dr. pradeep dubey - consultant pediatrician dr. pradeep dubey md (ped.), dch. dr. pradeep dubey md...

Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatricianwww.healthychildindia.com

Dr. Pradeep DubeyDr. Pradeep Dubey

MD (Ped.), DCH.MD (Ped.), DCH.

Dr. Pradeep DubeyDr. Pradeep Dubey

MD (Ped.), DCH.MD (Ped.), DCH.

ROLE OF EARLY INTERVENTION INROLE OF EARLY INTERVENTION IN

CEREBRAL PALSY & OTHERCEREBRAL PALSY & OTHER

DEVELOPMENTAL DISORDERSDEVELOPMENTAL DISORDERS

W. J. LITTLE


SIGMOND FREUD

““LITTLE HAS GOT IT ALL WRONG, INFANTILELITTLE HAS GOT IT ALL WRONG, INFANTILE

PARESIS OCCURS IN WOMB & NOT DURINGPARESIS OCCURS IN WOMB & NOT DURING

DELIVERY IN MAJORITY OF CASES”DELIVERY IN MAJORITY OF CASES”


Early intervention – as infant Early intervention – as infant

brain is more plastic (PL 99 – brain is more plastic (PL 99 –

457)457)

Preventable conditions.Preventable conditions.

Disability limitationsDisability limitations

Early intervention – as infant Early intervention – as infant

brain is more plastic (PL 99 – brain is more plastic (PL 99 –

457)457)

Preventable conditions.Preventable conditions.

Disability limitationsDisability limitations

EARLY IDENTIFICATION OF NEURO EARLY IDENTIFICATION OF NEURO DEVELOPMENT DISORDERS – WHY ?DEVELOPMENT DISORDERS – WHY ?EARLY IDENTIFICATION OF NEURO EARLY IDENTIFICATION OF NEURO

DEVELOPMENT DISORDERS – WHY ?DEVELOPMENT DISORDERS – WHY ?


Follow up of high risk babiesFollow up of high risk babies

High index of suspicionHigh index of suspicion

Brief account of developmental history & Brief account of developmental history &

examinationexamination

Detailed neuro developmental assessment by Detailed neuro developmental assessment by

child development group.child development group.

Investigations – USG, Metabolic screening, Investigations – USG, Metabolic screening,

EEG, CT/MRI EEG, CT/MRI

Scan.Scan.

Early & appropriate intervention.Early & appropriate intervention.

Follow up of high risk babiesFollow up of high risk babies

High index of suspicionHigh index of suspicion

Brief account of developmental history & Brief account of developmental history &

examinationexamination

Detailed neuro developmental assessment by Detailed neuro developmental assessment by

child development group.child development group.

Investigations – USG, Metabolic screening, Investigations – USG, Metabolic screening,

EEG, CT/MRI EEG, CT/MRI

Scan.Scan.

Early & appropriate intervention.Early & appropriate intervention.

EARLY IDENTIFICATION OF DEV. DISORDERS - ?EARLY IDENTIFICATION OF DEV. DISORDERS - ?EARLY IDENTIFICATION OF DEV. DISORDERS - ?EARLY IDENTIFICATION OF DEV. DISORDERS - ?


IMPORTANT ISSUES TO ADDRESSIMPORTANT ISSUES TO ADDRESSIMPORTANT ISSUES TO ADDRESSIMPORTANT ISSUES TO ADDRESS

Which infants are at risk.Which infants are at risk.

Signs or clusters most specific for Signs or clusters most specific for

prediction.prediction.

At what age assessment is most At what age assessment is most

predictive.predictive.

Screening tools/methods most specific.Screening tools/methods most specific.

Is routine developmental screening Is routine developmental screening

useful. useful.

Which infants are at risk.Which infants are at risk.

Signs or clusters most specific for Signs or clusters most specific for

prediction.prediction.

At what age assessment is most At what age assessment is most

predictive.predictive.

Screening tools/methods most specific.Screening tools/methods most specific.

Is routine developmental screening Is routine developmental screening

useful. useful.


Low birth weight babies.Low birth weight babies.

Severe H.I.E.Severe H.I.E.

Severe neonatal jaundiceSevere neonatal jaundice

Persistence of Abn. Neuro signs after 2 Persistence of Abn. Neuro signs after 2

wks.wks.

Hypodensisties in Ct. even after 4 wks.Hypodensisties in Ct. even after 4 wks.

Oliguria (<1ml./kg./ hr.) for 24 hrs. Oliguria (<1ml./kg./ hr.) for 24 hrs.

associated with H.I.E.associated with H.I.E.

Low apgar (0-3) after 20 mts.Low apgar (0-3) after 20 mts.

Late seizures in a depressed NBLate seizures in a depressed NB

Background abnormalities in interictal Background abnormalities in interictal

EEG.EEG.

Low birth weight babies.Low birth weight babies.

Severe H.I.E.Severe H.I.E.

Severe neonatal jaundiceSevere neonatal jaundice

Persistence of Abn. Neuro signs after 2 Persistence of Abn. Neuro signs after 2

wks.wks.

Hypodensisties in Ct. even after 4 wks.Hypodensisties in Ct. even after 4 wks.

Oliguria (<1ml./kg./ hr.) for 24 hrs. Oliguria (<1ml./kg./ hr.) for 24 hrs.

associated with H.I.E.associated with H.I.E.

Low apgar (0-3) after 20 mts.Low apgar (0-3) after 20 mts.

Late seizures in a depressed NBLate seizures in a depressed NB

Background abnormalities in interictal Background abnormalities in interictal

EEG.EEG.

HIGH RISK CONDITIONSHIGH RISK CONDITIONSHIGH RISK CONDITIONSHIGH RISK CONDITIONS


Responsiveness / AlertnessResponsiveness / Alertness

Spontaneous motilitySpontaneous motility

Persistant hyper excitability Persistant hyper excitability

Feeding difficultyFeeding difficulty

Constant fisting after 2 monthsConstant fisting after 2 months

Abnormal movements / convulsions.Abnormal movements / convulsions.

Abnormal posturesAbnormal postures

Abnormal Head circumerence.Abnormal Head circumerence.

Responsiveness / AlertnessResponsiveness / Alertness

Spontaneous motilitySpontaneous motility

Persistant hyper excitability Persistant hyper excitability

Feeding difficultyFeeding difficulty

Constant fisting after 2 monthsConstant fisting after 2 months

Abnormal movements / convulsions.Abnormal movements / convulsions.

Abnormal posturesAbnormal postures

Abnormal Head circumerence.Abnormal Head circumerence.

TWILIGHT SIGNS/CONSTELLATIONSTWILIGHT SIGNS/CONSTELLATIONSTWILIGHT SIGNS/CONSTELLATIONSTWILIGHT SIGNS/CONSTELLATIONS


Abnormalities of toneAbnormalities of tone

Primitive reflexes weak / persistent Primitive reflexes weak / persistent

(>6 mths)(>6 mths)

Delayed appearance of postural Delayed appearance of postural

reflexesreflexes

Delayed mile stonesDelayed mile stones

Ocular abnormalitiesOcular abnormalities

Lack of response to sound.Lack of response to sound.

Abnormalities of toneAbnormalities of tone

Primitive reflexes weak / persistent Primitive reflexes weak / persistent

(>6 mths)(>6 mths)

Delayed appearance of postural Delayed appearance of postural

reflexesreflexes

Delayed mile stonesDelayed mile stones

Ocular abnormalitiesOcular abnormalities

Lack of response to sound.Lack of response to sound.

TWILIGHT SIGNS/CONSTELLATIONSTWILIGHT SIGNS/CONSTELLATIONSTWILIGHT SIGNS/CONSTELLATIONSTWILIGHT SIGNS/CONSTELLATIONS


AMIEL TISON - 2 MTHS, 7 MTHS, 12 AMIEL TISON - 2 MTHS, 7 MTHS, 12

MTHSMTHS

P.G. I CHANDIGRAH – 9 MTHS.P.G. I CHANDIGRAH – 9 MTHS.

OTHERS - 8 MONTHSOTHERS - 8 MONTHS

AMIEL TISON - 2 MTHS, 7 MTHS, 12 AMIEL TISON - 2 MTHS, 7 MTHS, 12

MTHSMTHS

P.G. I CHANDIGRAH – 9 MTHS.P.G. I CHANDIGRAH – 9 MTHS.

OTHERS - 8 MONTHSOTHERS - 8 MONTHS

AGE FOR ASSESSMENTAGE FOR ASSESSMENTAGE FOR ASSESSMENTAGE FOR ASSESSMENT


AMEIL TISON’S METHODAMEIL TISON’S METHOD

VOJTA’S TECHNIQUEVOJTA’S TECHNIQUE

CAPUTE AND ASSOCIATES CAPUTE AND ASSOCIATES

INFANT NEUROLOGICAL INFANT NEUROLOGICAL

INTERNATION INTERNATION BATTERY (INFANIB)BATTERY (INFANIB)

AMEIL TISON’S METHODAMEIL TISON’S METHOD

VOJTA’S TECHNIQUEVOJTA’S TECHNIQUE

CAPUTE AND ASSOCIATES CAPUTE AND ASSOCIATES

INFANT NEUROLOGICAL INFANT NEUROLOGICAL

INTERNATION INTERNATION BATTERY (INFANIB)BATTERY (INFANIB)

NEURO DEVELOPMENTAL EXAMINATION METHODSNEURO DEVELOPMENTAL EXAMINATION METHODSNEURO DEVELOPMENTAL EXAMINATION METHODSNEURO DEVELOPMENTAL EXAMINATION METHODS


Head – size shape, fontanell suturesHead – size shape, fontanell sutures

Eyes – Setting sun, Strabismus, Eyes – Setting sun, Strabismus,

nystagmusnystagmus

skin abnormalities – Cafeaulet, Nevi etc.skin abnormalities – Cafeaulet, Nevi etc.

Cranial nervesCranial nerves

Altered mental statusAltered mental status

Spine Spine

Head – size shape, fontanell suturesHead – size shape, fontanell sutures

Eyes – Setting sun, Strabismus, Eyes – Setting sun, Strabismus,

nystagmusnystagmus

skin abnormalities – Cafeaulet, Nevi etc.skin abnormalities – Cafeaulet, Nevi etc.

Cranial nervesCranial nerves

Altered mental statusAltered mental status

Spine Spine

AMIEL TISON’S METHODAMIEL TISON’S METHODAMIEL TISON’S METHODAMIEL TISON’S METHOD

A. GENERAL DISCRIPTIONA. GENERAL DISCRIPTION


1.1. ToneTone - Scarf sign heel to ear - Scarf sign heel to ear

leg abduction, Popliteal leg abduction, Popliteal

angelangel

- - dorsoflexion of footdorsoflexion of foot Pull Pull

to sit.to sit.

prone, sitting positionprone, sitting position

- atnr,- atnr,

2. Vestibular2. Vestibular - Side ways sparachute, - Side ways sparachute,

backward & backward &

FunctionFunction forward parachute, body forward parachute, body

rotativerotative

3. Lethargy/Hyper excitability 3. Lethargy/Hyper excitability

4. Vision & Hearing 4. Vision & Hearing

5. Developmental delay 5. Developmental delay

1.1. ToneTone - Scarf sign heel to ear - Scarf sign heel to ear

leg abduction, Popliteal leg abduction, Popliteal

angelangel

- - dorsoflexion of footdorsoflexion of foot Pull Pull

to sit.to sit.

prone, sitting positionprone, sitting position

- atnr,- atnr,

2. Vestibular2. Vestibular - Side ways sparachute, - Side ways sparachute,

backward & backward &

FunctionFunction forward parachute, body forward parachute, body

rotativerotative

3. Lethargy/Hyper excitability 3. Lethargy/Hyper excitability

4. Vision & Hearing 4. Vision & Hearing

5. Developmental delay 5. Developmental delay

AMIEL TISON’S METHODAMIEL TISON’S METHODAMIEL TISON’S METHODAMIEL TISON’S METHOD


Vestibulo Kinesthetic stimulationVestibulo Kinesthetic stimulation

Tactile stimulationTactile stimulation

Auditory & Visual stimulationAuditory & Visual stimulation

Cognitive stimulationCognitive stimulation

Management of associated medical, Management of associated medical,

neurological & behavioral problemsneurological & behavioral problems

Vestibulo Kinesthetic stimulationVestibulo Kinesthetic stimulation

Tactile stimulationTactile stimulation

Auditory & Visual stimulationAuditory & Visual stimulation

Cognitive stimulationCognitive stimulation

Management of associated medical, Management of associated medical,

neurological & behavioral problemsneurological & behavioral problems

INTERVENTION - MODALITIESINTERVENTION - MODALITIESINTERVENTION - MODALITIESINTERVENTION - MODALITIES


BOTULINUM TOXIN IN CP

• Appropriate time -15 mths to 8 yrs.• Patient Selection –

Hemiplegia>Diplegia>Quadriplegia.• Muscle Strength,Spasticity& Selectivity• EMG of Muscles involved.• Gait analysis-before& after.• Followup – Day night orthosis- • Aggressive Physiotherapy. Serial Casting.


WE ARE GUILTY OF MANY ERRORS AND FAULTS, BUT OUR WORST CRIME ISWE ARE GUILTY OF MANY ERRORS AND FAULTS, BUT OUR WORST CRIME IS

ABANDONING OUR CHILDREN, NEGLECTING FOUNTAIN OF LIFE.ABANDONING OUR CHILDREN, NEGLECTING FOUNTAIN OF LIFE.

MANY THINGS WE NEED IN LIFE CAN WAIT, THE CHILD CAN NOT. MANY THINGS WE NEED IN LIFE CAN WAIT, THE CHILD CAN NOT.

RIGHT NOW IS THE TIME – HIS BRAIN IS GROWING ,RIGHT NOW IS THE TIME – HIS BRAIN IS GROWING ,

HIS BLOOD IS BEING MADE. HIS SENSES ARE BEING DEVELOPED.HIS BLOOD IS BEING MADE. HIS SENSES ARE BEING DEVELOPED.

TO HIM WE CAN NOT ANSWER TOMORROWTO HIM WE CAN NOT ANSWER TOMORROW

HIS NAME IS “TODAYHIS NAME IS “TODAY””

GABRIELA MISTRAL (NOBEL LAURIET FROM CHILE)GABRIELA MISTRAL (NOBEL LAURIET FROM CHILE)


FOR FURTHER DETAILS :

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““DEVCHHAYA” DEVCHHAYA” Early Intervention Centre

Prem Mandir Chowk, Wright Town - Jabalpur

dr. pradeep dubey - consultant pediatrician dr. pradeep dubey md (ped.), dch. dr. pradeep dubey md...

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