Masters Degrees (Occupational Therapy) 2021-08-02T01:12:57Z Factors influencing the design of an occupational therapy stroke program in primary health care Factors influencing the design of an occupational therapy stroke program in primary health care Naude, Catherina Elizabeth Johanna 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. 2019-06-01T00:00:00Z Sensory integration difficulties and dysfunctions in children with fetal alcohol spectrum disorders Sensory integration difficulties and dysfunctions in children with fetal alcohol spectrum disorders Du Plooy, Maritha 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. 2017-06-01T00:00:00Z Quality of life and occupation for people with dementia: the perception of caregivers Quality of life and occupation for people with dementia: the perception of caregivers Kotze, Corne 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.; Afrikaans: Gevorderde demensie is ŉ hoogs komplekse toestand wat vereis dat versorgers genoegsaam toegerus moet wees om sorg suksesvol toe te dien. Lewensgehalte vir diegene met demensie in langtermynversorgingsinstansies berus dus grootliks op die kennis, vaardighede en houdings van versorgers wat meestal by hierdie inwoners is. Hoewel verskeie professionele rade wêreldwyd persoongerigte sorg (met die klem op die persoon met demensie as ŉ unieke individu) aanmoedig, beskou die meeste residensiële versorgingsinstansies in Suid-Afrika steeds lewensgehalte as ŉ lys voltooide take aan die einde van ŉ dag. Versorgers se begrip en toepassing van ŉ persoongerigte sorgbenadering het hiervolgens dus oorweging vereis. Aangesien raadgewende arbeidsterapeute wat individuele, persoongerigte sorgprogramme vir inwoners met demensie ontwerp, van versorgers afhanklik is om die programme te implementeer, is ŉ studie onderneem om versorgers se persepsies rakende lewensgehalte, persoongerigte sorg en die werksbetrokkenheid van inwoners met demensie te ondersoek. ŉ Gemengde triangulasie metode is toegepas op ŉ omvattende steekproef voltydse versorgers in diens van ŉ residensiële versorgingsinstansie in Bloemfontein. Die navorser het spesifiek hierdie benadering met onderhoudskedules (kwalitatiewe bevindinge) en gestruktureerde vraelyste (kwantitatiewe resultate) gekies. Kwalitatiewe bevindinge is met kwantitatiewe resultate vergelyk om ooreenkomste tussen die twee stelle data te bevestig en verskille te identifiseer. Die ontwerp het dus tot die betroubaarheid van die studie bygedra. Die resultate en bevindinge dui daarop dat persoonlike en organisatoriese faktore ŉ wesentlike invloed op die perspektiewe van die versorgers het. Die versorgers is grootliks gekondisioneer om ŉ benadering te volg wat daarop gerig is om aan die fisiologiese behoeftes van die inwoners te voldoen en sorg te beskou as ŉ lys afsonderlike take ten opsigte van elke inwoner. Een van die redes vir ŉ oorwegend fisiologiese benadering is die organisatoriese kultuur in eenhede waar sorg voorsien word aan persone met demensie. Dit blyk dat indien persoongerigte sorg deur versorgers as ontvangers (werknemers van ŉ maatskappy) ervaar kan word, dit hulle dalk in staat kan stel om die persoonlike perspektiewe en behoeftes van elke individuele inwoner aan te gryp. Persoonlike faktore wat die perspektiewe van die versorgers beïnvloed het, sluit in hulle huislike omstandighede, die algemene openbare mening en die verhouding tussen hulle en die inwoners se gesin of familie. Dit blyk dat stres tuis die versorg-las by die werk vererger en persoongerigte sorg negatief beïnvloed. Die algemene openbare mening is deur ouderdomsdiskriminasie gevorm en beklemtoon die lae status van die versorgers se werk. Die verhouding tussen die versorgers en die inwoners se gesin/familie is deur misverstande, onrealistiese verwagtinge en rolverwarring tussen die twee groepe belanghebbendes versuur. Die versorgers is gerig deur die prioriteite van die familie – wat ooreenstem met die organisasie se fokus op fisiologiese sorg, wat weer met die tradisionele model eerder as persoongerigte sorg verband hou. Die waarde van die studie is daarin geleë dat dit aandui dat ŉ kultuurverandering ten opsigte van sorg op alle vlakke van die organisasie voordelig sal wees. ŉ Skuif vanaf die tradisionele, mediesgerigte sorgbenadering kan nuwe groei- en ontwikkelingsmoontlikhede inhou. Dit beteken dat die individualiteit en waardigheid van elke werknemer en inwoner verbeter kan word en volwaardige, kwaliteit lewens tot gevolg kan hê. 2012-07-01T00:00:00Z Personality characteristics, perception of pain and the attainment of self-care in patients with spinal fusion Personality characteristics, perception of pain and the attainment of self-care in patients with spinal fusion Van der Merwe, Chanette 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. 2017-06-01T00:00:00Z