4P-S1-2

 

EARLY DETECTION AND MANAGEMENT

OF CHILDREN DISABILITIES IN THE COMMUNITY

Angela B.M.Tulaar, Medical Faculty, University of Indonesia,

Jakarta, Indonesia

 

            The number of Pediatric disabilities in Indonesia tends to increase, not only due to the developments of science and technology in the field of medicine leaving more surviving high risk babies with severe disabilities, but also due to the increasing awareness of the parents making early consultations.

Early detection programs of disabilities have been carried out through different methods, at variable community levels in several places including through the primary health centers and the integrated health services post called the POSYANDU in the villages. Professionals ranging from medical, paramedical, and even volunteers or cadres in the community have been involved in these programs.

A simple method of early detection done by trained volunteers / cadres at the village level uses the WHO manual or its modification. Manuals and posters were developed locally by the Department of Health of Indonesia, and also by private institutions like the Foundation for the Care of Children with Disabilities (YPAC) at the Prof.Dr.Soeharso CBR center for excellence in Solo. Researches are continuously done, such as in the Training centers for Residents Physicians in Physical Medicine and Rehabilitation at the Medical Faculty in the Universities.

The ELM  (Early Language Milestone Scale) was tested to detect related factors influencing delayed language development (Sri Wahyuni, Nasution A, Tulaar ABM, 1998). Subjects were 214 Toddlers brought to the POSYANDU at an area in Central Jakarta. Results showed 9.3% delayed language development and a significant correlation was noted with the gross motor development (p< 0,05) which was evaluated using the 6 items of raising head, prone position, sitting, crawling, standing, and walking. A significant correlation was also found with working mothers with p< 0,05. No significant correlation found with bilingualism, parent education, number of children, social economic status, nutritional status, and gender.

The Functional Independence Measure for Children or the weeFIM, developed by the UDSMR (Uniform Data System for Medical Rehabilitation) is one of the instruments used to measure functional status in children. This weeFIM was modified in our institution (with the permission of UDSMR) to suit local conditions and comparatively tested (Erawati DN, Nasution A, Idris FH, Tulaar ABM, 1999).

Subjects were 235 children aged 2 to 6 years old, considered normal, joining several nurseries and play groups in the municipality of Tangerang. Modifications were made at the three (3) subscales of the weeFIM (selfcare, mobility, cognitive) namely on the items for eating, bathing, toileting, transfer in toileting and bathtub. Evaluation was done through an interview with the parents. Results showed that scores with the original weeFIM and the modified weeFIM are still below the standard scores of the UDSMR. This could be due to the inapplicability of some of the items such as bathing, toileting, toilet and bathtub transfers, because some of the subjects are not really performing those items in their daily activities. However, the modified weeFIM scored higher than the original weeFIM, which would lead to the conclusion that modified weeFIM has more suitable items for evaluation, and thus, instruments for evaluation of functional status should best be modified suited to the local culture and traditions. Maternal status of working showed correlations where higher scores were found in non-working mothers. The same thing was noticed with the number of people in the same household, wherein more people in the household resulted in higher scores, probably because there are more people attending to the child's needs which decreases independency.