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

2. 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

3. 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

4. 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

5. 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.

6. 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

7. 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

8. 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.

9. 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

10. 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.

11. 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.

12. Pictures

13. OT room and equipment at the Rehab Institute

14. Therapy for patients with SCI

15. Follow up with the patients in their homes

16. Questions?
Thank you!