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Early detection and intervention for any degree of hearing loss is critical to the linguistic, social and educational development of children with auditory deficit. Since parents and family members are in a position to identify hearing loss at an early stage, they can play a vital role in achieving the goals of early identification and intervention for their children.

Purpose: This study was conducted to determine the age at which parents and significant others begin to suspect hearing impairmentin their children, and to advocate for using them as resource persons in the early detection of hearing loss.

Method: Parents of children with hearing impairment were retrospectively surveyed and interviewed to determine the age at which suspicion, diagnosis, fitting of amplification and initiation of interventions occurred.

Results: Interviews revealed the average age to be 16.5, 24.3, 31.7 and 33.4 months, for suspicion, diagnosis, fitting of amplification and initiation of early intervention for hearing loss respectively. The obtained age of suspicion is lower than the age of identification of hearing loss reported in Indian literature. The current study found delays in diagnosis and fitting of amplification, both of which are essential to initiate early remedial programmes which facilitate development of speech and language skills in children with hearing impairment. Surprisingly, it was found that these delays were caused by professional failures.

Conclusion: It is emphasised that parents are in the best position to detect hearing problems in their children, and can be effectively utilised as manpower/ equal partners in achieving the goal of early identification of hearing loss. The study outlines appropriate ways and means to facilitate early identification and provide effective intervention for children with hearing impairment.

Purpose: Post-polio Syndrome (PPS) affects polio survivors many years after the initial attack, and causes new musculoskeletal symptoms and decline in physical function. This study aims to compare the effect of exercise and lifestyle modification versus lifestyle modification alone, on fatigue and functional capacity in persons with PPS.

Method: An experimental study was conducted at the physiotherapy department of VS Hospital in Ahmedabad. As per the criteria of Halstead (1985), 21 PPS subjects who were between 18 and 65 years of age, and able to walk indoors and outdoors, with or without assistive aids, were included. They were randomly allocated into 3 groups using the envelope method. Those with physician- diagnosed respiratory or cardiac insufficiency, disabling co-morbidity which interfered with the intervention programme or influenced the outcome, and those unable to cooperate due to cognitive impairment or use of any psychotropic drugs, were excluded. Fatigue and functional capacity were measured using Fatigue Severity Scale (FSS) and 2-minute walk distance, respectively. Physical and psychological functions were assessed using Patient Reported Outcome Measurement Information System (PROMIS) questionnaire and Patient Health Questionnaire (PHQ-9) respectively. Intervention was given for 5 days a week, over 4 weeks. Group A received exercise and lifestyle modification, group B received lifestyle modification alone and group C continued their usual routine for 1 month.

Results: There was a significant difference in fatigue and functional capacity within groups A and B, with group A showing better reduction in fatigue than groups B or C. Physical function improved only within group A, and a significant difference was seen compared to groups B and C. Psychological function showed no difference within or between the groups.

Conclusion: There was improvement in fatigue, functional capacity and physical function in PPS subjects after 4 weeks of exercise and lifestyle modification. Lifestyle modifications alone for 4 weeks improved fatigue and functional capacity in PPS subjects. There is significant reduction in fatigue and improvement in functional capacity when lifestyle modification advice is given along with exercise.

Habilitation and rehabilitation call for a paradigm shift from the traditional intervention programmes which focus on physical functioning to programmes that include aspects of physical, psychological and social wellbeing.

Purpose: To develop a quality of life instrument, using focus group discussions to assess the outcomes of interventions for school-going children with hearing loss.

Methods: Separate focus group discussions were held with children with hearing loss between 8 and 18 years of age, special educators and mothers. Focus group discussions were conducted separately for boys and girls. Each focus group had 8–10 participants. In-depth interviews were conducted with the heads of institutions and rehabilitation professionals. Fathers had to complete self-administered questionnaires. The focus group discussions were guided by topics and probes drawn from literature reviews, and were audio recorded, transcribed and analysed.

Results: Around 421 problem statements were classified under 7 themes: Educational implications; Social integration; Psycho-social wellbeing; Family relationships; Speech, language and communication; Leisure and recreation; and General functioning. Education and career aspirations were considered to be most important. The problem statements revealed that the primary focus of training was on improving academics. Integration and feeling comfortable with social situations were cited as limitations; as also, the preference for friendship with people of similar abilities. For the majority of children, leisure and recreation was limited to watching television. Parents and siblings were considered vital to their progress and achievements.

Conclusions: Multidimensional and varied perspectives of different stakeholders, especially family members, are necessary for a comprehensive analysis of the impact of hearing loss on the quality of life of school-going children.

Purpose: Since very young people benefit from early identification of communication disorders, the primary caregivers (generally the parents) become the fulcrum of the intervention services provided. This article deals with the measures taken to empower caregivers, as part of the early intervention services offered at the All India Institute of Speech & Hearing (AIISH) in Mysore city in India, and the impact this has had on their wards’ progress.

Method: A survey was conducted among the caregivers of 205 clients who availed of early intervention services. Five-pronged data were collected, pertaining to family demographic details, early intervention measures for their children with communication disorders, type and intensity of caregiver empowerment measures provided along with early intervention services, resultant caregiver participation in the education and training of their wards, and the consequent development in children with communication disorders. The mutual influences among these factors were analysed using simple correlation measures.

Results: The findings revealed that informal, but continuous and consistent efforts to empower parents, such as counselling and guidance, had a better impact. Empowered caregivers in turn contributed towards the education and training of their children with communication disorders, resulting in improved development of their wards’ communication skills and academic achievements.

Conclusion: The evidence adds strength to recommendations that caregiver empowerment and participation need to become integral components of early intervention services for young children with special needs.

Purpose: It is a common and well‐recognised phenomenon that functional deterioration occurs many years after people are affected by poliomyelitis infection. This study aims to determine the presentation of pain in subjects with post-polio syndrome (PPS) and also the correlation between severity of pain and interference in activities of daily living (ADL).

Method: A cross-sectional survey was conducted among 72 persons with PPS in Gujarat state in India. Each one was given a self-administered questionnaire which included an 11‐point Numeric pain rating scale (NRS) for intensity of pain, questions about site, duration and diurnal variation of pain, and an 11‐point Numeric pain rating scale for pain interference.

Results: The study showed that 17 persons (24%) had only joint pain, 28 (39%) had only muscular pain and 27 (37%) had both joint as well as muscular pain. The highest number of subjects or 34 persons (47%) had knee pain, followed by 24 (33%) with shoulder pain, 21% with hip and 19% with low back pain. Muscle pain was maximum in arm musculature, as reported by 33 persons (45%), followed by pain in leg and foot muscles among 25 (36%) and 17 (23%) persons, respectively. Maximum number of subjects or 31% had pain while working which was relieved by rest, while 28 % had pain which continued all day. 43% experienced more pain in winter while 57% had no seasonal variation in pain. 30 persons (42%) had severe pain, 26 had moderate pain and only 16 had mild pain. Mean pain intensity was 5.88 ±1.52. Interference in ADL on NRS was 4.72 ±2.70. Interference in ADL and pain intensity were found to be positively correlated with Pearson’s co-efficient r=0.6295(p<0.0001).

Conclusion: The majority of those who had recovered from polio experienced increased or new symptoms and problems in ADL, muscle pain, joint pain, and difficulties in walking.

Purpose: The ability to recognise emotions in oneself and in others is a fundamental prerequisite to function successfully in the social world. Emotion recognition deficit in people with learning disability may therefore be an important contributory factor to deficits in social skills and poor social adaptation. This study aimed to examine the level of emotional understanding in students with learning disabilities (LD).

Method: A pre-test, post-test equivalent groups design was adopted for this study. The focus was on identification of emotions through verbal and pictorial situations, and the appropriate expression of emotions. Training was provided to enhance the emotional understanding of students through the use of ‘I C ME’ module. The 6 emotions addressed in this study were anger, excitement, embarrassment, jealousy, love and anxiety. 30 children with LD, in the age group of 9-12 years, were selected for the study.

Results: It was seen that while children with LD had difficulty in the identification of an emotion, they found it more difficult to express the emotion in a socially appropriate way. The post-test results indicated that the training provided to the students significantly improved their emotional understanding.

Conclusions: The students learnt about the 6 emotions (anger, excitement, embarrassment, love, jealousy, and anxiety), the vocabulary associated with these emotions, and also the appropriate way to express, self-monitor and self-regulate each emotion.

Limitations: Intervention was done for only 6 emotions

Purpose: The aim of the study was to investigate and compare factors related to recovery and relapse outcomes after treatment, among adults with stuttering.

Method: The participants were 24 adults who underwent fluency therapy and reported for follow-up 6 months after cessation of treatment. Pre, immediate post and 6-months post-treatment follow-up evaluations were done using stuttering severity instrument SSI-3. On the basis of total scores and severity obtained, participants were then grouped as either recovered or relapsed persons with stuttering. A questionnaire was administered to obtain their ratings for the different domains of factors that contributed to treatment outcomes.

Results: A significant difference was found between both the groups with respect to factors contributing to recovery and relapse. The four domains which were found to be more responsible for treatment outcomes in persons with stuttering were: individual related, therapy related, environment related, and behaviour and personality related factors.

Conclusion: The study was conducted with fewer participants, and it is possible that there could be many other pre-treatment and post-treatment factors such as attitude, anxiety, and speech naturalness which may influence the treatment outcomes in persons with stuttering. Future research should include these other factors.

Purpose: The Kudumbashree mission, an initiative of the Government of Kerala state in India, has collaborated with Local Self Governments to set up ‘Buds’, a special school system for individuals with intellectual disability. The objectives of this study were to evaluate the structure and functioning of ‘Buds’ schools, to identify the healthcare needs of the students, and to conceptualise a framework for healthcare provision.

Method: A cross-sectional survey was conducted among 202 children at 11 registered ‘Buds’ schools in Kerala. A multidisciplinary team consisting of a psychiatrist, public health personnel and a social worker from the Medical Colleges of Kerala, visited the institutions. Data collection consisted of abstraction from medical records, interviews with parents, and clinical assessment and prescription of intervention by the specialists concerned. A pre-tested semi- structured questionnaire was used for every child. Using both quantitative and qualitative techniques, the public health personnel in the team evaluated the structure and functioning of the schools.

Results: The most commonly associated condition was epilepsy, seen in 11.9% of the children, while 28.2% had behavioural problems. The medicines needed were mainly anti-epileptics and drugs for behavioural problems. Interventions for self help and social skill training were also among the important requirements. The infrastructure and other facilities were poor in many schools, with the average student to teacher ratio at 14:1. While these institutions were well utilised, functioning was good only in 27.2% of the schools. Healthcare services and visits by healthcare personnel were far from adequate. This study proposes a framework in which the Medical Colleges and Health Services can function together to deliver healthcare services to children at these schools, with linkages from the District Mental Health Programme (DMHP).

Conclusion and Recommendation: Evidence that these schools are well utilised indicates a need to propagate this initiative in other areas of the state, country and other countries. However, improvements in infrastructure, human resources and other logistics are required. Besides, the healthcare needs of these children have to be addressed. A comprehensive healthcare programme through the existing system, using a multidisciplinary approach, needs to be developed.

Purpose: Inclusion of children with disabilities in mainstream classrooms has become the focus of extensive research in education. It has both academic and social benefits for all students, such as providing opportunities for communication and social interaction. The evaluation of teachers’ attitudes towards inclusion appears to be a good method to determine the success of the programme. Although this has been widely researched in many countries, the available evidence is not consistent. This study was undertaken in the state of Andhra Pradesh in India, to measure and compare teachers’ attitudes towards the inclusion of children with hearing impairment in schools.

Method: A questionnaire developed by Giles and Tanner (1995) measuring three domains - (1) effective strategies for meeting the needs of all students, (2) the support for educational change in their district, and (3) inclusive education - was modified in keeping with cultural and geographical variations and used as the test tool. A hundred teachers of various Government and non-Government schools in 2 districts of Andhra Pradesh, India, participated in the study.

Results: Higher scores on domain 1 indicate that teachers feel effective strategies to benefit students with disabilities should be implemented in schools. The results also indicate that most teachers are agreeable to the inclusion of students with disabilities in their classrooms. Significant difference in attitudes was observed, based on the teachers’ qualifications, teaching experience, gender, level of teaching and management.

Conclusion: The study concludes that there is a need for intervention to foster more positive attitudes among teachers, if the implementation of inclusive education is to succeed. It also has implications for the framing of laws and policies for children with hearing impairments.