PHYSICALLY CHALLENGED CHILDREN

INTRODUCTION Handicapped child is one who deviates from normal health status either physically, mentally or socially and requires special care, treatment and education.

DEFINITION According to WHO, the sequence of events leading to disability and handicapped conditions are as follows: Injury or disease - Impairment - Disability - Handicap.

Impairment It is defined as any loss or abnormality of psychological, physiological or anatomical structure or function. Eg: loss of vision, hearing. Disability It develops as the consequence of impairement. Eg: loss of limbs result in inability to walk. Disability is the inability to carry out certain activities which are considered as normal for the age and sex. Handicap It develops as the consequence of the disability. It is defined as a disadvantage for a given individual resulting from an impairement or a disability, that limits and prevents the fulfilment of a role which is normal for that individual, depending on age, sex, social and cultural factors.

Primary handicap condition leads to secondary handicap condition. Eg: blindness leads to economical handicapped situation, i.e, poverty. The child may have single or multiple handicap condition.

Physically handicapped children can be grouped according to the affected part of the body. Orthopedically handicapped: congenital birth defect ( club foot), amputation due to accidental injury, bony defects following ricket, fracture, arthritis, leprosy, etc. Sensory handicapped: Visual problems: partial or complete blindness, refractory errors Auditory problems: partial hearing loss, deaf and dumb Speech problems: stammering, dysphonia Neurologically handicapped: cerebral palsy, mental retardation, convulsive disorders, hydrocephalus, spina bifida, post meningitic, or post- encephalitic sequel, post-polio- residual paralysis, degenerative diseases of CNS, learning disabilities. Handicapped condition due to chronic systemic disease: heart disease, bronchial asthma, diabetes mellitus, muscular dystrophy, etc. Multiple physically handicapped children: having combination of orthopedically, sensory and neurological handicaps.

CAUSES congenital anomalies, genetic disorders, poliomyelitis, other

communicable diseases, perinatal conditions, , infection, malnutrition, accidental injury, socio- cultural factors

PREVENTION CHILDREN

OF

HANDICAPPED

CONDITIONS

IN

YOUNG

Handicapping conditions of children can be prevented by improvement of maternal health and adequate care during periconceptional, perinatal and intranasal period along with preventive measures during infancy, childhood and adolescents.

PRIMARY PREVENTION Genetic counselling: optimum maternal age for producing normal babies is between 20-30 years, this information should be explained to the couples along with prevention and different aspects of genetic and chromosomal problems. Genetic screening of at- riskpeople to prevent inherited diseases like chromosomal or sex linked congenital anomalies ( eg: Downs syndrome, haemophilia) Reduction of consanguineous marriages by creating health awareness. Universal immunization coverage especially for poliomyelitis and MMR Improvement of nutritional status of mother and children especially for girl child, the future mother. Prevention of iodine deficiency and folic- acid deficiency conditions in periconceptional period. Essential care in antenatal , intranatal and neonatal periods. Prevention of maternal and neonatal infections, birth injuries, asphyxia,

hyperbilirubinemia etc Avoidance of teratogenic agents in antenatal periods and special care of high- risk mothers and children. Medical termination of pregnancy of malformed fetus

 Improvement of health awareness about the preventive measures of handicapped conditions in children by elimination of causes like malnutrition, accidental injuries, etc.

MANAGEMENT OF HANDICAPPED CHILDREN Management of handicapped children requires multidisciplinary

approach. Early diagnosis and treatment of the particular cause of handicapping condition along with disability limitation and rehabilitation should be promoted. The aim of management is to safeguard against or halt the progression of the disease process from impairement to disability and handicap. The approaches of management should include following aspects. Careful history, thorough physical examination and necessary

investigations for early detection of improvement.

handicapped conditions are

Regular medical supervision and developmental assessment help to identify the abnormal condition early in initial stage by MCH or school health services. Treatment of particular handicapped condition by medical or surgical management .eg: cataract, otitis media, leprosy, accidental injury, rickets, congenital anomalies. Correction of deformity. Eg: visual or hearing problems by spectacles or hearing aids. Physiotherapy and exercise to improve physical conditions. Occupational therapy according to the childs ability and that should be provided with music, painting, weaving, wood-work, pottery. Speech therapy to improve communication ability. Prosthetics eg: provision of artificial limb in a child with amputed leg. Special care for mentally handicapped children with love, warmth, patience, tolerance, discipline and avoidance of criticism.

 Counselling and guidance to the parents and family members for continuation of care of the children with emotional, educational and social support. Referal for services (Govt, NGOs) for assistance of aids and appliances, for special training and education, rehabilitation and support services like pension, scholarship, special allowances.

REHABILITATION OF HANDICAPPED CHILDREN Rehabilitation includes all measures to reduce the impact of disabled and handicapped conditions and to achieve social integration by active participation of the individual in the community. The process of rehabilitation should involve the following aspects: Medical rehabilitation includes restoration of functions by prosthesis, artificial limbs etc. Social rehabilitation includes restoration of family and social relationship by replacement in the family. Educational and rehabilitation includes specialised training and educational facilities.eg: braille for blind, sign language for deaf and dumb. Psychological rehabilitation includes restoration of personal dignity and confidence during the period of growth and development and in adult life. Vocational rehabilitation includes restoration of the capacity to earn a livelihood .This can be achieved by community participation and social legislation for the handicapped individual. The community needs to offer employment opportunities in shops, factories and other business establishment to the handicaps. The handicapped child needs to be trained for an independent living with special training and education. These include day care centers, special

school, (for blind, deaf and dumb) vocational training centers, special hospitals for crippled children. These available welfare services of Govt. Of India provide support services to the handicapped individuals and enabling the families to assume a large share of rehabilitation within the family cycle. Non-govt. Organisation are also working along with Govt. Institutions for training , vocational guidance, counselling, manpower development, research , assistance for supply of aids and appliances to the handicapped and dissemination of informations. The Ministry of Welfare, Govt. Of India has introduced a comprehensive Bill in the parliament known as Persons with disabilities ( equal opportunities, protection of right and full participation) Bill, 1995.It deals with preventive and promotional aspects of rehabilitation.

The Children Act, 1960, provides for the care, protection, maintenance, welfare, education and rehabilitation of socially handicapped children. The following National Institutes are working for the specific disabilities to provide care and welfare services in various aspects of the handicapped. National Institute for Orthopedically Handicapped, Kolkotta National Institute for Mentally Handicapped, Secunderabad National Institute for visually Handicapped , New Delhi and Dehradun. Ali Yavar Jung National Institute for the Hearing Handicapped, Munbai. National Institute for Rehabilitation, Training and Research, Cuttack.

NURSING MANAGEMENT OF HANDICAPPED CHILDREN Nursing Assessment Complete assessment of a handicapped child include detailed history of the condition, thorough physical and neurological examination, special investigations, review of developmental screening, assessment of parent child

interaction and family coping, socioeconomic status, available support facilities, etc.

Nursing Diagnosis Ineffective family coping and altered parenting related to handicapped condition. Anxiety of the parents and family members Altered nutrition, less than body requirements. Potential for infection Injury, risk for Self- care deficit, bathing, feeding, dressing, toileting, hygienic care. Communication impaired. Physical mobility impaired Elimination pattern, altered Activity intolerance Altered sleep pattern Sensory alteration, visual/ auditory Growth and development altered Diversional activity deficit Knowledge deficit related to continued care of handicapped children.

Nursing Interventions Handicapped children can be cared in the general hospitals, special health care setting, community health care centers in primary level and at home. Day care centers , special school, (for blind, deaf and dumb) vocational training centers , occupational therapy also can provide various services to these children. The goal is to bring them as close to normality as possible, physically, mentally and socially.

 Nurses are key person for home based or hospital based care to guide and assist the parents and family members to promote optimum health of the handicapped children. Assist family to strengthen effective relationship and bondage to prevent children from becoming socially handicapped. Create awareness in the society about the prevention of handicaps, the abilities of the handicapped child and the potentialities present in him.

CONCLUSION The term physically challenged child indicates that a child has a limitation in performance of motor function. In the mildest expressions of these diagnostic entities, a child actually may overcome the condition. Most physical challenges, however, are chronic, persisting to varying degrees throughout childhood despite improvements achieved with intervention.

REFERENCE Marlow.Dorothy.R, Redding Barbara.A. Text book of Pediatric Harcourt Brace & Company Asia PTE Nursin.6th edition. Singapore: LTD;1998 Gupte Suraj. T.B of Pediatrics.8 th edition.NewDelhi: Jaypee Brothers

(P) Ltd;1998 Wong.L.Donna, Eaton. Marilyn Hockenberry. Essentials of pediatric Nursing.6th edition. Missouri:Mosby Publishers;2001