training and rehabilitation of challenged children

2. TRAINING AND REHABILITATION
OF CHALLENGED CHILDRENS
M.VIJIYALAKSHMI

3. INTRODUCTION
Challenged children are one who deviated from normal health
status either physically, mentally or socially and requires special
care, treatment and education.

4.  DISEASE- accident
 IMPAIRMENT- loss of limb
 DISABILITY- cannot walk
 HANDICAP-unemployed

5. DEFINITION
According to World Health Organization (WHO) the sequence
of events leading to disability and handicapped conditions are
as follows:
IMPAIRMENT
It is defined as any loss or abnormality of psychological,
physiological or anatomical structure or function, e.g. loss of
vision, hearing.
DISABILITY
It develops as the consequence of impairment, e.g. loss of
limbs results inability to walk. Disability is the inability to carry
out certain activities which are considered as normal for the

6. HANDICAP
It develops as the consequence of the disability. It is defined as a
disadvantage for a given individual resulting from impairment or a
disability that limits and prevents the fulfillment of a role which is
normal for that individual, depending on age, sex, social and
cultural factors.

7. Types of Handicaps

8. PHYSICAL HANDICAPS
INTRODUCTION
Physical handicap is loss of or failure to develop a specific bodily
function or functions, whether of movement, sensation,
coordination, or speech, but excluding mental impairments or
disabilities.

9. BLINDNESS
DEFINITION
WHO (1975) defined blindness as, "visual acuity of less than 3/60
(Snellen) or its equivalent". If visual acuity chart (Snellen) is not
available, then the criteria that inability to count fingers at 3 meters
distance in day light is followed, which is equal to a visual acuity of
3/60 or less.
United state
Legal blindness
Visual acuity-20/200

10. CAUSE
• Ocular trauma
• Corneal ulcer
• Congenital
glaucoma
• Xerophthalmia
Refractive
errors
Cataract
unknown
Diabetic
retinopat-
hy

11. m/c blindness
cataract
m/c blindness in
chlidren
Vit A deficiency
Congenital cataract
ROP

12. Problems of a Blind Child
 Physical aggresion
 Throwing toys or objects.
 Inconsolable crying.
 Yelling or screaming.
 Falling to the ground or on the furniture.
 Excited and active one minute and sad or angry the next.

13. Program for Multi-Disabled Visually Impaired
(MDVI)
Early
Interventio
n
Functiona
l
assessm
ent
Academic
Training
Picnics and
Outings

14. MANAGEMENT
 Refractive errors are managed by corrective lenses and cataract is
treated by surgery.
 Macular degeneration is treated with medications that slow down
the progression of the wet (hemorrhagic) form.
 Lowering eye pressure with medication, laser, and/ or surgery
controls glaucoma.
 Corneal transplants can correct many types of corneal opacities due
to scarring or swelling.
 Anti VEGF medications like ranibizumab, aflibercept are given for
diabetic retinopathy. Laser treatment is also done for diabetic
retinopathy.
 Eye surgery - to remove blood or scar tissue from the eye, if laser
treatment isn't possible.

15. DEAFNESS
DEFINITION
Suspect a hearing handicap, if the child does not respond to sound or voice or
has not started speaking by 2 years of age.

16. cause
 Birth complications
 Premature birth
 nervous system or brain disorder
 Use of ototoxic medication
 Infection of mother during pregnancy
 Maternal diabetes
 Drug or alcohol abuse

17. Problems of Deaf Children

18. MANAGEMENT OF A DEAF CHILD
 Early diagnosis is essential for treatment and the proper development
of speech.
 All babies should therefore be given a screening test for hearing
around the age of two to six months.
 Particular attention to be given to those babies on the 'at risk' register.
 Mothers are extremely competent at appreciating the inability of their
young children to hear normally.

19.  The ability to learn auditory discrimination diminished as the child
grows older. Therefore, the child must be taught to hear as early
as possible.
 Delays cause diminished capacity for hearing the consequent
impairment of speech being seen in its most severe form in the
deaf mute.
 Total deafness is exceptional and only 1-2% of deaf children have
no hearing at all.
 All children should therefore have to hear period of auditory
training before being regarded as totally deaf.

20. DUMBNESS
 The state of being dumb (either mute or dim-witted), not
communicating vocally, whether from selective mutism (refusal to
speak) or from an inability to speak is called dumbness. Also
known as Muteness, silence or abstention from speech.

21. The various types of speech
disorders

22. Impact of speech impairment
includes:
 Poor communication skills.
 Less social interactions.
 Behavioral problem like shame, anger, frustration, depression,
etc.
 Poor academic performance.

23. MANAGEMENT
 Early identification of speech impairment.
 Elimination of hearing impairment.
 Medical and surgical interventions for underlying cause.
 Psychological counseling.
 Voice or speech therapy.
 Physical therapy.
 Cognitive rehabilitation.

24. CRIPPLING
 A cripple is a person with a physical disability. particularly one
who is unable to walk because of an injury or illness.
 Cripple is also a transitive verb, meaning "cause a disability or
inability.

25. MANAGEMENT
 Correction of deformities.
 Physical therapy.
 Occupational therapy.
 Massage therapy.
 Prosthetics.
 Devices for positioning and mobility.

26. MENTAL HANDICAPS
INTRODUCTION
Mental handicap is a condition in which the intellectual of a child is
permanently lowered or under capacity of a developed to an extent
which prevents normal function in society.

27. MENTAL RETARDATION
DEFINITION
Mental retardation is a particular state of functioning that begins in
childhood and is characterized by significant limitations in both
intellectual functioning and adaptive behavior skills.

28. Measurement of IQ
Mental Age
Intelligence Quotient (IQ) = x 100
Chronological Age

29. CLASSIFICATION OF MR

30. Common Health Problems
Associated with Mental Retardation
Behavioral problem
Convulsion
Sensory impairment

31. Causes of Mental Retardation
1. Infections (present at birth or occurring after birth):
 Congenital rubella
 Congenital toxoplasmosis
 Encephalitis
 HIV infection
 Meningitis

32. 2. Chromosomal abnormalities:
 Chromosome deletions.
 Chromosomal translocations
 Defects in the chromosome or chromosomal inheritance.
 Errors of chromosome numbers (such as Down's
syndrome).
3. Genetic abnormalities and inherited metabolic
disorders:
 Phenylketonuria
 Tuberous sclerosis
 Rett's syndrome

34. Signs and Symptoms
 Developmental delay in motor mile stones and cognitive skills.
 Delay in urine and toilet training.
 Delay in oral language development.
 Deficits in memory skills.
 Difficulty in learning social rules.
 Difficulty with problem solving skills.
 Delays in the development of adaptive behaviors such as self-
help or self-care skills.
 Lack of social inhibitors.

35. Diagnostic Evaluation
According to the Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV), three criteria must be met for a diagnosis of
mental retardation:
Significantly sub-average intellectual functioning: An IQ of
approximately 70 or below on an individually administered IQ test
(for infants, a clinical judgment of significantly sub-average
intellectual functioning).
Concurrent deficits or impairments in present adaptive functioning.
The onset is before age of 18 years

36. management
The treatment plan should:
 Include community caregivers and hospital staff.
 Formulate specific treatment goals
 Avoid (as much as possible) treatments that cannot be continued
in the community, such as medications taken as required or
seclusion and restraint.
 Use therapy, activity groups or both to bring out the person's
capacity for learning and participation

37. SOCIAL HANDICAPS
INTRODUCTION
Social handicap can refer to any disorder that leads to the inability
to make progress socially and emotionally, meaning the impact of
the disorder degrades a person's quality of life.

38. ORPHANS
DEFINITION
An orphan is a child who has one or two deceased parents. In
common usage, only a child who has lost both parents due to death
is called an orphan.

39. Problems of an Orphan Child

40. Central adoption resource authority
 It is a autonomous and statutory body of ministry of women and
child development in the govt. of India. It was set up in 1990.
 It is statutory body under juvenile justice( care and protection of
children) act, 2015.
 Counselling of prospective adoptive parents focus on
1. pre adoption counselling- psychological preparation
2. Counseling during process of adoption
3. Post adoption counselling

41. Eligibility criteria
 The consent of both the spouse for the adoption shall be required, in the
case of a married couple
 A single female can adopt a child of any gender
 A single male shall not be eligible to adopt a girl child
 No child be given in adoption to a couple unless they have at least two years
of stable marital relationship expect in the cases of relative or step-parent
adoption.

42. Age of child Maximum age of
couple
Maximum age of
single parent
Upto 2 yrs 85 yrs 40 yrs
> 2 to 4yrs 90 yrs 45 yrs
>4 to 8 yrs 100yrs 50 yrs
>8 to 18yrs 110 yrs 55 yrs

43. The Hindu adoptions and maintance
act
 HAMA was established in the year 1956 as part of the Hindu code bills.
CRITERIA
 A person who is a Hindu by religion in any of its form or development
 A person belong to a buddhist, jain can adopt a child
 A person who has been convert to Hindu, buddhist, jain religion

44. NEGLECTED CHILDREN
Child neglect is defined as a type of maltreatment related to the
failure to provide needed, age-appropriate care. Unlike physical
and sexual abuse, neglect is usually

45. 1. Physical neglect: Failing to provide for a child's basic
needs such as food, clothing or shelter. Failing to adequately
supervise a child ,or provide for their safety.
2. Nutritional neglect: Failing to achieve the proper growth
of the child. The main causes of neglect in nutritional needs
are female child, working parents, too many children in a
family and disharmony among parents.
3. Emotional neglect: Failing to meet a child's needs for
nurture and stimulation, perhaps by ignoring, humiliating,
intimidating or isolating them. It's often the most difficult to
prove.

46. 4. Educational neglect: Failing to ensure a child receives an
education.
5. Medical care neglect: Failing to provide appropriate health care,
including proper immunization, exclusive breastfeeding, weaning,
dental care and refusal of care or ignoring medical
recommendations.

47. CHILDREN OF DIVORCED PARENTS
 Many families face the challenge of divorce or separation. the
causes of the separation, and whatever the circumstances, it's
hard for everyone involved. Divorce can be painful for parents,
but eventually, each person involved starts to heal.

48. Reaction of a Young Child to Parent's
Divorce
1. Fear
2. Sadness
3. Temper tantrum
4. Guilt
5. Loneliness
6. Rejection
7. Regression
8. Sleep problems

49. Reaction of Adolescents to Parent's
Divorce
1. Academic problems, like poor grades.
2. Trouble sleeping.
3. Increased stress.
4. Sadness or anger at one parent or both.
5. Defiance and non-compliance.
6. Substance abuse.
7. Depression.
8. Suicidal ideation and attempts.
9. Behavior problems at school.
10. Trouble getting along with siblings, peers, and parents.

50. Causes of Handicaps
Preconceptual factors:
 Genetic conditions
 Chromosomal abnormalities
Antenatal factors:
 Rh incompatability.
 Maternal infections such as
rubella, cytomegalovirus,
toxoplasmosis, syphilis.
 Drugs such as thalidomide,
stilbestrol, anticonvulsants,
 Advanced age at
conception.
 Toxemia of pregnancy.
 Maternal diseases such as
diabetes, cardiac failure.
 Irradiation

51.  Perinatal factors:
 Birth asphyxia
 Birth injuries
 Hypoxia
 Cerebral palsy
 Hypoglycemia
 Hypercalcemia
 Kernicterus
 Low birth weight babies
 Premature babies
 Obstructed labor
 Postnatal factors:
 Infections such as
meningitis, encephalitis
 poliomyelitis
 Trauma
 Head injuries
 Accidents
 Malnutrition
 Vitamin A deficiency
 Vitamin D deficiency
 Lead poisoning
 Mercury poisoning

52. Diagnosis/Assessment of Handicaps
 Physical assessment reveals deviation in physical functioning.
 Neurological assessment reveals mental and neurological
impairment.
 Absence of normal reflexes and feeding problems.
 Child's postures are normal.

53. Family Reactions towards Handicapped
Children
 Denial
 Anger
 Bargaining
 Depression
 Acceptance

54. WELFARE SERVICES FOR CHALLENGED
Deendayal Disabled Rehabilitation Scheme (DDRS)
objectives
 To create an enabling environment to ensure equal
opportunities, equity, social justice and empowerment of
persons with disabilities.
 To encourage voluntary action for ensuring effective
implementation of the People with Disabilities (Equal
Opportunities and Protection of Rights) Act of 1995.

55.  Assistance to Disabled Persons for Purchase/Fitting of
Aids and Appliances (ADIP)
This scheme is in operation since 1981 with the main objective
to assist the needly disabled persons in procuring durable,
sophisticated and scientifically manufactured modern,
standard aids and appliances that promote their physical,
social and psychological rehabilitation by enhancing their
economic potential thereby reducing the effects of disabilities.
 The National Handicapped Finance and Development
Corporation (NHFDC)
The National Handicapped Finance and Development
Corporation provides concessional credit to persons with
disabilities for setting up income generating activities for self

56. Scheme for Implementation of Persons with Disabilities
(Equal Opportunities, Protection of Rights and Full
Participation) Act, 1995 (SIPDA)
The SIPDA Scheme has been formulated 2016. Provision of
following activities have been provided under the SIPDA
Scheme:
To provide barrier free environment for the persons with
disabilities which include access to built environment in
schools, colleges, academic and training institutions, offices
and public buildings, recreational areas, health
centres/hospitals, etc.

57. FACILITIES FOR DISABLED
 Educational facilities for handicapped:
The disabled child shall have the right to free education till the age of 18 years
in integrated schools or special schools.
 Employment scheme:
Department of empowerment of person with disabilities, Ministry of Social
Justice and Empowerment, and Government of India have been introducing
the several facilities to enhance self employment to handicapped people.

58. REHABILITATION SERVICES FOR
DISABLED
 Medical rehabilitation: Restoration of function
 Vocational rehabilitation: Restoration of the capacity to earn a
livelihood.
 Social rehabilitation: Restoration of family and social
relationships.
 Psychological rehabilitation: Restoration of personal dignity
and confidence.

59. Examples of rehabilitation are:
 Establishing schools for the blind.
 Provision of aids for the crippled.
 Reconstructive surgery in leprosy.
 Muscle re-education.
 Graded exercises in neurological disorders.

60. CONCLUSION
 Handicap is a major problem in pediatric health today. Disability
occurs as a part of the continuum of health and illness which
can influence quality of pediatric life today. Disability occur as a
result of the disease, congenital or genetic condition or some
type of impairment of health or physical function of children

61. SUMMARY
 So far we have seen about definition of challenged children, its
type, mentally challenged, physically challenged, socially
challenged causes, signs and symptoms, diagnostic evaluation,
management and facilities provided for challenged children.

63. BIBLIOGRAPHY:
 BOOK REFERENCE:
 RimpleSharma,’’Essential Of Paediatric Nursing,’’2 nd edition,Jaypee
publication Pg No:502-504.
 Parul Data ‘’Pediatric Nursing’’ 2 nd edition(2009),Jaypee Brothers
medical Publication Pg No:483-485.
 Ghai, ‘’Essential Pediatrics’’7 th Edition(2009),Cbs Publisher Pg No:371-
374 .
 NET REFERENCE:
 https://www.who.int/health-topics/breastfeeding
 https://www.ncbi.nlm.nih.gov/books/NBK153471/
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5052805/