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CASE REPORT
Play-based occupational therapy intervention on social skills in children with autism spectrum disorder and attention deficit hyperactivity disorder: A case series
Kinkuri Sahib Kaur, Ranjit Pathak
January-March 2019, 51(1):31-36
DOI:10.4103/ijoth.ijoth_5_19  
The profound deficit in social reciprocity skills is the core underlying feature of the autism spectrum disorder. Inattention and impulsivity of attention deficit hyperactivity disorder children interferes with their ability to accurately identify, imitate, and model appropriate social behaviors. Social skill is any skill that facilitates interaction and communication with others, and evidence suggests that they can be acquired with specific training, opportunities, and practices. Literature suggests that in a developmental approach to social skills training, play is used as the primary medium for intervention, especially with younger children. Three children in the age group of 4–5 years were selected for the study. Socialization domain of the Vineland adaptive behavior scales-second edition was used to get the baseline scores. The children participated in the play-based occupational therapy intervention and each session was carried out for 60 min, twice a week. The children were reassessed after 6 months. The scores' data showed an upward trend and the socialization score of child 1, 2, and 3 improved by 11.6%, 14.8%, and 8.3%, respectively.
  4,201 128 -
ORIGINAL ARTICLES
To develop an occupational therapy kit for handwriting skills in children with dysgraphia and study its efficacy: A single-arm interventional study
Monika Verma, Rashida Begum, Richa Kapoor
July-September 2019, 51(3):85-89
DOI:10.4103/ijoth.ijoth_20_18  
Background: Handwriting is a complex perceptual-motor skill dependent on the maturation and integration of a number of cognitive, perceptual, and motor skills. Handwriting develops through instruction and is a complex process of managing written language by coordinating the eyes, arms, hands, pencil grip, letter formation, and body posture. Handwriting Without Tears Methodology™ (HWT) is an established handwriting curriculum created by Jan Olsen and is used by occupational therapy (OT) practitioners in traditional one-on-one service delivery. It is also designed for full classroom implementation and instruction and is used in thousands of Mainstream and Special Schools across the world. Objectives: The objective of the study is to analyze the impact of handwriting intervention with OT Kit (OTK) in treating children with dysgraphia (OTK included HWT products, other multisensory material, and fine-motor activities) and to establish the norms on OTK to enable it to be used by therapists for handwriting intervention in India. Study Design: Single-arm interventional study design was chosen for the research. Methods: In a pre- and post-single-arm interventional study design, 40 children diagnosed as dysgraphia (age group 6–11 years; male:female: 31:9) were recruited from a regular school and OT clinic. The handwriting performance was assessed using HWT Screener™ for 1st, 2nd, 3rd, and 4th Grade from mainstream school and the Print tool®. The intervention using OTK was based on HWT program™, multisensory activities, and fine-motor activities. Results: Boys had difficulty in lowercase formations more than girls, and 9-year olds were found to have maximum difficulties in sequencing and memory components of written production. Variables of memory, placement, letter, and word spacing have shown maximum improvement. Where the primary outcomes are P < 0.05; 95% confidential interval [CI]: −4.15 to −1.61 (memory), −14.58 to −4.91 (letter spacing). Analysis of HWT screener shows memory, placement, orientation, and sentence formation to have maximum improvement in students of Grade 1st to 3rd where P < 0.05; 95% CI: −18.56 to −10.18 (memory) and P < 0.05; 95% CI: −12.49 to − 5.88 (placement). In Grade 4th variables, word and capital cursive have shown better improvement than lowercase cursive P < 0.05; 95% CI: −31.54 to − 11.49 (word cursive). Conclusions: OTK (HWT™ manipulatives, multisensory products, and fine-motor activities) was found to be beneficial in improving the handwriting skills in Indian children with dysgraphia. Significant benefits were seen in boys and younger children, when receiving HWT curriculum instructions.
  3,482 65 -
Effect of hand splinting versus stretching exercises for reducing spasticity and improving hand function in poststroke hemiplegia: A comparative interventional study
Mokhtar Ahmad Khan, Pragyan Singh
October-December 2018, 50(4):125-129
DOI:10.4103/ijoth.ijoth_19_18  
Background: Hand splints are used to prevent muscular hyperactivity in adult poststroke patients. Reflex inhibitory splints may be used as an integrative treatment of poststroke upperlimb spasticity. Hand splints are used by occupational therapists as a method of reducing the increased muscle tone of the upper extremity following stroke. Muscle stretching is becoming a very common practice in the rehabilitative management of spasticity. It includes several types of muscle stretching such as passive stretching, active stretching and prolonged stretching, isotonic stretching, and isokinetic stretching. Objectives: The objective of this study was to study the difference between the effects of splinting and stretching in reducing spasticity and improving hand function in poststroke hemiplegia. Study Design: This was a two-arm comparative interventional study. Methods: A total of 30 poststroke hemiplegic patients fulfilling the inclusion criteria which mainly include patients having tone of the affected upper extremity at wrist and fingers ≥2, according to the Modified Modified Ashworth Scale (MMAS), having score ≥25 on Mini-Mental State Examination and having age between the age group of 35 and 65 years are enrolled for the study. Consecutive sampling was done by putting all odd number patients in the splinting group and all even number patients in the stretching group. Assessment tools and outcome measures were B and C subscales of Fugl-Meyer Assessment of Physical Performance for Upper Extremity and MMAS. The patients of the splinting group were given a resting hand splint to wear for 10–12 h continuously per day for 6 weeks. Stretching exercise using a prolonged slow stretch technique was carried out to patients of the stretching group. Results: The patients of splinting group showed more improvement in spasticity and hand function than stretching group with mean difference of 1, P= 0.695, and 95% confidence interval (CI) = −26.41–−22.39 for wrist flexor spasticity, for finger flexor spasticity mean difference was 4, P= 0.143, and 95% CI = −8.28–−5.42 and for hand function mean difference was 4, P= 0.13, and 95% CI = 14.62–20.47. Conclusion: There was the statistically nonsignificant difference between the efficacy of hand splinting and stretching exercises, in reducing spasticity and improving hand functions in poststroke hemiplegia. However, clinically, hand splinting is more beneficial than stretching exercises for the desired outcomes.
  3,178 48 -
To investigate the relationship between psychological factors and stress in two different developmental stages in adults: A cross sectional study
Sushant Deepak Sarang, Arthi Govardhan Karnam, Rakesh Bharat Shitole
July-September 2019, 51(3):102-106
DOI:10.4103/ijoth.ijoth_8_19  
Background: Stress can cause significant impact on social and occupational participation. This study aimed to investigate association between psychological factors (six factors of psychological well-being [PSW] and self-reported mindfulness) and perceived stress. Further, the study aimed to compare the relationship of psychological factors and stress between Erick Erickson's two adult developmental stages, i.e., intimacy versus isolation (19–40 years) and generativity versus stagnation (40–65 years). Objectives: To measure PSW (six factors), mindfulness, and perceived stress in people from the two developmental stages, to study the correlation between psychological factors (the six factors of PSW and mindfulness) and stress in each group, and to compare the relation between psychological factors and stress in these two developmental stages. Study Design: A cross-sectional study design was chosen for the research. Methods: Males and females belonging to intimacy versus isolation (19–40 years) and generativity versus stagnation (40–65 years) stages of Erick Erikson's classification of development were included in the study. Written informed consent was taken from all the participants. Paper-based version of Perceived Stress Scale (PSS), mindful attention awareness scale (MAAS), and Ryff's PSW scale were administered. The scores obtained on PSS, MAAS, and Ryff's PSW were compared. Results: Individuals belonging to the intimacy vs. isolation stage (19-40 years) and generativity vs. stagnation (40-65 years) stage of development showed a significant correlation between psychological factors and stress, with a significant correlation (P = 0.010, 95% CI: 187.600-169.080) in the intimacy vs. isolation stage and (P = 0.005, 95% CI: 165.004-155.136) in the generativity vs. stagnation stage. Conclusions: Individuals in the generativity versus stagnation (40–65 years) stage are more stressful than those in intimacy versus isolation stage (19–40 years) stage. Thus, practicing mindfulness and being mindful helps us to deal with stress better.
  2,922 11 -
Pretend play as a therapeutic modality to enhance social competence in children with autism spectrum disorder:A quasi-experimental study
N Rhema Anu, S Sugi, K Rajendran
July-September 2019, 51(3):96-101
DOI:10.4103/ijoth.ijoth_11_19  
Background: Social development for a child is the child's ability to approach others, get along with other children and their ability to manage a relationship with other peers. Play as an occupation allows the child to express who they are as a player and to socially interact with others. Such a recognized play for a child to develop important skills is pretend play. Children who do not imitate or initiate play are likely to have difficulty in some area of childhood performance that limits their ability to respond. Objectives: To explore the pretend play behaviors and to improve social competence through pretend play for children with autism spectrum disorder (ASD). Study Design: A prospective, comparative, interventional, quasi-experimental study design was chosen for this research. Methods: The study included 42 children, aged 3–7 years of both genders, diagnosed with ASD, verbalizing a word or two productively for interacting. All the children were assessed using Child-Initiated Pretend Play Assessment and Communication DEALL Developmental Checklist for social skills, who were then grouped into experimental group with Learn to Play program and into control group who were under general play-based social skill training for 80–100 sessions within 6 months of the study period. Results: Nineteen children out of 21 in the experimental group showed the presence of typical indicators of pretend play. There was a significant improvement (P < 0.005, 95% confidence interval [CI]: 0.000–0.069) in pretend play skills and social skills of the children in the experimental group after Learn to Play program. Further, an improvement on the elaborate play and imitative actions of pretend play and social skills of the control group (n = 21) was attained by general play-based social skill training. However, the effect of pretend play in the experimental group (P < 0.005, 95% CI: 0.000–0.133) was more than that in the control group. Conclusion: Learn to Play program to develop and improve pretend play of children with ASD is better than the general play-based social skill training. The study thus concludes that pretend play is an efficacious therapeutic modality to enhance social competence of children with ASD.
  2,832 60 -
Visual-perceptual training for handwriting legibility and speed in children with handwriting difficulties: A single-arm interventional study
Pooja Pankaj Mehta, Hemant Parshuram Nandgaonkar
January-March 2019, 51(1):14-20
DOI:10.4103/ijoth.IJOTH_11_18  
Background: Empirical evidence relating motor-free visual-perception (VP) skills and handwriting (HW) legibility and speed is sparse, despite the theoretical belief that VP is necessary for letter recognition and is an essential component of HW. Therefore, the study was carried out to investigate the effect of VP training on scanning skills, motor-free VP skills, and HW legibility and speed. Objectives: The main objective is to study the effect of VP training on HW legibility and speed; motor-free VP skills and scanning skills. Study Design: This was a single-arm interventional study design was chosen for the research. Methods: Single arm of 10 children of either gender between 6 and 10 years of age, with HW difficulties meeting the inclusion and exclusion criteria, was recruited by convenience sampling. They were assessed pre- and post-training (6th and 12th week) using the letter cancellation test (LCT), Test of VP Skills-3rd Edition (TVPS-3) and Evaluation Tool of Children's Handwriting (ETCH). The intervention included individualized VP training weekly twice along with home program. Results: The mean scores of LCT, TVPS-3, and Evaluation Tool of Children's Handwriting-Manuscript (ETCH-M) of n = 10 were analyzed. Post 12-week intervention, statistically significant improvement were found in mean scores of LCT (P < 0.05, 95% confidence interval [CI] [0.411,0.699]) and on TVPS-3 subtests (P < 0.05, 95% CIs [13.14, 17.46], [11.60, 15.60], [11.46, 14.14], 11.73, 15.87], [11.33, 15.27], [11.66, 15.44] and [11.56, 15.44] sequentially) and on overall mean scores (P < 0.05, 95% CI [12.67, 16.13]). Statistically significant improvements were calculated on ETCH-M subtests- total letter, number, and word legibility scores (P < 0.05, 95% CIs [88.91, 95.69] [100,100] and [79.01, 93.19] respectively); and on near-point copying speed (P < 0.05, 95% CI [35.98, 55.42]) but non-significant improvement was seen on far-point copying speed (FPS) (P = 0.103, 95% CI [23.69, 36.31]). Conclusion: VP training, without HW practice, has an effect in improving scanning skills, motor-free VP skills, and HW legibility and speed (except FPS). Thus, VP training may influence HW legibility and speed.
  2,681 50 -
Occupational therapy workforce in India: A National survey
Karthik Mani, Savitha Sundar
April-June 2019, 51(2):45-51
DOI:10.4103/ijoth.ijoth_1_19  
Background: Workforce data offer critical information to thrust a profession forward. The insights generated through workforce data provide foundations for benchmarking and advocacy initiatives pertaining to a given profession. Periodic salary surveys help professionals monitor trends and gauge the growth of their profession. Objectives: To determine the average compensation of occupational therapy practitioners in India and benchmark the profession's growth against 2015 workforce data. Study Design: The survey research design was used to conduct this study. Methods: The electronic survey used in 2015 salary survey study was modified and sent via e-mail and social media to Indian occupational therapy practitioners identified through convenience and snowball sampling. Data were collected from October 1, 2018, to October 27, 2018. Results: The number of responses received was 191. The average salary range of full-time OT practitioners in India was 35,001–45,000 Indian National Rupee/month. Gender, job title, level of OT education, practice area, years of experience, and geographical region influence the compensation received by OT practitioners in India. The profession has demonstrated a notable growth in multiple fronts. Conclusions: Occupational therapy in India is in growth trajectory. This workforce study points to the continuing demand for occupational therapists in India. Further, in-depth exploration is recommended.
  2,710 20 1
Effect of reactive postural adjustment and anticipatory postural adjustment in improving sitting balance in children with spastic diplegic cerebral palsy
Jaya Dixit, Anurupa Senapati, Animesh Kumar
July-September 2018, 50(3):76-80
DOI:10.4103/0445-7706.244552  
Background: The purpose of this study was to examine the effect of providing activities which give internal and external perturbations on the static and dynamic trunk balancing abilities of children with cerebral palsy and generate some postural response in the trunk of these children with cerebral palsy. Objectives: To find out the effect of activities providing reactive postural adjustments and anticipatory postural adjustments, in improving sitting balance, in children with spastic diplegic cerebral palsy. Study Design: Pre- and posttest study design. Methods: Children with spastic diplegic cerebral palsy who were fulfilling the inclusion criteria were selected by convenient sampling from the department of occupational therapy, with a sample size of 60. Written informed consent was obtained from the guardians. Ethical permission was taken from the institute. Pediatric balance scale and pediatric reach test were used as instruments for measuring improvement in sitting balance. A frame for reaching and a platform for external perturbation were designed for the study. Therapy for both groups was given for 1 h/session. Children in the experimental group were exposed to 15 min each of reactive postural adjustment and anticipatory postural adjustment along with 1 h of conventional occupational therapy, whereas children in the control group were exposed to 1 h of conventional occupational therapy. Results: The results of the Wilcoxon signed-rank test of pediatric reach test were significant for experimental and control groups (P = 0.004; 95% confidence interval [CI]: 5.34–10.67 and P = 0.014; 95% CI: 4.16–7.89, respectively). There was also significance of the results of the Wilcoxon signed-rank test of pediatric balance scale in the experimental and control groups (P = 0.025; 95% CI: 8.98–11.12 for experimental group and P = 0.005; 95% CI: 8.09–9.54 for control group), with the level of significance set at P ≤ 0.05. This shows that the results were significant for experimental group as well as control group. Furthermore, the results of the Mann–Whitney U-test showed that Z = −3.507 for pediatric balance scale is more, making it more sensitive to capture changes in balances in children than that for pediatric reach test with Z = −3.905 (P = 0.002; 95% CI: 4.14–9.00 for pediatric balance scale and P = 0.001; 95% CI: 7.56–9.70 for pediatric reach test), with the level of significance set at P ≤ 0.05. Conclusion: It can be concluded that activities providing reactive postural adjustment and anticipatory postural adjustment can be used to enhance and improve sitting balance among children with spastic diplegic cerebral palsy, so that they can have the functional balance in sitting, to safely meet the demands of everyday life.
  2,467 48 -
REVIEW ARTICLES
Outcome measures used in stroke rehabilitation in India: A scoping review
Karthik Mani, Savitha Sundar
October-December 2018, 50(4):111-118
DOI:10.4103/ijoth.IJOTH_9_18  
Background: Stroke is one of the prevalent noncommunicable diseases in India. In stroke rehabilitation, valid and reliable outcome measurements help in evaluating treatment effectiveness, systematic program evaluation, and justifying reimbursement. Measuring outcomes is construed as a good practice in the field of rehabilitation. Objectives: The purpose of this scoping review was to identify and review the outcome measures used in stroke rehabilitation in India to provide an up-to-date understanding of the nature of outcome measures used, their cultural relevance, linguistic relevance, and validity. Study Design: This is a descriptive scoping review. Methods: The scoping review framework proposed by Arksey and O'Malley in 2005 was used in this review. Following the development of review questions, relevant studies were identified, suitable studies were selected and critically reviewed, and the data were charted, collated, and summarized to generate themes. Results: Thirty-three studies identified 46 outcome measures. Most of the outcome measures used in stroke rehabilitation research in India were ordinal scales and body structure/function assessments. Reliability and validity scores of the identified scales ranged from 0.37–1.00 to 0.65–0.96, respectively. Modified Rankin Scale and Barthel Index were the most used outcome measures. Only two of the identified measures were developed in India. Conclusion: There is a dearth of culturally sensitive stroke-related outcome measures in India in all domains. The authors suggest that researchers in India exert caution when selecting and using outcome measures developed in foreign countries as the review identified only two translated and validated cognitive scales and one performance measure specific to the Indian population.
  2,461 10 -
CASE REPORT
Occupational therapy for knee osteoarthritis: A case study
Karthik Mani
October-December 2019, 51(4):151-154
DOI:10.4103/ijoth.ijoth_34_19  
Osteoarthritis (OA) is a prevalent condition in India. It can cause functional limitations and affect the quality of life (QoL). This case study describes the occupational therapy (OT) services implemented for a female patient diagnosed with bilateral knee OA. The patient described in this case study experienced pain and fatigue. Further, the suboptimal performance in instrumental activities of daily living tasks affected her subjective well-being. The patient was consulted for seven sessions in total, including the follow-up. The treatment techniques used were patient education, home modification, activity modification, and assistive device prescription and training. The patient verbalized improvement during the follow-up visit after 6 months. The improvement was also evident through improved fatigue and QoL scores. The implications of the case for OT practice in India were highlighted.
  2,445 22 -
EDITORIAL
Developing trends in occupational therapy: Global versus Indian perspective
Shashi Oberai, Anil K Srivastava
July-September 2019, 51(3):75-76
DOI:10.4103/ijoth.ijoth_20_19  
  2,456 8 -
ORIGINAL ARTICLES
A study to identify prevalence and effectiveness of sensory integration on toilet skill problems among sensory processing disorder
Nikhila Mary Koshy, S Sugi, K Rajendran
July-September 2018, 50(3):86-91
DOI:10.4103/0445-7706.244548  
Background: Toilet skill problems have been reported among children with sensory processing disorders (SPD) in recent literatures. Pollock concluded that children with dysfunctional elimination syndrome (53%) had SPD than was reported for the general population. Occupational therapists from India experience similar observations in their clinical practice. However, there is limited evidence within the Indian context. Objectives: The objectives of the study are to find the prevalence of problems in toilet skills in children with SPD and the effectiveness of sensory integration therapy (SIT) for the improvement of toilet skills in children with SPD. And also to compare the effectiveness of SIT with behavior modification for developing age-appropriate toileting habits in children with SPD. Study Design: A cross-sectional survey and quasi-experimental pre-posttest design were adopted for the study. Methods: The study consisted of 2 phases. In Phase 1, 96 children with SPD were screened to find out the prevalence of toilet skill problems among them. In Phase 2, the study effectiveness of SIT on toilet skill development was investigated on 22 children. The baseline and posttest measurement were done using sensory profile (SP), Canadian Occupational Performance Measure and modified diet schedule. The control group underwent behavior modification therapy, and experimental group, in addition, underwent SIT for 4 months. Both groups also underwent conventional occupational therapy. Results: This study found out among 96 SPD children, 68.75% had toilet skill problems. There was the difference in sections, factors, and quadrants in SP for children with and without toilet skill problems. In Phase 2, the result shows a significant difference (P < 0.05) for experimental group and had improvement in both sensory problems and toilet skill problems in followed by the SIT when compared to control group. Conclusion: The study concluded that there is association between toilet skill problems and SPD. SI has benefits in toilet skills problems in addition to other known benefits cited in the literature.
  2,311 53 -
Effectiveness of visual schedule in combination with sensory-integration therapy for developing self-care in children with autism
Sailendri Dash, Anurupa Senapati
July-September 2018, 50(3):98-102
DOI:10.4103/0445-7706.244553  
Background: Developmental disorders like autism are heterogeneous and lifelong disorder which will have mild-to-severe limitations for which they rely heavily on others for support in self-care, daily living, employment, relation, and overall independent living. Objectives: The aim of this study is to explore the effect of visual scheduling for developing self-care in children with autism and to incorporate the visual scheduling as a therapeutic intervention in combination with sensory integration therapy (SIT). Study Design: This was pretest–posttest control group design. Methods: Convenient sample of 32 children with autism were screened with childhood autism rating scale (CARS) were allotted to experimental and control group. The pretest score was taken using Wee-FIM, after that, both groups underwent 12 weeks of intervention. Experimental group followed conventional therapy (SIT) along with visual schedule protocol of self-care and control group followed conventional therapy and the culture-based rearing techniques. The potential impact of the program on participation was assessed as post Wee-FIM score. Results: The present study aimed at knowing the effectiveness of the combined approach of visual schedule and SIT for increasing self-care in children with autism. Statistical analysis shows that there is a significant difference between both groups after posttest. Result shows the change in mean score 25.56–40.43. Moreover, the result is highly significant at the level of P = 0.00 (95% confidence interval). Conclusions: This study shows the combined effect of visual schedule and SIT is an effective intervention to improve self-care activities in children with autism.
  2,262 57 -
Effectiveness of cognitive orientation to daily occupational performance to improve shopping skills in children with learning disability
Madhumala Karunakaran, S Sugi, K Rajendran
July-September 2018, 50(3):92-97
DOI:10.4103/0445-7706.244551  
Background: Studies reports that children with learning disability were more dependent in shopping skills than typical children, and studies reports that shopping experience will promote cognitive and social development and understanding the sequences of events involved in shopping is clearly one of the most important aspects of transaction knowledge, there are many approaches to improve shopping skills. Hence, till date, the cognitive orientation to daily occupational performance (COOP) approach is not done in learning disability to improve shopping skills. Objectives: The aim and objectives of this study are to find out the effectiveness of COOP to improve the shopping skills in children with learning disability. Study Design: Two group pre- and post-test quasi-experimental design. Methods: Totally 30 children diagnosed with learning disability based on inclusion and exclusion criteria were included in this study and children were divided into two groups 15 in experimental group and 15 in control group. Assessment tools such as Test of grocery shopping skills (TOGSS), Canadian occupational performance measure (COPM), and Performance quality rating scale (PQRS) were used as outcome measures. Experimental group underwent regular occupational therapy and COOP intervention and control group underwent regular occupational therapy and money handling skills training for 36 sessions within 12 weeks. Scores obtained were subjected to statistical analysis. Results: Statistical analysis using independent t-test of pre- and post-test scores of TOGSS where P = 0.001 (<0.05), COPM and PQRS where P = 0.001 (<0.05) shows significant improvement in shopping skills in learning disability children, Effect size of TOGSS, COPM, and PQRS were greater in the experimental group. Thus, finding of this study indicated that there was a significant improvement in experimental group when compared to control group. Conclusion: COOP approach showed significant improvement in shopping skills for learning disability children and children were satisfied with their performance. Thus, COOP approach is effective in improving shopping skills for learning disability children.
  2,161 54 -
Efficacy of social stories in coping with bullying among children with childhood psychiatry conditions: A randomized controlled interventional study
S Sakthi Srija, S Sugi, D Srinivasan
April-June 2019, 51(2):52-56
DOI:10.4103/ijoth.ijoth_10_19  
Background: In schools, bullying is a regular occurring behavior problem and the most common form of violence. As stated in studies, bullying peaks during middle school years and higher rates of being bullied are reported in children with special educational needs and disabilities. Social story, as a teaching intervention, helps in preparing the children to respond appropriately to a bullying situation and to develop adaptive coping responses. Objectives: The objective of this study is to identify the victims of bullying among childhood psychiatry conditions, to develop coping skills for them, and to determine the effectiveness of social stories. Study Design: A randomized controlled interventional study was chosen for the research. Methods: Children were screened using Illinois Bully Victim Scale, and 22 children, of both genders, aged 8–13 years diagnosed with attention-deficit hyperactive disorder, learning disability, and mild intellectual disability were randomly assigned to two study groups. Coping strategies were taught to the children in the experimental group with the help of social stories, for two target behaviors, and role play at end for 30 min, 3 days a week, for 13 sessions, whereas in the control group, children underwent conventional occupational therapy along with coping strategies and role play for 30 min for 13 sessions. The Canadian Occupational Performance Measure and the Coping with Bullying Scale for Children were administered before and after intervention. Results: Both experimental (n = 12) and control (n = 10) groups equally improved with their respective intervention. However, children achieved clinically significant scores in their mean values (68.42 ± 61.50,P < 0.02, 95% confidence interval [CI]: 0.00–0.12) in the level of performance, suggesting that they used more of adaptive responses in coping with bullying situation. Typically, children in both the groups showed some amount of maladaptive strategies even after their respective interventions (8.03 ± 6.2,P = 0.20, 95% CI: 0.00–0.13), referring that social story was found to have an impact only on adaptive coping responses. This warrants the importance of addressing the awareness of adverse consequences of maladaptive coping through social stories. Conclusion: Social stories were effective in improving coping skills as well as in enabling the strategies application of learned coping skills (performance) during bullying situation.
  2,096 14 -
Understanding parents' difficulties in executing activities of daily living of children with autism spectrum disorder: A qualitative descriptive study
Siddhi Jaikrishna Naik, Pooja Vivek Vajaratkar
July-September 2019, 51(3):107-112
DOI:10.4103/ijoth.ijoth_22_19  
Background: Activities of daily living (ADLs) refer to the ongoing behaviors that occur on a daily basis. Such behaviors include eating, cooking, bathing, social interactions (such as leisure activities, attending school or work, or assisting with chores), and other activities that one might routinely expect an individual to perform or participate in. Some of the major ADL tasks include personal hygiene, toileting, dressing, and eating. Researchers have documented delayed self-care performance in children with autism spectrum disorder (ASD). Parents report their child to have difficulties with feeding and toileting in particular. Objective: This qualitative pilot study endeavored to understand the difficulties faced by the parents of children with ASD in conducting their children's ADL. Study Design: Qualitative descriptive study was chosen for the research. Methods: The qualitative descriptive study included participants (n = 20) whose children were primarily diagnosed as ASD. Convenient sampling method was used for study sample calculation. The study included parents of children of age group between 5 and 9 years (mean ± standard deviation [SD]: 6.9 ± 1.57 months) with intelligence quotient of ≥80%. The study was conducted in a tertiary care hospital. The parents (fathers = 9 and mothers = 11) were given a semistructured questionnaire to understand difficulties faced by the parents of children with ASD (mean ± SD: 5.56 ± 33.6 months). Results: According to the study, it was observed that most of the parents have reported that their child had maximum difficulties in eating, followed by brushing and grooming and least for toileting. This study also found the priority list of difficulties in ADL. It was noted that early and proper training of the child gives good results in managing a child with ASD. Many parents reported that early training is beneficial. Conclusion: The outcome of this study shows the hierarchy of difficulties in ADL reported by the parents of children with ASD. This study also found that early ADL training gives good results in managing child with ASD.
  2,067 31 -
Occupational therapists' perception of efficacy of sensory integration in Tamil Nadu, India: A Statewide Survey
Karthik Mani
January-March 2019, 51(1):8-13
DOI:10.4103/ijoth.IJOTH_10_18  
Background: Perception regarding efficacy of any intervention may influence clinical reasoning and treatment choice. Despite the fact that the current evidence on the effectiveness of sensory integration (SI) interventions is equivocal, practitioners use them widely in practice. This could be due to the perceived effectiveness. Objectives: This study aimed to gain an understanding of Tamil Nadu (TN) occupational therapy (TNOT) practitioners' perception of the efficacy of SI interventions in pediatric practice. Study Design: The survey research design was used to conduct this study. A ten-item electronic survey was developed based on the research question. Methods: The survey was e-mailed to 295 occupational therapists in TN identified through convenience sampling. The survey link was also shared on three WhatsApp Messenger groups (TNAIOTA Official Group, OTist Group, and OT Friends Group) with a large number of TN occupational therapists (snowball sampling). Data were collected between March 30, 2018, and April 30, 2018. Results: Forty-nine occupational therapists responded to the survey. Many respondents believed that SI interventions are effective, citing positive therapeutic outcomes and the child-centric nature of the interventions as the reasons behind their beliefs. Respondents also believed that for SI interventions to be effective, therapists' knowledge and skill on SI are critical. Gender, years of experience, additional training on SI, and level of education did not have any influence on practitioners' perceptions regarding the efficacy of SI. Conclusion: Pediatric OT practitioners in TN have a favorable attitude toward SI interventions and use them in practice. Although practitioners report perceived positive therapeutic outcomes, they need validation through clinical research. TNOT practitioners must collaborate with researchers to add to the scientific evidence base of SI.
  2,023 14 -
THE ALL INDIA OCCUPATIONAL THERAPISTSí ASSOCIATION (AIOTA )
OTICON'2019 Abstracts

April-June 2019, 51(2):58-71
DOI:10.4103/0445-7706.259177  
  2,002 11 -
ORIGINAL ARTICLES
Comparison of efficacy of the Test of Visual Perceptual Skills-3 and the Rivermead Perceptual Assessment Battery with Performance of Indian drivers on driving simulator for determining off-road perceptual skills: A pilot study
Sheetal Shyamsunder Gupta, Anita Dipak Gupta, Sushmita Dinesh Ahirwal
July-September 2019, 51(3):90-95
DOI:10.4103/ijoth.ijoth_15_19  
Background: Driving simulator (DS) is frequently used in traffic research in order to study various traffic scenarios with related traffic phenomena. This current pilot study assesses off-road driving skills of Indian drivers using driving simulator and perceptual test batteries such as the Test of Visual Perceptual Skills-3 (TVPS-3) and the Rivermead Perceptual Assessment Battery (RPAB). Objectives: The objective of this study is to determine the off-road skills of Indian drivers using DS and comparing their performance on visual perceptual test batteries (TVPS-3 and RPAB). Study Design: An observational cross-sectional study design was chosen for the research. Methods: A sample size of 30 participants, based on convenient sampling method, who met the following inclusion criteria were included: participants with driving experience of ≥1 year, age range: 20–60 years, and no obvious visual and/or physical impairment or other such comorbidities. Participants underwent evaluation in two phases. Phase 1 included screening of participants for inclusion criteria and assessment of screened participants on DS. Driving Simulator: Participants were tested on “city driving test” for 10 min. In Phase 2, after completing assessment on driving simulator, participants were randomly assigned to either of the perceptual tests. By perceptual tests, participants' perceptual abilities were assessed either using RPAB or TVPS-3. Results: The RPAB group had 12 males and 3 females, whereas the TVPS-3 group had 11 males and 4 females. The mean age for the RPAB group was 40.33 ± 11.33 and for the TVPS-3 group was 40 ± 11.06. Pearson's correlation to compare the visual perceptual tests and performance on DS was found to be statistically significant (RPAB group: r = 0.80, P = 0.00, 95% confidence interval [CI]: 0.50–0.92 and TVPS-3 group: r = 0.82,P = 0.00, 95% CI: 0.56–0.93). The performance of Indian drivers on perceptual tests and driving simulator is highly correlated. Conclusion: There is a strong positive correlation between off-road driving skills (DS) with visual perceptual skills (tested on TVPS-3 and RPAB).
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A comprehensive study of community-based inclusion, rehabilitation, and multidisciplinary approach toward cross-disabilities in panchayats of North India
Narender Paul, Balbir Guleria, Sanjeev Gupta
July-September 2019, 51(3):77-84
DOI:10.4103/ijoth.ijoth_17_19  
Background: Demonstrated multidisciplinary, scalable, and replicable panchayat models for effective inclusion of persons with disabilities (PwDs) are much needed in a developing country like India, with its 70% of population being rural. Literature on disability suggests a shift in policy thinking from the charity-, medical-, and institutional-based models of disability to social, community-based rehabilitation (CBR), and rights-based models. This study explored in-depth the Community-Based Inclusion and Rehabilitation (CBIR) program model of the Chinmaya Organisation for Rural Development (CORD), a nongovernmental organization working with 1800 PwDs in 100 panchayats of Kangra district of Himachal Pradesh. Objectives: The objectives were to identify PwDs with all types of disabilities in ten selected panchayats associated under the CORD's CBIR program as per the definitions of disabilities under the PWD Act, 1995, and the National Trust Act, 1999, and to explore multidisciplinary, scalable, and replicable aspects and interventions under the CBIR as a model for inclusion of all types of PwDs in rural India with reference to the World Health Organization's (WHO's) CBR matrix. Study Design: This is a descriptive, qualitative, and quantitative study conducted on the CORD's CBIR model with reference to the WHO's CBR matrix. Methods: A convenient sample of ten panchayats out of 100 panchayats under the CORD's CBIR interventions was studied. The principal investigator with a team of two co-researchers and five field facilitators worked as a team to conduct this study. A baseline format with reference to the WHO's CBR matrix was developed and administered for the collection of primary data besides related interviews of PwDs, their families, and related stakeholders. The CORD's CBIR program data, narratives, and focus group discussions were used to supplement the outcomes of this study. Results: This study observed that availability of disabilities specific, disaggregated and recorded government data on PwDs at the panchayat level was poor and non-existent. Primary data of 124 (100%) PwDs among the 4487 households with a total population of 22,438 in ten panchayats were collected and further investigated from April 2017 to March 2018. The findings highlighted 87 (70%) PwDs newly identified during the study, 60 (48%) PwDs below poverty line, and 113 (91%) marginal and socially backward PwDs. The program interventions enrolled 26 (21%) PwDs in schools, 72 (58%) mothers and women with disabilities in community groups, and 44 (35%) PwDs in productive livelihoods locally. Conclusion: There was evident marginalization of PwDs in multiple ways varying from data to dignity issues at the panchayat level. The CORD's CBIR model promotes the “empowering inclusion and development” of PwDs in the mainstream community at the panchayat level. The recent enactment of the comprehensive Rights of Persons with Disabilities Act 2016, covering 21 types of disabilities, further share an opportunity for effective inclusion of PwDs within the existing policies, programs, and development agenda in rural India as well as globally.
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Comparison between myofascial release and myofascial taping as an adjunct to conventional occupational therapy in the management of dequervain's tenosynovitis: A randomized controlled trial
Taslina Abdulkader, Karuna Nadkarni
October-December 2019, 51(4):145-150
DOI:10.4103/ijoth.ijoth_26_19  
Background: De Quervain's tenosynovitis, the most common overuse injury involving the wrist. There is no consensus in the treatment of De Quervain's tenosynovitis; both surgical and conservative medical management have adverse effects. Myofascial release (MFR) and myofascial taping (MFT) are newer techniques which have been proven effective for other inflammatory and noninflammatory musculoskeletal conditions. Hence, the study was planned to determine and compare the effectiveness of the both the above-mentioned adjunct method along with conventional occupational therapy in the treatment of De Quervain's tenosynovitis. Objective: The objective of this study is to compare and study the effectiveness of MFT and MFR as an adjunct to conventional occupational therapy treatment in patients with De Quervain's tenosynovitis. Study Design: A prospective, comparative randomized controlled trial was conducted for 18 months. Methods: A total of 31 patients (both males and females aged 20-40 years) diagnosed with De Quervain's tenosynovitis, referred to outpatient department were randomized into two groups after screening by simple random allocation using computerized generated table, patients in MFT group (n = 16, 11 females and 5 males) received MFT along with conventional treatment and patients in MFR group (n = 15, 9 females and 6 males) received MFR along with conventional treatment. They followed up for treatment for 5 weeks, two times a week with each session lasting for 30-40 min. Pain level and functional improvement were evaluated using Visual Analog Scale (VAS) score and Patient-Specific Functional Scale (PSFS) score, respectively, before therapy and at the end of the 3rd and 5th week of the 5-week therapy program. Results: Both the groups showed significant improvement in pain scores on VAS at the 3rd and 5th weeks (P < 0.05). There was no significant difference in the values between the two groups at 3rd week, but at the end of 5th week, MFT Group showed significant improvement in pain than MFR Group. Both the groups showed significant improvement in functional scores on PSFS at the 3rd and 5th weeks at value ofP < 0.05 with 95% confidence interval. Conclusion: Although both MFT and MFR showed improvement in function and decrease in pain, when compared we could conclude that MFT along with conventional occupational therapy yield significantly better outcome measures in terms of decreasing pain and improving function.
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A trend of cumulative trauma disorders in indian computer users: A comparison of surveys of the year 2009 versus 2019
Pooja Pankaj Mehta, Chandanbala Ojas Maru
April-June 2020, 52(2):50-55
DOI:10.4103/ijoth.ijoth_6_20  
Background: Digitalization has resulted in increased computer use. Computer use involves repetitive movements and relatively static posture of neck, limbs, and trunk, contributing in cumulative trauma disorders (CTDs). Over a decade, ergonomic awareness has increased, but CTDs have prevailed. Objective: A comparison of 2009 versus 2019 surveys was done to understand CTD trends and to find the significance of the number of people affected due to hours per day computer use. Study Design: A comparison of two surveys was conducted to research trend in occurrences of CTDs. Methods: The sampling was done using the snowball method. Both surveys had identical research methodology and collected data of (n) 100 computer users of India with an age range of 20–50 years, i.e., total of N = 200 in combined surveys. Participants filled in the self-explanatory questionnaire on Google Forms that assessed areas of CTD pain, severity of pain, and functional performance during pain. Results: Data analysis showed a higher percentage of pain in the neck, eye strain, and back pain in computer users in both 2009 and 2019 surveys. There was an overall decrease in the percentage of computer users affected with CTDs from 86% to 70%, but anatomically, an increase in percentages of pain in the upper limb, headaches, and lower-back pain was reported in 2019. The relation between duration of computer use and number of computer users affected was found to be nonsignificant for both 2009 and 2019 surveys (χ[2] = 3.5408; P = 1.7027 and χ[2] = 1.3739; P = 0.5031, respectively, 95% confidence interval [CI] [4.605, 7.378]). Spearman's correlation showed no significant correlation between duration of computer use and severity of pain in both 2009 (r = 0.078; P = 0.443, 95% CI [−0.120, 0.270]) and 2019 (r = −0.085; P = 0.398, 95% CI [−0.277, 0.114]). Conclusion: The comparison of 2009 and 2019 surveys showed an overall decrease in the percentage of computer users affected with CTDs in the 2019 survey. An increase in upper-limb pain, headache, and lower-back ache percentages was noted, while upper-back pain, neck pain, and eye strain percentage showed a decreasing trend in the 2019 survey. The percentage of computer users affected with pain in the neck, pain in the back, and eye strain was higher than other CTD areas in both the surveys. The duration of computer use did not show a significant correlation to the presence of CTDs among computer users in both surveys.
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To investigate the association between sleep and happiness among nurses with different personality traits: A cross-sectional study
Sushant Deepak Sarang, Rakesh Bharat Shitole, Arthi Govardhan Karnam
January-March 2019, 51(1):3-7
DOI:10.4103/ijoth.ijoth_7_19  
Background: Sleep and happiness play an important role in the functioning of a person. This study investigated the association between sleep and happiness among nurses and also studied if individual personality traits play a role. Objectives: To measure perceived stress, sleep, happiness and personality trait among nurses & To analyze the relationship between the sleep, happiness and personality trait. Study Design: A cross-sectional study design was chosen for the research. Methods: Thirty nursing staff (females, aged 22–53 years) were selected for the study. The Perceived Stress Scale (PSS) was used for screening stress. Those who scored low (0–13) on the PSS were included in the study. Written informed consent was obtained. Sleep quality, happiness, and personality traits were measured using the Pittsburgh Sleep Quality Index, Oxford Happiness Questionnaire, and Big Five Personality Test, respectively. Scores were analyzed using MedCalc Statistical Software. Results: The mean age of nursing staff with good sleep was 28 years and that with poor sleep was 36 years. It was found that 63% of nursing staff had poor sleep and 37% had good sleep. Among nursing staff with good sleep, 36% were unhappy and 64% were happy. Among nursing staff with poor sleep, 47.7% were unhappy and 52.6% were happy. The mean score for neuroticism was higher in patients with poor sleep (t-test, P = 0.003, 95% confidence interval: -7.96 to -1.76). Conclusions: Nursing staff with good sleep were happier compared to nurses with poor sleep though the difference was not significant. Sleep disturbances increased with age among nurses. The personality trait of neuroticism was higher in patients with poor sleep.
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Dual task training, fall, and functional independence in patients with Parkinson's disease: A longitudinal study
Soumyakanta Sahu, Padmalaya Jali, Arpita Srivastava
October-December 2018, 50(4):134-138
DOI:10.4103/ijoth.IJOTH_13_18  
Background: Most of the daily living activities (ADL) require dual-task (DT) performance so as to efficiently accomplish different tasks in everyday life like shifting objects from one place to other, monitoring the environment, and judging the threats and balancing efficiently to transfer self, etc. Due to disruption of the motor function of basal ganglia, patients with Parkinson's disease (PD) demonstrate noticeable problems while performing DT with a significant amount of gait and balance impairments which are also known as fall risk factors. Objectives: In this study, we evaluated the long-term effect of a DT training program applied with basic principles of motor learning on falling and ADL in patients with PD. Study Design: Pre-test and post-test experimental study design. Methods: Fifty-four patients with PD were allocated into two groups by simple randomization. Outcomes were recorded for fear of fall (FOF) by Tinetti Fall Efficacy Scale, ADL by functional independence measure and a number of falls within the last 6 months. Both the groups received occupational therapy services, whereas the patients of the experimental group received a 4 weeks program of one-on-one training program including walking while performing several motor and cognitive tasks. Data for all outcomes were measured before training and posttraining. Follow-up scores were recorded till 2 years after completion of the training program. Results: Both the groups showed significant improvements in FOF and ADL scores. Between the group, analyses showed experimental group had a significant difference in the improvements than the control group. There was a significant difference noted between posttraining and follow-up scores for both the groups. The number of falls in both groups reduced significantly. The experimental group showed a significant reduction in some falls as compared to the control group. Conclusion: The result of this study showed feasibility as well as the efficacy of DT training program to minimize falls and FOF thus resulting in improvement of functional independence with its strong retention effect till 2 years after posttraining.
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Risk of musculoskeletal disorders associated with kitchen platform tasks in young and middle-aged women of a metropolitan city: An observational cross-sectional study
Sonal Mahendra Kumar Sharma, Farheen Viedh Shaikh, Pradnya Dattaram Bhovad, Jayashri Shripad Kale, Yash Prakash Gupta, Mahima Bharat Bhuta
October-December 2019, 51(4):130-135
DOI:10.4103/ijoth.ijoth_33_19  
Background: Musculoskeletal disorders (MSDs) are one of the prominent causes of physical impairment. Traditional homemaking tasks require substantial and sustained physical repetitive movements. The presence of awkward work postures and patterns causes musculoskeletal pain. Objectives: The study aims on quantifying the risks associated for MSDs due to kitchen work in young- and middle-aged women and correlate the contribution of each task and kitchen platform type to the risk of MSDs. Study Design: An observational, cross-sectional study was chosen for the research. Methods: Based on the convenient sampling method and the inclusion criteria, 140 women from different areas of large metropolitan were selected. To assess women for pain using Nordic Musculoskeletal Pain Questionnaire (Nordic MPQ) was used, for at least three of five meal preparation tasks (chopping, lifting, stirring, mopping the kitchen platform, and utensils washing) using the Rapid Entire Body Assessment (REBA) was the objective. Measurements of anthropometric characteristics (height of kitchen platform and participant and linear distance between the tip of the shoulder to the kitchen platform and waist to heel) was done using a standard measuring tape at their residence. To correlate the score of Nordic MPQ and REBA with kitchen platform height for finding the risk of MSDs. Results: Women were found to have increased incidence of shoulder pain (mopping task) (P < 0.01) and upper back pain (mopping and stirring task) (P < 0.01). Furthermore, a weak negative association was found between the kitchen platform height with the REBA Score of lifting with r = −0.227 and P = 0.01 (two-tailed). The height of the person was negatively correlated with the REBA Scores of stirring and mopping with r = −o. 228 and − 0.229, respectively and P = 0.01 and 0.03 (two-tailed). Conclusion: Kitchen platform tasks performed in an awkward repetitive posture, over an improper work surface height are associated with increased incidence of MSDs.
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