presented at the 40th NACIACP, SRM University, Chennai on 2nd March 2014

1. EFFICACY OF OCCUPATIONAL THERAPY ON
NEUROBEHAVIOURAL DEFICITS, ACTIVITIES OF DAILY
LIVING AND SOCIAL SKILLS IN SCHIZOPHRENIA:
CASE STUDY
SNIGDHA SAMANTRAY, MASROOR JAHAN, K.S.
SENGAR

2. OUTLINE OF THE PRESENTATION
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Rational of the study
Aim of the study
Methodology
Case report: Ms. S
Intervention
Results
Conclusion

3. RATIONALE OF THE STUDY
Nowadays, schizophrenia is one of the most important
disabling mental disorders in the world. The
neurobehavioral deficits underlying schizophrenia
places a considerable amount of limitation on the
activities of daily living and social skills.
Occupational therapy is considered to be the most
essential
treatment
for
rehabilitation
and
mainstreaming of schizophrenic patients. A number of
researches have been carried out in the west regarding
the efficacy of occupational therapy, however there is a
dearth of research in this sphere in the Indian context.

4. AIM OF THE STUDY
To assess the efficacy of occupational therapy on
neurobehavioral deficits, activities of daily living (ADL)
and social skills of schizophrenia.

5. METHODOLOGY

6. Sample
It was a single case study and the patient , Ms. S
diagnosed with “undifferentiated schizophrenia” as per
ICD-10 DCR criteria was chosen for the study from
Ranchi Institute of Neuro-Psychiatry and Allied
Sciences, Kanke, Ranchi.

7. Tools
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Socio-demographic and clinical data sheet
Arnadottir OT-ADL Neurobehavioral Evaluation (AONE), Árnadóttir, 1990
Cognitive symptoms checklist (CSC), O’Hara et
al,1993
Social skills checklist (SSC), Bellack et al, 2004

8. Procedure
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At first the socio-demographic and clinical details were
recorded and Informed consent was taken from the
patient selected for the study.
Then the baseline assessment was done. For this
purpose first, the AONE was administered early in the
morning by observing the patients daily activities in
their wards. This tool was administered to assess the
underlying neurobehavioral deficits and ADL of the
patients.

9. Then cognitive symptoms checklist was administered to
assess the underlying cognitive deficits in the patients.
Following this the social skills checklist was
administered observing the behaviour of the patients in
the ward.
 Then the intervention programme was started using
an occupational therapy module specially designed to
suit the need of the patient. For this purpose the patient
was engaged in the female OT section of RINPAS. The
intervention period was for three months during which
the patient was under thorough supervision.

10. 
After the intervention programme, the post assessment
was done to determine the effect of the intervention on
the patient. For this purpose the AONE, cognitive
symptoms checklist and the social skills checklists
were re-administered upon the patient. Then the
protocols of pre and post assessment were scored and
subjected to analysis.

11. CASE REPORT: Ms. S

12. Sociodemographic details
Ms. S, 40 yrs old female, Hindu, graduate, unmarried,
hailing from urban area of West Bengal, belonging to
middle socioeconomic status, diagnosed with
undifferentiated schizophrenia, with a long history of
illness for the past 20 years, has been admitted in
RINPAS female section since the last 1 year.

13. Symptoms (Ms. S)
Positive
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Hallucinations (auditory)
Delusions - paranoid
Thought broadcasting
Negative
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Emotional blunting
Social withdrawal
Lack of motivation

14. Phases of illness (Ms. S)
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‘Prodromal’ period began in Ms. S’s early 20’s
Recent acute phase leading to hospital admission
Now in ‘4th phase/residual’ – following resolution of the
acute phase and previous ‘relapses’
Ms. S adheres well to her medication but response to
medications was poor.

15. Impact of illness on Ms. S’s
Functional Ability

Attention: Ability to focus on specific aspects of the
environment while excluding others (often distracted
and unable to stay on task)
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Executive functions: Planning and problem solving
(deficits in planning, sequencing of actions)

16. INTERVENTION

17. Module
A module was designed to cater to the individual need of
Ms. S. It included the following components:
 Psychoeducation
 Activity scheduling
 Motivation enhancement
 Group meeting
 Activity analysis and occupational engagement.
 Positive reinforcement
 Constant supervision
 Feedback

18. Choice of Activity
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The choice of activity for Mrs. S was knitting and
embroidery.
She had immense interest in knitting and embroidery
and since her adolescent days she had been stitching
her own dresses. She always wanted to own her own
boutique.

19. Activity Analysis – Graded
approach

Stage 1 – Building therapeutic relationship : Explore Ms. S’s goals and ability
and discuss safety issues
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Stage 2 – Quick knitting tasks: ask Ms. S to make simple knitting

Stage 3 – Longer knitting tasks Once Ms. S can make simple knitting
independently, she is asked to make comparatively more complicated knitting.

Stage 4 – knitting Independently with observation Ms. S makes simple knitting
(as per stage 1) with no assistance from OT. Once mastered this, makes complex
knitting without assistance.

Stage 5 – Kniting Independently Ms. S engages in knitting independently

20. Duration of intervention
Ms. S received occupational therapy for three months
during which she attended OT regularly 9:30 am to12
noon.

21. RESULTS

22. Intervention results for AONE
DEFICIT DOMAIN AT
THE TIME OF PREINTERVENTION
BEFORE
INTERVENTION
Neurobehavioral deficits Motor apraxia (mild)
AFTER
INTERVENTION
Absent
Organizing and
sequencing problem
(moderate)
Activities of daily living
Present (mild)
Dressing (mild)
Absent
Grooming hygiene
(moderate)
Absent
Communication (mild)
Absent

23. Intervention results for CSC
DEFICIT DOMAINS AT
TIME OF PREINTERVENTION
% IMPAIRMENT
PRESENT BEFORE
INTERVENTION
% IMPAIRMENT
PRESENT AFTER
INTERVENTION
Attention and
concentration
73
58
Executive functions
69
52
language
11
0

24. Intervention results for SSC
DEFICIT DOMAIN AT
TIME OF PREINTERVENTION
BEFORE
INTERVENTION
AFTER
INTERVENTION
Initiates conversation
Present (impairment)
Absent
Has social contact with
other people
Present (impairment)
Absent
Maintains at least one
close relationship
Present (impairment)
Present
Express positive
feelings
Present (impairment)
Present

25. CONCLUSION
Thus, we can conclude from the findings of this study that
occupational therapy is effective in schizophrenia for
considerably improving neurobehavioral deficits,
activities of daily living and social skills.
Occupational therapy being a client centred approach
uses occupation as a therapeutic means to help
patients achieve functional autonomy and thereby
adding meaning and purpose to their life. However,
further research needs to be done upon a larger
population and patients suffering from other psychiatric
disorders as well.

26. “The man, through the use of his hands as
energized by mind and will, can influence the state
of his own health”
-Reilly, 1962

27. THANK YOU FOR YOUR PATIENT
AUDIENCE