3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Botox to reduce drooling in South African neurologically impaired children : a retrospective study.(2009-03-20T09:22:10Z) Hay, Nicola MichelleDrooling management in the neurologically impaired pediatric population is a challenge. Surgery is considered an invasive procedure, while behaviour modification techniques, correction of situational factors and oral-motor therapy do not always produce sustained improvement. In recent years Botox® has been investigated. This study comprised analyses of clinical data obtained from a Drooling Treatment Project (DTP) conducted at a school for special needs children in South Africa. The aims of the DTP were to establish the response of drooling in a number of different contexts, following bilateral submandibular salivary gland injections of Botox®. Two groups of children were involved, 7 children with cerebral palsy and 2 children with operculum syndrome. Drooling was assessed in 5 different situations and at different time points pre- and post Botox® injection up to 6 months. Parents’/primary caregivers’ perceptions of drooling and treatment with Botox® were also measured using an interview form and a quality of life questionnaire. Results showed that drooling was reduced in all situations, with significant reductions in the general and communicating situations. These results indicate that the context in which drooling occurs is an important factor and suggest the value of considering the situational context when making drooling judgements. Further, there was a difference in the pattern of response between the 2 groups. This finding has implications, not only for future research, but also for models of explanation of the effects of Botox®. Most parents/primary caregivers felt their children’s lives and their own had improved following the Botox® injection and would repeat the treatment. Clinical and research implications are discussed, with reference to the South African context.Item The relationship between gross motor function and psychological well-being in adults with cerebral palsy.(2009-01-28T05:57:25Z) Timmins, Monica ClareMotor deficits are debilitating in that they affect everyday function in human beings (Zillmer & Spiers, 2001). Cerebral Palsy (CP) is one particular disorder that is primary characterised by motor deficits, more specifically gross motor function deficits. As a result, people with CP are restricted in their everyday function and lack independence and self-sufficiency. With other factors such as stigmatisation and prejudice, social participation becomes limited which leads to isolation and loneliness, which may further lead to psychological disorders such as depression, anxiety, low self esteem and poor quality of life. These assumptions are based on the application of the mental health model, and one could assume the poorer the level of functioning the more likely a person’s psychological well-being will suffer. Thus, the study attempted to investigate these assumptions by exploring the relationship between levels of gross motor function and psychological well-being. A sample of 43 participants based in a care centre in Johannesburg completed a demographic questionnaire, the Major Depression Inventory (MDI), The Becks Anxiety Inventory (BAI), The Rosenburg Self Esteem Scale (RSE) and the Comprehensive Quality of Life Scale (COMQOL – A5). In addition, through observation, the level of gross motor function was determined by utilising the Gross Motor Function Classification System (GMFCS). The data that was gathered and was statistically manipulated to explore three main questions. Before the relationship between gross motor function and psychological well-being could be explored it was necessary to examine the suitability of the use of psychological measure on an adult with CP sample. Results indicated that the MDI (r = 0.78), BAI (r = 0.76). RSE (0.77), and COMQOL (r = 0.99) had high internal constancy reliability. The relationship between demographical variables, namely, age, gender, years of residency, experience of motor deterioration and presence of epilepsy, were tested against the level of gross motor function. No significant results were found apart from motor PDF created with pdfFactory trial version www.softwarelabs.com 4 deterioration. More participants with a higher level of gross motor function experienced motor deterioration (77%) than those with a lower level of gross motor function (44%). Lastly, the relationship between psychological variables and gross motor function was investigated as well as difference between the levels. Correlations revealed very weak positive relationships, with the exception of depression having a very weak negative relationship. All relationship were non significant. Although slight differences were seen between levels, they were non significant. 7% of participants were diagnosed with depressive disorders, and 47% with anxiety disorders. Problems with certain questions pertaining to the BAI raised concerns over the suitability of its use in CP adult samples. The study concluded that psychological measures, excluding the BAI, were suitable for use on a sample of adults with CP. It also highlighted that the level of motor functioning is not related to or determines psychological well-being in adults with CP. PDF created with pdfFactory trial version www.softwarelabs.comItem The experience of caring for a child with cerebral palsy in Tonga, Mpumalanga : caregivers' stories.(2008-06-10T07:00:25Z) Barratt, Joanne FrancesCerebral palsy is a condition primarily defined by damage to the developing brain primarily resulting in a physical impairment, although the affected individual may present with concomitant impairments. The number of children presenting with cerebral palsy appears to be increasing, and while the medical effects of this disability have been well documented in the literature, a paucity of knowledge exists on the parental experience of caring for a child with cerebral palsy, particularly in rural South Africa. This dissertation will report on a study conducted in Tonga, a rural area of South Africa, which assessed caregivers’ experiences of caring for a child with cerebral palsy. Qualitative methods, including participant observation and narrative interviews were used and the SiSwati narratives of 27 participants were transcribed and analysed using theoretical coding. A number of recurrent themes emerged including the impact of gender on caregiving, the influence of traditional beliefs and practices and the experience of western medicine. However, the pervasive nature of poverty served to influence all aspects of caring for a child with cerebral palsy. These themes are discussed in relation to current healthcare policies, the influence of the HIV/AIDS pandemic, the concept of ‘ubuntu’ and socio-political aspects of healthcare. The findings highlight the value of using cultural narratives and participant observation as a means of exposing aspects related to the experience of disability that cannot be portrayed using quantitative methods. It emphasizes the nature of disempowerment amongst marginalized communities and draws attention to the need for both multisectoral and community involvement to bring about transformation.