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 Article of Interest - Disability

Class Helps 3-year-old Through Disability
by Cynthia T. Pegram, The News & Advance, January 2, 2003
For more articles visit www.bridges4kids.org

With five of his classmates, Christopher sits in a diminutive chair at a low table eating a snack at Lynchburg City School's Hutcherson Early Learning Center.

 
Christopher, the grandson of Pamela and Louis Gallaher of Lynchburg, is enrolled in a program for children with developmental delays.

On the back of Christopher's chair is his name in Braille. His early childhood special education teacher, Ghana Ramey, or her assistant, Janice Barbour, make sure that as he comes and goes from the table, his tiny hand will feel the bumps that his fingertips will some day read as his name.

Christopher has cortical blindness from damage to the visual systems of the brain. At the time of his injury from shaken baby syndrome, he had flame-shaped bleeding in the back of the eye in the area of the retina.

He has a small patch of vision at the inner edge of one eye on the side near his nose.

So when Heidi Fisher, his vision teacher, walks with him down the hall, she teaches him trailing - how to run one hand against the wall to help guide his way to where he wants to go.

And several days a week, Christopher works with colored forms against a light board, to help capture and educate him to understand the fragment of vision that remains.

She helps him understand that his fingertips can figure out which button to push to get the music from the toy he uses - he loves music. Or how to ask for what he wants by pushing the right button on a device that has a tape-recorded request.

Christopher does not often speak.

This is a busy classroom - it's just about non-stop for the adults trying to keep six or seven 3-year-olds on task despite the disabilities that brought them.

While Christopher doesn't wriggle restlessly like some of his classmates, he seems just as agile. As snacks are completed, children are asked to return their bowls to the sink, which he does, earning a "Thank you, Christopher."

Later, when they're reading together, Ghana Ramey uses his right hand to run along the Braille words. Without adult attention, when he is involved in a group activity, sometimes Christopher will suddenly give a sweet smile, and begin to rock.

When the children have a period to do what they want, they seek favorite toys. Christopher is curious about the full-length mirror, tilting his head this way and that as he presses his face close to the reflective surface.

On this morning they're all back near the low table when his grandmother, Pamela Gallaher, slips in. She's about 20 feet from Christopher, making no sound as she nears a chair. But incredibly, he sees her immediately and goes over to her as she pretends to hide. He laughs.

In September 2000, Christopher nearly died from the injury to his brain. Yet he walks with only a small brace at his ankle. He uses both hands and does not seem to have balance problems.

His grandfather, Louis Gallaher, says doctors tell him Christopher's brain is rewiring.

Following injury, the brains of infants and children can develop existing areas for new uses in ways that adults cannot.

"After eight or 10 years of age, the capacity to relocate is considerably less," said Dr. Rob Rust, pediatric neurologist at the University of Virginia.

An injury to both sides of the brain is more difficult to recover from because there is no way for the brain to rewire, Rust said.

Yet one of the problems in trying to accurately track the outcomes is finding the precise cause of the injury - the accused person won't admit to having done it, even when convicted and in prison.

"So we don't know what kind of injury was done to produce what kind of result," Rust said.

Some babies are only shaken, but others are swung and hit into a wall. Others are shaken, then smothered or strangled, "and that causes the greatest degree of injury."

The results can be low vision, hemorrhage in the eye, the chest squeezed, bruises or brain injury. Some make a reasonably good recovery, he said. "We've tried to figure out why - maybe it has something to with the circumstances.

"No generality can explain the variation we see," Rust said.

Hemorrhages in the retinas (the nerve receptors at the back of the eye that lead to the optic nerve) are symptoms of shaken baby syndrome. That happens even though the retinas of children are attached more tightly that those of adults, he said.

But very young children have the disadvantage of poor neck control and developmental weakness.

"When they're being shaken and spun around, they can't protect their heads, so they have that vulnerability," Rust said.

How can the brain be rewired?

"Most of what we do in every day life is very simple," he said. "We make change and walk around. We're not called on to do complex things - 95 percent of what we do is reasonably normal, doesn't take a whole lot of space.

"We use that space more and more efficiently as time goes on," he said. And it gets pretty full.

"It's probable people who have injuries to the brain lose some potential. We do know of situations where considerable degrees of noticeable injury don't leave a clear hallmark," Rust said.

For example, surgery to cure epilepsy involves removing a portion of the brain, but doesn't seem have too much other effect.

Current research indicates shaken baby probably has occurred more often than documented.

The first descriptions date back to the 1860s. The pathology has been known since the 1940s. About 30 years ago, in 1972, a pediatric radiologist discovered that certain kinds of injuries went with certain things he saw on skull films.

CT scans have added to the knowledge base.

"Putting it all together as a syndrome is a post-1972 phenomenon," Rust said. "Since that time we've made the diagnosis more frequently."

To some degree, he said, the child's capacity is diminished with injury even in children with a good outcome. For example, if the child was destined to play the violin he may lose that capacity. "Others may lose the capacity for vision."

The more severe the injury, the less capacity over all.

"To estimate the prognosis is not easy," Rust said.

Many people know about Christopher and his successful fight for life.

"We've fallen in love with Christopher," said Bobby Wood, pastor of Sandusky Baptist Church which the Gallaher family attends.

"He's been on our prayer list, and part of our prayer ministry ever since we learned about the situation," Wood said.

"We rejoice in the improvement he has made over these months."

Louis Gallaher said he believes Christopher will continue his phenomenal improvement.

"I believe the Lord will take care of his eyesight," he said. He cites Christopher's musical ability, and the very normalness of his temperature, breathing and lack of seizures.

"Christopher is going to live a productive life which far surpasses any prognosis," Gallaher said.

Contact Cynthia Pegram at cpegram@newsadvance.com or (434) 385-5541.

 

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