3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Evaluating the effectiveness of behaviour guidance intervention on tolerance for dental treatment in autistic children from a Johannesburg school(2017) Crous, StephanusIntroduction: The prevalence of Autism Spectrum Disorder is increasing exponentially with most affected individuals coming from middle and low-income countries. Managing this condition throughout a lifetime is costly and therefore the World Health Organization (WHO) has called for cost-effective behavior management solutions that can be used by non-professionals in lower resource settings. Dental care is the highest unmet health care need in individuals with special health care needs, autism being the most prominent. The objective of this study was to investigate the effectiveness of two behaviour guidance techniques, a visual schedule and social story, in facilitating successful dental treatment and to describe the relationship between oral health status and level of functioning. Materials and Methods: A cluster randomised controlled trial (CRCT) was implemented to evaluate the effectiveness of a specific combination of behavioural interventions: a social story and visual schedule on oral health examination and treatment outcomes. Twenty-five classes were randomized from the low, middle and high support levels to the control or intervention arms. The primary outcomes of interest were: sitting in the dental chair, cooperative behavior as rated by the Frankl scale and the number of fissure sealants placed. In addition, the oral health status was measured for the high, middle and low support groups. The intervention was administered by classroom teachers daily for two weeks prior to the dental visit. Intention-to- treat analysis was conducted. Data were analyzed using t-tests, ANOVA and chi-squared tests to compare the intervention and control groups. Multivariate models were built to test the hypothesis that the oral health status differed by level of support while controlling for age. Results: One-hundred and sixty-five children from the 25 classes obtained parental consent to participate in the study. There were no differences between the study arms for the outcome of sitting in the dental chair (p=0.6) or the number of fissure sealants placed (‘Fisher’s exact’ p = 0.24). However, the evidence suggests that the intervention group performed marginally better and more dental treatment was possible over a longer period of time, (‘Fisher’s Exact’ p = 0.057). There was a significant difference between the treatment and control arms in behavior as measured by the Frankl scale where the control groups displayed more cooperative behavior (‘Fisher’s exact’; p=0.014). When analyzing these outcomes against the level of support, significant differences was found showing that as the level of support needed to function increases, children became increasingly more uncooperative during sitting in the dental chair, behavior was more uncooperative (p<0.001) and fewer fissure sealants could be placed (p<0.001). Logistic regression analysis showed that level of support was the strongest predictor for sitting, behavior and fissure sealant placement while controlling for socio-demographic characteristics and treatment arm. More caries was observed in the primary teeth with caries prevalence of 42.7% and mean decayed, missing, filled teeth (dmft) of 2.01 (Std Dev.=3.07; 95% CI: 1.34; 2.69) compared to the secondary teeth 28% of children had caries and the mean DMFT was 0.9 (Std Dev = 1.91; 95% CI: 0.54; 1.25). Higher mean DMFT score were associated with increased level of support (p=0.001) and children with a DMFT score of 3 and more, required the highest level of support (level 3) and experienced the highest burden of decay while controlling for age. (aOR = 4.6; p<0.006) Conclusion: Level of support required by children with ASD was the strongest predictor of ability to sit in the dental chair, behave in a cooperative way and placement of fissure sealants and none of the primary outcomes were associated with the intervention. The severity of caries observed in the permanent dentition was positively associated with higher levels of support required to function. The social story was ineffective in improving the primary outcomes in the less structured environment of the classroom and administered by non-professionals.Item The efficacy of a 12-week exercise intervention in 11-16 year old adolescents with autism spectrum disorder(2016-10-17) Neophytou, NataliaBACKROUND: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder, which often results in an array of motor impairments. These motor impairments often lead to reduced performance in activities of daily living (ADLs) as well as in societal tasks which require specific motor abilities and skills. Individuals with ASD have also been reported to have significantly lower physical activity levels compared to typically developing individuals. Motor impairments and these lower physical activity levels have led to various health problems including obesity, cardiovascular disease and insulin resistance syndrome. It may therefore be necessary to intervene in the population, to reduce sedentary-related health risks as well as attempt to improve motor impairments. Since exercise has been shown to be an effective therapeutic modality in reducing motor impairments and improving cardiovascular fitness, the efficacy of exercise interventions within the ASD population needs to be established. OBJECTIVE: To determine the efficacy of a 12 week exercise intervention by assessing the change in posture, body composition, balance, coordination, agility, gait and physical fitness pre- and post-exercise intervention in adolescents with autism aged 11 to 16 years. METHODS: A randomised control trial was conducted to assess the efficacy of an exercise intervention programme in 27 adolescents with ASD (mental age 5.6 ± 1.8 years). The sample was divided into 2 groups (intervention (n=16) and control (n=11)) using randomisation software. Validation of a 12-week exercise intervention was conducted by an expert panel via an online form. The intervention included an aerobic warm up, upper, core and lower body exercises, balance exercises, agility drills, fine motor skill training and a brief aerobic cooldown. All participants were tested pre- and post-intervention, and the intervention group participated in the exercise intervention bi-weekly for 12 weeks, while the control group received their usual standard care. Posture was assessed using a posture grid, and scores out of 10 were given per body area, where good posture = 10, average posture = 5 and poor posture = 0. Body composition, and physical fitness were assessed using the Brockport Physical Fitness Test (BPFT), and balance and coordination were assessed using the MABC-2 test and checklist. Gait was assessed using Dartfish two-dimensional video analysis, and agility was assessed using a standard agility T-test. Data analysis was performed using Stata version 13.1. Descriptive data were expressed as means and standard deviations. To compare variables during pre-and post- intervention within groups for continuous variables, the Wilcoxon signed-rank test was used. To compare variables during pre and post intervention within groups, for categorical variables, Mc Nemar’s test for symmetry was used. Fisher’s exact test was used for categorical variables. Significance was accepted at 95% (p< 0.05). RESULTS: Overall compliance to the intervention was 88.78%; high functioning individuals demonstrated 97.24% compliance, while low functioning individuals demonstrated 77.89% compliance. Posture: there was a significant increase in the overall posture scores (p=0.0004), specifically in the ankle area (p=0.0183) in the intervention group. Cardiovascular fitness: the intervention group showed significant decreases in resting systolic blood pressure (p=0.0069), and systolic blood pressure taken one minute following exercise (p=0.0007). A significant decrease in resting Heart rate (p=0.0046), as well as in heart rate taken one minute following exercise (p=0.0096) was also seen. Anthropometry: although the intervention groups’ weight and body fat percentage did not significantly decrease, there was a significant reduction in BMI (p=0.0130) post intervention. Strength: handgrip strength significantly increased in the non-dominant hand only (p=0.0289), yet there was an overall increase in strength in both hands. The intervention group improved significantly in the amount of curl-ups they were able to perform following the intervention (p=0.0094). Flexibility: for the majority of the flexibility parameters, no significant changes were seen from pre to post testing besides in the intervention group for the sit and reach test for the non-dominant limb (p=0.0088). Manual dexterity: In the MABC-2 test (for age-band 3) there was a significant difference seen in the intervention group (p = 0.200) for the turning pegs item for the non-dominant hand in the intervention group. Coordination: a significant difference was seen in the intervention (p=0.0007) and control group (p=0.0112) for the throwing activity. No conclusive information regarding the efficacy of exercise for this component was however noted. Balance: the intervention group was able to hold their balance for a significantly (p=0.0028) longer time post intervention (17.0 ± 11.0 s) compared to pre intervention (10.5 ± 9.2 s) in the two-board balance task. Agility: there was a significant (p=0.0061) improvement in the agility times from pre (27.4 ± 12.1s) to post (23.0 ± 9.9s) intervention in the intervention group. Gait: there were no significant differences seen following the intervention for all gait parameters. CONCLUSION: A 12 week exercise intervention significantly improved overall posture, cardiovascular fitness, BMI, hamstring flexibility, coordination, balance and agility in individuals with ASD. Handgrip strength and manual dexterity also improved . This therefore suggests that exercise may be a viable therapeutic intervention in the ASD population.