Prevalence of Disability in different countries

Country
India Germany United Kingdom Canada United States Australia

Prevalence
2.1 % (2001 census) 8.4 % (1992 data) 12.2 % (1991 data) 18.5 % (2001 data) 19.4 % (2000 data) 20.0 % (2000 data)

Disability in Children

Country

Prevalence

United Kingdom United States Australia WHO Estimate

18 % 12.4 % 8.4 % 8%

No specific data on disability in children in India Disability is proportionately higher as people get older So, we can assume that official child disability in India is < 2% This sounds very unlikely

Types of Disability according to 2001 census (India)

1. Disability in seeing 2. Disability in hearing 3. Disability in speaking 4. Disability in movement 5. Mental disability a) Mental Retardation b) Mental illness

We can add one more category to this: Children with other chronic health conditions,

Epilepsy, Severe Asthma, Diabetes etc

Children with disability you are likely to see in the clinic Children with Disability in seeing (visual impairment) a) Severe visual impairment defined as, vision <6/60 in better eye b) Blind defined as, vision < 3/60 in better eye Prevalence: 0.5 1 per 1000 children Causes: a) anomalies of the globe (microphthalmos / anophthalmos) 25% of severe and blind cases (these are probably largely hereditary) b) childhood cataracts 15% of severe and blind cases (one quarter of this due to maternal rubella) c) hereditary retinal anomalies 20% d) Corneal scarring 5-20% (main causes, ophthalmia neonatorum, Vit A deficiency and measles)

Difficulty in Hearing (Hearing Impairment, Deafness)

1. Conductive 2. Sensorineural 3. Mixed a. Prelingual (all congenital hearing loss is prelingual but not all prelingual hearing loss is congenital) b. Post lingual i) Non Genetic, prenatal infections from TORCH, meningitis, iatrogenic (drug induced, Gentamycin, other aminiglycosides) ii) Genetic

Genetic Deafness 1. Syndromic (30% of Genetic Deafness) (associated with phenotypic features of other disorders a) Waardenburg syndrome b) Branchiootorenal syndrome c) Stickler syndrome d) NF2 i) Usher syndrome ii) Pendred syndrome iii) Refsum disease 1. Alport syndrome 2. Mohr-Tranebjaerg syndrome

2. Non Syndromic Deafness (70% of Genetic Deafness are Non Syndromic) a) X-linked (Genes are called DFN, 1,2,3 etc.) b) Autosomal Dominant (Genes are DFNA, 1,2,3 etc.) c) Autosomal Recessive (Genes are DFNB, 1,2,3 etc.)

Prevalence of Prelingual hearing loss 1 in 2000 to 1 in 1000 ( .05 to .1%)

Severity Classification: 1. Mild ( 26-40 dB ) 2. Moderate ( 40-55 dB ) 3. Moderately Severe ( 56-70 dB ) 4. Severe ( 70-90 dB ) 5. Profound ( > 90 dB )

Speech and Language Babbling (normal 6-8 months) Single words, (normal 12-15 months) (note, ma-ma, ba-ba, ka-ka are not considered as words) 2 word phrases (normal 18-24 months) Sentences (normal 24-30 months) If there is speech problem, you must ask about childs a) social interaction, b) play, c) any repetitive or obsessive behaviour RED SIGNALS No babble, pointing or gesture by 12 months No single word by 16 months No 2 word phrases by 24 months Any Regression in Speech or Development at any Time

Causes of Speech Delay

1. Hearing Impairment

2. Mental Retardation
3. Specific Language Impairment

4. Autism
5. Selective Mutism

6. Other causes

Disability in Movement (Causes) 1. Cerebral palsy 2. Mental Retardation 3. Congenital Abnormalities (arthrogryposis, spina bifida, CDH) 4. Myopathies (muscular dystrophy, myotonic dystrophy, spinal muscular atrophy) 5. Other causes

Cerebral Palsy (also called, Littless Disease)

Not a single disease but a Group of nonprogressive disorders Of Movements and Posture Due to injury to Fetal or Immature Brain

Prevalence:

2.5 cases per 1000 children born More common in boys

Common associations: Prematurity Twins / Triplets / Multiple births (IUGR)- Baby not growing well inside mothers womb Low APGAR score (score below 5) Intrauterine infections (CMV, Toxoplasma, Rubella, Chicken Pox, Severe malaria, TB) Mother Hypothyroid or Hyperthyroid Baby having stroke in mothers womb Birth asphyxia

Types of Cerebral Palsy Spastic Hemiplegia- affects mostly one side of body, arm > leg Spastic Diplegia- affects both legs, milder affect on arms Spastic Quadriplegia- affects both arms and both legs(also called full body CP- most severe form) Dyskinetic CP (Athetoid, Choreo-athetoid, Dystonic) Mixed CP

Hypotonic CP
Functional classification Mild Moderate Severe

Associated problems

Mental retardation (60-70% cases have associated mental retardationSevere and almost universal in whole body CP (quadriplegia)
Less severe and in about 50-60% cases of Hemiplegia

Less severe and in 40-50% cases of Diplegia

Less severe and in 40-50% cases of Dyskinetic CP Epilepsy in 40-50% cases Speech problem 70-80% cases Hearing problem- 40-50% cases Squint/Vision problem- 30-40% cases Growth impairment- 70-80% cases

Presents with delay in motor milestones or problem with Muscle Tone Poor Head control (normal by 2 months), Floppy Baby Not Rolling (normal 4-5 months) Not Reaching for object with hand (normal 4 months) Not Sitting (normal 6-8 months) Not Walking (normal 12-14 months) Feeding problem Not putting on weight Cries constantly, does not respond socially, not smiling Fits Frequent chestiness Stiff, arches head back, arms and legs stiff when picked up Keeps one hand fisted (Hemi) Always reaches or picks up with one hand, does not use other

Diagnosis Diagnosis is clinical- from history and from examination of baby NO TESTS ARE NEEDED FOR DIAGNOSIS Brain scan, Ultra-sound scan, Blood Tests are not needed for diagnosis Special tests are only needed in Unusual cases and rarely Treatment Treat the CHILD, not the ARM or LEG Physiotherapy is helpful but DOES NOT CURE CP Check hearing Check eyes if there is squint Help with speech and communication Check nutrition/weight gain Advise parents about posture / sitting / standing Arrange educational support Keep a positive attitude / support and encourage parents Treat any problems, such as epilepsy promptly

Complications:
Failure to thrive / poor weight gain / feeding difficulty / swallowing difficulty Constipation Dental Caries Recurrent chest trouble Asthma / Bronchitis Joint contractures Hip dislocation Scoliosis Attention Deficit Hyperactivity Disorder Learning problem Depression

A Protocol for Assessment, Investigation & Intervention for Children with Chronic Health Conditions Take a detailed History
How many children, ages and sex Position of index child Any miscarriage or abortion, at what gestation, how many ? Any pregnancy complication, Raised BP / Pre-eclampsia (swelling of feet, protein in urine) / Bleeding (at what gestation / how much / how many times) / Any fever with rash / any other illness Gestation of index child (calculate gestation from EDD) <37 weeks = Pre-term, 37-42 weeks = Term, > 42 weeks = Post Term Type of delivery, Normal / Forceps / Section / Vacuum extraction Birth weight of child (check discharge certificate) Any problem at birth (APGAR score, time of first cry, breathing problem, fits). APGAR, A=Activity, P=Pulse, G=Grimace, A=Appearance, R=Respiration, Maximum score is 10, score of 7 or above satisfactory Any jaundice / Neonatal Sepsis, How Treated? How long in hospital

Feeding history Breast Fed: Yes / No, How Long? Any Problem with Feeding? When solids introduced?

Developmental History: Motor Milestones Smiling / Focusing / Following (normal 6-8 weeks), delayed in mental retardation, CP, visual problem Reaching for & Picking up toys (normal 4-5 months), very limited or absent on one side in Hemiplegia; delayed in CP, Mental Retardation Rolling (normal 4-5 months), very delayed in CP Sitting (normal 6-8 months), sitting is a crucial milestone, delayed sitting, > 9 months, cause for concern; delayed in CP, Mental Retardation Walking (normal 12-14 months, can by delayed up to 18 months without causing worry); delayed in CP, Mental Retardation