Introduction--Being a physiotherapist since 30 years,
I have experienced various changes in the field of neurology and pediatrics.
Not only therapists know much more about HOW
the brain functions, but we are also witness to change in the frequency of
occurrence of various diagnoses. Until the 90s, we treated children with
Cerebral palsy, Down syndrome, Spina bifida, etc. clinical presentations that
were obvious to the eye. Rehabilitation
terms changed from handicap and disability to later physically challenged, and
now to special needs and specially abled. A glaring change is the increasing
numbers of conditions such as autism spectrum disorder (ASD) and attention
deficit hyperactivity disorder (ADHD). The signs and symptoms of ASD and ADHD
fall along a wide spectrum, not so obvious to the common eye unless quite
severe, and can be confusing to parents.
Therapy – Despite these changes, the ultimate reason
for therapeutic intervention is to make the child as functional as possible. It
is mostly a bottoms-up approach where, through the right therapy, we influence
the development of the brain in the right direction.
Therapists generally assess not
only whether the child moves (turns over, crawls, walks, jumps) but also the
quality of posture and movement—which reflects neuro motor maturity.
Young parents find themselves in a dilemma when they
sense that all is not well with their child while at the same time grandparents
or friends advise them to wait and watch. Denial that a child is atypical is a
major issue in our fiercely competitive society where we wish only academic
success. However, it is crucial to recognize that academic development cannot
occur without the foundation of robust sensory & motor systems.
Myths prevalent about children in Indian
society—
- Spend a year or more with a larger joint family, and the child will start speaking.
- Put the child in playschool, and he/she will learn to walk.
- Child’s father / mother also walked on toes, and the problem was outgrown.
- All is fine, except that there is no speech.
- Walking, jumping, climbing…no problem, BUT my child does not sit still.
- This kid is so smart that he can use an ipad / phone/tablet and teaches himself.
- Crawling is just a missed milestone, does not matter.
Development has to be viewed as an entity of several
components such as physical, cognitive,
speech and language, emotional, as well as social. Development occurs in all of
these areas simultaneously or in parallel, additionally there is an influential
effect of one component on another.
A child may rarely have only
speech delays, it is highly likely to be accompanied by difficulties in sitting
still, engagement in purposeful play, and mingling with other kids. He/she may
have other motor issues such as catching /throwing a ball, clumsiness, being
unable to hold a pencil, cutting with scissors.
If a child exhibits any of the
following symptoms, he/she needs to be evaluated by a qualified clinician.
•
Speech delays, echolalia, poor social skills.
•
Playing with a limited variety of objects.
•
Toe walking.
•
Mouth open.
•
Hand flapping/constantly moving/looking at spinning objects.
•
Poor eye contact.
•
Lack of manipulation with hands.
•
Eating/feeding problems.
•
Serious toileting problems.
•
Sensitivity to loud noises.
•
Attracted to rhythmic sounds such as alarm clock, machines
etc.
