Search Results (296)

Background: The management of pediatric microtia and congenital hearing loss typically necessitates coordinated multidisciplinary input. Traditional fragmented care pathways across multiple specialties may contribute to delayed diagnosis and treatment intervention, inconsistent counselling, increased logistical burden, and suboptimal care integration. Objectives: We aimed to evaluate family-reported outcomes following implementation of a multidisciplinary Hearing Disorder and Microtia (HDM) clinic, focusing on family satisfaction, perceived care efficiency, understanding of disease and treatment, and early uptake of hearing rehabilitation. Methods: A prospective observational study was conducted on families attending the HDM clinic at a tertiary pediatric center between 2022 and 2024. A structured post-visit survey assessed satisfaction, perceived efficiency, understanding of disease and treatment options, and overall experience. Quantitative data were analyzed descriptively, while qualitative responses underwent thematic analysis. Results: Twenty families were included. Overall satisfaction was high, with 95% rating the clinic experience as very good to excellent and expressing willingness to recommend the service. Improved care coordination and clarification of counselling were reported by the majority of respondents, alongside reduced logistical burden. Notably, 65% of families initiated hearing rehabilitation at the first visit. Thematic analysis identified convenience, unified specialist communication, and clarity of management planning as key strengths of the multidisciplinary model. Conclusions: A structured multidisciplinary HDM clinic significantly improves caregiver experience and facilitates earlier hearing rehabilitation in children with microtia and congenital hearing loss. Integrated care delivery enhances communication, reduces fragmentation, and supports timely, family-centered decision-making. This model may serve as a framework for other complex pediatric otologic conditions requiring longitudinal multidisciplinary management. Full article

Background: Microtia is a congenital anomaly of the external ear that is frequently associated with conductive or mixed hearing impairment and potential developmental consequences. Although genetic factors may contribute to some cases, social and economic conditions can influence access to diagnosis, hearing rehabilitation, and specialized care. This study examined clinical severity, hearing disability, and socioeconomic characteristics among patients with isolated and familial microtia evaluated in Ecuador. Methods: A cross-sectional study was conducted at a tertiary referral center in Quito, Ecuador. A total of 143 patients with microtia were included. Clinical variables included hearing impairment, hearing device use, microtia severity, associated risk factors, and family history. Sociodemographic variables included age, sex, residence, economic level, and healthcare access. Categorical variables were summarized as frequencies and percentages, and continuous variables as medians with interquartile ranges. Group comparisons were performed using the chi-square test and the Mann–Whitney test. Multivariable logistic regression was used to assess factors associated with hearing device use. Statistical significance was set at p < 0.05. Results: Hearing impairment was present in 41.78% of patients, with similar prevalence in isolated and familial cases. Hearing device use was reported by 19.86% of the sample. Familial microtia showed a significantly different distribution of right-ear severity, with higher frequencies of grade 1 and grade 4 anomalies, whereas isolated microtia was more commonly grade 3. Significant differences were also observed in sex distribution and economic level. Isolated cases were more frequent among males, whereas familial cases showed a higher proportion of females. Familial microtia was concentrated mainly in the low-middle economic stratum. In multivariable analysis, no factor was independently associated with hearing device use, and confidence intervals were wide, indicating limited precision. Conclusions: In this tertiary referral sample, microtia-related disability and access to care appeared to reflect the combined influence of clinical vulnerability, familial aggregation, and socioeconomic disadvantage. The low use of hearing devices despite frequent hearing impairment indicates an important gap between clinical need and rehabilitation. Equity-oriented strategies, including early hearing screening, timely referral, financial protection for assistive devices, and improved access to specialized care, may help reduce unmet needs among patients with microtia. Full article

Background: Hearing health in Kazakhstan is documented through parallel administrative systems whose indicators are often conflated. We examined three administrative layers of hearing health during 2020–2025: dispensary registration of ear and hearing-loss diagnoses, disability certification as a severe administrative endpoint, and cochlear implantation (CI) as the specialised treatment response, with reference to Global Burden of Disease (GBD) 2021 estimates. Methods: We conducted a national ecological, region-year, multi-source administrative registry study across all 20 regions of Kazakhstan from 2020 to 2025. The dataset included 114 region-year observations and integrated Dispensary Report Form No. 12, the State Register of Persons with Disabilities, and the Electronic Register of Inpatient Patients. Dispensary indicators were interpreted as registered healthcare-utilisation measures, not population prevalence or incidence. Trends were assessed using Mann–Kendall tests with Benjamini–Hochberg false-discovery-rate correction. Regional patterns were examined using Spearman correlation, inequality metrics, and exploratory clustering. Results: Among adults, registered H60–H95 annual morbidity increased from 231,209 to 278,897 cases (CAGR +3.8%; FDR p = 0.016), and first-time registrations rose from 126,513 to 167,674 (CAGR +5.8%; FDR p = 0.016). Active dispensary observation declined modestly from 21,840 to 19,881. H65–H66 chronic otitis first-time registration remained stable, while active observation declined sharply. Paediatric H90–H91 registration was stable. In 2025, 31,560 persons were registered with hearing impairment-related disability, including 26,522 adults. CI procedures increased from 285 to 523. Adult CI activity was intermittent between 2012 and 2018 (peak 140 in 2013), ceased in 2019–2020, and was re-established from 2021 (14 → 129 procedures in 2025), reaching 24.7% of all CI. Most procedures were concentrated in Almaty and Astana. Compared with the GBD-2021 estimate of 17,212 per 100,000, administrative indicators captured much narrower service-utilisation and severe-certification layers. Conclusions: Kazakhstan’s administrative data describe distinct hearing-health layers rather than competing prevalence estimates. Adult screening, regional audiology capacity, post-CI rehabilitation, and longitudinal outcome registries are priority areas. Full article

Background: Individuals with sensory impairments often encounter barriers to oral health information, preventive care, and dental services. Despite a growing body of research, oral health among individuals with hearing and visual impairments has not been comprehensively evaluated across the full spectrum of oral health outcomes. This systematic review aimed to evaluate oral health outcomes and dental treatment needs in individuals with hearing and visual impairments. Methods: A literature search was performed in Ovid MEDLINE, Ovid Embase, and Web of Science from database inception to 8 January 2026, in collaboration with a medical information specialist, and in accordance with the PRISMA 2020 guidelines. Observational studies reporting oral hygiene, periodontal status, dental caries, dental needs, and other relevant oral health outcomes in individuals with hearing and visual impairments were included. Given the substantial clinical and methodological heterogeneity across the included studies, findings were synthesized using a narrative approach. Results: A total of 5650 records were identified, of which 84 studies were included. Oral health problems were frequently reported among individuals with sensory impairments. Dental caries was the most common finding. Poor oral hygiene, gingival inflammation, periodontal problems, and unmet treatment needs were also often described. Additional findings included traumatic dental injuries, malocclusion, salivary and microbiological alterations, functional oral limitations, and reduced oral health-related quality of life. Conclusions: Individuals with sensory impairments are likely to experience poorer oral health and considerable unmet dental needs. These findings highlight the need for improved preventive strategies, effective communication approaches, and more inclusive dental care. Full article

Background/Objectives: Intracochlear electrocochleography (ECochG) is increasingly used to monitor cochlear function during cochlear implantation, particularly in patients with residual hearing. However, optimal acquisition parameters and interpretation of intraoperative ECochG patterns remain unclear. To (1) establish optimal stimulation and acquisition parameters for intracochlear ECochG, (2) evaluate the feasibility of signal acquisition in pediatric patients, and (3) characterize intraoperative ECochG response patterns in relation to surgical events. Methods: The study consisted of two phases: an optimization phase (n = 50) and a clinical observational phase (n = 28). In the optimization phase, various stimulation frequencies (500–2000 Hz), recording configurations, and acquisition modes were tested. Based on these findings, a standardized ECochG protocol was developed and applied in the clinical cohort. Results: Optimal ECochG recordings were obtained using 500 Hz and 1500 Hz tone bursts at 100 dB nHL, recorded from the apical electrode contact (ICE22) in continuous mode. In the clinical cohort, ECochG responses were detected in 11/28 patients (39%). Cochlear microphonics were observed even in patients without preoperative evidence of residual hearing. Intraoperative signal fluctuations were temporally associated with specific surgical events, including electrode manipulation and suctioning. Conclusions: Intracochlear ECochG enables real-time monitoring of cochlear function during implantation. However, interpretation of signal changes remains complex and requires standardized protocols as well as careful consideration of the surgical context. Full article

Background: Advances in neonatal intensive care in Kazakhstan have improved the survival of preterm infants, including those with very low birth weight (VLBW) and extremely low birth weight (ELBW). However, after hospital discharge, these medically vulnerable children may remain insufficiently protected against vaccine-preventable infections because of prolonged temporary medical exemptions, clinical caution, parental concerns, and fragmented coordination between specialized follow-up services and primary health care. Objective: This study aimed to assess vaccination coverage in a 10-year cohort of high-risk preterm infants and to identify clinical, parental, and organizational factors associated with delayed immunization. Methods: We conducted a retrospective cohort study of 331 high-risk preterm infants followed at a specialized pediatric center in Astana, Kazakhstan, between 2015 and 2024. Vaccination status at hospital discharge and at 24 months of chronological age, documented temporary medical exemptions, reasons for delayed or missed vaccination, and confirmed cases of pertussis and measles were analyzed. A supplementary cross-sectional survey of parents, physicians, and health care managers was conducted to further explore barriers to catch-up immunization. Results: At hospital discharge, 259 infants (78.2%) had not received the BCG or hepatitis B vaccine. By 24 months of age, 34.1% (n = 113) were fully vaccinated according to age, whereas 49.8% (n = 165) remained completely unvaccinated. During the observation period, 30 cases of measles and 17 cases of pertussis were recorded within the cohort, primarily during nationwide outbreaks. Among the 10 children with a history of measles before 12 months of age, 2 developed subacute sclerosing panencephalitis (SSPE), 1 developed profound hearing loss, and 1 required prolonged oxygen therapy following pneumonia. In addition, 2 children with periventricular leukomalacia (PVL) experienced clinical deterioration, while 1 infant with pertussis required hospitalization during the acute phase of illness. Conclusion: High-risk preterm infants in this cohort experienced substantial and persistent gaps in immunization after hospital discharge. These findings underscore the importance of regular reassessment of temporary medical exemptions, improved coordination between specialized follow-up services and primary health care, and strengthened catch-up immunization strategies for medically vulnerable children. Full article

Background: Tuberculosis (TB) remains a leading cause of global morbidity and mortality, yet its impact extends far beyond microbiological cure. Many TB survivors experience persistent structural lung damage or functional impairment consistent with post-TB lung disease, while growing evidence highlights long-term non-respiratory health outcomes. Synthesizing evidence across lung and non- respiratory health outcomes, along with their risk factors, is critical to inform long-term TB care. Methods: We conducted a scoping review including systematic reviews reporting on post-TB long-term health outcomes. A search was performed in PubMed/MEDLINE on 27 July 2025, using terms related to “tuberculosis,” “systematic review,” “meta-analysis,” “sequelae” and “long-term health outcomes,” without language restrictions. Results: Nine systematic reviews met inclusion criteria. Most focused on pulmonary outcomes and consistently demonstrated that TB is associated with chronic airflow obstruction, reduced lung function, and an increased long-term risk of lung cancer, although residual confounding from environmental, clinical, and socioeconomic factors cannot be excluded. While younger adults are more prone to developing COPD after TB in high TB burden settings, older individuals face a higher risk of broader post-TB lung sequelae. Evidence suggested that TB survivors are at increased risk of non-respiratory complications. HIV co-infection, low CD4 counts, older age, pre-existing hepatitis, prior TB treatment, and hypoalbuminemia were associated with post-TB liver injury, while baseline hearing impairment and HIV co-infection increased the likelihood of post-TB hearing loss. TB was also linked to elevated risk of several non-pulmonary cancers, including oesophageal, cervical, hematological, pancreatic, and gastric malignancies, with the highest risk within the first year after TB diagnosis and persisting, though attenuated, in subsequent years. Conclusion: TB should be viewed as a chronic condition with enduring lung and non-respiratory health outcomes. TB survivors face increased risks of COPD, lung cancer, and a range of non-respiratory health outcomes, including hepatic and auditory complications, particularly among high-risk groups, such as those living with HIV infection, along with baseline hearing and hepatic impairment. Public health programmes must extend care beyond microbiological cure to include integrated, post-TB long-term monitoring of lung, hepatic and hearing across all ages, including malignancy surveillance, after baseline assessments to identify high-risk TB survivors. Future research should also elucidate risk factors for post-TB malignancy, and clarify the relationship between neurological, renal, and musculoskeletal sequelae and TB to inform evidence-based TB survivorship care. Full article

Background/Objectives: Chronic otitis media (COM) in children carries a risk of irreversible sensorineural hearing loss (SNHL), which impairs language development and academic performance, although an objective clinical threshold does not exist to identify patients requiring urgent surgical intervention. Methods: We retrospectively analyzed 60 pediatric patients (aged 5–18 years) who underwent surgery for COM or cholesteatoma and performed linear regression, Pearson’s correlation, and receiver operating characteristic (ROC) curve analyses to quantify the relationship between otorrhea frequency and shifts in bone conduction (BC) threshold at least six months postoperatively. Results: Otorrhea frequency was significantly correlated with BC deterioration (r = 0.327, p = 0.011, R² = 0.107). ROC analysis identified five or more episodes as the optimal cutoff for predicting a clinically significant BC shift of ≥10 dB (area under the curve = 0.712; sensitivity 75.0%, specificity 80.0%). Bacteriological findings, including the presence of non-skin commensal pathogens, did not significantly influence hearing outcomes (p = 0.721). Conclusions: Five or more otorrhea episodes constitute a quantitative, equipment-free red flag for imminent cochlear injury in pediatric COM, and this threshold provides primary care physicians and pediatricians a simple, age-independent criteria for timely surgical referral to prevent lifelong auditory morbidity. Full article

Background/Objectives: Antenatal corticosteroids (ACSs) form the basis of prenatal care for women at risk of preterm birth, primarily due to their proven benefits in reducing neonatal mortality and short-term morbidity. However, there are growing concerns about the potential long-term consequences of fetal exposure to ACSs. The aim of the meta-analysis was to assess the relationship between exposure to corticosteroids administered during the prenatal period and long-term effects. Methods: PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials were searched for studies published up to 28 January 2026. Randomized controlled trials and observational studies reporting long-term outcomes after exposure to ACSs were included. A random effects model was used to calculate effect sizes. Results: Among the neurological disorders analyzed, our meta-analysis showed an increased risk of 17% of suspected neurocognitive disorder (RR = 1.17; 95% CI [1.13; 1.21]; p < 0.0001, I² = 10%), 18% of hearing impairment (RR = 1.18; 95% CI [1.13; 1.24]; p < 0.0001, I² = 41%), 3% of visual impairment (RR = 1.03; 95% CI [1.01; 1.05]; p = 0.0012, I² = 0%), 25% of autism spectrum disorders (RR = 1.25; 95% CI [1.09; 1.42]; p = 0.001, I² = 43%) and 25% of any mental or behavioral disorder (RR = 1.25; 95% CI [1.1; 1.43]; p = 0.0008, I² = 77%). The results of other neurological disorders, as well as other analyzed outcomes, were not statistically significant (p > 0.05). Conclusions: Although this meta-analysis suggests an increased risk of certain long-term neurological outcomes following prenatal exposure to corticosteroids, these findings should be interpreted with caution in light of the well-documented short-term benefits for newborns and the need for a careful assessment of the benefit–risk ratio and further long-term observational studies. Full article

Background/Objectives: Tinnitus is a significant global health concern with substantial geographic variation in prevalence. However, data on tinnitus epidemiology in southern Saudi Arabia remain limited, despite emerging evidence suggesting a relatively high regional burden. Therefore, this study aimed to estimate the prevalence of tinnitus and identify its epidemiological determinants among adults in southern Saudi Arabia. Methods: A community-based cross-sectional study was conducted among 501 adults from four regions in southern Saudi Arabia (Jazan, Aseer, Najran, and Al-Baha). Data were collected on sociodemographic characteristics, chronic medical conditions, noise exposure patterns, and clinical features of tinnitus. Multivariable logistic regression analysis was used to identify factors independently associated with tinnitus. Results: The overall tinnitus prevalence was 31.1% (156/501). The mean age of participants was 30 ± 11 years, and 61.7% were female. Bilateral tinnitus was the most common (47.4%). Symptom duration was reported as <3 months in 31.4% of cases and between 3 months and 1 year in another 31.4%. The mean severity score was 3.7 ± 1.9. Most affected individuals (76.9%) did not seek medical care. Primary exacerbating factors included sleep deprivation (41.7%), noise exposure (41.0%), and stress (39.1%). Multivariable analysis identified two significant independent predictors: weekly noise exposure exceeding 5 h (odds ratio [OR] = 2.14; 95% confidence interval [CI]: 1.34–3.42; p = 0.001) and higher body mass index (BMI) (OR = 1.06; 95% CI: 1.02–1.10; p = 0.005). The most commonly associated underlying conditions were ear infections (25.6%) and hearing loss (24.4%). Conclusions: Tinnitus prevalence in southern Saudi Arabia (31.1%) substantially exceeds global estimates. Noise exposure and elevated BMI are key modifiable factors associated with tinnitus. The substantial healthcare gap, with most affected individuals not seeking treatment, represents a critical public health challenge requiring targeted prevention programs, provider education, and improved access to evidence-based care. Full article

Background: Genetic testing is increasingly part of the diagnostic pathway of congenital hearing loss (CHL), clarifying etiology and supporting clinical management. However, its psychosocial impact, especially differences between syndromic and non-syndromic conditions, remains underexplored. Objectives: This study evaluated the differential psychological impact of genetic diagnosis in syndromic versus non-syndromic pediatric patients, its relationship with clinical and rehabilitative variables, and the role of post-diagnostic psychological assessment. Methods: A cross-sectional post-diagnosis survey was conducted in families of children with genetically confirmed syndromic (Usher syndrome, n = 21) and non-syndromic (GJB2-related, n = 21) CHL; a total of 37 families responded. Parental empowerment was assessed using an Italian translated version of the Genetic Counseling Outcome Scale (GCOS-24). In an exploratory analysis, GCOS-24 items were grouped into three author-derived domains (understanding/awareness, emotional experience, and informational support) based on semantic content, not validated psychometrically. Results: No significant differences in GCOS-24 scores emerged between groups, nor in relation to clinical variables like hearing loss severity, auditory outcomes, or rehabilitative interventions. Genetic diagnosis occurred later in the syndromic group. Qualitative observations suggested parental empowerment varied with timing of diagnosis, clarity of information, and therapeutic alliance quality. Conclusions: Overall, these results highlight the importance of integrating psychological support and structured communication into clinical pathways to support families and patients in understanding and adapting to the diagnosis over time. Further longitudinal studies are needed to clarify the evolving psychosocial impact of genetic diagnosis in CHL. Full article

Background: While previous research has examined individual aspects of hearing loss, such as perceived hearing handicap, functional hearing ability, or hearing device outcomes, these domains are rarely evaluated together within the same cohort. We aimed to address this gap by providing a multidimensional assessment of hearing-related outcomes and comparing measures of perceived hearing handicap, psychosocial adjustment to hearing loss, functional hearing ability, and device-related benefit between hearing aid, cochlear implant, and bimodal device users. Methods: Cross-sectional data were collected from 749 adults aged ≥40 years using hearing aids (n = 467), cochlear implants (n = 150), or bimodal devices (n = 132), during 2022–2024. Measures of hearing handicap (Hearing Handicap Inventory for the Elderly Screening, HHIE-S), psychosocial responses to hearing loss (Attitudes towards Loss of Hearing Questionnaire, ALHQ), real-world hearing ability (Speech, Spatial and Qualities of Hearing Scale, SSQ), and outcomes of hearing device use (International Outcome Inventory for Hearing Devices, IOI-HD) were collected. Results: After multivariate adjustment, hearing aid users versus bimodal and cochlear implant users had significantly higher ALHQ scores in the domain of negative associations (suggestive of negative attitudes or stigma attached to hearing aid use): 2.22 (0.05) versus 1.92 (0.09) (p = 0.0067) and 1.90 (0.09) (p = 0.0145), respectively. Hearing aid users had significantly higher SSQ spatial scores (better sound localization and spatial perception) compared to bimodal device users (5.13 versus 4.45, p = 0.0254). Total IOI-HD scores were significantly lower in hearing aid users (reflective of irregular, inconsistent daily usage of the device) compared to cochlear implant users (p < 0.0001) and bimodal device users (p = 0.0007). HHIE-S scores were not significantly different between device user groups after multivariate adjustment. Conclusions: This multidimensional approach provides new insight into the heterogeneity of hearing experiences and may help inform more person-centered models of hearing care. Full article

Academic setbacks are common in college, yet instructor responses to poor performance vary widely and may shape students’ motivation, emotional reactions, and perceptions of faculty support. Prior work suggests that supportive communication matters, but less is known about which types of messages students prefer after academic failure or whether faculty accurately anticipate these preferences. The present research examined how college students and instructors evaluate different instructor responses to a disappointing exam grade and assessed alignment between student preferences and faculty perceptions. Using a mixed-methods design, college instructors and undergraduate students responded to parallel vignette scenarios involving a poor exam outcome and rated brief instructor comments representing three response types: solution-focused, emotional validation, and interpersonal affirmation. Participants also provided open-ended responses describing what they would say to a student or want to hear from an instructor. Across two studies, students rated affirmation as most effective, validation as moderately helpful, and solution-focused responses as least effective, despite perceiving solution-focused comments as most common in actual classrooms. Faculty in our sample rated validation and affirmation as more effective than solution-focused responses but primarily generated strategy-focused advice in their own responses. Faculty correctly anticipated students’ preference for encouragement but rarely offered such messages. These findings point to a gap between what faculty believe students value and what they typically communicate following academic setbacks, suggesting that incorporating brief affirming and emotionally responsive messages may strengthen student–teacher relationships by signaling care, understanding, and support in moments of academic difficulty. Full article

Background/Objectives: For patients with profound deafness resulting from auditory nerve pathology, as in Neurofibromatosis type 2, auditory brainstem implantation (ABI) can restore meaningful acoustic input. The literature reporting real-world results for ABI users is limited, especially regarding patients with bilateral implants. Here, we provide an updated report on the audiologic outcomes among all ABI patients treated at a tertiary institution, including high-performing bilateral ABI users. Methods: In this updated and expanded retrospective case series, audiologic outcomes were reviewed in sixteen consecutive patients who underwent ABI placement by a single neurosurgeon-neurotologist team at our center since 2018. Implantation in four of these patients was on their second side after having undergone first side implantation prior to receiving care at our hospital. Main outcome measures were sound awareness (sound-field threshold testing) and speech understanding (pattern perception, spondee, open-set speech testing). Results: Sound awareness was achieved in 100% of patients (16/16) using an average of 12 electrodes (range 7–20). Persistent non-auditory sensations were reported by 12.5% (2/16). Postoperative speech differentiation (with or without lip-reading) was experienced in 87.5% (14/16). Two second-sided ABI recipients experienced exceptional outcomes as high-performing outliers: one achieved 57% audio only and 86% audio + visual hearing in noise test (HINT) sentence scores; the second bilateral user scored 92% with auditory-only input. Conclusions: ABI represents a viable option for patients who are at risk of developing bilateral profound deafness resulting from auditory nerve disruption. Second sided device implantation is safe and has the potential to significantly improve auditory outcomes. Full article

Background/Objectives: Cochlear implantation (CI) represents a well-established intervention for the management of severe to profound sensorineural hearing loss. The co-occurrence of severe hearing loss and Autism Spectrum Disorder (ASD) presents unique diagnostic and therapeutic challenges that significantly impact post-implantation outcomes. This review aims to synthesize the current literature on cochlear implantation in children with Autism Spectrum Disorder (ASD), including diagnostic, audiological, rehabilitative, and functional outcome considerations. Methods: A structured search of PubMed and Scopus was performed for English-language articles published between January 2000 and January 2026, focusing on audiological assessment, rehabilitation challenges, multidisciplinary management, and post-implant functional outcomes in this population. Results: The findings synthesized in this review suggest that cochlear implantation in children with Autism Spectrum Disorder must be interpreted within a broader communicative-ecological framework rather than through auditory metrics alone. These findings highlight a multidimensional model of post-implant outcomes, shaped by the dynamic interplay between auditory access, social engagement, family context, and language-learning environments. Conclusions: Most children with ASD and severe-to-profound hearing loss show improvements in speech perception and production after cochlear implantation, although outcomes are highly variable. A multidisciplinary approach, through coordinated collaboration among specialists, enhances family engagement, optimizes compliance with care plans, and ultimately contributes to improved clinical and developmental outcomes. ASD should not be considered a contraindication for CI; however, careful individual assessment, realistic parental counseling, and a multidisciplinary approach availability to evaluation and rehabilitation are essential. Full article