Field trip report to Nubra August 21th to August 24th

• Dechen, Urgain, and I travelled to the Nubra region on  21st to 24th August  for a field trip. On 21st We directly travelled to Nubra  Sumoor to meet the  our patient T. G.. We asked his mother," Are you doing exercises for him at home what ma'am Chuskit taught you last time visited. We applied the sitting position where we learnt from the Rosemarie and Haikey ma'am during the training time. I also give him some passive range of motion exercises for his hands and legs. We also showed his mother how to support him while sitting position. We asked his mother to record a video of him in sitting position and send it to us. He was overjoyed to see us. During our visit he able to communicated both verbal and non-verbal. In verbally he able to speak in 2-3 words utterances but not intelligible. So, we taught her mother to do oromotor exercise for them like tongue and lip movement. and also, for improve his speech intelligibility we taught his mother the placement of articulation and ask his mother to teach him whenever he produces articulation error. His hygiene was good compare to last visit.

• Next patient we went to meet the T. D. at Sumoor village, Nubra. We asked him," Are you doing exercises regularly which ma'am Chuskit taught before. He told us his left leg becomes more weeks as compared to before and sometimes he has problems in balance and suddenly it becomes unconscious. He requires an orthotic shoe as well as a urine bag
• Next patient name S. C.. She was completely dependent on her parents. She is not able to speak. So, we taught her mother to teach prelinguistic skill like oromotor exercise, blowing in different level and object to object matching and imitation and show the flash card and try to produce the cooing sound.She drooled a lot, so we showed her mother some oral motor exercises to stop it. I advised the mother to keep the cushion on both of her daughter's knees because they were joined together. We also keep her on a chair to keep her in a sitting position, but since she couldn't keep her legs on the floor, we placed a pillow under them to make it easier for her to do so. We also taught her mother to maintain a sitting position.I also showed her mother how to do a passive range of motion exercise with her hands and legs.
•  Next patient at Bokdang Nubra, we proceeded to meet the G. A. He wasn't feeling well on the last visit. This time, he was using both hands to support himself as he moved from one room to the next room. For fifteen minutes, we kept him on sitting position with contact support so he able to sustained and feel more comfortable. We also instructed his mother to maintain his seating position for ten minutes, I instructed him breathing exercises. We also instructed him to write the alphabet and he is doing his best .I give the active range of motion exercises his both hands.  He able to speak 2-3 words utterances. We taught some articulation placement for him because hes produces articulation error for some sound.

• Next patient M. A. he came to Gulzar house to meet us and to give therapy for him there its self because he like to do exercise with Gulzar. he frequently used to come Gulzer house to play with him. I taught him breathing exercise, side walking with contact support of wall with both hands, arm raising and leg extension and reflection. We also taught his sister, on sleeping position that is the best position for scoliosis is to sleep on back as well as you should try your brother to sleep on his side or back which is typically more comfortable with a roll pillow. We also took him outside to climb the stapes and stairs and try to walk on the each. He feels little bit difficult for higher stapes so we taught his sister to give little support while he was working on higher stapes and stairs. He is very active to do all this exercise.  He is well communicated with us.
• Next patient S. A. at his home. Currently he is working independently and well communicated with others. Now he had a complaint of his right-side leg is paining sometimes. Other than that, he is doing well.

• Next patient we went to meet the S. U. at Turtuk village Nubra. When we met Saif uid din, he improved a lot and he started to speak one to two word in Hindi as well as Ladakhi. We asked her mother to do oral motor exercises and increase his vocabulary using flash card and models to improve his length of utterances regularly at home. He is very happy to play with his elder sister.
• Next patient we meet I. A. at home. He able to move indecently. His father borrows work out cycle with twister for improving his exercise. He is doing very well doing with this equipment.  We did some passive range of motion exercise for his both legs. He able to go  up and down by using stairs. 

•  Our next patient we proceeded S. K. at Turtuk  .We give her exercises for side walking  without support and squeezing a ball with her left hand because her left hand is week. We also advised her mother to perform the squeezing ball exercise frequently at home. We also give her two different level of sensory balls so she may workout with a ball. She able to produce single sound so we taught her as well as her mother to try to produce babbling sound and oromotor exercise. She able to follow all the command and well understanding.

• Our next patient is J. P.. We went to meet  his mother's office . He was very intelligent and he loved to draw on the computer . He loves to use the computer and he mostly watches cartoons. With the support of us, we tried to walk him for 10 minutes. I also provide the passive range of motion and ankle range of motion . We put him in a sitting position on sofa. His mother is planning for him to send a Ladakh for therapy because his father was retired from army. He able to speak one words like /ama/, /aba/ etc. inspired of watching cartoon we taught his mother to show phoneme production for alphabet to improve his articulation in you tube and also ask him to draw and watch different kind of lexical category like fruits, vegetable, transport, body parts, shapes, and common object to improve his vocabulary as well as length of utterances. 

• Next, we went to meet the T. F. But unfortunately, we didn't meet her because some of her relatives passed away, so her mother told us that she is in her relatives'  home . We asked mother" how's your child. Are you doing exercises regularly and if you have any questions related to therapy, just call for us we will meet through video call to teach you.

We found a new patient in the village of Nubra.

• Our first new patient name is A. K., he is 13 years old. who is a student at the government model school Turtuk, he is trying to get away from us because he was very shyness person. Although we try to bring forward to us. We done the assessment for him. He was diagnosed with slow learner. So, we counselling to his teacher to put him on special school to improve is education. He is currently living with his father because his mother was no longer together.

•  Next new patient Z. in Takshi Nubra, we meet him at the Higher Secondary School Takshi. His diagnose was Scoliosis. His is 14 years old. He is in sixth standard. He is currently struggling with speech issues and learning difficulties.I performed for him the side walking exercise, breathing exercises,  and arm and leg raise exercises. He was unable to read or write when we asked him to write the alphabet. He enjoyed to play the game.

• Next new patient N. F. we meet her at Thang Nubra. Her diagnose is bilateral cerebral palsy. She is 19 years old. She was lying on the side of the bed when we first meet her, and even her parents were not properly caring for her. Her left hand has fully become constructed. She is the only serious patient we met at Nubra thang. We keep  her in a sitting position with the support of a pillow under her legs . I did the passive range of motion exercise and ankle range of motion.. I also told her brother to do exercise for her regularly, which I taught her . Her left hip was rotated to the right side of her leg. We keep the pillow underneath of the foot so she can relax for a time. She has a wheelchair, but that wheelchair is too small for her. So, we told her brother to brought to bring bigger size wheelchair. We also told his brother to keep her clean because her hygienic was very poor.  

• Next new patient name is T. C.. His diagnose with spoken language disorder secondary to hearing impairment. He is 19 years old. His grandparents are looking for him. His family background is very poor because his father is marred with another girl and his mother has mental illness. So, we gave some counselling to his grandparents and we provide some cloths to him.  They need financial support for him so, we took some document to try to get sponsor ship with the help of social department.
• Next new patient name J. C.. Her diagnose was bilateral cerebral palsy. she was completely dependent on his parents. She is not able to speak. So, we taught her mother to teach prelinguistic skills like oromotor exercise, blowing in different level and object to object matching and imitation. And ask her bother to play with her by introducing toys names and making some symbolic play to improve her attention as well as to improve prelinguistic skill. Now she is on cooing stage (produce single sound like a, e, u) so, we taught her mother to teach babbling, combination of vowel and consonant like /ba/, /ma/etc.  Her parents were biggest supporters. Her mother often does exercises her at home. I performed the passive hip range of motion once more, beginning with hip flexion and extension and ankle range of motion. We also taught her mother to put her in the sitting position and we advised her to offer the child some activities to practise her fine motor skills and make eye contact with others. She had previously owned ortho shoes, but those shoes had become too small, her mother asked us to provide her with new ones.

Report by Therapist Lobzang Dolma