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What are the stages of coma?This is a very educational page:Understanding Stages of Coma - Rainbow Rehabilitation CentersUnderstanding Stages of ComaThree stages of comaOften lumped under the label of “Coma” are three stages of disordered consciousness. Disorders of Consciousness (DOC) are a set of disorders that effect a person’s ability to be awake. DOC includes coma, the vegetative state (VS) and the minimally conscious state (MCS). These disorders (see sidebar at right for further information about each of these stages) are among the most misunderstood conditions in medicine.1 Published estimates of doctors making mistakes among people with disorders of consciousness range from 15%-43%.2,3,4Coma – the battle to surviveA coma is a state of unconsciousness when a person cannot be wakened with touch or noise. The inability to waken makes coma different from sleep. It is the length of time that a person remains in coma that has commonly been used to label the severity of a person’s brain injury.What causes a coma is an area of great interest. The brain stem is often injured. The brain stem processes automatic, unconscious controls (often called the vegetative functions) of the body including heart rate, blood pressure, body temperature, and breathing. The reticular activating system (RAS) is located within the brain stem, and is the important “on/off” switch for consciousness and sleep.To be awake, the RAS and at least one cerebral hemisphere (we have two) must be functioning.If a person loses consciousness, either the RAS has stopped working, or both cerebral hemispheres have shut down.The reticular activating system stops working in two situations:When there is brain stem bleeding or loss of oxygen. This shuts off the reticular activating system.When there is swellingin the brain. The skull is a rigid box that protects the brain. Unfortunately, if the brain is injured and begins to swell, there is no room. Increased pressure within the brain (increased intracranial pressure) causes compression of the brain tissue against the skull bones. This swelling can affect other parts of the brain.If the intracranial pressure continues to increase without being treated, the brain will continue to swell until it pushes down through the opening at base of the skull. This damages the brain stem where the reticular activating system is located. This also damages the breathing and blood pressure control centers of the brain and can be the reason for death in the hours or days after injury.The Battle to Survive – Acute Care Treatment of Coma from SwellingWhen the members of the medical trauma team are concerned about swelling of the brain, an intracranial pressure monitor may be placed inside the skull to read the pressure inside. A small hole is drilled into the skull and the monitor tip is placed inside the skull. Or, surgeons may temporarily remove a portion of the skull to minimize the risk of further injury to the brain due to the pressure. Later, sometimes months later, the skull is repaired through a surgery called a “cranioplasty”.Doctors may also give medications to “induce” a coma if they are worried about brain swelling. Medications can be injected similar to providing a general anesthetic. An induced coma is used to decrease intracranial pressure and to rest the brain. An induced coma can make it difficult to use the Glasgow Coma Scale as a predictor of TBI severity.Hospital staff may ask family members and friends to be very quiet when visiting when there is a concern about high pressure spikes in the brain. The lighting of the room may be kept low and the room kept cool. This is called “keeping the stimulation low” so that the brain can rest and recover.Coma usually evolves into the vegetative state or a higher level of consciousness within two to four weeks for those who survive. 5,6After Coma; Vegetative State and Minimally conscious States – Waiting for signs of improvementThere have been improvements in taking pictures of the brain and measuring the electrical activity of the brain in the last five years. The results of new studies, and the well-documented reports of recovery months after the initial injury, challenge the long held view that people with long periods on unconsciousness cannot recover. Cases of late recovery point to the remarkable plasticity of the human brain and its potential for long-term recovery.1The Vegetative State (VS) and the Minimally Conscious State (MCS) are stages on consciousness that can follow coma. They are different stages. The person’s awareness of their surroundings and prognosis (ability to recover) is different for VS and MCS.■ The vegetative state can be a temporary or long-term state following coma in persons who have experienced TBI. Both the terms “persistent” and “permanent” are controversial, with a practice guideline that the term “permanent” not be used until the VS state has lasted 12 months.7 Persons in VS may move in a non-purposeful manner and may smile, grimace, have tears in their eyes, and may moan. Individuals in VS generally do not follow people or objects with their eyes or remain visually focused on people or objects. If a person can keep eye contact or follow movement with their eyes, it can often mean that the person is transitioning to MCS. Some people in VS have episodes of “autonomic storming” (refer to separate article in Visions). A sleep/wake pattern is reestablished and the “vegetative functions” of breathing, body temperature regulation start to normalize.Prognosis for Recovery after months in a VS stage: In the TBI population, 35% of individuals who remain in VS for 3 months will recover consciousness by 12 months post-injury. Among this group, 20% will be left with severe disability, while the remaining 15% will have a moderate to good outcome.1Persons with MCS retain the brain functioning responsible for understanding language, despite their inability to communicate reliably. Persons may have a delayed and an inconsistent way that they respond to “yes” and “no” questions. Persons may show different emotional response when loved ones are present. He/she may show different facial expressions depending on the topic of conversation and may laugh or cry. The storage of new memories and short term memory (knowing what day it is, knowing who visited yesterday) is thought to be impaired thought it is difficult to measure.Prognosis for Recovery after months in a MCS stage: The recovery for this population is slow and long. In the MCS group, 50% will have moderate to severe disability while 27% will have mild to moderate disability.8,9Rehabilitation for People Who are Slow to Regain ConsciousnessHospitals will start discharge planning as soon as life-threatening medical problems have resolved. People who are in a VS or MCS when they become stable medically (despite the fact that they still may have tubes) will need to leave the hospital.There is no doubt that people who experience severe TBI need rehabilitation after their hospital stay. And chances are good that further recovery will occur. Choices of where to go next could be a rehabilitation facility (like Rainbow), a skilled nursing facility, or home with 24 hour family/caregiver assistance. In some instances, a person who is VS or MCS may be admitted to a rehab hospital for a short stay (2-4 weeks) for family teaching and the development of needed rehab equipment.Rehabilitation for persons at this stage of recovery takes into consideration their unconsciousness and/or memory problems.Rehabilitation and nursing goals can include:To establish a normal pattern of being up and out of bed with the right wheelchairTo start sitting on the edge of the bed or matt and using a tilt table or standing table to put weight on feetTo get good nutrition for healing through a tubeTo move and position the injured person regularly so that skin stays healthyTo establish a “yes”/”no” system through movement of eyes or mouth or hands or feetTo work on swallowing, a prerequisite of eating, and to keep lungs clear and healthyTo combat abnormal muscle spasticity that can occur when the brain is injured which can cause joints to get tightTo use medications and therapy that could improve wakefulness/arousalDiagnostic CriteriaComaAll of the following criteria must be evident on bedside examination:No eye opening and absence of sleep-wake cycles on EEG.No evidence of purposeful motor activity.No response to command.No evidence of language comprehension or expression.Inability to discretely localize noxious stimuli.2. Vegetative StateAll of the following criteria must be evident on bedside examination:No evidence of awareness of self or environment.No evidence of sustained, reproducible, purposeful, or voluntary behavioral responses to visual, auditory, tactile, or noxious stimuli.No evidence of language comprehension or expression.Intermittent wakefulness manifested by the presence of sleep-wake cycles.Sufficiently preserved hypothalamic and brain-stem autonomic functions to permit survival with medical and nursing care.Bowel and bladder incontinence.Variably preserved carian-nerve reflexes and spinal reflexes.3. Minimally Conscious StateAt least one of the following criteria must be clearly evident on bedside examination: 1Simple command following.Gestural or verbal yes/no responses.Intelligible verbalization.Movements or affective behaviors that occur in contingent relation to relevant environmental stimuli and are not attributable to reflexive activity. Any of the following examples provide sufficient evidence for this criterion:Pursuit eye movement or sustained fixation that occurs in direct response to moving or salient stimuli.Episodes of crying, smiling, or laughter in response to the linguistic or visual content of emotional but not neutral topics or stimuli.Vocalizations or gestures that occur in direct response to the linguistic content of comments or questions.Reaching for objects that demonstrates a clear relationship between object location and direction of reach.Touching or holding objects in a manner that accommodates the size and shape of the object.Tools used to measure level of consciousness (10)Since consciousness cannot be directly measured, clinicians must observe behavior and draw conclusions about an individual’s underlying state of consciousness. Those observations are then used to fill out measurement scales. Different scales are used in different settings. Two measurement scales that are important to life saving, establishing a prognosis, and tracking recovery are as follows:The Glasgow Coma Scale is used at the scene of the accident, in the Emergency Department, and during the life saving hospital stay. It is a useful scale for doctors and nurses who want to track improvements in brain recovery or predict recovery. A sudden decline in being awake can mean that the brain pressure is changing for the worse or that there may be an area of bleeding in the brain that needs attention. An increase in the number means that the brain is getting better. The Glasgow Coma Scale is rarely used after the initial hospital stay.Glasgow Coma ScaleEye OpeningSpontaneous 4To loud voice 3To pain 2None 1Verbal ResponseOriented 5Confused, disoriented 4Inappropriate words 3Incomprehensible words 2None 1Motor ResponseObeys commands 6Localizes pain 5Withdraws from pain 4Abnormal flexion posturing 3Extensor posturing 2None 1A fully conscious patient has a Glasgow Coma Score of 15.A person in a deep coma has a Glasgow Coma Score of 3 (there is no lower score).The Rancho Level of Cognitive Functioning Scale (LCFS) is a scale used to assess cognitive functioning in people with brain injury.11 The first three levels are similar to the stages of coma, VS, and MCS. This scale is most often used in the first year after brain injury. This scale is available for free in its complete form at : Level of Cognitive Functioning ScaleLevel ExplanationI – No response Patient appears to be in a deep sleep and is completely unresponsive to external stimuli. COMAII – Generalized Patient reacts inconsistently and non-purposefully to stimuli in a non-specific manner. Responses are limited in nature and are often the same regardless of stimulus presented. Responses may be physiological changes, gross body movements, and/or vocalization. Often the earliest response is to deep pain. Responses are likely to be delayed. VEGETATIVE STATEIII – Localized Patient reacts specifically but inconsistently to stimuli. Responses are directly related to the type of stimulus presented, as in turning head toward a sound or focusing on an object presented. The patient may withdraw an extremity and/or vocalize when presented with a painful stimulus. Simple commands may be followed in an inconsistent, delayed manner, such as closing eyes, squeezing or extending an extremity. Once external stimulus is removed, the patient may lie quietly. A vague awareness of self and body may be shown by responses to discomfort produced by pulling at tube. Bias may be shown by responding to some persons (especially family/friends) but not to others. MINIMALLY CONSCIOUS STATEReferencesBerube J, Fins, J, Giacino J, et al. The Mohonk Report: A Report to Congress. Disorders of Consiousness: Assessment, Treatment, and Research Needs. 2011.Tresch DD, Sims FH, Duthie EH, Goldstein, MD, Lane PS. Clinical characteristics of patients in the persistent vegetative state. Arch Internal Med. 1991;151:930-932.Childs NL, Mercer WN, Childs HW. (1993). Accuracy of diagnosis of persistent vegetative state. Neurol, 43:1465-1467.Andrews K, Murphy L, Munday R, Littlewood C. Misdiagnosis of the vegetative state: Retrospective study in a rehabilitation unit. BMJ. 1996; 313:13-16.Plum F, Posner J. The diagnosis of stupor and coma, 3rd Edition. Philadelphia: F.A. Davis. 1982.Multi-Society Task Force on the Persistent Vegetative State. Medical aspects of the persistent vegetative state, part I. N Engl J Med. 1994; 330:1499-1508.American Academy of Neurology. Practice parameter: Assessment and management of persons in the persistent vegetative state. Neurol. 1995; 45:1015-1018.Giacino JT, Kalmar K. The vegetative and minimally conscious states: A comparison of clinical features and functional outcome. J Head Trauma Rehabil. 1997; 12(4):36-51.Whyte J, Katz D, Long D, et al. Predictors of outcome in prolonged posttraumatic disorders of consciousness and assessment of medication effects: A multicenter study. Arch Phys Med Rehabil. 2005; 86: 453-462.Huff JS, Martin ML. Altered mental status and coma. In: Worlfson AB, Hendey GW, Ling LJ, et al., eds. Harwood-Nuss’ Clinical Practice of Emergency Medicine. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009: chap 14.Hagen C, Malkmus D, Durham P. Levels of cognitive functioning. Downey (CA): Rancho Los Amigos Hospital; 1972.

An occupational therapist works systematically with a client through a sequence of actions called the occupational therapy process. There are several versions of this process as described by numerous scholars. All practice frameworks include the components of evaluation (or assessment), intervention, and outcomes. This process provides a framework through which occupational therapists assist and contribute to promoting health and ensures structure and consistency among therapists.The Occupational Therapy Practice Framework (OTPF) is the core competency of occupational therapy in the United States. The OTPF framework is divided into two sections: domain and process. The domain includes environment, client factors, such as the individual's motivation, health status, and status of performing occupational tasks. The domain looks at the contextual picture to help the occupational therapist understand how to diagnose and treat the patient. The process is the actions taken by the therapist to implement a plan and strategy to treat the patient.Occupational therapists work with infants, toddlers, children, youth, and their families in a variety of settings, including schools, clinics, homes, hospitals, and the community.Assessment of a person's ability to engage in daily, meaningful occupations is the initial step of occupational therapy (OT) intervention and involves evaluating a young person's occupational performance in areas of feeding, playing, and socializing daily living skills, or attending school.Occupational therapists take into consideration the strengths and weaknesses of a child's underlying skills which may be physical, cognitive, or emotional in nature, as well as the context and environmental demands at play. In planning treatment, occupational therapists work in collaboration with parents, caregivers, teachers, or the children and teens themselves in order to develop functional goals within a variety of occupations meaningful to the young client. Early intervention is an extremely important aspect of the daily functioning of a child between the ages of birth-3 years old. This area of practice sets the tone or standard for therapy in the school setting. OT's who practice in early intervention develop a family's ability to care for their child with special needs and promote his or her function and participation in the most natural environment as possible. Each child is required to have an Individualized Family Service Plan (IFSP) that focuses on the family's goals for the child. It's possible for an OT to serve as the family's service coordinator and facilitate the team process for creating an IFSP for each eligible child.Objectives that an occupational therapist addresses with children and youth may take a variety of forms.For example:Providing splinting and caregiver education in a hospital burn unit.Facilitating handwriting development by providing intervention to develop fine motor and writing readiness skills in school-aged children.Providing individualized treatment for sensory processing.Teaching coping skills to a child with Generalized Anxiety Disorder.Consulting with teachers, counselors, social workers, parents/ caregivers, or any person that works with children regarding modifications, accommodations, and supports in a variety of areas, such as sensory processing, motor planning, visual processing sequencing, transitions between schools, etc.Instructing caregivers in regard to mealtime intervention for children with autism who have feeding difficulties.In the United States, pediatric occupational therapists work in the school setting as a "related service" for children with an Individual Education Plan (IEP).Every student who receives special education and related services in the public school system is required by law to have an IEP, which is a very individualized plan designed for each specific student (U.S. Department of Education, 2007).Related services are “developmental, corrective, and other supportive services as are required to assist a child with a disability to benefit from special education,” and include a variety of professions such as speech-language pathology and audiology services, interpreting services, psychological services, and physical and occupational therapy.As a related service, occupational therapists work with children with varying disabilities to address those skills needed to access the special education program and support academic achievement and social participation throughout the school day (AOTA, n.d.-b). In doing so, occupational therapists help children fulfill their role as students and prepare them to transition to post-secondary education, career, and community integration (AOTA, n.d.-b).Occupational therapists have specific knowledge to increase participation in school routines throughout the day, including:Modification of the school environment to allow physical access for children with disabilitiesProvide assistive technology to support student successHelping to plan instructional activities for implementation in the classroomSupport the needs of students with significant challenges such as helping to determine methods for alternate assessment of learningHelping students develop the skills necessary to transition to post-high school employment, independent living or further education (AOTA).Other settings, such as homes, hospitals, and the community are important environments where occupational therapists work with children and teens to promote their independence in meaningful, daily activities.Outpatient clinics offer a growing OT intervention referred to as “Sensory Integration Treatment”. This therapy, provided by experienced and knowledgeable pediatric occupational therapists, was originally developed by A. Jean Ayres, an occupational therapist.Sensory integration therapy is an evidence-based practice that enables children to better process and integrate sensory input from the child's body and from the environment, thus improving his or her emotional regulation, ability to learn, behavior, and functional participation in meaningful daily activities.Recognition of occupational therapy programs and services for children and youth is increasing worldwide.Occupational therapy for both children and adults is now recognized by the United Nations as a human right which is linked to the social determinants of health. As of 2018, there are over 500,000 occupational therapists working worldwide (many of whom work with children) and 778 academic institutions providing occupational therapy instruction.Health and wellnessAccording to the American Occupational Therapy Association's (AOTA) Occupational Therapy Practice Framework, 3rd Edition, the domain of occupational therapy is described as "Achieving health, well-being, and participation in life through engagement in occupation".Occupational therapy practitioners have a distinct value in their ability to utilize daily occupations to achieve optimal health and well-being. By examining an individual's roles, routines, environment, and occupations, occupational therapists can identify the barriers in achieving overall health, well-being, and participation.Occupational therapy practitioners can intervene at primary, secondary, and tertiary levels of intervention to promote health and wellness. It can be addressed in all practice settings to prevent disease and injuries, and adopt healthy lifestyle practices for those with chronic diseases.Two of the occupational therapy programs that have emerged targeting health and wellness are the Lifestyle Redesign Progra and the REAL Diabetes Program.Occupational therapy interventions for health and wellness vary in each setting:SchoolOccupational therapy practitioners target school-wide advocacy for health and wellness including bullying prevention, backpack awareness, recess promotion, school lunches, and PE inclusion. They also heavily work with students with learning disabilities such as those on the autism spectrum.A study conducted in Switzerland showed that a large majority of occupational therapists collaborate with schools, half of them providing direct services within mainstream school settings. The results also show that services were mainly provided to children with medical diagnoses, focusing on the school environment rather than the child's disability.OutpatientOccupational therapy practitioners conduct 1:1 treatment sessions and group interventions to address: leisure, health literacy, and education, modified physical activity, stress/anger management, healthy meal preparation, and medication management.Acute careOccupational therapy practitioners conduct 1:1 treatment sessions, group interventions, and promote hospital-wide programs targeting: leisure, stress management, pain management techniques, physical activity, healthy food recommendations, and medication management.Community-basedOccupational therapy practitioners develop and implement community-wide programs to assist in the prevention of diseases and encourage healthy lifestyles by: conducting education classes for prevention, facilitating gardening, offering ergonomic assessments, and offering pleasurable leisure and physical activity programs.Mental healthThe occupational therapy profession believes that the health of an individual is fostered through active engagement in one's occupations (AOTA, 2014). When a person is experiencing any mental health need, his or her ability to actively participate in occupations may be hindered. For example, if a person has depression or anxiety, he or she may experience interruptions in sleep, difficulty completing self-care tasks, decreased motivation to participate in leisure activities, decreased concentration for school or job-related work, and avoidance of social interactions.Occupational therapy practitioners possess the educational knowledge base in mental health and can contribute to the efforts in mental health promotion, prevention, and intervention. Occupational therapy practitioners can provide services that focus on social-emotional well-being, prevention of negative behaviors, early detection through screenings, and intensive intervention (Bazyk & Downing, 2017).Occupational therapy practitioners can work directly with clients, provide professional development for staff, and work in collaboration with other team members and families. For instance, occupational therapists are specifically skilled at understanding the relationship between the demands of a task and the person's abilities.With this knowledge, practitioners are able to devise an intervention plan to facilitate successful participation in meaningful occupations. Occupational therapy services can focus on engagement in occupation to support participation in areas related to school, education, work, play, leisure, ADLs, and instrumental ADLs (Bazyk & Downing, 2017).Occupational therapy utilizes the public health approach to mental health (WHO, 2001) which emphasizes the promotion of mental health as well as the prevention of, and intervention for, mental illness. This model highlights the distinct value of occupational therapists in mental health promotion, prevention, and intensive interventions across the lifespan (Miles et al., 2010).Below are the three major levels of service:Tier 3: intensive interventionsIntensive interventions are provided for individuals with identified mental, emotional, or behavioral disorders that limit daily functioning, interpersonal relationships, feelings of emotional well-being, and the ability to cope with challenges in daily life. Occupational therapy practitioners are committed to the recovery model which focuses on enabling persons with mental health challenges through a client-centered process to live a meaningful life in the community and reach their potential (Champagne & Gray, 2011).The focus of intensive interventions (direct–individual or group, consultation) is engagement in occupation to foster recovery or “reclaiming mental health” resulting in optimal levels of community participation, daily functioning, and quality of life; functional assessment and intervention (skills training, accommodations, compensatory strategies) (Brown, 2012); identification and implementation of healthy habits, rituals, and routines to support wellness.Tier 2: targeted servicesTargeted services are designed to prevent mental health problems in persons who are at risk of developing mental health challenges, such as those who have emotional experiences (e.g., trauma, abuse), situational stressors (e.g., physical disability, bullying, social isolation, obesity) or genetic factors (e.g., family history of mental illness). Occupational therapy practitioners are committed to early identification of and intervention for mental health challenges in all settings.The focus of targeted services (small groups, consultation, accommodations, education) is engagement in occupations to promote mental health and diminish early symptoms; small, therapeutic groups (Olson, 2011); environmental modifications to enhance participation (e.g., create sensory-friendly classrooms, home, or work environments)Tier 1: universal servicesUniversal services are provided to all individuals with or without mental health or behavioral problems, including those with disabilities and illnesses (Barry & Jenkins, 2007).Occupational therapy services focus on mental health promotion and prevention for all:encouraging participation in health-promoting occupations (e.g., enjoyable activities, healthy eating, exercise, adequate sleep);fostering self-regulation and coping strategies (e.g., mindfulness, yoga);promoting mental health literacy (e.g., knowing how to take care of one's mental health and what to do when experiencing symptoms associated with ill mental health).Occupational therapy practitioners develop universal programs and embed strategies to promote mental health and well-being in a variety of settings, from schools to the workplace.The focus of universal services (individual, group, school-wide, employee/organizational level) is universal programs to help all individuals successfully participate in occupations that promote positive mental health (Bazyk, 2011);educational and coaching strategies with a wide range of relevant stakeholders focusing on mental health promotion and prevention; the development of coping strategies and resilience; environmental modifications and supports to foster participation in health-promoting occupations.Productive agingOccupational therapists work with older adults to maintain independence, participate in meaningful activities, and live fulfilling lives. Some examples of areas that occupational therapists address with older adults are driving, aging in place, low vision, and dementia or Alzheimer’s Disease (AD).When addressing driving, driver evaluations are administered to determine if drivers are safe behind the wheel. To enable the independence of older adults at home, occupational therapists perform fall risk assessments, assess clients functioning in their homes, and recommend specific home modifications. When addressing low vision, occupational therapists modify tasks and the environment.While working with individuals with AD, occupational therapists focus on maintaining the quality of life, ensuring safety, and promoting independence.Geriatrics/productive agingOccupational therapists address all aspects of aging from health promotion to the treatment of various disease processes. The goal of occupational therapy for older adults is to ensure that older adults can maintain independence and reduce health care costs associated with hospitalization and institutionalization.In the community, occupational therapists can assess older adults' ability to drive and if they are safe to do so. If it is found that an individual is not safe to drive the occupational therapist can assist with finding alternate transit options.Occupational therapists also work with older adults in their homes as part of home care. In the home, an occupational therapist can work on such things as fall prevention, maximizing independence with activities of daily living, ensuring safety, and being able to stay in the home for as long as the person wants. An occupational therapist can also recommend home modifications to ensure safety in the home.Many older adults suffer from chronic conditions such as diabetes, arthritis, and cardiopulmonary conditions. Occupational therapists can help manage these conditions by offering education on energy conservation strategies or coping strategies. Not only do occupational therapists work with older adults in their homes, but they also work with older adults in hospitals, nursing homes, and post-acute rehabilitation. In nursing homes, the role of the occupational therapist is to work with clients and caregivers on education for safe care, modifying the environment, positioning needs, and enhancing IADL skills to name a few.In post-acute rehabilitation, occupational therapists work with clients to get them back home and to their prior level of function after a hospitalization for an illness or accident. Occupational therapists also play a unique role in those with dementia. The therapist may assist with modifying the environment to ensure safety as the disease progresses along with caregiver education to prevent burnout.Occupational therapists also play a role in palliative and hospice care. The goal at this stage of life is to ensure that the roles and occupations that the individual finds meaningful continue to be meaningful. If the person is no longer able to perform these activities, the occupational therapist can offer new ways to complete these tasks while taking into consideration the environment along with physical, psychosocial, and physical needs. Not only do occupational therapists work with older adults in traditional settings they also work in senior centers and ALFs.Visual impairmentVisual impairment is one of the top 10 disabilities among American adults.Occupational therapists work with other professions, such as optometrists, ophthalmologists, and certified low vision therapists, to maximize the independence of persons with a visual impairment by using their remaining vision as efficiently as possible.AOTA's promotional goal of “Living Life to Its Fullest” speaks to who people are and learning about what they want to do, particularly when promoting the participation in meaningful activities, regardless of visual impairment.Populations that may benefit from occupational therapy include older adults, persons with traumatic brain injury, adults with the potential to return to driving, and children with visual impairments. Visual impairments addressed by occupational therapists may be characterized into 2 types including low vision or neurological visual impairment. An example of neurological impairment is a cortical visual impairment (CVI) which is defined as “...abnormal or inefficient vision resulting from a problem or disorder affecting the parts of the brain that provide sight”.The following section will discuss the role of occupational therapy when working with the visually impaired.Occupational therapy for older adults with low vision includes task analysis, environmental evaluation, and modification of tasks or the environment as needed. Many occupational therapy practitioners work closely with optometrists and ophthalmologists to address visual deficits in acuity, visual field, and eye movement in people with traumatic brain injury, including providing education on compensatory strategies to complete daily tasks safely and efficiently. Adults with a stable visual impairment may benefit from occupational therapy for the provision of a driving assessment and an evaluation of the potential to return to driving. Lastly, occupational therapy practitioners enable children with visual impairments to complete self-care tasks and participate in classroom activities using compensatory strategies.Adult rehabilitationOccupational therapists address the need for rehabilitation following an injury or impairment. When planning treatment, occupational therapists address the physical, cognitive, psychosocial, and environmental needs involved in adult populations across a variety of settings.Occupational therapy in adult rehabilitation may take a variety of forms:Working with adults with autism at day rehabilitation programs to promote successful relationships and community participation through instruction on social skills.Increasing the quality of life for an individual with cancer by engaging them in occupations that are meaningful, providing anxiety and stress reduction methods, and suggesting fatigue management strategiesCoaching individuals with hand amputations how to put on and take off a myoelectrically controlled limb as well as training for functional use of the limbAs for paraplegics, there are such things as sitting cushion and pressure sore prevention. Prescription of these aids is a common job for paraplegics.Using and implementing new technology such as speech to text software and Nintendo Wii video gamesCommunicating via tele-health methods as a service delivery model for clients who live in rural areasWorking with adults who have had a stroke to regain their activities of daily livingAssistive technologyOccupational therapy practitioners or OTs are uniquely poised to educate, recommend, and promote the use of assistive technology to improve the quality of life for their clients. OTs are able to understand the unique needs of the individual in regard to occupational performance and have a strong background in activity analysis to focus on helping clients achieve goals. Thus, the use of varied and diverse assistive technology is strongly supported within occupational therapy practice models.Travel occupational therapyBecause of the rising need for occupational therapy practitioners in the U.S., many facilities are opting for travel occupational therapy practitioners—who are willing to travel, often out of state, to work temporarily in a facility. Assignments can range from 8 weeks to 9 months, but typically last 13–26 weeks in length.Travel therapists work in many different settings, but the highest need for therapists is in home health and skilled nursing facility settings.There are no further educational requirements needed to be a travel occupational therapy practitioner; however, there may be different state licensure guidelines and practice acts that must be followed.According to Zip Recruiter, as of July 2019, the national average salary for a full-time travel therapist is $86,475 with a range between $62,500 to $100,000 across the United States.Most commonly (43%), travel occupational therapists enter the industry between the ages of 21–30.Occupational justiceThe practice area of occupational justice relates to the “benefits, privileges, and harms associated with participation in occupations” and the effects related to access or denial of opportunities to participate in occupations. This theory brings attention to the relationship between occupations, health, well-being, and quality of life.Occupational justice can be approached individually and collectively. The individual path includes disease, disability, and functional restrictions. The collective way consists of public health, gender, and sexual identity, social inclusion, migration, and the environment.The skills of occupational therapy practitioners enable them to serve as advocates for systemic change, impacting institutions, policy, individuals, communities, and entire populations.Examples of populations that experience occupational injustice include refugees, prisoners, homeless persons, survivors of natural disasters, individuals at the end of their life, people with disabilities, elderly living in residential homes, individuals experiencing poverty, children, immigrants, and LGBTQI+ individuals.For example, the role of an occupational therapist working to promote occupational justice may include:Analyzing tasks, modifying activities, and environments to minimize barriers to participation in meaningful activities of daily living.Addressing physical and mental aspects that may hinder a person's functional ability.Provide intervention that is relevant to the client, family, and social context.Contribute to global health by advocating for individuals with disabilities to participate in meaningful activities on a global level. Occupation therapists are involved with the World Health Organization (WHO), non-governmental organizations and community groups, and policymaking to influence the health and well-being of individuals with disabilities worldwideOccupational therapy practitioners’ role in occupational justice is not only to align with perceptions of procedural and social justice but to advocate for the inherent need of meaningful occupation and how it promotes a just society, well-being, and quality of life among people relevant to their context. It is recommended to the clinicians to consider occupational justice in their everyday practice to promote the intention of helping people participate in tasks that they want and need to do.Occupational injusticeIn contrast, occupational injustice relates to conditions wherein people are deprived, excluded, or denied opportunities that are meaningful to them.Types of occupational injustices and examples within the OT practice include:Occupational deprivation: The exclusion from meaningful occupations due to external factors that are beyond the person's control. As an example, a person who has difficulties with functional mobility may find it challenging to reintegrate into the community due to transportation barriers.Occupational apartheid: The exclusion of a person in chosen occupations due to personal characteristics such as age, gender, race, nationality, or socioeconomic status. An example can be seen in children with developmental disabilities from low socioeconomic backgrounds whose families would opt-out from therapy due to financial constraints.Occupational marginalization: Relates to how implicit norms of behavior or societal expectations prevents a person from engaging in a chosen occupation. As an example, a child with physical impairments may only be offered table-top leisure activities instead of sports as an extracurricular activity due to the functional limitations caused by his physical impairments.Occupational imbalance: The limited participation in a meaningful occupation brought about by another role in a different occupation. This can be seen in the situation of a caregiver of a person with a disability who also has to fulfill other roles such as being a parent to other children, a student, or a worker.Occupational alienation: The imposition of an occupation that does not hold meaning for that person. In the OT profession, this manifests in the provision of rote activities which does not really relate to the goals or the interest of the client.Within occupational therapy practice, injustice may ensue in situations wherein professional dominance, standardized treatments, laws, and political conditions create a negative impact on the occupational engagement of our clients.Awareness of these injustices will enable the therapist to reflect on his own practice and think of ways in approaching their client's problems while promoting occupational justice.Community-based therapyAs occupational therapy (OT) has grown and developed, the community-based practice has blossomed from an emerging area of practice to a fundamental part of occupational therapy practice (Scaffa & Reitz, 2013).Community-based practice allows for OTs to work with clients and other stakeholders such as families, schools, employers, agencies, service providers, stores, day treatment and daycare, and others who may influence the degree of success the client will have in participating. It also allows the therapist to see what is actually happening in the context and design interventions relevant to what might support the client in participating and what is impeding her or him from participating.Community-based practice crosses all of the categories within which OTs practice from physical to cognitive, mental health to spiritual, all types of clients may be seen in community-based settings. The role of the OT also may vary, from advocate to consultant, direct care provider to program designer, adjunctive services to the therapeutic leader.EducationWorldwide, there is a range of qualifications required to practice as an occupational therapist or occupational therapy assistant. Depending on the country and expected level of practice, degree options include associate degree, Bachelor's degree, entry-level master's degree, post-professional master's degree, entry-level Doctorate (OTD), post-professional Doctorate (OTD), Doctor of Clinical Science in OT (CScD), Doctor of Philosophy in Occupational Therapy (PhD), and combined OTD/PhD degrees.Both occupational therapist and occupational therapy assistant roles exist internationally. Currently, in the United States, dual points of entry exist for both OT and OTA programs. For OT, that is an entry-level Masters or entry-level Doctorate. For OTA, that is an associate degree or bachelor's degree.The World Federation of Occupational Therapists (WFOT) has minimum standards for the education of OTs, which was revised in 2016. All of the educational programs around the world need to meet these minimum standards. These standards are subsumed by and can be supplemented with academic standards set by a country's national accreditation organization.As part of the minimum standards, all programs must have a curriculum that includes practice placements (fieldwork). Examples of fieldwork settings include acute care, inpatient hospital, outpatient hospital, skilled nursing facilities, schools, group homes, early intervention, home health, and community settings.The profession of occupational therapy is based on a wide theoretical and evidence-based background. The OT curriculum focuses on the theoretical basis of occupation through multiple facets of science, including occupational science, anatomy, physiology, biomechanics, and neurology. In addition, this scientific foundation is integrated with knowledge from psychology, sociology, and more.In the United States, Canada, and other countries around the world, there is a licensure requirement. In order to obtain an OT or OTA license, one must graduate from an accredited program, complete fieldwork requirements, and pass a national certification examination.Theoretical frameworksA distinguishing facet of occupational therapy is that therapists often espouse the use of theoretical frameworks to frame their practice. Nonetheless, many have also argued that the use of theory complicates everyday clinical care and is not necessary to provide patient-driven care.Note that terminology differs between scholars. An incomplete list of theoretical bases for framing a human and their occupations include the following:Generic modelsGeneric models are the overarching title given to a collation of compatible knowledge, research, and theories that form conceptual practice.More generally they are defined as "those aspects which influence our perceptions, decisions, and practice".Person-Environment Occupation Performance ModelThe Person Environment Occupation Performance model (PEOP) was originally published in 1991 (Charles Christiansen & M. Carolyn Baum] and describes an individual's performance based on four elements including environment, person, performance, and occupation. The model focuses on the interplay of these components and how this interaction works to inhibit or promote successful engagement in occupation.Occupation-Focused Practice ModelsOccupational Therapy Intervention Process Model (OTIPM) (Anne Fisher and others)Occupational Performance Process Model (OPPM)Model of Human Occupation (MOHO) (Gary Kielhofner and others) MOHO was first published in 1980. It explains how people select, organize, and undertake occupations within their environment. The model is supported by evidence generated over thirty years and has been successfully applied throughout the world.Canadian Model of Occupational Performance and Engagement (CMOP-E)Occupational Performances Model – Australia (OPM-A) (Chris Chapparo & Judy Ranka)The OPM(A) was conceptualized in 1986 with its current form launched in 2006. The OPM(A) illustrates the complexity of occupational performance, the scope of occupational therapy practice, and provides a framework for occupational therapy education.Kawa (River) Model (Michael Iwama)The Biopsychosocial ModelThe biopsychosocial model takes into account how disease and illness can be impacted by social, environmental, psychological, and body functions. The biopsychosocial model is unique in that it takes the client's subjective experience and the client-provider relationship as factors to wellness. This model also factors in cultural diversity as many countries have different societal norms and beliefs. This is a multifactorial and multi-dimensional model to understand not only the cause of disease but also a person-centered approach that the provider has more of a participatory and reflective role.Frames of referenceFrames of reference are an additional knowledge base for the occupational therapist to develop their treatment or assessment of a patient or client group. Though there are conceptual models (listed above) that allow the therapist to conceptualize the occupational roles of the patient, it is often important to use a further reference to embed clinical reasoning. Therefore, many occupational therapists will use additional frames of reference to both assess and then develop therapy goals for their patients or service users.As with the conceptual models discussed above, these frames of reference are used infrequently in routine clinical practice, and often obfuscate clinical decision-making. ,Biomechanical frame of reference. The biomechanical frame of reference is primarily concerned with motion during occupation. It is used with individuals who experience limitations in movement, inadequate muscle strength, or loss of endurance in occupations. The frame of reference was not originally compiled by occupational therapists, and therapists should translate it to the occupational therapy perspective, to avoid the risk of movement or exercise becoming the main focus.Rehabilitative (compensatory)Neurofunctional (Gordon Muir Giles and Clark-Wilson)Dynamic systems theoryThe client-centered frame of reference this frame of reference is developed from the work of Carl Rogers. It views the client as the center of all therapeutic activity, and the client's needs and goals direct the delivery of the occupational therapy process.Cognitive-behavioural frame of referenceEcology of the human performance modelThe recovery modelThe sensory integration framework is commonly implemented in clinical, community, and school-based occupational therapy practice. It is most frequently used with children with developmental delays and developmental disabilities such as autism spectrum disorder and dyspraxia.Core features of sensory integration in treatment include providing opportunities for the client to experience and integrate feedback using multiple sensory systems, providing therapeutic challenges to the client's skills, integrating the client's interests into therapy, organizing of the environment to support the client's engagement, facilitating a physically safe and emotionally supportive environment, modifying activities to support the client's strengths and weaknesses, and creating sensory opportunities within the context of play to develop intrinsic motivation. While sensory integration is traditionally implemented in pediatric practice, there is emerging evidence for the benefits of sensory integration strategies for adults.ICFThe International Classification of Hearing, Functioning, Disability, and Health (ICF) is a framework to measure health and ability by illustrating how these components impact one's function. This relates very closely to the Occupational Therapy Practice Framework, as it is stated that "the profession's core beliefs are in the positive relationship between occupation and health and its view of people as occupational beings".The ICF is built into the 2nd edition of the practice framework. Activities and participation examples from the ICF overlap Areas of Occupation, Performance Skills, and Performance Patterns in the framework.The ICF also includes contextual factors (environmental and personal factors) that relate to the framework's context. In addition, body functions and structures classified within the ICF help describe the client factors described in the Occupational Therapy Practice Framework.Further exploration of the relationship between occupational therapy and the components of the ICIDH-2 (revision of the original International Classification of Impairments, Disabilities, and Handicaps (ICIDH), which later became the ICF) was conducted by McLaughlin Gray.It is noted in the literature that occupational therapists should use specific occupational therapy vocabulary along with the ICF in order to ensure correct communication about specific concepts.The ICF might lack certain categories to describe what occupational therapists need to communicate to clients and colleagues. It also may not be possible to exactly match the connotations of the ICF categories to occupational therapy terms. The ICF is not an assessment and specialized occupational therapy terminology should not be replaced with ICF terminology.The ICF is an overarching framework for current therapy practices.Global occupational therapyOccupational therapy is practiced around the world and can be translated in practice to many different cultures and environments. The construct of occupation is shared throughout the profession regardless of country, culture, and context. Occupation and the active participation in occupation are now seen as a human right and is asserted as a strong influence in health and well-being.As the profession grows there is a lot of people who are traveling across countries to work as occupational therapists for better work or opportunities. Under this context, every occupational therapist is required to adapt to a new culture, foreign to their own.Understanding cultures and their communities are crucial to occupational therapy ethos. Effective occupational therapy practice includes acknowledging the values and social perspectives of each client and their families. Harnessing culture and understanding what is important to the client is truly a faster way towards independence.The World Federation of Occupational Therapists is an international voice of the profession and is a membership network of occupational therapists worldwide. WFOT supports the international practice of occupational therapy through collaboration across countries. WFOT currently includes over 100 member country organizations, 550,000 occupational therapy practitioners, and 900 approved educational programs.The profession celebrates World Occupational Therapy Day on the 27th of October annually to increase visibility and awareness of the profession, promoting the profession's development work at a local, national, and international platform.WFOT has been in close collaboration with the World Health Organization (WHO) since 1959, working together in programs that aim to improve world health.WFOT supports the vision for healthy people, in alignment with the United Nations 17 Sustainable Development Goals, which focuses on "ending poverty, fighting inequality and injustice, tackling climate change and promoting health".Occupational therapy is a major player in enabling individuals and communities to engage in "chosen and necessary occupations" and "the creation of more meaningful lives".

Before I ellaborate on my answer, I would like to qoute a few lines from the immortal poem, “The Charge of the Light Brigade”.Someone had blundered.Theirs not to make replyTheirs not to readon WhyTheirs but to do and die.BUTIt was something, those moments of magnificent chivalry, a Nation can never forget.It was that Charge where lives never mattered.Lord Alfred TennysonThe Charge of the Light Brigade (poem)LanguageAlfred, Lord Tennyson"The Charge of the Light Brigade" is an 1854 narrative poem by Alfred, Lord Tennyson about the Charge of the Light Brigade at the Battle of Balaclava during the Crimean War. He wrote it on 2 December 1854, and it was published on 9 December 1854 in The Examiner. He was the Poet Laureate of the United Kingdom at the time.The Charge of the Light Brigade1890 recording by Alfred, Lord Tennyson on Edison wax cylinderDuring 1854, when Great Britain was engaged in the Crimean War, Tennyson wrote several patriotic poems under various pseudonyms. Scholars speculate that Tennyson created his pen names because these verses used a traditional structure Tennyson employed in his earlier career but suppressed during the 1840s, worrying that poems like "The Charge of the Light Brigade" (which he initially signed only A.T.) "might prove not to be decorous for a poet laureate".The poem was written after the Light Cavalry Brigade suffered great casualties in the Battle of Balaclava. Tennyson wrote the poem based on two articles published in The Times: the first, published on 13 November 1854, contained the sentence "The British soldier will do his duty, even to certain death, and is not paralyzed by the feeling that he is the victim of some hideous blunder," the last three words of which provided the inspiration for his phrase "Some one had blunder'd."The poem was written in a few minutes on December 2 of the same year, based on a recollection of The Times's account;Now back to the answer, why I believe that NARENDRA MODI is the PRIDE OF INDIA.Three Prime Minister’s , who sat on the Chair during my adult life needs mention.Smt. Indira Gandhi.Shri Atal Behari Vajpayee,Shri Narendra Modi and alsoShri P V Narsimha Rao.Besides, in the negative list, we have ,Manmohan SinghI K GujaralV P SinghHD Dewegowda.There were others too, Morarji Desai, Shri Chandrashekhar and Choudhary Charan Singh.One more eminent personality had profound influence on us.Dr APJ Abul Kalam happened to be our President. As such Dr Kalam was never that much involved in the decision making process as a Prime Minster of the Nation is much involved.But then their impacts were negligible. Much less as reflected in my answer.( please note : Smt Indira Gandhi was our Prime Minister as I grew up)As I write my answer, our Nation is gripped with, both anxiety and excitement.ANXIETY, because we are in the middle of one of the worst crisis this Modern World has to ever come face to face with.The COVID-19 pandemic, making its journey from the Wet Markets of WUHAN has threatened every Nation including India .In fact we Indians, till a few weeks back: after the transmission of this Chinese virus started between Nations : Were doomed to be the worst sufferrer in terms of individual transmissions and deaths.Given the bare details of our Health Infrastructure : India is 122nd in the list, headed by the Western Countries and the prosperous one’s from the Gulf.The COVID-19 pandemic was sure to doom us.BUT Narendra Modi, our Prime Minister had other idea’s. Like a skillful General who knew both the strength and weaknesses of his rivals as well as the shortcomings of his own troops : Narendra Modi meticolously prepared a Road map to tackle the dreaded CORONA VIRUS right from an early stage.While other Nation's were debating on their own priorities : President Trump was weighing the possible impacts on American Economy : European Countries, blinded in their false beliefs that their State of the Art Health Infrastructure is capable of tackling this COVID - 19 : NARENDRA MODI never dithered.While the Coronavirus positive cases in the County were still below Five Hundred number's, NARENDRA MODI clamped the Lockdown and made Indians to accept SOCIAL DISTANCING as a part of their lives till the COVID-19 pandemic is over.Modi is a firm believer in saving precious human lives.His early LOCKDOWN ensured that the battle against the COVID - 19 pandemic remains firmly in Control. Indians don't die because of this Chinese Virus.I have, in my entire adult life never seen such a Cavalier like and an enterprising and caring Prime Minister.Doomsayers won't agree with me. We are still in what appears to be the crucial stages of the COVID - 19 pandemic in our Country.“ It’s still early Day’s”. The Holy doubters repeat every then and again. Charts showing both, spiralling as well as the flattening of the Curves are on the TV Screens for us to see. But the Government's decisions to relax some sectors of the Industry demonstrates amply the Confidence it is gaining day by day and after passing of each and every precious hour.Like Lord Cardigan, the General who led nearly Six hundred Soldier's of the British Light Cavalry Brigade against the numerically overpowering Russian Army : NARENDRA MODI too had a very small Army of Indian Doctors and nurses and a very few Hospital bed's and Ventilators, when it came to face the mammoth onslaught of the COVID - 19 pandemic.Forget those HAZMAT SUITS, resembling the one the Astronauts wear : Many State's were short of the mandatory PPE kit's. In some, Rain Coats were used as alternatives.BUT then this war against the COVID - 19 pandemic continued, enthusiastically and wholeheartedly.Every Doctor, Nurse, Para Medical, Policeman, Security Guards, Cleaner's, Hospital Staff and every class of people whose service was needed : behaved and fought ruthlessly against the war with Coronavirus in the same fashion the small Light Brigade Cavalry took on the mighty Russian Army.As I repeat the line,“Someone has blundered”.UP FRONTCOVID-19 | Is India’s health infrastructure equipped to handle an epidemic?Prachi Singh, Shamika Ravi, and Sikim ChakrabortyTuesday, March 24, 2020With growing number of coronavirus cases in India (and worldwide), policymakers have sprung into action – more information is being disseminated about preventive measures such as hand washing and not touching the face. Social distancing has been suggested as a tool to “flatten the curve”, or in other words, prevent the health system from being overburdened. Although the number of COVID-19 cases are still low in India, experts have warned against community spread of the disease which will lead to rapid and huge increase in demand for health facilities. Private healthcare is expensive and unavailable for many poor households in India which leaves public healthcare facilities as the only available option for them. For patients who are found to be COVID-19 positive, isolation wards are needed; additionally, for critical cases, intensive care is needed. Currently, almost all suspected cases of coronavirus are referred to government hospitals and it’s important to assess where we stand in terms of medical capacity to provide necessary healthcare to the affected individuals.In this piece we focus on availability of government hospital beds[1] for major states in India. Using data from National Health Profile–2019, we observed that there are 7,13,986 total government hospital beds available in India. This amounts to 0.55 beds per 1000 population[2,3]. The elderly population (aged 60 and above) is especially vulnerable, given more complications which are reported for patients in this age group. The availability of beds for elderly population in India is 5.18 beds per 1000 population. In the heatmaps below, we show the state-level variation in availability of government beds in India.We observe that many states lie below the national level figure (0.55 beds per 1000 population)[4], these include Bihar, Jharkhand, Gujarat, Uttar Pradesh, Andhra Pradesh, Chhattisgarh, Madhya Pradesh, Haryana, Maharashtra, Odisha, Assam and Manipur. These 12 states together account for close to 70% of the total population in India. Bihar has an acute shortage of government hospital beds with just 0.11 beds available per 1000 population. Some states do better on this metric such as West Bengal (2.25 government beds per 1000) and Sikkim (2.34 government beds per 1000). The capital city of Delhi has 1.05 beds per 1000 population and the southern states of Kerala (1.05 beds per 1000) and Tamil Nadu (1.1 beds per 1000) also have better availability of beds. The scenario is pretty similar when the analysis is done for just the elderly population: Northeastern states do far better than others; southern states also have higher number of beds available for elderly population — for example, Kerala (7.4), Tamil Nadu (7.8), Karnataka (8.6) — while northern and central states have relatively low availability of government beds for elderly population.The availability of government beds is abysmally low in India, and an epidemic like coronavirus can very quickly complicate the problem even further. An estimated 5-10% of total patients will require critical care in form of ventilator support. In a worst-case scenario, according to one estimate at least, we may end up with 2.2 million cases in India[5] by May 15, which implies that we will need 110,000 to 220,000 ventilators. We have no official figures on the number of ventilators available in the public sector, however ,we arrive at an estimated figure using the number of hospital beds available — 7,13,986 total government beds, out of which 5-8% are ICU beds (35,699 to 57,119 ICU beds)[6]. Assuming that 50% of these ICU beds have ventilators, we arrive at an estimate of 17,850 to 25,556 ventilators in the country. Even in the best-case scenario where all ICU beds are equipped with ventilators, we have a maximum of ~57k ventilators to cater to a growing number of COVID-19 patients. Clearly, the growing demand for ventilators is going to outstrip the limited supply really soon.While demand is being kept down by behavioural interventions such as social distancing etc, supply of beds and critical care equipment like ventilators needs to be quickly ramped up. In this regard, the government has already banned the export of critical care medical equipment. Additionally, excess capacity in private healthcare can be strategically used by the government and emergency plans of setting up hospital beds in army camps should be executed as soon as possible.Footnotes:[1]Total number of government hospital beds include Central Government, State Government and Local Government bodies (PHCs are also included in the number of hospitals).[2]Population figures have been used as of year 2019. Decadal population growth rate was calculated using Census data from 2001 and 2011 and a linear projection was used to arrive at population figures for year 2019.[3]Figures for Andhra Pradesh and Telangana have been combined together under the entries for Andhra Pradesh.[4] World Bank data reports 0.7 beds per 1000 for India for year 2011 which includes inpatient beds available in public, private, general, and specialized hospitals and rehabilitation centers.[5]“Predictions and role of interventions for COVID-19 outbreak in India”, published in Medium on March 22nd by COV-IND-19 Study Group.6] Yeolekar, M. E., and S. Mehta. “ICU care in India-status and challenges.” JOURNAL-ASSOCIATION OF PHYSICIANS OF INDIA 56, no. R (2008): 221.THIS article appeared on 24th of March.AFTER three weeks, enduring a continuous Lockdown, the Country has shocked the Doomsayers.We are still in the middle of the COVID - 19. BUT surely lot better than what our detractors had predicted.EVERY INDIAN, PRESENTLY IS THE MAN OF MATCH.BUT it is Narendra Modi who filled in us the urge to fight back tremendously. In the face of such gruelling odds.No doubt at this hour he is our Pride.Indeed “ PRIDE OF OUR NATION”.