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COTE Program Key Resource Faculty


Kavitha Vinayak Mahamankar

Faculty: Kavitha Vinayak Mahamankar, OTR/L, NDT, PhD

Affiliation: Occupational Therapist, Chaitanyam Institute, Thane, Mumbai

Email: kavithamohora@gmail.com

Title: Evidence Based Occupational Therapy for Visual Impairments in Neurological Disorders

Older adults experience varied conditions that impair their visual capacity. Low vision resulting from macular degeneration, glaucoma, diabetic retinopathy, stroke etc. can cause difficulty in visualizing letters and numbers. Routine tasks such as reading, writing, managing curbs, steps, or recognizing facial features, and distinguishing between similar colors, such as black and blue become difficult to perform. Adults who have visual problems may have trouble maintaining their independence and completing typical day-to-day activities. Occupational therapists can assist people with vision impairments to continue to live independent and meaningful lives. They can promote independence with everyday tasks such as showering, dressing, cooking, grocery shopping, managing finances, and getting around in the community. Therapists can assist ophthalmologist and optometrist in providing comprehensive low vision rehab to individuals with visual impairments.

This presentation has the following objectives:

  • Introduce common visual impairments experienced by our older adult population
  • Explain how the visual impairments disable the individual in performance of everyday occupations
  • Provide an overview of the role of occupational therapy in low vision
  • Generate discussion in order to develop this niche practice of occupational therapy
  • Practical implications:

Children may have visual perceptual developmental issues affecting form constancy and visual attention limiting learning. Adolescents and young adults may have neurological conditions such as stroke or head injury affecting their field or gaze causing behaviours such as neglect, nystagmus, visual in coordination etc. Low vision OT can help improve visual scanning, attention and visual memory to aid in learning and memory. Eye exercises can aid in cases like strabismus and in-coordination. Environmental scanning and guided attention helps overcome issues of neglect or hemi-inattention. Compensatory strategies may include use of visual fixers, physical markers for maneuvering, magnifiers for reading, use of technology etc. Low vision can span various diagnoses across different age groups. It is a niche area for therapists to explore and pursue. With this presentation, it is my attempt to provide a glimpse into the world of low vision practice for Occupational therapists.

COTE Program Key Resource Faculty


Dr. Priya Kothavale - Tawde

Faculty: Dr. Priya Kothavale - Tawde, BSc (OT), DROT, MOTh

Affiliation: In-charge Occupational Therapy, Neuro Rehabilitation, Jupiter Hospital, Thane, Mumbai

Email: priyaadvay@gmail.com

Title: Robotics & Aquatic Therapy as an Adjunct to Occupational Therapy in Neurological Disorders

New trends in Neuro Rehabilitation is increased emphasis on treatment techniques and technology to promote neurological recovery. The recent advances in Neuro Rehabilitation techniques show the cortical restructuring takes place in the brain in response to the treatment we provide which is also known as neuroplasticity. New techniques in Neuro Rehabilitation are: Rehab Robotics, Functional electrical stimulation, Aqua therapy

Rehab Robots: Is an external device that assists or guides movements with the intention of improving function. It reproduces motion more accurately than manual therapy, improves training effect. It achieves more repetitions per session than manual therapy; Gives accurate documentation of results for the use so increased motivation. Virtual reality games and tasks to the patients that can be adjusted to the level of ability, interest and specific movement problems. The Types of devices are: Active, Passive, Hapatic and Coaching Depending on the mechanical designs they are: End effector based, Exoskeleton, Planar based and Only some negative aspects are they are very expensive and the availability is limited.

EMG Triggered Neuromuscular Electric stimulation in Neuro Rehabilitation is used as: Electrical Stimulation, Biofeedback. EMG triggered NMES helps: Detect EMG levels, Triggers muscle movement, Relearning, and Neuroplasticity. Functional Electrical Stimulation: Used to activate paralyzed muscles in order to mi in normal function of those muscles. Four channel stimulation helps in simultaneous Stimulation’s to two different groups of muscles at two different sites to enhance muscles movement.

Aqua Therapy: Therapy in the water is useful in: Relief situation for support and movement apparatus; Physiological immersion effects; Pain reducing ambient medium and Patient is not dependent on aids. Goals of aqua therapy are: Training balance, Improvement of coordination, Muscle strength, Cardiovascular training, Improvement of static and dynamic balance, Proprioceptive neuromuscular facilitation, Emotional well-being, Understanding of the different movement behaviours in water.

Physical factors of aqua therapy are: Buoyancy i.e. a force which counteracts gravity, Density, Temperature of around 34•C for rehabilitation of pain and stiffness, Water resistance offers targeted force training by varying the speed of movements. Hydrostatic pressure helpful in cardiovascular conditions, Muscle responses includes reduction in tone / spasticity, pain reduction, pressure relief on joints, release of neurotransmitters, improvement in mobility. And also improved blood circulation. Free exercises using accessories help improving deep stabilization, Flexibility, strength and coordination.

Robot Aided Rehabilitation, EMG & Functional Electrical Stimulation and Aqua therapy are useful in patients with neurological disorders as an adjunct to conventional occupational therapy treatment.

Key Note Address


Dr. Dimitrios Mylonadis

Faculty: Dr. Dimitrios Mylonadis, MSc OT, PG Cert Neurosciences

Affiliation: CEO ASIC, CEO Hopscotch Children’s Therapy Centre, Faculty at The Great Ormond St. Children’s Hospital, Fellow at the Royal College of Occupational Therapists, United Kingdom

Email:dmylonadis@gmail.com

Title: Interdisciplinary Vs. Multidisciplinary Assessment in Children with Complex Conditions

Guest Talk


Dr. Dimitrios Mylonadis

Faculty: Dr. Dimitrios Mylonadis, MSc OT, PG Cert Neurosciences

Affiliation: CEO ASIC, CEO Hopscotch Children’s Therapy Centre, Faculty at The Great Ormond St. Children’s Hospital, Fellow at the Royal College of Occupational Therapists, United Kingdom

Email:dmylonadis@gmail.com

Title: The Value of Play and Movement in Sensory Integration - Why It Matters and What can go Wrong?

Guest Talk


Dr. Alok Sharma

Affiliation: Director, NeuroGen Brain & Spine Institute, Navi Mumbai, India Professor of Neurosurgery, Head of Department, LTMG Hospital & LTM Medical College, Sion, Mumbai, India.

Email: alok276@gmail.com

Neuro Rehab: Then & Now

Neuro-rehabilitation has changed considerably over the past years with development in science and technology. More emphasis was given to impairment and disability. But, WHO’s new classification emphasizes individuals’ abilities rather than disabilities along with social context. Earlier, rehabilitation functioned as individual departments with separate goals for patients. Now, it is a holistic treatment. Earlier, it was believed that a damaged nervous system cannot be repaired so, rehabilitation was done on damaged nervous system and the outcome remained unsatisfactory. However, newer regenerative treatments like stem cell therapy has transformed this age-old belief. Stem cells address the underlying neuropathology therefore; rehabilitation techniques are now being applied on repaired nervous system resulting in better outcome. Muscular dystrophy patients died at an early age, but now with this combined intervention they live longer. SCI patients who remained wheelchair bound can walk. Autism children, who continued to be hyperactive are now calm. We studied the efficacy of neuro-rehabilitation in combination with autologous bone marrow mononuclear cell transplantation in incurable pediatric and adult neurological disorders and present our published data.

(A) Pediatric Neurological Disorders:

In Autism, 92% cases showed improvement in ISAA, CGI and FIM indicating cognitive and functional improvements. In CP, 95% patients showed improved oro-motor activities, neck control, sitting, standing, walking balance and speech with improved metabolism recorded in the PET CT scan brain. In ID, all patients in the intervention group showed improvement while, there was no improvement in 20.69% patients from only rehabilitation group.

(B) Adult Neurological Disorders:

In MD, 86.67% showed improved strength in trunk, upper and lower limbs and gait. In ALS, it was found that the survival duration of the treated population was 30.38 months more than that of the control group. In SCI, 91% thoracolumbar SCI patients and 74% cervical SCI patients showed improved spasticity, sensation, trunk control, bladder management, standing and sitting balance, ambulation, ADLs along with FIM, ASIA, and EMG/NCV. In TBI, 93% displayed improved balance, voluntary control, muscle tone, oro-motor activities, cognition, coordination, speech, ambulation and ADLs. In brain stroke, better outcome was observed in patients with ischemic stroke as compared to haemorrhagic stroke with improvement in ambulation, hand function, standing and walking balance.

Recent developments in neuro-rehabilitation techniques and combining them with new treatment strategies like stem cell therapy help in optimum neural reorganization and functional recovery making these patients independent and improving their quality of life.

Guest Talk


Dr. Uday Govindrao Bodhankar

Faculty: Dr. Uday Govindrao Bodhankar, MBBS, MCPS, DCH, MD, FIMAAMS, FIMSA, FICMCH, FIAP FNNF FRCPCH (UK)

Affiliation: International President: Commonwealth Association for Health & Disability, UK Adjunct Associate Professor Pediatrics: Sydney University International Council Member: ASPR, Japan Nodal Officer: RCPCH-DCH, UK Ramdaspeth Nagpur-440012, Maharashtra, India

Email: ubodhankar@gmail.com

Website: www.comhad.com

Title: Community Based Rehabilitation: Indian Vs. Global Scenario

Community-based rehabilitation (CBR) was initiated by WHO following the Declaration of Alma-Ata in 1978 in an effort to enhance the quality of life for people with disabilities and their families; meet their basic needs; and ensure their inclusion and participation. While initially a strategy to increase access to rehabilitation services in resource-constrained settings, CBR is now a multi-sectoral approach working to improve the equalization of opportunities and social inclusion of people with disabilities while combating the perpetual cycle of poverty and disability.

Community-based rehabilitation (CBR) was initiated by WHO following the Declaration of Alma-Ata in 1978 in an effort to enhance the quality of life for people with disabilities and their families; meet their basic needs; and ensure their inclusion and participation. While initially a strategy to increase access to rehabilitation services in resource-constrained settings, CBR is now a multi-sectoral approach working to improve the equalization of opportunities and social inclusion of people with disabilities while combating the perpetual cycle of poverty and disability.


Community Based Rehabilitation Guidelines

Recommendations to develop guidelines on community-based rehabilitation (CBR) were made during the International Consultation to Review Community-based Rehabilitation which was held in Helsinki, Finland in 2003. WHO; the International Labour Organization; the United Nations Educational, Scientific and Cultural Organization; and the International Disability and Development Consortium – notably CBM, Handicap International, the Italian Association Amici di Raoul Follereau, Light for the World, the Norwegian Association of Disabled and Sight savers - have worked closely together to develop the Community-based rehabilitation guidelines.

More than 180 individuals and representatives of nearly 300 organizations, mostly from low-income and middle-income countries around the world, have been involved in their development.


The Community-Based Rehabilitation Guidelines:

  • Provide guidance on how to develop and strengthen CBR programs;
  • Promote CBR as a strategy for community-based development involving people with disabilities;
  • Support stakeholders to meet the basic needs and enhance the quality of life of people with disabilities and their families;
  • Encourage the empowerment of people with disabilities and their families

The Community-Based Rehabilitation (CBR) Matrix:

The CBR matrix gives an overall visual representation of CBR. The matrix illustrates the different sectors, which can make up a CBR strategy.

It consists of five key components, each divided into five key elements. Each of these elements will have a dedicated chapter in the guidelines. The elements are sub-divided into content headings. Each element has between four to nine key content headings.

The components and elements are underpinned by a number of principles which inform the work. These principles are intended to be translated into tangible ways of working and should be observable in programme activities.

It is a ‘pick and mix’ series of options, a set of components and elements from which the practitioner can select. Any one programme may choose to address only some of the components and elements. The matrix should not be seen as sequential. At the same time, the implementer needs to be in touch with other key organizations that usually take care of other components/elements.

The CBR Practitioner May Choose

  • The most practical entry point for the programme, for example, an initiative on primary schooling or organizing parents of children with disabilities
  • The next logical steps to build up the programme, for example, an initiative on ante-natal and primary health care;
  • And so on…until a coherent programme of appropriate components and elements is formed, supported by a strong set of cross-sector alliances and partnerships.

Community-based Rehabilitation (CBR) is still in its infancy in India and developing countries but enjoys wide acceptability. Disability rehabilitation is primarily considered to be the responsibility of the family. The significant place of family, religion, and traditions to an individual cannot be overlooked in the success of any CBR movement in India.

Poverty, negative attitude of the society, lack of access to education, and information are a few of the factors responsible for the slow growth of CBR. Policies and strategies initiated in the recent past by the Government and NGOs could be considered as a shift and maturity in the field.

Now the welfare-based model of rehabilitation exists in the country in place of the earlier charity-based model. The need to accelerate the pace of CBR programs is required by the Government, NGOs, Institutions, Professionals, and, above all, by the disabled themselves

Guest Talk


Dr. Rehab Zaytoun

Faculty: Dr. Rehab Zaytoun

Affiliation:Medical Doctor, Medical Doctorate in Speech and Language Pathology. Kasr Aini, Faculty of Medicine, Cairo University, Cairo

Email: akram@karmagrouptrade.com, rehab.zaytoun@gmail.com

Title: Therapeutic Feeding and Oral Placement Therapy: The Myths of Picky Eaters and Feeding Difficulties

Muscle based feeding and speech disorders (Disorders that happen as part of sensory processing disorders, cerebral palsy, Down Syndrome, apraxia of speech, post CVA patients…etc.) have been always a challenge for the professionals. These patients have seldom improved using the traditional visually and auditory - based speech and language therapy or behavior approaches that frequently assumes that feeding difficulties are behavior based.

Oral placement therapy is a complementary approach -for the traditional approaches- addressing structural placement in clients with movement or placement disorders.

It is an approach that targets the following: Increasing the awareness of the oral mechanism on the somatosensory and metalinguistic levels, normalizing the tactile oral sensitivity, improving the differentiation of oral movements which will reflect on the feeding and the speech intelligibility. The function of the jaw musculature in feeding and speech has always been identified. However, we lack the information on how to assess or improve the jaw function. Oral placement therapy focuses on building the strength and the stability of the jaw in order to achieve the optimum dissociation, grading and endurance.

Guest Talk


Dr. Rehab Zaytoun

Faculty: Dr. Rehab Zaytoun

Affiliation:Medical Doctor, Medical Doctorate in Speech and Language Pathology. Kasr Aini, Faculty of Medicine, Cairo University, Cairo

Email: akram@karmagrouptrade.com, rehab.zaytoun@gmail.com

Title: The Connection Between Language and Executive Functions: The Role of Parents, SLPs and OTs

Executive function is a multidimensional construct involving skills such as attention control, planning or organizing tasks, behavioral inhibition and working memory. Language development and executive function (EF) skills have a reciprocal relationship. EF skills represent a set of cognitive processes that underlie self-control of thoughts, feelings, and behaviors. They are important predictors of school success. Weaknesses in executive function have been reported in ADHD, autism spectrum disorders and many neurodevelopmental disorders. Promoting bilingualism and family centered communication enhances the executive functions and facilitates the role of speech and language pathologists and occupational therapists.

Guest Talk


Dr. Vijay Suple

Faculty: Dr. Vijay Suple, BSc OT, PhD (Psychology)

Affiliation:Consultant Occupational Therapist, Closing the Gap Health Care Group, St. Thomas, Ontario, Canada

Email: vsuple@yahoo.com

Phone: 519-995-7091

Title: Cognitive Assessment & Clinical Implications in Driving

Cognitive skills including attention span, decision making ability, and analytical abilities are examined to determine the driver’s ability to process and respond to information in driving environment. The presenter will describe some cognitive tests, their importance in driving assessment and interpretation of the results. Also, presenter will describe about OT role in driver's re-training. In addition, presenter will discuss about Ontario Ministry of Transportation's new regulation called "Discretionary Reporting that allows occupational therapist to report any cognitive impairment that will make it dangerous for person to drive.

Faculty Talk


Joe Wells

Faculty: Joe Wells, OTD, OTR/L, DPMIR; Neeti Wells, PhD (AM), OTR/L; Anu Garg, MD, CMD

Affiliation:CEO, SAI Group; Adjunct Assistant Professor, University of Findlay, USA

Email: jwells@thesaigroup.org

Title: Cognitive Assessment & Clinical Implications in Driving

Introduction: Home health or community-based practitioners have lesser contact with their peers than other work settings. They have difficulty retrieving information most often needed expeditiously or in real-time at patients’ homes. Mobile technology has improved access to information and can be used to better inform and guide clinical practice. However, given the plethora of apps available, it is necessary to properly evaluate them for feasibility/ utility before their implementation.

Objectives: To evaluate the perceived utility of a web-based application, Care Mapp ®, as a tool to inform and support home health practice.

Method:

  • Design: Pilot observational study.
  • Participants: Home health practitioners from occupational therapy, physical therapy and nursing.
  • Data Collection: Qualitative methods mainly using surveys and unstructured interviews.
  • Data Analysis: Using descriptive statistics.

Results: The study results supported the usability/ effectiveness of Care Mapp® as a tool to help clinicians improve their skills as evidence based practitioners, improve their ability and convenience in facilitating patient education, and fostering greater confidence in their practice.

Conclusion: Telehealth can greatly impact how we access, use and share information beyond the boundaries and limitations posed by physical locations. As a mode of service delivery, applications of telehealth, such as Care Mapp®, also aim at informing practice and educating the participants of care. Principles of the Technology Acceptance Model can be used to test the usability of applications, and facilitate success with their selection and implementation at the organizational level.

Sponsored Talk


Dr. Amit Ramesh Dhumale

Faculty: Dr. Amit Ramesh Dhumale, MBBS (Bombay), Diploma Orthopedics, DNB (Physical Medicine & Rehabilitation)

Affiliation:Director, Neuro-Motor Rehabilitation, Jupiter Hospital, Thane, Mumbai

Email: amit.dhumale@jupiterhospital.com

Title: Jupiter Hospital’s Neuro-Motor Rehabilitation: Center of Excellence (A Comprehensive Inter-Disciplinary Approach to Rehabilitation)

Jupiter Thane is a tertiary care centre providing comprehensive healthcare in all segments, from birthing to geriatrics and end of life care, ‘a community hospital’, since last 11 years. Equipped with 350+ beds across seven floors, the facility houses a Neuroscience facility, cancer care clinic, cardiac care including open heart surgeries, the region’s largest paediatric facility with a 50 bedded Children’s ICU, as well as a liver and kidney transplantation facility. We have recently inaugurated our state of art Neuro-motor Rehabilitation centre in the month of May 2018. On the accreditations front, Jupiter Hospital Thane became the region’s first NABH accredited institution. We are also in a process of starting our first overseas facility a Jupiter rehabilitation centre in California.

Jupiter Hospitals Neuro-motor rehabilitation center of excellence is one of its kind in the country. It provides interdisciplinary rehabilitation as an integral part of the hospital services in line with evidenced based medicine & best practice guidelines. The coordinated, structured & integrated team approach makes it truly interdisciplinary. It is a convenient one stop access to all multiple therapy services, all under one roof that caters to all the rehabilitation needs of the patient. The interdisciplinary rehabilitation approach provides customized & tailor-made programs suited to the needs of the individual. Regular interdisciplinary case conferences to monitor the progress of the program towards achieving measurable functional goals & endpoints.

This presentation will showcase latest advanced Rehab technology available at Jupiter Hospital. Robotic rehabilitation, sensor-based computer aided rehabilitation for upper & lower limbs (Amadeo, Pablo, Tymo, Diego, Myro, Lokostation, Anti-gravity treadmill, Virtual reality tread mill & Aqua Rehab) This presentation will conclude with introduction of a training course for occupational therapists in association with AIOTA.

Sponsored Talk


Faculty:

Affiliation:Godrej

Email:

Panel Discussion


Panel Experts

Dr. Alok Sharma, Neurogen, Mumbai, India

Dr. Sahil Mehta, PGIMER, Chandigarh, India

Dr. Jayashri S. Kale, SGSMC & KEMH, Mumbai, India

Moderators

Dr. Neeraj Mishra, New Delhi, India

Dr. Anupama Khanna, New Delhi, India

Dr. Vikramdeep Saxena, Amritsar, India


The panel discussion will be based on 3 key clinical questions, wherein, for each question firstly the answers will be sought from the panel experts, secondly from the audience and thirdly what the literature has in store till date, will be showcased and then the moderator will summarize the answers to each questions based on these expert rounds. The panel discussion is planned with the aim to answer the need of the hour questions concerning the minds of all occupational therapy clinicians for day to day clinical decision making, for research conduct and for patient education.

Panel Discussion


Title: Need for Indian Nomograms for Occupational Therapy Assessments in Children with Neuropsychiatry Disorders

Panel Experts

Dr. Lokesh Saini, PGIMER, Chandigarh, India

Dr. Jyothika N. Bijlani, Mumbai, India

Dr. Sanjeev Padankatti, Vellore, India

Moderators

Dr. Joseph Sunny, Cochin, India

Dr. Nitesh Kumar Shrivastav, Lucknow, India

Dr. Bhavya Gour Chandrakar, Mumbai, India


The panel discussion will be based on 3 key clinical questions, wherein, for each question firstly the answers will be sought from the panel experts, secondly from the audience and thirdly what the literature has in store till date, will be showcased and then the moderator will summarize the answers to each questions based on these expert rounds. The panel discussion is planned with the aim to answer the need of the hour questions concerning the minds of all occupational therapy clinicians for day to day clinical decision making, for research conduct and for patient education.

Panel Discussion


Title: Purposeful Occupation- and Activities-Based Hand Rehabilitation: Current Evidence!

Panel Experts

Dr. Vishal Kumar, PGIMER, Chandigarh, India

Dr. Raj Kumar Sharma, Ghaziabad, India

Dr. Shovan Saha, Manipal, India

Moderators

Dr. Punita V. Solanki, Mumbai, India

Dr. Ranjit Pathak, Chandigarh, India


The panel discussion will be based on 3 key clinical questions, wherein, for each question firstly the answers will be sought from the panel experts, secondly from the audience and thirdly what the literature has in store till date, will be showcased and then the moderator will summarize the answers to each questions based on these expert rounds. The panel discussion is planned with the aim to answer the need of the hour questions concerning the minds of all occupational therapy clinicians for day to day clinical decision making, for research conduct and for patient education.