Q: We often use the term ‘head weight’, does it mean head is heavier than rest of the body?
A: Well, a man carries 1.2- 1.4 kg of brain in his head, if u call that heavy. But creator was kind enough to make sure the weight is not felt as it floats in a bag of fluids.

Q: How does that brain gets to know everything happening in and around ourselves?
A: That’s because we have enthusiastic messengers (quicker than e-commerce buddies),Basic unit of brain is neuron. There are about 10¹² neurons in the brain which transmits/receives impulses from all the parts of body.

Q: You said that brain floats, does that mean it is protected? if yes, then how does accidents/ trauma lead to its damage?
A: Yes, it is protected by a hard skull and a bag of fluids. Brian is not like other organs such as heart, kidneys, liver etc., which can be handled in vivo. Brain is soft and fragile in nature. Imagine a butter that is got from churning curd, usually kept in pot containing water, undisturbed. If u disturb the pot or the water, the butter gets disintegrated same applies for the brain. Keep it safely.

Q: Interesting! Can you tell us how nutrition affects brain function?
A: Nutrition is very important. Brain is dependent on glucose level of your body. Hypoglycaemic coma is a condition where when your blood sugar level falls around 70, the person loses consciousness. Hence make sure you take right amount of nutrients as metabolism of brain is not like other organs in our body.

Q: Brain and communication – How does that happen?
A: There are areas which carry out specific functions. Some of these areas are specific to memory, audition, vision, emotion, behaviour, language and skeletal movements. Brain receives impulses from sense organs through specified networks. Brain acts as a computer to store, recollect and relay.

Q: What happens when a person meets with accident and gets head injury?
A: Remember the butter analogy? When inertial forces are applied, brain undergoes trauma. The result of an accident can be an open head injury or closed head injury. Closed head injury is the severe form as there is a chance that brain had undergone diffuse axonal injury (where your fibres are sheared due to rapid acceleration/ deceleration). This condition is hard to find in CT/ MRI.

Q: Can u give us an analogy of how sensitive it is to handle a person with head injury?
A: All that is aimed, is to protect from further damage to neuron. Imagine a wilted crop/ plant, you will have to protect it from all the organic and inorganic harms that is bound to occur. Keep it undisturbed to any of the causes, watch, protect and nurture for it to rejuvenate.

Q: They say a team of members are required following trauma care, Is it true?
A: Yes, from the person who attends and calls up for help, medical team (Physician, Neurosurgeon, Anaesthetist, various technicians when life support needed, Rehabilitation professionals, Nurses and significant staff members who attend, till the family members who takes care on a daily basis form the entire circle of team members for trauma care.

Q: Any general tip for public regarding trauma care?
A: Remember, Medical team can make all the effort to save the recovery done, rehabilitation can be supported through the allied medical professionals, however, it is up to the individual to protect from enemies by maintaining healthy life style. Prevention is better than cure, hence, protect yourselves and the loved ones by following simple traffic rules and healthy rules to win over after effects.

Q: What is Seizure?
A: ‘Seizure’ means ‘fit’, a neurological disorder in which individual throws repetitive jerky limb movements with or without loss of consciousness. Sometimes patients fall to the ground with occasionally frothy draws from the mouth and urinate. They usually recover after 2-3 minutes with deep breathing.

Q: What causes seizure?
A: Seizure is caused due to increased electrical spike of action potentials of neurons. It can also be expected due to head injury, brain fever, meningitis, brain tumor or stroke hematoma. In some it can occur due to metabolic conditions such as hypoglycemia or diabetes.

Q: Can giving iron articles help? If not, how do we help them?
A: There is no benefit in giving key or iron articles to the individual during seizure. The best way will be to make them lie flat, turn his/her body and face either towards the right or left side. Just keep him/ her in that position till jerky movements stop. Slowly the individual is bound to recover. They will start breathing deeply in and out. Make him/her comfortable to take good air and breathing, loosen tight bearings such as hip belts, to release abdomen pressure if any. Keep his/ her head turned on to one side so that individual do not choke his/ her own frothy saliva or any foreign bodies in the mouth, dentures etc.

Q: What are the after effects of seizure?
A: After recovery, the individual often feels body pain due to post tonic clonic skeletal muscle convulsions. Some may feel weakness in the limb which is called skeletal post seizure weakness.

Q: Can seizure happen to anyone across the age range?
A: In children ‘febrile fits’ are more common. It usually occurs between 6 months to 5 years of age when temperature is about 100 F or more. But this is not common to all children. In adults, usually they are known to have history of seizure. They need to be careful after full stomach, as they are prone to chocking of food particles and saliva. There are other diseases mimicking seizure disorders across age groups,

1. Syncopal attack: A normal standing person on hearing emotional, shocking news or sudden pain, falls on the ground with loss of consciousness and throws jerky movements of limbs. They often sweat, few minutes after pulse returns, regain consciousness, and resumes back to normality

2. Urinary syncope: (micturition syncope) more common in old people, who had no previous history of seizures. On getting up from bed in the early morning, goes to toilet, urinate and falls in the bathroom with few jerky movements of limbs and later regain consciousness 3. Photosensitive epilepsy occurs when patient is exposed to flickering lights, commonest being television & mobile phones, it is seen around puberty and is also genetically determined.

Q: Does that mean children will be on anti-convulsive drugs?
A: Febrile fits do not require anti-convulsive drugs; line of treatment involve subsiding temperature, and not all children throw fit at high temperature.

Q: Are there any early indicators for seizures?
A: Some early signs include mild headache, confusion, unusual smell, burnt meat or rotten egg smell and lip smacking.

Q: Suggest preventive measures for seizures
A: Do’s Good sleep (as deprivation precipitates seizure), Mental relaxation- meditation, avoid strenuous eye strain (binge watching television, mobile phones), eating right (balanced diet), regular medicines

Dont's Avoid alcohol, avoid driving car/ two wheelers, going near wells/ ponds, standing on top of building, edge of staircase, working near fire/ electrical appliances The most important measure is to continue medicine till seizure free interval of 3 to 5 years, and don’t terminate medicine without consulting the treating doctor.

The aforementioned legislation was enacted by repealing the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995. The new enactment is pursuant to the UN Convention on the Rights of Persons with Disabilities to which India is a signatory.

One of the most significant changes in the present Act is the enlargement of the benefits under the Act to certain specified disabilities such as acid attach victims, persons suffering disability to neurological disease such as Multiple sclerosis, Parkinson’s disease and blood disorders such as haemophilia, thalassemia, and sickle cell disease.

In addition to the above the Central Government has also been empowered to notify any other category under the definition of Specified disability.

One of the more significant features of this enactment is that it provides for free education for children with benchmark disability between the age of six and eighteen years in a school within his neighbourhood. Further, special reservation is also being mandated to the extent of not less than 5% in higher educational institutions and provides for relaxation of five years in upper age limit.

While reservation in Government positions is mandated under the enactment, it also provides for incentives to employers in private sector. However, it is not clear as to the nature of incentives for ensuring atleast 5% of persons with benchmark disabilities.

The 2016 Act also enforces the provisions contained therein by imposing penalties for contravention of the Act. To quote some of the notable ones, any form of intentional insult or intimidation of a person with disability, assaulting such person, sexually exploiting them, and committing similar such atrocities shall be liable for imprisonment for a term that is not less than six months and extend to up to 5 years. This is a significant development from the 1995 Act which did not provide for any specific way offences against persons with disabilities can be dealt.

In addition to the above, the 2016 Act also includes the guidelines for the assessment and certification of specified disabilities. The Act also creates a special National Fund as well as individual state funds for persons with disabilities and the said Funds are to be utilized for the benefit of the persons having disabilities.

While physical disabilities have always been recognized under Indian laws, Mental health and its well being have often been overlooked and thus in the year 2017 India enacted the Mental Healthcare Act, 2017 in line with the Convention on Rights of Persons with Disabilities and its Optional Protocol, which India had signed and ratified on 01.10.2007. This particular enactment brings mental illness on par with physical illness, which is a significant step ensuring the rights for patients with mental illness.

Q1. Are oral problems common in children with special needs?

Children with special needs may have impaired cognitive abilities, behavioural problems, impaired mobility, neuromuscular problems—drooling, gagging and swallowing problems, uncontrolled body movements, gastroesophageal reflux, or seizures. These complications can be barriers to adequate oral care and put them at higher risk for developing oral health problems. Further, some factors contributing to poor oral health in children with special needs are:

1. Genetic structural (enamel/ dentin/ bone), missing teeth and malocclusion (that do not align properly), gum disease.

2. Physical Cannot chew or move their tongues properly do not benefit from the natural cleaning action of the tongue, cheek, and lip muscles. Difficulty brushing and flossing as po

3. Physiological Reduced saliva flow and reduced intake of water owing to disability are predisposed to difficulty in swallowing and dental caries. Also, some tend to produce thick pasty saliva normally that predispose them to salivary stone.

4. Medications Using sweetened medications for a long time can get tooth decay also some anti-seizure medications may cause swelling or bleeding in the gums

5. Restricted diets Children who have difficulty chewing and swallowing may often eat puréed food which may stick to their teeth.

Q2. Can you please elaborate frequent dental issues in children with special needs and what to expect?

Yes, the following are some of the common conditions observed in children with special needs:

1. Teeth grinding (bruxism) -Severe tooth wear from grinding can result in teeth being worn flat or tooth abrasion, which can lead to tooth loss. Commonly seen in children with sensory difficulties and compromised intellectual ability

2. Dental trauma (injury) is most common in children who experience seizures, uncontrolled protective reflexes or poor muscle co-ordination.

3. Dental/oral anomalies are abnormal variations in the development of teeth, which affect eating, feeding and maintaining oral hygiene. They are usually linked to inherited defects or spontaneous genetic mutations which could be seen as malformed, missing or extra teeth. E.g: Downs syndrome, cleft of lip and palate, ectodermal dysplasia and many more.

4. Malocclusion (misalignment of upper teeth with lower teeth) -teeth crowding create problems for oral health care because affected teeth and their interdental spaces are harder to clean. Children with developmental disorders, craniofacial anomalies, muscular dystrophy and intellectual disabilities may be affected.

4. Malocclusion (misalignment of upper teeth with lower teeth) -teeth crowding create problems for oral health care because affected teeth and their interdental spaces are harder to clean. Children with developmental disorders, craniofacial anomalies, muscular dystrophy and intellectual disabilities may be affected.

5. Others include early onset periodontal disease may be experienced by children with immune response and connective tissue disorders. Early, late, stagnant or erratic tooth eruption may happen to children with growth disturbances in their tooth formation and development.

Q3. What Parents Can Do to Maintain Good Oral Health?

Toothbrushing positions There are many ways to position a child for brushing. These may change with child’s age, and they depend on the child’s physical or medical condition. Try different positions for brushing your child’s teeth to find one that works for your child and you. Brushing does not have to happen in the bathroom, try your child’s room or other spaces. Here are some more examples you may try:

1. On the floor – Place your child on the floor, sitting up. Sit right behind him or her on a chair or stool. Tip the child’s head back into your lap. If your child will not sit still, gently place your legs over your child’s arms to keep him or her still. You can also lay your child on the floor, with his or her head on a pillow or on your lap. Kneel or sit behind your child’s head. If you need to, use your arm to keep him or her still

2. In a beanbag chair –If your child can’t sit up, place your child in a beanbag chair. Use the same position described above for sitting on the floor.

3. On a bed or sofa. Lay your child on a bed or sofa, with his or her head in your lap. Support your child’s head and shoulders with your arm. If your child will not stay still, another person can gently hold his or her hands and feet.

4. In a chair or wheelchair. Stand behind the chair or wheelchair. Use your arm to brace the child’s head against the chair or wheelchair or against your body. You can use a pillow to make the child more comfortable.

Q4. Any word of caution to parents?

Yes, some children make extra saliva during toothbrushing. To prevent the child from choking on saliva, make sure the child’s head is not tilted far back. Whichever toothbrushing position you choose, hold the child’s head upright or to the side.

Q5. Any tips/ tricks to make brushing fun?

Sing a song while brushing your child’s teeth. Or count or say the alphabet while you brush your child’s teeth. You can also tell a story, sing a nursery rhyme, or make animal sounds while brushing.

Q6. Any tips/tricks to parents to make dental visits stress-free?

Before visiting the dentist, sit down with your child and discuss the process. Explain to them in a way that they would understand, you can also use visual prompts that the dentist is there to look after their teeth and assure them there is nothing to be afraid of. Regular visits to the dentist can help to build a good rapport and trust between the dentist and child, reinforce daily oral care techniques and identify any problems before they turn into major issues. Avoid Negative reinforcements with your child while addressing Dental issues.

COVID-19 pandemic situation has forced the people to stay indoors most of the time we find over selves forced to stay and carry on our activities from home, similarly people with disabilities are also forced to stay and adapt to a lifestyle at home. Focus of this paper is towards the same, Design strategies proposed here are/were implemented in the industry for a certain period of time Architectural interventions include spaces that can be provided for users with certain disability and spaces required by that user group for a particular therapy to be conducted at their homes.

Additions to the existing spaces such as ramps for easy accessibility, provision of elevators are generic design implementation prevalent in the design of the building. Another addition could be light mechanical elevators which can be wheelchair friendly, accessibility can be provided for wheelchair users by providing them by providing mechanised height changeable countertops.

Provision of tactile paving can be helpful for users who are unable to see and provision of marked tiling on the walls can make the users move with ease. Also creating a new space catering towards treatment of one of the therapies may it be hydrotherapy – where a pool area can be provided for the therapy, colour therapy can be reflected in the material of the rooms reflecting emotions also providing certain sound cues that will be pleasing to the users which would be beneficial for users experiencing autism.

Similarly for speech therapy by creating interactive spaces which would respond to the user when they use or interact with paintings. This space can act as a therapy room whenever the user senses that particular object by interacting with it. Another design intervention can be alteration of rooms for Alzheimer patients in a way creating a repetitive learning process for their memory.