ICD BLOG

Workshop on Developmental Disability Management

Academy of Habilitation Sciences

(A Unit of ICD, New Delhi)

Organizes

First National Workshop

On Developmental Disability Management

Theme

Management of Developmental Disorders with Integrated Treatment Approach

Date: Sunday, May, 28, 2023

Venue: PHD Chamber of Commerce and Industry, Khel Gaon Marg, Hauz Khas, New Delhi-110016

Time: 9.00 AM to 6.00 PM

Topics to be covered

1. Integrative Treatment Approach and Developmental Disability (PDD and IDD)
2. Updates on Habilitation Therapies in Developmental Disabilities

           Infant Stimulation Therapy

           Early Intervention

           Play Therapy

           Developmental Therapy

           Physiotherapy (NDT, NET, PNF, Vojta, Patterning, Rood, Pilate, TMR, etc)  

           Occupational Therapy (CIMT, BMIT, HABIT and Sensory Integration Therapy)

           Speech Therapy (AAC, Bliss Board, Jellow, etc)

           Cognitive behaviour Therapy

           Electrotherapy (NMES, FES, TES, EMG Biofeedback Therapy, Therapeutic Ultrasound)

           Assistive Technology (orthotic Aids, Postural Aids, Mobility Aids, Adaptive Aids, Aligners)

           Hippo therapy

           Hydrotherapy

            VRT / Mobile Applications / Computer Games

• Update on Medical Management of Developmental Disabilities
• Role of Chemo denervation in the integrated treatment approach (Phenol / Botox)
• Recent advancement in Orthopedic Intervention
• Advancement in neurosurgical procedures (SDR / ITBP / DBS)
• Regenerative Medicines- Where it stands? (HBOT / Stem Cell Therapy / Gene Therapy)
• Complementary and Alternative Medicines- Should we include in our treatment plan?

Who can attend?

All professionals who cater the needs of children with developmental delay or disabilities

Parents of children with developmental delay or disabilities who can understand Basic English

How to register?

Ask for the registration form through whatsapp or mail. Fill the registration form and send us with the requisite registration fee

How much to pay for registration?

Rs 3000/-(Rupees Three Thousand) only

10% discount to all Registered AHS Members

10% discount to all professionals having 10 years or more working experience in pediatric disability management

20% discount to all professionals having 20 years or more working experience in pediatric disability management

25% discount to Head of Departments / Directors of all pediatric disability management organizations

30% discount to all whose case studies are accepted to present during the zero hour of the workshop

30% discount to all parents with children with Developmental Disorders

Registration amount includes Certificate of Participation, Refreshment (Breakfast + Lunch + High Tea) and Free Academy Life Membership worth Rs 3000/-

Registration Desk

Whatsapp: + 91-9810154411 / 7838809241

Mail ID: ahsicd@gmail.com, helpicd@gmail.com

Website: www.icddelhi.org

Academy of Habilitation Sciences

(A Unit of ICD, New Delhi)

Payment Portal

Registration Fee: Rs 3000/-

If you are eligible to get concession / rebate, please mention the category and pay the discounted amount

Bank Details

Name of the Account

INSTITUTE FOR CHILD DEVELOPMENT

Name of the Bank

Yes Bank

Branch Address

Yes Bank Ltd.

C-79, Ground Floor

Bank Street, Malviya Nagar, New Delhi-110017

Account Number

042394600000144

IFS Code

 YESB0000423

Please Whatsapp the screenshot of the invoice @7838809241 / Mail the invoice at helpicd@gmail.com

Alternately, you can pay through Paytm / G-Pay / Phone Pe @ 9810154411

Please share the payment screenshot @ 7838809241 / 9810154411

Academy of Habilitation Science (AHS)

          A Unit of ICD, New Delhi, India

Academy of Habilitation Science (AHS) is the newest wing of “Institute for Child Development (ICD), New Delhi”.  ICD, New Delhi is a registered company with Ministry of Corporate Affairs, under section 25 of Company Registration Act, 1956. ICD is considered a tertiary care centre for children with developmental disabilities in India. ICD’s primary unit “PediaMed” is located at Malviya Nagar, New Delhi. PediaMed-ICD has more than 10 departments which cater different needs of children with poor health, developmental delay and developmental disabilities.

As all of us know, the need of pediatric populations is very much different from the needs of adults. Pediatric populations with developmental delay or disabilities require a unique multimodal treatments model which is popularly known as habilitation. Habilitation treatments / therapies are purely based on habilitation science. Habilitation science is a very much new when it is compared with rehabilitation science.

Habilitation Services are specialized form of physical therapy for pediatric populations. Habilitation therapies are such types of health care services that help a child to learn new skills, improve learned skills and functioning for daily living. These services are available in limited set up all around the world especially in India. These services exclusively provided by qualified and specifically trained habilitation professionals.  All children with developmental delay / developmental disabilities require habilitation services for ultimate habilitation

Our Vision

To cultivate young minds with knowledge, skills, judgement to be global leaders and to meet challenges of today's science and technology

Our Mission

To motivate the professionals and provide the opportunities to develop all the essential skills and knowledge by excelling activities to achieve professional goals

Objectives

• To help professionals acquire the skill and expertise to achieve their habilitation career
•  To aspire professionals by providing a thorough variety of knowledge essential for optimal habilitation
•  To enhance professionals academic ability
•  To make all professionals able to understand the topics conceptually
•  To enrich problem solving skills and practice Time Management
•  To strengthen originality and creativity in thinking

Projects and Programs under AHS

Workshops / Webinars

Short Term Certificate Courses (Online Mode / Onsite Mode/ Hybrid Mode)

Screening and Evaluation Camps

Awareness Raising Events / Campaigns            

Conferences ( Onsite / Virtual)

Publications- Newsletter / Journals

If you feel "like us" pediatric habilitation matters, you should join us

For more details, please connect us at

Whatsapp: 9958586136

Mail: ahsicd@gmail.com

Sleep Issues among children with Neurodevelopmental disorders

Sleep disturbances are very common in infancy, childhood and pre-adolescence. It is estimated that 5% to 40% children can have sleep issues and it is very high when a child has some forms of Neurodevelopmental disorders such as cerebral palsy or autism.

Sleep disturbances can impact on the health and development of children with developmental disorders many ways. It can impact on learning, memory, attention span, behavior, mood regulations, immunity and metabolic function. It not only affects the child but also the care givers / parents by impairing mental health and may cause parental depression which impairs the quality of life of the whole family. 

Sleep disturbances can be due to sleep habit, behavior, and sleep arrangement, parenting styles, sleep awake cycle and brain development.  Very common sleep issues due to behaviors are bedtime resistance, night time waking, early morning awakenings, etc.

Although, the sleep duration varies child to child but there is a general sleep pattern.

Common sleep duration according to age (Adapted from Waters, Suresh and Nixon, 2013)

Age	Sleeping Requirements
Newborn infants	16-18 hours per day in cycles of 3-4 hours
6 months+	Able to sleep 6+ hours at night without a feed
18 months+	Overnight sleep+ 1 daytime nap
School age	Sleep through the night (11-12 hours)
Pre-puberty	Sleep duration decreases to around 10 hours
16 years+	8 hours per day

Sleep issues require holistic assessments so that treatment can be started. Lot of assessment scales are available. To name a few: “the children’s sleep habits questionnaire” ‘Epworth sleepiness scale”, “BEARS questionnaire” etc.

Children with all Neurodevelopmental disorders can have sleep issues but it is high with children with Autism and Cerebral Palsy.

Sleep issues in cerebral palsy have been categorized into seven headings

1. Breathing disturbances
2. Movement impairments
3. Sleep-wake Cycles
4. Epilepsy
5. Sleep pattern impairments
6. Psychological factors
7. Pain and discomfort

Sleep problems with autistic children can due to

1. Anxiety
2. Bedwetting
3. Biological causes
4. Illnesses and health conditions
5. Night terrors and nightmares
6. Restless sleep
7. Snoring
8. Social communication difficulties.

Various studies investigated sleep disturbances to get optimal sleep management but no concrete method is specifically designed. Following methods are used in combination to manage sleep related issues

1. Postural management in relation to bed
2. Massage or sensory integration therapy
3. Cranial Osteopathy / Cranio-sacral therapy
4. Use of Medicines like Melatonin
5. Anti-spastic medicines like Baclofen
6. Adeno-tonsillectomy-Removal of the tonsils in  case obstructive sleep apnea

If you have a child with sleep related issues, please contact us

Mail ID: helpicd@gmail.com

Voice Call: +91-11-41012124

Whatsapp: +91-7838809241

Hearing Disorders in Children with Developmental Disorders

• 0.1 % to 1.7% children have hearing deficits or loss worldwide. In one survey, it is found that 15% children and teens have hearing loss in one ear. Severe hearing loss in both ears is very rare
• Children with developmental disorders are prone to hearing impairments comparing normal populations. About 30% children with neurodevelopmental disorders have some or the other hearing deficits
• Hearing problems can be identified very early. Look for hearing problems if the child

Does not startle at loud sounds

Does not respond to your smile or voice

Does not turn head towards the source of sounds

Does not respond to his / her name

Does not listen music, rhymes or natural sounds

Try to watch the speaker’s face very intently

• Hearing problems can be congenital or acquired
• Genetic factors cause more than 50% of total hearing loss. It can be autosomal recessive hearing loss, autosomal dominant hearing loss or due to genetic syndromes
• Some children can have temporary hearing loss due to middle ear infection
• All new born are screened for hearing before leaving the hospital. It is mandatory in all countries
• Different hearing tests are available for different age children
• Visual reinforcement audiometry, play audiometry, tympanometry, BERA, etc are the common tests
• Hearing aids are a kind of assistive aids than can help children with hearing loss hear clearly
• Basic to sophisticated hearing aids are available for different categories of hearing loss
• Cochlear implant is a device that is surgically implanted and its directly stimulate the auditory nerve in the inner ear with electrical stimulation
• Bone anchored hearing systems are very helpful to those who have severe outer or middle ear malformations such as microtia or one-sided deafness
• All children with hearing loss get benefits with speech therapy. Some children may need training in sign language communication
•  Hearing loss can affect a child’s ability to develop speech, language, and social skills. The earlier a child who has hearing deficits, starts getting services, the more likely the child’s speech, language, and social skills will reach their full potential.

If you want to know more about hearing loss or impairments, please contact us

Mail: helpicd@gmail.com

WhatsApp: +91-7838809241

Voice Call: +91-11-41012124

Visual Disorders associated with Neurodevelopmental Disorders

Vision is one of the most important senses we have. Vision gives us tremendous access to learn about the world around us. When we see faces, we automatically learn about the expressions. That’s why it is said “seeing is knowing”

When a child has a visual impairment, it requires immediate attention.  When vision problems go undetected, children become delayed in developing milestones.

Signs and Symptoms of Visual Impairment

It’s very important to diagnose and treat visual impairment in children as soon as possible. Mostly vision screening is done at birth, especially if the baby is born prematurely or there’s a family history of vision problems. In case of visual concerns, visual examination should be done every six months for the first few years. 

Common signs that a child with visual impairment will have

• While following objects or face, the eyes don’t move together
• The child has crossed eyes, eyes that turn out or in, eyes that flutter from side to side or up and down
• The  child is unable focus
• The child has bulge eyes, or there is rapid rhythmic movements
• The child repeatedly covers his / her eyes
• Lazy eye, clumsy in movements
• The child has squint, may be fluctuating
• The child rubs his / her eyes frequently
• Sitting too close to the TV or holding toys and books too close to the face
• Avoiding tasks and activities that require good vision

If any of these symptoms are present, parents should consult an eye specialist as soon as possible. Please note, early detection and treatment are very important to the child’s overall development.

 Children with Neurodevelopmental disorders are very prone to eye disorders, especiall children wih cerebral palsy, autism spectrum disorder, spina bifida, down syndrome, infantile spasm, hdrocephalus, etc. Following common eye disorders have been reported in our practice

• Achromatopsia
• Albinism
• Amblyopia
• Aniridia
• Anophthalmia
• Aphakia
• Astigmatism
• Cataract
• Coloboma
• Color blindness
• Congenital eye defects
• Corneal disease
• Cortical visual impairment
• De Morsier's Syndrome
• Dry eye syndrome
• Hemianopia
• Hyperopia
• Legal blindness
• Low vision
• Macular degeneration
• Marfan Syndrome
• Microphthalmia
• Myopia
• Nystagmus
• Optic nerve atrophy
• Optic nerve hypoplasia
• Retinal detachment
• Retinoblastoma
• Retinopathy of prematurity (ROP)
• Strabismus
• Sturge-Weber Syndrome, etc

Most of these visual disorders are treated by pediatric ophthalmologist. Simultaneously, vision stimulation therapy can be incorporated to get extra improvements for a specific number of pediatric vision disorders.

Vision Stimulation Therapy / Vision Restoration Therapy / Vision Therapy

Vision Therapy is a specialized, supervised, individualized treatment program performed by a qualified professional to correct visual-motor and perceptual-cognitive deficiencies. 

It helps the child to develop normal coordination between the two eyes to get binocular vision. 

It is a non-surgical customized program of visual activities designed to correct certain vision problems and improve visual skills.

Vision therapy can include the use of lenses,filters, prism, computerized visual activities and non-computerized viewing instruments. Special therapy equipments like balance boards, metronomes and other devices can also play an important role in a customized vision therapy program.

Overall, the goal of vision therapy is to treat vision problems that cannot be treated successfully with eyeglasses, contact lenses and/or surgery alone, and and help people to achieve clear, comfortable and binocular vision

If you know a child, who has above mentioned signs or symptoms and you wan combination therapy. Please contact us for customized remedial program at

Mail at: helpicd@gmail.com

Whatsapp at: +91-7838809241

Voice Call at: +91-11-41012124

Seizure problems in children with developmental disorders

Epilepsy is a very common problem in children. Children with Neurodevelopmental disorders are very prone to convulsion/ seizure disorders. According to the Epilepsy Foundation, it is estimated that 40% children with cerebral palsy may have convulsion or seizure disorder. Similarly children with Intellectual Disability have 22.5%, children with Autism Spectrum Disorder have 20% and children with ADHD have 15% more vulnerability than the normal population.

When a burst of disorganized electrical activity interferes with functioning of normal brain it causes seizure. Seizure can be in different forms, based upon the origin of the disorganized signal within the brain. 

Brain areas like motor cortex and the temporal lobes are more vulnerable for seizure disorders. 

More than two third children with epilepsy recovers from epilepsy and become seizure free. With an organized and systematic care most of the children become seizure free and lead normal lives.

The effects of epilepsy vary in each child. It depends on age of the child, the type of seizure the child has, how well the child responds to treatment, and on other existing associated conditions.

A seizure can be for a few seconds to a few minutes, sometimes more than 15 minutes. Seizure can be more than 20 different types in children with neurodevelopmental disorders. The most common forms of seizures are

Grand mal seizures (Generalized Tonic Clonic Seizures)

Characteristics of GTCS

• A motor seizure involving the entire body

• Usually the child the person makes a short cry and fall to the floor

• In tonic phase, there will be muscles stiffness, and in clonic phase, there will be jerk and twitch of the limbs

• The child may lose bladder control.

• The child may feel fatigue, confusion, and disorientation.  These feelings especially confusion may last from few minutes to several hours or even days / weeks. 

• Sometimes the child may fall asleep after the seizure

Petit mal seizure

Characteristics of Petit mal Seizure

• The child become absence minded and stares

• The child can have brief loss of consciousness

• They don’t fall generally as there is no muscle tone fluctuation

Psychomotor seizures

Characteristics of Psychomotor Seizure

• It is the result of unusual electrical activity in the temporal lobe portion of the brain

• It involves involuntary repetitive behavior, such as chewing of lips or hand rubbing

• The child may have unusual sensory experiences (unusual sights, sounds, or odors)

• The child becomes fearful or angry during the seizure episode

• The child gets usually confusion after a psychomotor seizure.

Focal Seizures

Characteristics of Psychomotor Seizure

• It results from disorganized electrical impulses from one part of the brain

• Generally a motor or sensory seizure that is restricted to one side of the body

• The child remains conscious if the seizure is not generalized

 Causes of Epilepsy

In most cases, epilepsy has no identifiable cause but a few developmental conditions can be potential cause for epilepsy

• Developmental disorders, including  cerebral palsy, autism

• Genetic conditions

• Febrile convulsion, due to high fever 

• Meningitis, encephalities or other Infectious diseases

• Maternal infections during pregnancy

• Poor nutrition during pregnancy

• Oxygen deficiency before or during birth

• Trauma to the head

• Cyst or tumor in the brain

Treatment of Seizure Disorders

Due to advancement in the medical field, lot of treatment options is available

Medications

Medication is the first line of treatment for children with epilepsy. Medications help to reduce the frequency and duration of the jerks / seizure. With consistent and proper medication, most of the jerks stop.  Mostly children who are seizure free don’t require medications. Parents should not stop treatment without medical consultation, as seizures may come back any time or may get worse.

Ketogenic diet

Ketogenic diet is special diet which can control seizure in specific children with seizure disorders. Ketogenic diets are prescribed by dietician who works closely with the pediatric neurologist

Neuro-stimulation

When epilepsy doesn’t respond well with the use of continuous medication for longer period, a neurosurgeon may prescribe neurostimulation. In this treatment, a device is used. Currently three different types of neurostimulation are used for the treatment of epilepsy. These are Vagus Nerve Stimulation, Responsive Neurostimulation, and Deep Brain Stimulation (DBS)

Surgery

These days’ neurosurgeries are practiced quite comfortably due to technical advancement and professional expertise. In few cases, these surgeries can improve a lot.

If you have any questions / queries regarding epilepsy, ask our xperts team. We will be very happy to answer your queries.

For more information, please contact us at

Mail ID: helpicd@gmail.com, WhatsApp@+91-7838809241, Voce Call @+91-11-41012124

Tips for parents with Cerebral Palsy

Tips for Parents and Care givers of Children with Cerebral Palsy

ICD is a premier institute dedicated for children with developmental disorders. It has been working in the field since 2001. ICD’s training programs are well appreciated all over the world. Here is the latest support to parents with children with cerebral palsy for scientific parenting through proper handling and treating with the help of assistive technology.

Children with Cerebral Palsy Spastic Hemiplegia 

• There should be emphasis to stimulate the affected side as much as possible; the child should be encouraged to transit with the help of affected side. While carrying the child should be given opportunity to use the affected side as much as possible.
• Children with Hemiplegia should be helped with corner chair when the child has no neck control. Arm chair with tray cut out should be used to promote hand functions while sitting when the child is unable to sit independently. Australian Standing frame should be used to promote hand function of the affected side by promoting trunk control of the affected side. In general, very few cases require the help of standing frame as these children have good trunk.
• Children with Hemiplegia should be placed in AFO early as preventive care during night. When AFO is prescribed for the affected foot, the other foot is taken care with foot plate. Otherwise, the child will have leg length discrepancy in the long run. As the upper limb is more affected, Modified Cock up splint should be used to keep the wrist and thumb in neutral position as night splint. The hand splint if it is static should be used during day rather CIMT band should be used for the normal hand. A large proportion of this group has Genu recurvatum so modified angular AFO should be tried. In case of Genu recurvatum, gaiters have no role at all. 
• Mostly children with CP Spastic Hemiplegia do not require the support of mobility aids. In case of requirement, posterior Rollator is considered better than anterior Rollator

Children with Cerebral Palsy Spastic Diplegia 

• Children prefer to sit in ‘W Sitting” posture. This pattern should be avoided as much as possible. While carrying the child, it should be tried to keep the hips abducted if possible.
• Children with Diplegia should be encouraged to sit on arm chair with pommel so that the child does not start “w sitting”.
•  Children with Diplegia require AFO by the age of 6 months or so. Preventive AFO should be used while night as early as possible. The corset gaiters should be replaced with 3-points gaiters as the child becomes 3 years old if there is a need. If the child shows sign of tibial torsion, the gaiters should be modified to work as anti-torsion splint. A few children with hyper-extended knees may be helped with modified AFO where the AFO is kept in 5-7 degree flexion.  Always remember, there is no place for HKAFO / Calipers / KAFO in the current management technique so these splints should be discouraged as far as possible). In few cases GRFO can be tried although there is little data available to support the use of GRFO.
•  Most children with diplegia will require Posterior Rollator. Researchers have demonstrated the efficacy of the posterior Rollator higher than anterior Rollator. Parents / Professionals should follow the FMS (Functional Mobility Scale) guidelines as much as possible.

Children with Cerebral Palsy Spastic Quadriplegia 

•  Special handling technique should be used during infancy as these children have hypotonic trunk and hypertonic limbs. Postural alignment should be taken care properly to reduce the chance of hip subluxation scoliosis and other postural deformity.
•  Children with Quadriplegia should be provided corner chair with tray cut as they become 3-4 months old. These children take more time to achieve head control and prone development comparing to Spastic Diplegia. Arm chair with tray cut out and pommel should be used to get good trunk control and hand function. Standing frames are also being used in this group.
•   Children with Quadriplegia should be provided with Preventive Orthotic aids to reduce mal-alignment of ankle joints. The occurrence of hip subluxation is very high in this group so special splints should be made. These children may require splints for the upper limbs also as they have elbow flexors, mid arm Pronators and wrist flexors tightness. A few cases may require Thumb abduction splint also. Although, the use of HKAFO / Caliper has been outdated in the management of cerebral palsy, a few children can be benefited with these splints.
•  Children with quadriplegia should be given support to the trunk while making him mobile. The actual FMS has been developed for this group of children. Children who are more than 3 years old and not able to move from one place to other with any means should be provided with wheel chair.

Children with Cerebral Palsy Dyskinesia 

•  Due to dystonia, these children require guarded handling. While carrying, all possible care should be given to reduce fluctuation of tone and sudden fall. These children easily slip from lap.
•  In the initial stage, a modified corner chair can help the child to get midline orientation with trunk stability. The children with good head control can use the modified arm chair with tray cut out. In all chairs a pommel should be placed to prevent hip dislocation. Prone standers are better suited for these children.
•  Usage of Orthotic Aids
  Generally Solid AFO is prescribed for putting optimal weight bearing on feet. Anti-torsion splint may be used to prevent tibial torsion.  
•  Due to fluctuate tone of the child, Posterior and Anterior Rollator are not prescribed. Training walker should be used for these children.
•  Adaptive aids to promote hand function are being used according to the need of the children

Children with Cerebral Palsy Ataxia

•  These children require specific handling due to poor muscle tone or floppiness. Extra care should e given to have the head in midline while carrying and transfer  
•  Children with Ataxia should be provided corner chair with tray cut as they become 4 months old. These children take more time to achieve head control and prone development. An Arm chair with tray cut out should be used to get good trunk control and promote hand function. These children may need Standing frames also
•  Solid AFO or SMO should be prescribed to get good ankle and foot alignment as the child is ready to weight bear while sitting and standing
•  Most children with ataxia require the support of a walker initially but they switch over to walking cane or walking sticks very soon. Few children require the support of walking sticks for longer duration and sometimes life long

Children with Cerebral Palsy Hypotonia

•  The child should be handled with care till the child achieved head control. Spinal alignment should be observed while sitting and standing
  Transfer and carrying should be modified according the milestones achieved
•  Initially the child should be given corner chair to protect the spine and gain head control. As the child gets proper head control any arm chair with tray cut can be used. Few cases with hypotonic trunk can get help from a standing frame.
•  Initially a SMO can be given for aligned weight bearing.
•  The FMS approach should be practiced for better outcome in mobility skills