


 Low cognition, Intellectual impairment / disability
or mental retardation
 Sensory loss / Abnormal touch or pain perceptions
 Problems with coordination and equilibrium
 Presence of Microcephaly (small size head) /
hydrocephaly (watery fluid in the head) , etc


(Meningocele / Myelomeningocele / Myelocele)
 A birth defect affecting the spinal column. It can be very
mild to severe in according to the defect or damage in the
spinal column. Spina bifida begins in the womb, when the
tissues fold to form the neural tube. This causes an
opening in the vertebra which surrounds & protects the
spinal cord. This occurs just a few weeks or 21 to 28 days
after conception. Unfortunately it begins usually before
the woman knows that she is pregnant.
Prevalence / incidence
1 in 1000 live birth
Spina Bifida


A child with spina bifida can have many of these signs /
symptoms
 In most cases, a lump / wound on the back at the spine
 In some cases, dimple, dark, small hairy patch on the skin
overlying the base of spine, other may have a fatty
growth called as epidural lipoma, that forms within the
spinal cord. This is usually harmless but may result in
tethering of spinal cord.
 People with Spina bifida occulta, are always completely
asymptomatic (No obvious symptoms).
 Presence of various degrees of leg paralysis
Spina Bifida


 Spine, hip, foot, and leg deformities are often due to
muscle imbalance.
 Most common bladder & bowel problems and inability to
voluntarily relax the muscles that hold urine in the
bladder and stool in the rectum
 Hydrocephalous affecting about 90% people with Spina
bifida
 Abnormalities at the lower spine are always accompanied
by upper spine abnormality (ARNOLD CHIARI
MALFORMATION) causing subtle co-ordination.
Spina Bifida


 Tethered spinal cord -the cord is attached to surrounding
tissues and can’t move up and down freely as it normally does.
This can cause foot / leg deformities, hip dislocation or
scoliosis. The problems can worsen as the child grows and
tethered cord is stretched.
 Obesity & urinary tract disorders (due to poor drainage)
 Pathologic bone fractures occur in as many as 25% of people
with Spina bifida.
 Growth hormone deficiency resulting in short stature people
which is common in Spina bifida
 Although most people with Spina bifida have normal
intelligence, a few may have learning disability.
 An allergic reaction to latex can be life threatening.
Spina Bifid


 Neuromuscular disorders / diseases are the problems of
the nerves that control voluntary muscles and sensory
nerves. These disorders cause muscle weakness and
fatigue that progress over time. These neuromuscular
disorders can have symptoms from infancy, or may
appear in childhood or even adulthood. Symptoms vary
according the type of neuromuscular disorders. These
neuromuscular conditions affect boys and girls of all ages.
 Majority of the neuromuscular disorders are inherited in
nature
Muscular Dystrophy


Common signs / symptoms of neuromuscular disorders are
 Muscle weakness that can lead to twitching, cramps, aches and
pains
 Numbness, tingling or painful sensations
 Movement problems
 Muscle spasticity
 Muscle pain
 Muscle loss
 Balance problems
 Trouble swallowing
 Double vision
 Droopy eyelids
 Trouble breathing, etc
Muscular Dystrophy


Visual Disorders occur owing to total absence of sight or
visual acuity not exceeding 6/60 or 20/200 (Snellen
chart) in the better eye with correcting lens and/or
limitation of field of vision subtending an angle of 20°
or worse.
Persons with low vision have impairment of visual
functioning even after treatment or standard refractive
correction. They may use or are potentially capable of
using vision for planning or executing tasks with
appropriate assistive devices.
Visual Disorders


Hearing Disorders are where the sense of hearing in
individuals is not adequately developed for the
ordinary activities of life. They do not ear/understand
sound at all, even with amplified speech.
By definition, there must be a loss of hearing of 60 decibels (dB) or
more in the better ear for conversational range of frequencies.
There are various severity levels (in terms of dB) for classification
of hearing impairments based on audiological evaluations of the
better ear
Hearing Disorders


Hearing Level (dB) Severity of Hearing Loss
0–25 Normal
26–40 Mild
41–55 Moderate
56–70 Moderately severe
70–90 Severe
91+ Profound
Severity Levels in Hearing Loss


Conductive-hearing loss occurs when transmission of sound is
interrupted in the outer or middle ear. The usual cause of
conductive-hearing loss in children is middle ear infection
(such as otitis media), and, in adults, it is due to
osteosclerosis.
Sensori-neural hearing loss occurs when the hair-cells of the
cochlea or the acoustic nerves are damaged. This loss of
hearing through bone conduction is more or less permanent,
and can be due to the side effects of drugs (including
antibiotics), infections (such as meningitis or rubella),
syphilis or anoxia at birth, aging, etc.
Types of Hearing Loss


A mixed hearing loss involves a combination of sensori and
conductive hearing loss with damage to the air and bone
conduction pathways, even though latter may the be better
of the two.
Central auditory disorder originates from lesions in the central
auditory system with damage to the auditory nerve rather
than the external and/or middle ear.
A retro-cochlear pathology involves damage to the nerve fibers
along ascending auditory pathways from the internal
auditory meatus to the cortex.
Types of Hearing Loss


Intellectual Disability is identified as a significantly
sub-average level of intellectual functioning associated
with deficits in adaptive behaviour and manifests itself
during the developmental period (Grossman, 1972).
In a more recent definition, Intellectual Disability is
defined as a disability characterized by significant
limitations both in intellectual functioning and in
adaptive behaviour as expressed in conceptual, social
and practical adaptive skills. This disability originates
before the age of 18.
Intellectual Disability (Mental Retardation)


Severity Levels Range of IQ
Mild MR 50–70
Moderate MR 35–49
Severe MR 20–34
Profound MR Below 20
Classification of Mental Retardation (MR)


Learning disorders or academic-skills disorders are invisible
disabilities. Children with this disability appear to have
average or even above-average intelligence. They have had
normal exposure to school or academic training. They show
no apparent physical or sensory problems by way of hearing
loss, visual impairment, mental illness and/ or mental
retardation.
There is no evidence of any organic pathology, psychological
disease or disorder. They may even show sparks of overt
intellect in many facets of daily life. Yet, these children show
an intriguing slowness or incapacity in dealing with one or
more of subjects like reading, writing, spelling or arithmetic.
Learning Disorders


Learning Disorders may occur in isolation in one area
of school performance (such as reading, spelling or
arithmetic), or in a cluster of mixed variety (reflected as
generalized scholastic backwardness).
Learning disorders are diagnosed when the child’s
academic achievement in individually administered,
standardized tests in reading, mathematics or written
expression is substantially below that expected for the
child’s age, schooling and level of intelligence.
Learning Disorders


The learning problems significantly interfere with academic
achievement or activities of daily living that require reading,
and mathematical or writing skills. A diagnosis of learning
disorder is generally avoided if the difficulties can be
explained by sensory deficits (such as hearing or visual
impairments).
Learning disorders persist into adulthood. The identification
of learning disorders is necessarily a diagnosis by exclusion
Learning Disorders


Multiple Disabilities refer to conditions where the child has two or
more disabilities concurrently. For example, a child that has visual
impairment along with primary mental retardation.
Dual or multiplicity of handicaps a single person is more
frequently encountered in clinical practices than can be imagined.
In case a child has a dual diagnosis, the helper should be
conversant about both the conditions independently, as also their
mutually interactive effects, for the proper planning or
implementation of training programmes.
Multiple handicap is the co-existence of two or more disabilities
in an individual
Multiple Disabilities


Parents must be conversant with these conditions since some of
them may be present in their preschool children, if not as primary
disorders, at least as associated features of a primary disorder.
1. Pervasive developmental disorders
2. Attention deficit and disruptive disorders
3. Communication disorders
4. Motor skills disorders
5. Feeding or eating disorders
6. Elimination disorders
7. Emotional disorders
8. Epilepsy or convulsion disorders
Common Psychological
Disorders in Children


Pervasive developmental disorders (PDDs) are
characterized by severe and ubiquitous impairment in
several areas of a child’s development, including
reciprocal social and communication skills.
PDD is distinguished from mental retardation, wherein
impairments occur in all areas of a child’s development.
The general intellectual/developmental level of
children with PDD, or their history of early
development milestones, will be typically age
appropriate.
Pervasive Developmental Disorders


In a few cases, a degree of mental retardation may be
evidenced, usually as a consequence and not as a cause of
PDD. Therefore, the normal history of early developmental
milestones predating the onset of PDD is a critical element in
their final diagnosis. Terms like ‘childhood psychosis or
schizophrenia’ were once used to designate these children.
There is now enough evidence to suggest that PDD is
distinct from these conditions. However, a few of these
children may eventually develop adolescent/adult
schizophrenia.
Pervasive Developmental Disorders


Autistic Spectrum Disorder (ASD) usually shows an onset
during infancy or early childhood (below three years).
Unlike Intellectual Disability, children with ASD show an
early developmental history of near normal sensori-motor
and/or even language milestones followed by typical
qualitative abnormalities in reciprocal social interactions and
patterns of communication, and by restricted, stereotyped
and repetitive interests and activities.
Abnormal pattern of social interaction, language and
restricted or repetitive behaviours are, so to speak, the
elemental triadic properties of autism
Autism Spectrum Disorder


Difficulty in interacting and playing with other children.
Acts as if deaf and does not react to speech or noises.
Strong resistance to learning new behaviours or new skills.
Lack of fear about realistic dangers; may play with fire.
Resists changes in routine—a slight change may produce
disproportionate anxiety.
Prefers to indicate wants by gestures and speech may or may
not be present.
Laughs or giggles for no appropriate reason.
Clinical Features of Autistic
Spectrum Disorders


Not cuddly as a baby.
Marked physical over-activity.
No eye-to-eye contact; persistently looks past or turns away
from persons.
Unusual attachment for inanimate objects like soap case,
plastic, paper, etc.
Spins objects, especially round ones.
Repetitive and sustained odd play, such as rattling stones in
a can.
Stand-offish manner—treats persons as objects rather than as
persons.
Clinical Features of Autistic
Spectrum Disorders


Retts’ Syndrome lies in close proximity to ASDs in children, and is often
confused with it. The patterns or difficulties in social interaction are
similar in both conditions. There is normal psychomotor development in
the early phase of infancy/childhood, and there are similar impairments
of expressive/receptive language development.
However the similarities end there; RS is invariably diagnosed only in
females, whereas ASDs occur more in males.
RS shows a characteristic pattern of head-growth retardation, loss of
previously acquired hand skills (evidenced by hand wringing or hand
washing), appearance of poorly co-ordinated gait/trunk movements and
only transient loss of social engagement early in course of this disorder.
Normal social interactions sometimes develop spontaneously later.
Retts’ Syndrome


Childhood disintegrative disorder (CDD) is also called Heller’s
syndrome, dementia infantilis or disintegrative psychosis. The
diagnosis is made only when there is at least a two-year history of
normal developmental milestones before the onset of this disorder,
and the child is within 10 years of age.
There is a significant loss of previously acquired skills and a
greater likelihood of mental retardation towards the end of this
course. A significant loss of previously acquired skills occurs in
areas like expressive or receptive language, social skills or adaptive
behaviour, bowel or bladder control, play and motor skills. These
changes are not to be attributed to schizophrenia, head injuries or
some known organic pathology.
Childhood Disintegrative Disorder


Aspergers’ disorder shares several features with autistic
disorders.
There is marked impairment in multiple non-verbal
behaviours such as eye-to-eye gaze, facial expression, body
posture and gestures to regulate social interaction.
Children with this disorder show a failure to develop peer
relationships appropriate to their developmental level. They
lack spontaneous sharing or interests, achievements or
enjoyments with others.
Aspergers’ Syndrome


There is general lack of social or emotional reciprocity.
A crucial difference between AS and ASD lies in the
fact that there are no delays in language development.
There is no clinically significant delay in cognitive
development of age-appropriate self-help skills,
adaptive behaviour and curiosity about the
environment in childhood, either before or after the
onset of this disorder.
Aspergers’ Syndrome


Although schizophrenia is primarily an adult psychological
disorder, some early writers describe its occurrence in
children. The concept of childhood psychoses led to terms
like autistic disorders and, eventually, PDDs.
The early literature as we know it today may actually be
descriptive of what we now call PDDs. A distinct category of
childhood schizophrenia is still justified by some authors
against disintegrative,
autistic and/or PDDs.
Early Onset Schizophrenic Disorder


Childhood schizophrenia is characterized by an early onset,
presence of positive or active behaviour symptoms like
hallucinations, delusions and bizarre or disorganized thinking.
Negative symptoms consist of paucity of speech, decreased pro-
social behaviour, avolition, apathy and flat affect.
Additionally, there are serious disturbances in sleep and appetite.
Most children with PDDs require a supplementary course of
medicines, especially if there are noticeable disturbances in their
sleep and/or appetite. Otherwise, behaviour therapies and non-
drug interventions suffice fairly during the rehabilitation processes
of these children. An accurate and expert diagnosis at the hands of
specialists is recommended before putting the label of PDD on
young children.
Early Onset Schizophrenic Disorder


ADHD (earlier called ‘hyperkinetic’) disorders have an early onset,
either in childhood (below five years) or early adolescence. It is
typically characterized by a short attention span, over-activity and
impulsivity. The manifest behavioural patterns often reflect in
reckless/impulsive or accident-prone actions.
Individuals with this disorder often find themselves in disciplinary
trouble due to their unthinking rather than a deliberately defiant
breach of rules. They appear to be socially uninhibited, often lack
social reserve or caution and are generally unpopular with their
peers.
Parents experience immense stress in routine management of
children with ADHD in home settings.
Attention Deficit and Disruptive Disorders


All levels of IQ occur in ADHD. It is vital to distinguish
ADHD as a primary disorder and/ or against few of these
features seen in association with some other primary
conditions like hearing impairment, learning handicap,
severe/profound mental retardation, etc.
There are instances wherein a restless child seen briefly in a
clinic (presumably tired after a long journey) has been
hastily diagnosed with ADHD and even put on strong anti-
psychotic or stimulant
medication!
Attention Deficit and Disruptive Disorders


Behavioural problems are actions that are harmful
either to the child himself or to others who are around.
They interfere in the learning/ teaching process, are age
inappropriate or socially deviant and are a cause of
immense strain for care-givers.
Some examples of problem behaviour are hitting
others, screaming, stamping of feet, rolling on the floor,
pulling objects from others, biting oneself, etc.
Behavioural Problems and Conduct Disorders


Communication disorders manifest independently, or they
co-exist with some other primary disability. In any case, they
must be recognized and intervened with for their own merit.
Some commonly seen communication disorders originating
during early childhood are:
Expressive Language Disorder
Mixed Receptive-Expressive Language Disorder
Phonological Disorder
Stuttering
Communication Disorders


Developmental co-ordination disorder (DCD) is a major form of
impairment in this area. It manifests itself as a failure to co-
ordinate routine or age- appropriate motor activities like walking,
crawling, buttoning clothes, somersaulting, sitting, tying shoe
laces, using scissors, assembling blocks, building models,
throwing/catching a ball, standing or walking, handwriting, etc.
These difficulties are seen despite average or above average
general intellectual abilities in the child. In other words, primary
conditions like mental retardation, ADDs, cerebral palsy, muscular
dystrophy, PDDs, sensory impairments, neurological conditions or
allied conditions of environmental deprivation cannot explain
these difficulties. Only a history of delay in motor development is
evidenced.
Motor Skills Disorders


Feeding or eating disorders are characterized by persistent
disturbances in feeding and eating during infancy or early
childhood. An area of intense concern for the mothers of
toddlers is the feeding/eating behaviours of these children.
Most mothers carry a long list of complaints regarding their
children’s eating habits.
The sub-types of this disorder are:
Pica
Rumination Disorders
Psychogenic Vomiting
Feeding or Eating Disorders


These are disorders of the gastro-intestinal tract
precipitated by psycho-social rather than medical or
organic factors.
Some common sub-types included under this disorder
are:
Psychogenic/Non-organic Encopresis
Psychogenic/Non-organic Enuresis
Elimination Disorders


Emotional disorders reflect a heterogeneous group of
problems in a child’s social-emotional relationships
with his peers and family, and outside members of
society. These problems begin during the toddler phase
after an initial period of normal social development.
It is important to distinguish these disorders from
PDDs that are characterized by a primary constitutional
social incapacity/deficit that pervades all areas of
functioning.
Emotional Disorders


Some important disorders that fall under this category
are:
Attachment Disorders of Early Infancy or Childhood
Elective or Selective Mutism
Childhood Phobias
Depressive Disorders
Separation Disorders
Conversion Disorders
Sibling Rivalry Disorder
Emotional Disorders


Convulsion disorders reflect the neurological status of an
individual. The clinical presentation of epilepsy depends upon its
causes, anatomical lesion within the brain, pattern of spread of
epileptic discharges, age of onset and a host of other factors.
Several types of epilepsy can be recognized. There are ‘simple’
types with slight jerking or deviation of the eyes, fluttering
of eyelids, oral/facial movements, isolated muscle spasms and the
like. There are also more ‘complex’ seizures with extensive jerking
movements of the upper and lower limbs, tongue bites,
unconsciousness, frothing, incontinence and so on.
Epilepsy or Convulsion Disorders


 Rehabilitation Services are the process of helping a
person who has suffered an illness or injury restore
lost skills and so regain maximum self-sufficiency.
Generally adults are the main beneficiaries in case of
rehabilitation services
 Refers to a process aimed at enabling persons with
disabilities to reach and maintain their optimal
physical, sensory, intellectual, psychiatric or social
functional levels;
Rehabilitation


Habilitation Services are types of health
care services that help a child to keep calm, learn, or
improve skills and functioning for daily living. These
services are exclusively used in pediatrics set up.
Generally these services provided by non-medical but
qualified habilitation professionals. Adults can also
benefit from habilitative services, if they have
locomotors or intellectual disabilities or disorders.
All children with developmental delay /
developmental disabilities require habilitation services
or pediatric therapy
Habilitation


Habilitation Services
Medications
Chemo denervation
Orthopedic Interventions
Neurosurgical Interventions
Regenerative Medicines
Complementary and Alternative Medicines
Components of Holistic
Habilitation Plan


Infant Stimulation
Early Intervention
Play Therapy
Developmental Therapy
Physiotherapy
Occupational Therapy
Speech Therapy
Cognitive Therapy / Special Education


Behaviour Modification Therapy (BMT/ ABA)
Assistive Technology / Equipment Oriented Therapy
Electrotherapy
Hippo therapy (Real / Robotic)
Hydrotherapy
TAL –Technology Assisted Learning
(Computer oriented Games and learning apps)
Nutritional Support / Nutriceutical Therapy


Pharmacological Therapy / Drugs therapy
 Medications for primary Disorders
Spasticity Management
Movements Management (Dystonia and Ataxia)
 Medications for Associated Conditions
Epilepsy
Drooling
GERD
Constipation
Osteoporosis
Hormonal imbalance, etc
Medications


Nerve Block
Phenol
Alcohol
Use of Bonta A (Botulinum Toxin)
Botox-Allegan
Dysport- Spywood
Nobota-Dr Reddy
Xeomin-Merz, etc
Chemo denervation


Soft Tissue Release ( Tenotomy, Myotomy, etc)
Osteotomy
Percutaneous Technique
SESLS
SEMLS
SEMLLARS
OSSCS
Ilizarov
Orthopedic Intervention


Implant
Intrathecal baclofen pump therapy
Deep brain stimulation
Rhizotomy
SDR / SPR
Fasciculotomy
Neurosurgical
Intervention


Hyperbaric Oxygen Therapy-HBOT
Stem Cell Therapy
Gene Therapy
Regenerative Medicines


Homeopathy
Ayurveda
Unani
Acupuncture
Yoga
Complimentary and
Alternative Medicines


Habilitation Therapy
Pediatric Therapy
Rehabilitation Therapy (Need Based))


 Infant stimulation is a process of providing supplemental
sensory stimulation in any or all of the
sensory modalities to an infant as a therapeutic
intervention
Visual
Auditory
Tactile
Vestibular
Olfactory
Gustatory
 Begins at NICU
 Mostly continues till 1 year of age
Infant Stimulation


Providing the Right Stimulation at the Right time is
the Key for Brain Development
Infant Stimulation improves not only medical outcome
but also neurodevelopment outcome by preventing
active inhibition of the central nervous system
pathways due to inappropriate input, and supporting
the use of modulating pathways during a highly-
sensitive period of brain development.
Infant Stimulation


 The stimuli used vary based on the patient and the
sense involved.
 The stimulation is usually presented on a regular
schedule for specific amounts of time (e.g., 30
minutes per day for 20 days).
Infant Stimulation


 Stimulation in NICU via tactile, vestibular, and auditory
channel; similar to stimulation received in the womb.
 Visual stimulation may be added, and the program may
be modified to approximate the typical sensory
environment of the home.
 In the first years of a baby’s life, the brain is busy building
its wiring system. The amount of stimulation the baby
receives has a direct affect on how many synapses are
formed. Repetitive stimulation strengthens these
connections and makes them permanent, whereas young
connections that don’t used eventually die out.
Infant Stimulation


 Kangaroo Care
 Need based ROM Exercises
 Need Based Joint Compression
 Positioning for weight bearing
 Positioning for Milestones development
 Hand Function Development
 Feeding Development
Infant Stimulation


Early intervention means intervening as soon as possible to tackle
problems that have already emerged for children and young
people
Any time during the first year of life
Till 3 years of age ( In some countries till 6 Years of age)
Based on child developmental Profile / Domain
Gross Motor
Fine Motor
Cognition / Receptive Language
Expressive Language / Speech
Social-Emotional/ Behaviour
Self Help
Early Intervention


 Early intervention and prevention often overlap in
practice.
 Early intervention can help children from pregnancy to 18
years, not only when they are very young.
 Neuroscience is showing that the healthy growth of very
young children’s brains can be impaired by poor early life
experiences.
 In that early period, interactions and experiences
determine whether a child’s developing brain architecture
provides a strong or a weak foundation for their future
health, wellbeing and development
Early Intervention


 Early intervention is a process not an event
 For early intervention to be successful, each stage of
the process must be carried out well and followed
through
 A key ingredient is the capacity of professionals to
win the trust of children, young people and families
Early Intervention


Many children lack skills that they need to survive in the
world. One method of teaching children social skills,
problem-solving skills, negotiation skills, and assertiveness
skills uses toys, art, and play materials to provide them with
direct instruction in a fun way that optimizes their learning
Play therapy is a powerful medium for young children to
build adult-child relationship and social skills
The intense sensory and physical stimulation that comes
with play therapy helps to form the brain circuits and
prevents loss of neurons
Play therapy


 Play is nearly as important as food and sleep
 Throughout the life
 Based on Developmental Domains
Gross Motor
Fine Motor
Cognition
Speech
Behaviour
ADL
Play Therapy


1. Helps in physical development
2. Helps child to learn language and speech
3. helps in learning and development of intelligence
4. Improves child’s ability to socialize
5. Helps children develop emotionally
6. Serves as a means of alleviate fear
Importance of Play Therapy


 Exploratory Play
 Manipulative Play
 Combinatorial Play
 Symbolic Play
 Pretend Play
 Constructive Play
Types of Play


Developmental Therapy is a service provided by
professionals with a specialized knowledge of infant /
toddler development.
The DT looks at the whole child and the impact of the
child’s development on the family and care givers


Domains under DT
 Physiotherapy
 Occupational Therapy
 Speech Therapy
 Cognitive Therapy


Developmental Therapy differs from PT / OT in many
ways:
1. DT- Exclusively for pediatric populations
(Birth to 18 Years)
2. DT- Primarily a combinations of PT and OT
- Need based intervention for Communication and Cognition
3. DT- Functional Therapy
4. DT-ICF Oriented
5. DT- Holistic in nature


Focuses Components
Reflex Integration
1. Preventive Sequential-Milestones
oriented
2. Functional Task Analysis based
intervention
3. Developmental Postural Management
4. Muscles and Joints Care
5. Use of Assistive Technology
6. Equipment based Therapy
7. Home Management
Program


 Developmental Profile
Gross Motor Development
Fine Motor Development
Cognitive Development
Expressive Language Development
Social emotional Development
Self Help Development
 Use of Developmental Checklists
HELP
Denver
Trivandrum Developmental Checklist


Physiotherapists, viewed as the 'movement expert',
play a key role within MDT.
The main aim of Physiotherapy, as identified by Gunel
(2011), is to support the child with Cerebral Palsy to
achieve their potential for physical independence and
fitness levels within their community, by minimizing
the effect of their physical impairments, and to improve
the quality of life of the child and their family who have
major role to play in the process.
Physiotherapy


 Backbone of a habilitation program
 Traditional Physiotherapy Versus Advance
Physiotherapy
 Overlapping with Occupational Therapy
 Overemphasized
 Require Multifaceted, Specialized and Exclusive
Training
Physiotherapy


 Bobath Approach / NDT
 Rood Approach
 Kabat, Knot and Vass Approach / PNF
 Doman-Delacto Approach (Patterning)
 Ayres Approach (SIT)
 Peto Approach ( Conductive Education)
 Vojta Approach ( Reflex Integration)
 Brunnstorm Approach
 Carr and Shepherd Approach
 Feldenkrais Approach
 MNRI Approach
 Total Motion Release Approach
 Eclectic Approach
Physiotherapy Approaches


 No Passive ROM Exercises
 Active ROM / Stretching-Stretch and Hold Technique
How much is too much
 Sustained Stretching-Use of Night Splint / More than 6
hours sustained stretching(increase muscle length)
 Joint compression-Combined stretch and strength
technique
 Strengthening Versus Stretching
 Alignment- New essence of Physiotherapy
 Spasticity / SMC
Pediatric Physiotherapy


Sequential therapy- Developmental Profile
Positioning-NEP / TRP
Promoting Postural Milestones
Static Positioning
Dynamic Positioning
Transitory Positioning
Promoting Mobility
Floor Mobility
Off Floor Mobility
Pediatric Physiotherapy


 Occupational therapy is a practice that uses goal-
directed activity to promote independence in
function.
 The goal of occupational therapy intervention is to
increase the ability of the client to participate in
everyday activities, including feeding, dressing,
bathing, leisure, work, education, and social
participation


HABIT
BMIT
CIMT
Hand Writing Task Practice
SIT
Goal Directed Training
Approaches


 Create, promote (health promotion)
 Establish, restore (remediation, restoration)
 Maintain
 Modify (compensation, adaptation)
 Prevent (disability prevention)
Occupational Therapy Approaches


Speech and language therapy can help improve
communication, eating and swallowing. It can also
encourage confidence, learning and socialization.
Speech therapy can help with the following:
 Articulation – Pronunciation - Fluency/stuttering
 Sound and word formation – Listening - Pitch
 Language and vocabulary development- Speech volume
 Word comprehension- Word-object association
 Breath support and control- Chewing- Swallowing
 Speech muscle coordination and strength
Speech Therapy


Exercises Used in Speech Therapy
 Articulation Therapy
 Blowing Exercises
 Breathing Exercises
 Jaw Exercises
 Language and Word Association
 Lip Exercises
 Swallowing Exercises
 Tongue Exercises
Pediatric Speech Therapy


Special education, also called special needs education, the
education of children who differ socially, mentally, or physically
from the average to such an extent that they require modifications
of usual school practices.
Objective of Special Education:
1. To develop motivational patterns in the CWSN that will
produce achievement in school.
2. To develop a realistic self-concept in CWSN.
3. To reach the maximum level of effectiveness in school subjects.
4. To pursue those curricular matters that strategically determine
effective living or specific types of CWSN.
5. To consider the mental as well as the physical hygiene of CWSN.
Cognitive Therapy / Special Education


Behavioral therapy is an umbrella term for types of
therapy that treat mental health disorders. It’s based on
the idea that all behaviors are learned and that
behaviors can be changed.
 Behaviour Modification Therapy-BMT
 Behavioral Interventions
 Applied Behaviour Analysis-ABA
Behavioural Therapy


It’s a combination therapy. The professionals assess the
children in need to have a baseline data and formulate an
amalgamated program containing all essential components
of communication enhancement, cognition development and
behavioral modification.
Mostly, CCBT / CSBT is provide by specially trained
 Special Educator
 Speech Therapist
 Clinical Psychologist
Communication (Speech),Cognition
and Behaviour Therapy- CCBT


 Equipment Assisted Therapy (EAT)
 Aids Oriented Therapy(AOT)
 Postural Aids
 Orthotic Aids
 Mobility Aids
 Adaptive Aids
Assistive Technology-AT


Postural Ability and Postural Alignment Oriented
 Prone Wedge
 Side Lying board
 Corner Chair with tray cut out: High / Floor
 Arm Chair with tray cut out / Table
 Standing Frame: Supine Stander / Prone Stander
Supine stander are considered better
Long leg sitter with cut out table
Peto bar / Peto Chair / Peto Table
Creeper / Crawler
Aligners
Stretching Board
Postural Aids


Modified Arm
Chair with Tray
Cut Out
Postural Aids


Side Lying
Board
Postural Aids


RIGHT ORTHOSIS can help a child with CP:
 Walk sooner (more stability)
 Walk better (better alignment)
 Perhaps walk more (if energy efficient)
Earlier it was only preventive in nature, now its almost
corrective and preventive both
3 C in orthoses
 1st C- Correction
 2nd C –Comfortable
 3rd C-Cosmetic
Orthoses


Spinal Orthoses
Spinal Jacket
Upper Limb Orthoses
Cock Up Splint
Use only in night as night splint
Elbow and arm band
Thumb abductor
Mid Arm Supinators
CIMT Band –Use with the unaffected / better hand during play only
Orthoses


Lower Limb Orthoses
Ankle Foot Orthoses (Solid / Hinged / Limited Joints)
Solid AFOs are always better than Hinged AFO
There is no scientific data available to support rubber pad below AFO soles, few studies
have shown negative impact on long term gait
Knee Immobilizers ( Corset / 3 Points)
Corset doesn’t work after 2 years of age
Knee gaiters can be modified to anti-torsion splint
Night splint is always better than using day time
Genu Recurvatum ( Knee Hyperextension) doesn’t require KAFO, it can easily be
controlled with 5-8 degree dorsiflexed AFO
HKAFOs are totally banned in practice in CP Management
Dynamic Hip Abductors are available in place of costly SWASH
SMO and Insole Arch Support never help to prevent or correct Equino-Valgus
/ Varus. Both help Pes Planus only
Orthoses


 Use FMS (Functional Mobility Scale) for better gait
outcome
Mobility Aids


Scooter Board / Creeper
Crawler
Rollator / Walker
Posterior Rollator are considered better than Anterior Rollator
Elbow Crutches
Most Functional Mobility Aids
Tripods / Quadripods / Cane / Stick
Tripods are better than Quadripods due to optimal support
Wheel Chair: Ordinary / Self pushed / Motorized
Motorized: Sound oriented / head movement oriented / Switch oriented
Mobility Aids


 Elbow Crutches
Elbow Crutches


 Bent Spoon
 Pencil / Pen Holder
 Modified Straw
 Soap Net / Soap Stick
 Modified Computer Accessories
 Heavy Feeding Plate

Adaptive Aids


Magnetic Plate with adapted Spoon


 NMES / NEMS / EMS
 FES / Spinex
 TES
 EMG Biofeedback
 ?? TENS / Therapeutic Ultrasonic / IFT /
Diathermy
Electrotherapy


 Horseback riding actively engages several of the
body's muscle groups with significant background
work from the joints and tendons that they are
attached to. The hip flexors are a group of muscles
that help to provide free range of motion allowing
the body to bend in to the hips, and the hips to be
pulled in towards the torso
 Real Horse
 Robotic Horse
Hippo therapy


 Aquatic physical activity may be significantly beneficial
for higher GMFCS levels, that is, those with significant
movement limitations for whom land-based physical
activity may be difficult and limited. It should be noted
that there are limited land based programs for this
population
 There is supportive evidence that aquatic exercise in a
group environment can provide a motivating and socially
stimulating environment for children
Hydrotherapy


 Virtual Reality is the use of technology to simulate a
three-dimensional environment. Those using it typically
wear a helmet or goggles with a screen as well as gloves
and other equipment and sensors. The user experiences
an environment that seems real and that can induce all
the sensations and responses of a real environment.
 The VR provides significant gains in functional motor
skills by increasing cortical reorganization and
neuroplastic changes. The biofeedback during VR
therapy is multimodal, as it uses sensory and cognitive
functions simultaneously, and it is also entertaining,
interesting, motivating, and easy to understand
Technology Assisted
Learning (TAL)


Learning Applications (App) are used to help students with disability
to enhance
 Listening Skills
 Solving mathematical difficulties
 Organization and memory
 Reading
 Writing
 Communication
 Balance / Equilibrium
 Hand Function
 Gait quality
 Mobility skills
 Activities of daily livings
Computer / Mobile based
Games and Learning Apps


 Jellow- A Speech and Communication enhancing app
 Be My Eyes: Connecting visually impaired travelers
 Dragon Dictation: Communication for the hearing-impaired
 Assistive Touch: Operating a smartphone with physical
disabilities
 JABtalk: Communication for nonverbal adults and kids
 Perfect Keyboard: Assisting with limited dexterity or vision
 SuperVision + Magnifier: Zoom-in on printed documents
 NotNav and NowNav GPS Accessibility: GPS for the Blind
 Wheel Mate : Find wheelchair-accessible toilets and parking
space
 Voice4u AAC: AAC App
 Proloquo2Go: App for speech challenges
Learning Apps


 FuelService: For fuel refilling
 Subtitles Viewer: For watching TV
 Access Now: Interactive App for accessible locations
 CoughDrop: Speech App
 Speak for Yourself: Speech and communication app
 Snap + Core: Speech and Communication App
 ModMath: Mathematics App
 Rufus Robot: For autism
 Autism Core Skills: For children with ASD
 Wheelmate: For wheel chair users
 Assistive Touch: ADL based App
Learning Apps


 Management
 Treatment
 Multidisciplinary
 Interdisciplinary
 Trans disciplinary
Treatment Approaches


Please contact us at
Institute for Child Development
C-27, Malviya Nagar,
New Delhi-110017
Phone@ 011-41012124
Whatsapp@ 7838809241
mail@ helpicd@gmail.com
Website: www.icddelhi.org
Thanks for listening

Dr. Mansoor Alam's Guide to Children with Special Needs

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Dr. Mansoor Alam's Guide to Children with Special Needs

Similar to Dr. Mansoor Alam's Guide to Children with Special Needs (20)

More from ICDDelhi

More from ICDDelhi (6)

Recently uploaded

Recently uploaded (20)

Dr. Mansoor Alam's Guide to Children with Special Needs