Masters Degrees (Occupational Therapy)

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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
Occupational markers and supportive structures in individuals with developmental dyslexia: an occupational therapy perspective
(University of the Free State, 2023) Engelbrecht, Hendrika Augustha (Helé); Jansen, Anthea
𝗕𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱: Early identification leading to appropriate intervention and support for individuals with developmental dyslexia is paramount in the optimal management of this neurodevelopmental disorder. In the absence of clearly defined genetic markers, developmental dyslexia are currently noted through the behavioural signs (in the current study referred to as occupational markers) displayed by an individual with developmental dyslexia. Despite the call of international researchers for the development of a dyslexic profile as opposed to a single deficit in the identification of developmental dyslexia, a gap in research defining a dyslexic profile still exists. This indicated the need for further research to aid in the identification of occupational markers that may contribute to the compilation of a possible dyslexic profile as well as identification of possible supportive structures for individuals with developmental dyslexia. The aim of the study was to identify possible occupational markers for developmental dyslexia as well as supportive structures that may guide intervention. 𝗠𝗲𝘁𝗵𝗼𝗱: The study followed the guidelines provided by Arksey and O’Malley to conduct a scoping study utilizing the 5 Stage framework. 𝗙𝗶𝗻𝗱𝗶𝗻𝗴𝘀: The first scoping study revealed the presence of possible occupational markers that may be indicative of the presence of developmental dyslexia in an individual. Dyslexic strengths were also noted and may contribute to a possible dyslexic profile. The second scoping study investigated the supportive structures available to individuals with developmental dyslexia, noting social support (as described in the PEOP model) as a major contributor. The results also indicated that early identification served as means of support thus highlighting the importance of timely identification. 𝗜𝗺𝗽𝗹𝗶𝗰𝗮𝘁𝗶𝗼𝗻: The results of the research may inform the compilation of a dyslexic profile thus enabling early identification of individuals with developmental dyslexia. The use of a profile will also enable identification irrespective of language and culture thus promoting inclusion and occupational justice. 𝗥𝗲𝗰𝗼𝗺𝗺𝗲𝗻𝗱𝗮𝘁𝗶𝗼𝗻𝘀: Further research should be conducted to investigate the use of occupational markers to aid in the compilation of a dyslexic profile as well as supportive structures available to individuals within the South African context. The knowledge of occupational markers could also guide research within the South African context to develop a screening tool. The current research may also inform the development of an interdisciplinary working model to foster interprofessional communication and guide future research.
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
Victims of intimate partner violence: an occupational justice perspective
(University of the Free State, 2020-12) La Cock, Tanya; Van der Merwe, Tania Rauch; Strauss, Monique
Background: One in three women in South Africa report being affected by IPV. Every eight hours, a woman dies at the hands of her intimate partner, making South Africa the country with the highest rate of intimate partner homicide. Experiencing IPV affects all aspects of health including physical, intellectual, social, emotional, and spiritual well-being. IPV should therefore be considered a public health priority in South Africa. Occupational therapists are likely to encounter people affected by IPV and are equipped to provide interventions for people affected by IPV. However, literature on this topic from an occupational therapy perspective is scarce. In South African occupational therapy literature specifically, there are no publications relating to IPV. The silence in literature indicates that occupational therapists may not be aware of the holistic needs of their clients, who, if they are female, have a 33% chance of being affected by IPV. This topic should be explored in order for occupational therapists in South Africa to respond appropriately to clients affected by IPV. Accordingly, the researcher conducted a study that purposed to explain how women affected by IPV experience and adapt to occupational risk factors. The study describes IPV from an occupational justice perspective to advocate for an improved response among occupational therapists toward the plight of people affected by IPV. Methods: The study is positioned in the constructivist and feminist paradigms, utilising aspects of a phenomenological design. Data was collected from eleven participants who had been affected by IPV and were residing at women’s shelters in Gauteng using a collage technique with in-depth, unstructured interviews. The interviews were manually analysed using inductive content analysis. The coded data were grouped into categories and synthesised into three emerging themes. Rigour was enhanced during this process by utilising investigator triangulation. Discussion: The first theme “perpetrators of occupational rights violations”, illuminates how coercive control, family attitudes, community institutions, and cultural attitudes contributed to an environment that allows for IPV to be perpetrated continuously. The second theme, “experience occupational rights violations” describes how the participants experienced restricted activity participation, feeling unsatisfied in activities, lost/changed identity, feeling dehumanised, and had challenges in areas of occupation. The last theme “changes and adaptations within the women affected by IPV” describe how the participants responded to IPV through mental changes, emotional adaptations, behavioural adjustments, spiritual changes, and leaving the relationship. Conclusion: This study firstly illustrates that IPV is perpetrated on a relational, community, and societal level. These are largely attributed to societal stigmas, patriarchal beliefs, and ignorance surrounding IPV. Occupational therapists in all settings can influence all these contexts. However, their first responsibility is to be cognisant of the prevalence of IPV and reflect on how their own beliefs may contribute to the perpetration of IPV. Secondly, the study describes the adversaries women affected by IPV face from an occupational perspective, as well as the resilience they displayed by adapting to these adversaries. This allows therapists who are confronted with IPV to be aware of the holistic needs of their clients and respond in ways that support the occupational well-being of their clients.
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
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
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
PEOP related environmental factors and occupational performance of persons with spinal cord injury in Saudi Arabia
(University of the Free State, 2020-01) Moonsamy, Yarmon; Swanepoel, Azette; Van Wyk, Heleen
Background: This study focused on the environmental factors as identified by the PEOP Model that influence the occupational performance of persons living with spinal cord injuries in Saudi Arabia. Spinal cord injury is a devastating and life-disrupting condition and the person living with SCI will face many impairments and complications as a consequence of their injury. Impaired performance of daily activities e.g. activities of daily living, leisure, home maintenance, vocational and educational activities is a prevailing reality for the person living with SCI. Limited research has been conducted on the impact of the environment on the occupational performance of persons living with SCI in Saudi Arabia. The aim of the study was thus to determine which environmental factors as identified by the PEOP model influence the occupational performance of persons living with SCI in Saudi Arabia. The research was conducted at a tertiary care medical facility in Riyadh, Saudi Arabia. Methods: The objectives of this research study was to identify and describe the environmental factors as identified by the PEOP model which are either barriers or facilitators of occupational performance of persons with SCI, and to compare the identified barriers or facilitators of occupational performance as it relates to the time since previous inpatient rehabilitation. A descriptive quantitative research approach was used, and convenience sampling was selected as the most appropriate sampling method. One hundred and twenty-one participants were included in the research study over a three-month period (April to June 2019). A questionnaire was developed by the researcher based on the environmental factors as described in the PEOP model of practice. Data was gathered during a structured interview with participants. Results: The results are presented in three sections namely the demographic description, the known environmental factors that act as barriers or facilitators of occupational performance and the barriers or facilitators of occupational performance since previous inpatient rehabilitation. The physical layout shows that the home is a facilitator in nine self-care activities and a barrier of occupational performance of the remaining three self-care activities. Results show that three of the six components of the design properties of the home are facilitators of occupational performance. The remaining three are barriers of occupational performance. The geographical location of the home and type of terrain is a facilitator of occupational performance however climate is a barrier of occupational performance. All participants indicated that their religious beliefs and customs or traditions are facilitators of occupational performance. The results show that social acceptance and social prejudice by others is a barrier of occupational performance. Participants also indicated that social interaction and the social support by others is a facilitator of their occupational performance. The participants indicated that there was a significant change in their economic status after their injury and that their current economic status is a barrier of occupational performance. Access to health care services was also identified as a barrier of occupational performance. Conclusion: The results confirm that certain environmental factors are either barriers or facilitators of occupational performance, participation and well-being of persons living with SCI. A few limitations were identified by the researcher during the research study. Recommendations that arose from the outcomes of this study were provided on the impact for OT practice, institutional level, governmental level and opportunities for future research. Furthermore, it is the hope of the researcher that the recommendations gained from this study will aid relevant stakeholders and policymakers to ease the plight of persons living with SCI in Saudi Arabia.
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
The perceived burden of care for caregivers of post discharged CVA patients with functional impairments at a private rehabilitation unit in Bloemfontein
(University of the Free State, 2018-08) Serfontein, Lyndall; Visser, Marieta; Van Schalkwyk, Mia
Article 1: Recent surveys show an alarming increase in the number of individuals suffering from strokes annually, resulting in functional impairments. Comprehensive rehabilitation is crucial in order to enhance patients’ level of independence in daily activities and to facilitate community integration. Unfortunately, rehabilitation services in South Africa are hampered by several factors, leaving many patients without the opportunity for comprehensive rehabilitation. This place a higher burden of care on informal caregivers and family members, who are often forced to take up the unplanned occupation as caregivers. Not being adequately prepared for this new role results in occupational loss and unbalanced activity profiles. Caregiver education, home-based caregiving services, support groups, and therapeutic home visits should, therefore, take priority. Therapeutic intervention throughout all rehabilitation outcome levels is advised in order to assist with the transition between the rehabilitation and community reintegration phase of patients with strokes, in order to ensure that they will be as independent as possible in their daily occupations and decrease the burden on caregivers. This literature review aims to provide a background of the current rehabilitation services in South Africa for persons who suffered strokes, the occupation of caregiving, caregivers’ burden of care, as well as recommendations for clinical practice. Article 2: Introduction: The transition between inpatient rehabilitation and discharge of survivors of strokes from private rehabilitation services in South Africa is often challenging. After discharge, the caregiver role as an extension of rehabilitation, as well as the assistance of patients in daily occupations, becomes important. Although the occupation of caregiving could have positive attributes for the caregiver, it can be perceived as a burden. This study investigates the burden of care as experienced by patients’ caregivers post discharge, contributing factors to burden of care, and how occupations relate thereto. Method: A quantitative descriptive study was conducted with 63 patients and caregivers, using a consecutive, non- randomised sampling method. Patients’ Functional Independence Measure (FIM) scores upon discharge were obtained. Telephonic interviews were conducted two months after discharge, using the Modified Caregiver Strain Index (MCSI), as well as a non-standardised questionnaire. Results: Patients’ median FIM scores at discharge were 86, indicating that they needed minimal assistance. Caregivers experienced some burden of care, since the median MCSI score was nine, interpreted as minimal/moderate strain. Contributing factors include financial, physical, psychological, and social aspects. Caregivers also seem to have unbalanced occupational profiles. Conclusions: The problematic transition between private inpatient rehabilitation and discharge needs to be addressed.
Open Access
Sensory integration difficulties and dysfunctions in children with fetal alcohol spectrum disorders
(University of the Free State, 2017-06) Du Plooy, Maritha; Van Jaarsveld, A.; Raubenheimer, J.; Janse van Rensburg, E.
Introduction: The effects of Fetal Alcohol Spectrum Disorders (FASD) are devastating and enduring, impacting on performance skills and limiting successful participation in activities of daily life. The high prevalence of FASD in the Western Cape, together with poor results in school performance, are reasons for concern. Symptoms of sensory integration dysfunctions are reported as challenges faced by children with FASD. The aim of this study was to describe sensory integration difficulties and dysfunctions experienced in a group of children aged five to eight years old from the Cape Winelands Education District (CWED), both with and without a diagnosis of FASD. Objectives: The main objectives were to investigate sensory modulation, as measured by the Sensory Profiles, and sensory processing and practic abilities, as measured by the SIPT, of an identified group of children with FASD and a matched controlled group without a diagnosis of FASD. A final objective was to identify patterns of sensory integration difficulties and dysfunctions, to describe these findings, and to draw conclusions about the distinctive patterns of sensory integration difficulties and dysfunctions among children with FASD. Methodology: Thirty children with FASD (cases) were compared with a matched sample (controls) without FASD. Standardized measuring instruments, the Sensory Profile (SP), Sensory Profile School Companion (SPSC) as well as the Sensory Integration and Praxis Tests (SIPT), were used in this quantitative, observational, analytical study. Results: Higher percentages of cases than controls experienced challenges in 22 of the 23 categories of the Sensory Profile, with significant differences in nine of the categories. According to the results of the Sensory Profile School Companion, cases experienced more challenges in all 13 of the categories, with significant differences in three. Comparison of the mean scores of the matched sample showed significant differences in eight categories of the SP and three of the SPSC, with the cases performing poorer. The highest percentages of cases in the Definite Difference and Probable Difference ranges were recorded for Sensory Seeking (90% (n=18)), Inattention/Distractibility (85% (n=17)), Auditory Processing (70% (n=14)), Multisensory Processing (85% (n=17)), Registration (62% (n=19)) and Avoiding (62% (n=19)). The identified sensory processing difficulties seemed to occur in multiple sensory systems, ranging from under- to over-responsiveness. It is important to note that sensory processing difficulties were also reported for the controls, although at lower percentage levels. The paired t-test results indicated significant differences between the paired cases and controls in eleven of the seventeen test items of the SIPT, with the cases performing poorer. According to the results, 14 (46.7%) of the cases adhere to the criteria recognised as a Visuo- and Somatodyspraxia pattern of dysfunction. The difficulties and dysfunctions identified by the Sensory Profiles and SIPT could contribute to the challenges experienced in occupations of the children with FASD. Conclusion: Although further research is needed, the results from this study confirm sensory integration difficulties and dysfunctions of the FASD population impacting on their daily functioning and performance. Consistencies with previous research results were found. The outcome of this study has clinical importance for occupational therapists working with children with FASD, and for educators and caregivers in terms of intervention, education and caring.
Open Access
Quality of life and occupation for people with dementia: the perception of caregivers
(University of the Free State, 2012-07) Kotze, Corne; Du Toit, S. H. J.; Van Heerden, S. M.
English: Advanced dementia is a very complex condition and requires that caregivers be equipped to administer care successfully. Therefore, quality of life (QoL) for persons with dementia in long-term care facilities relies heavily on the knowledge, skills and attitudes of caregivers who spend the majority of time with these residents. Although various professional bodies all over the world encourage person-centred care, (i.e. promoting the focus on the resident with dementia as a unique individual), most residential care facilities in the South African context still measure QoL as a list of completed tasks at the end of the day. Therefore, the caregivers’ understanding and application of a person- centred care approach needed careful consideration. Due to the fact that consultant occupational therapists who designed individualised personcentred care programs for residents with dementia depends on the caregivers to implement these programs, a study was undertaken to describe and explore caregivers’ perceptions of QoL, person-centred care and occupational engagement for residents with dementia. A triangulation, mixed methods design was applied with a comprehensive sample of full-time caregivers employed at a residential care home (RCH) in Bloemfontein. The researcher specifically chose this approach with interview schedules (qualitative findings) and structured questionnaires (quantitative results). Qualitative findings were compared and contrasted with quantitative results in order to verify similarities and to identify discrepancies between the two data sets. Literature was also consulted to support similarities and discrepancies. The mixed methods triangulation design, therefore, contributed to the trustworthiness of the study. Results and findings indicated that personal and organisational factors had a major impact on the perspectives of the caregivers. The caregivers were mostly conditioned to operate within an approach associated with meeting the physiological needs of the residents and addressed individualised care as a list of separate chores associated with each resident. One of the reasons supporting a more physiological approach is the organisational culture found in units where care is provided for persons with dementia. It was also evident that if person-centred care could be experienced by caregivers as receivers (employees of an organisation), it might enable them to embrace the personal perspectives and needs of each resident individually. Personal factors that impacted the perspectives of the caregivers were their home circumstances, the general public opinion and the relationship between them and the family of residents. It appeared that stress factors associated with their home circumstances further aggravated the burden of care at work, negatively impacting person-centred care. The general public opinion was led by ageism, which emphasised the low status of their job as caregivers. Lastly, the relationship between the caregivers and family of the residents was guided by misunderstandings, unrealistic expectations and role confusion between these two stakeholders. The caregivers were guided by the priorities of the family which were, similar to those of the organisation, focused on physiological care associated with the traditional model, rather than person-centred care. The value of the study is that it indicated that a culture change towards care would be beneficial to the organisation at every level. A move away from the traditional medical-focused care approach could provide new opportunities for growth and development. This implies that the personhood and dignity of every employee and resident could be promoted, leading to a life worth living.
Open Access
Personality characteristics, perception of pain and the attainment of self-care in patients with spinal fusion
(University of the Free State, 2017-06) Van der Merwe, Chanette; Hough, R.; Nel, M.
Background Self-care activities are often most affected after a spinal fusion and are priority goals of the individualised treatment approach. Many patients undergo spinal fusions with similar levels and instrumentation. Despite procedural similarities, some patients return to participation within self-care activities effortlessly, whilst others display delayed independence. Literature suggests that personality traits and patients` perceived experience of pain is two contributing factors in rehabilitation. The aim of this study was to investigate the associations between these factors. Methods A descriptive cross-sectional study design was used. The study population included 61 patients who underwent a spinal fusion amid October 2015 and June 2016. Data was gathered pre-operatively and post-operatively. Selfcompiled - and standardised questionnaires were used to measure pain, personality and self-care activities. Results Perfectionism (57.4%), tension (44.3%) and apprehension (44.3%) were high-indicated primary factors. Low emotional stability and seriousness were found in majority (73.8%) of the participants. Study participants (49.2%) who had high functional impairments due to pain displayed high levels of anxiety. Low levels of functional impairments were related to high levels of independence, tough-mindedness and self-control. Caring for toe nails, drying hair and engaging in sexual intercourse were the most affected self-care areas pre- and post-operatively. 68.9% of participants attained both self-care goals. Conclusion Participants with high anxiety and low independence, tough-mindedness and self-control, experienced more pain. Higher levels of pain are associated with decreased goal attainment. However, despite a higher pain perception, the presence of certain personality characteristics namely: low extraversion, high independence and self-control leads to higher goal attainment. Results confirm that personality characteristics influence pain perception and the attainment of self-care goals.
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
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
Die voorkoms van visuele persepsieprobleme en die effektiwiteit van arbeidsterapie groepbehandeling onder Graad 1 kleurling leerders
(University of the Free State, 2006-11) Van Romburgh, Jacomina Adriana; Van Jaarsveld, A.
Visueel-perseptuele vaardighede speel 'n belangrike rol in 'n kind se suksesvolle vordering op skool. Graad 1-leerders word gekonfronteer met belangrike ontwikkelingstake, soos skoolaanpassing, sosiale aktiwiteite en akademiese verwagtings ten einde hulle voor te berei om 'n bydrae te lewer tot die gemeenskap waarin hulle woon. Visueel-perseptuele vaardighede lê die fondament vir daaropvolgende ontwikkeling ten opsigte van hoër kognitiewe vaardighede. Agterstande ten opsigte van visuele persepsie kan lei tot probleme met skooltake soos lees, spelling, handskrif, visueel-motoriese koërdinasie en wiskunde. Deur doeltreffende terapie kan funksionele probleme in 'n kind se lewe voorkom word. Vroeë intervensie kan 'n kind help om basiese vaardighede te ontwikkel wat die fondament vorm waarop formele onderrig of funksionele vaardighede gebou kan word. Arbeidsterapie-intervensie onder kinders het ten doelom hul funksionaliteit te verbeter en te kompenseer vir beperkte deelname deur middel van terapeutiese, doelgerigte en ouderdomsrelevante aktiwiteite of omgewingsaanpassings. Suksesvolle terapie kan 'n kind help om aan daaglikse aktiwiteite deel te neem wat vir hom doelgerig en betekenisvol is. Arbeidsterapeute wat met skoolgaande kinders werk, is gemoeid met 'n kind se vermoë om take en aktiwiteite, wat 'n invloed op sy skoolfunksionering het, so funksioneel moontlik uit te voer. 'n Kind maak staat op sy vaardighede om volgens sy potensiaal te funksioneer. Kinders het nie gelyke geleenthede vir die ontwikkeling van visuele persepsie nie. Perseptuele probleme kom by kinders van verskillende ouderdomme voor en kan verskeie oorsake hê. Kinders met emosionele probleme asook ontwikkelingsagterstande toon dikwels perseptuele probleme. Dit hang gewoonlik nou saam met die soort stimulasie waaraan hulle blootgestel is. Die aantal kinders wat remediëring of hulp in die grondslagfase benodig, vermeerder toenemend en neem kommerwekkende afmetings aan. Dit word vererger deur 'n leemte in bestaande dienslewering in die gemeenskap om ontwikkelingsagterstande aan te spreek. Buiten dat privaatterapie kostes inhou, is daar nie 'n privaat arbeidsterapie-diens in die Heidedalof omliggende woonbuurtes beskikbaar nie. As gevolg van lae sosio-ekonomiese omstandighede en maatskaplike probleme in 'n gemeenskap, kan 'n gebrek aan stimulasie noodsaak dat 'n kind hulp moet ontvang om sy visueel-perseptuele vaardighede te ontwikkel. Kinders met visueel-perseptuele agterstande moet die geleentheid kry om deel te neem aan terapie ten einde hul skolastiese vermoë te verbeter en hul potensiaal te bereik. Die behandeling van kinders met persepsieprobleme in privaatpraktyk en by hospitale geskied hoofsaaklik individueel. Die studie het aangetoon dat daar In baie hoë voorkoms van visueel-perseptuele probleme onder graad 1 Kleurlingkinders in Heidedal, Mangaung is. Die studie het verder getoon dat arbeidsterapie-intervensie by beide individuele- en groepterapie In positiewe invloed op die kinders se visueel-perseptuele vaardighede gehad het. Geen statisties beduidende verskille tussen individuele- en groepterapie vir die behandeling van visueel-perseptuele probleme het voorgekom nie. Dit blyk egter dat die kinders wat in groepe terapie ontvang het, neig om meer te verbeter ten opsigte van hul algemene visuele persepsie en visueel-motoriese integrasie vaardighede. Behandeling in groepe lei tot meer effektiewe benutting van mannekrag, tyd en finansiële bronne. Deur kinders in groepe te behandel kan In groter aantal kinders bereik word in die arbeidsterapeut se hantering van kinders met visueel perseptuele agterstande.
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
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
Wheelchair basketball and community reintegration of people with a spinal cord injury
(University of the Free State, 2016-06) Wiggill, Wilene; Rauch van der Merwe, T.; Hough, P. A.
English: As part of the occupational therapists role with a patient who suffered a spinal cord injury, the therapist aims to assist the patient in returning to his and her usual life, participating in activities that he or she regards as normal within his or her life. Such activities include basic tasks that are often taken for granted, such as caring for the home, caring for oneself and family, going to work, socialising with peers and managing one’s finances. From previous experience, it has been noted that occupational therapists often do not give enough attention to addressing the community reintegration needs of patients. Limited time, resources and too little knowledge regarding communication reintegration could contribute to this. Limited findings exist regarding the role of wheelchair basketball to address community reintegration. The researcher aspires to address this gap in the knowledge, by making use of a qualitative, explorative design within the specific context of the participants. By conducting in-depth interviews with the players of the wheelchair basketball team of the Northern Areas in Port Elizabeth, the researcher aimed to describe wheelchair basketball and the community reintegration of these participants. The interviews were conducted by Mr Kegan Topper, who is experienced in the interview process. The players in the wheelchair basketball team have acquired spinal cord injuries, and were between the age of 26 and 57 years. Informed consent was obtained from participants, and the participants were reimbursed for travel expenses. Participants had the opportunity to withdraw from the study at any time, without penalty or losing benefits. The identities of the participants will remain confidential. The researcher has used the findings to make recommendations regarding the community reintegration of people with spinal cord injuries.
Open Access
The suitability of the DTVP-2 as a measurement instrument for 5 years and 6 months to 5 years and 11 months English-speaking children in South Africa
(University of the Free State, 2015-07) Smith, Mariska; Van Heerden, S. M.; Visser, M. M.
English: As there is limited comprehensive visual perceptual skills test that has been standardised on a representative South African population, occupational therapists in South Africa make use of measurement instruments standardised in other countries to measure children’s visual perceptual skills. A measurement instrument frequently used by SA OTs, the DTVP-2, is a reliable and valid test for the population on which the test was standardised. However, the DTVP-2’s suitability is questioned in a crosscultural setting, specifically the SA population. The aim of the study was to investigate the suitability of the Developmental Test of Visual Perception – 2nd edition (DTVP-2) as a measurement instrument for 5 years and 6 months to 5 years and 11 month English-speaking boys and girls from the City of Tshwane, South Africa. A quantitative, descriptive, observational study was conducted. One-hundred and thirty four (134) study participants were recruited by means of stratified random sampling from English Language of Learning and Teaching schools located within the four educational districts in the urban-suburbs of the City of Tshwane. A selfadministered screening questionnaire was used as a screening method to establish children’s eligibility for inclusion in the study, as well as for parents/caregiver to provide informed consent. Children of parents/caregivers who returned the questionnaires were assessed with the DTVP-2. The DTVP-2’s motor-enhanced subtests were administered according to the prescribed method, while each of the motor-reduced subtests of the DTVP-2 was administered with an adapted method of not implementing the ceiling rule. Results of the study yielded that the SA study sample’s scores differed to the American normative sample. The position in space- and visual closure subtests yielded more accurate results when the ceiling rule was not implemented. It was established that the DTVP-2 was unbiased for gender, with the exception of figureground, when scored according to the prescribed method. The DTVP-2 displayed overall acceptable reliability, however the individual subtests of visual closure, visualmotor speed and form constancy was found to be unreliable. A Rasch analysis revealed that figure-ground and form constancy of the motor-reduced subtests measured a single construct and the four motor-reduced subtests of the DTVP-2 exhibited distorted item difficulty and –linearity resulting in misapplication of the ceiling rule. It is concluded that the DTVP-2 should be used with caution to measure 5 years and 6 months to 5 years and 11 months English-speaking children’s visual perceptual skills and care must be taken when interpreting and conveying scores to parents and other health care professionals. It is recommended that South African occupational therapists adjust and/or be sensitive in their assessment procedures in order to inform evidence-based practice.