An Indo-Sweden research grant funded by the Indian Council of Medical Research, Govt. of India. Swedish collaborators include Uppsala University and Karolinska Instituet, Sweden. The cross-cultural research project aims to understand the usefulness of time assistiv devices on time processing abilities and daiy time management of older adults with dementia and benefits to caregivers

An interdisciplinary collaboration funded by the Indian Council of Medical Research, Govt. of India. the research project aims to study the effectiveness of a mother mediated technology enabled early intervention program on mothers' self-efficacy and infant development.

An interdisciplinary research project funded by the the Department of Health Research, Indian Council of Medical Research, Govt. of India. The research project aims to develop a mobile-based application for fall education and determine its effectiveness on reducing fall risk factors

Books and Chapters

Dsouza SA, Galvaan R, Kaushik A (2017). History of occupational therapy in India and South Africa. In SA Dsouza, R Galvaan, E Ramugondo (Eds.), Concepts in Occupational Therapy: Understanding Southern perspectives. Manipal: Manipal University Press

Rege S, Acharya V, Dsouza SA (2017). Practice settings for occupational therapy. In SA Dsouza, R Galvaan, E Ramugondo (Eds.), Concepts in occupational therapy: understanding Southern perspectives. Manipal: Manipal University Press.

Dsouza SA (2017). Practice frameworks for occupational therapy. In SA Dsouza, R Galvaan, E Ramugondo (Eds.), Concepts in occupational therapy: understanding Southern perspectives. Manipal: Manipal University Press.

Ramachandran M, Dsouza SA (2017). Explicating the occupational therapy process in clinical scenarios. In SA Dsouza, R Galvaan, E Ramugondo (Eds.), Concepts in occupational therapy: Understanding Southern perspectives. Manipal: Manipal University Press

Nagrajan A, Dsouza SA (2017). Teaching and learning in a therapeutic setting. In SA Dsouza, R Galvaan, E Ramugondo (Eds.), Concepts in occupational therapy: understanding Southern perspectives. Manipal: Manipal University Press

Rajagopal P, Lewis L, Dsouza SA, Acharya V, Rege S (2017). Group interventions in occupational therapy . In SA Dsouza, R Galvaan, E Ramugondo (Eds.), Concepts in occupational therapy: understanding Southern perspectives. Manipal: Manipal University Press.

Lewis L, Rajagopal P, Dsouza SA (2017). Conducting Effective Occupational Therapy Groups. In SA Dsouza, R Galvaan, E Ramugondo (Eds.), Concepts in occupational therapy: understanding Southern perspectives. Manipal: Manipal University Press.

Duncan M, Ramachandran M, Dsouza SA (2017). Ethics and professionalism in occupational therapy practice. In SA Dsouza, R Galvaan, E Ramugondo (Eds.), Concepts in occupational therapy: understanding Southern perspectives. Manipal: Manipal University Press.

Saha S, Dsouza SA (2010). Occupational Therapy Perspective of Dementia. In: Kar N, Jolley D, Misra B, eds. Handbook of Dementia.6th ed. New Delhi: Paras: 251-279.

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Abstract: Occupational therapy (OT) educators recognize a need to ensure that OT students are culturally competent. The researchers developed the International Collaborative Project on Cultural Competence (ICPCC) to help students understand the impact of cultural context on client care. Entry-level MOT students from a university in the US (N = 18) collaborated with BOT students (N = 4) and advanced MOT students (N = 9) from two universities in India using an online course management system WebCT. The study explored the impact of the ICPCC on OT students’ cultural competence and discusses students’ perceptions of culture on the OT process. The Inventory for Assessing the Process of Cultural Competence among Health Care Professionals Revised© measured students’ cultural competence at baseline and immediately after participation in the ICPCC. Qualitative data was collected using a Self-Reflection Form. There was an increase in the cultural competence scores among all three groups of students after participating in the ICPCC at p value < .05. Three themes emerged from the qualitative data analysis: meaning of the term culture, impact of cultural on client centered practice, and impact of cultural on OT outcomes. OT students recognized the role that cultural differences play in OT evaluation and intervention. The Open Journal of Occupational Therapy, 2(3), Article 7

Abstract: In the absence of culturally relevant measurement tool to assess behavior factors leading to fall in Indian older adults, this study aims to develop an objective measure to assess behavioral factors leading to fall by modifying the existing Falls Behavioral Scale for Australian older adults and establish its content and construct validity. METHOD: Following interviews with older adults, the existing scale was modified for language and relevant items. The 30-item preliminary scale thus developed was sent to experts for content validation, following which five items were added. For the field trial, 193 older adults were assessed with the 35 items Modified Falls Behavioral Scale, the Berg Balance Scale, and physical functioning component of SF-36. RESULTS: Following factor analysis, one item was eliminated, the items were reloaded to different dimensions and one new dimension “Anticipatory Strategies” was introduced. The final 34- item scale was positively associated with history of fall in last one year (r =0.021, p < .005) and age of the older adults (r = 0.26, p <.001). The scale also had significant negative correlation with Berg Balance Scale (r=-.4, p< .001), number of times an older adult went out in last one month (r = -0.031, p < .001), and SF 36 Physical Functioning (r = -.18, p = .01). CONCLUSION: In the present study, a 34-item Modified Falls Behavioral Scale was developed to assess fall behaviors in Indian older adults, and its content validity and construct validity is established International Journal of Scientific Research, 1(2): 152-154

Abstract: Among the heavy metals, lead still remains the major toxic pollutant of the environment. Human exposure to lead can occur through numerous pathways including air, food, dust, soil, and water. In the present study 14 lead poisoned patients with non-occupational lead exposure were evaluated. They were followed up and compared against the controls with no history of lead exposure. The patients had high blood lead levels and symptoms of weakness, dizziness, abdominal pain, generalized body ache, loss of appetite, and anxiety. Repeated course of chelation therapy helped to bring down their body burden of lead. Alternative sources for lead exposure can cause severe lead poisoning in general population. Screening and medical management of such individuals is very important to identify and eliminate sources of lead. The treatment and management requires a thorough medical evaluation and environmental intervention. Indian Journal of Clinical Biochemistry; 26(2): 197–201.

Abstract: OBJECTIVE: This cross-sectional survey aims to investigate the awareness of Computer Related Injuries (CRI) and in computer users and their health behaviors related to computer use. METHOD: using a questionnaire 200 computer users were interviewed about their awareness of CRI and health behaviors with respect to computer use. RESULTS: Among the participants, 58.5% were aware of CRI of the various symptoms, pain was commonly identified (60%). Few identified prolonged keyboard use (40%), mouse use (33%) and striking key hard (22%) as causes of CRI. Participants were are of CRI as preventable (69%) and most preventable methods, with the exception of “pacing work” (41.5%). As compared to use of keyboard tray (49.5%), keeping mouse in easy reach (67.5%) and taking one break in an hour (45.5%); the other recommended methods of computer use were not used. 12% undertook computer activities in their break. Few were involved in regular stretching (12.5%) and exercises (25.5%). There was no significant relationship between prevalence of musculoskeletal symptoms and awareness of CRI. CONCLUSION: Computer users awareness of CRI appears to be fragmented. Education progams should emphasize on the appropriate health behaviors, cautions use of computers of leisure and encourage an active lifestyle for effective prevention of CRI. Indian Journal of Occupational Therapy; 43(1): 10-15

ABSTRACT: Objective: To determine the test-retest reliability of Moberg Pick-Up Test (MPUT), Indian version and establish normative values for Indian adults of 30 to 60 years of age. Methods: The performance of 600 adults in the age groups 30-39, 40-49 and 50-60 years, on MPUT (Indian version) was assessed. 50 subjects were reassessed after three days. Results: The coefficient alpha for test-retest reliability was 0.985.There was no significant difference in test components between 30-39 and 40-49 years age groups, and significant difference (P<0.05) between 40-49 and 50-60 years age groups. Women were significantly faster (P<0.05) than men on most components. Performance with dominant hand was significantly faster (P<0.05). Conclusion: The test has good test-retest reliability. Hand dexterity declines with age, especially after 50 years. The normative values based on age and gender will be useful in occupational therapy practice. Indian Journal of Occupational Therapy; 42(3): 9-12.

Abstract: Lead (Pb) is widely used because of its useful properties and it is ubiquitous in human environment. There are various lead based industries and several workers who are working in these industries without the knowledge of the ill effects of lead and hence not taking proper precautions while handling lead. Many a times, these workers who have accumulated lead in their blood and body organs, are not properly diagnosed and might receive only symptomatic treatment. We describe a thirty-two-year old male, who was working in an unorganized lead based industry for 3 yr, developed severe lead poisoning leading to wrist drop. Since one year the patient received only symptomatic treatment for abdominal pain. His laboratory investigation showed elevated blood lead levels. The chelation therapy using D-Penicillamine brought down his blood lead levels and is on follow up presently. It is required to take proper history about the occupation of the patient, exposed to potentially hazardous levels of lead in the workplace and medically evaluate them. Industrial Health; 47: 677–680

ABSTRACT: Background and Purpose: Poor balance confidence has been recognized as an intrinsic factor of falls that leads to restriction of daily activities thereby affecting the quality of life of older adults. The aim of this study was to investigate the balance confidence in Indian community dwelling older adults and its influence on performance of daily activities. Methods: Sixty older adults above 65 years of age volunteered to participate in the study. Mean age of the participants was 74.28 years (S.D=6.90). Balance confidence was determined using the Balance Confidence Scale which was administered through personal interview. The mean balance confidence was then categorized on the basis of severity as low (0%-30%), medium (31%-60%) and high (61%-100%). Results: Five percent Indian community dwelling older adults reported low balance confidence, 23.33% reported medium and 71.67% reported high balance confidence. Analysis of balance confidence on individual activities showed that older adults reported lower balance confidence on community mobility activities like going to hilly areas (31.67%), walking in crowd (26.67%) and crossing a road (25.0%). Conclusion: The study suggests that Indian community dwelling older adults report decreased confidence in activities of community mobility, which may hinder their participation in social activities; which is essential to promote active ageing and improve the quality of life. An early screening of balance confidence and its influence on activity participation is essential in fall risk assessment. Intervention strategies directed towards intrinsic factors along with modification in the attributed environmental factors may enhance balance confidence and reduce risk for falls in older adults. Journal of the Indian Academy of Geriatrics; 4(4): 149-155, 2008

Abstract: PURPOSE: In the absence of culturally relevant measurement tools to assess fear of falling (FOF) in older adults, this study aims to develop an objective measure to assess balance confidence in the community dwelling Indian older adults (>65years), establish its test-retest reliability, content and construct validity. METHOD: Items were generated from reviewof literature, semi-structured interview of older adults and discussion with experts. After content validation, the Balance Confidence Scale (BCS) with 22 items was developed. To establish the construct validity of BCS, field trial on 60 respondents was done comprising of high and low mobility groups with 30 respondents each. To establish test-retest reliability and reliability of phone as a mode of administration, 15 respondents were reassessed after two weeks interval. RESULTS: The experts validated the content of BCS. Construct validity of BCS is established (p<0.001). BCS has high test– retest reliability (r=0.93, p<0.001), high internal consistency (a=0.97) and reliability on phone (r=0.96, p<0.001). CONCLUSION: BCS is a reliable tool for assessing balance confidence in Indian community dwelling older adults with content and construct validity established. BCS may contribute significantly to a comprehensive, functional and culturally relevant fall risk assessment and guide intervention in fall prevention and rehabilitation programs. Indian Journal of Occupational Therapy; 40(2): 33-47

ABSTRACT: Objective: To determine the prevalence, circumstances and consequences of falls in Indian older adults. Methods: 190 older adults, 60 years and above were interviewed for history and description of falls in the previous two years. Results: 72 older adults (38%) fell, amassing 95 falls, 47% women fell as compared to 31.2% men (p=.040). Fall prevalence increased with age (p=.035). 58.6% older adults using mobility aids/personnel assistance for ambulation fell as compared to 34.2% older adults not using mobility aids (p=.022). Falls most often occurred in the morning (54.7%); while engaged in ambulatory activities (58.9%) and bathing (18.9%). Most of the falls occurred on the road (30.5%) and in the bathroom/toilet (21.1%). Slips (44.2%) and trips (25.3%) were the most prevalent causes of falls. Soft tissue injuries (28.4%) were most common injuries and physician’s treatment was required for 47.37% of fall related injuries. 52.8% of older adults with falls had fear of fall and 30.6% reported activity restriction especially outdoors. Conclusion: Falls are a prevalent health problem in Indian older adults. Fall prevention is important to promote health and well-being in older adults. The results provide insight into circumstances of falls. Implications for occupational therapy in fall prevention are discussed. Indian Journal of Occupational Therapy; 40(1): 3-11.

OBJECTIVE: In this study, intermanual transfer effects of an occupationally embedded task (chopsticks activity), its underlying skill (dexterity) and the ability to generalize the skill to near (spoon activity) and far (lock activity) transfer tasks were examined. METHOD: 50 right-handed college students (mean age = 20.58; SD = 2.41) who volunteered were trained in chopsticks activity (right hand). Before training they underwent pretest on spoon and lock activities (left hand) and left hand subtest of Purdue pegboard (dexterity).24 hours after training, posttest was conducted on all the three pretest activities (left hand) and chopsticks activity (both right & left hands). Dependent variables measured were performance time, number of errors and number of pegs placed. RESULTS: Analysis revealed no significant difference in error (p>0.05), but significant difference in time (p<0.001) for chopsticks activity. Comparison of pre & post test data showed significant change in both error (p<0.001) and time (p<0.001) for spoon activity and in time (p<0.001) for lock activity and in performance of Purdue pegboard (p<0.001). CONCLUSION: The study indicates that in a population without impairments, intermanual transfer of an occupationally embedded task and its underlying skill occurs with asymmetry and the skill is generalized to near and far transfer tasks. Indian Journal of Occupational Therapy; 38(1): 3-8

OBJECTIVE: The study aimed to determine the effect of cognitive and perceptual deficits on sitting and standing balance following stroke. METHOD: 32 patients with a first episode of acute stroke participated in the study. Lowenstein Occupational Therapy Cognitive Assessment (LOTCA) was used to assess their cognitive and perceptual functions. Sitting and standing balance was assessed with a six and seven point ordinal scale respectively. RESULTS: Chi-square tests revealed significant correlation of sitting balance with LOTCA subtests Orientation in Place (p= .04), Riska Object Classification Structured (p=.04) and Unstructured (p=.01) and attention (p=.02). Standing balance showed significant correlation with LOTCA subtests of Visual Shapes Identification (P = .03), Pegboard Construction (P = .01), Riska Object Classification Structured (p =.003) and Unstructured (P <.001), Geometric Sequencing (P == .01) and Attention (P = .001). CONCLUSION: Cognitive and perceptual deficits following stroke influence sitting and standing balance and should be addressed in balance assessments and interventions following stroke Indian Journal of Occupational Therapy; 33(1): 11-15.

Chapter in Kar N, Jolley D, Misra B, eds. Handbook of Dementia. 6th ed, 2010: 251-279. New Delhi: Paras.

Abstract Community mobility supports occupational participation among older adults and promotes active ageing. This study aimed to explore community mobility of older adults within an urban Indian context in view of the limited available literature in this area. A cross sectional survey was conducted on a convenience sample of 75 older adults residing in Chennai city using a questionnaire and a non-retrospective, open format, two-day time diary. Participants engaged in community mobility and activities outside home for 10 % of time over two days. Activities and roles related to religious and spiritual activities and expression, social participation, leisure and informal personal education participation occupied most time and were engaged in most frequently. Walking was the most frequently used mode of transportation and participants reported numerous road-related hazards (lack of proper pavements, disobedience of traffic rules, difficulty crossing roads, crowded roads, and poor condition of roads). Participants used public transport less often. Public transport-related barriers (difficulty boarding and alighting buses/trains due to high steps/insufficient time, inadequate seat reservation for older adults, overcrowding and increased expense on auto rickshaws/taxis) were also expressed as concerns. Participants linked their ability to use public transport with independence and assigned relatively less value to driving. The findings emphasize the significance of community mobility to promote participation in older adults and recommend age-friendly environments in Indian cities. Journal of Cross-Cultural Gerontology. DOI 10.1007/s10823-015-9276-7. Published online 26 December 2015

ABSTRACT: Background. Bathroom accidents are a common cause of injury in older adults. This study aimed to identify the types and prevalence of bathroom hazards in the urban Indian elderly. Methods. 110 female and 88 male community-dwelling older adults in Ahmedabad aged ≥60 years living in a house with at least one bathroom were included. Hazards in their bathrooms were identified using the 18-item Bathroom Hazard Checklist. Results. Of the 198 bathrooms, 85 (42%) had 7 to 10 hazards, and 113 (58%) had 11 to 15 hazards. Frequent architectural hazards included absence of bidirectional doors (100%), inadequate door width (100%), slippery floor (91.9%), inappropriate bathroom size (80.3%), and high door threshold (53.5%). Frequent non-architectural hazards included absence of non-skid mat at entrance (99.5%), absence of grab bars (97%), absence of exhaust fan (96.6%), inadequate bathroom illumination (94.4%), inadequate illumination of bathroom pathway (91.4%), unavailable/unsafe hot water use (89.9%), unsafe seating surface (55.6%), absence of light switch at entrance (53%), and cluttered pathway (39.4%). Conclusions. The prevalence of bathroom hazards in the urban Indian elderly was high. Modification of non-architectural hazards is important to reduce injury risk. Guidelines for age-friendly bathroom design and construction are recommended. Improving awareness of older adults and caregivers is also important to safety. Asian Journal of Gerontology and Geriatrics; 10(2): 83–91

Learning disability (LD) is a prevalent problem among Indian children. Due to poor awareness among teachers and parents, children with LD face many challenges in school that adversely affect their self-confidence and career prospects. The present case study describes a novel community-based awareness program for LD. Occupational therapy students performed street plays, a culturally relevant art form in public places and schools, depicting the symptoms of LD, effect on the child and family and management. The program also involved a pilot workshop for 20 primary school teachers emphasizing on early signs and symptoms, their critical role in early identification during the formative years of a child, behavioral issues and management strategies. The program required engagement of key stakeholders, namely the university, healthcare team, district education department, schools, civic authorities and philanthropists in the community. It demonstrates how occupational therapists could liaison and develop creative partnerships to serve community needs. World Federation of Occupational Therapists Bulletin, 73(2), 125-127. DOI: 10.1080/14473828.2017.1308085

Mehrotra, S., & Dsouza, S. (2017). Self-management Skills for Occupational Therapists. In Dsouza. S. A., Galvaan. R., Ramugondo. E. L. (Eds.), Concepts in Occupational Therapy: Understanding Southern Perspectives (368-384) Manipal. Manipal University Press.

This publication was part of project named “ASHA: An awareness program for learning disability” which was financially supported by Lions and Lioness Club, Manipal, Udupi. It included a case study of a novel awareness program for learning disability using creative art forms.

This study investigates the inter-limb coordination in marching-in-place and studies the influence of age and gender on the same.

This study compares elderly women with good and poor mobility to understand the impact of mobility on participation and satisfaction in life roles. It concludes that mobility impairments influence the participation and satisfaction with life roles.

Normative Performance of Indian Older Adults on Modified Jebson Hand Function Test This study establishes the normative values for Indian older adults on the Modified Jebson Hand Function Test, a test of gross dexterity.

This is a qualitative study involving older adults of Chennai city on their experience of community mobility, the problems encountered and the strategies they us to deal with the problems.

This study aimed to understand the challenges Indian older adults faced in home establishment and management

This study involved a randomized controlled trial to determine the effectiveness of caregiver education for prevention of shoulder pain and subluxation in patients with acute stroke

This study explores the IADL participation of Indian elderly. It identifies IADL that Indian elderly find meaningful and determines the level of independence in IADL participation.

This mixed-method study aimed to understand the impact of caregiving on caregivers of stroke survivors

This qualitative study explores the experiences Indian older women of an essential instrumental activity of daily living - food procurement and preparation

This cross-sectional study studied the relationship between interlimb coordination during marching-in-place and fall risk as measured by two balance tests.

This mixed-method study explored the roles and routines of youth diagnose with seizure disorder

This study entailed a qualitative study to understand experiences of occupational therapists and caregivers of stroke survivors regarding home program provision. Based on the study findings guidelines were developed to support home program provision by occupational therapists at discharge from acute care

This study involved a randomized controlled trial to determine the effectiveness of an activities of daily living- based home program to reduce symptoms and improve participation in daily activities for individuals with peripheral vertigo

This qualitative study explores the experiences of older adults and their family members regarding leisure participation following retirement

This qualitative study explores the experiences of occupational therapists and patients with neurological disorders regarding the process of goal setting during rehabilitation.

This cross-sectional study explores the impact of occupational participation on quality of life of institutionalized older adults in Kerala, India

This study involved establishing consensus guidelines for occupational therapy services in acute stroke care.

In this study, the investigators established the validity of two Swedish tools: the KaTid-old for time processing abilities and Time-Self report for daily time management that were adapted and translated to the Indian context as a part of an Indo-Sweden funded research collaboration

This study involved the development of a tool for assessing home-related fall hazards in the Indian context

This qualitative study explores the occupational participation of older adults with low vision in India

This qualitative study explores experiences of primary caregivere in managing daily occupations of people with dementia

This qualitative study explores perspectives of Indian older women regarding fatigue experienced while doing their daily occupations

This qualitative study aims to understand sleep-related behaviors of older women in India

This cross-sectional study aims to understand the impact of screen time on sleep quality of older adults

This cross-sectional study aims to understand attitude, confidence and competence regarding evidence-based practice of occupational therapists working in neurorehabilitation settings in India

This qualitative study based in Mumbai aims to understand the attitudes of family members regarding older adults' participation in home management and meal preparation activities, an essential instrumental activity of daily living

This qualitative study based in Mumbai explores the perceptions regarding social participation of Indian older women living in Mumbai