Dr. Pradeep Dubey MD (Ped.), DCH.

ROLE OF EARLY INTERVENTION IN CEREBRAL PALSY & OTHER DEVELOPMENTAL DISORDERS Dr. Pradeep Dubey MD (Ped.), DCH.

W. J. LITTLE

SIGMOND FREUD “LITTLE HAS GOT IT ALL WRONG, INFANTILE PARESIS OCCURS IN WOMB & NOT DURING DELIVERY IN MAJORITY OF CASES”

EARLY IDENTIFICATION OF NEURO DEVELOPMENT DISORDERS – WHY ? • Early intervention – as infant brain is more plastic (PL 99 – 457) • Preventable conditions. • Disability limitations

EARLY IDENTIFICATION OF DEV. DISORDERS - ? • Follow up of high risk babies • High index of suspicion • Brief account of developmental history & • examination • Detailed neuro developmental assessment by • child development group. • Investigations – USG, Metabolic screening, EEG, CT/MRI • Scan. • Early & appropriate intervention.

IMPORTANT ISSUES TO ADDRESS • Which infants are at risk. • Signs or clusters most specific for prediction. • At what age assessment is most predictive. • Screening tools/methods most specific. • Is routine developmental screening useful.

HIGH RISK CONDITIONS • Low birth weight babies. • Severe H.I.E. • Severe neonatal jaundice • Persistence of Abn. Neuro signs after 2 wks. • Hypodensisties in Ct. even after 4 wks. • Oliguria (<1ml./kg./ hr.) for 24 hrs. • associated with H.I.E. • Low apgar (0-3) after 20 mts. • Late seizures in a depressed NB • Background abnormalities in interictal EEG.

TWILIGHT SIGNS/CONSTELLATIONS • Responsiveness / Alertness • Spontaneous motility • Persistant hyper excitability • Feeding difficulty • Constant fisting after 2 months • Abnormal movements / convulsions. • Abnormal postures • Abnormal Head circumerence.

TWILIGHT SIGNS/CONSTELLATIONS • Abnormalities of tone • Primitive reflexes weak / persistent (>6 mths) • Delayed appearance of postural reflexes • Delayed mile stones • Ocular abnormalities • Lack of response to sound.

AGE FOR ASSESSMENT • AMIEL TISON - 2 MTHS, 7 MTHS, 12 MTHS • P.G. I CHANDIGRAH – 9 MTHS. • OTHERS - 8 MONTHS

NEURO DEVELOPMENTAL EXAMINATION METHODS • AMEIL TISON’S METHOD • VOJTA’S TECHNIQUE • CAPUTE AND ASSOCIATES • INFANT NEUROLOGICAL INTERNATION • BATTERY (INFANIB)

AMIEL TISON’S METHOD A. GENERAL DISCRIPTION • Head – size shape, fontanell sutures • Eyes – Setting sun, Strabismus, nystagmus • skin abnormalities – Cafeaulet, Nevi etc. • Cranial nerves • Altered mental status • Spine

AMIEL TISON’S METHOD • Tone - Scarf sign heel to ear • leg abduction, Popliteal angel • - dorsoflexion of footPull to sit. • prone, sitting position • - atnr, • 2. Vestibular - Side ways sparachute, backward & • Functionforward parachute, body rotative • 3. Lethargy/Hyper excitability • 4. Vision & Hearing • 5. Developmental delay

INTERVENTION - MODALITIES • Vestibulo Kinesthetic stimulation • Tactile stimulation • Auditory & Visual stimulation • Cognitive stimulation • Management of associated medical, neurological & behavioral problems

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 IS ABANDONING OUR CHILDREN, NEGLECTING FOUNTAIN OF LIFE. MANY THINGS WE NEED IN LIFE CAN WAIT, THE CHILD CAN NOT. RIGHT NOW IS THE TIME – HIS BRAIN IS GROWING , HIS BLOOD IS BEING MADE. HIS SENSES ARE BEING DEVELOPED. TO HIM WE CAN NOT ANSWER TOMORROW HIS NAME IS “TODAY” GABRIELA MISTRAL (NOBEL LAURIET FROM CHILE)

FOR FURTHER DETAILS : PLEASE VISIT www.healthychildindia.com THANK YOU “DEVCHHAYA” Early Intervention Centre Prem Mandir Chowk, Wright Town - Jabalpur

Dr. Pradeep Dubey MD (Ped.), DCH.