3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item The value of a short practical training course for newly qualified therapists working with children with cerebral palsy in South Africa(2018) Bakuwa, TakondwaBackground: Cerebral palsy (CP) is one of the most complex disabling disorders in children that newly qualified therapists face in practice. Newly qualified therapists do not feel prepared to deal with complex conditions despite being expected to. Short practical training courses could potentially help bridge this gap in readiness. The aim of the study was to determine the value of the practical training course on CP to the practice of newly qualified therapists. Methods: Secondary analysis of therapists’ course evaluation records from eleven short practical training courses was done. Mixed methods were used to establish expectations of course participants, change in their level of CP knowledge, aspects of the course deemed useful for CP practice and change in attitudes, perceptions and practice intents. Results: Course expectations of the majority of the therapists were met, most of whom reported having also gained skills and confidence. Significant change was observed in the self-perceived level of knowledge in various aspects of CP after the course (p < .001). Aspects on communication and play therapy showed the most significant difference (p < .001). Therapists appreciated adult teaching and learning methods, conducive learning environment, the relevant and organised content and holistic approach of the course. They reported readiness to adopt positive attitudes and perceptions and practice. Conclusion: A short practical training course was therefore valuable in addressing the perceived lack of readiness amongst newly qualified therapists working with children with CP. It was capable of improving their knowledge and changing their attitudes, perceptions and practice intentions positively.Item Children with cerebral palsy living in a resource constrained community: the efficacy of a thumb opponens splint - a case study(2018) Lachenicht, MichelleCerebral Palsy is a common diagnosis in childhood and is often associated with upper limb impairments affecting hand function and participation in daily activities including personal management. A case study based research design was used with a sample of five children with spastic hemiplegic CP at Tambo Memorial Hospital to evaluate the efficacy of a thumb abductor splint for thumb in palm deformity in a resource constrained environment. The children involved in the study continued to receive their typical monthly occupational therapy service as well as any other therapy services they were involved in the time of the study. They were all splinted with a soft neoprene thumb abductor splint which they were advised to wear during participation in functional activities. A range of outcome measures were used to assess their hand function and functional performance before and after splint application over the three month data collection period including the Movement ABC and the Pediatric Evaluation of Disability Impairment scale. In spite of the small sample size and the limited clinically significant findings of the study - a potential benefit to wearing the splint during functional activity participation was highlighted in a resource constrained environment.Item Parents'/caregivers' and rehabilitation professionals' perspectives of occupational performance of children with cerebral palsy: a comparative study(2017) Chigonda, BeniginerThe study sought to compare the caregivers’ evaluation of the occupational performance and assistance needed by children with cerebral palsy (CP) to that of treating therapists to ascertain agreement about the children’s strengths/weaknesses so goals for intervention can be set. The Paediatric Evaluation of Disability Inventory (PEDI) parent/caregiver and therapist scores of 50 children with CP in Harare aged four to six and half years were analysed. The association between PEDI scores and the Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) levels as well as the internal consistency of the PEDI for this sample were also determined. Correlations for the caregivers’ and therapists’ scores on the PEDI were strong to excellent. A marked decrease in functional skills on the PEDI was noted in relation to the GMFCS and MACS levels with a negative moderate correlation between the PEDI scores and the GMFCS levels for self care, a negative strong correlation for mobility but a negative weak correlation for social function. The similarity of scores indicates positive correlation that allows for collaborative goal setting and Family Centred Therapy with these children. Internal consistency was excellent for all functional skills domains and caregiver assistance.Item The influence of the Malamulele onward intervention model on caregivers of children with cerebral palsy(2016) Adan, Marilyn JeanAim This study utilised data collected during focus group discussions with caregivers of children with cerebral palsy in the Mnquma sub-district of the Eastern Cape that were conducted as part of a much larger, longitudinal study into the use of the Malamulele Onward Intervention Approach. This Approach provides intensive therapeutic intervention for children with cerebral palsy who live in poor rural areas in South Africa as well as education and home programme training for their caregivers. Method This study explored the influence of the Approach on the caregivers’ lives whose children attended the cerebral palsy clinics at the Butterworth and Tafalofefe Hospitals. The focus group discussions took place after the initial assessment of the children in 2007 and during follow-up visits in 2008, 2009 and 2010. The participants included IsiXhosa-speaking primary caregivers (N = 21, 16 mothers and 5 grandmothers). The discussions were audiotaped, transcribed and translated from IsiXhosa to English by professional translators and the content was analysed using thematic coding techniques. Findings Five main themes emerged related to the open ended questions posed to participants, namely ‘validation’, ‘empowerment’, ‘wellbeing’, ‘faith and hope’ and ‘stress and strain’. They revealed positive feedback on the Malamulele Onward programme and indicated that participation was worthwhile. Information on cerebral vi palsy proved useful and techniques learned and special equipment provided resulted in improvement in their children. Conclusions In general, the caregivers of children with cerebral palsy in this study reported a reduction in burden of care, improvement in psychological status and social support with enhanced quality of life overall.Item Occupational therapy practice used for children diagnosed with a dual diagnosis of cerebral palsy and visual impairment in South Africa(2016-11-04) Van Rensburg, Zone JanseOccupational therapy aims to assist children diagnosed with cerebral palsy (CP) to achieve independence in their occupational performance areas. Treatment includes the use of sensory stimulation but when a child’s vision is impaired the use of visual stimulation becomes difficult. Research guiding occupational therapists on how to combine treatment methods successfully when treating children with CP with a co-morbid diagnosis of visual impairment is limited(15)(16). This study aims to determine the occupational therapy practice used, including the therapists’ knowledge; skill and perceived confidence, for children with a dual diagnosis of CP and visual impairment in South Africa. It uses a descriptive, non-experimental, cross-sectional framework within a quantitative research approach. Purposive sampling was used to select participants. This study finds uniformity in the approaches occupational therapists use when managing these children, but these approaches are not always based on best practice. Therapists use clinical expertise and integrate evidence based practice rather than the other way around. This study demonstrates a need for clear protocols on how to manage these children and more accessible postgraduate training in the management of them.Item Development of a self care inventory for children with cerebral palsy living in poorly resourced contexts in South Africa(2016-10-17) Burg, JuliaChildren with cerebral palsy (CP) struggle to participate within activities of daily living (ADLs), especially self-care. Occupational therapists need to consider many factors that influence self-care for intervention to be clinically significant. There is little documentation regarding culturally appropriate assessment tools for African children with CP. The purpose of this study was to determine criteria for items of the Self Care Inventory for Children with Cerebral Palsy (SCICP) against which dysfunction within the CP population can be measured. The study included initial development of the items and content validity of the SCICP was determined. Field-testing of the items of the SCICP was done to evaluate the administration and the item appropriateness. Age, hand function and cognition play a role in self-care skills. The SCICP is able to determine what a child’s actual self-care performance is and differentiate between a typically developing child and a child with delayed self-care skills.Item Parental perceptions and experience of rehabilitation services for children with cerebral palsy in poorly-resourced areas(2008-09-18T13:11:30Z) Saloojee, Gillian MargaretBackground No data exist about caregivers’ beliefs surrounding a diagnosis of cerebral palsy (CP), its causes and how this influences caregivers’ perceptions of therapy in poorly-resourced South African settings. Neither is there any information about how rehabilitation therapy influences the life of the child or the caregiver. The appropriateness, the outcomes and the effectiveness of therapy for children with CP in a South African setting have not been studied. Numerous tools and scales for measuring outcomes of rehabilitation relating to both the child and the caregiver are available internationally but none have been validated for use in South Africa. Caregiver-related outcomes were the focus of this study and included maternal well-being and mental health, personal quality of life, availability of support and interaction with the child. These are factors known to potentially be influenced through contact with rehabilitation services. Aims The aims of this study were firstly to ascertain whether caregiver-related outcome measures developed in high-income settings were appropriate for a poorly-resourced South African setting; and secondly, to describe parental perceptions and experiences of rehabilitation therapy received in public service hospitals in disadvantaged areas. Methodology The study was undertaken in two phases. Phase One was a quantitative cross-sectional, analytical study and addressed the first aim. Five scales were identified from the literature as being suitable for measuring the caregiver-related outcomes of interest in this study: the Caregiver-Child Scale, the Family Support Scale, the Personal Quality of Life Scale, the Mental Health Subscale of the Medical Outcomes Study (MOS) Short-form 20 Health Survey, and the Measure of Processes of Care (MPOC) Scale. The first four scales measure aspects of maternal well-being and interaction with the child whilst the MPOC assesses caregivers’ reported experiences of family-centred behaviours of rehabilitation service providers. These scales were modified and adapted to make them relevant to a South African setting through a process that included focus groups with caregivers and experienced therapists. After the modified scales had been translated into six local languages and then back-translated into English, the translators, researcher and interviewers met to discuss discrepancies between the two versions (the original modified English version and the back-translation) and to reach consensus on the final translation. The scales were further refined during a pilot study where two trained interviewers administered the modified scales to 24 caregivers of children attending public service hospitals for therapy. Items in the scales which were confusing for caregivers or which they found difficult to understand were clarified. In addition, where necessary, concrete examples were given of the type of behaviour or action being asked about in the scale. Following the pilot study, two trained interviewers administered the modified scales to a convenience sample of caregivers attending rehabilitation therapy in public service hospitals in Gauteng and Limpopo. The reliability and validity of each scale was assessed using multi-trait scaling and factor analysis. Phase Two employed qualitative methodology to address the second aim of the study. A purposive sample of 24 information-rich caregivers attending therapy in public service hospitals in Gauteng and Limpopo participated in one of five focus groups. The discussions were conducted in local languages. Taped recordings were transcribed and translated into English before being analysed using a grounded theory approach. Results Two hundred and sixty three caregivers from 31 hospitals in Gauteng and Limpopo provinces were interviewed during the first phase of the study. The mean age of their children was 3.3 years (± 2.6).Two-thirds of the children (66%) had severe limitations in motor function and few (15%) could communicate verbally. Only one of the five scales, the Mental Health Subscale, proved to be both reliable and valid in South African settings. A second scale - the MPOC - was potentially useful if reduced to an eight item scale (from the original 20 items). The Family Support Scale was reliable but not valid whilst the Caregiver-Child and Personal Quality of Life Scales were neither reliable nor valid. The process of administering the scales combined with the qualitative data helped to explain why the scales did not perform as well as expected in a South African setting. Reasons for these findings included the caregivers’ inexperience in completing these kinds of questionnaires; their difficulty with the concept of grading their responses which meant that Likert-type scales were difficult for them to complete; and thirdly language and cross-cultural applicability. This was because the scales were developed for very different cultural groups. It was not the questions or scale items that were the problem; it was rather finding the language and words that caregivers themselves would use to express the underlying concepts. The study found that caregivers living in disadvantaged South African settings live very differently from their counterparts in well-resourced areas. They lived in poverty; were beset by financial concerns; often abandoned and rejected by their partners; and endured gossip and ignorant attitudes from their neighbours and the community. The burden of daily care-giving was high as most of the children were severely disabled. This was compounded by concern about the child’s health and the future. Despite this, the study found that they were happy, healthy and generally well satisfied with their lives. Support from informal support structures such as relatives and close family members, together with formal support structures, was an important dimension in helping caregivers cope. Qualitative data from the focus groups yielded information regarding caregivers’ beliefs surrounding the perceived cause of the child’s disability. These ranged from traditional and cultural beliefs to medical explanations, and to frank confusion between the two. This was accompanied by misconceptions about therapy and the outcome thereof. Parental perceptions and experiences of rehabilitation were positive although many caregivers initially expected therapy to provide a cure. Respectful and caring attitudes, “hands on” therapy, practical help and assistance with assistive devices and school placements were aspects of service most valued by caregivers. The study helped define the components of an “ideal” therapy service in disadvantaged South African settings. They would include the availability of parent support groups; greater involvement of fathers, close family members and traditional healers in the rehabilitation process as well as the implementation of innovative strategies to ensure clearer communication and understanding between therapists and caregivers operating in a cross-cultural setting. Elements of care not traditionally perceived as part of therapy such as promoting supportive networks and taking on advocacy role for children with disabilities may offer additional advantages. Conclusion The study confirms the view that scales developed in high-income settings are not necessarily immediately applicable to less well-resourced settings and often require extensive modifications to ensure reliability and validity. Whilst the Mental Health Scale is a reliable and valid tool for caregivers attending public service hospitals in South Africa, other scales, such as the MPOC, a popular scale in North American and Europe, require substantial modification for a South African setting. In addition to highlighting the challenges involved in finding suitable outcome measures of therapy intervention for this population, this study has objectively documented the lives and experiences of caregivers of children with CP in South Africa for the first time together with their experiences and perceptions of rehabilitation therapy. Using this information, the components of an “ideal” rehabilitation service in a disadvantaged South African setting have been identified and described. This may facilitate the establishment of a more effective and appropriate therapy service for caregivers and children with CP living in poor areas.