Dr. Ruwan M. Jayatunge M.D.

The term ‘learning difficulties’ is used to cover a wide range of problems. Children who have difficulty with handwriting or in learning to read and spell often manifest problems such as memory recall blocks, attention deficit, speech delay, clumsiness, poor co-ordination and other health problems.

Each child’s difficulties are unique - a combination of auditory, visual, muscular, chemical, emotional and neurological imbalances.

According to Dr. Thilokasundari Kariyawasam - a renowned Educational Psychologist nearly 30 per cent of Sri Lankan children show learning difficulties. Learning difficulties sometimes considered as a form of an infirmity which needs therapy. Many children with learning difficulties continue to struggle with learning in the classroom.

Learning is accomplished through complex and interrelated processes, one of which is vision. Determining the relationships between vision and learning involves more than evaluating eye health and clarity of sight.

Problems in identifying and treating children with learning-related vision problems arise when such a limited definition of vision is employed. Children with undetected vision problems complain of headaches when they try to read and they often avoid reading exercises.

Individuals who struggle with learning are especially vulnerable. Their difficulties may be hard for them to understand, and may go unrecognized by others. Many soon experience the embarrassment, confusion, and humiliation that go hand in hand with falling behind their peers in school.

Behavioral and adjustment difficulties - from isolation or withdrawal to clowning or acting out - can mask the original, less visible signs of learning difficulties.

Because learning difficulties are frequently not recognized early, the following signs may also be clues that an individual is experiencing difficulties with learning:

* having difficulty paying attention

* hiding, losing or avoiding schoolwork or homework

* being especially sensitive to criticism, mistakes, or poor grades

* giving up easily, appearing poorly motivated

* showing anger and frustration when engaged in schoolwork, homework or other settings

* having attendance problems, developing school induced sickness, becoming school phobic.

* avoiding schoolwork through over involvement in other activities

* becoming withdrawn, shy, anxious, helpless, hopeless, or depressed

* making excuses, externalizing blame

* lowering personal expectations for performance, anticipating difficulty or failure

* attributing difficulties to other causes, such as disinterest in the subject matter or teacher

* demonstrating lowered self esteem, difficulty taking risks, devalued sense of personal worth.

Dyslexia

Dyslexia, meaning “reading difficulty” was originally called “word blindness” and thought to be a visual problem. Many more recent studies point to language and auditory problems as the fundamental cause.

Listening is the most basic skill required for verbal communication and a weakness in listening ability may hinder the development of a strong language base.

Consequently, the child encounters problems when it comes time to approach the more complex linguistic tasks of writing and reading. If the sounds of speech have not been accurately heard, they cannot be accurately conveyed by symbols.

The left hemisphere of the brain is the main centre for processing language. In order for speech sounds to reach the brain efficiently the right ear must take a leading role in listening because the right ear communicates most directly with the left hemisphere.

Some experts contend that children with dyslexia have failed to achieve right ear dominance and that therefore the order in which they hear sounds becomes jumbled. If they sometimes use the left and sometimes the right ear as the directing ear, sounds may reach the brain at different speeds, so letters will be jumbled.

Autism

Autism is a disorder of the brain that causes lifelong development disability. Symptoms become evident either from birth or may being to appear after a period of normal development.

Autism is known as a spectrum disorder, because the severity of symptoms ranges from mild learning and social disability to serve impairment with, multiple problems and highly unusual behaviour. The disorder may occur alone or with accompanying problems such as mental retardation or seizures.

Alzheimer’s risk skyrockets when both parents diagnosed: study

The risk of developing Alzheimer’s disease skyrockets when both parents are struck by the degenerative brain disorder, a study published Monday has found.

The dementia also seems to strike at an earlier age among patients with a wide family history of the disease, the study published in the Journal of the American Medical Association’s Archives of Neurology found.

“Because Alzheimer’s disease is so common in the general population, it is not uncommon for both spouses to develop the disease,” wrote lead author Suman Jayadev, of the University of Washington, Seattle.

“Offspring of two such affected individuals would presumably carry a higher burden of these Alzheimer’s disease-associated genes.”

Jayadev and her colleagues studied the frequency of Alzheimer’s disease in adult children of 111 families in which both parents had been clinically diagnosed with the disease.

They found that of the 297 offspring who reached adulthood, 22.6 percent developed Alzheimer’s disease compared with an estimated six to 13 percent of the general population.

But since 79 percent of those still untouched by the disease had not yet reached the age of 70, it is likely that the actual risk is higher, the authors concluded. That’s because they found that the risk of developing the disease increased with age: 31 percent of those older than age 60 and 41.8 percent of those older than age 70 had been diagnosed with Alzheimer’s.

At age 80, the cumulative risk was determined to “beyond 60 percent.”

The presence of Alzheimer’s disease elsewhere in the family did not seem to increase the likelihood of developing the disease.

But it was linked to an earlier onset: those whose family history of Alzheimer’s was limited to their parents had an average onset of 72 years; those who had one parent with a family history of Alzheimer’s had an average onset of 60 years; and those with a history of Alzheimer’s on both sides of their family had an average onset of 57 years.

AFP

Dr. Yamuna Kumari Ranaweera Most Outstanding Innovative Physician of the Year

The Ceylon College of Physicians has honoured Dr. Yamuna Kumari Ranaweera Dassanayake, Consultant Physician, Base Hospital N’Eliya as the Most Innovative Outstation Physician of the year.

The Sri Lanka Medical Association in its February News bulletin writing about her under Doctors who have gone that extra mile - series says “we salute her and hope that the Ministry of Health too will develop recognition and reward scheme for such hidden jewels glowing in the dark” Here’s the SLMA tribute to her.

“Doctors who have gone that extra mile” series:

Dr. Yamuna Kumari Ranaweera Dassanayake was appointed as Consultant Physician to the Nuwara Eliya Base Hospital in 2005.

Since then, with her curative team she has infiltrated into the peripheries of the District conducting many awareness programmes on risk factors of Non Communicable Diseases (NCD) and screening programmes for early detection of NCD. Attempted suicide using pesticide is a major problem in the area.

She has introduced the so called “safe poison box” to keep pesticides. It has two padlocks and therefore requires two persons, each with a key to open the box. There is a high prevalence of Rheumatic Heart Disease (RHD) among females of child bearing age in the District.

They usually present during their pregnancy. Dr. Yamuna has introduced a method of early screening for RHD among young girls so that timely initiatives can be taken for a safe pregnancy.

Another commonly encountered problem is burn injuries among epileptics caused during the epileptic episode as they fall into the cooking fire place. She has initiated the concept of safe fire places in homes with epileptic patients.

The SLMA recognised her efforts by awarding her unit with the special diabetic day award in 2006 and in 2007 the Ceylon College of Physicians honoured her as the Most Innovative outstation physician.

We salute her and hope the Ministry of Health too will develop a recognition and reward scheme for such hidden jewels glowing in the dark. Other Districts with similar health problems could be encouraged to emulate these initiatives.

Good eggs and bad eggs among doctors

Prof. Lalitha Mendis SLMA President writing on Good Eggs and Bad Eggs in the Medical profession in the SLMA News sheet February 2008 says.

Good eggs and bad eggs

We often see media focus on alleged malpractice and unprofessional conduct by doctors as well as deficiencies in the health services of this country. In fact, doctor bashing appears to have become a national past time.

It is perhaps time that the profession and its various limbs such as the Ministry of Health, Private Hospitals Association, the SLMC, SLMA, Professional Colleges, the GMOA and the PGIM examine if the existing processes to deal with such persons and situations is full proof. e.g. why do supervisors of postgraduate students fight shy of recording a negative observation in a progress report?

Do administrators in the Ministry of Health devote sufficient attention to verbal complaints about doctors? Can procedures at the SLMC be fine tuned and accelerated? What contribution can the GMOA make as a responsible Trade Union? Conversely, there are very many doctors who go that extra mile on behalf of the well being of their patients. In nearly all government hospitals, doctors deal with an incredible load of patients.

Several innovations have been introduced into practice. The medical Professional Colleges dedicate themselves to improving patient care and meet with Ministry of Health officials regularly to put identified improvements to practise.

Several such suggestions have in reality been picked up and introduced by the Ministry. Unfortunately much of this goes unrecognised and is not acknowledged and not brought into the public eye.

Free papers at SLMA sessions

Among the free papers to be presented by doctors and discussed at this year’s Annual SLMA scientific sessions to be held at Cinnamon Grand Hotel, Colombo from March 19-22nd are:-

Anxiety - the chameleon of Medicine by Dr. Sherva Cooray (under Mental Health)

A successful story from Sri Lanka - by Dr. J. W. Karannagoda (Under Hospital Waste Management).

Preventing a death in the family - by Dr. Seneth Samaranayake (Under Patient Safety and Safety in Practice)

Making mistakes apparent - by Dr. Jayantha Jayatissa (Under Patient Safety and Safety in Practice)