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.