Vol. - 48 : Issue - I I J O TISSN 0445 - 7706. January 2016 - April 2016 An official publication of the All India Occupational Therapists' Association.
www.aiota.org/ijot EDITORIAL STATEMENT: EDITORIAL BOARD • The Indian Journal of Occupational Therapy (IJOT) is published three times a year in January-April, Editor-in-Chief May-August and September-December. Dr. Anil K. Srivastava 93, Laxmanpuri, Faizabad Road, • The official language of the Journal is English. Lucknow- 226 016, UP • The Journal publishes original scientific research papers, case reports and preliminary articles on all Tel: +91-522-2350482, aspects of Occupational Therapy. M:+91 9415405095, 9415415095 • It welcomes contributions, news and information related to occupational therapy and rehabilitative Email: [email protected] aspects from all over the world. It also publishes Book Review & Letters to Editor. All scientific Editor Dr. Zarine D. Ferzandi contributions for publication are to be submitted to Associate Editor, IJOT. Associate Editor • Guidelines to Authors : Visit AIOTA website www.aiota.org / ijot/ Dr. Pratibha M.Vaidya Assistant Editor (Promotion) CIRCULATION: Dr. Punita V. Solanki IJOT is circulated to all members of AIOTA [within the territory of Indian subcontinent, and it would Assistant Editor (Subscription) subject to AIOTA's discretion to post the Journal overseas]. However others may also subscribe the Dr. Nitesh Kumar Shrivastav Journal. Members Dr. Chavan Shashidhar Rao, Manipal Developmental Disability SUBSCRIPTION RATES: (Inclusive of Postage) Dr. B.D. Dasari, UK INDIA: Rs. 350.00 Single issue or Rs. 1000.00 Annual; Rs.1200 (Annual by Registered / Speed Post) Ergonomics, Traumatology & Work FOREIGN: US $ 80.00 Single issue or US $ 200 Annual (or equivalent to Indian currency) Rehabilitation Dr. Ebenezer W. Rajkumar D., New Delhi PAYMENTS: Community Based Rehabilitation All payments to be made by Demand Draft in favour of “ALL INDIA OCCUPATIONAL THERAPISTS' Dr. Jyothika Bijlani, Mumbai Developmental Disability ASSOCIATION” payable at Mumbai and be sent to Editor-in-Chief, IJOT (the subscription rates are Dr. Jayashri Kale, Mumbai subject to revision). Cardio pulmonary/ Neuroscience Dr. Jeetendra Mohapatra, Kolkata ADVERTISEMENT: OT & Work Rehabilitation The Journal offers good opportunities for advertising. Prospective advertisers may contact Editor, IJOT for Dr. Joseph K. Wells, USA commercial information. Community Based Health, Ethics & Health Management Dr. Kamal N. Arya, New Delhi DISCLAIMER: Neuroscience / Physical Rehabilitation The Editor disclaims any responsibility or liability for statements made, opinion expressed or claims Dr. Lakshmanan S., Bangalore made by authors, readers and advertisers. Mental Health Dr. Odette Gomes, Mumbai COPYRIGHT & PHOTOCOPYING RIGHTS: Mental Health No part of the publication may be reproduced or transmitted in any form by any means, electronically or Dr. Pankaj Bajpai, Kolkata mechanically, without the written permission from the Editor. The Editorial Board reserves the right to Musculo-Skeltol, Developmental Disability refuse any matter for publication and decision of the Board must be accepted as the final. Dr. R.K. Sharma, Gurgaon Sports Injury, Hand Rehabilation Dr. Sofia Azad, Nagpur EDITORIAL OFFICE: Orthopedics 93, Laxmanpuri, Faizabad Road, Lucknow- 226 016, Uttar Pradesh, India Dr. Sabestina D’souza, Manipal Tel.: +91-9415405095, +91-9415415095, +91-522-2350482 Neuroscience/Ergonomics Email: [email protected] Dr. Shailaja Jaywant, Mumbai Developmental Disability CONTACT FOR Dr. Sujata Missal, Coimbatore Neuroscience/ Ergonomics Submission of News, Submission of Manuscripts, Submission of Requests for Dr. Shashi Oberoi, Mumbai Neuroscience Information and Enquiry Studies & Letters : Subscription, about status of submitted Advertisement, Circulation • The Bibiliographic details of the Indian materials: and/or Complaints if any Journal of Occupational Therapy is available for non receipt in ICMR-NIC Centre’s IndMED database http://indmed.nic.in of Journals: • The full text of articles published in the journal from the year 2000 onwards, is Editor Associate Editor Assistant Editor available in medIND database: http.// Dr. Zarine D. Ferzandi Dr. Pratibha M.Vaidya Dr. Nitesh Kumar Shrivastav medind.nic.in Khambata House, Khambata Lane, Dr. E 10,Pranam Society, 513,Shimpoli Link 2/302, Vivek Khand, • Journal is also indexed/listed on following Baba Saheb Ambedkar Marg, Byculla, Road, Borivali(W), Mumbai-400092, Gomti Nagar, national & international databases: Mumbai- 400027, Maharashtra Maharashtra. Lucknow-226010 (UP) www.epnet.com; www.ergothemen.de; Tel: 022- 23703750, 09820742360 Tel: 022- 28982208, 09821536404 Tel: 08853263445 www.otdbase.org, Email: [email protected] Email:[email protected] Email: [email protected] www.j-gate.informindia.co.in, http://eng.scholar.cnki.net, http://www.indiancitationindex.com and DONATIONS ARE EXEMPTED FROM INCOME TAX UNDER SECTION 80-G http://www.otseeker.com
IJOT : Vol. 48 : No. 11 January 2016 - April 2016 The Indian Journal of Occupational Therapy : Vol. 48 : No. 1 (January 2016 - April 2016) EDITORIAL………………………………..
OTICON’2016; The 53rd Annual National Conference was superbly organized by SRM College of OT in collaboration with T.N. Branch of AIOTA at SRM University, Chennai. It was attended by more than 600 members, OT’s, guests and students from all parts of the country. The participation and presentation of delegates from UK, Canada, Japan and Singapore was an added academic highlight of the event. I take this opportunity on behalf of members of AIOTA to congratulate Dr. D. Suresh the Organising Secretary & the team and Dr. Pratibha Vaidya, Chairperson of the Scientific Program for their organizational expertise in making this conference a wonderful experience. OTICON’2017 will be convened by Mahatma Gandhi OT College at Mahatma Gandhi University of Medical Sciences & Technology, Jaipur in collaboration with Rajasthan Branch of AIOTA. The tentative dates are Feb. 17-19, 2017. Dr. S.K. Meena is having experience, expertise and enthusiasm to organize it as an international event to commemorate the 100 years of OT Profession globally. The conference is aimed to retrospect the glorifying past and our preparations to face the challenges of future. I am confident of a grand OT Meet at Jaipur in 2017, under the dynamic leadership of the Organising Secretary, Dr. S.K. Meena. As a token of love & regard and in recognition of the lifelong dedication in nourishing the profession of occupational therapy in India, AIOTAitself was honored to honor Prof. Mrs. Meera Manik Shahani with the prestigious ‘AIOTA’s Life Time Achievement Award’, in the inaugural session of OTICON’2016 at Chennai on Jan. 30 2016. It is for the first time that this award was presented posthumously. She was most reputed, recognized and respectful name in OT fraternity after Mrs. Kamala Nimbkar, She was Prof. & Head of OT School at K.E.M. Hospital, Mumbai during 1957- 1989 and also Dean of Academic Council of OT (1987-1991). Members of AIOTA offer condolences to the bereaved family on her sad demise at Chennai. The personal presence of her husband Prof. Manik Shahani and his brief talk in the inaugural session of the conference was a memorable and emotional experience for the delegates. Life Time Achievement Award was also conferred to Dr. Mrs. Nirmala Venketeswaran (Kochi) and Dr. Mrs. V.S. Bole (New Delhi). Dr. Pratibha M. Vaidya (Mumbai) was presented with Professional Excellence Award of AIOTA during OTICON'16 at Chennai. AIOTA has revised the criteria for Award of Fellowship of Academic Council of OT, which will be effective from April 1, 2016. The revised guidelines have also provision for inclusion of members holding faculty position in AIOTA accredited institutions.The revised guidelines and application form is uploaded on AIOTA Website. Thanks to Dr. Lalit Narayan the Chairman of Election Committee and his team for smoothly conducting the AIOTA election to elect the Executive Committee for 2016-2020. Election of Academic Council of OT was also held during the GB Meeting of ACOT to constitute the new Executive Committee for 2016-2020. I congratulate all members who were declared elected for AIOTA & ACOT Executive Committee and wish the newly elected team of executives would work with dedication to further advance and glorify the profession and the organization with their hard work, experience and expertise. The issue of IJOT carries 4 useful research studies on various aspects of clinical OT and an informative article on Rights of Persons with Disabilities Bill 2014 in respect to practice opportunities of occupational Therapists. The ‘News and information’ would highlight the OTICON’2016 brief with winners of awards and trophies under various categories of presentations, AIOTA/ACOT election results and other significant information for members and others.
Dr. Anil K. Srivastava Editor-in-Chief
IJOT : Vol. 48 : No. 12 January 2016 - April 2016 The Indian Journal of Occupational Therapy : Vol. 48 : No. 1 (January 2016 - April 2016) Reliability and Validity of the Hindi Version of Falls Efficacy Scale - International (FES-I) among Older Adults Residing in Alberta, Canada Pranshu Arora1 (MScRS, BOT), Lili Liu2 (PhD), Mary R. Roberts3 (PhD ), Sharla King4 (PhD), Rosalie Freund-Heritage5 (MScOT)
Key Words: Abstract Falls Efficacy Scale – International Aim of the study: The FES–I is a scale developed to measure fear off alling by assessing an individual’s confidence in (Hindi), Fear of falling, falls, older performing daily activities. The aim was to determine the reliability and validity of the FES–I (Hindi) among older adults adults, ProFaNE. residing in Alberta, Canada. Methods: The FES-I (Hindi) was administered to 23 Hindi speaking older adults, aged 60 years and older. It was correlated with Berg Balance Scale and Timed Up and Go Test, to examine construct validity. Cronbach’s alpha provided internal consistency of the scale.Test-retest reliability was determined using Intra-Class Correlation Coefficient (ICC) by asking participants to complete the scale twice with a two-week interval. We compared differences in mean FES–I (Hindi) scores among participants by age, gender, occupational status and history of falls. Findings: As expected, FES–I (Hindi) scores were correlated negatively with the Berg Balance Scale (ñ = - 0.827), and positively with the Timed Up and Go Test (ñ = 0.691). Internal consistency and test-retest reliability of FES–I (Hindi) were significant : á = 0.831 and ICC = 0.894, (p = 0.000) respectively. Mean FES-I (Hindi) scores were significantly different between participants by occupational status, t (21) = - 1.63 (p = 0.014), but not by age, gender or history of falls. Conclusion: The FES–I (Hindi) showed construct validity, high internal consistency and test-retest reliability. The scale 1 Student, University of Alberta was also valid insofar as demonstrating that participants who were working performed better on the FES-I than those who 2 Chair and Professor, Department were not working. of Occupational Therapy Introduction 3 Assistant Professor, Department of Occupational Therapy A fall is defined as an event which brings person to rest on the ground or other lower level in an 4 Associate Professor, Department unexpected manner (1). In Canada, about one-third of Educational Psychology of community-dwelling seniors, 65 years and older (2) 5 Project Manager, Alberta Health fall at least once eachyear . The consequences of Services falls can be physical injuries, or psychological trauma, leading to fear of falling and activity Institution: avoidance(3-8). Fear of falling and restriction may University of Alberta, Edmonton, create a downward trend associated with AB, Canada deterioration of functional abilities and quality of Figure 1. life (Figure 1) (10,13-18). Downward trend due to fear of falling Period of Study : November, 2013 to November, Measuring fear of falling: Before the creation of the Falls Efficacy Scale, few approaches were 2014 known for assessing fear of falling. A single item questionnaire with dichotomous answers(9,17,18) Correspondence : was commonly used, however, it does not discriminate between different levels of fear, nor identify activities a client performs with low confidence. A10-item “Falls Efficacy Scale” (FES) Pranshu Arora, MScRS, BOT (9) Apt# 102, 9740-82 Avenue, NW, was created in 1990 to assess older adults’ confidence levels when performing daily activities . Edmonton, AB, Canada. T6E 1Y5 But, the scale had limitations : 1) it addressed only basic activities, and 2) it used a 10-point rating system, which was thought to be challenging for older adults. Tel. : +1 (780) 807-1490 Later, scales such as, Activities- specific Balance Confidence (ABC) scale, and Survey of Activities E- Mail : [email protected] and Fear of Falling in the Elderly (SAFFE)(23) were developed to examine the concept of falls efficacy. These addressed the limitations of the FES, but none was as well validated as the Paper was presented in original FES. In light of these limitations, a modified version of the Falls Efficacy Scale was OTICON ' 2015 : the 52nd Annual developed by the Prevention of Falls Network Europe (ProFaNE), named Falls Efficacy Scale– National Conference of AIOTA at International (FES-I), comprising 16 items that address basic as well as complex activities. New Delhi in April 2015 and was Unlike, the original FES, the modified version uses a 4-point scale (18). awarded with Best Paper under KEMOT Youth Trophy. Researchers have examined cross-cultural comparisons, and established reliability and validity
IJOT : Vol. 48 : No. 13 January 2016 - April 2016 of versions of FES–I in various languages(12,18,22). The FES–I had 3) Able to understand and read Hindi, 4) No severe medical been validated into more than 15 languages (ProFaNE). It has condition that would prevent a participant from performing tests, been shown that the FES-I has strong psychometric properties e.g., stroke, Parkinson’s disease or severe cognitive impairment. across different cultures (across Europe) and languages (Brazilian, 5) Does not use artificial legor prosthesis for mobility. Chinese, Greek, Italian, Norwegian, Turkish and more), and has become a widely accepted tool for assessing fear of falling(12,15- Measures: 1) The FES-I (Hindi), was used to assess fear of falling 23). Further, the strong reliability coefficients of the FES-I (á=0.96 when participating in 16 every day activities. Each item is scored and ICC=0.96), indicated that it could be shortened for screening on a four-point scale (1 = not at all concerned to 4 =very purposes while preserving its psychometric properties. So, a concerned) for a summarys core of 16–64 for the16-item FES-I shortened version comprising seven items from the FES-I was of which alow score indicated low concern for falling. 2) The developed(22), and further validated into different languages. Timed Up and Go Test, measured in seconds, was used to evaluate mobility requiring static and dynamic balance. Times Rationale for the study: The FES-I was translated to Hindi in greater than 13.5 seconds indicates risk for falls among 2010, at Southampton University, UK, but it was not yet community dwelling older adults (27). 3) The Berg Balance Scale validated for use among Hindi speaking population. Falls are was used to evaluate balance. It is rated on a five-point ordinal an age-related challenge common among Hindi speaking older scale (0 to 4) to score subjects performing 14 functional activities. adults, and a validated falls efficacy scale could be used to identify individuals at risk for the downward trend due to fear The maximum score on the Berg Balance Scale is 56; a score (28) of falling. Currently, only one scale, the 22-item Balance below 40 indicates a fall risk of nearly100% . Confidence Scale (BCS) (24), has been validated for use with Hindi Procedure:The FES-I (Hindi) was administered in participants’ speaking clients. In comparison, the FES-I (Hindi) offers two homes. Demographic data with information regarding age, advantages : 1) it has fewer items, therefore, requires less gender, history/number of falls in past one year, and their administration time, and 2) the items are applicable in different occupational status (working or not working) were collected. cultural settings, i.e., it has been validated for use in various Functional measures, such as the Timed Up and Go Test (25), international settings. With growing populations of Hindi and the Berg Balance Scale (26) were translated into Hindi and speakers around the world, the FES-I (Hindi) may be the scale of also administered. After two weeks, the FES-I (Hindi) was re- choice by health care professionals and researchers who administered to each participate to evaluate the scale’s test- collaborate between countries. retest reliability. Objectives of the study were to determine: 1) the internal Ethical consideration: The study received ethical approval from consistency and test-retest reliability of the FES-I (Hindi), 2) the the Health Research Ethics Board (HREB), University of Alberta construct validity of the FES-I (Hindi) by correlating it with the Berg Balance Scale and the Timed Up and Go Test, two well- in March, 2014. Approval to use the FES-I (Hindi) for this study known functional balance tests, and 3) the differences in mean was received from ProFaNE in April, 2013. FES–I (Hindi) scores among participants by age, gender, Data Analysis occupational status and history of falls. 1) Demographic statistics (age, gender, occupational status and Methods history of falls) were used to describe the participants. 2) Internal Sample recruitment : Participants were recruited through consistency of the FES-I (Hindi) was calculated using Cronbach’s advertisement (posters) in the Hindu Society of Alberta, two á coefficient. 3) Test-retest reliability of the FES-I (Hindi) was Gurudwaras (Sikh) and two Hindu temples across Edmonton. calculated using intra-class correlation coefficient. 4) Construct The study was also advertised at the Millwoods Cultural Society validity was determined using Spearman correlation coefficients of the Retired and Semi-retired, Edmonton, Alberta. Recruitment between the FES-I (Hindi) and the Timed Up and Go Test, and posters were prepared in both English and Hindi. between the FES-I (Hindi) and the Berg Balance Scale. 5) Mean FES-I (Hindi) scores among the participants were also compared Sample size calculation: It was proposed that with power (1 - â) using the known group method, i.e., we used independent t- set at 0.88, alpha level (á) as 0.05 and an expected correlation tests by age, gender, occupational status and history of falls. coefficient value of 0.6 between the FES-I (Hindi) and the Timed up and go test, and between the FES-I (Hindi) and the Berg Data for this study was analyzed using statistical analysis software Balance Scale, The study would need a sample size of 19 SPSS version 21. participants1. A larger number of participants (n=23) was Results recruited to mitigate attrition. Participant demographics: The mean age of participants was Inclusion criteria:1) Age 60 years or above (15,18,19), 2) No 71.09 ± 6.29 (SD) years, with range of 60 – 88 years. Table 1 significant cognitive impairment, i.e., Mini Mental Screening presents distribution of gender, occupational status and history/ Examination (MMSE), score should be higher than 24 out of 30, number of falls in the past year.
IJOT : Vol. 48 : No. 14 January 2016 - April 2016 Table 1.Frequency distribution of the participants (n = 23) Mean FES-I (Hindi) scores: We also used the known group method approach to determine the comparison between groups. Variable n (%) We compared participants’ FES-I (Hindi) scores by four variables Gender that may affect falls efficacy: age, gender, history/number of falls, and occupational status (see Table 2). The overall mean Male 15 (65.2) score for the FES–I (Hindi) was 22.39 ± 4.83 (SD), range = 16 Female 8 (34.8) – 64. FES–I (Hindi) scores were significantly different between Occupational status the participants who were not working or were retired and those who were working (t (21) = - 2.68, p = 0.014). Whereas, there Working 8 (34.8) was no statistically significant difference found between the Not working 15 (65.2) Hindi FES–I scores by variables age (t (21) = - 1.63, p = 0.117), gender (t (21) = - 1.37, p = 0.184) and history of falls (t (21) History/number of falls = 0.76, p = 0.451). 0 10 (43.5) Discussion 1 10 (43.5) While there have been several international studies that examined 2 2 (8.7) the reliability and validity of the FES–I, this study was not only 3 1 (4.3) the first to be conducted with Hindi speaking older adults, but also the first in Canada. Compared to previous studies on the Internal consistency: The FES-I (Hindi) showed high internal FES-I, this study used a relatively small size, therefore, further consistency, Cronbach’s alpha was 0.831 (p = .000). research with larger sample sizes are warranted. Test-retest reliability: The FES-I (Hindi) showed high test-retest This study had only 23 participants, compared to the original reliability, ICC = 0.894 (95% CI = 0.768 – 0.954). study of the FES-I (English) which had 704 participants. The Construct Validity: FES–I (Hindi) scores were correlated with current study also had 33.8% females compared to the original the Timed Up and Go Test, Spearman’s ñ = 0.691 (p< 0.0001). study which consisted of 72.9% females. Over three quarters This indicated that poorer performance on the Timed Up and (78.3%) of the participants in this study was below 75 years of (18) Go Test (or high score) was associated with poorer performance age, compared to about half (52.1%) of the original study . on the FES-I (Hindi) scale (high FES–I score). Indeed, the average age of the participants in this study of (71.09 ± 6.29 (SD) years) was younger than samples used in these FES–I (Hindi) scores were negatively correlated with the Berg countries: Greek (19), Brazilian (20), European (12), Chinese (15), Balance Scale, Spearman’s ñ = - 0.827 (p < 0.0001). This Italian (16); and the original English (18). Only a Turkish study had indicated that poorer balance scale scores (low BBS score) was participants with comparable or slightly younger average age associated with poorer FES-I (Hindi) scores (high FES-I score). (69.7 ± 4.59 (SD) years) (17), The percentage of history/number of falls among participants was similar in both studies: Hindi 56.5% and, English 53.1%. More than half of the participants Table 2. FES–I (Hindi) scores of participants by age, gender, in this Hindi study were in the group of retired or not working history/number of falls and occupational status. (65.3%), whereas the percentage of such participants was very Variable (n=23) Mean (SD) low among the participants of original study (19.9%) (18). Age The internal consistency for this study (á = 0.83) was lower than alpha values reported for other studies: original English Less than 75 21.56 (4.5) FES–I (0.96)(18), Germany (0.90)(12), the Netherlands (0.96)(12), 75 or above 25.40 (5.1) UK (0.97)(12), Turkish (0.94)(17), Chinese (0.94)(15), Greek (0.92)(19), Italy (0.98)(16), Brazil (0.93)(20), and Norwegian (0.95)(21). This Gender could be due to the small sample size of the current study. Male 21.40 (4.6) Test-retest reliability was examined using standardised Intra- Female 24.25 (4.9) class correlation coefficient (ICC), as in previous studies (e.g., Turkish (17), Chinese(15)). The reliability in this study (0.89 with History/number of falls 95% confidence interval 0.76 -0.95) was comparable or higher None 21.50 (4.8) than some studies: Germany (0.79), Netherlands (0.82), Brazil (0.84), Chinese (0.89), but lower than others: English (0.96), At least 1 or more 23.08 (4.8) Italy (0.98), Greek (0.95) and Turkish (0.94). Occupational status FES–I (Hindi) scores were significantly different by occupational Working 19.13 (2.8) status (lower in “working”group and higher in “not working” group) (p‹ 0.05), i.e. participants in the not working group had Not working 24.13 (4.8) more fear of falling while performing the daily activities.
IJOT : Vol. 48 : No. 15 January 2016 - April 2016 Interestingly, a similar trend was seen in the original study, status occupation” and “higher status occupation” did not readily where FES-I (English) scores were found significantly higher in apply to a Canadian culture. the sample who were working in “lower status” occupations Implication for future research:The statistically significant results (18). Though, instead of “lower” and “higher” status occupations, of this study are promising and suggests that a study with a we used “not working” and “working” categories in our study. larger sample size would allow comparisons with populations Despite a different terminology used for the categories of in Europe and Asia. Canada is a multi-cultural country. A unique occupation in both studies for example - in English (higher characteristic of this study was that the Hindi version of the occupational status and lower occupational) and, in Hindi FES-I was examined outside of India, with immigrants in Canada. (working and not working), a similarity was noticed. But it is It would be important to validate current international versions the terminology which was different and not the criteria for of the FES-I among immigrants outside of their native lands. grouping the participants into respective categories of Likewise, it is warranted to determine the psychometric properties occupational status. As participants in the lower occupational of the FES-I (Hindi) for use among Hindi-speaking citizens in status group FES–I (English) had been in semi-routine their native land of India. Finally, the clinical significance of occupations, low technical jobs or retired, this was considered the FES–I (Hindi) as an outcome measure could be determined similar to the participants in “not working” group of FES–I through an intervention study with clients at risk for falls. Such (Hindi) who were retired or not working. While the other group, a study could also examine the utility of the shortened version higher occupational status in FES–I (English) had participants of the FES–I (Hindi), especially for screening purpose. who were at higher managerial positions, were considered to be similar to the “working group” in FES–I (Hindi), where all Conclusion participants are working. Nevertheless, the difference in terminology is a limitation in this study. In conclusion, this study showed that the Hindi version of the Falls Efficacy Scale–International had high reliability (internal An assessment of individual items in FES–I (Hindi) was done to consistency and test-retest reliability) and construct validity for interpret the cultural adaptations across the population use among Hindi speaking older adults living in Alberta, Canada. participated in this study. The median score of each item The FES-I (Hindi) can help address communication gaps between responded by the participants of this study was evaluated. Items health professionals and immigrant, Hindi-speaking clients living in the FES–I (Hindi) hada median score of 1 (1 = not at all outside of India. concerned, 2 = somewhat concerned, 3 = fairly concerned and, 4 = very concerned), except four items, which had the Acknowledgement median score of 2. This suggested that Hindi speaking participants were more concerned about the following activities: Reaching We thank the Prevention of Falls Network Europe (ProFaNE) for up and bending down (item 9),Walking on a slippery surface granting us permission to use the FES-I (Hindi) version for this (item 11), Walking on an uneven surface (item 14) and, Walking study. Also, we thank the participants and Gurudwara up or down a slope (item 15). These activities are particularly committee, Temple committee, and Millwoods Cultural Society challenging during the winter season in Alberta, Canada. of Retired and Semi-retired for helping us recruit participants for this study. The literature indicates that balance issues and instability in gait can cause an individual to fall and lead to fear of falling References: (1,29,30). Therefore, an aim of this study was to determine whether 1. World Health Organization. WHO Global Report on Falls Prevention or not the FES–I (Hindi) was associated with the constructs of in Older Age. [Online] 2007; 1-25. Retrieved from http://www.who.int/ balance and mobility. The results demonstrated a positive, ageing/publications/Falls_prevention7March.pdf moderate correlation between FES–I (Hindi) scores and the Timed 2. Public Health Agency of Canada. The Safe Living Guide—A Guide to Up and Go test (Spearman’s ñ = 0.691, p< 0.0001). Similarly, Home Safety for seniors.[Online] 2011. Retrieved from http:// the results indicated a negative, strong correlation between the www.phac-aspc.gc.ca/seniors-aines/publications/public/injury- FES-I (Hindi) scores and the Berg Balance Scale (Spearman’s ñ blessure/safelive-securite/chap2-eng.php = - 0.827, p< 0.0001). Similar results have been reported in 3. Alberta Center for Injury, Control and Research. Seniors’ Falls Injuriesin other international studies (15,17,19). Alberta. [Online] 2013; 1-2. Retrieved from http:// www.findingbalancealberta.ca/cat_view/7-practitioner-page/8-finding- Study Limitations: This study was performed with a small sample balance-falls-prevention-network/16-data- of participants. Although the sample size provided adequate reports?dir=ASC&limit=15&limitstart=0&order=name power for statistical analyses, it limits comparison with larger 4. Fletcher P, Guthrie D, Berg K, & Hirdes J. Risk Factors for Restriction international samples. Another limitation is that the convenience in Activity Associated With Fear of Falling Among Seniors Within the sample was based on volunteers, thereby introducing potential Community. Journal of Patient Safety. 2010;6(3), 187-191. bias. Due to time constraints, only the full version of the FES– 5. Lin M, Wolf S, Hwang H, Gong S, & Chen C. A Randomized, I (Hindi) was administered, and not the seven items shortened Controlled Trial of Fall Prevention Programs and Quality of Life in Older Fallers. Journal of the American Geriatrics Society. 2007; 55(4), version. Therefore, we could not report reliability and validity 499-506. results of the shortened version. Finally, the terminology for 6. Logghe I, Verhagen A, Rademaker A, et al. The effects of Tai Chi on fall occupational status used in this study was not the same as used prevention, fear of falling and balance in older people: A meta- in the original study because the original categories of “lower
IJOT : Vol. 48 : No. 16 January 2016 - April 2016 analysis. Preventive Medicine. 2010; 51(3-4), 222-227. International (FES-I). Age and Ageing. 2005; 34(6), 614-619. 7. Public Health Agency of Canada. Report on Seniors’ falls in Canada. 19. Billis E, Strimpakos N, Kapreli E, et al. Cross-cultural validation of the Minister of Public Works and Government Services Canada. [Online] Falls Efficacy Scale International (FES-I) in Greek community-dwelling 2005. Retrieved from http://publications.gc.ca/collections/Collection/ older adults. Disability and Rehabilitation. 2011; 33(19-20), 1776- HP25-1-2005E.pdf 1784. 8. Scheffer A, Schuurmans M, van Dijk N, van der Hooft T, & de Rooij S. 20. Camargos F, Dias R, Dias J, & Freire M. Cross-cultural adaptation and Fear of falling: measurement strategy, prevalence, risk factors and evaluation of the psychometric properties of the Falls Efficacy Scale - consequences among older persons. Age and Ageing. 2007; 37(1), 19- International among Elderly Brazilians (FES-I-BRAZIL). Brazilian Journal 24. of Physical Therapy. 2010; 14(3), 237- 43. 9. Tinetti M, Richman D, & Powell L. Falls Efficacy as a Measure of Fear 21. Helbostad J, Taraldsen K, Granbo R, Yardley L, Todd C, &Sletvold O. of Falling. Journal of Gerontology. 1990; 45(6), 239-243. Validation of the Falls Efficacy Scale-International in fall-prone older persons. Age and Ageing. 2009; 39(2), 259-259. 10. Curcio C, Gomez F, & Reyes-Ortiz C. Activity Restriction Related to Fear of Falling Among Older People in the Colombian Andes Mountains: 22. Kempen G, Yardley L, Van Haastregt J, et al.The Short FES-I: a shortened Are Functional or Psychosocial Risk Factors More Important? Journal version of the falls efficacy scale-international to assess fear of falling. of Aging and Health. 2009; 21(3), 460-479. Age and Ageing.2007; 37(1), 45-50. 11. Deshpande N, Metter E, Lauretani F, Bandinelli S, Guralnik J, &Ferrucci 23. Lachman M, Howland J, Tennstedt S, Jette A, Assmann S, & Peterson E. L. Activity Restriction Induced by Fear of Falling and Objective and Fear of Falling and Activity Restriction: The Survey of Activities and Subjective Measures of Physical Function: A Prospective Cohort Fear of Falling in the Elderly (SAFE). The Journals of Gerontology, Series Study. Journal of the American Geriatrics Society. 2008; 56(4), 615- B: Psychological Sciences and Social Sciences. 1998; 53B (1), 43-50. 620. 24. Sharma A, & D’souzaS. Developing a scale to assess balance confidence 12. Kempen G, Todd C, Van Haastregt J, et al. Cross-cultural validation of in Indian community older adults. The Indian Journal of Occupational the Falls Efficacy Scale International (FES-I) in older people: Results Therapy. 2008; 40(2), 33-47. from Germany, the Netherlands and the UK were satisfactory. Disability 25. Podsiadlo D, & Richardson S. The timed “Up & Go”: a test of basic and Rehabilitation. 2007; 29(2), 155-162. functional mobility for frail elderly persons. Journal of the American 13. Sattin R, Easley K, Wolf S, Chen Y, & Kutner M. Reduction in Fear of Geriatrics Society. 1991; 142-148. Falling Through Intense Tai Chi Exercise Training in Older, Transitionally Frail Adults. Journal of the American Geriatrics Society. 26. Berg K. Measuring balance in the elderly: preliminary development of 2005; 53(7), 1168-1178. an instrument. Physiotherapy Canada. 1989; 41(6), 304-311. 14. Van Haastregt J, Zijlstra G, van Rossum E, van Eijk J, de Witte L, & 27. Cook A, Brauer S, &Woollacott M. Predicting the probability of falls in Kempen G. Feasibility of a cognitive behavioural group intervention to community dwelling older adults using the Timed Up & Go Test. Journal reduce fear of falling and associated avoidance of activity in community- of the American Physical Therapy Association. 2000; 80(9),896-903. living older people: a process evaluation. BMC Health Services 28. Cook A, Baldwin M, Polissar N, & Gruber W. Predicting the Probability Research. 2007; 7(1), 156. for falls in Community-Dwelling Older Adults. Journal of the American 15. Kwan M, Tsang W, Close J, & Lord S. Development and validation of Physical Therapy Association. 1997; 77, 812-819. a Chinese version of the Falls Efficacy Scale International. Archives of 29. Public Health Agency of Canada. Seniors’ Falls in Canada: Second Gerontology and Geriatrics. 2013; 56(1), 169-174. Report.[Online] 2014. Retrieved from http://www.phac-aspc.gc.ca/ seniors-aines/publications/public/injury-blessure/seniors_falls- 16. Ruggiero C, Mariani T, Gugliotta R, et al.Validation of the Italian chutes_aines/index-eng.php version of the Falls Efficacy Scale International (FES-I) and the Short FES- I in community-dwelling older persons. Archives of Gerontology and 30. Todd C, & Skelton D. What are the main risk factors for falls amongst Geriatrics. 2009; 49, 211-219. older people and what are the most effective interventions to prevent 17. Ulus Y, Durmus D, Akyol Y, Terzi Y, Bilgici A, &Kuru O. Reliability these falls?[Online] World Health Organization, 5-28. 2004. Retrieved and validity of the Turkish version of the Falls Efficacy Scale International from http://www.euro.who.int/__data/assets/pdf_file/0018/74700/ (FES-I) in communitydwelling older persons. Archives of Gerontology E82552.pdf and Geriatrics. 2012; 54(3), 429-433. (Footnotes) 18. Yardley L, Beyer N, Hauer K, Kempen G, Piot-Ziegler C & Todd C. 1https://www.statstodo.com/SSizCorr_Tab.php Development and initial validation of the Falls Efficacy Scale-
IJOT : Vol. 48 : No. 17 January 2016 - April 2016 IJOT : Vol. 48 : No. 18 January 2016 - April 2016 The Indian Journal of Occupational Therapy : Vol. 48 : No. 1 (January 2016 - April 2016) Metabolic and Functional Responses to Cardiac Endurance Training in Subjects with Thoracic (T1 – T6) Level Spinal Cord Injury Amit Kumar Mandal* (M.O.Th.) Abstract Key Words: Aims and objectives: spinal cord injury, cardiac The purpose of the study was to find out the effect of cardiac endurance training on metabolic and functional responses in endurance, arm Ergometer, persons with thoracic (T1 – T6) level Spinal Cord Injury. metabolic, heart rate Methods: A convenient sample of 22 adult thoracic (T1 –T6) level Spinal Cord Injury subjects ASIA classified B through D were selected. Subjects were randomly divided into a control group (N = 9) and experimental group (N = 13). Experimental group received an additional Endurance training in Arm Ergometer for consecutive 30 sittings. Subjects were encouraged to perform the activity in optimum speed so, heart rate can maintain at target heart rate range. MET level was calculated by indirect method and functional status on FIM and SCIM – II. Results: There were significant improvements in both groups. As found significant difference in MET level between the groups exists. Experimental group showed better score in FIM, SCIM-II and MET level at post therapy. Also, observed moderate co-relation (r = 0.549) between two functional scales. Conclusion: Use of cardiac endurance training can be helpful as an additional therapy for improving the metabolic level and functional status in subjects with upper thoracic level spinal cord injury. Introduction Cardiac function of spinal cord injury is strongly influenced by lesion level; individuals with thoracic (TI – T6) lesion will have partial preservation of supra spinal sympathetic control of the heart and upper body vasculature.1 Thoracic level SCI subjects present a low physical capacity, due to extensive muscle mass paralysis mostly trunk and lower extremity, sympathetic autonomic impairment and decrease Venous return, resulting in diminished heart rate, cardiac output and oxygen uptake.2 * Demonstrator As per World Health Origination (WHO) estimates; the incidence of SCI is on the rise in Institution: developing country like India, Pakistan, and Brazil. Burden is equal to industrialized world, Department of Occupational 35% of which is in thoracic level injury.3 Therapy, S.V.N.I.R.T.A.R., Cuttack Literature survey from 1995 on wards prevalence rate of SCI is 223–755 per million inhabitants Period of Study : worldwide. Mean age is 33 years and sex distribution (men/women) as 3.8/1. 4 April 2009 - October 2010 Endurance, which is the capacity of the muscle to contract continuously at sub maximal level, Correspondence : decreases due to physical inactivity of SCI patient.5 Dr. Amit Kumar Mandal Department of Occupational Physical inactivity is defined as a daily level of physical activity that is below an optimum Therapy, Swami Vivekananda required to maintain adequate musculoskeletal and cardiovascular functional capacity.6 Institute of Rehabilitation Training Energy expenditure, for different activities reflected in MET s is well documented.7 and Research, P.O. - Bairoi, Olatpur, Cuttack - 754010 (Odisha) Eating, hygiene, toileting, dressing and bathing, all components of self – care to perform require range in MET levels is from 1.0 to 4.0. One MET is the equivalent of approximately to 1.2 Tel. : 9437191126 calorie/minute. The term is preferred for energy requirement or use.7 Thus MET values can be E- Mail : measured indirectly by estimating the total energy expenditure in calories and the duration in [email protected] which it is spent. It is a qualitative assessment of capacity for aerobic metabolism.8
Paper was presented in A case report of bilateral shoulder shrug progressive exercise performed at self – perceived ‘Hard to very hard” levels provoked increase in metabolism and cardio pulmonary function for OTICON ' 2015 : the 52nd Annual sedentary person with a C4 level spinal cord injury.9 National Conference of AIOTA at New Delhi in April 2015. Subject with thoracic level SCI gets difficulty to sustained self care task due to low capacity of
IJOT : Vol. 48 : No. 19 January 2016 - April 2016 energy expenditure. A large number of study supports that The SCIM II is a sixteen items measure of self care, endurance training helps to improve cardiovascular function and respiration, sphincter management and mobility. Maximum endurance in subjects with Tetraplegia. But there are a limited total score of SCIM II is 100 point, number of studies available with thoracic level SCI. It is an independence scale specifically developed for AIMS AND OBJECTIVES subjects with SCI.12 1. The purpose of the study was to find out the effect of Cardiac 2. Functional independence Measure (FIM): Endurance training on metabolic and functional responses It is an eighteen items measure self care, sphincter control, in persons with Thoracic (T1 – T6) level spinal cord injury locomotion, communication and social- cognition. The FIM 2. To find out relationship between Functional Independence was found to be valid and reliable as a functional assessment Measure and Spinal Cord Independence Measure II in tool for various patient groups including SCI patients.13 subject with Thoracic level spinal cord injury Procedure: Materials and Method A pre test – post test control group design was used to conduct The study was conducted over a period from April 2009 to the study. The subjects were explained about the nature and October 2010 in the Department of Occupational Therapy, purpose of the study. Subjects were included in the study after SVNIRTAR, Cuttack. having their written informed consent. Convenient sample of 22 subjects were divided into control and experimental group Inclusion criteria: through randomization. 1. Traumatic spinal cord injury having age 18 to 45 years Baseline data: 2. Subjects having neurological level of T1 – T6 Demographic and health status data were collected by using an 3. Duration of injury is minimum 3 Months evaluation format and health questionnaire. 4. Classified on American Spinal injury association (ASIA) To collect the data proto type test of Exercise Tress Test (EST) 10 impairment scale as B through D was used by Arm Ergometer.14 5. Cleared from physician to participate in study Age adjusted maximum heart rate (AAMHR) and submaximal 6. Subjects who can sit on their wheelchair for minimum heart rate (70% of AAMHR) was calculated. Functional status 40 minutes comfortably was recorded on FIM and SCIM II on perform and interview Exclusion criteria: based and MET level calculated by indirect method on first day 1. Subject previously diagnosed any cardiac disease morning before start any kind of therapy and after observing 2. Subjects is an antihypertensive medication that subject is calm and comfortable. Blood pressure (BP), heart rate (HR) was also recorded on pre – post training basis daily. 3. Any problem in the upper limbs restricting the subject to crank efficiently The crank height adjusted for individual subject so that the grip 4. Not able to perform work of at least 23 watts arm would be at shoulder level. Each subject was put on Arm Ergometer Ergometer and started cranking with command “START”. The base line pre training calorie expenditure was noted for each Independent variables: subject when subject achieved the 70% of AAMHR, and Arm Ergometer cardiac endurance training maintained it for 30 seconds by cranking continuously on manual Dependent variables: protocol (uniform resistance). On achieving this target a Cardiac endurance command “STOP” was given and time duration, distance, total energy expenditure (in Calories) was recorded from the display Functional status monitor and BP was measured using Sphygmomanometer as Instrumentations: kept as pre training base line data. 1. Arm – leg Ergometer (Endorphin 370 series e4)11: the The ability to spend energy in term of MET status was calculated electronic monitor of the equipment displays pulse, time, through indirect method .Self report of Perceive Exertion (RPE), distance, speed, calories and heart rate. An oscultometer any angina symptom and feeling of any diginess was noted. cable of the equipment is connected with body over the ear lobule to detect heart rate. Adjustable cranks which Protocol: can be adjusted as per requirement. Arm crank component All 22 subjects were provided conventional occupational was used in this study. therapeutic intervention aiming to improve cardiac endurance. 2. Stethoscope and desk type manometric mercury Control group received conventional occupational therapy for Sphygmomanometer 30 minutes for 30 sittings. Outcome measures: Enabling activities, functional training and wheel chair propulsion training in ramps and curbs were given as a 1. Spinal Cord Independence Measure II (SCIM II): conventional therapy.
IJOT : Vol. 48 : No. 110 January 2016 - April 2016 Experimental group received an additional Arm Ergometer Training was continued for consecutive 30 sessions with one training with gradual increment in time duration for cranking. session per day. Subjects were encouraged to maintain cranking Subjects were encouraged to crank in speed so that heart rate speed so, that submaximal heart rate would be maintained. can maintain at 70% to 80% of AAMHR (hard to very hard of After terminating of training heart rate, energy expenditure, blood Borg’s RPE scale).15 pressure, distance and time duration was noted. Adopting American College of Sports Medicine (1995) Guidelines following protocol were used for arm Ergometer Data Analysis and Result cardiac endurance training for experimental group.16 The data comprised 22 subjects.17 men and 5 women between Warm up Training duration Cool down the ages of 18 to 45 years participated in the study. In control group mean age of participant was 29.88 (men 8 and women 05 minutes for 5 sessions 1). In experimental group mean age of subjects were 34.53 (men 10 minutes for 5 sessions 9 and women 4). 15 minutes for 5 sessions 5 minutes 5 minutes Statistical analysis was done by using Mann- Whitney U test for 20 minutes for 5 sessions group comparison. Wilcoxon signed rank test for comparisons within the group and Spearman’s rank order correlation 25 minutes for 5 sessions coefficient test was done for correlation between two functional 30 minutes for 5 sessions scales. SPSS for Windows version 16 (SPSS Inc., Chicago, IL, USA) was used for all data analysis. All analysis yielding a p < 0.05 was considered significant.
Experimental group who received additional cardiac endurance training have shown better change of score in MET (mean 5.223 to 6.875), FIM (mean 71.15 to 95.079) and SCIM II (mean 33.307 to 61.846) at pre to post therapy. Subjects of control have shown improvement in all parameters. Change of score at pre to post test was in MET (mean 5.492 to 6.161), FIM (mean 77.111 to 87.444) and in SCIM (mean 46.111 to 57.111). In group comparison, MET (p = 0.035) value is significant. But, SCIM II (p =0.331) and FIM (p = 0.071) did not show Graph 1 significance. Shows change of score control group and experimental group pre - post therapy in MET, FIM and SCIM II
120 100 80 Series1 60 Series2 40 20 Where as Experimental group have shown significant 0 improvement (p = 0.00) in all parameters in pre to post therapy. 1 2 3 4 5 6 7 Similarly subjects of control group have shown significant improvement (p = 0.007) in all parameter at pre to post therapy. 1 and 2: MET, 3 and 4: FIM, 5 and 6: SCIM II
IJOT : Vol. 48 : No. 111 January 2016 - April 2016 Series 1 shows pre therapy and series 2 shows post therapy score Moderate intensity aerobic arm training (20 – 60 minutes / day) of control group and experimental group. for 6 – 8 weeks is effective in improving the aerobic capacity and exercise tolerance of subject with SCI. 18 There was significant (p = 0.000) association between two functional scales. A moderate positive correlation (r = 0.549) Six weeks arm Ergometer training (20 – 60 minutes / day) effective between FIM and SCIM II was observed. for improving cardiovascular fitness and exercise tolerance in subject with SCI. 19 Scatter gram 1 between FIM and SCIM II at pre therapy Five to seven months vigorous arm exercise in arm Ergometer has improved cardiac endurance significantly in Tetraplegic SCI 70 subjects. 20 60 Subjects of Experimental group have shown better score in pre 50 to post FIM (mean 71.15 to 95.075) and SCIM (mean 33.307 40 to 61.846).Subjects of control group also shown improvement Series1 in pre to post FIM (mean 77.111 to 87.444) and in SCIM (mean 30 46.111 to 57.111). Therefore both groups have shown 20 improvement in functional status. 10 But, the level of functional improvements between the groups 0 does not vary significantly. 0 50 100 Scattergram 1 and 2 shows that moderate positive correlation between two functional scales at pre therapy as well as post therapy. (SCIM II)Y MET is a measure of the rate of oxygen utilization for the X (FIM) production of energy similar to VO2 max. 21 Scatter gram 2 between FIM and SCIM II at post therapy The recording of total energy expenditure (in calories) from the Ergometer monitor and calculating MET values was used for study instead of VO max which needs more sophisticated 100 2 equipment. The accuracy of calculated MET values may be
80 questioned in comparison of VO2 max calculation. Only one woman was in control group and four women were 60 in experimental group. Therefore the training effect could not Series1 be studied in the light of gender variable separately. 40 Conclusion 20 The study concludes that use of cardiac endurance training can 0 be helpful as an additional therapy for improving the metabolic 0 50 100 150 level and functional status in subjects with thoracic (T1 – T6) level spinal cord injury. There is moderate co -relation between Functional Independence Measure and Spinal Cord (SCIM II)Y Independence Measure II in subjects with thoracic level spinal X (FIM) cord injury. Discussion Limitations: Small sample size All 22 subjects completed the study without any discomfort or Short study duration angina. The Experimental group who received endurance training Subject’s improvement in possible daily task and social activities showed significant improvement in MET as observed in table – must have sharing effect in the improvement of MET and I . The mean values of pre to post MET for the experimental functional area. group shows improvement (mean 5.223 to 6.875). The mean value of pre to post MET for control group shows improvement Recommendation: (mean 5.492 to 6.161) which is lesser as compared to Long term follow up is required to investigate the sustainability experimental group. of the achieved metabolic level and functional status. Similar In group comparison, experimental group who received study may be carried out in ideal lab conditions and with large additional cardiac endurance training have shown significant sample size. improvement (p < 0.035) in MET value at post therapy. Result Acknowledgement of the present study is accordance with the following studies. I would like to convey my sincere thanks to Dr. R N Mohanty, Endurance training for 8 weeks showed significant increase in Director (Offg.), SVNIRTAR for allowing me to conduct this cardiac endurance in subject with spinal cord injury.17
IJOT : Vol. 48 : No. 112 January 2016 - April 2016 study in the institute. I express my sincere gratitude to Dr. Mrs. profile and insulin sensitivity in early rehabilitation of spinal cord Anurupa Senapati Assist. Prof. and Officer in-charge, Deptt. of injury individuals. Spinal cord. 2003; 41(12):673 – 679. OT, Mr. Ramkumar Sahu and all staff of Dept. of OT, 18. Warburton DER et al. Cardiovascular health and exercise following spinal cord injury. Spinal cord injury rehabilitation evidence. SVNIRTAR for help. I wish to thank Mr. G. Ganesh and Mr. Vancouver. 2014; 5 (0):1 - 48. Soumakanta Sahoo for statistical analysis. Finally I express my 19. Ordonez et al. In: Warburton DER et al. Upper extremity exercise sincere gratitude to my subjects and their relatives for following spinal cord injury. Spinal cord injury rehabilitation evidence. participation, interest and patience during the study. Vancouver. 2014; 5 (0):1- 48. 20. Hjeltnes N and Henrikson W. Improve work capacity but unchanged References : peak oxygen uptake during primary rehabilitation in tetraplegic patient. Spinal cord. 1998 ; 36: 691 – 698. 1. West CR et al. In: Warburton DER et al. Cardiovascular health and exercise following spinal cord injury. Spinal cord injury rehabilitation 21. Hoffman MD et al. Therapeutic Exercises. In: Physical medicine and evidence. Vancouver. 2014; 5 (0):1-48. Rehabilitation – Principles and practice. Philadelphia, Lippincott Williams and Willkins. 2006 : 389 – 433. 2. Dallmeijer AJ, Hopman MTE, Van HHJ, Van der Woude LHV. Physical capacity and physical strain in persons with tetraplegia: the role of sports activity. Spinal Cord 1996; 34: 728 – 735. ANNEXURE 3. Mukherjee AK. Spinal injury and disability care. Vikas publishing house Pvt. Ltd. New Delhi, 1999: 333 – 354. And www. Rehab council 1. Exercise Stress Test(EST) was used by Arm Ergometer. .nic.in. Following variables were noted during EST: 4. Wyndale M, Wyndaele JJ. Spinal Cord. 2006 ; 44: 523 – 529. Angina symptom 5. Shumway – Cook A, Woollacott HM. Motor Control Therapy and Heart rate Practical Applications, 2nd ed. Lippincott Williams and Wilkin, 2001: Energy expenditure 228 – 229. Digenes 6. Eugen M and Halar MD. Physical Inactivity: A major risk factor for Self report of perceive exertion (RPE) by patient coronary heart disease. Physical medicine and rehabilitation clinic of Blood pressure (immediate after exercise) North America. 1995; 6(2): 55 – 63. 2. Borg’s rate of perceived exertion 15 grade scale: 7. Wilde CK and Hall JA. Occupational therapy in cardiac rehabilitation: Rating Description Resumption of daily life activities. Physical medicine and rehabilitation 6 No exertion at all clinic of North America. 1995; 6(2): 55 – 63. 7 Very, very light 8. Miles DS. Weight control and exercise. Clinics in sports medicine.1991; 8 10(1): 157 – 180. 9 Very light 9. Birk TJ, Nieshoff E et al. Metabolic and cardio pulmonary responses to 10 acute progressive resistive exercise in a person with C4 Spinal cord 11 Fairly light injury. Spinal cord. 2001; 39: 336 – 339. 12 10. Krishblum S, Dnovan NW. Neurological assessment and classification 13 Somewhat hard of traumatic spinal cord injury. In: Krisblum S, Compacnalo ID, Delisa 14 AJ. Spinal cord medicine. Lippincott wilkins.2001: 82 – 95. 15 Hard 11. Arm – Leg Ergometer – Manual. Endorphin 370 Series e4, endorphin 16 corp. florida. 17 Very hard 12. Catz. A, Itzkovich M, Steinberg F et al. The Catz – Itzkovich SCIM: a 18 revised version of the Spinal Cord Independence measure. Disability 19 Very, very hard Rehabilitation. 2001; 23: 263 – 268. 13. Hall KM et al. Characteristics of the Functional Independence Measure 3. Worm up activities: in traumatic spinal cord injury. Arch Phys. Med. Rehabil.1999; 80(11): (Ten repetition each) 1471 – 1476. · Figure eight one arm at a time 14. Stiens AS, Johnson CM, Lyman JP. Cardiac rehabilitation in patients · Bicep curls, one arm at a time with spinal cord injuries. Physical medicine and rehabilitation clinic · Lateral raises, both arms at the same time of North America. 1995; 5(2): 263 – 296. · Frontal deltoid raises, both arm same time 15. Flores MA. Hospital – based cardiac rehabilitation. Physical medicine · Over head extensions, both arms at the and rehabilitation clinic of North America. 1995; 6(2): 243 – 261. same time 16. American college of sports medicine: ACSM’s guidelines for exercise · Punch out, one arm at a time th testing and prescription. 5 ed. Baltimore: William and Wilkins, 1995: · Internal rotations, one arm at a time 153-176. · Wrist curl, both arms at the same time 17. De Groot PC et al. Effect of training intensity of physical capacity, lipid · Reverse curls, one arm at a time
IJOT : Vol. 48 : No. 113 January 2016 - April 2016 The Indian Journal of Occupational Therapy : Vol. 48 : No. 1 (January 2016 - April 2016) NEWS AND INFORMATION
AIOTA : ELECTION RESULT-2016 Dr. Ashley Jayapaul (Singapore) delivered Key Note Address on the theme of the conference ‘Innovations in Occupational Therapy – AIOTA Executive Committee [2016-2020] The Key towards Excellence’. Helen C. Ribchester (UK), Dr. Vinay Following were declared elected after counting of votes, during Singh , Canada, Dr. B.D. Dasari (UK), Dr. Vijay Suple (Canada), Kei the GB Meeting of All India Occupational Therapists Association Nakamura & Kohei Yoshida ( Japan) delivered talks on various (AIOTA) on Jan.29, 2016 at S.R.M. University, Chennai, to innovative areas of OT practice. COTE-1 was conducted by Dr. constitute the Executive Committee of AIOTA for the Financial Panakaj Bajpai (Kolkata) on “Transport Modes and Accessibility of Years 2016-2020. Dr. Lalit Narayan (New Delhi) was the Chairman PwDs while for COTE-2 on ‘Advances in Hand Splinting’, Dr. Shovan Election Committee. Saha (Manipal) was the resource faculty. Dr. D. Suresh, Dean, SRM President : Dr. Anil Kumar Srivastava, Lucknow College of OT was the Org. Secretary and Dr. Pratibha M. Vaidya Vice President : Dr. Shashi Oberai,Navi Mumbai Associate Prof. OT at T.N. Medical College Mumbai was Chairperson Hon. Secretary : Dr. Satish S. Maslekar, Aurangabad of the Scientific Program. Treasurer : Dr. Pratibha M. Vaidya, Mumbai The Winners of Awards & Trophies Executive Members : 1) Kamala V. Nimbkar Trophy for the Best Scientific Paper Dr. Joseph Sunny: Kochin Name: Dr. Soumyakanta Sahu (Bangalore) Dr. Amitabh Kishore Dwivedi, Jaipur Title: Effect of dual task training on quality of life in Dr. Surendra Kumar Meena, Jaipur patients with Parkinson’s disease. Dr. Neeraj Mishra, New Delhi 2) Kailash Merchant Trophy for the Best Paper in Ex-Officio: Neuroscience Dr. Zarine D. Ferzandi, Mumbai- Name: Dr. Sinoy Sam (Bangalore) The former Vice President of AIOTA Title: Effectiveness of driving training program in a patient with GBS - A single case study. Following were Co-opted as EC Members during the mandatory EC Meeting of AIOTA held on Jan. 30th, 2016 at Chennai. 3) AIOTA Trophy for the Best Paper in Mental Health Name: Dr. Aishwarya Swaminathan (Mumbai) 1. Dr. R.K. Sharma, Gurgaon Title: Fostering Self-Regulation in Children with ADHD 2. Dr. Lalit Narayan, New Delhi 4) KEMOT Youth Talent Trophy ACOT EXECUTIVE COMMITTEE [2016-2020] Name: Vrushali Kulkarni (Mumbai) Following were declared elected to constitute the Executive Title: Helping parents become their child’s Therapist- Committee of Academic Council of Occupational Therapy An outcome based study (ACOT) for the Financial Years 2016-2020. The elections were 5) Gazala Makda Trophy for best paper in Peadiatrics held on Jan. 29 during GB Meeting of ACOT. President AIOTA Name: Dr. K R Banumathe (Manipal) shall be the Executive Chairman of ACOT: Title: Relationship between Visual Motor Integration Dean : Dr. Jyothika N. Bijlani, Mumbai and Academic Performance in Elementary School Children: A Cross Sectional Study Executive Members: Dr. Jaya Kale, Mumbai 6) AIOTA Trophy for the Best Poster Dr. Shovan Saha, Manipal Name: Vijay Batra (Delhi) Dr. V.S. Bole, New Delhi Title: Gender Based variations in plantar weight Dr. Veena Slaich, New Delhi distribution in functional positions across normal vs. Knee OA population in India
THE HIGHLIGHTS OF OTICON’2016 AT CHENNAI: 7) Dr. N. Swaroop Trophy for the best Innovative technology Name: Dr. Meenakshi Batra (Delhi) OTICON 2016:the 53rd Annual National Conference of AIOTA was Title: Multipurpose Head Gear hosted by SRM college of Occupational Therapy & SRM University, Students' Category Chennai in collaboration with Tamil Nadu Branch of AIOTA at SRM University Chennai from 29th Jan. to 31st Jan. 2016. It was 1) AIOTA Trophy for Best Speaker in Intercollegiate Debate attended by around 600 participants from India and overseas. The Theme: Conventional Therapy vs Innovative Technology conference was inaugurated on Jan.30 by Dr. S. Geetalakshmi , Vice I PRIZE - Ms. Kaveri Jadhav (T. N .Medical College, Mumbai) chancellor of The T.N. Dr. M.G.R. Medical University. Dr. Prabir K. II PRIZE- Ms. Priya Surendran (L.T.M. Medical College, Bagchi the VC of SRM University presided over the function with Mumbai) renounced dignitaries including Prof. Manik Shahani formerly Head of Physiotherapy and a Neurophysiologist. III PRIZE- Ms. Shifa Ansari (Pad. Dr. D. Y. Patil College of OT, Navi Mumbai)
IJOT : Vol. 48 : No. 114 January 2016 - April 2016 2) AIOTA Trophy for Best Poster WORLD OT DAY - WFOT Theme: Agro Ergonomics World OT Day celebration compiled report from India, may be I PRIZE- Smt. Kamalaben P. Patel Institute of PT & OT, visited on WFOT webpage as under Anand Gujarat http://www.wfot.org/AboutUs/WorldOTDay.aspx For Full report go to II PRIZE- O.T. School & Centre, Seth G. S. Medical College, http://www.dropbox.com/s/aqfh58p4ots9fvi/World%20OT% Mumbai 20DA%20215_India.pdf?dl=0 IIIPRIZE- O.T. School & Centre, G.M.C. Nagpur WFOT has extended thanks to all countries that supported World OT Day 2015. 3) AIOTA Trophy for Best Innovative Technology OT DAY CELEBRATION AT PUDUCHERRY I PRIZE- O.T. School & Centre, LTMMC Sion, Mumbai World OT Day was also enthusiastically celebrated at Deptt. of II PRIZE- S.R.M. College of O.T., Chennai Orthopedics/PMR at JIPMER, Pondicherry. An OT awareness Video was released by the Director of the Institute Dr. Parija. –The video III PRIZE- O.T. School & Centre, Seth G. S. Medical College, contain significant information regarding OT intervention in Stress Mumbai management, Stroke Rehabilitation, Sensory Integrative therapy, High Award from Branches Risk Infants, Early Interventionand lively Occupational Therapy treatment in the department. The program was covered up and 1) Gold Medal –Best OT Graduate of 2015 (Odisha Branch of published in leading News Papers of the city. AIOTA) Information; Mr. Bibhuti Bhushan Baliar Singh (S. V.NIRTAR, Cuttack) Dr. S.Sathishkumar 2) Best OT Delegate (Kerala Branch Of AIOTA) Senior Occupational Therapist /Incharge, JIPMER Hospital, Puducherry Dr. Soumyakanta Sahu (Bangalore) E-mail : [email protected] 3) Best Student Delegate (Karnataka Branch of AIOTA) WFOT: RESEARCH PRIORITIES WITHIN WFOT MEMBER ORGANIZATIONS SURVEY Ms. Khotal Zainab Faiyaz The WFOT is working with the University of Sydney to identify (Seth G. S. Medical College, Mumbai) research priorities within occupational therapy that will be used to AIOTA AWARDS & HONORS inform the development of an international research strategy for the profession. Request from WFOT was received for nominations from Following were conferred with AIOTA’s prestigious awards during India to participate in the survey. Following nominations from India the inaugural function of the conference on Jan.30 for their were accepted by WFOT: meticulous and life ling contribution in development of OT 1. Dr. Jyothika Bijlani, Mumbai 2. Dr. Kamal N. Arya (New Delhi) profession in India and AIOTA: 3. Dr. Vijay Batra (New Delhi) Life Time Achievement Award: The nominated members are actively participating in the survey. WFOT WHO-GATE GLOBAL SURVEY TO IDENTIFY THE TOP 1. Posthumously presented to Prof. Mira Manik Shahani (1930- 50 PRIORITY ASSISTIVE PRODUCTS 2015). Late Mrs. Shahani was retired after serving Head OT WFOT has requested to participate in the WHO-GATE global survey School & Center, K.E.M. Hospital, Seth G.S. Medical College, to identify the top 50 priority assistive products.The survey is open Mumbai during 1957-1989. She was also Dean of ACOT to all stakeholders, but users or potential users of assistive 2. Dr. Mrs. Nirmala S. Venkateswaran (Kochi) Fellow of ACOT, technologies, their families and organizations from all countries. The online survey is available in 38 different languages through this Formerly : Vice Principal, SRM College of OT Chennai, link on or before March 3,2016. Program Manager Handicap International for Earthquake https://extranet.who.int/dataform/355553/ Rehabilitation and Asstt. Prof. RRTC,Govt. of India. TEMPORARY SUSPENSION OF JAIPUR OT COLLEGE, JAIPUR 3. Dr. Mrs. V.S. Bole (New Delhi), EC Member ACOT, Formerly The surprise inspection for physical verification of Jaipur College of HOD OT, Kalawati Saran Childrens’ Hospital, Lady Harding Occupational Therapy of Maharaja Vinayak Global University, Medical College, New Delhi. Jaipur, was carried out by the three members’ inspection committee of ACOT, on 11th September 2015. Professional Excellence Award: Based on the individual reports submitted by the inspection committee, the AIOTA accreditation of Jaipur Occupational Therapy Dr. Mrs. Pratibha Vaidya, Associate Prof. OT at T.N. Medical College, Jaipur is temporarily suspended, with effect from 6th Dec College and BYL Nair Hospital, Mumbai, EC member of AIOTA. 2015, till the compliance as per ‘The Minimum Standards of OT Education of AIOTA/WFOT‘ is satisfactorily achieved by the AWARDED institution. Dr. Pankaj Bajpai, Hon.Secretary AIOTA was presented with Life ACOT suggested to university authorities, that in wider interest of Time Achievement Award during 7th National Rehab Meet 2016 at students, the institution should make sincere efforts in overcoming Patna from Feb.13-15, 2016. It was jointly organized by Rehabilitation the reported shortcomings as for as possible within the period of Council of India and Indian Institute of Health Education and three months. Research. He also delivered a talk on ‘Accessibility of Children with On recommendation of ACOT, the decision to this effect was taken Multiple Disabilities in School Environment’. by AIOTA Executive Committee Meeting in Dec. 2015 at New Delhi.
IJOT : Vol. 48 : No. 115 January 2016 - April 2016 CONTINUING OT EDUCATION PROGRAMS The Applicant must fulfill the following revised ELLIGBILTY Criteria effective from April 01, 2016, for submitting request for Fellowship COTE-1 : Statistical Methods & Art of Writing Research in of ACOT: OT 1. He/ She should be a continued & uninterrupted member of 12-13 March 2016, Mumbai AIOTA for not less than 15 years with minimum qualification of (2 full days course Contact Hours-18, Credits 2 CEU) Master’s degree in Occupational Therapy &/ or OT related Organised by : ACOT & OT School & Centre, LTMM College, specialty. However, the Bachelor’s degree in Occupational Sion Hospital, Sion, Mumbai Therapy from AIOTA /WFOT accredited institution is mandatory. Resource Persons: Or He/ She should be a continued & uninterrupted member of Dr. R.M. Pandey, Prof. & Head, Deptt. of Biostatistics AIIMS, New AIOTA for not less than 12 years with minimum qualification of Delhi & Dr. Punita Solanki, Consultant OT & Former Asst. Prof. Ph.D. in OT related areas but post professional Master’s degree OT School & Center, G.S. Medical College, K.E.M. Hospital, in OT&/ or OT related specialty is essential. However the Mumbai. Bachelor’s degree in Occupational Therapy from AIOTA /WFOT Information: accredited institution is mandatory. Dr. Rashmi Yeradkar, HOD, OT School & Centre, 2. He/ She should have at least five publications related to the field LTM Medical College & Sion Hospital, Mumbai of Occupational Therapy as an Author/Contributing Author in Email: [email protected] the text books and/or Principal Author in the indexed journals. Mob:+91-9820954156 Or COTE-2 : Physical Agent Modalities: As an Adjunct to OT He/she must have held a recognized faculty position in 22-24 April, 2016, Ghaziabad Occupational Therapy, for not less than 10 years & not lower (3 full days course Contact Hours-27, Credits 3-CEU) than Asst. Professor/ Lecturer in an AIOTA/WFOT accredited OT Organised by: UP Branch of AIOTA in collaboration with ACOT And and Santosh Education & Health Care Pvt. Ltd., at Santosh OT He/ she should be principal guide of minimum five post College, Santosh Hospital, No.1, Ambedkar Nagar, Opp. Bus graduate students in AIOTA accredited Master’s program Stand, Ghaziabad, UP. in OT and minimum 5 publications as Principal author or Resource Persons: Eminent Professionals from Physiotherapy, Associate author in the text books or in the indexed Physics, Bio Engineering and US trained Occupational Therapists journals. Information: Or Dr. R. K. Sharma, He /She should have minimum three paper presentations Dean Allied Health and Principal/HOD, in national/international conference and conducted Santosh OT College, Ghaiziabad minimum two COTE/CME/Seminar/Workshop/Short Email: [email protected] Courses on OT related specialties as a “Resource Person.” Mob:+91-9811147426 in an institution of repute. OTICON’2017: JAIPUR 3. Only those members can apply for Fellow of ACOT whose membership has not been withheld or suspended and there th The 54 Annual National Conference of AIOTA is scheduled to be have been no disciplinary proceedings against the member due organized by Rajasthan Branch of AIOTA in collaboration with to any reason. Mahatma Gandhi OT College , Jaipur at R L Swarankar Auditorium, Additionally following merit points will be considered for eligibility Mahatma Gandhi University of Medical Sciences & Technology, criteria to prioritize the selection of applications: Jaipur. Exemplary scientific contribution to the OT profession by doing Theme : 100 YEARS OF OT GLOBALLY : GLORIES OF PAST AND research in basic and/or related subjects in Occupational Therapy CHALLANGES FOR FUTURE. other than retrospective clinical studies. Dates : Feb. 17-19, 2017. Recipient of number of awards for presentations in AIOTA/ International OT related conferences. Chairperson Scientific Program : Number of Publications in indexed national/ international journal Dr. Shashi Oberai, VP Elect - AIOTA (Navi Mumbai) of Occupational Therapy/Presentations in AIOTA /National & Information: international conferences. Dr. S. K. Meena Distinguished Awards and Honors in recognition of academic Organizing Secretary achievements by national and international organizations. Tel: +91 9414058796, 8502005480 Kindly note that: Email : [email protected] • Minimum processing time after submission of the application is 3 months. ANNOUNCEMENT • The decision of the ACOT followed with approval and /or non- Felloship of Academic Council of Occupational Therapy approval from AIOTA EC will be final & binding. Visit AIOTA website http://www.aiota.org/pdf/ecfacot.pdf for more Applications are invited by Dean ACOT from Members of AIOTA details and downloding the application form. on prescribed Application Form for Award of prestigious ‘Fellowship Information : st of Academic Council of Occupational Therapy before Aug. 31 Dr. Jyothika Bijlani, 2016. It should include up to date Bio Data and self-attested Dean ACOT, photocopies of certificates, desired documents and published Tel.: 09820964567 papers/articles/books etc. The application should be based on the E-mail: [email protected] Revised Eligibility Criteria for award of fellowship.
IJOT : Vol. 48 : No. 116 January 2016 - April 2016 The Indian Journal of Occupational Therapy : Vol. 48 : No. 1 (January 2016 - April 2016) Assertiveness in Indian Context: Perspectives of Urban Adults from Mumbai Vinita A Acharya1, P S V N Sharma2, Sreekumaran Nair3
Key Words: Abstract assertiveness, adults, Indian Introduction: Assertiveness is one of the important communication skill influencing our relationships and life role context, mental health promotion, participation. It is known to play a role in stress management, conflict resolution and in maintaining a positive self- qualitative research concept. Indians are traditionally considered to be not as assertive as their Western counterparts. However, with changing trends in the society and improvement in financial and educational status, it may be expected to change. Method: Qualitative methods were employed to understand the perspectives of urban adults in Mumbai about assertiveness. Four focus group discussions were conducted with men and women from different age groups and social backgrounds to understand their beliefs and experiences related to assertiveness. Findings: Three key themes emerged from the analysis of the data. ‘Acceptance by others’, ‘positive emotions as an outcome’ and ‘risk-benefits ratio’ appeared to be major concerns in being assertive. Conclusion: Understanding the views on assertiveness and perceived barriers to being assertive may help develop strategies for effective assertiveness training. It would enable occupational therapists to educate individuals in developing assertiveness which could be an effective step towards mental health promotion. Introduction Communication skills are an essential part of our occupational functioning. We use them to express our views, needs, emotions across our interpersonal relationships at home, work and in the community. The way we communicate can influence the quality of our relationships with people and our life role performance.1Assertiveness is one such communication skill which involves expressing our views and opinions in an honest, straightforward manner without affecting the rights of others.2,3Assertive behaviour has been considered along a continuum where 1 Assistant professor submissive/passive behaviour is considered at one end and aggressive behaviour at the other 2 Professor and Head, Deptt. of extreme end with assertive behaviour between the two. Passive aggressive is another dimension Psychiatry to this behaviour which has a mix of aggressive and submissive strategies. People are usually 3 Professor and Head, Deptt. of categorized as assertive, submissive, aggressive and passive aggressive based on their response 4 Statistics styles. Institution: Assertiveness is considered as a part of social skills and adds on to the individual’s social Manipal University, Manipal, competence. In the absence of which, an individual may experience stress, anxiety in some Karnataka, India. social situations, which in turn, may affect his productivity. On the other hand, an assertive person is assumed to be able to deal with his life situations in a positive manner, which helps Period Of Study : boost his self-confidence, self-esteem and in turn, his self-concept. 5It has also known to play June 2013 – August 2014 a role in stress management and conflict resolution.6 Correspondence : However, it is often suggested that Indians may not be as assertive as their Western counterparts. Dr. Vinita A Acharya 7,8Indian women in particular have an image of being docile and submissive in a patriarchal Assistant Professor, society bowing down to cultural norms. 9Various studies have highlighted the role of culture in Deptt. of Occupational Therapy, assertiveness. It is known to be a culture-specific and situation specific phenomenon. School of Allied Health Sciences, Manipal University Numerous studies have reported differences in Indians/ Asians and other cultures in terms of 7,8 Manipal - 576104, Karnataka, India assertiveness. It appears that Indians often come across as less assertive in comparison to Westerners. Tel. : 9986071111 Furnham (10) noted that the concept of assertiveness typically is an aspect of North American E- Mail : and European culture and in many other cultures such forms of assertiveness is neither encouraged [email protected] nor tolerated. Humility, subservience and tolerance are placed above assertiveness, especially so for women. However, very few qualitative studies have been conducted to explore the Paper was presented in concept of assertiveness among Indians. OTICON ' 2015 : the 52nd Annual National Conference of AIOTA at Also, assertiveness has been extensively studied in the context of adolescents and teenagers to New Delhi in April 2015. deal with peer pressure and refuse offers for substance use like alcohol and drugs.
IJOT : Vol. 48 : No. 117 January 2016 - April 2016 But there is limited literature about assertiveness in adulthood and socio-economic status were considered in recruiting the between 25-50 years of age. This phase needs to be explored as participants for the group discussion. Snowball sampling of this is the period where they assume significant life roles requiring convenience was also usedwherein the participant was asked to interpersonal communication at different levels on the personal recommend and inform any other similar person who would be and professional front. interested in participating in the group discussion. Each focus group had about five-seven participants. All the interviews were Hence, this study was undertaken to explorecommon views and conducted in Marathi language which was known to the perceptions of Indian men andwomen about assertiveness. Their participants as well as the first author who was also the opinions about specific situations requiring assertive responses moderator. A brief idea about the topic was given before were also sought. This was a part of a larger study which explored recruitment but details about the questions were not disclosed. the views about assertiveness among Indians in the age group of A common neutral place was decided for each interview and 25-50 years and included men as well as women from different the participants were informed about the venue and timing. backgrounds. This paper presents the views of subgroups of men The investigator reminded the participants or the key informant and women from Mumbai and their perceptions about being a day before each interview to confirm their participation. At assertive. the venue, they were briefed about the topic and were then Method encouraged to discuss amongst themselves about the topic. The interview was recorded with a digital voice recorder. Verbal Qualitative methods were employedfor this study about and written consent was taken to participate in the discussion assertiveness. Four focus group discussions were conducted with and for recording the interviews. The participants were assured men and women from different age groupsin Mumbai to of the confidentiality being maintained for the issues discussed. understand their perspectives on assertiveness. No incentives were offered for participation in the interview Focus group discussions are commonly used as part of qualitative however, refreshments were provided as a token of research to obtain a broad range of views from a varied population appreciation.The first author was the moderator for all the on a topic of their relevance. Standard guidelines were used to interviews. An assistant was included during the interview as a conduct these focus group discussions. 11, 12As the objective was note-taker.A semi-structured interview guide was used to facilitate to gain a collective understanding about assertiveness through discussion. Interview guide was not made available beforehand views of different people, we chose focus group as the method to the participants hence they were not aware of the exact of data collection. It is often the preferred method when the questions to be asked. The moderator began the discussion with purpose is to get diverse opinions and a breadth of views about an introduction about the concept of assertiveness and some a topic which people can comfortably speak about unlike in- examples for a clear illustration. The participants were then depth interviews which are preferred when the topic is very asked to relate and think of similar situations requiring assertive personal, sensitive or about something that the person may not responses. Further questions about their perceptions about willing to share in a group. 12 benefits of being assertive, difficulties in being assertive and people’s reactions to being assertive were asked. Each interview Thefocus group discussions (FGD) were done as follows: 1) lasted for about forty-five minutes to one hour. The audiotaped Housewives in the age group of 35-50 years, (2) Working women interviews were then transcribed and transliterated into English. in the age group of 25-35 years, (3) Young men in the age group They were further translated to English and taken up for analysis. of 25-35 years working in corporate sector and (4) men in the Thematic analysis methods13 were used to code the interviews. age group of 35-50 years working in public and private sector. Sections of data were coded by using key words and then formed Participant details are as given in Table 1.A total of 24 major categories and themes. An inductive approach to analysis participants were recruited through these four focus group was used throughout the process. interviews. Results: Procedure:The participants were recruited through a key contact personfrom the community where they were staying.Maximum Three key themes emerged from the analysis of the data. variation sampling method was used sothat different socio- Theme 1: Acceptance by others demographic criteria were met. This purposive sampling method ensured that criteria like age, educational status, working status Most of the participants reported that the decision for being
Table 1. Participant details
IJOT : Vol. 48 : No. 118 January 2016 - April 2016 assertive or not depended on how others would react to our “It depends on how committed you are at the job… if you behavior. They saidthat often one may not say anything fearing needed the change to occur… that would decide aggressive- disapproval or strained relations. submissive… now if I’m just not interested in what they are doing or what’s happening around… whether they are right or “They are just not in the frame of mind to listen to anything… wrong… if I just don’t have any interest… what can I say… I so then it happens that we cannot say anything… If the person don’t care about what is happening” is going to speak rudely or offensively, then we keep quiet” [Transcript 4] “We keep thinking… what will he feel… what will the other person feel… or what will people think… and then some things It was pointed out that if we have to gain something, then we are left unsaid or we are unable to say them out…” are more likely to be assertive. [Transcript 3] “When it comes to you, you… when it… when the things are going to affect you and some things move you… at that time Some others pointed out that it matters, who the person at the you have to be assertive”[Transcript 4] other end is. They claimed that certain relations or people may be easier to be assertive with but some others may not. They reported that one may need to be mindful of the consequences before considering being assertive with others “Now if I have to say [something] to my daughter’s mother-in- especially at workplace. law, then I would think ten times and wait even now… that how will she take it… that how would she react and how will “Say, if it’s my appraisal… and if I said all the true things… or it affect my daughter… thinking all this, then I back off” if someone said and then the ego [of the boss] may get offended and what will they do… they will score something or they may [Transcript 3] give you a transfer to some faraway place… I mean these things… Even at workplace, it was reported that the environment and or many things… they have to be seen through the perspective relations between people influenced the likelihood of being of profit and loss…” assertive. [Transcript 5] “It depends on the person before you… how has your relation been with him… with the seniors… if you have had good Discussion: relations, then you can be directly assertive with him… like’ The purpose of the study was to explore and understand the Sir, this is not working out… this is just not going to happen… views of individualsabout assertiveness in an Indian context. It then why should I do it?” appeared that the choice of being assertive was influenced by a [Transcript 4] number of factors; one of the most important factors being, ‘how it would be perceived by others’. Most of the participants Theme 2: Positive emotions as an outcome reported that it mattered how views were put across in any Participants believed that if one is able to be assertive, one may situation and how the other person reacted. They believed that feel happy about it. As one participant said, if the other person would not be receptive to your opinions, it would be better to be quiet or not voice out your views and “You will have a satisfaction that at least I… I expressed my opinions. In order to maintain relationships within the family, views…”, “If not all… at least some things will go my way” in social circles with friends, often they would prefer to be “There is a positiveness… and again… if there is a similar situation submissive.The participants acknowledged that inability to again… then I can handle that situation… or I can express my express their feelings could lead to bottled up emotions or sudden views again” outburst of negative emotions someday. [Transcript 4] In addition, it has been found that Indian culture and tradition may expect conforming to elders’ views or the opinions of people Another participant expressed the feeling of freedom after being in authority positions. 7, 8This leads to most people hesitating assertive in relationships. from going against the norm as they do not expect to be “Our conscience remains clear… so you won’t be in any tension… supported or accepted by others. Women in particular felt that you can mingle freely with others… you can talk to them… we it is better to avoid arguments or fights and chose to have peaceful can keep our relationships better… we are straightforward… that relationships even if it required them to be submissive at is the benefit…” times.Implications to occupational therapy practice:Considering [Transcript 5] the beneficial effects and positive emotions resulting from being assertive,occupational therapists may playan important role by Theme 3: Risk-benefit ratio educating people about assertive communication as part of However, most of the participants reported that they would mental health promotion. Helping individuals to be assertive weigh the consequences before being assertive. If a particular in their workplace or family situations has been known to improve 14, 15 issue did not matter to them, they would not bother being marital relationships and relations with colleagues. This may assertive. help occupational therapists enable their clients to achieve a
IJOT : Vol. 48 : No. 119 January 2016 - April 2016 better work-life balance by making assertive occupational they believed that expressing views and emotions assertively choices. had a positive effect. Occupational therapists can contribute to mental health promotion by exploring views and educating Being assertive may influence our decisions regarding people about assertive communication skills and provide occupational engagement and activity choices that we make on training, whenever found necessary to improve their functioning. a regular basis.Eg. Training a housewife in assertiveness may encourage her to keep her health and interests in mind and find References: some time for her leisure and not feel guilty about it. An employee working in an office may be taught to be assertive and refuse 1. Hargie O. Skilled Interpersonal communication: Research, theory and th additional work burden dumped on him by a colleague. Through practice. 5 edition. East Sussex: Routledge Publications; 2011 this, he may be able to achieve better work competence and 2. Rimm DC, Masters JC. Behaviour therapy: techniques and empirical nd minimize his stress. This may aid as a better stress management findings, 2 edition New York: Academic Press; 1979 strategy along with relaxation techniques. 3. Eisler RM, Frederiksen LW. The relationship of cognitive variables to the expression of assertiveness. BehavTher, 1978; Vol 9, 419-427 In addition, it may enhance communication and expressive skills 17 4. Rakos RF. Assertive behaviour: theory, research and training. London: essential for role functioning. Mosey identified assertiveness Rouletdge Publications; 1991 as an important interpersonal skill essential for role performance based on Role Acquisition frame of reference in Occupational 5. Percell LP, Berwick PT, Beigel A. The effects of assertive training on self-concept and anxiety. Arch Gen Psychiatry, 1974; 31 (4); 502-504 Therapy. She recommended assertiveness training to promote efficient life role performance in individuals. It may also 6. Ames DR. Assertiveness expectancies: How hard people push depends on the consequences they predict. J PersSocPsychol, 2008; 95 (6); contribute to improving self-concept and thereby promoting 1541-1557 positive mental health.5 7. Mueen B, Khurshid M. Relationship of depression and assertiveness in Thus assertiveness training for individuals identified with low normal population and depressed individuals. Internet Journal of assertiveness may help in improving coping skills and enable Medical Update, 2006; 1(2); 9-16 them to deal with their interpersonal relations efficiently. 8. Tripathi N. Assertiveness and Personality: Cross-cultural differences in Indian and Serbian male students, Psychol Stud, 2010; 55(4), 330- However, one needs to understand that in order to encourage 338 more people to beassertive in their communication, it would 9. Banerjee RN. Why Kali won’t rage: A critique of Indian feminism. be essential to create a safe environment which would tolerate Gender Forum, 2012; 38 assertive responses. As reflected by the participants in this study, 10. Furnham A. Assertiveness in three cultures: Multidimensionality and being assertive is often misunderstood as being arrogant or selfish, cultural differences. J ClinPsychol, 1979; 35 (3); 522-527 hence discouraging people to be assertive.16Fear of negative 11. Kreuger R. Focus groups: a practical guide for applied research.London: consequences in the form of strained relationships, being Sage Publications; 1988 labelled as a rebel, refused opportunitiesat workplace or going 12. Mack N, Woodsong C, Macqueen KM, Guest G, Namey E. Qualitative out of favour of authority figures have been identified as some Research Methods: A Data Collector’s Field Guide.Family Health of the reasons for not being assertive. Since assertive responses International; 2005 are learned behaviours, it might be necessary to educate society 13. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative at the family and community level to create awareness about Research in Psychology, 2006; 3 (2); 77-101 aspects of assertiveness in our daily interactions. Occupational 14. Abbassi A, Singh RN. Assertiveness in marital relationships among therapists are well placed to involve in community mental health Asian Indians in the United States, The Family Journal, 2006; October, programs and advocate for assertiveness in routine daily 14; 392-399 interactions and their influence on well-being and competence. 15. Lee S, Crockett MS. Effects of assertiveness training on levels of stress and assertiveness experienced by nurses in Taiwan, Republic of China, Conclusion: Issues in mental Health Nursing, 1994; 14; 419-432 Adults from this study believed that being assertive or not, 16. Wilson K, Gallois C. Assertion and its social context. New York: depended on various factors. Traditional Indian views may act Pergamon; 1993 as barriers to being assertive hence individuals may not 17. Mosey AC. Psychosocial components of Occupational Therapy. USA: demonstrate assertive behavior in their various roles. However, Lippincott Williams & Wilkins; 1986
IJOT : Vol. 48 : No. 120 January 2016 - April 2016 The Indian Journal of Occupational Therapy : Vol. 48 : No. 1 (January 2016 - April 2016) Effect of Sensory Integrative Therapy Combined with Neuro- developmental Therapy in Development of Postural Control in Children with Spastic Cerebral Palsy Nitesh Kumar Shrivastav* (MOT)
Key Words: Abstract Occupational Therapy, Purpose- The purpose of this study was to find out the effect of Occupational therapy based on Sensory Integrative Neurodevelopmental Therapy, Therapy combined with Neurodevelopmental Therapy is more effective than occupational therapy based on Sensory Integration Therapy, Neurodevelopmental Therapy alone in development of postural control of children with spastic cerebral palsy postural control, spastic cerebral Methods- Experimental pre & post test control group design was used. 30subjects were equally divided into two groups. palsy, Peabody Developmental All the subjects were recruited from pediatric section, Department of Occupational Therapy, Swami Vivekanand National Motor Scale-2 Institute of Rehabiitation Training and Research. Experimental group received one hour of Occupational Therapy based on combined principles of Sensory Integration and Neuro-developmental Therapy. Children in control group received one hour only Occupational Therapy based Neuro-developmental Therapy. The activities for the therapy for both the groups were given for 5 days in a week for 4 weeks. Gross Motor measurements were recorded for both the groups again using Peabody Developmental motor scale-2 at the end of 4 weeks Results- The results were analysed using paired’ test and independent‘t’ test. The results were statistically significant at the level of p< 0.05 between the groups in gross motor quotient of Peabody Developmental Motor Scale. (P = 0.009) Conclusion- This study shows that the Occupational therapy based on Sensory integration and Neurodevelopmental principles are an effective intervention than NDT alone for development of postural control in children with spastic di- plegic cerebral palsy. Introduction Cerebral palsy (CP) is described a group of permanent disorders of the development of movement and posture, causing activity limitations, which are attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain. The motor disorder of cerebral palsy is often accompanied by disturbances of sensation, perception, cognition, communication and behavior, by epilepsy, and by secondary musculoskeletal problems1, 2. Cp is clinically classified as spastic, athetoid, spastic, and hypotonic 3. * Occupational Therapist, Department of Physical Medicine CP is one of the most common movement disorders in infancy occurring in approximately 3 and Rehabilitation, King George's per 1000 live births in the India 4. Medical University, Lucknow Dysfunctional postural control is one of the key problems in children with cerebral palsy (CP), Institution: which interfere with the activities of daily life 5. Also, the severity of limitation in gross motor Swami Vivekanand National function among children with CP, the most common physical disability, is highly variable 6. Institute of Rehabilitation Training Children with an insult to the cerebral cortex & the pyramidal tract have spasticity. These and Research, Cuttack. children may also exhibit deficit in the ability to filter sensory input, as the pyramidal system Period Of Study : has an impaired role in regulating sensory information, insult to these area results in both October 2007 - May 2008 sensory & motor deficits. The motor deficits are more apparent & as a result are most often addressed in treatment. The sensory processing disorder may, however, impact function as Correspondence : much as the movement deficits. Sensory processing may also be affected by the movement Dr. Nitesh Kumar Shrivastav disorder. These processing disorders are referred to as secondary sensory processing deficits 7. 2/302, Vivek Khand, Gomti Nagar, Lucknow - 226010 One approach in Occupational Therapy is Neurodevelopmental Therapy developed by Berta & Karel Bobath 8. NDT exercise program include facilitation of movement technique & automatic Tel. : 8853263445 postural response & control the abnormal movement patterns. NDT was developed to address E- Mail : these sensorimotor aspects of movement. It is geared towards eliciting a greater variety of [email protected] movement experiences in the child with cerebral palsy, which in turn provide more normal sensory experiences in the child. Paper was presented in OTICON ' 2015 : the 52nd Annual Some studies have shown that the NDT approach is effective in improving measures of motor National Conference of AIOTA at performance in children with CP, especially in gross motor ability, postural control, and stability9, New Delhi in April 2015. 10,11,12,13.
IJOT : Vol. 48 : No. 121 January 2016 - April 2016 Advances in the area of motor learning control have modified The Peabody Developmental Motor Scale (PDMS-2) is a some of the initial assumption of NDT theory 14. Recent finding standardized norm referenced Test, it is widely used assessment suggests that sensory input is important in eliciting postural tool designed to evaluate both gross and fine motor skills in adjustments. children from birth through 71 months of age. It is composed of six subtests that measure interrelated motor abilities that In contrast, other investigators have found that the Sensory develop early in life. Integration Therapy is one of the methods for promoting motor activity skills and improving measures of motor performance in PDMS scoring is based on 3 point scale. The general criteria for children with CP because a child with cerebral palsy may scoring are 2, 1, or 0. experience sensory integration dysfunction as a result of central 2- The Child performs the item according to the criteria specified nervous system damage, or sensory integration dysfunction might for mastery. develop secondary to the limited sensory experiences that these 1- The child’s performance shows a clear resemblance to the 15, 16 children have as a result of their limited motor abilities . item mastery criteria but does not fully meet the criteria. Sensory Integration focuses on the processing & integrating 0. The child cannot or will not attempt the item, or the attempt sensory information & their impact on skill development. While does not show that the skill is emerging. NDT identifies the sensory components of movements but Procedure doesn’t address the impact that abnormal sensory processing has on the development of postural control & movement. SI Selected subjects were divided into two groups. complements NDT by increasing our understanding of sensory Group A (Experimental Group) was allotted 15 children and processing 17. For instance children who don’t process sensory information adequately will not respond as expected to the Group B (Control Group) was also allotted 15 children. therapeutic handling offered by an NDT approach. So, SI is Children of both the groups were assessed by general considered as additional to NDT therapy. occupational therapy evaluation format). In addition, both groups also underwent a baseline assessment by using Peabody The aim of the study is to find out whether Occupational therapy Development Motor Scale (PDMS-2). based on SI Therapy combined with Neurodevelopmental Therapy is more effective than occupational therapy based on Intervention Neurodevelopmental Therapy alone in development of postural The children in Group A received one hour of Occupational control of children with spastic cerebral palsy. Therapy based on combined principles of Sensory Integration Methods : and Neurodevelopmental Therapy. Therapy was individualized for each child’s condition and was dictated by the child’s unique Study Design- The study is experimental pre & post test control clinical needs. Therapy was provided in an individualized group design. treatment room equipped with suspension equipment (i.e., Subjects- platform swing, bolster swing, Rope Ladder), large mobile equipment (i.e., Therapy Ball and Bolsters, Barrel) and tactile A total number of 30 spastic diplegic cerebral palsy subjects exploration materials. The goal of the therapy was to improve were randomly selected for the study. All the subjects were postural control in different developmental position. It was recruited from pediatric section, Department of Occupational addressed through the application of controlled sensory inputs Therapy, SV NIRTAR over a period of 8 months (from October 2007 May 2008). through facilitation of movement components, and through manipulation of the environment, so the individual was required Inclusion criteria to anticipate need to adjust. • Subjects diagnosed as spastic diplegic cerebral palsy. Treatment activities incorporated sensory and movement • Age range from 1 to 6 years. components, which are given in Appendix. • Both sexes. Each activity was given for 10-15 minutes depending on child’s Exclusion criteria interest, attention and interaction with the environment. Each session started from the weight bearing activity combined with • Any associate problems like mental retardation, congenital sensory inputs and gradually followed by performance of the anomaly, autism, learning disorder, epilepsy. movement within the developmental context. For example a • Undergone any surgical procedure for correction of child who did not achieve independent sitting, the therapy in deformity, soft tissue release etc. following order was provided. Instrumentation • Weight bearing activity in different developmental positions Peabody developmental motor scale (PDMS-2) combined with sensory inputs for 10 to 15 minutes. Weight
IJOT : Vol. 48 : No. 122 January 2016 - April 2016 bearing on different textured surface. Kidlite barrel.
• Gradually shift the child in sitting position on angulated • The purpose of this activity was to provide increased tactile, platform swing for 10 minutes. The purposes of this activity proprioceptive, and vestibular input, provide opportunity were to process vestibular input and adjust body position for initiation of weight shifting to move barrel, allow for in response provided from the platform swing, encourage weight bearing and weight shifting in the upper and lower the child to laterally right the head and trunk against gravity extremities’, and also improves postural reactions and by stopping the platform swing at an angle, process adjustments in response to moving in the barrel. The proprioceptive input appropriately in order to correct posture duration of this activity is 10-15 minute and finally shifted in response to the position of platform swing and improve the child on therapy ball or bolster. postural control in sitting position. During this activity child can also throw objects into a container with one hand while holding on the rope of the swing that is more challenging. When the child puts 10 balls into a container then the child was shifted to next activity i.e. target shooting.
• The child sits on a ball with hips, knees, and ankles at 90º and both feet touching the floor and then placed stickers on the sole when the child closed the eye. And then asked child to remove the stickers. The purpose of this activity to enhance tactile localization of input, increased proprioceptive feedback from the movement p e r f o r m e d , i m p r o v e • Supine position inverted over the therapy ball and rotates p o s t u r a l the trunk to pick up a ball on a bench. Target was set up on adjustments and the other side of the child. While supine, the child should movement and rotate the trunk to shoot at the target with the arm that is e n c o u r a g e farthest from the target. The purpose of this activity was to motor planning. increase vestibular, tactile, and proprioceptive input from After that the the activity and feedback from the movement experience session was and use active trunk rotation with flexion and activation of terminated for abdominal muscles. When the child completed this activity that day. then the child was shifted to next activity that is rolling in
IJOT : Vol. 48 : No. 123 January 2016 - April 2016 Children in Group B received one hour only Occupational value is 0.001 in experimental group and 0.006 in control group, Therapy based Neurodevelopmental Therapy. In this group also which is less than acceptable significance of 0.05. the therapy was individualized and depended on child’s unique Graph-1 clinical needs. The activity was based on Neurodevelopmental principles and designed to improve the postural control. Intervention session started with weight bearing activity for inhibition. During intervention session the infants were handled to facilitate movement and active postures in the different developmental position. Treatment activity based on Neurodevelopmental Treatment is given in Appendix. The activities for the therapy for both the groups were given for 5 days in a week for 4 weeks. Gross Motor measurements were recorded for both the groups again using MAS and PDMS-2 at the end of 4 weeks. Data Analysis The Graph-1 shows that there is significant difference between The test parameters were compared before and after therapy. experimental and control group at Pre and Post therapy in Gross Statistical calculations were performed with statistical package motor quotient of PDMS-2. for social science (SPSS version 11). Statistical tests were carried In the experimental group the mean difference in gross Motor with the level of significance set at Pd”0.05. quotient of PDMS-2 is comparatively higher than the control The raw scores of stationary, locomotion and object group. manipulation were summed up and converted into gross motor Table- III Independent ‘t’ test results between the group. quotient by using the converting tables provided in the PDMS- 2 manual. The design of this study is experimental Pre test Post test control group design. So, in parametric test, paired ’t’ test were used to *Significance at p< 0.05 analyze the changes within the group, and Independent ‘t’ test was used to analyze the changes in Gross Motor Changes of Table–III shows the comparison between the groups in gross PDMS-2 between the experimental and control group. motor quotient of Peabody Developmental Motor Scale (PDMS- 2). P value is 0.009, which is less than acceptable significance Results of 0.05. Table- I Descriptive characteristics Table-IV paired ‘t’ test within the group
*Significance at p< 0.05 Table–IV shows the comparison with in the groups who had sitting balance in gross motor quotient of Peabody Developmental Motor Scale (PDMS-2). P values are 0.40 and 0.91 which is non significant. Table-1 Shows the description of both the groups. Graph-2 Table-II: paired‘t’ test results within the group
*Significance at p< 0.05 Table–II shows the comparison with in the groups in gross motor quotient of Peabody Developmental Motor Scale (PDMS-2). P
IJOT : Vol. 48 : No. 124 January 2016 - April 2016 The Graph-2 shows the mean differences in GMQ of PDMS-2 basic principles like addressing a central nervous system between experimental and control group, who had sitting dysfunction and offering neurological explanation, addressing balance at Pre and Post therapy in Gross motor quotient of automatic basis for movement, utilizing motor control and motor PDMS-2. learning theories to describe the treatment process and producing the Adaptive response in treatment. It can be said that NDT Table-V paired‘t’ test result within the group. addresses lower level adaptive responses, such as postural adjustments and SI addresses adaptive responses at lower and higher level. According to the Bobaths’ 8, the motor problems of CP arise fundamentally from CNS dysfunction, which interferes with the development of normal postural control against gravity and *Significance at p< 0.05 impedes normal motor development; the goal was the establishment of normal motor development and function. Table–V shows the comparison within the groups who had not Neurodevelopmental approach focused on sensorimotor achieved sitting balancein gross motor quotient of Peabody components of muscle tone, reflexes and abnormal movement Developmental Motor Scale (PDMS-2). P values are 0.19 and patterns, postural control, sensation, perception and memory. 0.40. Which is non significant. Handling techniques that controlled various sensory stimuli were The mean has increased more in experimental group than control used to inhibit spasticity, abnormal reflexes, and abnormal group, as it is shown in Graph-3 movement patterns, and were also used to facilitate normal muscle tone, equilibrium responses, and movement patterns. Graph-3 The child was a relatively passive recipient of NDT treatment. The normal developmental sequence was advocated as a framework of treatment. As the Bobaths’ gained experience through the years and as additional knowledge of neuroscience became available, they began to appreciate that it is necessary for children to, increasingly and systematically, take control of their own movement, especially of balance. Finally the Bobath discussed their realization that their treatment had not automatically carried over into activities of daily life. Consequently systemic preparation for specific functional tasks was instituted with an aim of treating the children in actual setting. SI originally was designed to treat children with learning disorder The Graph-3 shows the mean differences in GMQ of PDMS-2 and sensory integrative dysfunction. It was Ayres, who developed between experimental and control group who did not achieve the theory of sensory integration and defined sensory integration sitting balance at Pre and Post therapy in Gross motor quotient as “the neurological process that organizes sensation from one’s of PDMS-2. own body and from the environment and makes it possible to use the body effectively within the environment20. Ayres Discussion hypothesized that sensory integrative dysfunction was related The purpose of the study was to determine if SI based to central processing of the sensation; the theory is not intended Occupational Therapy administered along with occupational to explain the neuromotor deficits associated with such problems therapy based Neurodevelopmental Therapy on spastic diplegic as cerebral palsy, Downs syndrome or cerebrovascular accident. cerebral palsy would exhibit greater improvement in posture Although Ayres clearly articulated the boundaries of sensory development than those who received the activity based NDT integration theory, many researchers and theorists seem to have alone. Although the combined effect of NDT and SI has been exceeded those boundaries 21,22. She seemed to imply that some reported to benefit in children with Down syndrome and Autism of the sensoromotor deficits seen in the children with known 18, there is no such study in CP. Only few case studies are CNS dysfunction reflected poor sensory integration. Intervention available which show that combined NDT and SI can be of SI is mainly child- directed which means that the child needs beneficial for children with CP19. The result of the independent‘t’ to act on his or her environment to produce the adaptive test shows a significant improvement in the Gross Motor responses. A summary of characteristics of sensory integration Quotient of the Peabody Development Motor Scale (PDMS-2) treatment was developed by Kimball 23 and elaborated over time in the experimental group than the control group following a 4 by Bundy 24 included the following characteristics: active week intervention. The intervention program used for this study participation by the individual being treated , client directed was based on both the NDT principles and SI principles. activity, treatment that is individualized, activities that are Although NDT and SI evolved from different disciplines and purposeful and require an adaptive response, an emphasis on with different research traditions, they share the some common sensory stimulation, treatment based on improving underlying
IJOT : Vol. 48 : No. 125 January 2016 - April 2016 neurological processing and organization and treatment provided found by, where the changes were achieved in total scores of by a therapist trend in sensory integration. gross motor function and not in the entire goals30,31. The higher improvement in the experiment group than the control Conclusion group in spite of same duration of treatment for both groups could be because of the adequate amount of tactile, Children with cerebral palsy exhibit deficits in most area of proprioceptive and vestibular input that improved the sensory development, including motor, cognition, language, attention processing deficits which occurred as a result of movement and sensory processing. These sensory processing deficits may limitation. The children with spastic cerebral palsy have be primary or secondary. Secondary sensory processing deficits increased muscle tone, abnormal weight bearing pattern and occur as a result of movement limitation that affects the function movement limitations which influence the proprioceptive of the child. So, it is important that when identifying the problem kinesthetic feedback, vestibular and tactile input. SI therapy area of cerebral palsy, both the movement and sensory processing enhances the tactile, proprioceptive and vestibular experiences aspects must be considered. The significant improvement in of the child and NDT assists the child in the development of Gross Motor scores in experimental group can be considered as new movement pattern and proper positioning that would further significant improvement in postural control. improve the proprioceptive kinesthetic feedback. Therefore it is considered that the Occupational therapy based The result of this study is also supported by a pilot study done on SI and NDT principles are an effective intervention than by Shamsoddin Alireza and Allen, S & Donald, M. 25,26 to NDT alone for development of Postural control in children with consider the effect of occupational therapy on the motor spastic diplegic cerebral palsy. proficiency of children with motor/learning difficulties. Small sample size, short duration of the study, lack of Intervention was based on Ayres’ model of sensory integration, standardized scale for measuring sensory processing problems and the result showed the improvement in motor proficiency. and postural control are few limitations of this study. The result of this study also supports the study done by Ottenbacher et al, where clinically applied program of vestibular Acknowledgements stimulation made significant gains on the gross motor, fine motor, and reflex development in severely and profoundly I wish to express my sincere thanks & deepest gratitude to my retarded, non-ambulatory, developmentally delayed children27. respected teacher Mr. S.P. Mokashi, Associate professor & Head, Department of Occupational Therapy, SVNIRTAR for his kind The paired‘t’ test shows also significant improvement in gross guidance, valuable advice and help during the course of my motor quotient in control group (p=0.006). The development study. I would also like to thank my patients and their parents of postural control traditionally has been associated with a for trusting me, and their cooperation during the course of study. predictable sequence of Motor behavior referred to as Motor Milestones. These include crawling, sitting, creeping, pull to References stand, independent stance and walking. PDMS-2 evaluates the 1. Osenbaum P, Paneth N, Leviton A, Goldstein M, Bax M: A report: the performance of an infant or a child on functional skills that definition and classification of cerebral palsy April 2006. Developmental require postural control. High scores on the GMQ of PDMS-2 Medical Child Neurology 2006, 49:8-14. are made by children with well developed gross motor abilities 2. Heidi A, Ilona, Jutta S, Marjukka , Antti M. Effectiveness of physical and will have average movement and balance skills. Low scores therapy interventions for children with cerebral palsy: A systematic are made by those who have weak movement and balance. Early review. Biomedical Central Pediatrics 2008; 8(14):1-10. child development is characterized by the emergence of a series 3. Kuben KCK, Leviton A. Cerebral palsy. The New England Journal of of milestones (rolling, crawling, creeping, and walking). These Medicine 1994; 330(3): 188-95. gross motor skills occur in a typical sequence. However, these 4. Apexa G. Vyas, Virendra Kumar Kori, S. Rajagopala,and Kalpana S. skills can only occur as the infant develops the balance, PatelAyu. 2013 Jan-Mar; 34(1): 56–62. coordination and postural control needed to move his body 5. Van der Heide., J.C., Begeer, C., Fock, A., Otten, B., Stremmelaar,E.F., 28 about in space .The development of postural control is Van Eykern, L.A., Hadders-Algra, M., (2004), Postural control during postulated to be the foundation of normal gross motor activities. reaching in preterm children with cerebral palsy. Development Thus postural development and motor development are Medicine & Child Neurology, 46, 253-66. inextricably linked 29. So, it is assumed that the change in Gross 6. Hutton JL, Cooke T, Pharoah PO. Life expectancy in children with Motor Quotient reflect the change in postural control of the cerebral palsy. British Medical Journal 1994; 13: 430-435. child. 7. Moore j (1984). The neuroanatomy and pathology of cerebral palsy. In selected proceedings from Barbro Salek Memorial Symposium. Children in both group in spite of their sitting ability improved Neurodevelopmental Treatment Association Newsletter, May 1984. after the therapy as shown by Paired‘t’ test, this could be because 8. Bobath. K & B. Bobath (1984). The Neuro-development treatment. In the therapy was concentrated on specific goal based on management of the motor disorders of children with cerebral palsy, developmental stage of the child. No significant difference was edited by D. Scutton, 6-18, London; Spastic international medical found between the children in sitting group and the children in publication. the non sitting group as shown by Inpendent‘t’ test. This finding 9. Campbell SK. Efficacy of physical therapy in improving postural control may have been due to a small simple size. Similar result was in children with cerebral palsy. Pediatr Phys Ther 1990; 2: 135–140.
IJOT : Vol. 48 : No. 126 January 2016 - April 2016 10. Barry MJ. Physical therapy interventions for patients with movement 26. Allen, S. & Donald, M. (1995). The effect of occupational therapy on disorders due to cerebral palsy. J Child Neurol 1996; 11: 51–60. the motor proficiency of children with motor/learning difficulties: a pilot study. The British Journal of Occupational Therapy, 58, 385-391. 11. Ketelaar M, Vermeer A, ’t Hart H, van Petegem-van Beek E, Helders PJM. Effects of a functional therapy program on motor abilities of 27. Ottenbacher, K, Short, MA & Watson, PJ. (1981). The effects of a children with cerebral palsy. Phys Ther 2001; 81: 1534–1545. clinically applied program of vestibular stimulation on the neuromotor performance of children with severe developmental disability. Physical 12. Nikos T, Christina E, George G, Charalambos T. Effect of intensive & Occupational Therapy in Pediatrics, 1(3), 1-11. neurodevelopmental treatment in gross motor function of children with cerebral palsy. Developmental Medicine & Child Neurology 2004, 28. Shumway-Cook, A. & Woollacott, M.H. (1985). The growth of stability: 46: 740–745. Postural control from a developmental perspective. Journal of Motor Behavior, 17, 131-147. 13. Anttila H, Suoranta J, Malmivaara A, Ma¨ kela¨ M, Autti- Ra¨mo¨ I: Effectiveness of physiotherapy and conductive education interventions 29. Nicholas D.S. (2001). Development of Postural Control, Jane Case- in children with cerebral palsy: a focused review. Am J Phys Med Smith (2001) Occupational Therapy for Children. (4th edition), Rehabil 2008; 87: 478- 501. Philadelphia, Mosby. 14. Bly, L. (1991). A historical and current view of the basis of NDT, 30. Casady R.L., & Nichols-Larsen D.S. (2004). The effect of Hippotherapy Pediatric Physical Therapy; 3:131-135. on ten children with cerebral palsy. Pediatric Physical Therapy, 16, 165-172. 15. Bumin G, Kavihan H. Effectiveness of two different sensory-integration programmes for children with spastic diplegia cerebral palsy. Disabil 31. Knox V., Evans A.L. (2002), Evaluation of the functional effects of a Rehabil 2001; 23(9): 394-9. course of Bobath therapy in children with cerebral palsy: a prelimi9nary study. Developmental Medicine and Child Neurology, 44, 447-460. 16. Roseann CS, Lucy JM. Occupational therapy using a sensory integrative approach for children developmental disabilities. Mental retardation APPENDIX and developmental disabilities reviews, 2005; 11:143-148. TREATMENT PROTOCOL 17. Montgomery, P. and J. Gauger (1991). Introduction to the Underlying Theoretical Concepts of Neuro-Developmental Treatment and Sensory INTERVENTION FOR GROUP A Integration, Blanche Erna I., Botticelli T. M., & Hallway Mary K., (BASED ON COMBINED PRINCIPLES OF SI AND NDT) Combining Neuro- Developmental Treatment and Sensory Integration • Rolling in the Kidlite Barrel. Principles; An Approach to Pediatric Therapy, Therapy skill builders. • Target Shooting when child lie on therapy ball. 18. Uyanik M., Bumin G.,& Kayihan H. (2003). Comparison of different • Sitting on the therapy ball and ask to child to report where therapy approaches in children with Down syndrome. Pediatrics body parts are in relation to each other, to space and objects. International, 45(1), 68-73. • Prone on asymmetrical platform swing. 19. Bundy A.C., Lane S.J., Murray E.A. (1991). Sensory Integration Theory • Wheelbarrow Bowling and Practice (2nd edition). Philadelphia: F.A. Davis • Stickers on the feet and ask child to remove it when the child 20. Ayres, A.J. (1972a). Sensory Integration: A. Jean Ayres’ Theory Revisited, was seated on the ball. Bundy A.C., Lane S.J., Murray E.A., (Second Edition), Sensory • Swinging while holding on to a trapeze from one hand and Integration Theory and Practice, Philadelphia, F.A.Davis. throws ball into a container from the other hand. 21. Robichaud, L., Hebert, R., & Desrosiers, J. (1994). Efficacy of sensory • Standing on the angulated swing. integration program on behaviours of inpatients with dementia. American Journal of Occupational Therapy, 48, 355-360. • Tug of war • Pushing over a vertically placed bolster from a variety of 22. Soper, G., & Thorley, C.R. (1996). Effectiveness of an occupational positions, such as sitting, half kneeling, or standing. therapy programme based on sensory integration theory for adults with severe learning disabilities. British Journal of Occupational INTERVENTION FOR GROUP B Therapy, 59, 476-483. (ACTIVITIES BASED ON PRINCIPLES OF NDT) • Positioning activity on positional equipment like bolster, CP 23. Kimball, J.G. (1988). The issue is integration not sensory. American Journal of Mental Retardation, 92, 435-437. chair. • Weight bearing activity in different developmental position. 24. Bundy A.C., & Murray, E.A. (2002). Sensory integration: A. Jean Ayres’ • Weight shifting activity. theory revisited. Bundy A.C., Lane S.J., Murray E.A., Sensory integration theory and practice, Philadelphia, F.A. Davis • Facilitation activity of head and trunk in sitting. • Rolling and Belly Crawling 25. Shamsoddin Alireza (2010). Comparison between the effect of Neurodevelopmental Treatment and Sensory Integration Therapy on • Trunk rotation activity gross motor function in children with cerebral plasy. Iran J Child • Crawling Neurology Vol4 ,31-38.
IJOT : Vol. 48 : No. 127 January 2016 - April 2016 E-Copy of IJOT
Complaints if any received for non-receipt of the Journal are well taken care of by Editorial Office. However to avoid such complaints caused due to postal and/or other errors, AIOTA has made provision for sending IJOT in form of Prof. Meera M. Shahani e-copy by internet to members. Members may also (1930-2015) now download the recently published issue by log A condolence meeting was organized by Dr. Jaya Kale, Prof. & Head of in to AIOTA website www.aiota.org / membership Occupational; Therapy School & Center, KEM Hospital, Seth G.S. Medical College, Mumbai on Jan. 14,2015 and resolved for the peaceful directory rest of the soul of Prof. Meera Manik Shahani, died on 26th December 2015 at Chennai. Condolence Message from President AIOTA was read in the staid memory of the departed soul. Those interesed may submit request with scan copy of AIOTA Membership Certificate and e-mail Message of Condolence from President AIOTA address for receiving soft copy of IJOT.
I also take this opportunity to join you today at Occupational Dr. Nitesh Shrivastav Therapy Education Center, K.E.M. Hospital Mumbai, to Asstt. Editor (Subscription / Circulation) mourn the passing of Prof. MeeraManikShahani and unite in Tel. : 08853263445 honoring her exemplary life. There’s no word that can express E-mail : [email protected] how sorry we are to hear about the irreparable loss. I fully appreciate the fact that Mrs. Shahani’s leadership, pursuit of academic excellence and professionalism will inspire us all to work with more hard work and dedication for growth of the profession in the country. Mrs. Shahani proved her academic excellence while working as Prof. & Head of the pioneer OT School at KEM, Mumbai during 1957-1989. She also rendered her selfless services as Dean of Change of Contact Details Academic Council of OT of AIOTA during 1987-1991. She represented India in WFOT Council Meeting in 1979 in Members of AIOTA are requested to visit the Germany. The honorable legacy that Mrs. Shahani leaves Membership Directory on AIOTA website : behind offers both the inspiration and challenge to anyone, who aspires to emulate this great lady. She was a sweet and www.aiota.org to verify their contact details as on inspiring soul with a motherly figure for the students. We the records of AIOTA. all will miss that smile very much, and are deeply saddened by losing her from our lives. My thoughts and prayers are Any discrepency found and /or request for change with you all and the entire Shahani family. in address should be reported to Website Convenor AIOTA honored Mrs. Shahani with Stalwart Award during for updating the Membership Directory, to ensure in 1998 and now as a token of our love and regard to her and receiving AIOTA publications and information. in recognition of her lifelong dedication with which she nourished the profession of Occupational Therapy, I inform you all that AIOTA will be honoring her with its prestigious Dr. Joseph Sunny ‘Life Time Achievement Award’ during OTICON’2016 ie Website Convener the 53rd Annual National Conference of AIOTA at Chennai 32/1393, Pipeline Road, Palarivattom P.O., on Jan. 30 2016. (Near Mediscan) Cochin - 682 025 On behalf of Members and Executives of AIOTA, I offer our Tel.: 9600005002, 9746302444 condolences to the bereaved family. May Mrs. Shahani rest Email: [email protected] in peace. Jan 12, 2016 Dr. Anil K. Srivastava
IJOT : Vol. 48 : No. 128 January 2016 - April 2016 The Indian Journal of Occupational Therapy : Vol. 48 : No. 1 (January 2016 - April 2016)
An informative article The Rights of Persons with Disabilities Bill 2014 : Practice Opportunities for Occupational Therapists in India Karthik Mani* (MSc, OTD, OTR/L)
Key Words: Abstract Transition Assessment, Vocational Legislation and geopolitical context influence health care practice. Legislation to empower persons with physical and Skills, Adolescents, Low mental disabilities has great implications for the occupational therapy profession. This article explores provisions under Functioning Autism “The Rights of Persons with Disabilities (RPWD) Bill, 2014”to identify potential practice opportunities for occupational therapists in India. Manyservices listed under the RPWD Bill fall within the scope of occupational therapy practice. Occupational therapists must contribute their expertise to help the governmentfulfill the educational and employment provisions listed under the RPWD Bill. Occupational therapists should advocate and lend their expertise for barrier-free environmentsfor persons with disabilities in India. Occupational therapists can promote the visibility of the profession and extend the reach of their services by aligning their service provision with schemes and services established by the government. Occupational therapists collaboration with organizations that work for the cause of disability is recommended. Introduction India enacted its landmark legislation on disability titled Persons with Disabilities (PWD) Act in 1995.1This legislation is considered the first of its kind to enable the lives of PWD in India. Despite being criticized for lack of clarity in its provisions and medical oriented definition of disability, 2the PWD Act has been in effect till date. In 2007, India ratified the United Nations Convention on Rights of Person with Disabilities (UNCRPD).3In conformity, the Government of India (GOI) constituted a committee to draft new legislation replacing the PWD Act of 1995 in 2010.4After extensive consultations with various stakeholders, the committee submitted its report5 along with a draft bill titled “The Rights of Persons with Disabilities” (RPWD).4 The RPWD bill was introduced in the Indian parliament in February 2014 and subsequently referred to the Standing Committee (SC) in September 2014. The committee submitted its report in May 2015.8 The bill is yet to be passed as an act in the parliament. Legislation and geopolitical context influence healthcare practice. As occupational therapy (OT) practitioners enable PWD to engage in activities of their need or choice, legislation concerned with disability is imperative to occupational therapy practitioners. It is essential for occupational therapists (OTs) to familiarize themselves with disability related legislation as it present both opportunities and challenges to OT practice.The purpose of this article is to explore the provisions of the RPWD bill and identify practice opportunities for OTs. The latest draft of the bill available on the PRS legislative website has been used for the purpose of this article.9 RPWD Bill 2014 in respect to OT Practice Opportunities * Asst. Director, External & Regulatory Affairs The bill, as drafted, aims to prevent discrimination against PWD by ensuring their civil rights. NBCOT Inc., Gaithersburg, This bill could be considered analogous to the American with Disabilities Act of 1990 enacted MD 20877 USA. in the United States as both “provides comprehensive civil rights protection in the areas of employment, public accommodations, transportation, and government services…to enforce Correspondence : these rights”.10 This bill creates several potential avenues for OT practice. Dr. Karthik Mani 339 W Side Dr Rights and Entitlements of Persons with Disabilities Gaithersburg, MD 20878 Chapter II of the bill discusses the rights and entitlements of PWD. Clause 3 (2) requires the USA. government to take steps to utilize the capacity of PWD by providing an appropriate environment. Tel. : +1 301 250 6864 As per 2011 census, more than 26 million peoplehave some form of disability.11To assist the government in transitioning this massive manpower into economic productivity, OTs can identify E- Mail : [email protected] suitable jobs for PWD. Occupational therapists role in vocational rehabilitation (VR) has been
IJOT : Vol. 48 : No. 129 January 2016 - April 2016 affirmed in the literature.12In this arena, some potential OT enabling personal and community mobility of PWD. services include job and job-site analysis, functional capacity Occupational therapists shall participate in this commission as evaluations (FCE), andmodifications to job tasks or environmentto a volunteer or submit their views to the commission to help promote employee-job fit. create accessibility standards.Clause 40 (1) requires that the government ensure access to public places and transportation Reporting Abuse, Exploitation, and Violence for PWD. Clause 44 (1) mandates the government to ensure Clause 6 (2) requires any person or organization to report an act that all existing public buildings are made accessible to PWD of abuse, exploitation, or violence committed against PWD to adhering to the standards to be set by the NC within five years the local Executive Magistrate. Chapter XVI of the bill discusses from the date of publication of regulations. Occupational the penalties for offences related to fraudulently availing or therapists can act as consultants to help authorities ensure that misusing the benefits under this bill.As OTs work closely with public buildings adhere to the regulations of the NC. PWD in their practice, the probability of witnessing such acts Educational Provisions for Persons with Disabilities are high. When an abuse or offense is witnessed or suspected, OTs should report such incidents to the appropriate authorityin Chapter III of the bill discusses the educational provisions a timely manner and hence must familiarize themselves with underPWD. Clause 15 (i) demands the GFEI to provide the administrative structure of the Indian judiciary system. educational, sports, and recreational opportunities for PWD. With their extensive knowledge on pediatric rehabilitation, OTs Voting Rights of Persons with Disabilities caneducate school teachers modify educational strategies and Clause 10 demands the national and state election commissions environments to successfully integrate children with disabilities (EC) to ensure that all polling stations and materials related to in classroom environments.17 the election process are accessible to PWD to execute their Provisions for Children with Learning and Communication voting rights. Kothari stated that the majority of voting sites in Disabilities Bengaluru were not accessible to voters with physical and locomotor disability in 2014 Lok Sabha elections.13Through their Clause 15 (vi) of the draft requires GFEI to identify children state associations, OTs can volunteer to help state EC design with specific learning disabilities (SLD) and to take relevant accessiblepolling stations. measures to overcome them. Clause 16 (d) suggests that the government train professionals and staff to support inclusive Accessibility to Technology education. School based practice is one of the common areas of Clause 11 (4A) requires the government to ensure that all public practice for OTs in India.18As OTs encounter children with SLD documents are in accessible formats. Clause 41 recommends in their day to day practice, using their knowledge and the government ensure all audio, print, and electronic media experience, they can help school teachersand administrators content is accessible to PWD and electronic gadgets are available identify the symptoms and behaviors suggestive of SLD and in universal design. In this technology era, often, public modify classrooms and educational methods to suit the needs documents are made accessible through websites. Hence, the of children with SLD.19 Clause 16 (f) recommends that the issue of accessible website gains attention. The Ministry of Social government promote the use of appropriate augmentative and Justice and Empowerment awarded National Institute for alternative modes of communication to enable persons with Empowerment of Persons with Multiple Disabilities, Chennai communication or language disabilities to participate in the the best website award for the year2011, 14 which shows that community. Occupational therapists can assist in the process the emphasis on developing more accessible websites is growing of choosing an appropriate assistive and augmentative in India. Occupational therapists knowledge on the impact of communication device and its placement20in collaboration with virtual environment on human occupation combined with their other related service providers such as speech language experience in low vision rehabilitation15enables them to act as pathologists and special educators. consultants to government and private entities to help design Reasonable Accommodations for Education more accessible websites. Clause 15 (iii) of the bill mandates the GFEI to provide reasonable Accessibility to Environment accommodations according to individual requirements. Clause Clause 15 (ii) mandates all government funded educational 16 (g) recommends that the government provide learning institutions (GFEI) to make their buildings, campuses, and other materials and assistive devices, free of charge, to students with facilities accessible to PWD. Clause 24 (1b) mandates that the benchmark disabilities. As fabricating, fitting and training on government create an accessible environment in all government appropriate use of assistive/adaptive devices fall within the realm funded healthcare institutions. Occupational therapists can of OT, 21OTs canidentify cost-effective adaptive devices to assist perform environmental assessment on the GFEI and healthcare the government fulfill this provision. Clause 16 (i) suggests that campusesto recommend suitable modifications.Further, OTs the government make suitable modifications to the curriculum shall advocate for barrier free environments16 in all private health and examination system to meet the needs of students with institutions that serve PWD. disabilities. Occupational therapists utilizing their knowledge on functional strengths and weaknesses of children with Clause 39 mandates that the National Commission (NC) disabilities19 formulate accessibility standards for physical environment can volunteer on committees that decide suitable
IJOT : Vol. 48 : No. 130 January 2016 - April 2016 modifications. For instance, OTs may recommend that the dependence and empowering caregivers, 24they can take part in government/ school administration minimize writing the assessment board to determine the functional needs of the assignments, allow the use of calculators during testing, and applicants and required support. provide extra time during examinations for children with Prevention of Disabilities dyscalculia/dysgraphia. Clause 24 sub-sections 2a, 2c, and 2e recommends the Educational Provisions for Persons with Benchmark Disabilities government to conduct survey and research, perform annual The RPWD bill defines “persons with not less than 40 percent health screening, and disseminate health information of a specified disability” as persons with benchmark disabilities respectively, with the aim of preventing disabilities. Health (PWBD).9Clause 30 (1) entitles children with benchmark and wellness is an emerging area of practice for disabilities between the age of six and 18 years to free education OTs.25Occupational therapists possess research and evidence in a neighborhood school or special school. Clause 31 (1) based practice skills.Occupational therapists have a deeper requires the government and GFEI to reserve a minimum of five understanding of teaching learning process as they use patient percent of all seats for PWBD. Occupational therapists can education as an intervention.21Further, in addition to healers, disseminate these benefits to PWBD and support them by OTs also function as health advocates.26Hence, OTs are in a providing a letter of recommendation with appropriate best position to engage in abovementioned prevention activities. accommodations, when necessary. Occupational therapists can disseminate health information through awareness campaigns and educational materials on Employment Provisions for Persons with Disabilities health, hygiene, and disability prevention. During these Clause 18 mandates that the government formulate schemes campaigns, OTs canhighlight the role of occupation in ensuring and programs to facilitate and support employment of PWD. health and wellness.27 This clause also recommends that the government offer loans to Clause 24 (2f) recommends the government take suitable PWD at concessional rates. Occupational therapists can educate measures during prenatal, perinatal, and postnatal care of a PWD about their eligibility to obtain these loans for vocational mother and child to prevent the incidence of disabilities. training and self-employment purposes. Komblau suggested Occupational therapists can provide stress management OTs work with employers’ human resource professionals to help interventions to reduce labor anxiety to minimize the effect of them recruit PWD by enabling them to use functional job stress on pregnant women.28Occupational therapists can also descriptions during the interview process.10Occupational educate pregnant women on body mechanics and edema therapists may also organize and conduct vocational training management to manage back pain and edema associated with workshops along with a vocational trainer22 to train PWD on a pregnancy. specific job such as operating a photocopy or printing machine. Provisions for Persons with Disabilities throughNon- Employment Reservations for Persons with Benchmark Governmental Organizations Disabilities Clause 26 (2) advocates the government to offer financial Clauses 32 (i) and 33 (1) suggests that the government identify assistance to non-governmental organizations (NGOs) reserved posts and fill five percent of vacancies in its functioning for the cause of PWD. Occupational therapists can establishments withPWBD. Occupational therapists can educate establish NGOs to provide holistic rehabilitation and extend stakeholders about these provisions and assist in the process their services to PWD who belong to middle and lower through FCE and job-analysis. Further, OTs can review and socioeconomic classes, as the primary means of reimbursement recommend listed job postings to help PWD and PWBD identify for health care services in India is out of pocket an employment opportunity. payment.29Occupational therapists can also engage in advocacy Clause 34 suggests the government incentivize employers in activities through their NGOs as clause 26 (3) requires the the private sector to ensure five percent of their workforce is government to consult with NGOs when formulating composed of PWBD. Occupational therapists can advocate for rehabilitation policies. employment reservations for PWBD in the private sector. Clause 27 advises the government initiate research through Further, OTs can work with private employers to help them individuals and institutions on issues including habilitation and identify suitable positions while emphasizing how this will rehabilitation to empower PWD. Occupational therapists can benefit their business and goodwill.23 utilize this provision to engage in research on issues like the Provisions for Persons with Benchmark Disabilities with High impact of architectural barriers on community mobility; suitable Support Needs job opportunities for PWD; effective disability prevention strategies; influence of cultural practices on life of PWD; and Clause 37 (1) under chapter VII provides PWBD with rights to reasonable accommodations in educational and employment request high support if there is a need. When a request is settings for PWD. received, clause 37 (2) mandates that the government forward it to an assessment board to determine the need for high support Clauses 28 and 29 recommends the government take measures and take necessary measures. As OTs are skillful in using to enrich cultural and recreational life of PWD. Occupational rehabilitative and adaptive approaches to minimize functional therapists, on behalf of their organizations, shall organize sports
IJOT : Vol. 48 : No. 131 January 2016 - April 2016 and cultural events to cultivate interest and talent among 10. Komblau B. Position paper: Occupational therapy and the Americans PWD.Clause 36 (c) recommends that the government allot five with disabilities act. The American Jl of OT 1993; 47(12): 1083-1084. percent land on concessional rate if that land is used to 11. Punarbhava. Census of India 2011 data on disability. 2014 [updated accommodate/create employment opportunities for PWBD. 2014 Dec 26]. Available from http://punarbhava.in/ Occupational therapists may use this provision to acquire land index.php?option=com_content&view=article&id=1463&Itemid=758 to establish VR settings. 12. Chappell I, Higham J, McLean AM. An occupational therapy work skills assessment for individuals with head injury. The Canadian Jl of Advisory Board on Disability OT 2003 06; 70(3):163-9. Clauses 59 and 65 mandates the respective governments toform 13. Kothari J. The invisible voter. 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