VOTC Therapy Newsletter - Spring 2020 Points of Interest for Occupational Therapists in India The Allied and Healthcare Professions Bill, 2018 was introduced in Rajya Sabha on December 31, 2018. This bill seeks to regulate and standardize the education of 53 allied and healthcare professions, including occupational therapy (OT). The bill was referred to the Standing Committee on January 2, 2019. The Standing Committee submitted its report (Report No 117) to Rajya Sabha on January 31, 2020. This summary highlights some notable excerpts from Report 117 that have implications for the OT profession in India with related comments, thoughts, and arguments. PS: The All India Occupational Therapists Association (AIOTA) reported that the bill (National Commission on Allied & Healthcare Professions Bill, 2020) was approved by the cabinet on March 20, 2020. Awareness of Occupational Therapy among Medical Practitioners in South India Look for the research article in the forthcoming issue of Indian Journal of Occupational Therapy that reports the survey that was conducted among medical practitioners (anyone with a MBBS degree or above) in South India to determine their level of awareness about OT.  Utilization of Assistive Devices in Occupational Therapy Practice in Tamil Nadu Look for the research article in the forthcoming issue of Indian Journal of Occupational Therapy that reports the survey that was conducted among occupational therapists in Tamil Nadu regarding the utilization of assistive devices in their practice.  COVID-19 World Health Organization Centers for Disease Control & Prevention John Hopkins Coronovirus Dashboard Ministry of Health & Family Welfare Health & Family Welfare Department, Tamil Nadu Disability News BCCI rewards Indian disability team Chennai: After Santhome, 2 more parks for disabled kids to c .. 2,000 disabled people to receive motorised wheelchairs in Tamil Nadu Teachers to be trained to help disabled kids perform better Goa’s beaches accessible, but not disabled-friendly Disabled and extremely poor Data: How disabilities make life difficult for the affected

Evidence Corner (Links to Research that Support OT Practice) Effectiveness of School-Based Occupational Therapy Intervention on Handwriting Stroke Epidemiology and Stroke Care Services in India INCLEN Diagnostic Tool for Attention Deficit Hyperactivity Disorder (INDT-ADHD): Development and Validation   Evidence Based Practice

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VOTC Evidence Bytes: Multisensory, visuo-motor integration and cognitive interventions improve handwriting legibility of children

This article describes a study conducted in Punjab, India, in which the authors aimed to evaluate the impact of an intervention program in remediating visual perceptual skills of urban school children with poor handwriting. Occupational therapy screening tools were used for data collection. The results revealed that 12 sessions of remedial intervention program focused on multi-sensory interventions, visuo-motor interventions, and guided practices were effective in improving handwriting legibility.

https://search.proquest.com/docview/2157810922?pq-origsite=gscholar

VOTC Evidence Bytes: Effectiveness of Rehabilitation for Patients with Severe Mental Illness

This experimental study, conducted in Delhi, examined the effectiveness of rehabilitation intervention for patients with mental illness. After 3 months of rehabilitation intervention consisting of psycho-education, activity scheduling and social skill training, the authors found that there were improvements in subjective well-being, functioning, and cognitive areas.

http://medind.nic.in/daa/t10/i1/daat10i1p109.pdf

VOTC Evidence Bytes: Legal Implications for Healthcare Practice in India

This informative article highlights the fact that healthcare professionals fall under the purview of the Consumer Protection Act of  1986. Healthcare professionals need to exert caution when selecting treatment methods and inform care recipients the potential harm associated with the treatment. The article also presents various preventive measures that healthcare professionals take to avoid litigations. Though this article mostly discusses medical and dental practice in India, underscores the importance of proper and ethical judgements, proper documentation, standardized diagnostic tools and evidence-based treatment choices. the information can be generalized across healthcare professions, including occupational therapy.

http://medind.nic.in/daa/t09/i2/daat09i2p302.pdf

VOTC Evidence Bytes: Cognitive Retraining Helps Children with Learning Disabilities

After 36 hours of cognitive retraining, children with specific learning disabilities (SLD) in Delhi demonstrated improvements in verbal learning, delayed verbal recall, visuo-spatial skills, mathematics. Also, improvements were noted in sustained attention, visual memory and immediate verbal recall.  This study validates the use of cognitive retraining activities to help children with SLD.

http://medind.nic.in/daa/t09/i1/daat09i1p100.pdf

VOTC Evidence Bytes: Client-centered Occupational Therapy Practice in India

This article sheds light on the challenges associated with client-centered occupational therapy practice in India. From the perspective of occupational therapists, ‘practice contexts’ and ‘client’s condition, literacy level, and desire for independence’ affect client-centered practice.

https://svemedplus.kib.ki.se/Default.aspx?Dok_ID=125423

VOTC Evidence Bytes: Adulthood Manifestation of Autism Spectrum Disorder

This article discusses the clinical manifestation of a 21-year old adult in India who was diagnosed with autism to identify the symptoms that persists into adulthood and review the outcome. Severe abnormalities in the area of social interaction, fewer interests, stereotyped behaviours, and the need for constant supervision in activities of daily living characterize adulthood of severe cases of autism with delayed language acquisition and poor cognitive abilities. This article lends information to the conversation of ‘How can occupational therapists help adults with ASD’?

http://medind.nic.in/daa/t08/i2/daat08i2p238.pdf

VOTC Evidence Bytes: Health conducive self-care practices - Rural population differ from urban population in Northern India

Rural population differ from urban population with regards to health conducive self-care practices and elderly/child care. Both rural and urban population (nearly 3/4th) favor consulting quacks, faith healers, and indigenous practitioners. As self-care behaviors and caring for family members fall under the occupational therapy (OT) domain of practice, from the OT standpoint, how are we (OT practitioners in India) going to address these issues?

http://medind.nic.in/daa/t07/i1/daat07i1p46.pdf

VOTC Evidence Bytes: Cognitive Profile of Indian Children with ADHD

Clinical psychologists in Kerala assessed 60 children with Attention Deficit Hyperactivity Disorder (ADHD) and found that they score significantly low in Arithmetic, Information, Digit Span, Picture Completion, Block Design, Object Assembly, and Coding sub-scales of Malin’s Intelligence Scale for Indian Children (Smitha et al., 2014). This finding indicates the need for more attention to these areas when treating children with ADHD.

http://medind.nic.in/aaf/t14/i1/aaft14i1p28.pdf

VOTC Evidence Bytes: TN OT's Perception of Efficacy of Sensory Integration

What do Tamil Nadu occupational therapists believe about SI therapy and its 

effectiveness?

Occupational therapists' perception of efficacy of sensory 

integration in Tamil Nadu, India: A Statewide Survey

VOTC Evidence Bytes : Many Psychiatric Illnesses are Associated with Disability - Rehabilitation Yields Better Outcome

As per Indian Disability Evaluation and Assessment Scale (IDEAS), a majority of patients
with schizophrenia and bipolar disorder have mild or moderate disability; a majority of
patients with depression and anxiety disorders have mild disability. Disability was found
to be increased with the duration of illness. Better outcomes can easily be achieved in
patients with mild to moderate disability with proper management and rehabilitation.

http://medind.nic.in/aag/t12/i1/aagt12i1p36.pdf

VOTC Evidence Bytes : Caregiver Burden in Schizophrenia

Are you treating patients with Schizophrenia in India? You should also treat the caregiver.
Did you know that sex of the patient, middle age, and severity of the illness take a toll on
caregivers? (Ponangi et al., 2014)

http://medind.nic.in/aag/t14/i1/aagt14i1p117.pdf

VOTC Evidence Bytes:When treating children with ADHD, practitioner should focus on comorbidities. Why?

How many children with ADHD have comorbid conditions?

What are the frequently observed comorbidities?

What are the implications?

Pingali & Sunderajan (2014) underscored the importance of addressing comorbidities and
individualizing the clinical management through their retrospective analysis of case records.

http://medind.nic.in/aag/t14/i2/aagt14i2p206.pdf

VOTC Evidence Bytes: Challenges Associated with IRB Approval in Developing Countries

“A proper question to ask is whether all research requires the same level of ethical approval.”
(Farroq, 2014, p.156)

This informative, brief, commentary discusses the issue of obtaining Ethics Committee approval
for research in developing countries and feasible solutions.

http://medind.nic.in/aag/t14/i2/aagt14i2p156.pdf

VOTC Evidence Bytes: Clinical Psychologists in Kerala Found Social Skill Group Training Effective in Children with ADHD

Smitha et al. (2014) found social skill group training (SSGT) to be effective among children with Attention Deficit Hyperactive Disorder (ADHD). They noticed improvement in the areas of emotional management, peer relations, conduct problems, and prosocial behaviors after 10 weekly social skills training sessions. This finding validates the use of SSGT in children with ADHD.

http://medind.nic.in/aaf/t14/i2/aaft14i2p30.pdf?fbclid=IwAR2V_OAoagZG4ccaGSMwoIb6MKfqVtDU9SO_F5yApmefj84rEKDRO2Kw56w

Outcome Measures Used in Stroke Rehabilitation in India: A Scoping Review

This paper examines the literature on outcome measures used in stroke rehab in India.

What outcome measures have been used in stroke rehabilitation in India?

How many of them were developed in India?

How many were culturally and linguistically validated?

http://www.ijotonweb.org/article.asp?issn=0445-7706;year=2018;volume=50;issue=4;spage=111;epage=118;aulast=Mani

QOL of Patients with Parkinson's Disease Depends on the Ability to Perform ADL

A study conducted in Kerala states that Quality of Life of patients with Parkinson's Disease (PD) depends on their ability to perform ADL. 

"...difficulty to do leisure time activities, performing household activities, difficulty to carry bags, problems with walking, difficulty to get around in public places, need for assistance to go out of house, fear of fall, etc. can be considered as the main factors that influence the quality of life of patients with Parkinson's disease. Regarding the activities of daily living...difficulty to take bath without assistance, difficulty if [sic] dressing and grooming, difficulty to write clearly, cutting up of food and disability [sic] in drinking water from glass without spilling also can be considered as a factor [sic] which affect the qualify of life of patients with Parkinson's disease" (p.15)

Occupational therapists have a huge role to play in rehabilitating patients with PD. 

Parents of Children with ASD find OT and SI efficacious

Seventy two percent of parents believe that their child with Autism Spectrum Disorders (ASD) improved with occupational therapy and 73% believed their child with ASD improved with sensory integration.

Parental Ratings of Efficacy: Occupational Therapy

Child improved dramatically - 23.5%
Child improved somewhat - 48.5%
No noticeable effect - 22.2%
Child became worse - 3.9%

Parental Ratings of Efficacy: Sensory Integration

Child improved dramatically - 29.4%
Child improved somewhat - 43.9%
No noticeable effect - 22.0%
Child became worse - 4.3%

Source: Goin-Kochel, R. P., Mackintosh, V. H., & Myers, B. J. (2009). Parental reports on the efficacy of treatments and therapies for their children with autism spectrum disorders. Research in Autism Spectrum Disorders, 3(2), 528-537.

Occupational Therapists Diagnose ASD in India

Occupational therapists are involved in the final diagnosis of Autism Spectrum Disorders in India.

In a recent study, Mahapatra et al. (2019) identified that OTs were the second largest group of professionals who made the diagnosis of ASD, next to Psychiatrists. Of 76 parents interviewed for the study conducted in Odisha, 16 parents (21.2%) reported that OTs made the diagnosis of ASD.