FAQs on UDAAN Multimode Therapy
Based on the talks during our first workshop on UDAAN Multimode Early Medical Intervention Therapy for Cerebral Palsy, on October 1, 2000, at the Convention Center of Hamdard University, New Delhi, by various medical / surgical specialists.
It is today possible for an alert Pediatric Neurologist or Rehabilitation / Physiotherapy Specialist to diagnose a Neurodevelopmental disability soon after birth. However, since these disabilities are not taken seriously till too late in most towns, and passed off as "weakness" that will settle with time, be careful!!! If you have any doubt that your child is not keeping up in Neurodevelopmental progress as compared to a similar aged child of a neighbor, GO TO A METRO TOWN, and show your child to a pediatric neurologist, or Rehabilitation Department of the premier Medical College or the local Spastic Society. You are likely to get a better diagnosis there.
Modern diagnostic tools will come to your rescue. These include an alert specialist using standard means (OK for 75% cases) supplemented by SPECT scan, to delineate the extent of neurological damage, and presence of recoverable penumbra of ischemic brain tissue that could recover with timely HBOT.
Because that is the situation as of today. We do have the means to control further deformities, weaknesses and disabilities caused by the non-progressive birth trauma damage, with the help of standard physiotherapy, rehabilitation therapy, occupational therapy, speech therapy, behavior modifications, ADL training, and integration with normal children. But, the original Neurodevelopmental disability remains as a permanent birth damage.
We at UDAAN are going to try, for the first time in the India, to offer a package of experimental therapies as a sequential therapy spread over eight months, to see if we can make the slightest dent in the original definition of CP as a "non-progressive" Neurodevelopmental disability. However, we ourselves will not know the answer before at least 5 to 10 years of follow up. But then, someone, somewhere, has to make an attempt to start.
All centers for helping children with cerebral palsy, and that includes UDAAN, have on offer standard physiotherapy, rehabilitation therapy, occupational therapy, speech therapy, behavior modifications, ADL training, etc.
In addition, UDAAN offers on a voluntary basis (i.e. only if the informed and intelligent parent requests in writing) the following ADDITIONAL Multiple Modes of Therapy provided we assess that the child has a chance of benefiting from it on theoretical grounds:
Proof of benefit: The child with Neurodevelopmental disability is born with a certain brain damage, which causes a certain permanent neurological defect in the corresponding part of the body innervated by nerves from that area of brain, as a result of which the affected limb / muscles / organs undergo gradually progressive atrophy and degeneration and deformity. Though the body seems to be getting worse, the original brain/nerve defect is said to be "Non-Progressive". Now, if Multimode Therapy succeeds and we are able to reverse / recover some of the penumbra of ischemic and injured brain tissue, then the neurological defects in the corresponding parts of the body innervated must also recover permanently. THAT IS WHAT WE WILL TRY TO OBSERVE OVER THE 5 TO 10 YEARS OF FOLLOW UP IN CHILDREN (BELOW 4 YEARS OF AGE) GIVEN UDAAN MULTIMODE THERAPY FOR SIX MONTHS FOLLOWED BY PERMANENT STANDARD THERAPY AD INFINITUM.
Different modes of Multimode Therapy are applicable to various age groups.
HBOT is a > 50 year old technique, and its safety parameters, dosages, applications are well established. In the patient who is not claustrophobic, has normal ear/nose function, and other medical parameters as given elsewhere , it is a safe procedure.
Botulinum toxin therapy is a relatively new science to cause conditional paralysis of excessively spastic muscles. It may cause allergy and associated problems in the short run, and undue weakness in the long term. Both of these are generally reversible with time. Due to the inherent procedures and cautions, this mode is only applied under full care in teaching institutions and similar well equipped hospitals, by trained staff, in well selected patients, and carefully chosen injection sites. Under these circumstances, it is a safe procedure for all age groups.
Reflexology is a multi-millennium year old technique, which is non-invasive, and completely safe at any age group. However, it is not yet a regular feature of Multimode Therapy, due to non-availability of expertise and recorded evidence of benefit.
Acupuncture is a multi-millennium year old technique, which is invasive. Hence its safety depends on aseptic and antiseptic techniques, and careful selection of insertion points. As such the technique is safe in all age groups. Electrical stimulus augmented acupuncture is to be used with caution in patients with cardiac problems, and pacemaker use..
Unani medication, as of today, is a judicious mixture of Indian Ayurveda and Persian Unani medicine. It is based on observed effects of natural ingredients, and about two thousand or more years of experience. Their hallmark is that they are generally safe when well prepared according to ancient methods and precautions. They are of two types: local poultices and oral drugs. The former is without side effects except self limiting local intolerance or allergy rarely, while the oral medication is also quite safe. However, it is usually prescribed along with stringent dietary restrictions and rules, that sometime are difficult to follow under certain conditions of home atmosphere. The supplement used by us is purely herbal, based on established herbs.
All surgeries are by nature invasive procedures and a 0.5% surgical risk is always inherent. They can cause excessive scar, contracture relapse in long run, risk of infection, and inadequate correction requiring a repeat correction in later years. They are therefore to be given by well experienced surgeons dealing with CP, and who understand the inherent muscle weakness and in-coordination that the child already has, and makes allowances for them while deciding his surgery. He must have a team of physiotherapists and others to take over when the surgery has healed, other wise the contractures may relapse.
Selective Dorsal Rhizotomy is an irreversible surgical procedure. All surgeries are by nature invasive procedures and a 0.5% surgical risk is always inherent. This operation can cause risk of infection, and inadequate correction requiring a repeat correction in later years. Over-correction can also cause permanent weakness in the supplied limb. They are therefore to be given by well experienced surgeons dealing with CP, and who understand the inherent muscle weakness and in-coordination that the child already has, and makes allowances for them while deciding his surgery. He must have a team of physiotherapists and others to take over when the surgery has healed, other wise
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