A Comprehensive treatment Plan

The extent of the physical impairment a child suffers from the neurological /brain damage is taken as the primary condition of the child .However along with are various secondary , associative and co- mitigating conditions which exists due to  the primary effects. The primary physical impairment may involve challenges with muscle tone, reflexes, posture, balance, fine and gross motor functioning also oral motor functioning. Which in turn create secondary conditions such as difficulty to chew, swallow, or communicate that also require treatment.  Managing  Cerebral Palsy is further complicated by co-mitigating factors which are not caused by the same brain damage that caused CP but that still exists in the child as a separate condition which  requires  simultaneous treatment eg child my suffer from asthma or any such ailment.

Due such complications in the treatment and uniqueness of every child as far as extent of impairment is considered, the Children require or need a comprehensive treatment & care plan which differ from child to child .This plan takes into consideration all the conditions existing in the child, the child’s ability, his /her socio –economic background also kind & quality of home care received. The team includes the various multidisciplinary doctors, pediatrician, parents or the legal guardians. At the onset goals for the treatment are established keeping in mind the medical condition of the child .Then the set goals are achieved using a combination of drugs & therapies.

However a keen observation from the primary caregiver is required all time as complications may arise at any point of time, noticing them earlier can help the caregiver to act promptly and minimize the effect.  It takes lot from the general primary pediatrician and caregivers to accomplish the set goals of treatment to develop in the child abilities so that the/she can have degree of independence and lead a quality life.

Means of combating Cerebral palsy

Every individual suffering from cerebral palsy is unique in terms of severity of damage, extent and type of impairment. The symptomatology of this disorder (CP) is very varied; it may range from slight clumsiness to severe impairments. The classical symptoms are associated with abnormality in muscles, reflexes, motor development and coordination, sensory impairments, seizures, spasticity etc.

Hence developing a general protocol for treatment is very difficult. The damage caused to the brain cannot be healed however various therapies, surgeries, drugs, treatments and so on help the individuals to fight this disorder. All the courses of treatment aim to optimize mobility, cope primary conditions, regulate pain, manage and control  complications, associative conditions and co-mitigating factors, maximize independence, boost social and peer interactions, raise self-care, optimize ability to communicate, maximize learning potential & above all  to provide a quality  life.

Various Course of treatments are available today for Cerebral palsy to list a few  like  acupuncture, aqua therapy, behavioral therapy, physical therapy ,cognitive education , nutrition & diet therapy ,hippotherapy ,massage therapy ,occupational therapy ,play therapy ,recreational therapy , respiratory therapy ,sensory integration therapy ,social therapy ,speech & language therapy  , various surgeries & supplementary medications.

However in a long run the cost of these treatment goes high .We are in need for a one stop solution in terms of reliability, efficiency & economics of cerebral palsy treatment. 

A bit of fragrance clings to the hand that distributes roses

That was really a hectic day for me as I had a meeting with my directors in the early hours, had to meet all my deadlines, submit my report and then rush back home as my most awaited vacation was about to begin. I was so excited to take up the travel and experience the climate in north-east on my birthday.

I reported to office at my regular work hours and rushed to complete my work as planned. Mr. Aslam Khan then arrived at office for the meeting. “Mr. Khan is the kind of person you would love to hear and learn from. He is always a high energy person and has something positive to say all the time”. He greeted me with advance wishes on my birthday and till the other directors arrived, we both started talking about many things like daily commute, people, life and living.

Mr. Khan from his observations & memories filled college days, picked up the experience and wisdom he acquired from the commute to Byculla, Saboo Sidddique College by train to share with me what he intended me to understand was how to live and grow up in life. He said, “Over the period of nine years of travelling, I could categorize the people commuting from the train in three different Categories. The first category of people were the ones who would just rush to get into the train pushing & pulling others to get seats or appropriate places to stand .The second category were those better travellers who would first board the train and then assist others on the platform to get in. There were some other people who would let others get in first, help college students, co-commuters with children to board & then themselves would board, these formed the third category”.

He further explained me what exactly he wanted to convey. Life is a journey and we can make the best out of it, if we inculcate the values like empathy, sacrifice, helpfulness, being optimistic & patience in ourselves. Being helpful not only makes another person feel better but also makes us feel better from inside and also about ourselves. May be we ourselves must be going through tough time but being there for someone at his time of need will give us an eternal peace ,solace and contentment in a long run. Mr. Khan advised me to strive to be among the third category in life.

 I then kept pondering over this thought of his .And I really felt we can flourish with love and care in life only if we allow and help others to grow in life. The Chinese proverb “A bit of fragrance clings to the hand that distributes roses” rightly describes this.

Autism & Cerebral Palsy are they inter-related?

After three of  months reading about cerebral palsy , autism and  sensory impairment  ,vestibular and associated conditions ;A question  continuously arising is Are these conditions inter related???

Although from the studies it can be concluded that cerebral palsy is the condition wherein the brain is damaged and this disorder is non-developmental. However autism on another hand is a developmental disorder wherein the child doesn’t reach the age group milestones as the peers, since there is retardation in the process of brain and nerve development.

The common aspect expect for mercury poisoning is the vestibular system. Balance, posture and spatial orientation of body is achieved and maintained by a complex set of sensorimotor control systems. It includes inputs from eyes, inputs from muscle and joints, inputs from vestibular system, integration of sensory processing the conflict between the inputs, reflex motor output, learning and retention of knowledge. In cerebral palsy it is seen that either sensory inputs or motor reflexes or both can be affected due to the kind and extent of damage to the brain whereas in autism sensory integration dysfunction is observed which leads to their overstimulated or calm behavior.

It is still a topic of debate whether cerebral palsy and autism are interrelated. But it can be stated that the treatment of both involves stimulation of vestibular system by Swinging, Bouncing, Twirling, tilting and rotation motions etc  along with various other therapies and it should be noted  time plays a very important factor in both the cases.

Autism....

Another intellectual disorder which is less studied and closely related to CP yet differs in terms of physical impairment is Autism. Autism affects the social interaction and behavior of child .Also communication both verbal and non-verbal is seen to be affected. Like cerebral palsy every child has his/her own unique pattern of impairment. The extent of penetration of this developmental disorder differs from individual to individual.

Individuals and children suffer from the following conditions namely speech and language difficulties, intellectual disability, sleep problems, attention problems, epilepsy, anxiety, depression and difficulties with fine and gross motor skills.

An autism spectrum finds its roots in lack in sensory integration of body. It is observed that children with autism have either hypo or hyper activity of vestibular and nerves related to it. Unlike Cerebral palsy autism is treatable to an extent wherein the child can lead a normally life overcoming all the communication and behavioral challenges. Early detection of autism leads to quicker and better chances of recovery of the child.

There is no medical treatment which can cure autism. However drug therapy or medications can help to reduce depression, anxiety , manage  energy levels etc. ,behavioral and responsive training and interventions may help to teach them desired behavioral patterns; occupational and speech therapy helps to teach and inculcate basic living and communication skills. However the most important of all is the sensory integration therapy which involves stimulation of vestibular system and other nerves. This is achieved using various physiotherapy exercises involving rotation, tilting etc.

Exploring few facts on cerebral palsy....

Cerebral Palsy a less explored yet a serious neurological disorder. This condition is caused due to any brain injury or any abnormality in the  brain development occurring during a child’s birth ,during birth or immediately after birth. Also sudden fever, maternal infections, deprivation of oxygen during labour, birthing trauma during labour and delivery , complications during pregnancy or early childhood may lead to the Cerebral palsy . Cerebral palsy is often referred as CP. CP primarily interrupts posture , body movement, muscle coordination, reflexes and balance. The secondary health defects arising from the disorder are poor sensation, problems of communication, perception, behavior etc .

Cerebral palsy causes both physical as well as intellectual impairment. Individuals with CP find it difficult to crawl, walk, and sit or even to grasp an object at times. Their muscles contract too much, too little, or all at the same time. Limbs can be stiff and forced into painful, awkward positions. They often face difficulty in thinking and reasoning, .The type of movement dysfunction, the location and number of limbs involved, as well as the extent of impairment, varies from individual; to individual depending upon the extent of brain damage.

Cerebral Palsy is non-life-threatening, incurable, non-progressive & permanent disorder. Every case of CP is unique such as an individual may have complete paralysis while another may have partial, some individual may suffer from intellectual disability while some may not.

 Treatment of CP includes physiotherapy therapy, speech therapy, drug treatment to control seizures, relax muscle spasms, and alleviate pain; surgery to correct anatomical abnormalities or release tight muscles; all the types of therapies focus on managing abnormal muscle tone and minimizing its effects on function, maintaining and improving movement and mobility skills, maintaining flexibility and preventing pain or discomfort.

The fight of toddlers....

Life teaches us at every moment to move on forward without looking backwards. And in the process of living, learning and realization are two things each and every one procures from …their own and others life well. Over a few months day by day I have been realizing that  life at times seem to be too unjust to few people but I guess they are the strongest of  us all as they are fighting  a silent  battle within themselves. I happened to meet such little warriors at Amal Physiotherapy centre ,it was a very touchy experience to see them fighting the condition life has put forth in front of them .Six toddlers all not more than 4 years of age and their mothers showed me not giving up is the biggest victory .

All of the children there suffered from cerebral palsy. Cerebral meaning brain & palsy meaning   a condition that is characterized by uncontrollable tremor or quivering of the body or one or more of its parts. cerebral palsy is a collective term that refers to the  neurological disorders that appear in infancy or early childhood and permanently affect body movement, muscle coordination, and balance. The part of the brain that controls muscle movements is affected. The most common symptoms of CP are  lack of muscle coordination while performing voluntary movements (ataxia); stiff or tight muscles and exaggerated reflexes (spasticity); walking with one foot or leg dragging; walking on the toes, a crouched gait, or a “scissored” gait; and muscle tone that is either too stiff or too floppy. Other neurological symptoms that commonly occur include seizures, hearing loss and impaired vision, bladder and bowel control issues, and pain and abnormal sensations. It cannot be cured, but treatment often improves the child's capabilities. The earlier treatment begins the better chance the child has of overcoming developmental disabilities or learning new ways to accomplish the tasks that challenge him/her. Early intervention, supportive treatments, medications, and surgery can help them improve their muscle control.

At Amal, I could witness that struggle of toddlers towards gaining independency to some extent in day to day living .It was painful to see it but at the same time what more I saw was the spark in their eyes ..The quest to defeat the inadequacy.