Telerehabilitation during COVID-19: Experiences in service delivery from South India

Abstract

Dear Editor: The entire world is waging a battle to combat the threat of Corona virus,[1] the biggest healthcare challenge of our times; the people with visual impairment are no exception. The World Health Organization (WHO) cautioned that they are more vulnerable due to vision-related challenges in enacting social distancing and the need to touch things to obtain information from the environment or for physical support.[2] The compounded challenges of meeting both living needs and disability-linked needs make their living even harder in this crisis than it is for other sighted individuals. Hence, the WHO recommends immediate attention and action by key stakeholders to provide support to this vulnerable group.[2] Being a collaborative partner of WHO, the Institute for Vision Rehabilitation at LV Prasad Eye Institute, Hyderabad, South India, is addressing this concern through a telerehabilitation approach. Experiences from this model can be adopted by other organizations to deliver vision rehabilitation. The framework The WHO International Classification of Functioning, Disability, and Health (ICF) framework describes the effect of health problems relating to (a) body functions and body structures, (b) activities, (c) participation, and (d) contextual: both environmental and personal factors.[3] Addressing all of these components are important as anyone can interact with another. The ICF framework is used by a team of professionals including optometrists, counselors, special educators, therapists, computer instructors, digital librarians, and community workers to deliver services. The initiatives Counseling for mental well-being: The mental health effects of COVID-19 are important to address as are the physical health effects, hence stabilizing the mental well-being of people is given a high priority Information and resources: The WHO protocol on every aspect of COVID -19 preventive measures are addressed. They are also updated with information on special announcements on relaxations as applicable to their respective districts and states Financial support: The ex-gratia amount of INR. 1,000/- by the central government for PWDs is meager and grossly inadequate for their needs. Upon understanding the situation, financial support is extended through a coordinated effort from generous volunteers Therapeutic intervention for children with multiple disabilities: Continuity of intervention is important to minimize potential developmental delays in visual, cognitive, social/emotional, communication, adaptive, and physical areas. To ensure the continuity of training, the parents are encouraged to handle their children under the close guidance and supervision of therapists through a video call Training program for young adults: Using social platforms such as Skype, Zoom, and WhatsApp, several online classes are conducted for young adults who are students and at working age. The session includes training on mobile and computer-assistive technologies, web accessibility guidelines, access to books through Bookshare and Sugamayapusthakalu, personality development, improving writing skills, public speaking, etc. Talent hunt: Engaging children who are visually impaired during lockdown is one of the most difficult challenges expressed by many parents. To help these children keep up their spirit, a series of competitions such as singing, dancing, mimicking, storytelling, fancy dress up, creative writing talks on given topics, etc., is been organized more and more Helpline: From day one of the lockdown, the Helpline is active in attending and resolving the concerns raised by PWDs and their families. An average of 25 calls are attended each day and the counselors are available to support any in need Digital library: From the vast collection of library books from art, drama, history, economics, geography, literature, and academics, the books are issued as per individual choice. Competitive materials, children's stories, knowledge banks, vocabulary building, and English grammar are the commonly requested books by most students. The support system Volunteers are an integral part of LVPEI's rehabilitation activities. Over 250 volunteers joined hands in supporting the rehabilitation efforts in this difficult hour. Their compassion and empathy resonate much stronger in activities such as voice lending, content development, fundraising, translation of educational materials, classes on personality development, judging competitions, developing podcasts, and much more. The challenges The Rights of Persons with Disabilities Act (RPWD) 2016 emphasizes the provision of equal protection and safety in situations of risk, armed conflict, humanitarian emergencies, and natural disasters to be provided to PWDs.[4] However, lapses in effective implementation of this act is reported earlier and is seen in the current crisis too. They are facing several challenges and hardship during this lockdown period. To list a few, While social distancing has been widely promoted as the best strategy to avoid transmission, several parents have raised concerns in following this advice, especially by parents who care for their children with multiple disabilities, who require therapy or assistance with daily tasks The cumbersome procedures made it hard in accessing the welfare schemes by many of them especially by single parents with disabled children, those married to spouses who also have a disability, and those who have children or elderly parents who also require assistance Many of them could not make use of the services as they could not produce disability cards for verification. When the lockdown emergency was announced, their focus was to get back to their native villages as quickly as possible. Therefore, they did not even think of carrying their disability card Nutritionists suggest a healthy diet to help boost the immune system. But in many families with PWDs at least one guaranteed meal per day is expressed uncertainly. The impact of poor nutrition situation is expressed worst among those with existing comorbidities such as diabetes, hypertension, and medical conditions Many PWDs expressed their fear of losing a job with an assumption the job priority may be given to the sighted over people with vision impairment, especially for those working in the private sector on a contract basis. Experiences from this model prove that the telerehabilitation influenced by the combined efforts of families and therapists is successful in ensuring the continuity of rehabilitation intervention in the prevailing situation. The experiences, challenges, and perceptions of the children and adults with vision impairment and their family members are important and valuable which require serious thought on policy and action.