Occupational Therapy

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Open Access
Arbeidsterpie en die gebruik van musiektempo in behandeling: die effek op die geestesgesondheidsverbruiker met psigose
(University of the Free State, 2010) Strauss, Monique; Van Heerden, S. M.; Van Heerden, A.; Joubert, G.
𝑬𝒏𝒈𝒍𝒊𝒔𝒉 The mental health care user (MHCU) with psychosis presents with various restrictions in his/her occupational performance components (OPC’s) and occupational performance areas (OPA’s). Restricted motivation, inappropriate affect and sensory-motor problems, together with poor cognition, cause inability in directedness towards activity that leads to poor execution of tasks (Reed, 2001:821-823). These restrictions in OPC’s lead to restrictions in OPA’s, and therefore negatively affect the MHCU’s occupation. This negative effect compromises the promotion of Occupational Therapy goals with this population, as well as integration in the community and prognosis (Sue, Sue & Sue, 2006:421). In the field of psychiatry, music is used by music therapists to treat psychiatric illnesses. The effect of slow versus fast tempo music, together with activity, during Occupational Therapy treatment of the MHCU with psychosis was investigated by using a quantitative, experimental study design. The focus was specifically on MHCU’s with agitated symptoms versus MHCU’s with inhibited symptoms during the psychotic phase. The Ethics Committee of the Faculty of Health Sciences, University of the Free State, approved the study (ETOVS 23/9). Data was collected between October 2009 and September 2010 at the Free State Psychiatric Hospital (FSPC). Hundred and sixty (160) MHCU’s with psychosis, admitted in block A and C of FSPC, participated in the study. The median ages of the study population varied between 27.5 and 30.5 years in the four groups and 72.0% of the participants were male. The participants were included in the study after being evaluated by the inclusion criteria checklist. The MHCU’s were divided into two experimental groups by a process of randomisation. The groups did not contain more that four members and agitated, as well as inhibited MHCU’s could be included in one group. The activity participation of the MHCU’s, in terms of attention, following of instructions, directedness towards activity and willingness to participate, as well as behavior was evaluated by three evaluators by means of a pretest, composed by the researcher. Thereafter the two groups were exposed to either fast or slow tempo music, during Occupational Therapy intervention (creative leatherwork activity). The post test, evaluating the same components and behavior, followed and was administered by the same evaluators. The blood pressure and pulse rate of each participant were also measured and noted during the execution of the group. Results were analysed and presented in four groups. Department of Biostatistics, University of the Free State, analysed the data of the study. ___________________________________________________________________
Open Access
Assessment of in-hand manipulation by occupational therapists in paediatric practices in South Africa
(University of the Free State, 2020) Kruger, Annelize; Strauss, Monique; Visser, Marieta
Assessment of in-hand manipulation skills is fundamental in determining the appropriate treatment for a child with fine motor delays. For a child, in-hand manipulation is the complex movements required to effectively perform scholastic (e.g. writing), self-care (e.g. buttoning), and play tasks (e.g. puzzle-building), with precision. There is a growing interest in in-hand manipulation; thus, there is an increased effort to develop a modified classification system and various preliminary instruments. Handwriting studies were also performed that recognise in-hand manipulation as an essential performance component. However, there is limited research available that provide insight regarding the assessment of in-hand manipulation among South African occupational therapists. The main research question was to describe how paediatric occupational therapists in South Africa assesses in-hand manipulation of children. A descriptive quantitative research design was used to answer the proposed research question. The objectives were to describe the paediatric assessment instruments that have been published in literature, the assessment methods used by South African occupational therapists in paediatric practices, their preferences for a suitable instrument and if there were any associations between these results and the different practice sectors that the occupational therapists work in. This study was conducted in the form of two academic articles. The first study followed a non-empirical approach for a theoretical article, with the scoping review as the chosen method. Emphasis was placed on providing an overview of the different in-hand manipulation instruments described in the literature. Each identified in-hand manipulation instrument was critically evaluated pertaining to what extent the in-hand manipulation components are included in the study, the clinical utility that related to how accessible and practical the instruments were and what psychometric properties were established for each instrument. The second article used an empirical study approach with a quantitative cross-sectional study design. To ensure that the sample population represented the population of paediatric occupational therapists in South Africa, a non-probable, purposive sampling method was used. The data was collected using an online survey method. Test-retest reliability of the questionnaire was performed to determine the stability of the answers. Hence, the participants were asked to complete the questionnaire a second time, ten days after completing the first round. Ethical approval was obtained, and confidentiality was ensured. The data was analysed by a qualified biostatistician. The questions that tested reliable were further discussed in the article and indicated which formal and informal methods of assessment were used by paediatric occupational therapists, while also reporting on the contextual and practical aspects of the assessment process. The preferences for a suitable in-hand manipulation instrument for children were also reported and can be used for future studies as instrument design principles. In addition to the two publishable articles, this dissertation includes a supplementary file section in which the results of the second study’s last objective is reported, namely the associations between the different practice sectors (Academic, Community, Private, Public, Public-Private) and the current methods used by occupational therapists and their preferences for suitable instruments. The decision to separate the results was made as the data extracted from the study was too extensive to be discussed in a single empirical scientific article while remaining within the journal guidelines. Therefore, these results were reported on and added to the supplementary file section, with the intention to be discussed in a third article. Recommendations and clinical implications for practitioners, both South African and globally, are discussed in each article. Areas of future research are identified to advance the professions’ body of knowledge and provide valuable guidance when future instrument development research is undertaken.
Open Access
Caregiving as an occupation: the experiences of primary caregivers of young children with Cerebral Palsy in Mangaung
(University of the Free State, 2020-09) Bester, Jennilyn; Visser, M. M.; Hattingh, R. P.
Introduction: Cerebral Palsy (CP) is a permanent yet non-progressive disorder characterised by motor impairments and functional limitations. Children who are severely affected are dependent on the assistance of caregivers for daily tasks and activities such as feeding, toileting, dressing and even moving around. Despite alarmingly high prevalence rates of CP in South Africa (SA), a paucity of literature exists in relation to the experiences of those caring for these children in South African contexts. Purpose: The aim of this study was to explore and describe the occupational experiences of the primary caregivers (PCGs) of young children with CP in Mangaung in order to inform current and future practices for occupational therapists providing rehabilitative services to this population. Methodology: A qualitative study, embedded within constructivism was conducted to gain a better understanding of the occupational experiences of the PCGs of children with CP. Purposive sampling was used to select ten PCGs of young children with severe CP residing in Mangaung in the Free State province of SA. Data was captured through a socio-demographic form and Photovoice, a visual data gathering technique. Participants’ reflections on their own photographs, facilitated by the researcher in individual reflection sessions provided the primary source of data analysed in this study. Reflections were transcribed and analysed according to an inductive content analysis. Data was coded by the researcher and two co coders before clustering codes into categories and themes. Findings: Four themes were generated through analysis of the data, namely Caregiving in the local environment, A disabled child is still a child, I am a caregiver and Shared occupation. The first theme presented experiences of community attitudes such as acceptance or ignorance towards the disabled child alongside the value of certain resources and social support in the caregiving occupation. The second theme emphasised the child’s humanness by considering the child’s cognisance and other capacities. The third theme described participants’ experiences of their occupational identity as PCGs in relation to the responsibility they have towards the child, insights and understandings they have gained through caregiving and coping strategies employed. The final theme presents caregiving as a shared occupation where challenges related to the child or the environment are overcome, strengthening the unique connection between child and PCG. Conclusions: This study confirms the need for caregiver-professional collaboration in designing caregiver- and child-specific interventions for children with CP and their PCGs. The findings highlight a substantial need amongst PCGs for acceptance of their child by the community. Findings allowed the researcher to make recommendations for occupational therapists working with children with CP and their PCGs, which include caregiver-directed interventions, caregiver-specific education and training interventions, support groups and mobility devices and equipment. Recommendations are made for future research, before discussing the limitations and the value of this study.
Open Access
Cultural competence among occupational therapy students at the University of the Free State, South Africa
(University of the Free State, 2012) Janse van Rensburg, Elize; Van der Merwe, Tania; Nel, Mariette
English: The study investigates occupational therapy students’ perceptions about cultural competence and assessed their levels of competence to determine whether the undergraduate occupational therapy curriculum at the University of the Free State sufficiently equips students to become culturally competent professionals. A descriptive study was undertaken, using a non-standardised questionnaire. Students did not feel sufficiently equipped regarding cultural competence, and their levels of competence ranged between cultural incapacity and pre-competence. The results support students’ perceptions that the current occupational therapy curriculum at the University of the Free State does not sufficiently equip them to become culturally competent.
Open Access
Describing the performance of five-year-old children on 11 subtests of the revised clinical observations by the South African Institute for Sensory Integration
(University of the Free State, 2020-11) Janse van Rensburg, Elana; Potgieter, C.; van Rooyen, C.
Introduction: The Clinical Observations (COs) are a battery of 30 observations developed according to the constructs of Ayres Sensory Integration® (ASI®). The observations measure how children can do different body movements and see whether these movements are completed appropriately for their age. The COs are often used together with standardised assessments, to help occupational therapists determine whether or not children present with Sensory Integration Dysfunction (SID). The COs were developed more than a decade ago, and remain popular due to its time efficiency and being inexpensive. It is a nonstandardised assessment, and often the only assessment instrument at the disposal of occupational therapists working in resource-constrained settings. Purpose: In the current version of the COs interpretation is done by comparing performance to norms from the United States of America (USA). Some efforts have been made to describe performance of South African (SAn) children on certain subtests of the COs, however, not all the subtests have been investigated. The South African Institute for Sensory Integration (SAISI) is aware of the significance of the COs in South Africa (SA) for the identification of SID. They are also aware of the limitations of the assessment and the need for it to remain relevant. In 2016, SAISI set out to revise the COs so that they could maintain its clinical relevance. The Revision of the Clinical Observations (RCOs) is still under development and to the researcher’s knowledge none of the newly added subtests have been piloted. It is necessary to describe the performance of SAn children on subtests of the COs, not already investigated, in order to establish what the performance of typically developing South African children on these subtests look like. The purpose of the study was to describe the performance of five-year-old children from the Buffalo City Metro on 11 subtests of the RCOs by SAISI. Methodology: This is a quantitative, descriptive and analytical, cross sectional study. The participants consisted of 104, five-year-old children in the Buffalo City Metro, situated in the Eastern Cape, South Africa. Participants were selected in proportion with the gender and socioeconomic background of the area. Data was collected by means of data collection form based on the RCOs by SAISI (2016). The data collection form was used to record the performance of participants in 11 subtests of the RCOs. Performance characteristics were divided into measurable and observable characteristics. Measurable characteristics referred to observations which were quantifiable such as grade scoring and time taken to perform a task. Observable characteristics were structured observations determined before the data collection period and were divided into Should Have (SH) parameters and Should Not Have (SNH) parameters. SH parameters are characteristics which are favourable and indicate that a participant is performing well. SNH parameters are unfavourable characteristics and indicate that a participant experiences difficulty. The results were analysed by the Department of Biostatistics at the University of the Free State (UFS). Results: Results demonstrate that for most subtests’ children performed in accordance to available development norms. Children did however perform below the expected norms in some of the subtests. Few gender differences were identified in the performance of the investigated subtests. This indicates that boys and girls perform similarly in most of these subtests. Conclusion: The performance of SAn children in 11 subtests of the RCOs has been investigated. More research should however be completed to determine how SAn children perform in the remainder of the subtests. A collective picture of how SAn children perform in all the subtests of the RCOs will better equip therapists to test children more accurately with this tool.
Open Access
Description of occupational therapy fieldwork supervision at the University of the Free State
(University of the Free State, 2014-01) Hattingh, Rialda; Hough, R.; van Vuuren, S.; Nel, M.
English: Fieldwork education in Occupational Therapy provides students with the opportunity to integrate theory learned at higher institutions with practical skills and professional behaviour within real-life settings to become proficient occupational therapists. Fieldwork supervisors are the key role players and facilitators in realising the purpose of fieldwork education. To this end, supervisors must exhibit effective characteristics of supervision in order to provide quality and meaningful learning experiences for students. Concern has been raised throughout literature about the characteristics that supervisors display during fieldwork placements, because it has such a major influence on students’ learning and experiences of fieldwork education. Very little research has been done on fieldwork education of Occupational Therapy in South Africa and none on the characteristics of supervisors and supervision during fieldwork placements. This study aims to describe effective and ineffective characteristics of supervisors and supervision in Occupational Therapy fieldwork education at the UFS as identified by third and fourth year Occupational Therapy students and supervisors. These phenomena of supervisor and supervision characteristics have been researched in several qualitative studies internationally from either the supervisors’ or the students’ perspective. In this study, a quantitative, descriptive study design was used to gather information about effective and ineffective characteristics of supervisors and supervision during Occupational Therapy fieldwork education. The data collection instruments implemented consisted of two similar self-report questionnaires: one for the students and one for the supervisors. The research population consisted of all the third and fourth year Occupational Therapy students enrolled at the UFS in 2012 (a total of 69) as well as all the supervisors involved in fieldwork training of these Occupational Therapy students (a total of 41). The response rate for the students was 98.6% and for the supervisors 100%. Effective supervision characteristics have been identified and described, with specific emphasis on the main findings that reflect that a supervisor must be competent, professional, approachable, considerate and knowledgeable about what is expected from the student and must spend adequate time with the student. Furthermore, the supervisor must provide sufficient guidelines, support, guidance and feedback. Results were reported according to the five categories used in the questionnaires, namely: interpersonal; curriculum; clinical and professional; feedback and environment. Ineffective supervision characteristics identified in this study were similar to those detected in international studies. This study clearly indicates that supervisors viewed the limited time they had to supervise students as a major cause of ineffective supervising. Additionally, they had less than five years of supervision experience, which influenced the effectiveness of their supervision characteristics negatively. An unexpected finding of this study was the indication by supervisors that students’ attributes – whether positive or negative – had been the biggest influence on the supervision they provided during fieldwork education. In conclusion, extensive recommendations were made to redress the ineffective characteristics of supervision identified in this study as it pertains to students, supervisors and the university. This study contributes to Occupational Therapy’s body of knowledge with regard to supervision characteristics in fieldwork education in a South African setting, which can be used as a base for future research.
Open Access
Dialectical behaviour therapy as it informs occupational therapy in mental health in South Africa: a descriptive study
(University of the Free State, 2023) Ward, Kristy; Strauss, Monique; Tsatsi-Mosala, Itumeleng
South African occupational therapists show a growing interest in Dialectical Behaviour Therapy (DBT). However, there are currently minimal publications on the use of DBT internationally and no publications nationally. This gap supports the need to further investigate this incorporation of a traditional psychology theory with occupational therapy theory. The main research question was how the DBT approach is used to inform occupational therapy in mental health in South Africa. Two different methodologies were incorporated to answer this question. The first was a scoping review, and the second was a qualitative, descriptive design. The objectives were twofold and formed two phases of the research. The first objective was to review the literature on the use of the DBT approach by occupational therapists working in the mental health field. The second objective was to describe the current knowledge, attitudes, and practices of South African occupational therapists working in mental health regarding the DBT approach as an intervention approach for MHCUs. The results of this were captured in two academic articles. The first study followed a non-empirical approach for a theoretical article, with the scoping review as the chosen method. This review emphasized the need for more evidence and guidelines integrating DBT and occupational therapy. The second article used a qualitative descriptive design and the data from 17 online one-on-one interviews with South African occupational therapists to answer the research question. A non-probability snowball sampling technique was used. Ethical approval was obtained, and confidentiality was ensured. The knowledge, attitude, and practices of occupational therapists using DBT to inform their practice were presented. The following themes emerged from the study: (a) Potential challenges identified by occupational therapists using DBT, (b) The benefits/motivators of DBT-informed occupational therapy for the therapist and user, and (c) Variation in how DBT is being used by occupational therapists in practice. Recommendations for further research and implications of the study were described in both articles. Areas of future research are identified to advance the profession's body of knowledge and provide guidance with potential future research in the field of Dialectical Behaviour Therapy-informed occupational therapy.
Open Access
Enabling occupation through service learning: perceptions of community representatives in occupational therapy service learning engagements
(University of the Free State, 2015) Janse van Rensburg, Elize; Rauch van der Merwe, T.; Erasmus, M. A.
English: Introduction: Occupational therapists concern themselves with human occupation, and the enablement of occupation can be viewed as the profession’s collective domain of concern when working towards health, well-being and occupational justice. Six enablement foundations are described in occupational therapy literature, namely choice, risk and responsibility; client participation; vision of possibilities; change; justice and power sharing. Service learning is employed as a form of practice learning in undergraduate occupational therapy curricula across the globe, in South Africa and at the university where this study was conducted. Research into the effects of service learning has focused on students to a large extent, while the perspectives of community partners have been relatively under-examined. Without knowing how communities perceive occupational therapy service learning engagements, it is difficult to establish whether these engagements are done in a manner that promotes health, well-being and occupational justice, and in a manner that is effective and contextually relevant. Purpose: In an attempt to access the community’s voice regarding occupational therapy service learning engagements, so as to inform current and future practices, the purpose of this study was to describe the perceptions of community representatives in occupational therapy service learning engagements, regarding enabling occupation through service learning in communities, as well as the barriers and facilitating factors to this process, at a South African university. Methodology: Positioned primarily in an interpretive, constructivist paradigm the study utilised a descriptive, qualitative enquiry design. Semi-structured interviews were conducted with eight community representatives from seven different occupational therapy service learning community sites. Interviews were transcribed and analysed following an inductive, systematic content analysis approach. The data was coded, grouped into categories and synthesised into themes. The trustworthiness of the study was promoted by, among others, making use of investigator triangulation during data analysis and by conducting participant verification of the interpreted results. Findings: Two themes emerged from the data, namely ‘enabling occupation’ and ‘disenabling occupation’. The theme ‘enabling occupation’ illuminated factors which community representatives perceived as facilitators to occupational enablement through service learning, namely effective communication strategies; collaborative planning and project selection; interdependence; meeting tacit needs; positive student attributes and enabling service activities. In addition, findings that emerged within the category of ‘successful outcomes’ in this theme described evidence of participants’ perceptions of ‘enabling occupation’ as it related to occupational participation and occupational justice. The theme ‘disenabling occupation’ described participants’ perceptions of barriers to occupational enablement in service learning, namely intermittent contact, managerial challenges, barriers to sustainability and risks to students. Conclusions: This study revealed that community representatives perceived most of the enablement foundations to have been present in the occupational therapy service learning engagements; however, there were also instances where some community representatives did not have positive experiences of the operationalisation of these enablement foundations. Relating to the enablement of occupation, links to enhanced occupational participation, meaning, choice and balance emerged from the data; however, these links were mostly inferred by the researcher. Due to its individually appraised nature, participants tended to have difficulty articulating specific perceptions that related to the occupations of community members. The findings of the study enabled the researcher to construct a framework for enabling occupation through service learning, consisting of foundational principles; the enablement foundations; facilitators of enablement; activities and objectives; and outcomes of occupational therapy service learning engagements. Based on this framework, practical recommendations for the management and implementation of occupational therapy service learning engagements could be offered in order to inform occupational therapy service learning practices from the perspectives of community representatives.
Open Access
Eye movements and postural alignment in children with cerebral palsy
(University of the Free State, 2013-06) Scholtz, Christina Elizabeth; Van Heerden, S. M.; Visser, M.; Ellis, S. M.
English: The level of severity of disability may have increased among children with cerebral palsy and therefore continued monitoring of the characteristics of children with cerebral palsy is necessary. Cerebral palsy (CP) can be considered as a sensory-motor disorder that results from malformations in the developing brain that disrupts the development of the neuronal network and cortical and sub-cortical pathways. Although the motor behaviours and postural deficits are defining features of CP, visual disorders are a main symptom in the clinical picture of CP. There are well sounded reasons why children with CP have difficulties to partake in everyday activities. Neurologic pathology can affect specific aspects of postural control including the ability to maintain stability with alignment in a specific position. Postural control is necessary for maintaining all body segments in an upright position and to orientate the eyes to the environment. Problems with the visual system in CP include peripheral problems related to the anterior part of the visual system, visual problems of central origin and cerebral visual impairment. Observations of eye movements and postural alignment in sitting in children with CP were the focus of this study. These are variables known to potentially influence occupational-based activities. The aim of the study was to describe eye movements and postural alignment and to investigate if there was a possible association between eye movements and postural alignment in sitting in a frontal plane of children with CP, between the age of two and ten years. A non-experimental, quantitative approach addressed the aim. A descriptive study was used to describe the eye movements and alignment in body segments over the base of support against gravity. A correlation study was used to investigate the possible association between postural alignment and eye movements in children with CP. Following the pilot study the unstructured and structured observations were administered to a convenience sample of children with CP attending a clinic, school or a private practice. Fifty seven children with CP, between two and ten years of age participated in the study after meeting the pre-determined inclusion criteria. The data collected were numbers that reflected specific measurements of the characteristics in question and were analysed by using a grounded, observed – clinical reasoning approach. The mean age of the children was 5.3 years (SD = 2.26). Discussion of results was directed at describing eye movements and postural alignment and interpreting the implications of those associations for clinical practice. The obtained data from the unstructured and structured observations were statistically analysed and compared and did produce a statistically significant positive association between eye movements and postural alignment therefore, both the posture and the eye movements are critical to the provision of intervention. The study confirms the association between eye movements and postural alignment in sitting in children with CP. This study has documented the difficulties the child with CP has to encounter. This may facilitate the establishment of effective and appropriate measuring instruments for occupational therapists, assessing functional vision and postural alignment in any setting of practice.
Open Access
Factors influencing academic success of first year occupational therapy students at the University of the Free State
(University of the Free State, 2014-07) Swanepoel, Azette; Van Heerden, S. M.; Strydom, J. F.
English: The Occupational Therapy program at the University of the Free State is academically and emotionally challenging. Prospective students who wish to study occupational therapy are selected primarily on their academic abilities in high school or in other programs in higher education institutions. The selected first year students have provided evidence of their academic abilities. Thus, it is presumed that the students will be able to meet the demands set by the program and maintain their academic achievement levels. However, once entering higher education some students seem unable to meet the demands of the program while others deliver consistent academic achievements. The question arose as to which factors influence the first year occupational therapy students’ academic success. Literature points to various factors which influence academic success, but no study was found which included all possible factors influencing academic success. This study set out to investigate all the possible factors which influence academic success of first year occupational therapy students at the University of the Free State. A qualitative research approach was applied by making use of a Case study research design. Eighteen first year occupational therapy students, with no prior higher education experience, were randomly selected to take part in the study. Nine students from the Afrikaans and nine students from the English class were included in the study. Data was collected from documentation and Nominal Group Technique discussions. The documentation data included the students’ portfolio reflections by making use of the Kawa River model. Students reflected on all possible factors influencing their academic success by making use of the elements of the Kawa River model. In addition, students’ reflection on their test and examination writing skills was also included in the documentation data collection. The NGT discussions posed the following two questions to the participants: · Which factors influence your academic success positively in the first year of occupational therapy? · Which factors influence your academic success negatively in the first year of occupational therapy? Thematic analysis of the portfolios, a content analysis and qualitative interpretation of the factors identified in the NGT discussion groups were done after which data was categorized according to the domains of the Occupational Therapy Practice Framework (OTPF). Factors were placed in all six domains of the OTPF namely: · Areas of Occupation · Context and Environment · Client Factors · Activity Demands · Performance Skills · Performance Patterns The factors identified by the students were viewed holistically and were found to be interrelated thus, indicating the importance of acknowledging more than academic factors influence academic success in higher education. Academic-, social -, cultural-, physical -, cognitive - and psychological factors were identified as influencing academic success of first year occupational therapy students.
Open Access
Factors influencing the design of an occupational therapy stroke program in primary health care
(University of the Free State, 2019-06) Naude, Catherina Elizabeth Johanna; Janse van Rensburg, E.; Van Jaarsveld, A.
Introduction and background: The ideal of making health care services accessible to all people within South Africa, is envisioned through the implementation of National Health Insurance (NHI). The rendering of Primary Health Care (PHC) services is set to form the heartbeat of NHI and therefore a renewed focus is placed on the re- engineering of PHC services. Occupational therapy plays a vital role in the rendering of rehabilitation services within PHC, especially to stroke survivors. Stroke is one of the leading causes of disability globally and it is furthermore one of the top 10 non- communicable diseases in Thabo-Mofutsanyana Health District (TMHD) in the Free State province. Due to the limited availability of district hospitals in the TMHD, most stroke survivors are dependent on receiving occupational therapy services at the PHC clinics. Due to poor staffing norms, occupational therapy services are, however, often out of reach to the majority of stroke survivors within the TMHD. The need to design and develop renewed service delivery models for occupational therapy was identified to ensure that services are accessible to the stroke survivor. Aim: The aim of this study was to identify the factors that will influence the relevance and feasibility in the design of an occupational therapy program for stroke survivors within a rural PHC setting in the TMHD. Design and methods: A design science research (DSR) methodology was used for this study. Only phase one of DSR was implemented and both qualitative and quantitative research methods were employed. A total of five activities were executed, namely a document review of public health care documentation, structural observations at PHC clinics within the TMHD, structured interviews with community health care workers (CHWs), semi-structured interviews with stroke survivors as well as a focus group with permanently employed occupational therapists within the TMHD. Findings: Four groups of factors were identified that will influence the relevance and feasibility in the design of an occupational therapy stroke program for the PHC setting. Structural factors were identified that included the exclusion of occupational therapy in relevant public health care documentation as well as the inaccessibility of PHC clinics. The second group of factors that were identified are procedural factors and include the lack of outcome measures and standards of practice for occupational therapy services to stroke survivors within PHC, the possible inclusion of CHWs in the presentation of an occupational therapy stroke program as well as the possible design of a group therapy program. The third group of factors identified related to the challenges that stroke survivors experience while seeking occupational therapy services within PHC and include the physical and emotional distress post stroke, a lack of knowledge on the benefits of occupational therapy post stroke as well as transportation challenges. The last group of factors that have been identified is the content factors that might be considered for the future design of an occupational therapy stroke program for the PHC setting. Conclusions: Renewed ways of thinking are needed to overcome the challenges faced within PHC in order to ensure that occupational therapy services are relevant and accessible to stroke survivors. Derived from the factors that have been identified, a framework was designed to assist with the future design of an occupational therapy stroke program for the PHC setting.
Open Access
Feasibility of using the Residential Environment Impact Scale (REIS) and the Assessment for Occupation and Social Engagement (ATOSE) as assessment tools within Engo Residential Aged Care Facilities in the Free State province, South Africa
(University of the Free State, 2020-07) Kilian, Melissa; Du Toit, Sanetta Henrietta Johanna; Rauch-Van der Merwe, Tania
Introduction: The occupational wellbeing of elders is influenced by the physical and social long-term care environments in which they live. Elders living in Residential Aged Care Facilities are often exposed to occupational injustices and become institutionalised as a result of an environment that does not provide adequate occupational opportunities, support and stimulation. Purpose: The main purpose of this study was to investigate the feasibility of two occupation-based assessment tools, the REIS and ATOSE within Residential Aged Care Facilities affiliated with the Engo organisation. The REIS and ATOSE have not previously been used within the South African aged care sector or the Engo organisation. Methods: An embedded mixed methods approach with a qualitative focus was employed. The research was conducted in two phases. The first phase saw the researcher administering the two assessment tools within three participating facilities and providing each participating facility with their report containing the REIS and ATOSE findings. The reports contained quantitative statistics as yielded by each assessment, supported with descriptive information yielded by qualitative notes made by the researcher during the assessment period of phase one. During the second phase a discussion group employing the nominal group technique, was held with leadership staff of the participating facilities. Leadership staff considered and deliberated on the findings presented in the reports in order to identify possible enablers and obstacles of using the REIS and ATOSE assessment tools. A thematic analysis was employed during data analysis. Findings: The findings were categorised into two main themes, i.e. organisational culture and occupational justice issues. The findings of the REIS and ATOSE assessments (phase 1) and the nominal discussion group (phase 2) indicated an organisational culture which is dominated by a top-down management approach and distinguished by a medicallydominated care approach. Leadership staff struggled to directly conclude what enablers and barriers exist for using the REIS and ATOSE assessments. The findings of the research process, however, indicate that the assessments yield practical and usable information but the current Engo organisational culture is not receptive to implement the findings. Conclusions: The main contribution of this study is the exploration of two previously unused occupation-specific tools in the South African aged care sector, which presented information about elder communities that occupational therapists should consider when practicing in these environments to effect person-centred culture change.
Open Access
The impact of the "Developmental Resource Stimulation Programme" on children with Down syndrome
(University of the Free State, 2013-06) Russell, Dorothy Charmaine; Van Heerden, S. M.; Van Vuuren, S.; Venter, A.; Joubert, G.
The effect of stimulation programmes on children with Down syndrome is necessary especially with a South African impetus. This study was an attempt to investigate the impact of an intensive early-intervention programme, the Developmental Resource Stimulation Programme (DRSP), on Down syndrome children younger than 42 months in the South African context. The DRSP would assist any occupational therapist using one stimulation programme to enable parents to assist their child to develop to their full potential at an earlier age. Down syndrome is a multisystem chromosomal disorder, which has been recognised to be the single most common cause of intellectual disability occurring in approximately one in 650–700 births. Down syndrome is associated with cognitive limitations and speech as well as motor-developmental problems. Documented studies focused on motor and speech development in older children, with very few studies on babies younger than three years. Adequate early-intervention programmes for babies with Down syndrome with parent involvement do not exist in the South African context. Contrary to the literature, this study may show the benefits of the role of the occupational therapist in early intervention. The World Health Organization has adopted the International Classification of Functioning, Disability and Health (ICF-CY), a bio psychosocial model that emphasises components of health and reflects participation, activities and function. A holistic approach is essential to the developmental problems of children with Down syndrome to create a long-term difference in their functioning in totality. The researcher developed the Developmental Resource Stimulation Programme (DRSP) to assist in the management of early intervention of the child with Down syndrome over a period of 20 years. The DRSP is a unique, child-parent specific, one-on-one, integrated developmental programme for children with Down syndrome from birth to 42 months. Each activity of the DRSP is designed to accomplish specific activity performances in developmental domains, appropriate to the child’s ability for different age band groups younger than 42 months. The activities comprise cognitive, motor, sensory and language skills, as well as activities found in everyday living. The Developmental Resource Stimulation Programme was compared to Occupational Therapy Practice Framework. The aim of this study was to investigate the impact of the DRSP on Down syndrome children younger than 42 months in the South African context. There were four objectives in order to achieve the aim of the study. A quantitative approach with an experimental and descriptive study design was followed, to confirm results and enhance the reliability and validity of the study. The measurable attributes of the DRSP, including the participation of the parents were the focus. The Bayley Scales of Infant and Toddler Development (3rd edition) and DRSP checklists were used in a pre-test and post-test to measure the effect of the DRSP. There were two groups namely the intervention group, consisting of 32 participants (children and parents) and the control group, consisting of 28 (children and parents) over a period of six months. Evaluation and intervention sessions were video-recorded and moderated. Informed consent was obtained prior to the study, supported by an information document in the language of choice, namely Afrikaans, English and Sesotho. A self-administered questionnaire, developed by the researcher, focused on the attainment of information regarding the overall presentation of the area, service and treatment of the participants. The results were analysed, presented in tables and graphs, and discussed. The results of this study showed that a specifically designed programme with participation of a parent has a positive impact on the development of the child with Down syndrome. Contrary to the literature, there were positive changes in the language, fine-motor and >9- month gross-motor development of children with Down syndrome. The DRSP with specific goals indicated to be an attribute in the early-intervention process. The results emphasised the holistic approach, rendered by an occupational therapist in Down syndrome early intervention.
Open Access
Job satisfaction of occupational therapists in the public health sector, Free State Province
(University of the Free State, 2010-11) Swanepoel, Juanita Millicent; Van Heerden, S. M.; Van der Merwe, T.
English: The aim of this study was to investigate the job satisfaction status of occupational therapists in the Public Health Sector (PHS) of the Free State (FS). For the purpose of this study, job satisfaction referred to the occupational therapist’s perception of the fulfillment and gratification experienced while doing their work within the context of the PHS. A scientific inquiry was instigated to assess and address the job satisfaction of occupational therapists in the PHS of which the researcher, at the time of the study, was part. Employees of the PHS at that time seemed to suffer from low morale and the frequency with which occupational therapists became disillusioned with either the profession or the PHS was worrisome. The investigation was conducted by making use of multiple research methods namely questionnaires for the quantitative typical descriptive study design and semi-structured interviews for the qualitative phenomenological study design. Electronic self-administrative questionnaires were distributed to all the occupational therapists in the service of the Free State Department of Health in November 2008. Thirty-five (n=35) questionnaires were used for the analysis of quantitative data. In augmentation to this base-line data gathered, semistructured interviews with an opening question and an interview schedule were conducted among fifteen occupational therapists practicing in the PHS of the FS between November and December 2008. The thirty-five respondents in the quantitative investigation, as well as the sixteen participants in the semi-structured interviews, represented a largely homogenous group of white, Afrikaans-speaking females on senior, chief and assistant manager level. Community service occupational therapists who had already completed at least six months’ tenure were also included. Only occupational therapists directly involved in clinical services were eligible to participate in the study. The results of the study showed that the occupational therapists in the PHS of the FS experienced low levels of job satisfaction. This was found to be in contrast with most other studies conducted on the job satisfaction of occupational therapists in other parts of the world. This disparity was clarified when the contextual factors of the PHS such as; inadequate resources, excessive red-tape, poor management and an undesirable working environment were configured. The results and findings showed that the afore-mentioned facets were sources of dissatisfaction for the participants and consequently increased their job dissatisfaction. More so however, the main causes of the occupational therapists dissatisfaction were; the low status of occupational therapy as a profession and poor salary. Inadequate career-paths and disillusionment with the current performance appraisal system of the PHS added to further dissatisfaction for the participants in this study. The main source of the occupational therapists’ satisfaction with the job was that of “working with people, making a difference and experiencing success with clients”. Secondary facets of satisfaction were the relationships colleagues had with each other, inherent characteristics of the profession such as autonomy, creativity, diversity and to a lesser degree some advantages to working in the PHS such as fringe benefits and job/income security. In conclusion it was found that the job satisfaction status of the occupational therapists in the PHS of the FS was low. This was mainly due to the influence of contextual factors and not with regards to profession itself. As was the last objective of the study, extensive recommendations were made to redress the balance between job satisfaction and dissatisfaction for this population.
Open Access
Job satisfaction of occupational therapists in the public health sector, Free State Province
(University of the Free State, 2010-11) Swanepoel, Juanita Millicent; Van Heerden, S. M.; Van der Merwe, T.
English: The aim of this study was to investigate the job satisfaction status of occupational therapists in the Public Health Sector (PHS) of the Free State (FS). For the purpose of this study, job satisfaction referred to the occupational therapist's perception of the fulfillment and gratification experienced while doing their work within the context of the PHS. A scientific inquiry was instigated to assess and address the job satisfaction of occupational therapists in the PHS of which the researcher, at the time of the study, was part. Employees of the PHS at that time seemed to suffer from low morale and the frequency with which occupational therapists became disillusioned with either the profession or the PHS was worrisome. The investigation was conducted by making use of multiple research methods namely questionnaires for the quantitative typical descriptive study design and semi-structured interviews for the qualitative phenomenological study design. Electronic selfadministrative questionnaires were distributed to all the occupational therapists in the service of the Free State Department of Health in November 2008. Thirty-five (n=35) questionnaires were used for the analysis of quantitative data. In augmentation to this base-line data gathered, semi-structured interviews with an opening question and an interview schedule were conducted among fifteen occupational therapists practicing in the PHS of the FS between November and December 2008. The thirty-five respondents in the quantitative investigation, as well as the sixteen participants in the semi-structured interviews, represented a largely homogenous group of white, Afrikaans-speaking females on senior, chief and assistant manager level. Community service occupational therapists who had already completed at least six months' tenure were also included. Only occupational therapists directly involved in clinical services were eligible to participate in the study. The results of the study showed that the occupational therapists in the PHS of the FS experienced low levels of job satisfaction. This was found to be in contrast with most other studies conducted on the job satisfaction of occupational therapists in other parts of the world. This disparity was clarified when the contextual factors of the PHS such as; inadequate resources, excessive red-tape, poor management and an undesirable working environment were configured. The results and findings showed that the afore-mentioned facets were sources of dissatisfaction for the participants and consequently increased their job dissatisfaction. More so however, the main causes of the occupational therapists dissatisfaction were; the low status of occupational therapy as a profession and poor salary. Inadequate career-paths and disillusionment with the current performance appraisal system of the PHS added to further dissatisfaction for the participants in this study. The main source of the occupational therapists' satisfaction with the job was that of "working with people, making a difference and experiencing success with clients". Secondary facets of satisfaction were the relationships colleagues had with each other, inherent characteristics of the profession such as autonomy, creativity, diversity and to a lesser degree some advantages to working in the PHS such as fringe benefits and job/income security. In conclusion it was found that the job satisfaction status of the occupational therapists in the PHS of the FS was low. This was mainly due to the influence of contextual factors and not with regards to profession itself. As was the last objective of the study, extensive recommendations were made to redress the balance between job satisfaction and dissatisfaction for this population.
Open Access
Job satisfaction of occupational therapists in the public health sector, Free State Province
(University of the Free State, 2010-11) Swanepoel, Juanita Millicent; Van Heerden, S. M.; Van der Merwe, T.
Open Access
Die korttermyn invloed van sensoriese integrasie intervensie op die geestesgesondheidsorg verbruiker met versteurings gekenmerk deur simptome van psigose
(University of the Free State, 2013-02) Annandale, J. C. A.; Van Jaarsveld, A.; Van Heerden, S. M.; Nel, M.
English: The Mental Health Care User (MHCU) with psychosis presents with symptomology that impairs functionality and occupational performance. This limits the ability of the MHCU to perform activities of daily living and to actively take part in Occupational Therapy treatment. Sensory integration intervention addresses the functionality and the occupational performance of the MHCU (Smith-Roley, Mailloux, Miller-Kuhaneck & Glennon, 2007:1). The short term influence of sensory integration intervention on the MHCU with disorders charactarised by symptoms of psychosis was investigated by using a quantitative, randomised, controlled single blind clinical trial. The Ethics Committee of the Faculty of Health Sciences, Universtiy of the Free State, approved the study (ETOVS 30/11). Data were collected between October 2011 and July 2012 at the acute wards of a psychiatric institution in the Free State. Ninety-nine (99) MHCU‟s with symptoms of psychosis participated in the study. The median age of the study participants in the two groups varied between the ages of 30 and 32 years and 65.7% of the participants were males. Participants adhering to the inclusion criteria checklist were divided into an experimental and a controle group through a process of randomization and matching. Matching was done according to age, gender, level of functioning and pathology. The occupational performance of both groups were established with the “Therapeutic Functional Level Assessment” (TFLA) and the sensory integration dysfunction of the experimental group were established with the “Schroeder, Block & Campbell Adult Psychiatric Sensory Integration Measure” (SBC). After the pre-tests both groups were exposed to the standard Occupational Therapy intervention program of the specific wards and the experimental group was exposed to a two week (eight sessions) sensory integration intervention program. The TFLA and the SBC were used in the same manner to do the post-tests. The same assessors (qualified Occupational Therapists) were used to do the pre- an post-tests. The medication and the level of psychosis were also noted on a daily basis. These notes were completed according to the process notes of the clinical staff of the specific wards. Results were analysed by the Department of Biostatistics, University of the Free State. Despite the fact that there were limited statistically significant differences observed during the study, both groups showed clinical improvements. The experimental group showed statistically significant differences in the improvement of selfcare, social behaviour (logical speech and communication), appearance and the occurance of delusions and hallucinations, when compared to the control group. The SBC showed a statistical difference in the physical assesment aspects of the experimental group. Improvements were noted in the vestibular-proprioceptive system, the somatosensory system and the visual-vestibular system. Ongoing research with regard to the effect of sensory integration intervension on the MHCU appears to be warrented and will be of value within this field. Occupational Therapists should consider using sensory integration intervention, together with the standard Occupational Therapy intervention program in the treatment of the MHCU with psychosis in order to optimise function.
Open Access
Kritiese faktore vir ontwikkeling en groei by Parkinson-ondersteuningsgroepe
(University of the Free State, 2004-05) De Villiers, Danette Esther; Van Heerden, S. M.
English: The curative advantages of support groups are lauded in the literature and offer every individual to grow in self-knowledge (Nichois & Jenkinson 1991:16). Despite the physical, psychological and cognitive limitations of Parkinsons disease and old age, support groups offer positive outcome in many ways (Manicorn & Viljoen 1992:37): Groups are time-effective and economical. Support groups enable multidisciplinary teams to become involved in consulting and rehabilitating roles. Every member becomes a potential helper and thus each person's status and self-worth is increased. Each member has own unique experience that makes belonging to a group worthwhile (Haberman-Little 1991:165). Family, friends, life partners and caregivers are included in a supportive environment where processes, which are to everyone's advantage, can take place. Despite the advantages, the researcher found that Parkinsons support groups in South Africa are stagnating or disappearing. The aim of this study was to identify critical factors, which could initiate the growth and development of Parkinsons support groups. The information would enable the Parkinsons Association to initiate successful support groups in the community. A descriptive study design was used. Individual questionnaires were sent to 400 patients and caregivers who were drawn systematically from the Parkinsons Association's alphabetical address list. All group leaders, identified by the association, and who could be found, also received the questionnaire. Eventually, 312 completed questionnaires were returned (171 patients, 126 caregivers and 15 group leaders). The literature and empirical study identified both socialising and increasing knowledge of pathology, as the respondents' most important needs. Parkinsons support groups fulfil both these needs. Additional factors are needed to ensure the continued growth and development of Parkinsons support groups. The following critical factors that hamper development were found: - The lack of community awareness and involvement concerning Parkinsons support groups. The new health laws may possibly improve the situation by creating the relevant resources in the community. - All three groups are not aware of a support group's potential and what the Parkinsons Association is able to offer. - Communication is lacking between support groups and with the Parkinsons association, especially for the group leaders. - There are no specific group structure and aims (the internal mechanisms which develop and sustain a group). Program planning according to each individual group's needs and effective evaluation methods are lacking. - Basic skills training and development of Parkinsons support group leaders, in presentation and group management, should be done. - Patients are unsure of their own specific needs and which needs to choose for group subjects. Thus, the democratic compilation of the year program is affected. - The acknowledgement of the caregiver's role and needs in Parkinsons support groups is lacking. A multidisciplinary team involvement with groups is needed. - Rehabilitation and maintenance programs are not emphasized.
Open Access
Life skills that enable resilience: a profile of adolescents from a coloured community in Kimberley
(University of the Free State, 2013-11) Jansen, Anthea Natalie Blanche; Van Vuuren, S.; Van Heerden, S. M; Nel, M.
English: Adolescent development is synonymous with physical and emotional changes and challenges. This development has previously been termed "storm and stress" to further illustrate these turmoils that adolescents experience. Adolescents generally growing up in a coloured community further experience hardships such as gangsterism, unemployment, overcrowding and substance abuse. The implementation of life skills could be seen as a way to possibly reduce engagement in risky behaviour and effectively face adversity. Life skills include an unlimited list of complex and integrated skills and assist in the participation of meaningful occupations. The main occupation of an adolescent is that of a learner. Within schools, life skills are part of the form of Life Orientation. Life Orientation includes subjects such as vocational guidance, religion and physical education and it addresses the most crucial life skills. Not only can life skills assist with positive adaptive behaviour amongst adolescents, but supportive environments also contribute to resilient behaviour. Resilience is being able to bounce back from challenges. Adolescents engaging in risky behaviour, having poor to little knowledge of life skills, not applying their life skills and negative environmental factors all influence their ability to be resilient. The researcher undertook this study to establish a profile of coloured adolescents and their knowledge and application of life skills that lead to resilient behavior. This was a descriptive study involving a convenience sampling method. The study took place at four predominantly coloured schools in Kimberley in the Northern Cape. Three hundred and forty eight (348) learners returned signed permission letters that allowed them to complete the questionnaire. The sample comprised of both males and females aged 16 to 18 years. Grade 12 learners were in the minority, while there were mostly grade 11 learners (45.4%) that participated in the study. Learners mostly came from coloured suburbs with 26.4% of learners coming from other suburbs within Kimberley. The profile of coloured adolescents presented with learners possessing knowledge and/or application of different life skills. Learners presented with better knowledge of life skills within communication skills (90.3%), time management (72.8%) and values (89.9%). When expected to apply life skills, problem-solving skills (90.9%) and values (81.1%) were applied best. Learners applied time management and decision making poorly of all life skills. The researcher further noted that application of communication skills and time management (whether high or low) were directly related to resilience. Knowledge of the other life skills (whether high or low) were related to resilience. The only exception was within values, where knowledge and application were both directly related to resilience. Only small numbers of learners engaged in risky behaviour in the form of drinking alcohol mostly. Risky behaviour is considered a negative influence on life skills. Learners portrayed hope, optimism and competence within individual environmental factors. However learners from the lower socio-economic backgrounds presented with less hope (70.7%) compared to other suburbs (84.2%). Within family factors security, stability and support were prominent factors and had a positive influence on life skills leading to resilience. Peer acceptance was important for most learners (95.4%). To conclude the researcher will use findings to develop community and school programmes that could assist in the implementation of life skills that would serve to support and empower adolescents. The important role that the occupational therapist could play in adolescent development is to ensure optimal engagement in occupations through life skills in order to develop as healthy adults.
Open Access
Life skills that enable resilience: a profile of adolescents from a coloured community in Kimberley
(University of the Free State, 2013) Jansen, Anthea Natalie Blanche; Van Vuuren, S.; Van Heerden, S. M.; Nel, M.
Adolescent development is synonymous with physical and emotional changes and challenges. This development has previously been termed “storm and stress” to further illustrate these turmoils that adolescents experience. Adolescents generally growing up in a coloured community further experience hardships such as gangsterism, unemployment, overcrowding and substance abuse. The implementation of life skills could be seen as a way to possibly reduce engagement in risky behaviour and effectively face adversity. Life skills include an unlimited list of complex and integrated skills and assist in the participation of meaningful occupations. The main occupation of an adolescent is that of a learner. Within schools, life skills are part of the form of Life Orientation. Life Orientation includes subjects such as vocational guidance, religion and physical education and it addresses the most crucial life skills. Not only can life skills assist with positive adaptive behaviour amongst adolescents, but supportive environments also contribute to resilient behaviour. Resilience is being able to bounce back from challenges. Adolescents engaging in risky behaviour, having poor to little knowledge of life skills, not applying their life skills and negative environmental factors all influence their ability to be resilient. The researcher undertook this study to establish a profile of coloured adolescents and their knowledge and application of life skills that lead to resilient behavior. This was a descriptive study involving a convenience sampling method. The study took place at four predominantly coloured schools in Kimberley in the Northern Cape. Three hundred and forty eight (348) learners returned signed permission letters that allowed them to complete the questionnaire. The sample comprised of both males and females aged 16 to 18 years. Grade 12 learners were in the minority, while there were mostly grade 11 learners (45.4%) that participated in the study. Learners mostly came from coloured suburbs with 26.4% of learners coming from other suburbs within Kimberley. The profile of coloured adolescents presented with learners possessing knowledge and/or application of different life skills. Learners presented with better knowledge of life skills within communication skills (90.3%), time management (72.8%) and values (89.9%). When expected to apply life skills, problem-solving skills (90.9%) and values (81.1%) were applied best. Learners applied time management and decision making poorly of all life skills. The researcher further noted that application of communication skills and time management (whether high or low) were directly related to resilience. Knowledge of the other life skills (whether high or low) were related to resilience. The only exception was within values, where knowledge and application were both directly related to resilience. Only small numbers of learners engaged in risky behaviour in the form of drinking alcohol mostly. Risky behaviour is considered a negative influence on life skills. Learners portrayed hope, optimism and competence within individual environmental factors. However learners from the lower socio-economic backgrounds presented with less hope (70.7%) compared to other suburbs (84.2%). Within family factors security, stability and support were prominent factors and had a positive influence on life skills leading to resilience. Peer acceptance was important for most learners (95.4%). To conclude the researcher will use findings to develop community and school programmes that could assist in the implementation of life skills that would serve to support and empower adolescents. The important role that the occupational therapist could play in adolescent development is to ensure optimal engagement in occupations through life skills in order to develop as healthy adults.