Buddhi Stories Depression Elders Featured Patient Stories Traumatic Brain Injury

Varadarajan – Spiritual Odyssey

Varadarajan was on a pilgrimage to Badrinath in the company of extended family members in late 2010. Little did he imagine that he would be the victim of a fall, which proved disastrous and would alter the course of his life so abruptly. The initial 3-4 months of dramatic progress in his health condition reached a plateau, with minimal further improvement. It was at this point of standstill that the helplessness and hopelessness of a dependent status descended on him. The loss of self-esteem and of self-confidence built up, till the depression peaked in early 2013. All this in spite of a supportive family.


Mr. Varadarajan an engineering graduate, worked in a company for a few years before he decided to establish his own business. This he pursued in a committed manner and with enterprise, travelled a great deal on business, kept his family comfortable, educated his two children well, arranged & conducted his daughter’s marriage, an important milestone for any middle aged Indian couple. The daughter is settled abroad and visits with family every year. The trip to Badrinath, fulfilled Varadarajan’s religious inclinations as much as his urge to travel and seek adventure in the ‘mountainous Himalayan escape’!

Of Holy Shrines and Landslides The organised Char Dham pilgrimage is to the holy shrines of Lord Vishnu, Siva, Gangotri and Yamunotri, dotting the celestial Himalayan heights of Uttarakhand. The shrines are open to devotees in May and closed in early October, with the onset of the heavy snowfall. Roadblocks occur due to landslides, especially during the monsoon months of July-August, when the south-westerly winds bring with it rain, which lashes in all her fury on the slopes of the mountain ranges. Thousands of pilgrims may be stranded for a few days to a week for the roads to be cleared following a landslide. Natural disasters caused by the landslides and flash floods (the latter as in 2012 which claimed many lives) are no deterrent to the pilgrims, and year after year over 20 million pilgrims visit these holy temples in groups. The Border Road Organisation, Uttarakhand Government and the Badrinath-Kedarnath Temple Committee have their hands full during the pilgrimage season, not only to cater to basic amenities, which are sparse, but also to ensure the safety of vehicles on the winding, hazardous roads leading to the shrines. The Army is called upon to help in clearing heavy roadblocks and emergency helicopter service has to be sometimes deployed for medical emergencies and in disaster situations. The State Disaster Response Force has been established following the flash floods in 2013, to regulate the flow of pilgrims and towards better preparedness in the face of natural or man-made disaster situations. All these arrangements fall short of ideal organization, which the sheer enormity of the pilgrim population defeats.

The bus with the pilgrims had wound its way through the mountainous terrain until the driver was alerted of landslides ahead, and he knew by force of habit that he must halt the vehicle and warn the passengers to stay put. They had reached Pandukeshwar, a small town, 1829 metres above sea level, which lies about 20 km from the Vishnu temple at Badrinath. The bus crew took control of the situation, which was familiar to them, and made sure that there was no sign of panic among the busload of devotees. Their common mission was to reach Badrinath and that they would.

Exploring the Condition

Peace and calm prevailed and the long wait for the onward journey was taken as the ‘Will of God’. It was in the late evening that Varadarajan having just stepped out of the bus, perhaps to answer the call of nature, slipped on the slope, which sent him hurtling down 40 feet to land on his forehead. The bus crew and a few passengers rushed to the rescue. The wound was sutured and other first aid measures employed by the special team of healthcare providers. There was no immediate sequelae of loss of consciousness or seizures.

Varadarajan, within a few hours of the event, showed the foreboding signs of irritability and restlessness, pacing the floor of the shelter, becoming disoriented at times. He was transferred to the primary health centre at Joshi matt the following morning. In the next 3 days he progressed to semi-coma and was slipping into coma, and required specialized care. He was air-lifted by the Army helicopter and admitted to the ICU of a premier hospital in Dehradun, (the capital of Uttarakhand) which offered Neurosurgery as a superspeciality. The MRI reported ‘Subarachnoid haemorrhage and Subdural haematoma, with contusion on the right side’. His progress was monitored closely to minimize secondary brain injury following Traumatic Brain Injury (TBI), and the condition was managed conservatively with the patient on heavy medication. He regained consciousness after 21 days, was disoriented initially and did not recognize his immediate family members, who had rushed down on receiving the news. At discharge he was able to sit up, was on oral feeds and was continent and off the Foley’s catheter.

Back in Chennai, followed by a neurologist, and on home care, in familiar surroundings, stimulated by the presence of family and friends and with minimum therapies, the patient made slow progress. Over a few months, his memory improved, and he recovered his gross cognitive ability and other faculties, including to some extent language and writing skills. There was a residual right-sided weakness, but the patient could walk with a little support. He had impaired hearing in the right ear. Repeat MRI confirmed resolution of the blood clots over large brain areas, which correlated with return of efficient brain functioning. 

Traumatic Brain Injury

  1. Moderate to severe Traumatic Brain Injury (TBI) is a major Public Health concern in India, as  it is globally. 1.5 to 2 million persons are injured and 1 million succumb to death every year in India due to accidents. A comprehensive report in 2002 of the Dept. of Epidemiology, WHO Collaborating Centre for Injury Prevention and Safety Promotion, Rehabilitation, Policies and Programmes, at NIMHANS, Bangalore, India, headed by Prof. Gururaj, states that road traffic injuries are the leading cause (60%) of TBIs, followed by falls (20%-25%) and violence (10%). Since then, road traffic accidents have increased exponentially, and with an ageing population, falls in the elderly must add significantly to that category as well.
  2. Of all TBIs, 63% affect persons aged 15 to 64 and these represent the primary working population. These persons often have severe problems resuming a productive life and maintaining satisfactory interpersonal relations, despite the significant physical recovery within the first 6 months of injury. Depression can occur at any stage following an acquired brain injury, from the acute hospital stage to many years later. Post-injury depression may range from mild, (where a person may still be able to function in day to day life, but generally feel ‘low’), to severe depression and debilitation. Like in other forms of depression, the mood may be of sadness, despair, flat emotional reaction, increased frustration, irritability and anger. The thinking pattern may include a sense of hopelessness, pessimistic beliefs, and behaviour patterns may be of reduced attention to physical appearance, social withdrawal, loss of motivation to participate in activities the subject enjoyed premorbidly, accompanied by  fatigue, sleep disturbances and poor appetite. There may be inability to return to previous employment and the subject may become dependent and progressively isolated, with a gradual decline in ability to perform everyday tasks and progressive disability to cope with everyday stressors. Most of the patients with these disturbances are unable to identify the cause of their inner mental state or report their social functioning accurately and the family may be at an equal loss to fathom the reason. Researchers have consistently suggested that the psychosocial problems associated with TBI may be the major challenge facing rehabilitation. This is where a specialist integrative therapy team can step in to achieve what seems impossible, patiently holding the hands of the patient and family members, guiding them through the assessments followed by the therapies in a graded manner and coaxing stepwise positive advancement in the patient’s condition. This is the ‘Art of Medicine’.
  3. Recognition of pituitary hormonal insufficiencies after head injury and Aneurysmal Subarachnoid Hemorrhage (SAH) may be important, especially given that hypopituitarism-related neurobehavioral problems are typically alleviated by hormone replacement.
  • Gururaj G. Epidemiology of Traumatic Brain Injuries: Indian scenario. Neurol Res. 2002  Jan;24(1):24-8.
  • Rafael Gomez-Hernandez, Jeffrey E. Max, Todd Kosier, BS, Sergio Paradiso, Sergio Paradiso, Robert G. Robinson, Social Impairment and Depression After Traumatic Brain Injury Archives of Physical Medicine Rehabilitation 1997; 78: 1321-1326
  • Daniel F.Kelly, Irene T, Gaw Gonzalo, Pejman Cohan, Nancy Berman, Ronald Werdloff,  Christina Wang Hypopituatarism Following Traumatic Brain Injury and Aneurysmal Subarachnoid Hemorrhage: a preliminary report J Neurosurg; 93: 743–752, 2000

The Prolonged, Gloomy, Negative Phase

The rehabilitation progress seemed to have reached a plateau within the next few months . The realization of the problems related to recovery from TBI dawned on Mr. Varadarajan. He was no longer the independent, vigorous, frequent-traveller, successful businessman, to whom the whole family looked up and others marveled. He was dependent, even for some physical help, could no longer travel alone on business, and with the financial stress and poor back up of human resource for his private enterprise, he was in the verge of closing down his business, which he had nurtured with a certain nonchalant air of confidence through these years. Life seemed to be slipping away from his control, and he was home bound, sleeping much of the time, with poor appetite, poor socializing and full of all the negative thoughts which sheer hopelessness can bring with it.

At this juncture, Varadarajan’s son’s marriage was fixed and the wife was forced to take up single-handedly, the elaborate arrangements and formalities which go with an arranged south Indian marriage. The daughter, who arrived early from abroad for her brother’s marriage, was alarmed at the father’s state of health, with weight loss, socially withdrawn, curled up in bed and sleeping long hours and finding it difficult to participate spiritedly in the wedding activities, which was very unlike the father she knew. She realised that something had to be done to pull him out of this state and to instill in him some positive energy. It was at this point that she came across information of the novel and holistic TriMed-Neurokrish approach to healthcare and decided to pursue it.

Our Healing Approach

After putting the marriage celebrations behind her, Varadarajan’s daughter arrived at the Trimed-Neurokrish reception counter and made enquiries and met Dr. E. S. Krishnamoorthy. She knew right away that that ray of hope to give her father some quality of life lay in this setting. She did not delay by even a day to arrive with her father to initiate the comprehensive assessment, integrated therapy and counselling offered here.

The Neuropsychiatric diagnosis was Post-Traumatic Brain Injury Depression, and Gait Disability. The residual neurological deficit was minimal on clinical examination, with some gait dysfunction and right sided weakness. Blood examination was unremarkable except for D3 deficit. A careful endocrinal screening was done to rule out neurobehavioural problems secondary to hypopituitarism, which can occur in TBI with subarachnoid haemorrhage.

Varadarajan’s blood pressure was under control on regular medication with Amlodipine taken twice daily. He was also on regular Phenytoin Sodium twice daily, Clinidipine for heart function, started on admission soon after the TBI and these continued. Other medication introduced at Trimed-Neurokrish included antioxidants, piracetam, ginseng (all for brain health), pregabalin (for anxiety and seizure prophylaxis) once a day, Donepezil (for memory) and Paroxetine (for mood). Vitamin D3 and B12 supplementation was initiated as well. 

On neuropsychological evaluation, deficits in certain subtler areas of cognition were noted, which could hinder efficient performance. When questioned, Varadarajan said he felt hopeless, worthless, and had a sense of guilt for not being able to support his family. Cognitive Behaviour Therapy for depression and Cognitive Retraining were introduced and continued for over months, with a definite positive trend in his outlook. Family counseling and psychoeducation added to the improvement. The physiotherapist noted severe hamstring spasm, with restricted SLR bilaterally – basic exercises to make the limbs more flexible were given with Yoga and mud therapy. His gait disabilities were addressed specifically and over time he began to ambulate with greater ease. Yoga therapy helped his posture and balance, apart from reducing anxiety. Ayurvedic medicated oil massage for muscle spasm and joint flexibility, Shirodhara for cognition and mood and sessions of acupuncture were all spread over 3 months. Patient and family members were extremely pleased with the personal participation in the recovery process, the positive waves from the team enhancing the results of the long term therapies.

The focus of the TriMed-Neurokrish challenge was not just to improve the physical independent activity  of the patient, but to modify behaviour (with the negative feelings of hopelessness and helplessness of the patient, leading to severe depression), to positive waves in slow but sure stages through cognitive behaviour therapy for the patient and through family counseling. Gaining the trust of the patient and family as the first step made them go along with the therapies with a sense of total dynamic participation in the process of rehabilitation and it even became a ‘fun game’ as marked improvement was noted. Recognising the patient’s often warped ‘thoughts and beliefs’, the altered life situations and the loss of self-esteem that contribute to the maladaptive and social withdrawal behaviours and the immediate triggers that set it off, are part of the sensitive professional assessments. These can be remedied by cognitive behaviour therapy, (when followed with diligence), towards placing the patient back in his original zone of comfort and self confidence in the home and in the community. A supportive network in this process includes health care providers, family, old friends, new friends, and persons who have had similar experiences.

The yoga sessions, massages, and other integrative therapies reinforce the wellness of the person through their general and specific actions, ensure continuity with the treatment team, and motivate the patient and family to participate willingly in the path to patient recovery.

“She knew right away that that ray of hope to give her father some quality of life lay in this setting.”

Looking Ahead

Over months, Varadarajan has made a steady recovery. His cognitive difficulties have largely remitted, his walking has improved, so much so, that he now does 5 kms on his own and walks his dog as well; his mood has improved, anxiety reduced and confidence levels have been boosted considerably. He is attending to his business again and has started to strike new deals, possibly saving his factory from closure; he is even planning a visit to the USA to spend time with his daughter, rekindling too an old desire for travel. Mr. Varadarajan continues to attend his medical reviews and booster therapy sessions regularly as scheduled and is gregarious in his interactions with the treating team, often sharing a hearty laugh.

For us, Varadarajan and scores of courageous patients like him, are our true inspiration. His family are beside themselves with joy to have him well and truly back in their midst, for his has truly been “A Himalayan Odyssey”. The Longman’s Dictionary of Contemporary English which defines the word ‘odyssey’ (with its roots in the Homer’s epic poem by that name)  “as a series of experiences that teach you something about yourself or about life – a spiritual odyssey”, suits the theme of this TriMed-Neurokrish story best.

Adolescents Buddhi Stories Children Epilepsy & Seizures Featured Patient Stories

Asma – Building Rapport


Asma was the second born of two daughters to parents who were both working professionals and of a middle class background. Since the mother had some minor complication in the first delivery and as there was an eight-year gap between the two pregnancies with maternal age at 30 years, a planned, elective Cesarean was carried out. The delivery was conducted at term and the developmental milestones of infancy and early childhood were normal.

The maternal grandparents lived close to Asma’s home and looked after the two grandchildren when the parents were at work. In the Indian grandparenting context, this was carried out diligently, with focus on every aspect of traditional child development, covering the spectra of nutritional requirements, discipline, academic performance and physical, mental and spiritual growth. Asma’s attention-seeking behavior, temper tantrums and need to win every event she took part in might have been influenced by the environmental situation, but it was distinctly excessive on any account.

Exploring the Condition

Premorbidly, Asma was described as being intelligent, cheerful, sociable, enthusiastic about participation in extracurricular events like dance and music, and though a slow learner at school, she was keen on overcoming her academic deficiencies with added effort, which the teachers recognized and were lenient when marking her.

Asma’s clinical problems manifested at the age of six years, with two types of bizarre episodes of a repetitive, stereotypic nature. The first involved jumping up and down 10-20 times, in a seated position, clapping hands and bursting into unprovoked laughter, which could not be described as totally mirthless. She was aware and able to answer questions during the episodes, which were associated with sweating and terminated, after a couple of minutes in a cough, as if she was choking. These episodes occurred frequently.

The second type, 15-20 episodes in 24 hours, occurred both while awake and in sleep initially, and later was confined to the sleep stage. The attack was of arousal, stare, movement of hips  up and down 5-10 times rhythmically (pelvic thrust), followed by a smile, hyperventilation and incomprehensible muttering for a few minutes and back to sleep. Initially she was responding to call during these episodes, but later she became unresponsive right through the episode. After basic seizure screening, in a city Epilepsy Clinic, which included neurological assessment, EEG and MRI neuroimaging, anticonvulsant therapy had been initiated, with some control of the frequency of seizures. Meanwhile, behavioural patterns, which were a clear departure from the norm for Asma had peaked, which caused great alarm to the family and school teachers at the mainstream school where she had studied from lower kindergarten class. The Principal of the school, who had known many childhood neuropsychiatric problems sorted out for them by the TriMed and Neurokrish team, referred the child to the medical facility, with a word of encouragement to the dispirited parents.

Our Healing Approach

When Asma presented to our service, accompanied by her parents, a month after the initial symptoms, she had clusters of 5-6 one-minute seizure episodes packed into 1 hour of daytime sleep and 3-4 two-minute nocturnal episodes. Bedwetting occurred once in two days, and only at night. The abnormal behaviours ranged from hyperactivity, aggression, abusive behaviour, biting, spitting, excessive and disorderly eating, to bullying other children, lying and employing overtly manipulative behaviours and defiant behaviour towards figures of authority. This was reported after detailed assessment by the Child Behaviour Therapist of Neurokrish.

The TriMed-Neurokrish team was alerted to gear up to fulfil their individual and collective roles in remedying the enormous challenge posed by Asma’s health problems. They had to bring into action (with mild variations, to suit the individual and the situation) the protocol for ‘Comprehensive Care for Epilepsy’- a best practice model for a resource-poor country like India, developed by Dr. E. S. Krishnamoorthy, to suit the sociocultural milieu and fine-tuned over the years of its use by him and his team members.

The basic requirement is a multidisciplinary team, which provides treatment, therapies, counselling and hand-holding for the patient and parents to get over the worst initial phase and to participate with hope even as they witness a palpable shift towards the positive phase of patient management.

Detailed medical and neurological examination of Asma revealed no overt clinical markers – neurological, endocrinal or genetic, suggesting a developmental disability or heritable trait. Repeated electroencephalograms (EEG’s) were abnormal with bilateral spike and wave dysfunction but failed to reveal any localization or lateralization of epileptiform activity. There was no suggestion of any syndromic epileptic disorder. Detailed testing of hematological, biochemical, endocrinal and metabolic, infectious and inflammatory parameters was non-contributory. Repeated MRI scans were taken, including  a 3 Tesla MRI scan, the last, to define even a minute lesion if present It failed to reveal any neurodevelopmental markers of significance. We looked for hippocampal sclerosis, cortical dysplasia and hypothalamic hamartomas in particular and these were eliminated.

It was the turn of the clinical psychologist to assess the patient using standard assessment scales; Binet-Kamat Test for general mental ability, screening test for specific learning disability, NIMHANS Neuropsychological Battery for Children for profiling the neuropsychological component and Raven’s Control Projection Test, to assess the child’s attitude towards parents, friends, likes, dislikes, fears and worries.  On these tests, she was found to have bright normal intellectual ability with an IQ of 119, mild difficulty in (the ‘three R’s’ as they were referred to in the colonial days! – ‘a’ being silent in arithmetic in its verbal rendering) reading, writing and arithmetic. She fell behind what was expected at her age. She also had problems in the areas of working or online memory, comprehension, attention (more frontal lobe related), visuospatial ability and mild memory deficit.

The projection test revealed “fighting with friends, problems at school and fear of ghosts”. While the child was cooperative and it was possible for the psychologist to establish rapport with her easily, she had a tendency to stray into phases of inattention, verbosity, playfulness and gnosis. This resulted in tests being incomplete. Given her general levels of comprehension, her ‘show of indifference’ to the overall predicament struck one as being altogether incongruous.  

“The basic requirement is a multidisciplinary team, which provides treatment, therapies, counselling and hand-holding for the patient and parents to get over the worst initial phase…”

The Diagnosis

Asma was diagnosed to have epilepsy with complex partial seizures originating from frontal lobe. Behavioural problems are known to occur in complex partial seizures of frontal origin, as are the selective areas of learning disability. Her inability to keep up with the class, further aggravated the abnormal behaviour, as she was obsessed with being a winner every time.

The child was started on Levetiracetam and Clobazam, two of the anticonvulsants in the list of drugs of choice for this type of seizure disorder, in a girl child of pre-pubescent age. Risperidone in small doses was introduced in an attempt to control difficult behaviours. Multidisciplinary interventions included behavioural therapy, neurodevelopmental and task-based occupational therapy (specifically with focus on attention, fine motor skills and handwriting) and remedial educational support after school for dysgraphia and dyscalculia. With family counselling, it was possible to persuade the family to cooperate even more, as they developed awareness of the child’s genuine health problem and the basis of the multidisciplinary approach. The management protocol was complimented by working with the school, counselling the Head and the teachers, developing a joint statement of special needs and building a therapeutic alliance with her concerned but informed and enthusiastic parents and grandparents. Developing a process of continued and consistent communication between the family, school and treatment team was well established, and continued over several years.

Over weeks, with titration of anticonvulsant drug dosage, her episodes remitted. With optimal use of risperidone and the therapies, her behavior pattern also became more manageable. Her problems with inattention, learning and academic performance did however continue. Although through the six-year period of comprehensive care, Asma had managed to remain in mainstream education, and continued to work with her behavioral therapist and special educator, she was advised by Dr. Krishnamoorthy to drop a year and to consider more flexible educational streams in order to cope and with less tension all round, as stress of studies, a board exam to face, failures etc., could exacerbate the seizures and the behavioural problems. Following this  advice and guidance, her parents sought admission for Asma in a city special school offering the National Open School stream. This stream allows choice of subjects with which the candidate is comfortable and he/she can take the school leaving examination, covering 2 or 3 subjects at a time at a hassle-free pace.


The onset of any form of epilepsy can be devastating to the patient and family. It may repeat frequently or be moderate to severe, and persist through the lifespan, affecting education, employment, marriage and even independent living. Early diagnosis and treatment with anticonvulsants is essential. What is equally important is to have continued specialized and comprehensive epilepsy care to give the person with epilepsy a quality of life. Complex partial epilepsy of frontal origin are very uncommon, and can pose a diagnostic dilemma, unless the clinician has a clear knowledge of the condition. This is where a health care provider can draw from literature on the subject and know what others have said about it. A much cited author Williamson (1985), described “the complex partial attacks of frontal origin as brief, frequent attacks, complex motor automatisms, kicking, thrashing, pelvic thrusting, vocalization, while consciousness is maintained”, pretty much what our patient presented with.

Braakman (2012) undertook a comprehensive neuropsychological study of 71 children with cryptogenic (with no detectable lesion) frontal lobe epilepsy  (FLE) to report that,  “Across measures, the patients demonstrated a host of cognitive and behavioral impairments”, which again goes with Asma’s clinical picture and further confirmed by the presence of gelastic epilepsy.  Gelastic epilepsy (‘laughing epilepsy’- Gelastikos in Greek meaning laughter) is a very rare epilepsy form, and is most frequently due to a benign tumour in the hypothalamus, but may also originate from the frontal or temporal lobe. Unnwongse (2010) recorded the symptomatic zone of laughter in the frontal lobe of a patient with gelastic epilepsy, employing intracranial video EEG. Benge (2014) observed that Executive Functioning, which is the ability to initiate volitional responses, plan, decide, and monitor performance is one of the most frequently impaired cognitive constructs in FLE. The frontal lobes have a critical role to play in memory functions as well, including organization and encoding of information to be learned, memory retrieval, and prospective memory. Attention and working memory difficulties may add to the cognitive deficit.

With all these areas of deficit, it is not surprising that the patient manifest learning disability. The clinical psychological assessment at baseline with performance score recording, when the patient started the treatment regimen, followed once in 3-6 months, will give a clinical evaluation of the progress, status quo or even regressive tendency, correlating with the real world patient’s all round performance, and carry with it projection and prognostication value. 

  • Braakman HM, Ijff DM, Vaessen MJ, Debeij-van Hall MH, Hofman PA, Backes WH, et al. Cognitive and behavioural findings in children with frontal lobe epilepsy. Eur J Paediatr Neurol. 2012; 16: 707-715.
  • Williamson PD, Spencer DD Complex partial seizures of frontal origin Ann Neurol 1985 Oct.; 18,(4), 497-504
  • K. Unnwongse,  Wehner T,  Singaman W Gelastic Epilepsy and the anteromesial superior frontal gyrus Epilepsia Vol 51, issue 10, 19th March 2010
  • Jared F Benge, J Michael Therwhanger, Batool Kirmani The Neuropsychology of Frontal Lobe Epilepsy: A Selective Review of 5 Years of Progress. J. of Neurological Disorders and Stroke, Special issue on Epilepsy, May 2014, 2 (3), 1057

Our Focus:

Comprehensive Epilepsy Care

Comprehensive Epilepsy Care is about targeting patients, caregivers, healthcare professionals and society at large with focus on helping the person with epilepsy minimize stigma, achieve optimal activities of daily living (ADL), health related quality of life (HRQoL); social, educational and occupational milestones. It enquires into the goal of each treatment or therapy employed within a time frame, while including the patient’s (and their relatives) subjective evaluations and perspectives. There is considerable evidence to suggest that information, education and understanding help people deal with their condition better, as ‘knowledge is power’. There is also evidence in epilepsy that psychosocial interventions improve outcome. For the team to plan the intervention effectively, it is imperative that the problems diagnosed in the clinical or lab setting is converted to understanding their real world correlates and this derived knowledge is applied towards holistic and individualized patient care.

Looking Ahead

Asma has remained seizure free, has not shown any further behavioral decompensation and remains aligned with the therapeutic team and school. The parents express their heartfelt thanks everytime they come to TriMed for follow up. The Child Behaviour Therapist, in her inimitable way says that she will take Asma’s self confidence and self esteem to the next level as she enjoys total rapport with Asma (as with other children), teases and chides her and in turn hugs her to show appreciation. The Trimed-Neurokrish team is happy to deliver patient-centred, holistic healthcare with patience and diligence as a team in the midst of a modern consumerist healthcare environment.

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