Dear friends,

I have received nice pictures from our team in Kullu, and I have organised them in short slideshows to share with you such positive moments.  Take a look, I hope they will help you escape, for a few minutes, the fear of economic recession and the threat of downgrading of AAA rankings...

First of all, an overview of the final competitions of the Disability Sports Days organised on 2 and 3 December in Mandi, which gathered all teams from various districts of Himachal Pradesh.  Kullu district was of course represented with the selected children from NAB-School (blind children), NAV-Chetna (for mentally-retarded children) and of Handimachal (Ramneek and Sofia). 

Laura and Ajay actively participated and supported the competitors.  Sofia won a gold medal in assisted walk. This is the peak sports event for disabled children in Himachal Pradesh and it seems that everybody had good fun!

And yesterday 7 December was the first home visit session for our permanent OT, Naveen.  I should say "school" visit as, in Manali, our team mainly meets disabled children in the local government primary school, where parents of out-of-school disabled children also bring their kids in order to receive treatment (physiotherapy, speech therapy and of course occupational therapy). 

Since a few weeks, April has been putting all her energy in monitoring the work of the special educator hired by the government school (or rather teaching him what he is supposed to do with different kids...).  Yesterday's session introduced painting activities for Umesh and Mehul, 9 years old, both very happy to be engaged in new expression modes.  Aastha and Abhay, two CP children of 2 years old, have not reached this stage yet but their mothers are now aware of the necessity to provide physiotherapy exercices and stimulating activities at home.

We sincerely hope that we will be able to do more in terms of home visits and school interventions in 2012.

Dominique, 8 December 2011

This morning, the Handimachal team gathered on the Dhalpur ground in Kullu to attend the annual Sports Day for disabled children. Sport was not the only program of the day. This day was also the opportunity to share, discuss and for parents to meet while drinking “chai” (Indian tea).  It was good for children with disabilities to have a change from everyday activities. Children from Nab school (visually-impaired) and Nav Chetna (mentally retarded children) arrived in organised groups and seemed proud to wear their school uniforms!

 Mayur Sharma, physiotherapist in the Handimachal Kullu Therapy Unit (HKTU),
with kids, followed by Laura, April and Sofia

Finally, eight children and teenagers from HKTU reached the ground, one by one.  Apart from Ramneek, all of them attended this kind of event for the first time!  Different expressions could be seen on their face:  some of them kept their usual smiles like Sofia and Premjeet, but Kaartik and Keshav seemed a little unsure of all the excitement!

Kaartik ("what is this all about?...")	Ajay and Premjeet, during Bocce game: "So Premjeet, just throw the ball over there!"

Different activities were proposed to children according to their age and capabilities. By this way, each one could participate in athletics activities (race, assisted walk, softball throw, skipping) or/and in Bocce activity (a kind of ball game). The day took place in a convivial atmosphere, with a musical background created by two youngsters from NAB School.  After the last (of a long series) speech was delivered, each speaker congratulating and thanking each other, it was time for prize giving. Gifts and medals brought large smiles and many applause. The day ended with official guests, parents, children, representatives from NGOs and all volunteers sharing a big meal.

 Sofia (we are so proud of you!) and Laura

On the following day, good news arrived:  Ramneek, Premjeet and Sofia are selected for the State competition in Mandi – and this will be after a few days only!

Laura Turnacco, French adapted sports teacher,
volunteer in the Handimachal project (September to mid-December 2011)
25 November 2011 
 

Throwing a ball might not seem a big deal to you…  Ramneek was a very good cricket player before his stroke, and very popular in Kullu as we came to discover;  when we first proposed Sofia to do some sports activities in the Unit and realized she was left on the side of sports grounds in school, she naturally became very shy and probably thought that this was not for her at all… 

To push back the natural and social limits imposed by physical and/or mental impairment is one of our main goals:  proposing for each child a specific and daily rehabilitation program through sports, in addition to “usual” therapies, is now part of this global process.  Laura has been our first volunteer for this kind of program and thanks to her diplomacy and patience, thanks to her observation and analysis abilities, she managed to involve around ten children and teenagers in daily sports activities.  What is more, she succeeded in making them happy while challenging their impairment through playing, and, as far as we are concerned, she managed to impose adapted sports as an obvious development tool for disabled children.  Merci Laura!

Dominique, 29 November 2011

More pictures of that special day below, just click on images to launch the slide shows

No need to add much comments to this post, you will see from the sequence of Sanwi's pictures below how simple stimulation activities properly planned by our OT can enlighten a CP child' face within a few minutes...

Magic, isn't it?

Dominique, 3 September 2011

Three important facts should be highlighted this month:

The level of attendance has been quite good lately, during the summer holiday, with 7 to 9 children receiving treatment every day in the Handimachal Kullu Therapy Unit - let's hope that once schools will reopen again, parents will keep bringing children to the Unit.

Secondly, our speech therapist, Ajay, is the happy father of a newly born daughter.  All our congratulations and best wishes of happiness to Ajay and his wife Bhabuti!

Finally, April Knight, our new OT volunteer from the US, arrived in Kullu on 3rd August and is already fully emerged in the local community .  Yesterday, she could finally (after a few power cuts due to heavy rain) send her first article for this blog to deliver her first impressions on her first home visit in Naggar on 10 August.

First impressions of home visiting with the HKTU therapy team, by April Knight, occupational therapist

"Today we went up to Naggar and close to Manali to visit five children in their homes.  As we approached the home of Vaishali, we were met by cows in the front yard and a very elderly woman on the front porch. A very smiling Vishali and her mother greeted us in the sunny front room. Here I would have my first of four cups of tea this day.  We taught Vaishali’s mother to utilize items she already have in their homes for the children’s stimulation and therapy progress.

Vaishali and Ajay

For the second home visit we would climb two sets of clay stairs in the dark before entering into a dark room with an earthen floor to meet Sonali and her mom. Sonali is left with TV on all day - alone while mother is in the fields and father is in the shop. So much do I want her father to take Sonali to the shop with him but this is not done. She is a very bright child and I thoroughly enjoyed my visit with her.

Sonali during her physiotherapy session, with Mayur Sharma

During our third visit to meet Suraj, we are met by a smiling grandmother after creeping up an old wooden staircase. She is drying out herbs on the floor for medicine- some of which she gives to Suraj to prevent seizures. The family states Suraj has no mental abilities but I’d like to think otherwise. This family I would like to invest more time, for they think Suraj’s case is hopeless.  I believe this therapy team can show by example through regular visits that Suraj’s life is one to be valued and celebrated. During our visit today we discovered he is in danger of falling from the second floor as he is kept on the porch all day by himself while the family works. This team is working with the family on a more safe option. On a positive note he can watch the street activity through gaps in the railing. Never would I have thought of this as an ADL - attending to street activity - but perhaps more stimulating than TV!

Suraj on the house balcony, experimenting a new exercise:
playing with the lock of a wooden trunk...

The fourth visit takes us down a long tiny road where we then get out of our hired car to walk down a beautiful trail through an apple orchard to meet Harshit and both of his parents. We met Harshit sitting upright in his specially made chair. A former OT, Catriona from Scotland, made measurements for and purchased this wonderful chair for Harshit - I am so impressed with her skill. I can learn so much from all of the former OTs that have served the Unit before me!  Harshit has several seizures a day and we witnessed one as we were leaving.

Harshit and Ajay

Late in the day we saw our fifth child, Nitesh and I had my fourth cup of tea! With all the caffeine in my system I will be up all night! Nitesh comprehends much but his behaviour is a problem as he is very shy. We are encouraging the parents (who were both present and attentive) to bring Nitesh to the Unit. It is unfortunate for Nitesh that he does not have a one-on-one aide for primary school, as sometimes is offered by the government for children with disabilities.

Nitesh:  a new challenge for April

A challenge for our team members is to teach families how to utilize items they already have in their homes in order to provide creative play and to convince them of the importance of spending daily time with their children. I hope our team can continue these home visits on a regular basis. Teaching parents how to provide creative and playful stimulation in a safe manner within their own environments - this is the essence of the home visit, both here in India and abroad.

April Knight, OT volunteer
in the Handimachal Kullu Therapy Unit
(11 August 2011)

My time to join the Handimachal team is also coming near:  on 22 August I will reach Kullu-Manali for my annual stay in the valley.  September will be quite busy, with several visitors, friends and volunteers... More to read very soon on this blog!

Dominique, 16 August 2011

In order to give you a glimpse of what happens in the Handimachal Unit on a daily basis, I have requested Mayur, our new physiotherapist, to introduce part of his activity in relation to some selected children who are representatives of the many disability cases of children in Kullu district.

Name: Tavleen (girl, 1 year old)

Diagnosis: cerebral palsy with delayed mile stone.  Premature child (by 28 days) and joundice after 3 days.

Tavleen was reffered to the Handimachal Unit by Mission Hospital Manali for physiotherapy treatment. When we first assessed her on 17 May 2011, Taveleen was not able to move her arms and legs, could not use her hands for grasping things and there was no neck and trunk control.  After 10 regular sessions of physiotherapy, Taveleen improved and started doing little movements with arms and legs. Since the beginning of June, Tavleen’s parents have brought her to the Unit every day for treatment.

For the moment, physiotherapy treatment consists in passive movements, mobilisation techniques and PNF (proprioceptive neuromuscular fascilation) patterns.  Considering Taveleen’s very young age, speech therapy is not possible yet, although necessary, but in the meantime the parents have been advised to stimulate lip strengthening to make bilabial sounds possible.

Name:  Aslam  (boy, 1 year old)

Diagnosis: cerebral palsy with delayed milestones and squint eyes.

Aslam is again a premature delievery child who suffered jaundice 2 days after birth. When we first assessed this little boy on 12 May 2011, he had no neck or trunk control and, although he has the grasping reflex, he is not performing much active movements. Aslam has been brought to the Unit regularly by her mother in June, and his ability to performed active movements seems to be improving.

Aslam’s physiotherapy treatment focusses on passive movements, PNF (Proprioceptive Neuromuscular fascilation) patterns, exercices on physio ball and prone lying activities.

As for Tavleen, the mother has been shown how to perform some basic physiotherapy exercices to be done at home twice a day.  She was also advised to consult an eye specialist regarding the strong dilatation.

The arrival of our next occupational therapist will also increase activity stimulation for both children in order to break natural barriers already developed by Tavleen and Aslam.

Name:  Sabina  (girl, 10 years old)

Diagnosis:  cerebral palsy with mental retardation.  According to parents, forceps delivery caused injury to the brain.

Sabina has been benefiting treatment in the Handimachal Unit twice a week since beginning of September 2010. When she first visited the Unit she had lots of contractures in ankle, foot and in hands. She was not able to sit, stand nor walk actively. Most of her moves are stereotypies, resulting from archaic motricity (no sense moves, throwing, table hitiing, hands bitting...) although there seems to be no physical obstacle to the voluntary moves.  Sabina can hear and follows with eyes and head, but does not talk and salivates a lot.  She likes music but her mood is quite unstable.

Thanks to regular visits in the Handimachal Unit, the physiotherapy treatment seems to be improving the girl’s physical situation, decreasing contractures in ankle, foot and hands. Now Sabina has started sitting actively for some time.  Due to mental retardation, Sabina’s improvement is very slow but her parents are happy and satisfied with physiotherapy treatment. 

As far as speech therapy interventions are concerned, Ajay’s goals are to put Sabina onto a non-verbal mode of communication, use a communication board and improve her vegetative functions.  Speech stimulation exercises have been given lately with limited results up to now.

No doubt that the involvement of our next occupational therapist, further to Catriona and Sara’s patient efforts to develop her autonomy, stimulate balancing, improve communication, increase voluntary moves by making them have a sens (catch, touch, not just throwing, etc.), will also positively impact Sabina’s life. 

Gathering of children with their parents in the Unit.  Since the end of winter, 6 to 7 children come regularly for treatment and one of the main challenges is of course to continue motivating parents to bring children to the Unit very regularly, even if positive results cannot be seen day by day – and also to give them the discipline of coming on fixed appointments and not when they feel free to come so that they do not waste their time in the waiting room of the Unit...

Thank you Mayur for providing clinical information on children and also Ramneek for taking pictures!