Public Awareness:


​​​​​​​​​​​
1) Hearing Screening: Why It's Important And What Parents Need To Know About It?


                          Hearing screening at Hospital for new born, home, medical setup, school is critical care of the young. Often, such screening is the first step in detecting hearing loss that could otherwise have profound negative impact on children if it goes undetected. We will look at the national picture of hearing screening in all other setups, what it is, why it is important, and how it is done, and when and where it is taking place or not taking place, such as the case currently in India.

 We will also discuss what parents can do to help ensure that their children are screened.
 Exactly what is hearing screening, and who says it is important for the young and why?

                          let me define what a hearing screening is and what it is not. Hearing screening is not the same thing as a complete hearing evaluation. Instead, it is a quick and easy way to identify children who may have a hearing problem.



                          Hearing screening programs remove children with normal hearing quickly, leaving children who refer and need further testing to find out more about the hearing loss, such as how bad is the hearing problems and what can be done to improve the hearing.

                          Today, over 90 percent of newborns have hearing screening before they go home from the birth hospital. As successful as these programs are, they still do not identify all children with hearing loss. The newborn hearing screening often does not identify children with mild hearing loss. These types of hearing loss can go unnoticed in the preschool years . Hearing screening at hospital and school entry may be the first time the hearing loss is identified.

                          Approximately 15 percent of all school-age children have some degree of hearing loss in one or both ears. Most of this population of children have already been identified with hearing loss through the newborn hearing screening program and they are receiving intervention services and are wearing hearing aids, cochlear implants, or using other technology. But for those with mild or unilateral hearing loss - that is a hearing loss in one ear - those children may not have been identified during the newborn hearing screening. That is one in every 20 school-aged child may have a mild or unilateral hearing loss, and without the proper identification and treatment, more than a third of this group of children are projected to fail at least one grade at school. And as you can see, this creates a huge, costly burden to the educational system.

                          have seemed to be the most effective place to ensure that screenings can happen and that they are done appropriately. I do not really see that a screening program could possibly be completed out by audiologists in their private offices for a couple of reasons. I do not think it is reasonable to expect that parents would necessarily bring their children in one at a time, and because of that it would be far more costly to have it done, if it even could be done effectively, and it would be very expensive to have audiologists actually do all the screenings.



                          In most programs, as I understand it, the programs should supervised by an audiologist.



                          Traditionally pure tone screenings have been done on school-age children either through plate (ph) conditioning techniques or children raising their hand, depending on their age and ability. And I believe that most often it is recommended that screening be conducted at 1,000, 2,000, and 4,000 hertz at 20 dB. And I do believe that it is most effective to pair this with tympanometry, or measuring the middle ear function, to be able to identify which of the referrals may be due to middle ear problems.



                          I know that some programs incorporate a pure tone threshold surge, which is taking it one step further to also try to - for those children who do fail the initial screening - to really see if they can get some information on the level of the potential hearing loss.



                          I believe that there is now some interest and pilot programs actually underway investigating the use of auto acoustic emissions for screening in this particular age population, and I do believe that the efficacy of this should be looked into. And if the results are good, it would definitely be easier to train staff to do it effectively. It would not require - hardly any cooperation on the part of the children and probably could be done quicker.

                          It should be an audiologist as the overseer of all of the components to the program.



                          It is important to follow up on your concerns and have your child’s hearing fully evaluated by a certified audiologist.



                          And I would like to add one more thing, please; that it is important to understand that the terms “mild,” “slight,” or “minimal” can be confusing to a family. These terms underemphasize the negative effects of - any degree of hearing loss can have on a child’s success at any other setup.



                          I really also appreciate her comment about mild not really representing what happens to a child. There is a statistic that a child with a mild hearing loss can miss as much as 50 percent of what goes on in a classroom, and I think that that is important for everybody to know.



                          I think it would be interesting to just have every child screened by an audiologist, but insurance won’t cover that. And it is probably not necessarily the best route to say every child without any concern should have a full audio logical evaluation. It is probably just not a doable thing.



  Ram Pravesh Kumar

                          M.S.(Speech & Hearing)

                          Audiologist & SLP

                          ----------------------------------------------------------------------------------------------------------------------------------------------------



2) Speech Articulation Disorders: What is it?



                          Articulation problems may result from brain damage or neurological dysfunction, physical handicaps, such as cerebral palsy, cleft palate or hearing loss. Or the condition may be related to lack of coordination of the movements of the mouth, even dental problems. However, most articulation problems occur in the absence of any obvious physical disability. The cause of these so-called functional articulation problems may be faulty learning of speech sounds.


                          Cause:

                          In many cases, there is not a clearly identifiable, structural or physiological reason for the problem.



                          Delayed Speech.
                          Hearing Impairment.
                          Mental Retardation.
                          Learning Disability.




                          Articulation disorders are difficulties with the way sounds are formed and strung together, usually characterized by substituting one sound for another (wabbit for rabbit), omitting a sound (han for hand), or distorting a sound (ship for sip). The main characteristic of the disorder are:

                          Omissions - Sounds in words and sentences may be completely omitted. i.e. "I go o coo o the bu." for "I go to school on the bus.".

                          Substitutions - Children do not pronounce the sounds clearly or they replace one sound for another. i.e substitutes [w] for [l] or [r], or other similar errors

                          Distortions - An attempt is made at the correct sound but it results in a poor production. i.e a distorted /s/ sound may whistle, or the tongue may be thrusting between the teeth causing a frontal lisp.

                          Additions - Extra sounds or syllables are added to the word. i.e animamal.

                          The most common error sounds are [s] [l] and [r].

                          The speech is primarily unintelligible and difficult to understand.

                          Articulation patterns that can be attributed to cultural or ethnic background are not disabilities.



                          Associated Features:

                          Developmental delay, is the cause of most articulation disorders. This can be the direct result hearing problem. The child cannot hear the fine differences between sounds, so speech perception is inhibited. Articulation disorders are also associated with overall delayed language development.



                          Differential Diagnosis:

                          Some disorders have similar symptoms. The clinician, therefore, in his diagnostic attempt, has to differentiate against the following disorders which need to be ruled out to establish a precise diagnosis. An articulation problem sometimes sounds like baby talk because many very young children do mispronounce sounds, syllables, and words.

                          Expressive Language Disorder

                          Mixed Receptive-Expressive Language Disorder.

                          Phonological Disorder
                          Apraxia of Speech.



                          Treatment:
                          A speech evaluation should be performed by a speech-language pathologist. If there is a problem with articulation that is not developmental in nature, speech therapy is recommended. Parent involvement is necessary for the best progress and prognosis. The length of therapy can vary from 3 months to a number of years, depending on the cause, the severity, the child's motivation, and parental support.

                          Iindividual speech therapy sessions may be recommended as little as twice weekly or as often as daily.



Ram Pravesh Kumar

                          M.S.(Speech & Hearing)

                          Audiologist & Speech-Language Pathologist

                          ----------------------------------------------------------------------------------------------------------------------------------------------------



                          3) Cluttering: What is it and Can Individuals Affected by Cluttering Communicate?



                          Cluttering is a speech disorder that affects the fluency of speech. Unlike other disorders those who suffer from cluttering are sometimes not even aware of their condition or precisely when they clutter their speech. Most members of the general public are not aware of cluttering as a recognized speech disorder either. Below are some answers to frequently asked questions about cluttering.

 What is Cluttering?
                          Cluttering occurs when an individual’s speech accelerates to a more rapid pace than normal, when the individual (often unconsciously) repeats syllables or phrases, and/or when an individual goes back to repeat things multiple times in an effort to make his or her speech more clear. When these occur, the individual’s speech literally becomes cluttered.

  What are the Causes of Cluttering?
                          There is no single cause of cluttering, and in fact there may be medical causes of cluttering that are unique to the individual. Conditions that affect concentration may be related to an individual’s cluttering, and there may even be some prescription medications that are used to treat independent illnesses or conditions that could also bring about cluttering as a side effect. The use of alcohol or drugs such as marijuana/cannabis may also influence cluttering.



Does Cluttering Ever Go Away?
                          If cluttering is brought on by alcohol, drugs or prescription medication then it may go away when these substances are no longer being used. If cluttering is associated with another condition, it may be alleviated in line with the progress of that condition. Some individuals affected by cluttering, however, will deal with it indefinitely.

Can Individuals Affected by Cluttering Communicate?
                          Of course. Like stuttering or stammering, cluttering simply means that verbal communication is less efficient than it might be otherwise. Cluttering certainly does not preclude an individual from communicating, but it may mean that (s)he will need to consciously slow his or her speech and think through what (s)he would like to say. Stress may have an adverse effect on cluttering, so all efforts to stay relaxed while communicating should help, though at the very least they won’t hurt.

What If Speaking is Difficult for Someone with Cluttering?
                          Speaking will be difficult for someone affected by cluttering, but this does not mean that others should shy away from speaking with him or her. Instead, others should be sure to allow the individual as much time as is necessary for him or her to complete a communication. Others should avoid interrupting someone with cluttering, and should not finish his or her sentences. If others cannot understand something due to cluttering, they should be honest about it and continue to communicate until both parties are clear.

     Is there a Cure for Cluttering?
                          No, there is not a single recognised cure that will stop all cases of cluttering. However, speech and language therapy is usually useful in overcoming cluttering to a certain extent, and cluttering that is associated with another condition or substance may be alleviated in line with the recovery of that condition or when the substance is no longer ingested.



Ram Pravesh Kumar

                          M.S.(Speech & Hearing)

                          Audiologist & Speech-Language Pathologist
Articles:- ( all age groups)





Update Health Awareness
​1.Celiac Disease
2.Caring for Every Child's Mental Health
3.​​Industrial Hearing Awareness
4.A update about Dialysis diet​
https://twitter.com/#!/sonadevaarogyam








1.Public Awareness about Celiac 1.Public Awareness about Celiac disease - sprue

Celiac disease is a condition that damages the lining of the small intestine and prevents it from absorbing parts of food that are important for staying healthy. The damage is due to a reaction to eating gluten, which is found in wheat, barley, rye, and possibly oats.

Causes, incidence, and risk factors

The exact cause of celiac disease is unknown. The lining of the intestines contains areas called villi, which help absorb nutrients. When people with celiac disease eat foods or use products that contain gluten, their immune system reacts by damaging these villi.

This damage affects the ability to absorb nutrients properly. A person becomes malnourished, no matter how much food he or she eats.

The disease can develop at any point in life, from infancy to late adulthood.

People who have a family member with celiac disease are at greater risk for developing the disease. The disorder is most common in Caucasians and persons of European ancestry. Women are affected more often than men.

People with celiac disease are more likely to have:

Autoimmune disorders such as rheumatoid arthritis, systemic lupus erythematosus, and Sjogren syndrome

Addison's disease

Down syndrome

Intestinal cancer

Intestinal lymphoma

Lactose intolerance

Thyroid disease

Type 1 diabetes

Symptoms

The symptoms of celiac disease can be different from person to person. This is part of the reason why the diagnosis is not always made right away. For example, one person may have constipation, a second may have diarrhea, and a third may have no problem with stools.

Gastrointestinal symptoms include:

Abdominal pain, bloating, gas, or indigestion

Constipation

Decreased appetite (may also be increased or unchanged)

Diarrhea, either constant or off and on

Lactose intolerance (common when the person is diagnosed, usually goes away after treatment)

Nausea and vomiting

Stools that float, are foul smelling, bloody, or “fatty”

Unexplained weight loss (although people can be overweight or of normal weight)

Because the intestines do not absorb many important vitamins, minerals, and other parts of food, the following symptoms may start over time:

Bruising easily

Depression or anxiety

Fatigue

Growth delay in children

Hair loss

Itchy skin (dermatitis herpetiformis)

Missed menstrual periods

Mouth ulcers

Muscle cramps and joint pain

Nosebleeds

Seizures

Tingling or numbness in the hands or feet

Unexplained short height

Children with celiac disease may have:

Defects in the tooth enamel and changes in tooth color

Delayed puberty

Diarrhea, constipation, fatty or foul-smelling stools, nausea, or vomiting

Irritable and fussy behavior

Poor weight gain

Slowed growth and shorter than normal height for their age

Signs and tests

Albumin (may be low)

Alkaline phosphatase (high level may be a sign of bone loss)

Clotting factor abnormalities

Cholesterol (may be low)

Complete blood count (CBC - test for anemia)

Liver enzymes (transaminases)

Prothrombin time

Blood tests can detect several special antibodies, called antitissue transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA). The health care provider will order these antibody tests if celiac disease is suspected.

If the tests are positive, upper endoscopy is usually performed to sample a piece of tissue (biopsy) from the first part of the small intestine (duodenum). The biopsy may show a flattening of the villi in the parts of the intestine below the duodenum.

Genetic testing of the blood is also available to help determine who may be at risk for celiac disease.

A follow-up biopsy or blood test may be ordered several months after the diagnosis and treatment. These tests evaluate your response to treatment. Normal results mean that you have responded to treatment, which confirms the diagnosis. However, this does not mean that the disease has been cured.

Treatment

Celiac disease cannot be cured. However, your symptoms will go away and the villi in the lining of the intestines will heal if you follow a lifelong gluten-free diet. Do not eat foods, beverages, and medications that contain wheat, barley, rye, and possibly oats.

You must read food and medication labels carefully to look for hidden sources of these grains and ingredients related to them. Because wheat and barley grains are common in the American diet, sticking with this diet is challenging. With education and planning, you will heal.

You should NOT begin the gluten-free diet before you are diagnosed. Starting the diet will affect testing for the disease.

The health care provider may prescribe vitamin and mineral supplements to correct nutritional deficiencies. Occasionally, corticosteroids (such as prednisone) may also be prescribed for short-term use or if you have sprue that does not respond to treatment. Following a well-balanced, gluten-free diet is generally the only treatment you need to stay well.

When you are diagnosed, get help from a registered dietitian who specializes in celiac disease and the gluten-free diet. A support group may also help you cope with the disease and diet.

Support Groups

For additional information and support, see the organizations listed in celiac disease resources.

Expectations (prognosis)

Following a gluten-free diet heals the damage to the intestines and prevents further damage. This healing most often occurs within 3 - 6 months in children, but it may take 2 - 3 years in adults.

Rarely, long-term damage will be done to the lining of the intestines before the diagnosis is made.

Some problems caused by celiac disease may not improve, such as a shorter than expected height and damage to the teeth.

Complications

You must carefully continue to follow the gluten-free diet. When untreated, the disease can cause life-threatening complications.

Delaying diagnosis or not following the diet puts you at risk for related conditions such as:

Autoimmune disorders

Bone disease (osteoporosis, kyphoscoliosis, fractures)

Certain types of intestinal cancer

Low blood count (anemia)

Low blood sugar (hypoglycemia)

Infertility or repeated miscarriage

Liver disease

Calling your health care provider

Call your health care provider if you have symptoms of celiac disease.

Prevention
Because the exact cause is unknown, there is no known way to prevent the development of celiac disease. However, being aware of the risk factors (such as having a family member with the disorder) may increase your chances of early diagnosis, treatment, and a long, healthy life. - sprue Celiac disease is a condition that damages the lining of the small intestine and prevents it from absorbing parts of food that are important for staying healthy. The damage is due to a reaction to eating gluten, which is found in wheat, barley, rye, and possibly oats. Causes, incidence, and risk factors The exact cause of celiac disease is unknown. The lining of the intestines contains areas called villi, which help absorb nutrients. When people with celiac disease eat foods or use products that contain gluten, their immune system reacts by damaging these villi. This damage affects the ability to absorb nutrients properly. A person becomes malnourished, no matter how much food he or she eats. The disease can develop at any point in life, from infancy to late adulthood. People who have a family member with celiac disease are at greater risk for developing the disease. The disorder is most common in Caucasians and persons of European ancestry. Women are affected more often than men. People with celiac disease are more likely to have: Autoimmune disorders such as rheumatoid arthritis, systemic lupus erythematosus, and Sjogren syndrome Addison's disease Down syndrome Intestinal cancer Intestinal lymphoma Lactose intolerance Thyroid disease Type 1 diabetes Symptoms The symptoms of celiac disease can be different from person to person. This is part of the reason why the diagnosis is not always made right away. For example, one person may have constipation, a second may have diarrhea, and a third may have no problem with stools. Gastrointestinal symptoms include: Abdominal pain, bloating, gas, or indigestion Constipation Decreased appetite (may also be increased or unchanged) Diarrhea, either constant or off and on Lactose intolerance (common when the person is diagnosed, usually goes away after treatment) Nausea and vomiting Stools that float, are foul smelling, bloody, or "fatty" Unexplained weight loss (although people can be overweight or of normal weight) Because the intestines do not absorb many important vitamins, minerals, and other parts of food, the following symptoms may start over time: Bruising easily Depression or anxiety Fatigue Growth delay in children Hair loss Itchy skin (dermatitis herpetiformis) Missed menstrual periods Mouth ulcers Muscle cramps and joint pain Nosebleeds Seizures Tingling or numbness in the hands or feet Unexplained short height Children with celiac disease may have: Defects in the tooth enamel and changes in tooth color Delayed puberty Diarrhea, constipation, fatty or foul-smelling stools, nausea, or vomiting Irritable and fussy behavior Poor weight gain Slowed growth and shorter than normal height for their age Signs and tests Albumin (may be low) Alkaline phosphatase (high level may be a sign of bone loss) Clotting factor abnormalities Cholesterol (may be low) Complete blood count (CBC - test for anemia) Liver enzymes (transaminases) Prothrombin time Blood tests can detect several special antibodies, called antitissue transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA). The health care provider will order these antibody tests if celiac disease is suspected. If the tests are positive, upper endoscopy is usually performed to sample a piece of tissue (biopsy) from the first part of the small intestine (duodenum). The biopsy may show a flattening of the villi in the parts of the intestine below the duodenum. Genetic testing of the blood is also available to help determine who may be at risk for celiac disease. A follow-up biopsy or blood test may be ordered several months after the diagnosis and treatment. These tests evaluate your response to treatment. Normal results mean that you have responded to treatment, which confirms the diagnosis. However, this does not mean that the disease has been cured. Treatment Celiac disease cannot be cured. However, your symptoms will go away and the villi in the lining of the intestines will heal if you follow a lifelong gluten-free diet. Do not eat foods, beverages, and medications that contain wheat, barley, rye, and possibly oats. You must read food and medication labels carefully to look for hidden sources of these grains and ingredients related to them. Because wheat and barley grains are common in the American diet, sticking with this diet is challenging. With education and planning, you will heal. You should NOT begin the gluten-free diet before you are diagnosed. Starting the diet will affect testing for the disease. The health care provider may prescribe vitamin and mineral supplements to correct nutritional deficiencies. Occasionally, corticosteroids (such as prednisone) may also be prescribed for short-term use or if you have sprue that does not respond to treatment. Following a well-balanced, gluten-free diet is generally the only treatment you need to stay well. When you are diagnosed, get help from a registered dietitian who specializes in celiac disease and the gluten-free diet. A support group may also help you cope with the disease and diet. Support Groups For additional information and support, see the organizations listed in celiac disease resources. Expectations (prognosis) Following a gluten-free diet heals the damage to the intestines and prevents further damage. This healing most often occurs within 3 - 6 months in children, but it may take 2 - 3 years in adults. Rarely, long-term damage will be done to the lining of the intestines before the diagnosis is made. Some problems caused by celiac disease may not improve, such as a shorter than expected height and damage to the teeth. Complications You must carefully continue to follow the gluten-free diet. When untreated, the disease can cause life-threatening complications. Delaying diagnosis or not following the diet puts you at risk for related conditions such as: Autoimmune disorders Bone disease (osteoporosis, kyphoscoliosis, fractures) Certain types of intestinal cancer Low blood count (anemia) Low blood sugar (hypoglycemia) Infertility or repeated miscarriage Liver disease Calling your health care provider Call your health care provider if you have symptoms of celiac disease. Prevention Because the exact cause is unknown, there is no known way to prevent the development of celiac disease. However, being aware of the risk factors (such as having a family member with the disorder) may increase your chances of early diagnosis, treatment, and a long, healthy life.