ROLE OF EARLY INTERVENTION IN
CEREBRAL PALSY & OTHER
DEVELOPMENTAL DISORDERS
Dr. Pradeep Dubey
MD (Ped.), DCH.
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Dr. Pradeep Dubey - Consultant Pediatrician
W. J. LITTLE
SIGMOND FREUD
“LITTLE HAS GOT IT ALL WRONG, INFANTILE
PARESIS OCCURS IN WOMB & NOT DURING
DELIVERY IN MAJORITY OF CASES”
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Dr. Pradeep Dubey - Consultant Pediatrician
EARLY IDENTIFICATION OF NEURO
DEVELOPMENT DISORDERS – WHY ?
Early intervention – as infant brain
is more plastic (PL 99 – 457)
Preventable conditions.
Disability limitations
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Dr. Pradeep Dubey - Consultant Pediatrician
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.
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Dr. Pradeep Dubey - Consultant Pediatrician
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.
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Dr. Pradeep Dubey - Consultant Pediatrician
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.
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Dr. Pradeep Dubey - Consultant Pediatrician
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.
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Dr. Pradeep Dubey - Consultant Pediatrician
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.
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Dr. Pradeep Dubey - Consultant Pediatrician
AGE FOR ASSESSMENT
AMIEL TISON - 2 MTHS, 7 MTHS, 12 MTHS
P.G. I CHANDIGRAH – 9 MTHS.
OTHERS
- 8 MONTHS
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Dr. Pradeep Dubey - Consultant Pediatrician
NEURO DEVELOPMENTAL EXAMINATION METHODS
AMEIL TISON’S METHOD
VOJTA’S TECHNIQUE
CAPUTE AND ASSOCIATES
INFANT NEUROLOGICAL INTERNATION
BATTERY (INFANIB)
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Dr. Pradeep Dubey - Consultant Pediatrician
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
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Dr. Pradeep Dubey - Consultant Pediatrician
AMIEL TISON’S METHOD
1. Tone
- Scarf sign heel to ear
leg abduction, Popliteal angel
- dorsoflexion of foot Pull to sit.
prone, sitting position
- atnr,
2. Vestibular
- Side ways sparachute, backward &
Function
forward parachute, body rotative
3. Lethargy/Hyper excitability
4. Vision & Hearing
5. Developmental delay
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Dr. Pradeep Dubey - Consultant Pediatrician
INTERVENTION - MODALITIES
Vestibulo Kinesthetic stimulation
Tactile stimulation
Auditory & Visual stimulation
Cognitive stimulation
Management of associated medical,
neurological & behavioral problems
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Dr. Pradeep Dubey - Consultant Pediatrician
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.
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Dr. Pradeep Dubey - Consultant Pediatrician
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)
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Dr. Pradeep Dubey - Consultant Pediatrician
FOR FURTHER DETAILS :
PLEASE VISIT
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“DEVCHHAYA”
Early Intervention Centre
Prem Mandir Chowk, Wright Town - Jabalpur
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Dr. Pradeep Dubey - Consultant Pediatrician