Locally Made Paediatric Rehabilitation and Seating Systems for Cerebral Palsy Children in Sarawak

Children with cerebral palsy (CP) are often prescribed Rehabilitation and Seating Systems (RSS) to assist in daily activities, posture improvement and prevention of muscular-skeletal complications. In Sarawak, a special project to produce RSS was started under a partnership of a Japanese physiotherapist, health department and the community using local material.To document the RSS project and to determine usefulness and costaffordability of these systems for cerebral palsy children and their families. The details of RSS manufactured were retrieved from the clinic notes and secretary file. Parents of children who received the seating systems between July 2004 and September 2008 were invited to complete a 5-point Global Parental Perception Questionnaire (GPPQ) between December 2008 and January 2009.277 RSS were manufactured between July 2004 and February 2011 (which included modified wheel chair, wooden chair, corner chair, buggy chair and standing frame), and used by children all over Sarawak. Parents of 73 children who used the seating systems completed the 5-points GPPQ. Ten families required full sponsorship. Children spent more time sitting up and brought outdoor more often after the systems became available. Majority of parents reported positive experience in their children with sitting ability, smiles, interaction with people, learning skills and easiness of doing physiotherapy. No change was noted with passing of motion drooling / oral secretion. Most parents agreed that the cost was affordable and worth paying.A community based initiative to manufacture RSS by using locally available material and skill, at affordable price for the parents was feasible and useful for the family/children with CP.

Clinical Diagnosis and Non-Verbal Ability of Primary-One School Children with LD

More school children were referred for learning difficutly (LD), especially after the introduction of LINUS sccreening programme by Ministry of Education Malaysia. To study the clinical diagnosis and non-verbal ability of primary-one school children with LD after paediatric assessment, as well as associated behavioural issues and socio-economincal background. Assessment findings by Paediatricians and Naglieri Non-Verbal Ability Test® (NNAT®) results of all primary-one school children referred in year 2010 with LD were studied retrospectively. Ninety-three children were included (62.4% male), and 72.0% of them failed the LINUS screening programme. The commonest diagnoses were Borderline Intellectual Disability (ID, 37.6%) and Mild ID (19.4%). Other diagnoses included Attention Deficit Hyperactive Disorder (ADHD, 11.8%), Specific Learning Disability (SLD, 10.8%), Autistic Spectrum Disorder (n = 5) and Severe Language Disorder (n = 3). Mean NNAT scores were 84.6 ± 11.8 (n = 85), of which 9.4% children scored less than 70 (<2nd percentile), while 63.7% scored between 71 and 90 (3rd-24th percentile). Twenty-three children(27.1%) scored 90 - 110 (25th-75th percentile) and 111-119 (76th-90th percentile). More than two-thirds of the parents never attended school, or only received education up to Form 3. Nearly 80% of mothers were housewife and 78.7% of fathers were labour or semi-skilled workers. A significant numbers of children with ADHD, Borderline ID, Mild ID and Severe Language Disorder / SLD had significant or borderline internalizing and/or externalizing behaviours.Majority of primary-one school children referred for LD do not have intellectual disability. Their clinical diagnosis and non-verbal ability were very variable. A significant number of them have poor socio-economical background and associated behavioural problems. A more realistic education system and targeted program should be offered.