Occupational Therapy at The Rehabilitation Institute in India Madison Heil, OTS

Vellore, India Christian Medical College (CMC) is located in Vellore, India in the state of Tamil Nadu The primary language spoken here is Tamil however, many of the patients only speak their mother tongue. The unifying language is typically either Hindi or English CMC has several campuses in the area however, The Rehabilitation Institute is located on the Bagayam campus Tamil Nadu

The Rehabilitation Institute The Rehab Institute is an inpatient facility that provides therapeutic and medical services for individuals with Spinal Cord Injuries or Traumatic Brain Injuries Services include: Occupational Therapy, Physical Therapy, Speech Therapy, Counseling, Social Work, Nurse care, and pharmaceutical supply The average stay at the Rehab Institute is about 3 months; however, some individuals are only there for a couple weeks

Occupational Therapy at the Rehab Institute Patients are divided into morning and afternoon groups for both OT and PT Medical/Exercise Model Occupational therapists role: increase range of motion (ROM), strength, and endurance in upper extremities, increase participation in activities of daily living, identify the patients goals and interests, educate caregivers, and track the patient’s progress OTs also join a team of healthcare professionals (i.e., doctors, social workers, nurses, PTs, etc.) in traveling to patient’s homes to follow up after their stay at the Rehab Institute

Topic of Interest Since the Rehab Institute serves both individuals with Spinal Cord Injury (SCI) and Traumatic Brain Injury (TBI), my topic of interest involved the question: Is there a difference in OT services for individuals with SCI versus those with TBI in India? Exploring more of the differences between OT in India versus OT in the US.

SCI vs. TBI OT for SCI rehab Regaining upper extremity strength, endurance, and range of motion Using exercises and equipment (i.e., arm bike, grip strengtheners, etc.) OT for TBI rehab Re-learning pathways, memory, behaviors, etc. Using tests, pictures, and occupations as a means and an end Strategies might include: Assessing stage of recovery Introducing familiar pictures Establishing a reward system Practicing transfers ** OT/rehab interventions depends on the person and the type/level of injury

SCI vs. TBI Spinal Cord Injury Traumatic Brain Injury Individual: splints, exercises, orthotics, stretches, etc. Community: prevent injuries with driver education System: Instill road laws and regulations Traumatic Brain Injury Individual: relearn pathways, memory, routines Community: therapists can continue to research TBI and rehabilitation System: Expand rehabilitation programs across the country

Summary Rehabilitation varies from individual to individual In India, OT practices follow a medical or exercise model Occupations look different in India than they might in the U.S. For example, eating with the right hand is a part of the Indian culture; therefore, hand function is a priority during post-injury recovery Initially, TBI recovery involves learning new pathways while SCI recovery involves regaining strength, endurance, and ROM The economy in India poses a threat to individual healthcare Conclusions/Suggestions – Summary points regarding the identified topic. Include issues orproblems raised and how the clinical issue may be better addressed or improved.

Clinical Experience: Early Trauma Detection From my experiences at the Rehabilitation Institute in India, it seems as though patients with TBIs begin therapy much earlier than they would in the U.S. This early detection may improve patients with TBI’s overall long term recovery in India

Early Trauma Detection, cont. Occupational therapists conduct a coma rating scale which detects which stage the patient is at in recovery. The stages include: Vegetative (non-responsive) Reflexive Responses Some Voluntary Response (i.e., eye blinking, etc.) Agitated State At stages one and two, OTs may start therapy by stimulating the five senses. During the agitated state, they can identify a reward for the patient to work towards.

Cultural: Presence of Caregivers Caregivers are crucial to therapy in India because they are the ones who will help the patient when he or she returns to the home Ex: the caregiver learns how to transfer the patient from the bed to the wheelchair in order for him or her to participate in ADLs In the U.S., it is up to the patient to decide what role his or her caregivers play in therapy. Typically, therapy is guided toward the patient rather than the caregivers because they are the “experts” of their care.

Pictures

OT room and equipment at the Rehab Institute

Therapy for patients with SCI

Follow up with the patients in their homes

Questions? Thank you!