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Following are a few sample questions we have selected - you can use the category listing to the left to find more questions and answers relating to your areas of interest. Click on a question to see the answer.
I "follow" a CP chat group on facebook and one woman asked about phenol injections. no one had really heard of them. What is this? Who it is suitable for?
 Joshua Alexander, MD: Phenol injection is another option for spasticity management in a specific muscle (unlike baclofen or other medicines taken by mouth that decrease spasticity throughout the body). Here's an edited part of a description from (with my comments in parentheses- JJA) "Phenol and alcohol are injected onto nerves or into muscles to destroy them. Phenol and alcohol can effectively weaken a spastic muscle, which reduces spasticity and allows improvements in range of motion. These agents are effective in treating spasticity that occurs in large, powerful muscle groups close to the trunk, such as those of the thigh. Alcohol or phenol may be used in combination with BoNT (botulinum toxin- JJA), and all may be combined with other antispasticity treatments. The duration of effect is quite variable, from less than 1 month to more than 2 years (I usually hear it lasts from 4-8 months- JJA). The cost of either phenol or alcohol is much less than that of BoNT. When cost is a major concern, phenol or alcohol may be used to treat muscles in which BoNT could also be effective. (but this does not include the cost of sedation/anesthesia which always has to accompany phenol injections to allow the child to tolerate the electrical stimulation/shocks that are used to make sure the phenol is injected in the right place - JJA) Unlike BoNT, phenol and alcohol do not provoke a reaction by the immune system. There are several significant disadvantages to the use of phenol and alcohol. Phenol and alcohol may produce more troublesome initial side effects than BoNT, such as burning and odd sensations called dysesthesias. Damage to nearby sensory nerves may cause temporary or permanent pain, which may require medication to control."
Does anyone know of a private school that would be a good fit for a 6 year old with ADHD and learning disabilities?
 This question was posed to a number of experts on the WATCH ListServ, and the following are the responses. -Consider Fletcher Academy, although he might be a little young for them. -Don Rosenblitt, Director of The Lucy Daniels Center -Chesterbrook Academy in Cary, NC has a program that specifically works with children with LD. The program is called Paladin. It is expensive, but they are now fully mainstreaming the children into the private school setting with all the other supports for teachers and resource materials that, if they are still doing, are specific, research based and evidence based practices that will help children with ADHD, processing difficulties, social skill needs, and organization, study practices etc. I am not sure how it is run now, call Tina, the principal. -Mary Henson -If the family can make it over to Durham, I've heard good things about the Hill Center -Joshua Alexander -The Trilogy School is located behind CPI on Merton Drive (781-7804). Kids with ADHD and LD are their target population from what I understand. It is a small school with very small teacher/child ratios. -Kathi Gillaspy
I am trying to help a mom who has a young child with autism who is now trying to escape from her carseat while they are driving. Does anyone know if there are special latches or carseats that are harder to get out of?
 This question was posed to a number of experts on the WATCH ListServ, and the following are the responses: -I bought a device called BuckleGuard from Babies'R'Us. It slips right over the buckling mechanism and has a tamper resistant cover. It should be worth a try. -Vijaya Tangella, Psychologist -It appears that Babies r us no longer carries this but I did a google search for buckle guard and there are several websites that sell similar devices. Thank you for responding. I also have a family with this problem and I never realized there was a device to be used for seat belts. For the time being, the family placed her back in a harness car seat. -Alison, CCT -I've heard good things about the E-Z-On Vest -Joshua Alexander
Can You Give Me More Information About Salivary Gland Ligation Surgery to Treat Drooling?
 Joshua Alexander, MD: Drooling is a common associated condition in children and adults with cerebral palsy. In my opinion, partial ligation of salivary glands is a good option for those children whose drooling is not treated sufficiently by oral motor therapy, and medical management (with scopoplamine or robinul). Botulinum toxin injection management is also a useful, but temporary, intervention. For a more permanent solution, the surgeon will partially ligate (close-off) either the parotid or the submandibular glands (the glands that make saliva). When successful, this operation can significantly reduce the amount of saliva (and thus, drooling) the child exhibits without making the mouth too dry. If the mouth becomes too dry, it can impact eating and swallowing and increase their risk of tooth cavities. While I hope that this provides you both with a little more information, the best resource to answer this question is the surgeon or the surgeon's nurse, who can discuss the specifics of the surgery, the recovery (based upon their prior experiences), and the potential side effects.
Our child has recently been diagnosed with sensory integration dysfuntion. It has taken over our lives. She will give up fun activities with friends if the even requires her to wear socks, she now refuses to attend gymnastics class due to the leotard she has to wear, and we encounter "melt downs" every morning due to having to put on clothes that are "too tight" (although those clothes are a size too big). Do you think OT would be beneficial and what types of techniques are used?
 Linda King Thomas: The behaviors which are described indicate a Sensory Modulation Disorder (this is a type of sensory integration disorder also known as sensory integration dysfunction). Based on these behaviors your daughter would be a good candidate for sensory integration therapy. Intervention would include parent and child education regarding this diagnosis, therapy intervention and developing a home program of sensory input (sensory diet) to help modulate the over-responsiveness to sensation. A good reference on this subject is the book, Sensational Kids by Lucy Jane Miller. Linda King-Thomas MHS, OTR/L Developmental Therapy Associates 3514 University Drive #8 Durham, NC 27707 919-493-7002 ext.23


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