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MICA (P) 060/06/2010
sep
oct
2010
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helping mums
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Is that lingering
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Matters of
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五大版华文内容
Timely help for preschoolers
PHOTOS: 101TEAMWORK
Programme helps kids with learning difficulties
Children like six-year-old Dave Tan have benefited from the Mission I’mPossible pilot
programme.
By Thava Rani
The sobbing would turn into outright bawling by the time they reached
the kindergarten. School was a traumatic
experience for six-year-old Javier Tan.
But for two years, his parents felt
helpless as they couldn’t understand why
Javier was afraid of going to school. That
was eight months ago. Today, a confident
Javier walks eagerly into class smiling.
His transformation is a result of his participation in Mission I’mPossible, a programme which helps children overcome
their learning hurdles before mainstream
primary school.
It found that Javier was afraid of school
because he was unable to understand lessons and answer his teachers’ questions.
27 – 31
Programmes for preschoolers with
mild developmental needs are not new to
Singapore, but Mission I’mPossible is the
first to provide hospital-based therapy and
educational support in the familiar environment of the classroom. There are 92
preschoolers enrolled in the programme,
which is funded by Lien Foundation and
run by KK Women’s and Children’s Hospital (KKH) and PAP Community Foundation (PCF). The pilot is available at 22 PCF
centres in the Punggol-Pasir Ris area.
“This is the first time the various disciplines have been brought together in
a formalised programme, and we hope
it can be implemented islandwide,” said
Adjunct Associate Professor Lim Sok Bee,
Head and Senior Consultant, Department
of Child Development, KKH.
According to Professor Ho Lai Yun,
Senior Consultant, Department of Child
Development, KKH, and Director, Child
Development Programme, Ministry of
Health, about five to six per cent or 2,000
children in every preschool cohort have
some form of developmental impediment
that affects their learning ability. “For children with speech delays, timely intervention can help them overcome the problem.
A child with mild autism, on the other
hand, may not overcome his condition, but
his skills can be improved, which is vital
in helping the child integrate into a mainstream primary school,” said Prof Ho.
> Continued on page 8
Dialysis
on the go
A wearable artificial kidney in
development may give dialysis
patients more freedom and choice
by Keith G Emuang
Four times a day, every day for the
past 10 years, 65-year-old Foo Ming Tong
hooks himself to a machine via a small
tube in his abdomen to flush out body
waste, fluids and toxins built up throughout the day – a task his kidneys would do
automatically had they not failed.
Healthy kidneys clean the blood continuously by removing excess fluid, minerals and waste. When both kidneys fail in
end-stage renal disease, build-up of waste
causes symptoms like nausea, swelling and
itchiness. A kidney transplant is the best
solution, but if the patient is physically
unsuitable for surgery or a donor is unavailable, dialysis is the only alternative.
“Dialysis is very inconvenient. I can’t
go out for too long and when I’m having
dialysis, I can’t really move about,” said
Mr Foo, who undergoes a form of dialysis
known as continuous ambulatory peritoneal dialysis. The procedure is simple and
painless, but Mr Foo needs to be home
for the four 20- to 30-minute dialysis or
exchange sessions every day.
> Continued on page 7
sep/oct 2010
singapore health
07
News
> Continued from page 1
Dialysis on the go
The new portable machine,
which is strapped around
the waist or worn as a backpack, will give patients
greater freedom.
about once a month when the dialysate
in AWAK has to be changed, while this
procedure is performed several times a
day in conventional peritoneal dialysis.
AWAK Technologies will determine
the price of the device after the trial,
I am quite dependent
on my wife for
treatment, so a device
like AWAK will suit
someone like me who
dislikes the hassle.
although Dr Ku said the company is looking to lower the costs for dialysis patients.
Peritoneal dialysis costs between half to
two-thirds that of haemodialysis, while
the latter is priced from about $2,400 to
$3,000 per month.
A natural waste filter
Mr Kang Choon Yong (pictured below),
a 58-year-old retiree who has been on
peritoneal dialysis since 2003
associated with either type of conventional dialysis, such as disruptions to a
normal lifestyle and having to use and
store bulky machines and solutions.
Peritoneal dialysis patients have to store
bags of solution, a deterrent to overseas
travel as arrangements need to be made
in advance for these bags to be available
at their destination.
By recycling the dialysate, the artificial kidney may help preserve body
protein usually lost when dialysate is
discarded in conventional dialysis. With
AWAK, the risk of infection is significantly reduced because patients stay connected to the dialysis device throughout
the day, except when showering. Connecting the dialysis device to the permanent catheter needs to be done only
Unlike automated peritoneal dialysis
which requires patients to be hooked
up to the machine (above) for up to 10
hours, patients on continuous ambulatory peritoneal dialysis (right) rely
on gravity to drive the dialysis fluid
through the body. For both types, patients have a permanent catheter in the
abdomen to transport dialysis fluid.
PHOTOs: ALECIA NEO
Kidney failure patients in Singapore
undergo either haemodialysis or peritoneal dialysis. In haemodialysis, patients
have to go to a centre three times a
week for the four- to five-hour sessions.
The dirty blood is circulated through
a machine, which removes waste substances and returns the cleaned blood to
the body. Peritoneal dialysis can be done
at home, with patients using their own
peritoneal membrane, a fine membrane
that lines the gut and abdomen, as a filter.
The patient has a permanent catheter in
the abdomen, which is attached to a bag
for waste substances to drain into.
Globally, the number of patients with
end-stage renal disease continues to rise
every year.
But hope is at hand for dialysis patients
like Mr Foo. They may well regain their
freedom if a small, portable device in
development becomes available commercially. A clinical trial is under way using
a 3kg prototype designed and developed
by a team of international doctors, local
engineers and researchers. If the trial
is successful, AWAK Technologies, the
company making the device, will look to
develop a second-generation 1kg model.
The device, known as Automatic
Wearable Artificial Kidney (AWAK), is
strapped around the user’s waist much
like a traveller’s money pouch or worn as
a backpack, and uses the same principle
as peritoneal dialysis to clean the blood.
About 700ml of a solution – the dialysate
– is pumped into the body to clean the
blood, but unlike conventional peritoneal
dialysis, the dialysate and waste are recycled through a cartridge in the device,
and reused. The excess water is discarded
when the cartridge is changed every 10
to 12 hours.
AWAK Technologies is involving Singapore General Hospital‘s (SGH) Peritoneal Dialysis Centre and a US hospital in
the trial. “We were chosen because we
are one of the larger and more experienced centres in the Asia-Pacific region
for peritoneal dialysis,” said Dr Marjorie
Foo, Senior Consultant, Department of
Renal Medicine, and Director, Peritoneal
Dialysis Programme, SGH.
“This trial aims to give patients high-
quality dialysis, which we hope will
improve overall patient survival and
quality of life. AWAK will be convenient
for patients as the device works like the
kidney in giving round-the-clock dialysis.
Exchanges are simplified and can likely be
done any time, possibly anywhere, as long
as you have the cartridge,” Dr Foo said.
For patients on conventional dialysis, waste removal occurs once every few
hours for peritoneal dialysis or every few
days with haemodialysis. “But with this
device strapped on 24/7, waste is practically removed as soon as it passes into the
peritoneum via the bloodstream, with
little or no stagnation compared with
haemodialysis,” she said.
Dr Gordon Ku, Chairman, AWAK
Technologies, said the device could do
away with many of the disadvantages
Dr Marjorie Foo and Senior Staff Nurse Thanaletchumi Krishnasamy (far sides), as well as
their peritoneal dialysis patients, (from left) Mdm Wang Lian Huay, Mr Tai See Chong,
Mr Kang Choon Yong and Mr Foo Ming Tong, are looking forward to the outcomes of the
portable kidney trial.
It’s cheaper and more
convenient. Yet,
peritoneal dialysis
is a less common
alternative to
haemodialysis
for patients with
kidney failure.
In peritoneal
dialysis, the patient’s
peritoneal membrane
– the lining of the
abdominal cavity – is
used as a filter through
which fluids and dissolved
substances in the blood
are exchanged. Waste
substances are then flushed out
as a solution containing minerals is
passed through the abdomen.
Peritoneal dialysis patients
have a permanent catheter in the
abdomen. During dialysis, the catheter
is attached to a tube, with a bag of
dialysis fluid at the other end. This
form of dialysis can be done at home
during the day or at night while asleep.
During a procedure known
as continuous ambulatory
peritoneal dialysis, the
bag of fluid is transferred
into the abdominal cavity
and left in the body for
four to six hours to allow
for waste from the blood
to be transferred into the
peritoneal cavity before it is
drained. Continuous ambulatory
peritoneal dialysis is done three to four
times a day.
An alternative, known as
automated peritoneal dialysis, uses
a machine to pump the fluid into and
out of the peritoneal cavity. Because
automated peritoneal dialysis takes
eight to 10 hours, this is usually done
at night while the patient sleeps.
08
singapore health
sep⁄ Oct 2010
News
> Continued from page 1
Timely help for preschoolers
Empowering parents
Depending on a child’s needs, different
specialists will work with him over 15
weeks in a classroom setting. This mobile
team includes a paediatrician, a psychologist, speech language therapists and
occupational therapists.
Further reinforcement comes in the
form of home programmes for the parents and other caregivers. Arming parents
with the right skills helps them manage
their children’s needs, which eases their
children’s difficulties and frustration,
said Ms Marilyn Ong, Speech Language
Therapist, Mission I’mPossible.
For instance, six-year-old Dave Tan had
difficulty with speech and language. He
could only give one- or two-word responses
to questions – a level of development that a
much younger child would have achieved
– and avoided other children.
After therapy, Dave “is able to form
complete sentences on his own,” said his
grandfather, Mr Tan Ngak Pong. “The therapy sessions really benefited Dave, but we
also did our part with the home exercises,”
he said.
“From a child who was shy and lacking in confidence, Dave has blossomed
into a confident child and enthusiastic
learner, who chats comfortably with
friends and participates actively in class.
This would not have happened without
the cooperation of Dave’s family, teachers and the learning support educator,”
Ms Ong said.
KKH team members, with the principal and teachers from a PCF centre, try their hand at
some of the common games from the centre used to help children overcome developmental challenges.
Developmental milestones for toddlers
AGE
By 18 months
By 2 years
By 3 years
Teachers’ role Preschool teachers, in constant and close
contact with their students, are best
placed to identify children with developmental needs. Calling them “a critical
link” to the success of the programme, Mr
Tang Hui Nee, Educational Psychologist
and Head, Community Services, Department of Child Development, KKH, said
teachers are given training to help them
identify and support children with developmental needs.
“However much the therapy sessions
can do, ultimately the teachers must
know how to continue managing and sup-
porting these children,” he said.
To date, 70 per cent of the teachers from
the 22 pilot PCF centres have been trained
to identify children with mild developmental needs and enhance their motor or
speech development in the classroom.
Three senior teachers have been given
the role of learning support educators to
help children put into practice the skills
they learnt during therapy. Learning support educators may eventually support
teachers by also looking after those who
merely need a little extra attention in
class.
The programme has a zero dropout
rate thanks to the teamwork between
teachers, learning support educators and
therapists.
No child is deprived of the help. Subsidies by Lien Foundation are available for
children whose parents cannot afford the
$300 fee for 10 sessions. The foundation
has fully subsidised 60 per cent of the
children in the programme.
By 4 years
By 5 years
MOTOR SKILLSLANGUAGE AND SPEECH SKILLS
PSYCHO-SOCIALISATION SKILLS
Walk
Release objects from hand
Run without falling
Build a tower with three blocks
Respond to “no” and “bye-bye”
Say and understand at least
10 words
Reply to the question: “What is
your name?”
Play cause-and-effect games and
simple games, such as talking on
a toy phone
Point to interesting objects, and
look at objects that are pointed
out
Crawl up and down stairs
Scribble
Jump with both feet off the ground
Open a bottle by turning the lid
Say to two- to four-word phrases
or sentences
Follow simple instructions
Point to an object or picture
when asked
Interact with other kids
Show interest in other children
and adult activities
Stand briefly on one foot
Walk down steps without support
by putting one foot in front of
the other
Draw circles, plus horizontal and
vertical lines
Say simple four- or five-word
sentences
Ask questions using “who”, “what”
and “where”
Show affection for playmates
Imitate adults and playmates
Play make-believe with dolls,
animals or people
Enjoy playing with friends
Hop on one foot
Hold a pencil using the thumb
and forefinger
Say five- or six-word sentences
Follow three-step commands like “wash your face, get dressed, and
comb your hair”
Hop on alternate feet
Draw shapes such as a funnel,
cone, square or cross
Tell stories
Cooperate and play with other
children