Thursday, March 29, 2012

LEARNING DISABILITY (LD)

HI all.
whenever we admit our kids to school, we undergo a sense of euphoria... In bollywood style, "padh-likhkar badaa aadmi banega" and so on and so forth. Usually the school years pass by quickly even b4 we actually realize it!!
But what happens when there is a stumbling block? What happens if ur child is unable to study (not because he doesnt want to).... is subjected to humiliation in class and back at home? Well its time we have a reality check.
Aamir Khan had popularised Learning disability via his movie 'tare zameen par'. The young Ishaaan in the movie was the butt of jokes and ridicule till he was intervened.....


But such awareness is just a small beginning. We have a long way to go. Early diagnosis of children is the key to successful rehabilitation of children with LD.



(read more on Understanding and Supporting Learning Difficulties



by: Ms Areena Loo, Bridge Learning)


I had this child all of 8 yrs visiting me for a complete evaluation. He presented a picture.... he was smart, witty and quick to respond to any query abt anything under the sky.He apparently was very good in sports!  But when it came to reading and writing skills, he showed classic symptoms of LD. His shocked mother only said " why dint anyone tell me about this problem while i kept reprimanding him for his studies?"
It is surprising that though we ve come a long way since the establishment of Maharashtra Dyslexia Association, many school teachers, principals and peadiatricians and far from being aware of signs and symptoms of LD.

The catch here is the school boards (SSC, CBSE and ICSE) accept only reports from SIOn and Nair hospital and they inturn do not assess a child without a refferal letter from school! Most school principals whom i ve come across in my career DO NOT give any such letter and the child is left to fend for himself. Some manage by attending therapies and remedial education, but the severely afftected suffer the most due to apathy of a few.
Its time we wake up. Lets look around us. Most children with LD ve poor attention span  and are very distracted. They sometimes ve history of delayed motor milestones. These are red flags and an alert teacher or parent can make the most of it and prevent further debilitating effects.
PLEASE BE ALERT!



18-4-12

REcent updtae from the child:
As expected the school 'refused' to give a letter for his official diagnosis to the hospital, which now refuses to conduct evaluation. Occupational therapy assessment is done with and LD (with some features of ADHD......quite common)  is confirmed. His therapy has been initiated, but he needs help, i.e the facilities provided by the board.
My question to these schools, ' Why is the letter not given to the child? Its his right to ve a proper education.' There are very negligible schools for slow learners and those with scholastic backwardness...... where do these kids go, if the schools where they r in doesnt support them. I know that there r false positive cases too but most of these children are innocent victims and targetted for no fault of theirs. Why do they ve to suffer humiliation in class just because they ve some perception problems making reading and writing difficult for them?
AWARENESS is the need of the hour. ACCEPTANCE...... first by the parents then teachers and then classmates (through teachers) is very important, if the chld with LD has to have a normal school life.
I hope better sense prevails.

Sunday, March 25, 2012

Hearing aids........ needed or not?


Sharing with u readers about a client i saw very recently.  This lady had a lot of other issues besides her hearing loss. However a non-audiologist tried to fit her with an aid on the behest of an ENT (guys.... nothing personal here).  When they came to me for a second opinion, i found that she demonstrated classic symptoms of a medical condition and her 'fluctuating' hearing loss was just the tip of the ice-berg. I halted her hearing aid fitting, did a complete audiological evaluation and immediately reffered her to an ENT for complete evaluation.
Point to draw home: All hearing losses dont or cant be fitted with a hearing aid. There is a lot more to it than what meets the eye. One should always take things with a pinch of salt. Consult and audiologist for  complete testing before u decide on fitting urself with an hearing -aid!

8/04/2012
Just for an updtae here, She is confirmed with the medical diagnosis and is progressing well with treatment. I shudder to think of the damage that cud ve been caused to her ears had she been fitted with hearing aids!


We need to WATCH OUT!!

Monday, March 19, 2012

hearing education....

CONSUMER EDUCATION..... A MUST!

This is one of my experiences i want to share. Parents of children with hearing impairment are often at a loss when it comes to "what is best" for thier children. I saw a child with Moderate - moderately severe hearing loss (now 4 yrs old), diagnosed at a very good age i.e. 2yrs. HOwever parents were made to run from pillar to post over the hearing aid fitting and speech-language therapy.
An important reason for putting up this case here is, this child suffered from Middle ear infections. It is very very important to note that, the middle ear infections are often treatable and the hearing loss resulting from them are reversible. However very often the hearing loss is fluctuating and the child gives inconsistant responses. The parents and also the professionals involved should judge this.

A point to take home: Unless the child with hearing impairment also has Auditory Processing Disorder, it is highly unlikely that he will not develop adequate speech-language!!

Wednesday, March 14, 2012

BERA test!

Hello friends,

This happened a couple of days ago and i thought i must share it with you.

BERA (Brainstem Evoked Response Audiometry) is many times used for determining the extent of hearing loss in peadiatric patients and is also an important tool in test battery for diagnostic purposes. the procedure requires the child to be sedated before the electrodes are placed.

HOwever of late this has been widely misused by vested interests and put forth as a money making machine. A client of mine whom i had tranferred to another professional due to unavoidable reasons was a recent victim of such gimmics. The child in question is hyperactive with mental retardation. The therapist instead of catering to her speech-language status, insisted on getting her hearing status "confirmed " by BERA test. The child was tried sedation but it dint work and finally after gruelling attempts to try to make her sleep were in vain, the parents were charged a whooping Rs 3000/- I question: was this test needed? why was it even attempted?

In yet another instance, a Cerebral palsied child with a birth hisotry of severe kernicterus (jaundice) was fitted with strong hearing aids (worth Rs 1 lakh). On performing a BOA (behavioral audiometry), it turned out the child had normal hearing. I repeated the tests thrice and the child consistently responded to normal levels. From then on it was a struggle for the parents to get back the money!! (they eventually got it after 3 months  and after threatening the dispencer with media interference)

At this stage i only want to  point. BERA is NOT a test of hearing. It should be a part of the test battery. Hearing aids for children should be fitted only when the complete test battery is indicative of hearing loss.

UPDATE ON THAT CHILD:

I repeated this child's hearing test and now that his neck-control is much better, he gave me very good neck turning responses for sound and speech. The icing on the cake is he has started to speak in monosyllabic words, further strengthning the normal hearing diagnosis.
The point to draw home here is, the parents had to undergo undue anxiety (added to already existing ones) due to misdiagnosis. I wish the earlier guys had performed the test battery and observed the child .... this would have prevented all the heart burn. BUt then, 'better late than never'............

hearing loss!!

                                  Myths and challenges in hearing rehabilitation


What does one do when he has a hearing loss that is irreversible? Well, he uses a hearing-aid! (Wish the solution was as simple as that). Hearing rehabilitation is a challenge especially when those at the receiving end are children or senior citizens. Hearing aid dispensing these days is done indiscriminately. The aim of this article is to educate a potential receiver about the difficulties he may be facing and the possible options available for the same.



Adult hearing rehabilitation:

Whenever hearing loss is suspected or if the person is genetically or environmentally pre-disposed to hearing loss, it is mandatory that he undergo a hearing test at least annually. A qualified audiologist will perform a Pure Tone Audiometry along with Speech Audiometry and determine the degree and type of hearing loss. Speech Audiometry becomes important when a person complains of ‘not being able to understand’ in spite of ’hearing’ it. If middle ear problems are suspected then the ENT recommends an Impedance Audiometry. Hearing disorders (loss) which can’t be medically reversed, need to be compensated with adequate amplification i.e. hearing aid(s).

The client today is spoilt for choice with a number of companies and a number of hearing aid models! The advent of technology (read programmable hearing aids) has only added to the audiologists’ challenge. Though a client may insist on a particular make or company (usually because he has heard more about it, it is the audiologist who should help him make the ‘correct’ decision based on:


• Audiological suitability

• The clients’ specific requirement (i.e., traffic, interviews, board room meets, home, etc)

• Cosmetic requirement

• Financial aspects.

Digitally programmable hearing aids are a blessing for those with slopping hearing losses or the post-lingual deaf. These hearing aids (barring a few) have their limitations in cases of severe to profound hearing losses. The client must know that, more the number of features, greater is the cost. These features should be discussed with the audiologist before zeroing on aid (s) for trial. Once the fitting is done, the client should be informed of the care and maintenance of the hearing aid. Fine tuning (in case of digitally programmable hearing aids) should be conducted at least within a month for adequate benefits.

The client should be clearly explained about realistic expectations from a hearing aid and the limitations of the same. An important point to draw home is a hearing aid is ultimately an amplification device which can never replace our ears. Remember this when you light that sutli bomb the next time…….. Ears are precious!!




Hearing loss in children:

Aural habilitation in children is of utmost importance due to the developmental issues involved. Even before adequate amplification, comes ‘the correct diagnosis’ of hearing loss. It is often observed that a child at-risk for hearing loss or suspected loss is advised to undergo OAE and BERA. No harm done! But BERA is not a test of hearing… if it indicates a loss, then it has to be clinically correlated. From the age of 4 months a Behavior Observation Audiometry (BOA) can be performed and after about 6-8 months a Visual Reinforcement Audiometry (VRA) may be done. If hearing loss is indicated, then the child undergoes observation therapy sessions and finally gets fitted with the hearing –aids. Option of cochlear implants too should be explained to the parents. Once the child is aided then begins the very important stage of auditory training and speech-language therapy. It is a myth that the child with hearing impairment will speak immediately after fitting with hearing aids, without adequate training.

Another issue is the concept of partial deafness in children. Usually the age of diagnosis is higher considering the loss. However it is important that the parents `accept’ the hearing impairment and do the needful.

Considering the critical period of language development, it becomes imperative that the child be diagnosed early and habilitated well. So parents…… if your child is at risk, gear up quickly, else you may miss the bus!!!