Physiotherapy

Physiotherapy

Physical Therapy is administered when the utilization of medicine does not provide any significant or desirable benefit in the patient, and surgery isn't the most feasible or viable option for them either. This extends to the case of physically and mentally challenged children where extra care, regarding the same, must be kept. At Chingari our primary objective is to treat the children as naturally as possible; prescribing medicine and surgery are later stages of our treatment, only if we do not see positive changes along with significant results. In many cases however, allopathic medicines are complementary to the physiotherapy being provided to the challenged child. Generally speaking physiotherapy also has a major role to play in both pre and post surgery treatment phases.

The physiotherapy department at Chingari has seen some major changes since the year 2009. Shifting to a newer building and availing more space has proved to be quite beneficial for the department as physiotherapy sessions require a lot of space to be carried out efficiently. The occupational therapy department has been separated from the physiotherapy department since the Chingari Rehabilitation Centre was moved to the new Satguru Complex. Three physio-therapists are employed at the Chingari Rehabilitation Centre; they are well trained and are led by a Senior Physiotherapist.

Children suffering from spinal cord injuries (including cervical cord injury, Hemiplegia, Cordiplegia, head injuries, etc.) are some of the most challenging cases that experts at Chingari Rehabilitation Centre deal with. In cases of Cerebral Palsy and Muscular Dystrophy, physiotherapy is the most beneficial and at times the only beneficial mode of therapy that is provided to the challenged children. Children at Chingari who suffer from Down's Syndrome are specified exercises that stimulate sensory integration which help these children in catching up with the environment around them.

The reporting intern went to acquire information from Senior Therapist Dr. Sanjay Gour in the physiotherapy department but instead, he found that the children themselves wanted to tell the intern their respective stories and about their benefits from the sessions attended in this department.

Ayaan

is 7 years old suffers from Cerebral Palsy resulting in a flaccid lower body. He couldn't stand up and balancing and muscular co-ordination were seemingly out of the question. With the help of passive limb movements, strengthening exercises, use of balancing board, hand grasping and reaching exercises, and neck exercises, in 2 ½ years time it was possible to assist the child in sitting with the help of minor support and in a cross-legged position in the initial phase. Today he walks, plays and conducts daily activities without much help.

Shifon

was unable to walk properly when he first began visiting Chingari. His leg was spastic and crooked due to Cerebral Palsy, and his foot was deformed. With the use of muscle stimulator, cycling, breezing and trunk strengthening exercises today his legs have been straightened. The deflection between his knees has also significantly decreased. This was achieved through regular therapy roughly within the time period of 1½ years.

Farah

says that she is now much better physically as she no longer requires support to walk. Cerebral Palsy Ball (CP Ball) exercises, stretching and neck exercises have been made mandatory for her. Her legs have straightened although she does require some support to stand.

Farman

had congenital Hemiplegia in the right side of his body. Hand movements and leg exercises have helped with the considerable straightening of his limbs. Now, he says, not only can he walk but he also rides a tricycle. These changes were observed within just 1½ months of therapy.

Instruments and machines

such as a muscle stimulator, cycling and rowing machines, Knee exerciser, short warm diathermy machine apart from other machines have proven useful in the recovery of these children and more.

Parental help is of primary concern in the physiotherapy department because the staff cannot remain with the children 24x7. That is why we instruct and train willing parents in less complex exercises which can be practiced regularly at home in the absence of the staff. More complex exercises are discouraged to be carried out by parents and is only administered in the presence of experts in the physiotherapy department.

Additional resources could make this department even better. In the absence of equipments such as standing frame, exercising couch, corner stair and an ultrasound machine both the staff and the parents of the challenged children face inconveniences. Availing an ultrasound machine for the rehabilitation centre would mean that parents would no longer require to pay for its usage in a private clinic. Most of the children belong to extremely impoverished families and on most occasions, they unable to pay for check-up or medicine.

Occupational Therapy

Occupational Therapy

Occupational therapy is a rehabilitation science provision provided by the Chingari Rehabilitation Centre. It helps in improving basic motor skills and cognitive ability of children suffering from physical and/or mental disabilities so as to make the children independent in the activities of daily life. This is achieved both ways through modification of the environment and the child's adaptation into the environment. At present we handle 56 children in this department on a daily basis.

Dr. Poonam Bichpuria is the head of this department and the only Occupational Therapist at the Chingari Rehabilitation Centre. Occupational therapy is a practical training programme. Therefore, at Chingari we teach the challenged children basic skills required for daily activities such as bathing, eating their meals, grasping utensils and stationary etc.

The technical aspect of occupational therapy at Chingari is significantly different from Special Education. It is in the occupational therapy department that the child becomes mentally and physically prepared for further education in the formerly mentioned department. In that sense this department may be considered as an intermediary therapy.

However, at Chingari we provide various therapies simultaneously depending on the requirement of each child and based on the developments and progress observed in the children.

Children affected by Autism and Attention Deficit Hyperactive Disorder (ADHD) must undergo the sessions within this department. The reason being that Autistic children live in a world of their own and upon interference, such as touching them, they may get annoyed and even violent. This prevents the administration of any further therapies be it physio-therapy, speech therapy or special education.

In such cases occupational therapy becomes a pre-requisite for many children. This however does not mean that occupational therapy is only availed for the assistance of other departments. At Chingari it is an individual mode of therapy too.

The primary objective of occupational therapy at the Chingari Rehabilitation Centre is to counter physical problems and to encourage sensory integration in children via the methods of Pediatric Occupational Therapy. This facility is availed to all children suffering from Cerebral Palsy, Mental Retardation, Autism etc.

Chhaya is one of our more successful cases. She is autistic and was previously unable to walk upright. Her proprioreceptors were extremely sensitive and touching her induced pain. Her vestibular system was also problematic therefore she also had difficulty balancing her body. She resisted anyone from touching her face due to tactile issues. With continuous therapy she can now squat, sit straight and chew properly (a problem attributed to the faulty vestibular system).

Another major success has been achieved in the case of Yuvraj Thakur. He suffered from Attention Deficit Hyperactivity Disorder. He neither understood nor followed any command. The child was highly aggressive and even became violent from time to time. He now is able to talk and respond to commands. Hyperactivity has become negligible and his aggression has been reduced and has been channeled in the sense that now the child only gets aggressive if his needs are not met. Previously there was no plausibility in his perpetual aggression.

Mothers are instructed to make modification in objects of daily use and are also helped by the staff in the same. Parents are also trained in other aspects of occupational therapy as well. For instance, they are asked to only give short and positive commands to autistic children avoiding the use of words like "don't" and "no". Sensory diet once begun becomes a daily requirement and is a long tern therapy. Therefore daily attendance of the child is crucial and mandatory. Our staff takes special care to ensure that the child doesn't become dependent on the same.

After a certain point in time, the sensory diet reaches a saturation point and from then on the child slowly starts becoming independent. However, if during the period of therapy the child's sensory diet requirements are not met, then the child could become irritated and aggressive. Bed-wetting on purpose has also been reported to us if the parents take the child away in the middle of the therapy period or attend occupational therapy sessions irregularly.

For sensory integration bouncing exercises are carried out by children on the Therapy Ball. An equilibrium board has proven helpful in improvement in vestibular inputs in the children. A sensory kit is being used to manage and improve tactile problems in the children. And a vibrator is used for sensory integration. Apart from that, a finger brush is used for oral problems.

The occupational therapy department is the worst suffering department due to lack of resources. Apart from the fact that only one expert handles the department—with added help from physiotherapists (if they become available)— the occupational therapy lacks some of the most important equipments and setup when compared to other departments such as finger twister, a magnetic peg board, CPM (Continuous Passive Motion) Kit etc. ADL (Activities of Daily Living) Kit is incomplete. There is absolutely no equipment for vocational training of children. There is an urgent need for a sensory integration room which is a dark room equipped with various kinds, intensity and colours of light and glow in the dark stickers.

Special Education

Special Education

At Chingari we recognize the need for Special Education as a priority for many challenged children. This is what sets us apart from similar organizations when it comes to the care that is given to these children. Our staff in the Special Education department are academic, knowledgeable, professional and dedicated towards their work. A child is deemed special when their cognitive and/or motor abilities are either delayed or are non-functional. Through our special training programme at Chingari we attempt to bring the mental and chronological age of these children to the same level.

60 children registered with Chingari are given Special Education classes on a daily basis. The classes take place in only one classroom as new building space, although larger than our previous building, doesn't suffice our classroom requirements. In a single shift 8 – 9 children are taught for sessions lasting up to 20 minutes. As opposed to formal academic education, where children are not segregated according to their physical age but their mental age and comprehension abilities and Intelligence Quotient. Children in this department are trained for various things such as maintaining eye-contact, colour recognition, writing their names and even pursuit of formal education if their IQ is satisfactorily high.

According our latest records, we have gained much success in carrying out this particular programme for the children registered here.

Rajik

suffers from Cerebral Palsy as well as mental retardation. Our staff has managed to teach him the English language alphabet, numeric representation and reading with a 50% rate of success. It is important to note that teaching special children alphabets and the number system is a more tedious task than teaching normal children as the special children need to understand and memorize each and every symbol as an image so as to represent the idea behind that image. In numeric systems, when the numbers become double-digit or more the combination of two or more pre-existing symbols must be taught as a separate image individually if the child is unable to understand the idea of combining numbers and symbols.

Shifon

has an IQ of 50 and thus has a mild case of Mental Retardation. He has a short memory and requires constant encouragement during the learning process or else he forgets whatever is taught to him. Because of the help provided by our staff, today he can solve multiplication problems of up to two-digits. He is now quick in recognizing the images of fruits and animals and remembers the entire English alphabet. Besides this, he is also aided by the staff in studying for his Class IV syllabus, the classes of which are being attended by him in a normal school. While reporting, the child conversed with our educator and the reporting intern with grace asking what mental disability he had.

Asraan

has Down's Syndrome. His learning capabilities are limited, yet thanks to our staff in the Special Education department, he can now copy images and symbols with satisfactory accuracy. He recognizes colors and can segregate objects of individual colors from a pile of objects of various colors. Today he dresses himself in front of the mirror. He expresses his wants and needs efficiently now and dances upon hearing music.

Another child the staff is still working with is Ahmed. So far his participation in Special Education sessions has remained unsuccessful. His IQ ranges between 35 – 40. He doesn't take instructions and doesn't understand them either. He is 15 years old. An individual Special Educator is required for him to ensure his improvement in responding and participating more in the process of interactivity.

Chingari trains the willing and interested parents or guardians of these children so these children never lose touch with the process of Special Education even at home. Parents are taught how to coordinate with their children regarding their schoolwork and vocational training activities. Necessary everyday requirements such as bathing, brushing teeth, increasing attention span through eye contact, gripping objects into their hands, are also taught to these children. If any changes are made in these programmes then children need to be notified first and then convinced to get accustomed to the change.

Apart from these areas the Special Education department also trains children in opening and closing taps and latches through practical demonstration. Different varieties of these are housed on a wooden board that continually opened and closed to make the children understand the mechanisms of each. Grip training exercises, like lifting big pens and breaking clay and dough, have proven to be quite successful. Conducting morning prayers serves two purposes. Children have fun and our Special Education staff is able to recognize any children with speech disability or Attention Deficit Hyper-active Disorder etc and recommend them to concerned departments.

Last but not the least we believe in entertainment therapy as well. Animation films such as Bal Ganesha have been screened for the children in the special education department. Films that emphasize overcoming obstacles such as 3 Idiots, Taare Zameen Par, Qayamat Se Qayamat Tak have been screened for children and have been received well. Action films with too much violence are avoided. However the Special Education Department has observed that children, like all normal children, do find amusement in the songs from the film Dabangg and dance each time the songs are played.

Speech Therapy

Speech Therapy

At Chingari Trust we recognized the necessity and importance of speech therapy early on since our inception. This in light of the fact that the second and third generation child victims of Bhopal Gas Disaster of 1984, and the subsequent ground water pollution due to the toxic waste left by the Union Carbide factory, have been born with various deformities due to the consumption of toxic water by their parents. This has in turn caused congenital deformities and diseases in these children, a lot of which are cases of cleft lip and hearing impairment. Thus speech therapy is of the utmost importance to these kids so that they can convey their needs and feelings which will in turn help them to integrate with the society at large. However at Chingari we not only provide the children with speech therapy but also children with various mental disabilities such as autism and Cerebral Palsy. At present we are dealing with 36 children in this department on a day to day basis.

Providing the children with the opportunity and encouragement, speech disabilities can be overcome to a large degree. The degree of improvement however, depends from patient to patient. With normal children speech therapy deals with problems of articulacy. But at Chingari, when dealing with children with multiple disabilities our staff faces big challenges. For instance children with speech and hearing disabilities have less developed senses. As a result of which these children have a lesser ability in the first place, to take in instructions of any kind that would be therapeutic to them. If a child does not hear the instructions of a therapist, (the reasons maybe many ranging from Autism to hearing impairment) it becomes very difficult for the staff to make progress with the child at all. Yet our staff tries its best in overcoming these barriers and has succeeded in a large number of cases. We divide children into four different categories while administering speech therapy. These are: vision impairment, hearing impairment, orthopaedically handicapped and children with multiple disabilities.

It is a prerequisite for a child to hear in the first place to learn speech at all. In the light of this we use several methods to overcome hearing impairment at Chingari. Besides the use of hearing aid, we administer sound stimuli through auditory training, sound making instruments, drums, and whistles etc. Before this, however, we check the capacity of the ear drum of the child. For this we must get an Audiometery test done which at present, is not an in-house facility at Chingari Rehabilitation Centre. Therefore the test is a paid for by Chingari or by the parents if their financial condition allows them for the same.

For speech therapy exclusively we use brushes to control drooling if this is an issue the child deals with. Application of honey on a brush and massaging the insides of the cheek helps in stimulating and sensitizing the muscles. This controls drooling as the child begins to swallow the saliva. If drooling is not controlled then taught sounds come out incorrect. Nerve sensitization thus helps in obtaining the correct sound as muscles in the mouth gain greater control.

Speech Therapy requires total parental support. If parents help the child, the staff is able to make easier and quicker progress. Parents with children that suffer with Cerebral Palsy, mental retardation and hearing impairment are instructed to talk normally. "Baby-talk" and use of lisp is to be avoided while interacting with them. Parents are also enlightened about giving their child more interactive attention, eye contact etc. The technical skills are also taught as in how to articulate each sound.

One of the best examples of a child benefiting from this therapy is that of Aayaan who was diagnosed of Cerebral Palsy and was speech impaired. Now he has begun to talk and explain things. Another case is that of Abdullah who has Aphasia which is a difficulty in saying anything. His hypoglossal nerve was suppressed due to injury. As a result of this his tongue and vocal cord do not respond to stimuli correctly. His comprehension is decent and with training the child now talks in monosyllables and upon recognizing an object uses the first syllable of the object's name to convey that he has recognized the object.

Speech Therapy is a challenging as well as cumbersome therapy. If left half-way the training lapses. Normal cases in such a condition may recover easily but with challenged children this process is far more complex.

The interning reporter observed a rather lovable sight in this department where children had gathered around one of our speech therapy experts and imitated sounds as instructed by the expert with the index finger on their throats. A little girl with two pigtails stood out amongst them all and indeed appeared really cute imitating the instructor.

Sports

Sports

Sports are necessary for physical, mental, behavioural, social and intellectual development of a child. Sports have helped special children of Chingari in raising their confidence level. It has helped them in realizing that they are no different from normal children. In the recent past Chingari's children have participated in various events at various levels and have won medals.

These children being special, requires a lot of care whenever they are taken for participation in sports events. Our sports teachers had to do a lot of hard work in order to make our children participate in such events. First, they need to convince the parents or guardian of these children. As these are children with disabilities it's quite difficult to convince their parents, as many are reluctant to send their children away from their home to different cities for a time span which is usually about a week.

Apart from taking the permission another task which our sports teachers need to do, is to prepare our children to compete in these events. As we have children with different disabilities, the sport in which a particular child has to participate is decided by our sports teachers according to his or her abilities to participate. After this, children are coached accordingly in the sports at Chingari premises.

Whenever our children goes for any sports camps or events, then the whole responsibility of their safety and other issues lies on the shoulders of our sports teachers. Even some of the children who go for such event are not even toilet trained. Thus our sports teachers need to do a lot of hard work in order to take proper care of our children.

Despite of all the odds mentioned above our sports teachers had tried to make it sure that our children participate in maximum possible sports camps and events. Their hard work could be seen in the list of medals won by our children mentioned below. Achievements in Sports District Level Game Bhopal MP 2010-11 Date – 12, 13 Oct 2010 Venue- T.T. Nagar Stadium Bhopal

  1. Shiraj khan has won a gold medal in Bocce in age group of 8-11
  2. Sufiyan Khan has won a gold medal in Bocce in mixed age category
  3. Sachin has won a gold medal in Bocce in mixed age group
  4. Shyam Babu has won a gold medal in Bocce in age group of 8-11
  5. Devesh has won a silver medal in 50 M race in age group of 8-11
  6. Payal has won a silver medal in 50 M race in mixed age group
  7. Kartik has won a silver medal in Bocce in mixed age group
  8. Aman Yadav has won a silver medal in Bocce in age group of 8-11
  9. Adil has won a bronze medal in Bocce in mixed age group
  10. Vikas Yadav has won a bronze medal in Bocce in age group of 8-11

In District Level Competition arranged by Social Justice Department on the occasion of world disability day on 3rd and 4th December 2010 following children took part in sports/arts activities and won 4 Gold, 4 Silver and 7 Bronze medals as detailed below:

A. Games/Sports 1.Joya - Gold 2.Kartik – Gold 3.Sajid – Gold 4.Mohan – Gold 5.Sachin- Silver 6.Faizaan – Silver 7.Shyam Babu – Silver 8.Shifan – Silver 9.Payal- Bronze 10. Iyaan – Bronze 11. Sufiyaan – Bronze 12. Devesh- Bronze 13. Vikas Ahirwar- Bronze 14. Ishrat- Bronze 15. Chandraprakash- Bronze

Eight Children from chingari had participated in national championship (For disable Children) organized by Special Olympics Bharat Anantpur from 7th to 13th January 2010. List of athletes with their achievements is given below:

  1. Mohan won Gold medal in 25 Meter run
  2. Devesh Raikwar won Gold medal in 100 Meter run
  3. Ishrat won Silver medal in Soft Ball throw
  4. Payal won Silver medal in 200 Meter run
  5. Huber won Silver medal in 25 Meter run
  6. Ishrat won Bronze medal in 50 Meter run
  7. Mohan finished 4th place in 50 Meter run
  8. Devesh finished 4th place in 200 Meter run
  9. Alisha finished 6th place in 25 Meter run
  10. Alisha finished 5th place in 50 Meter run

Nine Children from Chingari Rehabilitation Centre had participated in national level football championship (For Disabled Children) organized by special Olympics Bharat (Bhopal) from 16 to 22 October 2009. A list of Athletes is given below:

  1. Rukhsar
  2. Farah
  3. Sanjay Tarani
  4. Sajid
  5. Kousar
  6. Aamir
  7. Shyam Babu
  8. Alisha
  9. Uber

Three children from Chingari Trust under the guidance of Tarique Ahmed (State Coach SOB M.P.) participated in national coaching camp "Football" held at Nagurata, Jammu and Kashmir from 17th to 24th March 2010. A list of participants is given below:

1. Sheraz Khan 2. Nadeem 3. Sharukh Khan