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Table of Contents
Year : 2021  |  Volume : 53  |  Issue : 2  |  Page : 77-92

OTICON'2021 Conference Abstracts

Date of Web Publication23-Jul-2021

Correspondence Address:
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0445-7706.322173

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How to cite this article:
. OTICON'2021 Conference Abstracts. Indian J Occup Ther 2021;53:77-92

How to cite this URL:
. OTICON'2021 Conference Abstracts. Indian J Occup Ther [serial online] 2021 [cited 2022 Nov 30];53:77-92. Available from: http://www.ijotonweb.org/text.asp?2021/53/2/77/322173

  Competitive Oral Presentations Top

  A Novel Sensory Rehabilitation Protocol in Poststroke Hemiparesis: A Feasibility Study Top

Akshay Kumar Joshi, Kamal Narayan Arya, Shanta Pandian

Department of Occupational Therapy, Pandit Deendayal Upadhyaya Institute for Person with Physical Disabilities, New Delhi, India

E-mail: [email protected]

Background: Majority of poststroke survivor experience reduces sensory ability that may affect motor recovery. There is a lack of active sensory rehabilitation regimens targeting the motor potentials in stroke.

Objective: To determine the feasibility of a novel sensory rehabilitation protocol based on the principles of neuroplasticity among stroke subjects.

Study Design: Pre–post-single-group feasibility design.

Methods: The investigation was carried out on 10 subjects within 1 year of poststroke duration and exhibiting motor as well as sensory impairment. The novel protocol utilized the principles such as repetitiveness specificity and salience. The program was designed in view of the motor recovery stages and types of sensory deficits such as tactile impairment, astereognosis, and proprioceptive deficit. The active sensory training such as recognizing texture, objects, and limb position with/without blindfold was utilized. Similar activities were also practiced using mirror therapy (subjects at lower motor stage) and constraint-induced movement therapy (subjects at higher motor stage). The intervention utilized various sensory-based motor tasks that were applied for 2 h/day, 5 days/week, for 8 weeks. The feasibility of the protocol was determined by examining adherence, duration, usefulness, and safety. The primary outcome measures were Fugl–Meyer assessment upper extremity (FMA-UE) and Nottingham sensory assessment (NSA).

Results: The protocol was found to be feasible for all the subjects; each session took 120–130 min. Participants perceived that the sensory rehabilitation protocol was useful and interesting with no adverse event. The subjects with lower upper extremity motor levels faced difficulty in manipulation with the affected side; thus, assistance of the unaffected side had been promoted to overcome the difficulty. Further, all the participants also experienced favorable changes in their respective outcome measures pre- and post-intervention (FMA-UE from 22.30 ± 7.81 to 31.89 ± 6.73, NSA from 21.10 ± 15.30 to 33.15 ± 12.19).

Conclusion: The novel sensory rehabilitation protocol based on the principles of neuroplasticity is a feasible regimen. The protocol has potential to enhance both sensory and motor recovery among subjects with stroke. Further trials are warranted to establish the effectiveness of the protocol.

Key Words: Astereognosis, Fugl–Meyer, Upper Limb, Motor, Recovery

  Functional Performance and Community Reintegration of Chronic Poststroke Survivors in Eastern India: A Cross-Sectional Study Top

Kshanaprava Mohakud, Samir Sahu, Sakthi Prasad Das, Srikant Sahu

Department of Occupational Therapy, SVNIRTAR, Cuttack, Odisha, India

E-mail: [email protected]

Background: Stroke is the first cause of functional incapacity for daily living. Poststroke individuals cannot participate in society fully. It becomes an economic burden for the person and society. Poststroke management in rehabilitation gives more emphasis on independent in his/her functional performance. Although improvement in functional activities, poststroke individuals become independent in his/her day-to-day activities in the home environment, but they cannot reintegrate or participate in the community.

Objective: To find the association of community reintegration with functional performance of poststroke survivors after 1 year in Eastern India and to determine the interrelation ship among functional performance and community reintegration of poststroke survivor.

Study Design: Cross Sectional Design.

Methods: The study was carried out on 86 poststroke survivors aged between 30 and 60 years with no sex barrier. Community integration questionnaire (CIQ), Lawton instrumental activities of daily living (LIADL), and functional independence measure (FIM) were used as outcome measures.

Results: To find the association between community reintegration to functional ability, and participation in extended daily living activities of the stroke survivors, Spearman's rank order correlation was used and found a significant positive correlation between (i)FIM to CIQ as the r = 0.565 (P > 0.01), (ii) LIADL to CIQ as the r = 0.687 (P > 0.01) and FIM to LIADL as the r = 0.532 (P > 0.01).

Conclusion: Community reintegration should be incorporated in stroke rehabilitation to maintain meaningful lives being a part of society and family.

Key Words: Community Reintegration, Functional Ability, Stroke

  Behavioral Intervention for Bladder Control: Its Impact on Quality of Life in Persons with Traumatic Paraplegia: A Cross-Sectional Study Top

Aradhana Nayak1, Ram Kumar Sahoo2

1SuVitas, Hyderabad, 2Department of Occupational Therapy, SVNIRTAR, Cuttack, Odisha, India

E-mail: [email protected]

Award: Won AIOTA's Best Scientific Paper in Neuro Sciences

Background: Injury to spinal cord results in many neurological problems, and bladder dysfunction is one of the major factors affecting quality of life (QOL). Improvement in bladder control leads to the improvement of psychosocial well-being related to urinary incontinence, thereby enhancing QOL. The effect of behavioral intervention on bladder control is well documented in patients with urinary incontinence. However, very few evidence is available on its effect in patients with traumatic paraplegia in the Indian context.

Objectives: (1) To determine the effect of behavioral intervention on bladder control and QOL in patients with traumatic paraplegia. (2) To find the relationship between status of bladder control and QOL.

Study Design: Single-group cross-sectional study design.

Methods: 36 traumatic paraplegics were taken for the study after screening by the American Spinal Injury Association Impairment Scale. Behavioral intervention along with traditional bladder management was provided to them for 8 weeks. Pre- and post-intervention data were recorded using urogenital distress inventory short form (UDI-6) and incontinence quality of life (IQOL). Follow-up data were recorded 6 months after completion of intervention to measure the retention effect.

Result: Friedman test along with post hoc Wilcoxon signed-rank test showed significant difference (P = 0.000) between pre- and post-test scores as well as pretest and follow-up scores for both outcome measures. There was no significant difference noted between posttest and follow-up scores (P = 0.482 and P = 731) for UDI-6 and IQOL, respectively. When pretest scores of UDI-6 and IQOL were correlated using Kendall tau correlation coefficient, it gave a high negative correlation (−0.725), which implied that the poorer status of bladder control is related to poorer QOL.

Conclusion: Behavioral intervention is an effective technique in improving bladder control, aid to faster improvement when used along with other traditional bladder management techniques in patients with traumatic paraplegia.

Key Words: Behavioral Intervention, Bladder Control, Bladder Management, Quality of Life, Traumatic Paraplegia

  Effectiveness of Action Observation Dual-Task Training on Balance and Its Impact on Activities of Daily Living among Elderly Population: An Experimental Study Top

Chetan Ladu Gaude1, Silpa Immanuel Voola2

1Department of Orthopedic Surgery, Goa Medical College, Bambolim, Goa, 2SRM College of Occupational Therapy, SRM Institute of Science and Technology, Chennai, Tamil Nadu, India

E-mail: [email protected]

Background: Elderly population is increasing rapidly over the years in India and worldwide. Loss of balance and high-risk falls in older people are directly proportional. Majority of the elderly sustain falls as a result of difficulty in execution of both cognitive and postural tasks simultaneously, which affects the activities of daily living (ADL) performance. Balance training program for dual tasks with increasing difficulty and shifting priorities between two tasks helps improve balance and functional recovery. The need to address the balance deficit as it hinders the ADL performance and independence therefore becomes of prime importance. There are studies that have evaluated the role of action observation with dual-task training on cognitive deficits, but there are no or limited studies that have assessed the effectiveness of action observation with dual-task training for motor deficits such as balance and its impact on their ADL performance. Hence, this study aims to contribute to the development of knowledge in these areas.

Objective: This study investigated the effectiveness of action observation dual task training on balance and its impact on ADL in the elderly.

Study Design: Quasi-experimental pre–post design was used.

Methods: Forty-two older adults above 60 years were recruited. All the participants were assigned to the experimental group (n = 21) and control group (n = 21). Participants from the experimental group were given action observation followed by dual-task training for a period of 3 weeks, with each session lasting for 35 min. However, participants in the control group received only dual-task training. Outcome measures used for balance were timed up go (TUG) test, functional reach test (FRT), and Berg balance scale (BBS) as well as for ADL were modified Barthel index (MBI).

Results: Experimental group has shown significant difference in both balance and ADL in comparison with control group. The findings had shown that there was marked difference significantly in the posttests of BBS (t = −18.198, P = 0.00), TUG (t = 9.727, P ≤ 0.00), FRT (t = −7.445, P ≤ 0.00), and MBI score (t = −16.166, P = 0.00).

Conclusion: Action observation dual-task training is effective in improving balance and ADL among the elderly.

Key Words: Action Observation Therapy, Balance, Activities of Daily Living, Dual-Task Training, Elderly

  Occupational Therapy Rehabilitation for Patient with Hemophilia Factor 13 Deficiency with Recurrent Stroke during COVID-19 Pandemic: A Single-Case Study Top

Sharda B Sethy1, Rajul Daftary1

1OT School and Centre, Seth GSMC and KEM Hospital, Mumbai, Maharashtra, India

E-mail: [email protected]

A 28-year-old male patient was a known case of hemophilia factor 13 deficiency since birth. Currently unemployed, earlier, he was (before onset of illness) working in mobile and computer repair shop. There is a history of blunt trauma to head at home on July 20, 2020. The patient was admitted in a tertiary care hospital with diagnosis of subarachnoid hemorrhage with intraparenchymal bleed in the left temporoparietal lobe and referred to the occupational therapy department for further rehabilitation. The patient had a history of injury to head which led to left hemiplegia in December 2011.

Deficiency of coagulation factor XIII is a rare anomaly; the risk of intracranial hemorrhage is particularly high at any age, either spontaneously or during minor trauma. We report this case to describe the recovery of a patient with hemophilia after traumatic brain injury despite poor prognosis and use of interdisciplinary protocol.

Patient's Details:

  • Higher function test: The patient was oriented to time, place, and person. Recent and recent past memory affected
  • Cranial nerves (CNs): CN II affected–right hemianopsia
  • Voluntarily control: Brunnstrom stage for hand – stage 4

  • Stage of upper limb – stage 5

    Stage of lower limb – stage 5

  • Range of motion: Within normal limit. Right ankle dorsiflexion 0–10
  • Muscle strength: Grade 3 in the right upper and lower limb. Grade 3+ in the left upper and lower limb.
  • Activities of daily living (ADL): functional independence measure (FIM) score - total 91/126
  • Scales: Montreal cognitive assessment score - 17/30
  • Rivermead behavioral memory test - recent and recent past memory affected
  • Occupational therapy adult perceptual screening test: Right unilateral neglected/right homonymous hemianopsia present
  • Caregiver burden scale score 30 - mild to moderate burden.

Functional Status:

  • Right hemiparesis with anomic aphasia
  • Patient needs maximal support for bed transfer and mobility activities.
  • Memory: Recent and recent past affected.

Objectives: To assess the effectiveness of occupational therapy intervention during COVID-19 pandemic for patient with hemophilia factor 13 deficiency with right hemiparesis.

The patient was assessed on October 19, 2020; the patient received intervention once in a week at outpatient department set up and home exercises programs through teletherapy. Outcomes measures are FIM scale, Montreal cognitive assessment (MOCA) test, Rivermead behavioral memory test, and caregiver burden scale.

The patient was assessed on December 27, 2020, ADL score was 105/126, MOCA was 23/30, the patient was able to name out common objects 3/5 without prompts, and the patient was able to perform bed transfers and mobility skills with minimal support/under supervision at hospital and home set-up.

Key Words: COVID-19, Hemophilia, Occupational Therapy Rehabilitation, Stroke, Teletherapy

  Occupational Therapy Intervention in Young-Onset Parkinson's Disease: A Case Study Top

Baldeep Kaur Sehra1, Preetee Gokhale1

1Occupational Therapy Training School and Center, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India

E-mail: [email protected]

Young-onset Parkinson's disease occurs in people younger than 50 years of age. With informed consent, Mrs. M was selected for the case report because young-onset Parkinson's disease is a rare diagnosis. The patient being in her early 30, many of her life roles were altered. Further, the impact of this disease is lifelong, but the lifespan is not affected; the symptoms increase gradually.

Mrs. M was treated on a weekly basis for an intervention period of 3 months using the Person-Environment Occupation Model and assessed using the Unified Parkinson's Disease Rating Scale, pre- and post-treatment. She was in Stage 3 of Hoehn and Yahr scale of classification of Parkinson's disease.

Scores were assessed on Unified Parkinson's Disease Rating Scale, pre- and post-3 months of intervention; she showed improvement in nonmotor and motor aspects of experiences of daily living, motor examination, and motor complications.

Component scores were decreased dramatically, especially in the areas of anxious mood, fatigue, tremors, posture, and bradykinesia, which revealed that functional levels improved.

Key Words: Person-Environment Occupation-based Occupational Therapy Intervention, Unified Parkinson's Disease Rating Scale, Young Onset Parkinson's Disease

  A Prospective Qualitative Study to Categorize Occupational Therapists Experiences in Providing Teletherapy in Hand Injuries Cases Top

Payal Surpam, Vaijanti Jain

OT School and Centre, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India

E-mail: [email protected]

Background: Current COVID-19 pandemic has affected patients' care services all over the world, and occupational therapy services being a part of tertiary care protocol have been affected the most. In such situation of fast-spreading contagious and communicable disease, teletherapy has proven to be the boon for rendering therapeutic services.

Objectives: To categorize the experiences of occupational therapists in using teletherapy as an alternative method of rehabilitation in hand injury cases between April 2020 and October 2020.

Study Design: Qualitative study design–content analysis type was chosen for the research.

Methods: Five occupational therapists including staff and postgraduate students working at tertiary care setup in Mumbai were asked an open-ended question about their “experiences while providing teletherapy services to 36 hand injury patients in a period of 7 months” (April 2020–October 2020) through text messages. Inductive content analysis through paper–pencil method was used to categorize the data obtained from the therapists by tagging it and to find its positive and negative effects on therapist's experiences.

Results: The inductive content analysis of all the five replies with paper–pencil method provided data which can be tagged into 15 categories including technical, assessment, mobilization, time-saving, safety, splint designing, flexibility, time disregardance, confidentiality, family support, individual attention, planned therapy, convenient, time-consuming, and record maintenance. The content analysis of the five replies divided the above categories into positive and negative experiences the participant had while using teletherapy.

Conclusion: The analysis of occupational therapists' experiences using teletherapy in hand rehabilitation provided around 15 categories both augmenting and affecting therapist's abilities in providing such services.

Key Words: Hand Injuries, Occupational Therapists, Qualitative, Teletherapy

  Effect of Simulated Functional Task to Improve Executive Function, Functional Balance, and Activities of Daily Living in Elderly People with Mild Cognitive Impairment: An Experimental Study Top

K Sanjeevkumar1, S Sakthi Srija1

1KMCH College of Occupational Therapy, Coimbatore, Tamil Nadu, India

E-mail: [email protected]

Background: Elderly people with mild cognitive impairment (MCI) have decline in executive function, functional balance, and the ability to perform activities of daily living (ADL). The simulated functional task (FcTSim) program provides conventional benefits on cognitive function of elderly participants with MCI.

Objective: This study aims to find the effectiveness of FcTSim to improve executive function, functional balance, and ADL in the elderly people with MCI.

Study Design: Pre- Post Test Experimental Design

Methods: The study was conducted on 15 patients with MCI and balance problem. The patients were selected on the basis of the mini mental status examination and Berg balance scale (BBS) and belonging to the age group between 65 and 85 years. FcTSim program was given for 4 weeks, a total of 12 sessions (3 sessions per week). Addenbrooke's Cognitive Examination–Revised (ACE-R), BBS, and Canadian occupational performance measure (COPM) scales were used as the outcome measure.

Results: The significant difference in the scores of ACE-R (11.53, P = 0.00, 95% confidence interval [CI]: 9.52–13.54), BBS (8.80, P = 0.00, 95% CI: 7.49–10.11), COPM-performance (1.00, P = 0.00, 95% CI: 0.53–1.46) and satisfaction (1.53, P = 0.00, 95% CI: 1.02–2.04), suggesting the effectiveness of FcTSim program in improving executive function, functional balance, and occupational performance.

Conclusion: FcTSim improves executive function, functional balance, and ADL in the elderly people with MCI.

Key Words: Activities of Daily Living, Executive Function, Functional Balance, Mild Cognitive Impairment, Simulated Functional Task

  A Systematic Review of Different Pain Assessment Scales Used in Neonates Top

Deepa Awasthi, Shailaja Jaywant

Department of Occupational Therapy, LTMMC and General Hospital, Mumbai, Maharashtra, India

E-mail: [email protected]

Award: Won Gazala Makda Award for Best Scientific Paper in Paediatrics

Background: Painful experiences in the neonatal intensive care unit are likely to evoke stress response, frequent activation of which can impact neonate's brain development and future outcomes. Thus, discern of an appropriate pain assessment scale by a clinician is highly significant.

Objectives: To analyze the dimensionality, type of pain measured, psychometric properties, scale components, and the target gestational age group assessed by the various neonatal pain assessment scales and their use in different clinical contexts.

Study Design: Systematic review.

Methods: Scientific databases such as Cochrane Database of Systematic Reviews, MEDLINE, EpiINFO, Biosis Preview, and PubMed were searched from their inception to October 2019. A search strategy was established combining subject headings and free terms. The search strategy included terms “neonate” AND “pain” AND “assessment,” OR “outcome measure” OR “scale” OR “Review” AND “psychometric.” Freely available neonatal pain assessment measures and their reviews were included. Measures, not published in English or for which only abstract was available, were excluded. Selected scales were systematically analyzed for their dimensionality, type of pain measured, target gestational age, scale items, reliability, and validity.

Results: Eighteen neonatal pain assessment scales were included, consisting of 9 unidimensional scales and 9 multidimensional scales. 7 (38%) scales assessed acute pain. 8 (44%) scales measured postoperative pain and 3 (16%) measured prolonged pain. 15 (83%) scales were validated for use in both preterm and full-term infants, while 2 (11%) scales namely behavioral indicator of infant pain and Echelle Douleur Inconfort neonatal pain and discomfort scale were validated for preterm infants, only along with 1 (6%) scale namely modified infant pain scale validated for use in full-term infants only. Facial expressions were considered as a component by 7 (38%) and 5 (27%) unidimensional and multidimensional scales, respectively. 9 (50%) multidimensional and 4 (22%) unidimensional scales scored behavioral state. Inter-rater reliability was possessed by 7 unidimensional and multidimensional scales, respectively. 6 (33%) scales considered content validity, and 10 (55%) scales considered construct validity.

Conclusion: Neonatal care providers must discern a pain assessment scale based on the knowledge of its characteristics, gestational age, type of painful stimulus, and environmental context of the neonate. Further research regarding clinical utility of these scales is recommended, especially in the Indian context.

Key Words: Gestational Age, Multidimensional, Neonatal Intensive Care Unit, Neonate, Pain Assessment Scale, Unidimensional

  Understanding Daily Routine and Schedule of Children with Attention-Deficit Hyperactivity Disorder, in Goa, India: A Qualitative Study Top

Divesha Shikerkar1, Pooja Vajaratkar1

1Department of Occupational Therapy, Goa Medical College, Bambolim, Goa, India

E-mail: [email protected]

Background: Attention-deficit hyperactivity disorder (ADHD) is characterized by diminished attention, impulsivity, and hyperactivity and has an impact on the daily routine and self-control issues in children. There is dearth in the evidence of understanding of the routine of parents and children with ADHD, which is necessary for structuring the routine for better management of daily occupations.

Objectives: This study aimed to understand the daily routine and schedule of children with ADHD in Goa.

Study Design: A qualitative descriptive study design was used.

Methods: The study design was a qualitative-based descriptive pilot study, conducted in resource rooms and schools of Goa, India. The recruitment of parents (n = 10, age 32–55 years) of children (n = 10, age 7–12 years) with ADHD was done by convenient purposeful sampling method, and parents were administered using a semi-structured questionnaire, and in-depth interview was taken to understand their daily routine.

Results: Ten parents (age 32–55 years, mean = 45.4 years, standard deviation [SD] = ±7.97) of children with ADHD (age = 7–12 years, mean = 9.5 years, SD= ±1.85) participated in this study. The routine was understood on the following themes (a) structure of routine, (b) school and home routine, (c) effect of this routine on the child and parents and changes expected, and (d) importance of routine in daily life.

Conclusion: The study helped in understanding of daily routine and schedule of children with ADHD and the effect of this routine on the child and parents in managing their daily activities and meaningful occupations.

Key Words: Attention-Deficit Hyperactivity Disorder, Daily Occupations, Routine, Schedule

  A Study on Impact of COVID 19 Pandemic on Activities of Daily Living, Play, and Sensory Behaviors of Children with Autism Spectrum Disorder: A Cross-Sectional Survey Study Top

G Daris Nithya, V Damodharan, V Mythili

Department of Child Psychiatry, Institute of Child Health and Government Hospital, Chennai, Tamil Nadu, India

E-mail: [email protected]

Background: New COVID-19 pandemic has greater influence on all of us and changed many of our everyday routines. Adjusting to a new routine is stressful for everyone, but especially for children with autism who have difficulty with change, it is more stressful. Environmental changes, home confinement, disrupted daily routines, restricted access to services, such as schools and therapy centers, will have a unique impact on children with autism and their families.

Objectives: To study the impact COVID-19 pandemic on activities of daily living (ADL), play, and sensory behaviors of children with autism spectrum disorder (ASD).

Study Design: Cross-sectional survey study.

Methods: Our sample consisted of 100 parents and primary caregivers of children with autism who are on regular treatment in Outpatient Department of Child Psychiatry, Institute of Child Health, Chennai. Semi-structured ADL, play, and sensory behavior questionnaire (45 items) was administered directly and through phone interview.

Duration of the Study: 1 month.

Results: 85% of the parents reported that inconsistent daily routines have become prominent since COVID-19, and it has become difficult to implement ADL on time. ASD kids spend more time on mobile phones and television. Home confinement resulted in lower physical activity and social withdrawal. Moreover, many parents mentioned increased intensity of vestibular-proprioceptive seeking, other sensory behaviors since COVID-19.

Conclusions: Our results suggest that the COVID-19 pandemic inflicts specific challenges to individuals with ASD and their caregivers, underlining the need for targeted, occupational therapy intervention and other support services during these pandemics.

Key Words: Activities of Daily Living, Autism, COVID-19 Impact, Occupational Therapy, Play, Sensory Behaviors

  Dysfunctional Behavior and Associated Risk Factors in Children with Autism in Eastern India: A Cross-Sectional Study Top

Durga Prasad Mishra1

1Department of Occupational Therapy, SVNIRTAR, Utkal University, Cuttack, Odisha, India

E-mail: [email protected]

Background: Children with autism show dysfunctional behaviors that not only impact daily functioning but also cause increased burden and distress to parents. The present study assessed the prevalence of clinically significant dysfunctional behaviors and associated risk factors among children diagnosed with autism.

Objectives: Literature on behavior problems among young children in India is very limited. The purpose of the study was to identify the prevalence of clinically significant dysfunctional behaviors and their associated factors among children aged 2–6 years diagnosed with autism.

Study Design: Cross-sectional study.

Methods: A study was carried out in 2018 involving mothers of 100 male children with autism aged 2–6 years. Using the child behavior checklist (CBCL), mothers rated their child's dysfunctional behaviors.

Results: Eighty-eight (88%) children with autism had a CBCL total problems' score in the clinically significant range (88% and 43% of children had clinically significant internalizing and externalizing problems, respectively). The CBCL syndrome scales with the highest percentage of clinically significant scores were withdrawn (94%), sleep problems (58%), and attention problems (58%). Overall, 92% of children with autism had more than one CBCL syndrome scale in the clinically significant range, indicating high degree of comorbidity of clinically significant dysfunctional behaviors. Several risk factors such as autism severity, screen time/day, and caffeine consumption for dysfunctional behaviors were identified.

Conclusion: The prevalence of clinically significant dysfunctional behaviors is very high among male children with autism. It warrants the need for designing effective behavioral management strategies incorporating various risk factors to improve the quality of life of these children.

Key Words: Autism, Child Behavior Checklist, Dysfunctional Behavior

  A Scoping Review on “Touching Private Parts” Behavior in Young Children (2–6 Years) Diagnosed with Autism Spectrum Disorder Top

Parveen Sheeba1, Samnani Manish2, Samnani Malvika2

1Department of Occupational Therapy, Jamia Hamdard, New Delhi,

2SOCH, Gurugram, Haryana, India

E-mail: [email protected]

Background: Childhood sexual development and the sexual behavior of young children with disabilities are the areas of research that remain particularly neglected. Although touching and pressing private parts are being observed in clinical settings during therapy/intervention, parents are often reluctant to report these behaviors as part of their behavioral concerns, although they are particularly disturbed by the same. Parents and therapists often categorize these behaviors as “sexual behavior” or “inappropriate social behavior.” Previous studies and systematic reviews state that these behaviors tend to be related to varied factors, such as curiosity, impulsivity, anxiety, trauma-related symptoms (e.g., re-experiencing symptoms of posttraumatic stress disorder), and attention-seeking.

Objective: This review provides a systematic analysis of studies that focused on behaviors which involve touching, pressing, and rubbing private parts in young children with autism spectrum disorder (ASD) aged 2-6 years.

Study Design: Scoping review.

Methods: The terms sexual behaviour, masturbation, touching private parts were individually searched and combined with the term ASD in young children in the electronic databases such as Pubmed, Google Scholar and Cochrane Library. The single-case study designs were also included in the review.

Results: It should be noted that although the term “sexual” is used, the reasons for engaging in such behavior in the age group of 2–6 years do not logically seem to be related to sexual gratification or stimulation. The studies were described to state various clinical and demographic factors associated with sexual behavior or inappropriate sexual behavior.

Conclusion: There are studies about sexual behavior in adolescents as part of sexuality and sexual development, but touching private parts in early childhood is still not being studied or described with much emphasis. There seems to be still a gap about terminology and operational definition or whether or not they should be separated from age-appropriate sexual development. The underlying reason for these and how to plan an intervention for these children can only be taken up only after there is a body of knowledge and understanding about them.

Key Words: Autism Spectrum Disorder, Sensory Exploration, Touching Private Part, Young Children

  Effect of Kinesio Taping on Seated Postural Control in Children with Cerebral Palsy: A Quasi-Experimental Study Top

Missal Sujata1, Govind Gopika1

1Department of Occupational Therapy, KMCH, Coimbatore, Tamil Nadu, India

E-mail: [email protected]

Background: Sitting posture provides postural background tone required for the functional movement of upper extremity, and children with cerebral palsy often show difficulty in achieving a well-balanced sitting posture. Therapeutic taping focuses on improving the information feedback, as well as stabilizing body for functional control.

Objective: The present study was designed to determine the effectiveness of Kinesio taping on trunk muscles in improving seated postural control in cerebral palsy.

Study Design: Quasi Experimental Study

Methods: The study included 16 children of age range between 1 and 6 years with cerebral palsy, and they were screened using Gross Motor Function Classification System–Expanded and Revised (below 2 years – Level III and Level IV, 2–4 and 4–6 years – Level IV were included). All participants were assessed using SATCo and Chailey Levels of Ability. Subjects were assigned to one of two groups: Kinesio taping and conventional occupational therapy or home program and conventional occupational therapy using convenient sampling. For Group 1, taping was applied over trunk muscles and effects were assessed immediately after the application of tape, after 6 weeks and after 12 weeks of intervention. Group 2 underwent home program and conventional occupational therapy and effects were assessed after 6 and 12 weeks of intervention. Wilcoxon signed-rank test and Mann–Whitney U-test were used to evaluate within- and between-group differences, respectively. The level of significance was applied as P ≤ 0.05.

Results: There was significant difference after 12 weeks of intervention with Kinesio taping in both SATCo and Chailey Levels of ability (SATCo, P = 0.041, Chailey supine – P = 0.025, prone – P = 0.025, floor sitting – P = 0.046) for Group 1 while there was no significant difference (P > 0.05) in scores for Group 2. There was no significant difference in scores immediately after application of tape or after 6 weeks of intervention using Kinesio tape in Group 1. The between-group comparison of scores showed no significant difference (P > 0.05), indicating that both groups have improved through their respective interventions. Effect size for SATCo was found to be medium (r = 0.37) while for Chailey prone (r = 0.03), floor sitting (r = 0.04), box sitting (r = 0.04) was found to be small, indicating more improvement in Group 1 after the intervention period.

Conclusion: Kinesio tape on trunk muscles led to improved sitting postural control and can be considered as a beneficial treatment technique for improving muscle activity and sensory feedback in children with cerebral palsy.

Key Words: Cerebral Palsy, Kinesio Tape, Sitting Postural Control, Trunk Muscles

  Effect of Oculomotor Intervention Program on Fine Motor Coordination and Balance in Children with Learning Disabilities Aged 8–12 Years: A Quasi Experimental Study Top

Yashwanti V Ughade1, Pratibha M Vaidya2

1OT School and Centre, TNMC and BYL Nair Charitable Hospital, 2Department of Occupational Therapy, TNMC and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India

E-mail: [email protected]

Background: Children with learning disabilities may have problems with balance and fine coordinated activities due to the presence of oculomotor dysfunWction. Oculomotor dysfunction is the inability to perform accurate, effective ocular pursuit, saccadic and/or fixation eye movement patterns. A study done by Maria Pia Bucci explored the effect of visual tasks on postural control in 30 dyslexic children. Many evidence proved improvements in reading skills after oculomotor training but have scanty research showing effects on fine motor skills and balance. Thus, an effort was made to study the effects of oculomotor intervention on fine motor coordination and balance in children with learning disabilities.

Objectives: To study the effect of oculomotor intervention program on fine motor coordination and balance in children with learning disabilities.

Study Design: Quasi Experimental Study.

Methods: An interventional study on 34 children was performed. Consent was taken from the parents and assent form was signed by the child. The developmental eye movement (DEM) test was a screening tool used to assess oculomotor problems. Children falling in the criteria of Type II and above behavior in DEM test were included in the intervention. Fine manual control and balance subtest of The Bruininks-Oseretsky Test of Motor Proficiency Second Edition (BOT™-2) was administered as an outcome measure for fine motor coordination and balance. Children included were treated using oculomotor intervention program, twice a week for 6 weeks, each session lasting for 40 min with reassessment at the end of 3 and 6 weeks. The scores recorded for BOT-2 were compared pre- and post-intervention.

Results: Wilcoxon signed-rank test was used. There was a significant difference between the median scores of fine motor precision, fine motor integration, and balance (P < 0.05). Percentage change from baseline to 3 weeks and 3 to 6 weeks for fine motor precision was 20.72% and 31.17%, fine motor integration was 22.28% and 7.05%, and balance was 26.9% and 13.20%. The total percentage change improvement seen was 51.89%, 29.33%, and 36.61%, respectively.

Conclusions: Oculomotor intervention program is effective along with conventional occupational therapy in improving fine motor coordination and balance in children with learning disabilities.

Key Words: Developmental Dyslexia, Developmental Eye Movement Test, Fine Motor Skills, Occupational Therapy, Ocular Motor Dysfunction, Postural Control

  Validation of INDIA EBUS among Professionals Practicing in Neonatal Intensive Care Unit: An Online Survey Top

Prachi Gangurde1, Hemant Nandgaonkar1

1OT School and Training Center, Seth GSMC and KEMH, Mumbai, Maharashtra, India

E-mail: [email protected]

Background: INDIA EBUS is a cloud-based software aimed at supporting optimal neurodevelopmental outcome in neonatal intensive care unit (NICU). INDIA is an acronym for Individual New-born Developmental Intervention Application, which is based on the available evidence. It includes various aspects such as neurodevelopmental, neurophysiological, neurobehavioral, developmentally supportive and trauma-informed care, splinting, and occupational therapy intervention, which helps in clinical assistance, interpretation, and documentation for professionals.

Objective: To check the content validity (CV) of the INDIA EBUS.

Study Design: Prospective online survey.

Methods: Request letter was sent to the professionals. Online recruitments of the participants were done. Thirty Professionals who are willing to fill consent form and having 1 year clinical experience in NICU were recruited by snowball sampling. After that, investigator briefly introduced the INDIA EBUS. Later, software access was given for 7–10 days to the participant. After sending Google Form, online recruitments of the participants were done if they click to “I agree;” as per Google Form, then data were collected.

Results: INDIA EBUS uses the combination of different models aimed at neuroprotection by the multidisciplinary team in NICU and postdischarge follow-up as a theoretical framework. The literature review and expert-based panel supported the CV of the INDIA EBUS. CV index for the components relating to the developmentally supportive care and neuromotor assessment was 0.87; for the neurodevelopmental assessment and intervention was greater than or equal to 0.78; for the trauma informed care, chest physiotherapy, and neurobehavioral assessment was below 0.50. The healthcare workers confirmed the understandability, completeness, and credibility of the INDIA EBUS. The different stakeholders in the study considered the software will be helpful for the brain-oriented care in NICU (neuroprotection) and beneficial for neurodevelopment. Negative ratings referred to the time required for the use of data entry and the use of digital devices.

Conclusion: There was strong evidence supporting the CV of the INDIA EBUS. Despite the substantial length and time requirement, software was considered helpful for comprehensive neurodevelopmental care in NICU. Further research on psychometric qualities, implementation, and effectiveness is needed.

Key Words: Digital Approach, Neonatal Intensive Care Unit, Neurodevelopmental Care

  Lifestyle Behaviors and Their Influence on Work-Related Musculoskeletal Discomfort. A Web-Based Survey during COVID-19 Pandemic Top

Bharati Jajoo1, Shweta Bhatbolan2, Sudhir Bhatbolan2

1Body Dynamics, Whitefield, Bengaluru, 2SDM College of Physiotherapy, SDM University, Sattur, Dharwad, Karnataka, India

E-mail: [email protected]

Award: Won MM Sangoi Award for Best Paper in Ergonomics, Access and Environment.

Background: Healthy lifestyle choices have a great impact on individuals' health. The COVID-19 pandemic has created an unprecedented amount of work from home (WFH) situations. This recent trend has led to computer users in WFH having limited access to healthcare options, ergonomic workstations, and social participation such as a visit to a gym or walking in the park, or any other meaningful engagements which people adopt to improve their health and well-being.

Objectives: This study aimed to identify the health and lifestyle behaviors and reported work-related discomfort of employees in WFH situations due to COVID-19 lockdown, through a self-reported survey, and to study if there is an association between reported discomfort and lifestyle behaviors.

Study Design: Cross Sectional Survey

Methods: A web-based e-mail survey was designed having three sections – first section consisted of demographic characteristics, second section enquired regarding work-related discomfort and its rating on the visual analog scale (VAS), and third section evaluated the scoring on the Simple Lifestyle Indicator Questionnaire (SLIQ). Completed questionnaires and the responses were analyzed using SPSS 20.

Results: Demographic data showed that most respondents were males (N = 190, 78%). 80% of respondents reported musculoskeletal symptoms. The SLIQ score showed 9% of the studied population in the healthy category, 40% in intermediate healthy, and 57% in the unhealthy category. The Pearson's correlation coefficient was calculated for the individual scores in each category with the VAS score. Physical activity and VAS score showed a significant negative correlation (r = −0.168) while the VAS score and stress level showed a significant positive correlation (r = 0.369).

Conclusion: WFH has led to an overall reduction of participation in healthy lifestyle behaviors, with a substantial percentage of people classified in the unhealthy category. Survey also elicits a significant association that higher levels of physical activity in people during the COVID-19 pandemic correlated with a lower reported work-related musculoskeletal discomfort. Similarly, the higher stress levels correlate positively with reported discomfort. Thus awareness measures to educate healthy lifestyle and promote healthy behaviors should be incorporated among computer users in WFH training.

Key Words: COVID-19 Lockdown, Exercise, Lifestyle Behaviors, Work from Home, Work-Related Discomfort

  ”I Want to Visit A Library Too:” Re-Imagining Libraries with Children with Disabilities and Their Caregivers to Promote Participation: A Qualitative Study Top

RP Shetty1, RS Mehta1

1Ummeed Child Development Center, Mumbai, Maharashtra, India

E-mail: [email protected]

Background: The able-bodied designing of books and library spaces, significant lack of representation of children with disabilities and their families in books, representation which Stefanie and Eva call Bandaid Books intent to make a point or teaching a thinly disguised moral, and lack of awareness of their needs add more layers of complexity in the conversation of children with disabilities and libraries. Moreover, these very layers form barriers for participation excluding children with disabilities.

Objective: To study factors influencing participation of children with disabilities and their caregivers in a library at a child development center.

Study Design: Qualitative research design based on grounded theory was used for this study.

Methods: A bi-weekly pop-up library was set up for 6 weeks in the waiting area of a child development center, which provides care to children with disabilities and their caregivers. Participants were those who were visiting the center for consultations and therapy and were recruited through convenience sampling. Data were collected through observations and unstructured interviews.

Results: Data were analyzed using inductive reasoning to generate the following seven themes: (a) opportunities to engage with books; (b) context informed collection; (c) toys and playful environment, (d) reducing physical barriers, (e) interactive activities and prompts, (f) caregivers as extensions of children's bodies, and (g) engaging professionals and support staff.

Conclusion: Children with disabilities and their caregivers can participate in the library as an occupation if libraries are made accessible. The themes that emerged are laying the groundwork for accessibility practices and can contribute to evidence for librarying as an occupation for children with disabilities and their families.

Key Words: Disability, Library, Occupation, Occupational Therapy, Participation

  Prevalence of Musculoskeletal Symptoms Associated with Ergonomic Factors in Undergraduate and Postgraduate Dental Students : A Cross-Sectional Survey Study Top

Alisha Tembhekar1, Sunita Koutarapu1

1OT School and Centre TNMC and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India

E-mail: [email protected]

Background: The prevalence of musculoskeletal disorders (MSDs) is higher than any other occupational disease among dentist and dental students. This is due to the fact that they work for long period in inflexible and prolonged static postures, carrying out delicate and accurate procedures.

Objective: To assess the musculoskeletal symptoms and the ergonomic factors that cause them in dental undergraduate and postgraduate students.

Study Design: Cross-sectional survey

Methods: This is a cross-sectional noninterventional study, convenience sample of 200 students, and consent was taken. Data collection was obtained by means of a structured validated questionnaire for identifying ergonomic factors related to dental procedures and the areas of pain. The variables evaluated were items regarding working conditions such as identification of common work tasks, frequencies and durations of the work tasks, and the dentists working positions relative to the patients' mouth and other related ergonomic factors.

Result: The adoption of inadequate postures such as exaggerated flexions or cervical torsions generates a higher frequency of muscular pain in dental students. Frequency of pain in neck (68%), upper back (46%), lower back (69%), shoulder (31%), wrist (42.5%), and thumb (32.5%) is more than other sites in the body. The frequency of pain in the elbow (14.5%), hip (11.5%), knee (12.5%), and ankle (27%) was less. In students who were using vibrating instruments, 63.1% complained of wrist pain. In students who do not have back support in sitting while working, 82.1% of students have low back pain. In our study, all the ergonomic factors related to procedures performed in dentistry are associated with the presence of musculoskeletal symptoms in dental students. This study suggests that a high prevalence (77%) of musculoskeletal pain among dental students and clearly indicates a concern for the future occupational health of this group.

Conclusion: Dental professionals need to carefully consider the adoption of appropriate strategies to help minimize the impact of the important occupational health issue on the next generation of dental practitioners and make sure that ergonomics of dental setting is appropriately taught to the students' right from their inception in dentistry so as to intercept development of MSDs.

Key Words: Dental Students, Ergonomics, Musculoskeletal Symptoms, Postures

  Perception of Psychiatrists on Occupational Therapy Practice in Mental Health: A Qualitative Study Top

Sadichha Paresh Kamat1, Pooja V Vajaratkar1

1Department of Occupational Therapy, Goa Medical College, Bambolim, Goa, India

E-mail: [email protected]

Award: Won Vijay Suple Award for Best Scientific Paper in Mental Health

Background: There is significant prevalence of mental illnesses in individuals of varied age groups in India which leaves them incapacitated in various domains of functioning (self-care, occupational and interpersonal functioning, and social participation). Moreover, with the current lifestyle and working conditions, a large majority of the population also face psychological issues hindering their emotional and psychosocial well-being. All of these individuals require a comprehensive interdisciplinary intervention. The psychiatrists serve as a primary source of referrals for occupational therapy Occupational Therapy (OT). To provide holistic treatment, it becomes essential to understand the perceptions of the psychiatrists on the role of OT practice in mental health and its relative contribution in the psychosocial rehabilitation and promotion of mental wellness.

Objective: This study aimed to explore the perceptions and understanding of OT practice in mental health among psychiatrists based in Goa, India.

Study Design: A qualitative descriptive design was used for this study.

Methods: A qualitative study was conducted on psychiatrists (n = 10) currently practicing in Goa, having an experience of 3 or more years in psychiatric practice. Purposeful, snowball sampling method was used. Participants were interviewed in-depth using a semi-structured questionnaire to explore their knowledge and understanding of OT practice in mental health.

Results: The psychiatrists have a general understanding of role of OT in mental health. They stated the importance of OT interventions in vocational rehabilitation and promotion of functioning. They also reported that occupational therapists (OTs) are an important stakeholder in the multidisciplinary team. However, it was found that there was limited knowledge about the scope and OT practice in mental health among the psychiatrists. They also lacked clarity over the professional roles of OT and other mental health professionals in a mental health setting. Three major themes that emerged from this study were (1) occupational therapist as an important stakeholder in mental health practice, (2) potential mental health settings and the beneficiaries in the mental health practice, and (3) occupational therapy intervention in mental health practice.

Conclusion: There is general understanding of OT practice in mental health among the psychiatrists; however, there exists lack of clarity about the roles of OT in mental health.

Key Words: Mental Health, Occupational Therapy, Perceptions, Psychiatrists

  Effect of Occupational Therapy on Self-Determined Routine Task Performances in a Young Adult with Intellectual Disability - A Case Report Top

Aishwarya Swaminathan1, Anuradha Pai2

1School of OT, DY Patil University, Navi Mumbai, 2OT Training School and Centre, Sion, Mumbai, Maharashtra, India

E-mail: [email protected]

A 19-year-old young adult with intellectual disability, comorbid autism, and obsessive–compulsive disorder presented with difficulty in self-determined routine task performances.

The study objective was to study the effect of occupational therapy on self-determined routine task performance in a young adult with intellectual disability.

Assessment was done using Yale Brown obsessive–compulsive scale, routine task inventory, self-determination observation checklist, and AIR self-determination scale (parent and teacher form). The assessment was done before and after the teleoccupational therapy intervention provided for 8 weeks.

Decrease in the compulsive behaviors interfering with the routine task performance, improvement in self-determination as observed by therapist as well as rated by parents/teachers, and improvement in the performance of the routine tasks were seen after occupational therapy intervention.

Occupational therapy had a positive effect on the self-determined routine task performance in a young adult with intellectual disability.

Key Words: Intellectual Disability, Occupational Therapy, Routine Tasks, Self Determination

  Proprioceptive Neuromuscular Facilitation Exercises versus Lumbar Stabilization Exercises for Chronic Low Back Pain Patients: An Experimental Study Top

Dipti Ghumare1, Sunita Koutarapu1

1OT School and Centre, TNMC and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India

E-mail: [email protected]

Background: Chronic low back pain (CLBP) causes pain and discomfort and disturbs the mechanoreceptor and proprioception. Exercises improve strength, flexibility, endurance, and ability to perform activities of daily living. Proprioceptive neuromuscular facilitation (PNF) improves muscle disharmony, atrophy, and movement limitation. Stabilization training improves muscle contraction and control. PNF has been shown to be individually effective but not been compared with each other.

Objectives: To compare the effectiveness of PNF and lumbar stabilization exercises (LSEs) on pain, disability, and flexibility in CLBP patients.

Study Design: It is a prospective, comparative, and interventional study.

Methods: Twenty-two subjects having mechanical low back pain for more than 3 months, between age group of 20 and 45 years, were randomized into two groups (Group 1 - PNF, Group 2 - LSE). Patients were assessed on visual analog scale (VAS), modified modified Schobers test, modified Oswestry LBP disability questionnaire (ODI), and Roland and Morris LBP and Disability questionnaire (RMDQ). For Group 1, concentric and eccentric contractions of agonist, antagonist, and PNF patterns were given. For Group 2, strengthening exercises were given with progressing difficulty level concentrating on core strength training. Patients were called to outpatient department for exercises for 45 min thrice a week for 4 weeks for both the groups.

Results: There was significant improvement in both the groups on VAS, modified modified Schober's (flexion and extension), ODI, and RMDQ scores. However, when compared with each other, significant improvement was seen on VAS (P = 0.002 PNF, 0.005 LSE) and ODI (P = 0.002 PNF, P = 0.005 LSE.). Though PNF was more effective than LSE, it was not statistically significant on RMDQ score (P = 0.061) and Modified modified Schober's test (flexion P = 0.174, extension P = 0.191).

Conclusion: There was significant improvement in VAS and ODI in the PNF over LSE group. Though LSEs are mainstay mode of intervention in the treatment of LBP, PNF provides an alternative form of intervention in the LSE group.

Key Words: Chronic back pain, Lumbar Stabilization Exercises, Proprioceptive Neuromuscular Facilitation

  Efficacy of Thermoplastic Halo Vest and the Clinical Outcome Following Its Use for C4–C5 Fracture Injury: A Case Report Top

Jyotsna Rupesh Bankhlele1, Rashmi Sudhakar Yeradkar1

1Occupational Therapy Training School and Centre, LTMMC and GH, Sion, Mumbai, Maharashtra, India

E-mail: [email protected]

More than 60% of spinal injuries involve the cervical spine, and the therapeutic options range from conservative treatment including soft neck collars, rigid cervical orthosis, and halo- vest immobilization to surgical treatments including anterior screw fixation or posterior screw fixation. Nonsurgical treatment with cervical collar or halo-vest immobilization may provide adequate support in type II or type III stable fractures. Hence, in this case report, we have analyzed preoperative and postoperative clinical and radiographic findings of a patient with C4–5 fracture that was treated with thermoplastic halo vest. Thus, the efficacy of thermoplastic Halo vest and treatment outcomes are discussed.

The objective of the staudy was to examine the improvement in clinical outcome with use of thermoplastic halo vest in C4–C5 fracture.

A 22-year-old male, sweeper by occupation, with alleged history of bike accident was brought to the emergency department with mild loss of motor power and numbness in the right upper limb, balance issues, and difficulty in walking. The patient was admitted and his X-rays showed fracture at C4–5 level. The fracture was treated with thermoplastic halo vest traction. The thermoplastic halo vest was fabricated by occupational therapists, and the ring traction unit with extensions was attached to the vest by the orthopedic surgeons. The patient's muscle power of right upper limb, functional mobility, posture, and quality of life using WHO BREF QOL were assessed before and after use of thermoplastic halo vest (3-month follow-up). Intervention included fabricating thermoplastic halo vest (which was given to patient for 3 weeks), strengthening exercises for upper and lower limbs, postural training, and activity of daily living training.

The patient was given thermoplastic halo vest reduce the fracture. Use of vest led to significant recovery of strength in the right upper limb, posture and was also able to walk independently.

The C4–5 fracture injury was successfully treated with Halo vest with favorable clinical outcomes, thereby greatly improving quality of life. The fracture was managed conservatively and the patient was able to join his previous occupation without any modifications.

Key Words: Cervical Injury, Halo Vest, Thermoplastics

  Occupational Therapy Activity of Daily Living Index to Assess Basic Activity of Daily Living in Indian Context Top

Parag R Adsule1, Akshata Mahale2, Sujata Jalmi3

1Department of Occupational Therapy, Goa Medical College, Bambolim, 2Hospicio Sub District Hospital, Madgoan, 3Sub District Hospital Ponda, Goa, India

E-mail: [email protected]

Background: Activity of daily living (ADL) deficit is a common and significant problem after any condition. Parameters in many scales just focus on the dependency and less importance was provided to important parameters such as values of activity, satisfaction, able to cope up, completion of the particular activity within time limit. These parameters are not well defined in many ADL assessments.

Objectives: There is a need to understand the basic problems faced in ADL by the patients in their routine with cultural diversity.

Study Design: Methodological Research.

Methods: Item was generated from review of literature, semi-structure interview of adult to geriatric patients and discussion with experts were carried out, and the new instrument was piloted among 100 patients with stroke. Content validity, internal consistency, and test–retest (30 patients) were evaluated.

Result: The new scale had good internal consistency (Cronbach's alpha = 0.984). Internal consistency value of 100 patients with ADL components were analyzed; feeding (0.850), grooming (0.852), bathing (0.815), dressing upper limit (0.840), dressing lower limit (0.818), toilet activity (0.852), bed mobility(0.844), transfer bed to chair and back (0.853), walking (0.788), and stair use (0.799). Test–retest reliability (intraclass correlation coefficient = 0.87) were found to be good.

Conclusion: Our study data are indicating that occupational therapy ADL index was reliable for rating the Basic Activities of Daily Living skills in deficit in stroke patients. Occupational Therapy ADL index is the objective assessment and will significantly contribute in evaluating activity limitation. This scale may contribute to OT practices and may research in India.

Key Words: Activity of Daily Living, Occupational Therapy, Tool Development

  Occupational Therapy Interventions Survey Study Part-I: Preferences and Practices of Therapeutic Interventions by Occupational Therapists: A Survey of Indian vs. Global Standards Top

Pooja Pankaj Mehta1, Punita Vasant Solanki2, Charmie Anil Dave3

1Anmol Child Development Clinic, 2AR Orthopaedic and ICU Hospital, Mumbai, 3LiveMore Rehab, Thane West, Maharashtra, India

E-mail: drpooja21 [email protected]

Background: As a part of evolving healthcare, occupational therapists (OTs) need to ensure “occupation” as core intervention. Studies conducted abroad highlighted the use of occupation-based intervention (OBI), creative activities, and other interventions in occupational therapy (OT) practice. However, information on OT practice in India and its current stand versus global standards is unavailable.

Objectives: To analyze differences, if any, in the OT practices and preferences of therapeutic interventions in India versus globally.

Study Design: An online, survey-based, observational, cross-sectional study was conducted.

Methods: A questionnaire was designed and validated by two expert OTs and three authors. The Google Form link for the questionnaire with electronic written informed consent was sent to prospective participants via e-mail from May 2020 to November 2020. Convenient sampling was used. Questionnaire included participant's demographics, areas of clinical practice, types of interventions used, and factors influencing OT practice. Of the 178 responses received from 11 states of India and 17 countries globally, 162 (81 in each group) fulfilled the selection criteria: OTs with at least Bachelor's degree and minimum 3 years of work experience.

Results: The interventions used by Indian OTs were client education, counseling and consultation (51.8%); interview, therapeutic relationship, and therapeutic use of self (49.3%); performance skills training (45.7%); adaptive interventions (44.5%); activities as therapeutic media (42%); OBI (42%); preparatory interventions (40.8%); preventive interventions (34.5%); and advocacy (25.95%) as well as by global OTs were interview, therapeutic relationships and therapeutic use of self (53.08%); client education, counseling, and consultation (45.67%);, activities as therapeutic media (40.74%); OBI (35.80%); adaptive interventions (30.86%); performance skills training (29.63%); preparatory interventions (28.40%); preventive interventions (22.22%); and advocacy (17.28%) in the descending order of frequency.

Statistically significant difference was found between Indian versus global practice for performance skills training: Proportion ± standard deviation (SD): 0.457 ± 0.055 versus 0.2963 ± 0.051 (P = 0.035, 95% confidence interval: 0.0137–0.3077), while other eight interventions did not show significant difference.

Conclusion: The study provides the current stand for preferences and practices of therapeutic interventions by OTs in India versus globally. It will guide OTs regarding the current scope and aid in reposition OT practice, focusing on core domains in the OT practice.

Key Words: Allied Health Occupations, Interventions, Occupational Therapy, Patient Care, Rehabilitation, Standards, Therapeutic Use, Therapy

  Functional Independence in Congenital Scoliosis – Occupational Therapy Perspective Top

Poornima S Raikar1

1Department of Occupational Therapy, B. Y. L. Ch. Nair Hospital, Mumbai Central, Mumbai, Maharashtra, India

E-mail: [email protected]

Congenital scoliosis is caused by early embryologic errors in the formation of vertebral column. It occurs when the vertebrae do not form normally or do not separate correctly before a baby is born. Different modalities used for treatment are observation, casting, bracing, occupational therapy, and surgery. The goal of treatment is to improve the children's quality of life and to give them the best chance to develop as an independent adult.

The Study objective was (1) To assess the effectiveness of occupational therapy intervention on balance, gait and activities of daily living in case of congenital scoliosis.

A 14-year-old young female student with thoracic spine scoliosis was assessed. She presented with lower extremity spasticity, imbalance, and scissoring gait. Assessment was done preoperatively and postoperatively. Immediate postoperative occupational therapy intervention was started inclusive of balance and gait training. Each session lasted for a period of 45 min once a week, and home program was explained. She was assessed at the end of 1 month and at 8 months posttherapy using Berg balance scale for balance and modified Barthel index for activities of daily living.

A significant improvement was seen in balance, gait, and activities of daily living [Table 1].
Table 1: Scores on outcome measures across the time

Click here to view

Key Words: Balance, Congenital Scoliosis, Functional Independence, Gait

  A Comparative Study of Conventional Occupational Therapy versus Balance Training along with Conventional Occupational Therapy in Reconstructed Anterior Cruciate Ligament Injury Top

Batul N. Vohra1, Shashikant Chandanshive1

1OT School and Centre TNMC and BYL Nair Ch. Hospital, Mumbai, Maharashtra, India

E-mail: [email protected]

Background: The anterior cruciate ligament (ACL) stabilizes the knee in the sagittal plane. ACL injury is the most common ligament injury of the knee joint. The primary goals of ACL reconstruction and rehabilitation include restoration of knee stability and preservation of menisci and articular surfaces. Balance is the ability to maintain an upright posture against the dynamically changing effects of gravity on our body segments. Balance training is often neglected during rehabilitation of patients with reconstructed ACL injury. There are very few studies which enhance the effect of balance training on knee joint post-ACL reconstruction. Hence, the aim of the study is to find the effect of the balance training exercises as an adjunct to occupational therapy treatment in patients after ACL reconstruction.

Objectives: To study the effectiveness of balance training exercises in reconstructed ACL injury.

Study Design: Randomized controlled trial.

Methodology: A total of 40 subjects aged between 20 and 40 years with unilateral ACL injury reconstruction were recruited; 20 subjects in each group. They were randomly divided into two groups using computerized generated table. Group A patients received conventional occupational therapy treatment, and Group B received balance training exercises along with conventional occupational therapy treatment for 4 weeks. All the participants were evaluated for knee function using Tegner Lysholm knee scoring scale, balance by using Bergs balance scale (BBS), range of motion (ROM) by goniometry, and muscle strength using Oxford rating scale. Assessment was done at 1st day and at the end of 4th week.

Results: A P < 0.05 was taken as statistically significant. The overall results were significant for improving ROM, improving balance, and improving the functional outcomes of the knee joint on comparing in between the two groups. For Group A in BBS, the mean value at baseline was 35.81 with standard deviation (SD) of 3.08, and at 8th week, mean and SD were 40.31 and 4.86, respectively. For Group B in BBS, the mean value at baseline was 35.29 with SD of 3.40, and at 8th week, the mean and SD were 50.35 and 3.98, respectively. For Group A, in Tegner scale, the mean value at baseline was 51.50 with SD of 5.22, and at 8th week, the mean and SD were 60.68 and 10.10, respectively. For Group B, in Tegner scale, the mean value at baseline was 53.29 with SD of 8.19, and at 8th week, the mean and SD was 75.52 and 6.70, respectively. However, the Group B who received balance training exercises as an adjunct to conventional occupational therapy showed better results than the Group A.

Conclusion: Thus, from the above results, we can conclude that using balance training exercises as adjunct to conventional occupational therapy is more effective than only using conventional occupational therapy alone in patients after ACL reconstruction.

Key Words: Anterior Cruciate Ligament, Balance Training Exercises, Conventional Occupational Therapy.

  Gender Differences in Quality of Life and Subjective Happiness in Community-Dwelling Elderly in India: A Cross-Sectional Survey Study Top

Sarju Moirangthem1, Gita Jyoti Ojha2

1National Institute for Locomotor Disabilities-Regional Centre, Aizawl, Mizoram, Assam, 2Department of Occupational Therapy, Institute of Human Behaviour and Allied Sciences, Delhi, India

E-mail: [email protected]

Background: Since the aging process is associated with decreasing functional abilities, lower quality of life (QOL), and increasing healthcare costs for the community, QOL measures can be utilized to monitor disease progress, evaluate treatment, and prioritize problems in clinical practice. It is therefore important to determine overall QOL and its related factors among older adults. Studies have shown that gender plays an essential role in decision-making as well as the perception of health and well-being across cultures. Although there have been reports of worse health-related QOL among women in developed countries, it is still not fully understood what role gender plays in overall QOL. With very few studies conducted on gender disparity in the elderly in India, It is necessary to build knowledge base on QOL associated with aging in India to increase awareness and improve quality of elderly services. Thus, the study was conducted to assess the differences in QOL and subjective happiness between male and female community-dwelling elderly.

Objectives: The study was conducted to assess the differences in QOL and subjective happiness between male and female community-dwelling elderly in India.

Study Design: Cross-sectional survey.

Methods: The data were collected from community-dwelling elderly (>60 years) on convenient sampling. The QOL and subjective happiness were tested by administering the WHOQOL–BREF and the Subjective Happiness Questionnaire. Informed consent was taken before administering the study-specific questionnaire via mail, telephone, or in-person. Only completed questionnaires were included in the study. Data hence collected were analyzed.

Results: The data were described by descriptive analysis (mean and standard deviation [SD]), whereas the differences between gender on QOL and happiness were computed by t-test. Gender and educational qualification correlated with quality of life measure WHOQOL at P = 0.05, two-tailed. Further, positive correlation (at P = 0.01, two-tailed) was found between WHOQOL–BREF and subjective happiness questionnaire. For overall QOL and general health section in WHOQOL-BREF, males scored a mean of 3.825 and 3.275 whereas females scored a mean of 3,875 and 3.35. For the four domains of WHOQOL-BREF and subjective happiness questionnaire, the differences in the means of elderly males and females were nonsignificant on t-test.

Conclusion: Since evidence shows that occupational therapy for elderly people can result in positive outcomes on functional ability, social participation, and QOL, This study helps increase our understanding of the gender-related factors so that interventions can be tailored to the needs of patients.

Key Words: Elderly, Happiness, Quality of Life

  Correlation among Cognitive Functions, Mood Disturbance, and Health-Related Quality of Life in Type 2 Diabetes Mellitus Patients: Cross-Sectional Survey Top

Noor Mohammad1, Neha Naaz1

1Department of Rehabilitation Sciences, Jamia Hamdard, New Delhi, India

E-mail: [email protected]

Award: won Kamala V Nimbkar Award for Best Scientific Paper

Background: Type 2 diabetes mellitus is associated with rapid fluctuations in blood glucose. Changes in blood glucose concentration rapidly affect cerebral function. The adverse effects of acute hypoglycemia on cognitive function and on mood are recognized. Health-related quality of life measures can demonstrate the impact of health on quality of life.

Objectives: The purpose of the study was to find the possible correlation among cognitive functions, mood disturbance, and health-related quality of life in patients with type 2 diabetes mellitus patients.

Study Design: Cross-sectional survey study

Methods: This study was a preliminary cross-sectional survey study carried out on 40 participants diagnosed with type 2 diabetes mellitus. The age group ranged from 35 to 55 years. Demographic data, height, weight, and blood glucose level were recorded. Cognitive function was assessed using mini mental state examination, mood disturbance was assessed using profile of mood states questionnaire, and health-related quality of life was assessed using Euroqol-5d-5l questionnaire.

Results: Data collected were statistically analyzed. It was found a significant negative correlation between mood disturbance and cognitive functions (r = −0.45, n = 40, P < 0.005), nonsignificant positive correlation between cognitive functions and health-related quality of life (examiner scoring) (r = 0.29, n = 40, P = 0.06), significant positive correlation between cognitive functions and health-related quality of life (participant self-score) (r = 0.37, n = 40, P < 0.05), significant negative correlation between mood disturbance and health-related quality of life (examiner scoring) (r = −0.66, n = 40, P < 0.001), and a significant negative correlation between mood disturbance and health-related quality of life (participant self-score) (r = −0.62, n = 40, P < 0.001).

Conclusion: Mood disturbances in patients with type 2 diabetes mellitus adversely affect cognitive functions. The health-related quality of life in patients with type 2 diabetes mellitus significantly depends on mood disturbances and cognitive functions.

Key Words: Cognitive Functions, Mood Disturbance, Quality of Life, Type 2 Diabetes Mellitus

  Effectiveness of Occupational Therapy Interventions in Children and Youth in India: A Meta-Analysis Top

Aishwarya Swaminathan1, Anuradha Pai2

1School of OT, DY Patil University, Navi Mumbai, 2OT Training School and Centre, Mumbai, Maharashtra, India

E-mail: [email protected]

Background: Occupational therapy interventions in children and youth are one of the most practice areas in occupational therapy, and synthesis of the research can give better insights about its effectiveness.

Objective: To estimate the effectiveness of occupational therapy interventions in children and youth in India.

Study Design: Meta-analysis.

Methods: Original articles published between 2001 and 2020 were searched from PubMed, Researchgate, Google Scholar, All India Occupational Therapy website, Indian Journal of Occupational Therapy website, and Indian Journal of Physiotherapy and Occupational Therapy website. Out of a total of 1781 articles, 49 articles were used for meta-analyses using the R software.

Results: Effect size estimates were calculated on the basis of F, Z, t, paired t-, or r-statistics and were found to be medium. Studies were combined through the calculation of unweighted and weighted means and 95% confidence intervals.

Conclusion: Occupational therapy interventions in children and youth in India produce positive results across a wide range of occupational performance components, areas, and contexts.

Key Words: Children, India, Occupational Therapy, Meta-Analysis, Youth

  Efficacy of Mirror Therapy Adjunct to Occupational Therapy in Patients with Phantom Limb Sensation and Pain in Below Knee Amputation: A Randomized Controlled Trial Top

Prachi R Kokate1, Shashikant Chandanshive1

1OT School and Centre, Topiwala National Medical College, Mumbai, Maharashtra, India

E-mail: [email protected]

Background: Amputation is an acquired condition that results in loss of limb from disease, injury, or congenital causes. Phantom limb pain (PLP) is a type of neuropathic pain felt in the extremity which has been amputed. Phantom limb sensation (PLS) is the presence of sensation of the limb which is no longer present. Mirror therapy is an alternative therapy used to alleviate phantom limb pain and sensation with the use of mirror. There was scarcity of literature which includes mirror therapy adjunct to occupational therapy in the treatment of phantom limb sensation and pain in the Indian population. Hence, the purpose of this study was to find the effectiveness of mirror therapy as an adjunct to occupational therapy in the treatment of phantom limb sensation and pain.

Objectives: (1) To study the effectiveness of mirror therapy in patients with phantom limb sensation and pain in below knee amputation.

Study Design: Randomized controlled trial.

Methodology: A total of 50 subjects both male and female participants aged between 20 and 60 years with phantom limb sensation and pain in below-knee amputation were recruited in the study. 25 subjects were in each group. They were randomly divided into two groups using computerized generated table. Group A patients received conventional occupational therapy treatment alone and Group B received mirror therapy along with conventional occupational therapy treatment for 4 weeks (weekly thrice). All the participants were evaluated for phantom limb pain using visual analog scale (VAS), phantom limb sensation using questionnaire, range of motion by goniometry, and muscle strength using Oxford rating Scale. Assessment was done at 1st day and at the end of 2nd week (6th session).

Results: A P < 0.05 was taken as statistically significant. The overall results were statistically significant for reduction in PLP (P = 0.000 for Group A and Group B) and PLS (P = 0.000 for Group A and Group B). The mean value for Group A in pre-VAS score was 6.7600 with standard deviation (SD) of 0.779 and post-VAS score was 2.7200 with SD of 0.891. For Group B, the pretreatment mean VAS score was 6.9600 with SD of 1.24097 and posttreatment mean VAS score was 1.7600 with SD of 1.16476. For PLS, in Group A, pretreatment mean score was 7.500 and posttreatment mean score was 0.00; in Group B, pretreatment mean score was 11.00 and posttreatment mean score was 0.00. Improvement in range of motion and muscle strength within both the groups from baseline to end of 4th week was seen. Statistically significant difference was seen within both the groups, but Group B who received mirror therapy along with conventional occupational therapy showed better results.

Conclusion: Group who received mirror therapy as an adjunct to occupational therapy had better results than group who received only conventional occupational therapy. After analyzing the data and comparing it with existing literature, we can conclude that using mirror therapy along with conventional occupational therapy is effective in patients with phantom limb sensation and phantom limb pain in below-knee amputation.

Key Words: Conventional Occupational Therapy, Mirror Therapy, Phantom Limb Pain, Phantom Limb Sensation

[TAG:2]Does the Informed Consent Document Follow the National Guidelines and Convey the Nature of the Study in Allied Health Biomedical Health Research?– A Retrospective Analysis of Proposals Submitted to an Institutional Ethics Committee of a Tertiary Care Hospital[/TAG:2]

Shilpshree Palsule, Jaimala Shetye, Manasi Lad

Seth GSMC and KEMH, Mumbai, Maharashtra, India

E-mail: [email protected]

Background: Informed consent process forms an important component of the research process, and it protects the participants' autonomy to allow him/her to freely decide whether or not to participate in the research.

It is expected that the informed consent document should explain the nature and content of the research to the participant in simple terminology and in the language that the participant understands. It is the responsibility of the researcher to obtain informed consent from every participant before his/her participation in the research.

Objectives: To evaluate whether the informed consent process documents of projects submitted for initial review by allied health branches of a tertiary care hospital follow the ICMR guidelines and whether they relate to the protocol submitted at the time of initial review.

Design: Retrospective.

Methods: After institutional ethics committee approval, all protocols submitted to the ethics committee of a tertiary care hospital by allied health branches in a period of 1 year were reviewed. Protocols submitted for exemption from review and retrospective studies with waiver of informed consent process were excluded. Thirty-five protocols were found to meet the inclusion criteria.

The informed consent documents (ICDs) of all these studies were evaluated for adherence to the ICMR 2017 guidelines. They were also compared with the protocols submitted. Ethics committee comments related to the ICDs were noted. The number of reviews required and the time taken from initial submission to final approval were noted.

Results: Most of the studies had included all the 10 mandatory points of the informed consent process, as per the bio-medical health research study norms. Six protocols did not complete the review process and hence did not receive letter of permission. Queries posed by IEC in terms of informed consent process were mostly related to (i) technical language used in the Purpose and Methods section, (ii) short forms of medical terms, iii) risks and discomforts not mentioned clearly, and iv) sample size not mentioned in the ICD.

Conclusion: This study concluded that the ICDs of the allied health research proposals submitted to the ethics committees of a tertiary care hospital were complete in terms of the sections as recommended by the ICMR 2017 guidelines. However, the use of technical words used in the section on purpose was a concern, which the investigators must pay attention to.

Key Words: Allied Health, Biomedical Health Research, ICMR 2017, Informed Consent Document

  Graded Occupational Therapy Rehabilitation Program for COVID-19 Survivor with Co-morbidities – A Case Study Top

Monalee Niphadkar

Department of Occupational Therapy, All India Institute of Physical Medicine and Rehabilitation, Haji Ali, Mumbai – 400 034, India

Award: Won Bharati Kirti Patel Youth Talent Award for Best Scientific Paper

Coronavirus disease 2019 (COVID-19) is caused by a new coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Knowledge about COVID-19, including its presentation and treatment, is changing very rapidly, and guidelines are quickly being created and updated. Much of what has been published is based on expert opinion but not on direct observation of the actual trajectories of patients with COVID-19.

Thus there is a need to closely assess and monitor covid 19 survivors and provide patient specific rehabilitation care.

This study involved subject who contracted COVID-19 and was hospitalized for same. Patient was a retired personnel whose major occupational roles revolved around assisting his significant other in household chores, buying and carrying groceries, visiting bank,etc .

Post contraction of COVID-19, there was a serious diruption in performance of his occupations.

The holistically designed occupational therapy rehabilitation program included pulmonary rehabilitation simultaneously followed by a graded exercises- activity program with introduction of graded resistance as tolerated by patient post discharge. The program also focused on psychosocial well being of the patient.

Patient was dependent on oxygen saturator constantly for 24 hours post discharge which was gradually weaned off during rehabilitation program .

The duration of this program was of two months

Assessments were done at the beginning of rehabilitation program and at the end of same followed by follow up assessment after one month.

The administration of rehabilitation program showed significant improvement in patient's oxygen saturation levels (without oxygen saturator) , independence in BADL and IADL tasks and gradual decrease in Dyspnoea level along with improvement in patient's quality of life.

Follow up assessment after a duration of one month post rehabilitation program also showed that the patient was well maintained.

Key Words: Activities of daily living, Dyspnoea, Occupational performance, Quality of life

  Noncompetitive Oral Presentations Top

  A Systematic Review of the Evidence for Occupational Therapy to Reduce Disabilities in Persons with Disabilities in India Top

Sureshkumar Kamalakannan1, Manigandan Chockalingam2, Lakshmanan Sethuraman3, Shobana Devi Moorthy4, Thirumugam Muthuvel5

1Public Health Foundation of India, Indian Institute of Public Health,

5Independent Researcher, Hyderabad, 3Centre for Addiction Medicine, NIMHANS, Bangalore, 4Smart Sensory Kids, Chennai, Tamil Nadu, India, 2National University of Ireland, Galway, Ireland

E-mail: [email protected]

Background: There is a paucity of evidence for occupational therapy (OT) in India. The current evidence for OT practice, teaching, and research is replicated and implemented significantly from the developed nations in the west. There are not any organized systems in place for the provision of rehabilitation and social care services in India, and this makes it practically nonfeasible for adopting evidence from the west to a context like India. This implies a gross strategic disadvantage to the development of OT in India. Therefore, a systematic review of existing evidence for OT that is generated specifically for people with disabilities in India is warranted.

Objectives: To evaluate the effectiveness of OT intervention for people with disabilities in India.

Study Design: Systematic review.

Methods: A systematic review of literature of OT for persons with disabilities in India was conducted based on the Cochrane guidelines. Randomized control trials of occupational therapy interventions for persons with disabilities were conducted in India were systematically searched in global databases using a comprehensive search strategy and those studies that met the eligibility criteria were included. Two independent reviewers screened the search results and selected the studies for the review. The data were extracted using a data extraction form. Given the heterogeneity among the studies included in the review, the results were summarized narratively.

Results: The database search retrieved about 175 records. There were not many randomized controlled trials of OT interventions for persons with disabilities in India. Available studies had several methodological flaws and the quality of evidence was very low.

Conclusion: There is dearth for evidence in OT in India. Research in OT must be considered a priority by OT academicians, practitioners, and researchers to bridge the gaps in evidence and promote evidence-based OT in India. Building the capacity for evidence-based OT research in India could be a potential strategy.

Key Words: Disabilities, Evidence, India, Occupational therapy, Review

  Understanding of Spirituality and Its Use as a Domain of Practice among Occupational Therapists in India: A Qualitative Study Top

Pooja V Vajaratkar1, Amitabh Kishor Dwivedi2

1Department of Orthopaedic Surgery, Goa Medical College, Bambolim, Goa, 2Jaipur Occupational Therapy College, Maharaj Vinayak Global University, Jaipur, Rajasthan, India

E-mail: [email protected]

Background: Most occupational therapy practitioners recognize that it is important to integrate a client's personal beliefs, values, and spirituality into occupational therapy practice. However, using it in day-to-day practice is problematic because of ambiguity and the large diversity of practitioners' understanding of the notions. Thus, the purpose of the study is to bridge this gap by understanding spirituality as a domain of practice in occupational therapy among occupational therapists in India.

Objective: This qualitative narrative study endeavored to understand spirituality and its use as a domain of practice among occupational therapists in India.

Study Design: The study design of this study is a qualitative narrative study design.

Method: Fifteen participants (n = 15) who are experts in the field of occupational therapy with major inclusion criteria of minimal 10 years' experience were recruited. The participants were purposefully selected to ensure representation of the population. The study was conducted with occupational therapists working in private and public sectors in India. The in-depth semi-structured interviews with senior occupational therapists were conducted to explore themes that covered the knowledge of occupational therapists on spirituality as a domain of practice in occupational therapy and their understanding of spirituality.

Results: Three major themes emerged from this study were (1) understanding of spirituality, (2) differentiating spirituality from religion, and (3) spirituality as a domain of practice in occupational therapy.

Conclusion: The key finding of this study was that spirituality has been understood considering both secular and theological concepts. This qualitative study also illuminates the issue of the theory and practice problems in relation to embedding spirituality into occupational therapy practice as a domain of practice in India.

Key Words: Occupational Therapy Practice, Spirituality, Spirituality and Religion

  Sensory-Motor Therapies to Augment Upper Limb Recovery in Stroke: A Systematic Review Top

Kamal Narayan Arya1, Shanta Pandian1, Akshay Kumar Joshi1

1Department of Occupational Therapy, Pt. Deendayal Upadhyaya Institute for Person with Physical Disabilities, New Delhi, India

E-mail: [email protected]

Background: Most of the stroke-rehabilitation regimen focuses primarily on the motor aspect. The associated sensory deficits may affect the motor recovery of the subjects. The evidence for the active sensorimotor intervention is sparsely available.


  1. To systematically review the available evidence from the studies on active sensorimotor therapies augmenting upper limb recovery among poststroke subjects
  2. To summarize the evidence for clinical practice and future investigation.

Study Design: A Systematic Review.

Methods: The following databases were searched for the desired articles: PubMed, The Cochrane Central Register of Trials, DORIS, PEDro, and OTseeker. The primary search keywords were stroke/hemiparesis/cerebrovascular accident and sensory/somatosensory and motor. The articles published in English till July 2020 was considered for the review. The studies with ischemic or hemorrhagic stroke, any age group, both the genders, any phase of recovery, motor paresis, and any type of somatosensory deficit were included for the review. In addition to this, only those investigations that studied active sensorimotor intervention to enhance motor recovery were considered for the review. However, studies of robotic training, virtual reality, electrical stimulation, and acupuncture were excluded. The motor recovery as measured by Fugl–Meyer assessment and/or Brunnstrom motor recovery stage were considered as the primary outcome measure, whereas sensory recovery (as measured by Nottingham sensory assessment/Semmes Weinstein monofilament/two-point discrimination test) as secondary measure.

Results: Out of 2889 screened studies, six studies were included for the present systematic review. A narrative synthesis of the findings from the selected studies was carried out. Active sensorimotor intervention in the form of motor imagery, mirror therapy, sensory discrimination, and specific somatosensory training was found to be utilized in the selected studies. Although the regimen varied between the studies, most of the interventions augmented the motor improvement among the subjects.

Conclusion: Integrated sensorimotor training is a crucial aspect of motor rehabilitation in stroke. No specific active sensorimotor has been widely investigated. There is a need to develop a structured and comprehensive sensory intervention regimen and to conduct more randomized trials to support the existing sensorimotor therapies.

Key Words: Fugl–Meyer assessment, Hemiparesis, Light Touch, Monofilament, Somatosensory, Two-Point Discrimination

  Underlying Mechanism of Synergy in Stroke-Implication for Rehabilitation: A Review Top

Shanta Pandian1, Kamal Narayan Arya1

1Department of Occupational Therapy, Pt. Deendayal Upadhyaya Institute for Person with Physical Disabilities, New Delhi, India

E-mail: [email protected]

Background: Synergistic linkage of various muscle groups is constrained by the central nervous system to produce a purpose and harmonious action. The functional linkage and synchronization get hampered and appear as abnormal synergy among poststroke subjects. Thus, the intervention methods based on the concept of synergy may have favorable effect on motor recovery in stroke. However, the evident protocols are sparse in the literature.

Objectives: The purpose of this review is to understand the neurophysiology and neuromechanics of synergy among poststroke subjects. Further objective was to review its clinical implications in view of the available protocols based on the mechanism of synergy.

Study Design: A review.

Search Methods: We searched the articles from Google Scholar, MEDLINE, PubMed, and Cochrane published during the last 20 years. The research articles of systematic nonsystematic reviews, Randomized controlled Trial (RCT), non-RCT, single-group design, and correlation and analytical design were included in this review.

Selection Criteria: The studies which considered the abnormal or hampered synergies in poststroke subjects either for the assessment or analysis or treatment were selected for this review.

Results: As per the selection criteria, 48 studies were included in the review. Out of which, majority of the studies were either analytical studies or correlational designs. There are evidences regarding the presence of abnormal synergy, but the concept is sparsely utilized for intervention programs. Majority of the studies are laboratory studies with expensive devices; handful of clinical studies are available. Systematic and nonsystematic reviews are also available, but RCT and experimental studies are very few.

Conclusion: The abnormal synergy hampers the motor recovery among poststroke subjects. Though the majority of the investigation is focused on objective evaluation of synergy, intervention protocol utilizing the concept is sparse. Studies to develop such protocols and further RCTs are needed to authenticate the role of synergies in stroke rehabilitation.

Key Words: Hemiparesis, Lower Limb, Motor Control, Stereotyped Movement, Trunk, Upper Limb

  Backward and Side Walking Training Improves Walking Speed and Endurance in Subjects with Poststroke Hemiparesis: An Experimental Study Top

Damayanti Sethy1, Eshani Mallick1

1Department of Occupational Therapy, National Institute of Locomotor Disabilities, Kolkata, West Bengal, India

E-mail: [email protected]

Background: There is a direct relationship exists between hemiplegic walking speed and functional limitations, both in household and community ambulation. Walking after stroke is characterized by slow gait speed, poor endurance, and change in the quality and adaptability of walking patterns. Side stability, symmetrical weight-bearing, and backward motor control ability are required to improve walking function.

Objective: To investigate whether a combination of backward and side walking training is effective in improving walking speed and walking endurance in subjects with poststroke hemiparesis.

Study Design: A pre–post-test experimental design.

Methods: Subjects with Poststroke hemiparesis (N=56) were recruited for the study. Subjects in the experimental group received 30 min of backward and side walking training and control group received conventional occupational therapy. Therapy was given for 30 min per session, 5 days a week for 6 weeks. Assessment of walking speed was done by 10 m walk test, and to evaluate change in walking endurance, 6 min walk test was used. Posttraining measurements were taken after 6 weeks of intervention.

Results: In the within-group comparisons, both experimental and control group showed significant differences between before and after the intervention (P < 0.05). In the between-group comparison, subjects in the experimental group showed more improvement than control group for walking speed (P = 0.001) and walking endurance (P = 0.004) after 6 weeks of intervention.

Conclusions: This study concluded that combined backward and side walking training has a better effect on waking speed and endurance than conventional therapy.

Key Words: Backward Walking, Side Walking, Stroke Hemiparesis, Walking Endurance, Walking Speed

  Occupational Therapy Post-COVID Rehabilitation: Case Series Top

Siddhant Nagine1, Shriharsh Jahagirdar1, Manasi Bande1, Pratibha Vaidya1

1OT School and Centre, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India

E-mail: [email protected]

Background: Many COVID patients show residual symptoms in the postacute phase. Most commonly seen residual symptoms are breathlessness, exertion, fatigue, generalized weakness, and psychological distress.

Objective: To assess the effectiveness of occupational therapy post-COVID rehabilitation program and subjective well-being, Faces scale of exertion, pre- and post-SpO2 levels were assessed. To assess the subjective well-being, subjective unit of distress scale was used.

Study Design: Case series of three patients was chosen for the research.

Methods: Three patients (two males, one female) diagnosed with COVID in postacute phase were referred from the chest medicine department. Patients were assessed before therapy and after a period of 6 weeks. They received occupational therapy rehabilitation services twice a week. The outcome measures were “faces scale of exertion” and “subjective unit of distress scale” for assessing perceived exertion and psychological distress, respectively.

Interventions: It included breathing exercises, whole-body stretching exercises, functional aerobic exercises, and energy conservation techniques.

Results: [Table 1]
Table 1: Levels of Exertion, Distress and saturation at baseline and post intervention

Click here to view

Conclusions: Post-COVID occupational therapy rehabilitation services are beneficial in improving perceived exertion, fatigue, reducing stress, and promoting wellness.

Key Words: Functional Training, Occupational Therapy, Post-COVID Rehabilitation, Wellness

  To Know the Level of Stress and the Effect of Wellness Program on the Stress of Healthcare Workers Top

Manasi Kadam1, Shriharsh Jahagirdar1, Pratibha Vaidya1, Shashikant Chandanshive1, Pallavi Naik1, Divyakumari Ughade1, Shraddha Nadgaonkar1

1OT School and Centre, TN Medical College and BYL Nair Ch. Hospital, Mumbai, Maharashtra, India

E-mail: [email protected]

Background: Coronavirus disease (COVID 19) changed the lifestyle of health workers drastically. Adapting themself to provide services new normal way, isolating themself from the family and other factors caused lot of stress to the health workers. there is a growing need to address the stress with wellness program.

Aim: To know the level of stress and the effect of wellness program on the stress of healthcare workers.

Objectives: To check the effectiveness of wellness program on healthcare workers.

Study Design:

Methods: A questionnaire was formed considering the stress level of healthcare workers. Details about stress level and how they manage their stress were asked. Questionnaire was sent through Google Forms. Participants filled the form, and those with stress level 5 and above were included for the wellness program. A program of 8 sessions was devised to help healthcare workers to cope up with the stress as they were working as front liners. Eight different sessions were conducted which included mindful breathing and relaxation through autosuggestion, mindful breathing with light aerobics, stretching exercises with blob tree activity, yoga, mindful breathing with scribble art, Zumba, brain gym, and mindful breathing with doodle art. A total of 8 sessions were taken, 2 sessions were taken per week, and the program lasted for 4 weeks. Each session lasted for about 45 min. Sessions were conducted on Google Duo. Instructions were given so that the participants would prepare themselves regarding clothing/for arranging material required for that session via WhatsApp. Participants were informed regarding checking for good quality of network. Each participant's heart rate and SpO2 level were being recorded pre- and post-sessions. After completing 4 weeks of online session, participants filled the feedback form according to the level of stress (0 – least stressed out and 10 – worst stressed out). Participants were asked regarding discomfort during and after every session.

Results: A total of 8 sessions were conducted for 4 weeks. After each session, heart rate dropped within normal limits. Average SpO2 was maintained above 98 for each participant for all the sessions. No discomfort seen or noted during and/or after session by any of the participants. Subjective distressed changed from 7 to 5 indicating improvement in subjective level of well-being. Suggestions were noted after completing the sessions.

Conclusion: Thus, the study shows wellness program was effective in reducing stress in healthcare workers.

Key Words: OT for COVID-19, OT Stress Management, OT Well-being, OT Wellness


  [Table 1], [Table 2]


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