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   2019| July-September  | Volume 51 | Issue 3  
    Online since September 20, 2019

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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
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.
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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
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.
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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
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.
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Developing trends in occupational therapy: Global versus Indian perspective
Shashi Oberai, Anil K Srivastava
July-September 2019, 51(3):75-76
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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
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.
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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
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 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
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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July-September 2019, 51(3):113-115
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