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This area will introduce selected resources to help you improve the lives of children with disabilities. Please help us spread this information by suggesting resources and web sites you've found to be helpful. Send us
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This section provides an update of news about TelAbility. Bookmark
this page to keep up with our progress. To see a list of news stories in
our archive, click here.
| Featured News |
| Title: | Medicaid Provider Rate Reductions |
| Date: | 08/16/2010 |
| Summary: | The NC Department of Health and Human Services has communicated to all Medicaid Providers about rate reductions due to North Carolina not recieving the anticipated full amount of ARRA/FMAP funds. The General Assembly included a special provision in this year’s budget to deal with any potential budget shortfall created by Congress’ failure to act or actions related to the ARRA/FMAP extension. The legislation instructed the Director of the Budget, the State Treasurer, the State Controller, and other state officials to effectuate extraordinary budget adjustments to the extent necessary to backfill ARRA funding should Congress fail to extend current ARRA/FMAP funding to State.
The General Assembly had expected and included approximately $500 million from ARRA/FMAP funds in the 2010-2011 budget. However, NC will only recieve $343 million. Therefore, DHHS is implementing across the board provider rate reductions. As of September 1, Medicaid Providers will see a rate reduction of 1.35%.
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| Author: | Allison Crumpler, CCC-SLP |
Click here to see a list of archived news stories.
This area highlights an internet site we feel are of special interest to the
TelAbility community. For a comprehensive listing of
sites please check our links page. To see a list of sites that were
previously featured, click here.
| Featured Site |
| 2008 Summer Camp Directory |
| http://www.fsnnc.org/camps/start.asp |
| An online directory from the Family Support Network of North Carolina that lists summer camps, both day and residential, serving children who have special needs. |
Click here to see a list of archived featured sites.
This area highlights a case
concerning a child with disabilities. As new cases are made available
previous cases will be archived for future reference.
To view all archived cases, click
here.
| Featured Case |
| Title: | WATCH Case Study-CHARGE Syndrome |
| Reviewer: | Joshua Alexander, MD |
| Summary: | Emma is a beautiful 3 year old girl with long dark hair, big blue eyes and a winning smile. She has many of the features of CHARGE syndrome (Coloboma of the eye, Heart defects, Atresia of the choanae, Retardation of growth and/or development, Genital and/or urinary abnormalities, and Ear abnormalities and deafness) although testing for this syndrome was negative. Emma has visual impairment affecting her right eye more than her left, choaneal astresia, genitourinary abnormalities, and global developmental delays. She had a tracheotomy from birth until March of this year. Emma sustained a grade III intraventicular hemorrhage as a newborn and she has a VP (Ventriculo-Peritoneal) shunt. She has had surgery to open her nasal passages and recently had tubes put in her ears. Emma’s muscle tone is mildly low, mostly at her feet and ankles. She has severe hind foot eversion and forefoot abduction in weight bearing and wears supramalleolar AFO’s during the day (#4 DAFO’s). Emma also has a progressive scoliosis convex to the right which is at 30 degrees. She wears a body jacket at night.
Emma’s motor development has been slow, but sequential. She learned to sit independently and roll prone to and from supine at about 15 months of age. At 24-26 months she learned to transition sit to and from quadruped and started creeping several months after that. She started cruising this past summer, but only cruises to the left. She does not like moving to the right probably because of her visual impairment. Emma still requires minimal assistance to pull to stand, but will lower herself to sit with both hands holding onto furniture. She will take steps with hands held and we are looking at gait trainers.
Emma does not have much interest in feeding herself. When handed a spoon with food on it she will put it in her mouth and then throw down the spoon. She will not attempt to pick the spoon back up nor will she attempt to pick up food from the tray. She will, however, take small pieces of food that are handed to her and put them in her mouth. Emma is able to chew small soft pieces of food, but has a tendency to pocket food behind her front bottom teeth. Emma does enjoy flavorful food and especially likes guacamole, Thai noodles, and banana pudding.
Communication skills are another area of concern. Since Emma had her tracheotomy removed in March we do get to hear her laugh and cry. Unfortunately she does not yet make any consonant sounds and is generally quite. Emma does recognize and use a few signs. She also uses a Tech/Talk Augmentative Communication Device (http://www.turningpointtechnology.com/Communication/AM/TechTalk.htm) and makes choices from 4 different pictures.
Emma is in her second year at Governor Morehead School’s Preschool program where she spends 4 mornings a week. She started at one morning last year and increased to 3 mornings over the school year. Her preschool teacher is working hard to integrate all areas of development into Emma’s preschool program. Emma has been receiving physical therapy since 4 months of age, occupational therapy since 12 months of age and speech therapy since 18 months of age.
Any comments, insights, or suggestions would be appreciated in the big three; walking, communicating and eating. The worsening scoliosis is also a big concern. Any thoughts on scoliosis management would be greatly appreciated.
Response by Darlene Sekerak, PhD, TelAbility Team Physical Theapist:
Emma sounds like a delightful child who presents us with many interesting challenges. It's hard to get a complete picture of a child in such a short description. I’m sure that her teachers and therapists have attempted many creative approaches to encourage her development. That being said, I'm happy to add a few comments that might apply to any child with some of the characteristic you describe. These suggestions may or may not be appropriate in this case.
1) I often worry about strengthening and endurance in young children with disabilities. Typically they do not have the same level of activity as their peers. Activity is really important for overall health as well as development. Sometimes we get too focused on facilitating the next developmental step and don’t encourage enough movement in general.
2) It is important to consider what excites a child. Does he/she respond to music? What kinds? What makes a child want to “dance”? Is a child prone to imitation – maybe of another child or an older child? A child with low tone, especially, may need a bit more stimulation for movement.
3) Scoliosis is always a concern but is not usually ameliorated by exercise alone. However, exercise targeted at improving respiratory function is important with or without a body jacket or orthotic.
4)A thorough assessment of sensory processing and integration can be very helpful in trying to understand and help a child in the areas of feeding, fine motor activities, and movement planning.
5) Family members are also important to consider. Family members (siblings and grandparents, included) have great insights.
6) The coordination of activities at home and at school can be helpful if possible. Sometimes its not possible, and sometimes the child benefits from different expectations in different situations.
Thanks for starting the discussion. What do others have to add to these comments?
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Click here to see a list of archived cases.
This area highlights medications we feel are of interest to the TelAbility
community. As new medication reviews are made available previous medication reviews
will be archived for future reference. To view the archived medications, click
here.
| Featured Meds |
| Name: | Phenytoin (Dilantin®) |
| Reviewer: | Joshua Alexander, MD |
| Summary: | COMMON USES:
Used to treat seizures.
Used to prevent seizures in children who have had a brain injury or recent brain surgery.
HOW IT'S SUPPLIED:
50-milligram tablets
30- and 100- milligram capsules
30- and 100- milligram extended release capsules
125 milligram / 5 milliliter suspension
HOW IT WORKS:
Slows the spread of seizure activity in the brain.
THINGS TO DISCUSS WITH YOUR DOCTOR:
* Can cause vision problems, decreased balance, slurred speech, decreased coordination, mental confusion, and/or increased hair growth.
* May also cause dizziness, difficulty falling asleep, nervousness, muscle twitching, and/or headache.
* If a rash occurs while on this medicine, contact your doctor immediately.
* Blood levels should be followed.
* Use with caution in children who have either liver or kidney disease.
* Don’t stop using this medicine suddenly as this may cause severe seizures.
* Long-term use may cause overgrowth of the gums.
*Long-term use may cause brittle bones or worsen diabetes.
*Tablets can be either chewed before being swallowed or swallowed whole.
* May cause urine to turn red.
* Affects the levels of other medicines in the bloodstream.
* Giving the drug during a tube feeding can interfere with the absorption of the drug and decrease its effectiveness. |
Click here to see a list of archived meds reviews.
This area highlights recent articles of interest to the TelAbility
community. As
new article reviews are made available previous article reviews will be
archived for future reference. To
view all archived articles, click
here.
| Featured Article |
| Title: | The Effects of Maternal Depression on Young Children |
| Author: | Geraldine Dawson, Profession University of Washington |
| Summary: | Many studies have indicated that maternal depression is correlated with infant irritability, delayed development, and later behavior problems. Dr. Dawson’s research indicates that the interaction between depressed moms and their babies is actually related to those children’s brain functioning.
Activity in the left frontal lobe of the brain’s cortex is associated with outwardly-directed emotion such as joy, interest, and curiosity. The right lobe is associated with withdrawal emotion such as distress and sadness. Dr. Dawson found that babies of depressed mothers showed less activity in the left frontal lobe and more activity in the right frontal lobe (compared to babies of non-depressed mothers). For those children whose mother’s depression improved, brain activity returned to normal. At age three, children whose mothers remained depressed continued to show differences in brain functioning, as well as problems with emotional regulation, aggressiveness, sleep patterns, and higher levels of stress hormone (cortisol).
Dawson says, “What we are learning is that very early in life there are these periods when certain parts of the brain are being wired and that later in life these patterns will be very difficult to change. We believe that by experiencing different emotions you’re stimulating different parts of the brain and that this leads to connections between the synapses.”
In other words, children who experience smiles and happy emotions from caregivers may have brains that are “prepared” for experiencing those emotions, while children who experience apathy, irritability, or sadness may develop brains that are predisposed to experiencing those negative emotions.
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Click here to see a list of archived articles.
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