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CASE REPORT a Case of Multiple Myeloma with Unusual Serum

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Introduction segments during the performance of activities. Acquired brain injuries, such as Thus, the rehabilitation of children with mild hypoxic-ischemic lesions up to the age of three, motor impairment of the hemiplegic type may are among the ten main causes of spastic prove to be especially challenging to therapists, hemiplegic cerebral palsy (CP). Although it requiring profound technical knowledge and does not severely impair functionality in creativity. children, hemiplegic motor impairment The progression of the therapy in these children produces neuromotor alterations that cause is often compromised by the difficulty in finding precision deficits in movement performance and tasks that motivate them, while at the same time deficits in postural control, which is responsible showing therapeutic efficacy. for the stability and alignment between the body Developmental therapy allows the child with and nervous system are maturing in the presence the human nervous system when damaged has of the damage and this cannot take place in a powers of compensation. In addition, the baby vacuum. The way the baby is handled and the and young child are still maturing and dormant mild motor impairment and high levels of temporal, posterior temporal and occipital attitudes that surround the baby influence how abilities can be activated. In cerebral palsy there functionality to perform tasks close to those regions. MRI of brain was advised. the maturation expresses itself in the subsequent is a potential for abnormal patterns of movement performed in their daily routine, facilitating the Developmental Therapy (motor therapy, child’s and adult’s ultimate function. and posture to become habitual and deformities transposition of the motor learning generated stimulation program, visual stimulation) is Although the motor delay and dysfunctions are can occur and become fixed. Prevention of during therapy and leading to measurable continue with regular follow up for 14 days the main problems in the cerebral palsies there is deformities is possible to a large degree and functional gains, increasing the social interval and psychological assessment the possibility of other handicaps. The brain often completely with early treatment. If integration to the environment that surrounds (BSID-III) is done. These assessment was damage itself can be diffuse enough to affect deformities are allowed to develop, then them. carried out based on observation during speech and hearing, vision, perceptual function, secondary deformities may also be promoted in administering BSID-III edition. Bayley Scales Case History mental ability and general behaviour. Epilepsy other parts of the child’s body. This handicaps of Infant Development third Edition is a A 9 months old male child came to the Child may occur. There may also be other associated him even more. standardized psychometric test for measuring development center of Apollo Hospitals Dhaka handicaps which are due to lack of motor Early treatment also decreases the associated children’s cognitive, receptive communication, with complaints of unable to sit from lying experiences in physically disabled children. handicaps which need specific therapy. The expressive communication, fine motor, gross positions and less interaction with surroundings. Lack of motor exploration affects development associated handicaps have also been known to motor, socio emotional, and adaptive behaviour Child was delivered at full term by caesarean of sensations, perceptions, mental abilities and become more severe than the motor problems. ability. Throughout this assessment we found his section with appropriate birth weight. Child was speech. Emotional and social skills are also Handicaps interact with one another and the Cognitive domain: Significantly delayed admitted in NICU up to his seven days of age hampered. Patients-child’s interaction is not cerebral palsied child must be considered as a intellectual functioning level, Language due to peri natal asphyxia stage- II. There was always easy and may create emotional multiple handicapped child. Not all cerebral (receptive and expressive) domain: history of delayed milestone and difficulties in problems. palsied children have multiple handicaps, but deglutition of semi-solid food without drooling. Significantly delayed, Motor (Fine and gross) Early therapy is advisable to minimize the today there seem to be increasing numbers domain: Significantly delayed. On examination by Rapid neurodevelopmental degree of motor handicap and of the secondary referred for therapy who are mentally and in assessment-Gross Motor: Couldn’t sideline in After 4th follow up in 14 days interval Rapid development handicaps. multiple ways handicapped. right and left side from lying position, Fine Neurodevelopmental assessment was done There are still medical practitioners who hesitate References Motor-No reaching and digital grasp with left whereas Gross Motor - could sit from lying about the referral of cerebral palsied babies for 1.Khan NZ. Best resource use for disabled children. and right hand, Vision- Only could fix and without support, Fine Motor- could transfer World Health Forum.1998:19(1):47-58. therapy. This may be due to the fact that some 2. Khan NZ, Muslima H, Parveen M. Neuro- follow adults face, couldn’t fix and follow object in both hands but radial digital grasp in babies improve and even become normal developmental outcomes of preterm infants in spinning bright ball from 12.5cm. right hand and digital grasp in left hand, Bangladesh. Pediatrics. 2006;118(1):280-89 without any treatment. Unfortunately we do not 3. Zaman SZ, Khan NZ, Islam S. Validity of the “Ten Hearing-Could locate voice at ear level with Cognition- could shake rattle and had yet know definitely which neurologically Questions” for screening serious childhood disability: minimum sound. Speech- Only had vocalization pat-a-cake. Vision - could fix and follow shiny results from urban Bangladesh. Int J Epidemiol. damaged babies will become cerebral palsied (ghh, ooh,eeh), Cognition- He had no social bright object, Speech - babbling was started. 1990;19(3):613-20. and which will not. It is best to give each child 4. Banu SH, Tanaka Y, Selim AF, Khan NZ. Evaluation smile. Discussion of neurodevelopmental status after an early stimulation the benefit of developmental therapy, and his program for babies at risk for developmental delay. Nervous system examination- Tone was The cerebral palsies are a group of conditions parents practical guidance in his daily care, by a Poster presentation at: 2nd International Perinatal increased in right side, Deep tendon reflexes due to non-progressive damage to the brain therapist who can also detect motor patterns of Congress of the Bangladesh Perinatal Society: November 21-2. 2008. Dhaka Bangladesh. were exaggerated on the right side. before, during or after birth. Although the brain cerebral palsy. Every chance for the baby’s 5.Ahmed AS, Muslima H, Anwar KS. Retinopathy of EEG was suggestive of abnormal record due to damage itself does not change nor is it curable, damaged nervous system to develop is offered prematurity in Bangladeshi neonates. J Trop Pediatr. 2008;54(5):333-39. presence of sharp transients over both anterior the symptoms may change with time. The brain by early treatment of this kind. We know that 6. Durkin MS, Khan NZ, Davidson LL. Validity of the CASE REPORT ten questions screen for childhood disability: results from after acquired brain injury: current and emerging A Case of Multiple Myeloma with Unusual Serum Protein Electrophoresis population-based studies in Bangladesh, Jamaica and approaches. Pediatr Neurol. 2012;46:339–44. [PubMed] Pakistan. Epidemiology. 1994;5(3):283-89. 14. Rodrigues SD, Ciasca SM, Guimarães IE, Elias KM, 1 2 7. Bobath K.1980. A neurophysiological basis for the Oliveira CC, Moura-Ribeiro MV. Does stroke impair Nargis W , Ibrahim M treatment of cerebral palsy. William Heinemann Medical learning in children? Stroke Res Treat [serial on the Books, London. Internet]. 2011;2011:1-6. 8. Gillette H.E.1969. Systems of therapy in cerebral http://www.hindawi.com/journals/srt/2011/369836/cta/ Abstract palsy. Charles C.Thomas, Springfield, Illinois. 15. Barela JA, Focks GM, Hilgeholt T, Barela AM, 9. Pearson H.P. & William S C.E. eds. 1978. Physical Carvalho R de P, Savelsbergh GJ. Perception-action and Monoclonal gammopathy is a group of B-cell disorders resulting in the secretion of a specific and therapy services in the developmental disabilities. adaptation in postural control of children and adolescents unique monoclonal immunoglobulin (M-component); best detecting with high resolution agarose Charles C. Thomas, Springfield, Illinois. with cerebral palsy. Res Dev Disabil. 2011;32:2075-83. gel electrophoresis. An M-protein is usually visible as a localized band on agarose gel 10. Bayley N. (1993) Bayley scales of infant [PubMed] development-second edition. San Antonio,TX:The 16. De Campos AC, Da Costa CS, Rocha NA. Measuring electrophoretic peak in the beta, gamma, or rarely in the alpha-2globulin region of the Psychological Corporation. changes in functional mobility in children with mild densitometer tracing. Here, we presented a multiple myeloma patient with IgA kappa paraprotein 11. Brauer,B.A.Braden,J.P.,Pollard ,R.Q, & Hardy-Braz, cerebral palsy. Devel Neurorehabil. 2011;14:140–44. showing an M spike in the alpha-2 globulin region in agarose gel electrophoresis. S.T. 1998. Deaf and hard of hearing problem. In [PubMed] J.Sandoval, C.L.Frisby, K.F.Geisinger,
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