Sunday, 8 October 2017

The Developmental Milestones.

Every child is unique and has his/hers’ own growth pace. The developmental journey of child is different in every case so is parenthood. The first roll over, crawl etc have their own charm and all together a different experience for parent. However, it is very necessary for a parent to make a note of all the milestones a child is attaining and when. It is very important to evaluate the gross motor development that is the physical development, speech and language, reasoning and social behaviour of a child from time to time.
As said earlier the development of every child is unique however the developmental journey has its own commonly set milestones. These are set of physical or behavioural activities that children generally show at that particular age group be it months or years.

It is important for a parent to keep a tab of these milestones because these are important markers in determining the overall development of a child from time to time. Attainment of developmental milestones in timely manner is indeed a very good indication of growth of one’s child. Any deflection or delay can be an indication of a developmental disorder in the child which might need the intervention by a specialist. Thus, Sooner the detection better it is. 

Tuesday, 26 September 2017

Common Vestibular Dysfunctions

There nearly 54 million people suffering from various other vestibular disorders. “1 in 5” people in the world are affected by some or the other vestibular disorders.

Few most common vestibular dysfunctions are:

1. Benign Paroxysmal Positional Vertigo (BPPV)
BPPV is the most common cause of vertigo. A short-lived, strong episode of vertigo activated by a specific change in the position of the head. There are both severe and mild forms of BPPV, which lead to different clinical symptoms.

2. Vestibular Neuronitis/Neuritis
Vestibular Neuronitis is characterised by severe and sudden onset vertigo, which is caused by inflammation of the vestibular nerve and often accompanied with nausea and vomiting.

3. Unexplained dizziness
Sometimes it very difficult, particularly in the acute phase to determine the cause of dizziness. it is important see neurotherapeutic doctor to ensure and eliminate any serious problem if any .

4. Falls
Many factors contribute to falls in the elderly and in those with neurological disorders such as stroke, Parkinson’s and Multiple Sclerosis. It is essential to have an assessment that screens the physiological systems that contribute to falls risk.

5. Ataxia
Poor co-ordination, tremor and reduced postural stability and balance create difficulties with many activities of daily living. There are many conditions that cause ataxia including stroke, multiple sclerosis and brain injury.

6. Migraine
Migraine is a common disorder of central sensory processing. It leads to  episodic symptoms, the most common of which is headache. However, migraine does not always cause headache, with some rare forms of migraine leading to dizziness. Other symptoms such as nausea, vomiting and light and noise sensitivity are common.

7. Meniere’s Disease
Meniere’s disease is a rare, chronic ailment that lead to episodic attacks of dizziness, nausea and vomiting, often with slow deterioration in the ability to balance and one-side hearing loss.

8. Endolyphatic Hydrops
Endolymphatic hydrops result in episodes of dizziness, imbalance and hearing changes.

9. Labyrinthitis
Labyrinthitis is an infection within the inner ear, which causes vertigo and imbalance sensations.

10. High Level gait disorders
Many people develop problems with walking, such as intermittent difficulty in walking, reduced confidence, and slow or shuffling steps.

11. Cervical Vertigo
In some cases, problems with the neck leads to feelings of dizziness and disequilibrium.

12. Perilymph fistula :
It is leakage of inner ear fluid into the middle ear. Perilymph fistula can occur after a head injury, dramatic changes in air pressure, physical exertion, ear surgery, or chronic ear infections.

13. Mal de Debarquement syndrome:
A feeling of continuously rocking or bobbing, typically after an ocean cruise or other sea travel. Usually the symptoms go away a few hours or days after you reach land. Severe cases, however, can last months or even years, and the cause remains unknown.

14. Acoustic Neuroma :
An acoustic neuroma is a benign (non-malignant), usually slow-growing tumour that develops from the nerves of inner ear.

15. Bilateral Vestibular Hypofunction:
Reduction or loss of vestibular function bilaterally results in difficulty maintaining balance, especially when walking in the dark or on uneven surfaces, and a decrease in the patient’s ability to see clearly during head movements.

16. CANVAS Syndrome :
Patients with CANVAS combine cerebellar ataxia (i.e. coordination problems -- the CA), peripheral nerve damage (neuropathy - N), and loss of vestibular function (vestibular areflexia -- the VA). This combination causes major disturbances to balance as each of these systems alone contributes to balance.

17. Concussion :
Concussion can occur under the following conditions:
The head strikes a stationary object.  Common examples include a fall where the head hits the ground or an object, or hitting the head on an object during an auto accident.
An object hits the head, such as a ball or stick during sports, or because of human collision.
A quick acceleration/deceleration of the head with no contact to any surface.  This can occur in dancers and gymnasts due to rapid movement, or during an auto accident where there appears to be no head trauma.
Trauma to the brain can result in abnormal vestibular system functioning, and the brain can receive abnormal signals regarding the position and movement of the head in space.

Monday, 18 September 2017

Cerebral Palsy & Types

Cerebral Palsy : Nearly 170 million people throughout the globe are affected by Cerebral Palsy with 25000 additional people every year according to world Cerebral Palsy Day organization Australia. Cerebral palsy is a Non curable disease caused by injuries or abnormalities of the brain at young age or low oxygen supply at any age.At present it is the most commonly occurring developmental disorder in the world. 3 to 4 children per 1000 births develop this condition by birth and many get affected in the early stages of growth.
Some important effects of cerebral palsy are Muscle tightness and spasticity, difficulty in moving or involuntary movements – This can include disturbances in gait, balance, coordination, walking, staying still, and more depending on an individual's condition and the affected areas of the brain. Mental Retardation, Learning disabilities, Breathing Difficulties – because of postural problems, feeding trouble – the muscles used for feeding may be impaired in people with cerebral palsy. This can lead to malnutrition and troubles with development and growth. There is no cure except occupational & physical therapy with supplementary medicines for this disorder.

Types of Cerebral Palsy:Cerebral palsy is categorized using two factors: the type of movement issues and the body part(s) being affected.

There are four types of cerebral palsy namely spastic, athetoid, ataxic and mixed type.
The type of movement problems seen in Cerebral Palsy Children/individuals depends on how severely a brain injury has impacted muscle tone. Muscle tone is the strength and tension of the muscles.
Terms used to describe how cerebral palsy affects muscle tone are
Hypotonia – Low muscle tone, causing a loss of strength and firmness
Hypertonia –  High muscle tone, causing rigidity and spasmodic movement
Different Types of Cerebral Palsy

Spastic Cerebral Palsy : Spastic cerebral palsy is the most common type of CP, making up 70 to 80 percent of cases. People with spastic cerebral palsy often experience exaggerated or jerky movements (hypertonia).
Common signs and symptoms of spastic cerebral palsy include:
Awkward reflexes
Stiffness in one part of the body
Contractures (permanently tightened muscles or joints)
Abnormal gait

Athetoid Cerebral Palsy :  About 10 percent of children with cerebral palsy are identified with athetoid CP, or “non-spastic CP”. This type of CP is characterized by a mixture of hypotonia and hypertonia, which causes muscle tone to fluctuate. The main feature of athetoid cerebral palsy is involuntary movement in the face, upper body and limbs.
Common symptoms related with athetoid cerebral palsy are:
Stiff or rigid body
Floppiness in the limbs
Problems with posture
Issues feeding

Ataxic Cerebral Palsy: Ataxia is a type of CP that causes problems with balance and coordination. Ataxic cerebral palsy makes up a small percentage of all cases.
Common symptoms of ataxic cerebral palsy include:
Difficulty speaking
Problems with depth perception
Shakiness and tremors
Spreading feet apart when walking

Mixed Cerebral Palsy: When a child is showcasing symptoms of more than one type of CP, it is mixed cerebral palsy. This diagnosis makes up less than 10% of all CP cases. The most common mixed cerebral palsy diagnosis is a combination of spastic and athetoid CP

Location of Movement Problems
Monoplegia: Only one limb’s movement of the individual is affected. This type is very rare.
Diplegia: Two limbs, generally the legs, are affected. Premature birth commonly results in Diplegia.
Hemiplegia: One side of the body is affected. The arm is usually more impacted than other limbs, distinguished by a rigidly flexed wrist or elbow. Some people with hemiplegia may not be able to use the affected hand. Prenatal bleeding in the brain can cause hemiplegia.
Triplegia: Three limbs are affected.
Quadriplegia: All four limbs are involved, but the legs are affected worse than the arms. There may be limited control over facial muscles as well.
Double hemiplegia: Like quadriplegia, all four limbs are affected, but the arms are more affected than the legs.

Sunday, 27 August 2017

Dizziness & Vestibular Rehabilitation

If you are suffering from dizziness, wooziness, light-headedness or unsteadiness then you are not alone. It has been estimated that 65% of individuals over the age of 60 experience dizziness or loss of balance on a regular basis, and vestibular problems account for one third patients reporting to doctors with symptoms of vertigo and dizziness.1, 2 In fact, recent research out of Johns Hopkins University suggests that as many as 35% of adults over the age of 40 in the United States (i.e., 69 million Americans) have some form of vestibular dysfunction as measured by a postural balance test.3

Dizziness can result in an inability to work, leave the house, walk, or stand. It also contributes to falls and severe injuries. Physiotherapy and vestibular rehabilitation as part of overall healthcare plan can help provide relief.

Physiotherapy for dizziness typically consists of vestibular rehabilitation. This is an exercised-based program to encourage the central nervous system to compensate for problems with the Vestibular apparatus
An assessment is typically carried out first to assess sensation, gather information about pain and severity, muscle strength, range of motion, posture, balance, coordination, and general abilities. Once this assessment is complete, a fully customized exercise plan is created aiming at decreasing symptoms and improving the function.

The treatment model contains Balance/coordination activities to retrain body awareness, Eye and head movement exercises which reduce dizziness & Flexibility and/or strengthening exercises.

At home exercises & proper counselling are the integral part of the treatment programme.  

A proper treatment model promoting a healthy lifestyle can help restore a person’s balance, mobility, and coordination. With vestibular rehabilitation, a person’s dizziness can reduce or get eliminated and they can return to their normal standard of living.


1Hobeika CP. Equilibrium and balance in the elderly. Ear Nose Throat J. August 1999; 78(8): 558–62, 565–6.
2Neuhauser HK, Radtke A, von Brevern M Et al. Burden of dizziness and vertigo in the community. Arch Intern Med. 2008; 168(19):2118–2124.
3Agrawal Y, Carey JP, Della Santina CC, Schubert MC, Minor LB. Disorders of balance and vestibular function in US adults. Arch Intern Med. 2009; 169(10): 938 944.

Tuesday, 1 August 2017

Special Needs & Nutritional Complexities

Good nutrition is critical from infants to teen to adults in order to sustain healthy growth and development. A healthy diet needs to meet the changing nutritional needs of a growing child and should prepare him/her for maintaining healthy eating habits lifelong. As Parents and/or caregiver We are obliged to inculcate healthy eating habits in children that meets their nutritional requirements and leads to proper growth as they are in a stage of continuous mental and physical development. But as children grow, they develop their own individual personality, tastes and preferences to everything around them including food. An exposure to various tastes, textures, combinations of food leads to development likes and dislikes towards certain food stuffs. Thus, making child meet their supply on nutrients is very difficult and thus requires a strict nutritional regime & discipline.
If you are a parent to special need child, then this becomes all the more difficult owing to complexities involved. For example, a child with autism spectrum disorder may have a deep negative reaction to textures, tastes or colours. Children with Down syndrome, prefer softer foods because of difficulties encountered when chewing or swallowing. Special need Children are often on prolonged medications which affects their food habits & weight gain. A child’s ability to consume is also a key factor in nutrition; Children with Cerebral Palsy often struggle, choke or worse on providing food hence absolute care is to be taken while feeding them. Issues like acid reflux or Gastroesophageal reflux disorder, Dysphagia, misaligned teeth, gum swelling, etc. can also impact a child’s nutritional plan as it dominantly affects the selection of foods. Some children can be overweight / obese due to mobility issues, reduced calorie usage or some might be underweight due to speedy metabolism, swallowing issues etc.

Overcoming the nutritional challenges in the children with Special Needs is a complex issue which needs co-joint efforts of family, pediatrician, therapist & nutritionist. It is very necessary to overcome the specific barriers children have, to help them create a healthy relationship with food & proper nutrition as nutrition & child development go hand in hand. 

Thursday, 13 July 2017

Balance & Vestibular sense

Our sense of balance is determined by a complex system controls viz the vestibular sight, and other sensory sensations. the vestibular system detects our orientation to gravity and our movement through space even in the dark. The vestibular system helps us maintain our equilibrium while we walk, spin, rock, run, bend or swing. Additional vestibular system functions include assistance to control muscle tone, and language. Shifting head positions, weight, and using both sides of body leads to a better development of vestibular system.
 Kids with overactive vestibular systems prefer slow movement, avoid tasks such as climbing, jumping precisely they avoid activities that require good balance and fast movement. They are fearful of falling, going up and down and being tipped upside down. On the contrary children who have under Sensitive vestibular sense enjoy fast motions and are always in the state of motion like jumping, running and are always moving.

Intervention of the therapist is very important in these cases. They suggest activities which will help child’s brains organize and process information more efficiently and effectively by stimulating the vestibular system. This prevents them from falling, keeping body properly aligned, grounded and contribute to coordinated balance & movement.

Wednesday, 14 June 2017

Knowing the Vestibular System

Vestibular stimulation is the feedback/stimulus that human body receives due to any of its movement (linear & rotational) in gravity. The intensity of these stimuli range from mild e.g. nodding to severe e.g. sitting on a swing / any amusement ride.
 The vestibular sense is first to develop in the growing fetus, it develops only in 5 months in utero and is stimulated by the movement of carrying mother’s body. It is the only system that integrates sensory senses (acoustic, optic, tactile, smell) with brain activities, proprioception and muscle reflexes & tone.
 The vestibular system comprises of the two components viz. the semi-circular canals, which respond to rotational movements; and the otoliths, which are sensitive to linear accelerations. The vestibular system sends signals primarily to the neural structures that control eye movements and clarity in the vision; and to the muscles that keep us upright in position. The brain uses information from the vestibular system and from proprioception throughout the body to understand the body's dynamics and kinematics (including its position and acceleration) from moment to moment.
The activities of Vestibular Apparatus can be summarized as: