Autism is a disorder of the brain that causes a lifelong development disability, primarily affecting the communication and social abilities of people. Symptoms of the condition are evident either from birth or may begin to appear after a period of normal development, but definitely by the time the child is two and a half years old.
Autism is known as a ‘Spectrum disorder’, because the severity of symptoms ranges from a mild learning and social disability to a severe impairment, with multiple problems and highly unusual behavior. The disorder may occur alone, or with accompanying problems such as mental retardation or seizures. Autism is not a rare disorder, being the third most common developmental disorder, more common than Down’s Syndrome. Typically, about 20 in a population of 10,000 people will be autistic or have autistic symptoms. 80% of those affected by autism are boys. Autism is found throughout the world, in families of all economic, social, and racial backgrounds. Doctors, politicians, and rickshaw drivers alike all have autistic children.
A child with high functioning autism may have a normal or high IQ, be able to attend a regular school and hold a job later in life. However, this person may have difficulty expressing himself and may not know how to mix with other people. Moderately and more seriously affected children with autism will vary tremendously. Some autistic children do not ever develop speech, while others may develop speech but still have difficulty using language to communicate. Often, there is an unusual speech pattern, such as echoing whatever is said to them, repeating a word over and over, reversing “You” and “I” when asking for something, and speaking only to express needs, rather than emotions.
A child with autism looks just like any other child, but has distinctive behavior patterns. A child who is autistic may enjoy rocking or spinning either himself or other objects, and may be happy to repeat the same activity for a long period of time. At other times, the child may move very quickly from one activity to another, and may appear to be hyperactive. Many autistic children have sensitivity to certain sounds or touch, and at other times, may appear not to hear anything at all. Autistic children may have very limited pretend play, they may not play appropriately with toys or may prefer to play with objects which are not toys. Autistic children may be able to do some things, like sing songs or recite rhymes very well, but may not be able to do things requiring social skills very well.
Blindness
Each year an additional 1.8 to 2.2 million people are blinded by cataract. Indian ophthalmologists, with the assistance of non–governmental organizations like the World Bank, perform about 2 million cataract operations annually. The numbers are impressive, but it will be virtually impossible to eliminate the backlog if the number of annual surgeries does not increase. There is an estimated backlog of 22 million cataract patients in India, though not all these patients are blind.
Not all Indian ophthalmologists perform surgery, but according to several physicians interviewed for this article, intracapsular cataract extraction (ICCE) remains the most common cataract removal technique among those who do. It is used in about 60% of cases. Manual extracapsular cataract extraction (ECCE) with phacoemulsification is preferred, but because of the costs associated with the equipment and the availability of IOLs and surgical microscopes, ICCE remains standard.
Glaucoma is also a major problem in India. A study slated to appear in the Indian Journal of Ophthalmology found that the prevalence of all types of glaucoma in people between ages 30 and 60 is about 3.0%. Unlike the West, most glaucoma is a result of chronic angle closure (5:1 compared with open angle glaucoma). Another study suggests that glaucoma accounts for 13% of blindness in patients over age 30.
Corneal blindness accounts for 3% of blindness, and refractive errors account for 7%. Several physicians commented that ocular trauma in children is a persistent problem in India. The chances of a child sustaining serious trauma to the eye are more than the chances of contracting poliomyelitis during an epidemic.
Refractive Surgery
As India’s wealthy and middle classes expand, refractive surgery is becoming increasingly popular. In all, there are probably fewer than 10 excimer lasers in India and most are found in the larger cities of the South. Like other Western trends, laser in situ keratomileusis (LASIK) is catching on quickly in India, however, photo refractive keratectomy (PRK) and radial keratotomy which is declining in popularity but still routinely used remain popular.
Deafness – The Invisible Handicap
Hearing loss is of 2 types
Conductive: Resulting from malfunction in the outer or middle ear. This can often be corrected medically or surgically.
Sensory neural loss: This results due to malfunction in the inner ear or in the auditory nerve.
Causes of Deafness before birth
- Hereditary causes.
- Consanguineous marriages.
- Rh factor or blood group incompatibility.
- High intake of antibiotic or ototoxic drugs.
- Exposure to X–Rays.
- Instrumental delivery.
- Birth anoxia.
- Birth weight less than 1200 gms.
- Jaundice.
- High fever.
- Measles–mumps–rubella.
- Convulsions.
- Heavy intake of antibiotics.
- Accidents.
- Meningitis–otosclerosis.
Prelingual prior to learning spoken language. Post lingual after learning spoken language i.e. after 2 to 3 years.A deaf child is not dumb: Hearing children learn to speak by imitating sounds that they hear and by enjoying the sounds that they make i.e. babbling, cooing etc.A deaf child has to be taught speech which is a very challenging task for the pupil and the teacher. Deaf children vary in intelligence like hearing children.
The following points should be considered
- A deaf child has to be helped to hear better by giving him amlification and conditioning his residual hearing.
- Visual supplement must be offered through lip–reading, manual signs etc.
Limb–Girdle Muscular Dystrophy
Diagnostic Criteria
The limb–girdle muscular dystrophies (LGMD) are a group of genetically determined progressive disorders of muscle in which the pelvic or shoulder girdle musculature is predominantly or primarily involved. The term was suggested to recognize the existence of cases which could not be definitively diagnosed as either X–linked muscular dystrophy or facioscapulohumeral muscular dystrophy in the classifications of Stevenson in 1953 and Walton & Nattrass in 1954.
Since then the existence of the group as a separate entity has been questioned because of the overlap of symptomatology with patients who can now be proved to have disorders which are known to be clinically and genetically different. For example, patients with Becker muscular dystrophy and manifesting carriers of dystrophin mutations were frequently diagnosed as having ‘Limb–girdle muscular dystrophy’ before the availability of direct genetic and dystrophin analysis for these conditions.
Disorders such as spinal muscular atrophy and mitochondrial and metabolic myopathies have also been the subject of diagnostic confusion as all of these conditions may present with weakness in a limb–girdle distribution. Nonetheless, some patients remain in whom the diagnosis of LGMD remains appropriate and this is still a heterogeneous group. The category of limb–girdle muscular dystrophy includes a number of separate and genetically distinct conditions, the molecular basis of some of which is now being resolved. Based on the collection of over 90 families and sporadic cases of LGMD presented in advance of an ENMC sponsored workshop on the limb–girdle muscular dystrophies.
The following criteria are for inclusion and exclusion of the diagnosis are suggested. These criteria encompass the range of symptoms and findings in the different groups diagnosed as LGMD and are suggested as a review of the current situation with regard to diagnosis in these conditions. As the molecular basis for each of these phenotypic varieties of LGMD becomes defined, it will become appropriate to provide diagnostic criteria for each separately.
(Inclusion criteria are indicated with an ‘I’, ‘E’ denotes exclusion criteria and ‘C’ stands for comment.)
Address:
Limb–Girdle Muscular Dystrophy
K. M. D. Bushby,
Dept. of Human Genetics,
University of Newcastle upon Tyne, United Kingdom.
Orthopedic Impairment
Mukti’s Artificial Limb
The Mukti limb
The Mahaveer Vikalang Sahayata Samithi, Jaipur, processed the effort towards an artificial limb that functioned better than the limbs made before. And with technical assistance from them, Mukti took off to launch itself on its mission of helping those poor disabled who cannot help themselves. That was how the Mukti Limb came into being.
The Mukti Limb is made from HDPE (a plastic material), which is lighter in weight. It looks like a natural foot, is waterproof, simple, sturdy, durable, made of locally available material and utilizes very simple technology while incorporating modern scientific ideas. The unique design of this foot permits squatting, sitting cross legged on the floor, walking on uneven ground, cycling, climbing, swimming, driving a truck, and working in paddy fields. In short, the Mukti Limb makes the user feel absolutely normal and in most cases enable the user to return to his vocation.Moreover, the Mukti Limb is very sturdy thereby enabling the user to climb trees, or perform other activities better than a normal human being.
The Mukti limb is constructed using the following material
- Skin colored HDPE, made specially for Mukti.
- Jaipur foot, which is flexible and shaped like the human foot (up to the ankle), giving the natural “Feel” to the user.
- Leather straps.
- Knee joints, for limbs made for amputations above the knee
- Consumables like adhesives, Plaster of Paris, nails, foam etc.
- The amputee is made to sit on a chair and a condom is stretched over the amputees’ stump. The technician will then wrap plaster of bandages over the stump and fashion a ‘Negative’ mould of the stump.
- Measurements of the amputees normal leg is taken to enable the matching of the Mukti limb,to the good limb.
- The plaster of paris mould is then taken and a mild steel rod of about 3 feet length is inserted in the center (of the jug like mould). The rod is mounted on to a vice and plaster of paris is poured in to the mould with the rod in place.
- Once the plaster of paris is set, the negative mould which is made of POP (plaster of paris) bandages is cut and removed, what is left behind is a copy of the stump of the amputee.
- Using files and chisels the POP mould is shaped into a leg. The steel rod is left in place at this time.
- A HDPE pipe of the appropriate (depending on the size and weight of the amputee) size and thickness is then taken and placed in an oven. The pipe is heated to 150 to 200 degrees Centigrade till it stretches.
- The hot pipe is taken (using gloves) to the mould and is stretched over the POP mould and pressed into every curve, allowing it to take the shape of the mould.
- Once the pipe is cooled, the pipe with the POP is removed from the vice and then, the pipe is beaten with the hammer to remove the POP mould inside the pipe. The POP is broken and removed and so also the steel rod, which is then reused.
- The leg shaped HDPE pipe is called the socket. This socket is now taken by the technicians and worked on to remove sharp edges and to prepare it for fitment.
- The socket is then taken and a Jaipur foot attached to the lower end, this is done by heating the socket over a small hot plate, till it stretches, the Jaipur foot (ankle end) is inserted into the socket and then pushed in to place. Once the socket cools down the Jaipur foot is held firmly, to ensure that the foot does not come loose, nails are driven into the foot through the socket.
- Leather straps are fitted onto the socket at the knee area to enable the user to strap the limb onto his thigh.
Dyslexia
Dyslexia is an imprecise term used to describe a variety of reading and writing disorders. It may be a disturbed understanding of what is read, (for example a child may copy down ‘Dog’ in the place of ‘God’ from the black-board in school) ranging from a minor disability to a complete and permanent inability to read that is inconsistent with the individual’s intelligence. It is often accompanied by an inability to spell correctly. The specific causes of dyslexia are disputed, but it may be due to congenital or acquired brain damage, probably affecting the speech centers. Reading disorders tend to run in families, many more boys are affected than girls. Dyslexia is not a sign of low intelligence, and some affected individuals may benefit from special teaching.
Explaining a Learning Disability to Parents and Teens.
Visual Impairments
Definition of Visual Impairments
The terms partially sighted, low vision, legally blind, and totally blind are used in the educational context to describe students with visual impairments. They are defined as follows:
- “Partially sighted” indicates some type of visual problem low vision, cataract surgery, corneal disorders, contact lenses resulted in a need for special education
- “Low vision” generally refers to a severe visual impairment, not necessarily limited to distance vision. Low vision applies to all individuals with sight who are unable to read the newspaper at a normal viewing distance, even with the aid of eyeglasses or contact lenses. They use a combination of vision and other senses to learn, although they may require adaptations in lighting or the size of print, and, sometimes, braille.
- “Legally blind” indicates that a person has less than 20/200 vision in the better eye or a very limited field of vision (20 degrees at its widest point)
- Totally blind students learn via braille or other non–visual media.
Report Card: India, Revised 2 September 1997.
| Population | 970 million |
| Portion of population below poverty line | 328 million |
| Annual population growth rate | 19.5% |
| Average per capita income | USD 92 |
| Number of blind | 6 million |
| Number of “Economically” blind (20/200 or worse) | 12.5 million |
| Estimated number of ophthalmologists | 8,500 |
| Average cost of cataract surgery | USD 48 |