3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Factors influencing community reintegration of persons with spinal cord injury who received private inpatient rehabilitation in Gauteng(2018) Van der Veen, Dale AnnePersons with spinal cord injury (SCI) continue to face numerous contextual barriers to community reintegration, despite receiving rehabilitation. To ascertain the perceived factors influencing community reintegration of persons with SCI, who received private in-patient rehabilitation, a quantitative descriptive approach was used. Fifty-four persons participated in this study by completing a cross-sectional online self-administered survey, including; a sociodemographic profile, the Reintegrated into Normal Living Index (RNLI) and the Craig Hospital Inventory of Environmental Factors – Short Form (CHIEF–SF). Data was analysed using STATISTICA 13.2. Majority (63.5%) of participants were male, living with incomplete paraplegia (75%a) and 52% were employed. Eighty percent of participants experienced moderate to severe restrictions to participation, with low satisfaction in community reintegration. Help at work/school, business policies, help at home, attitudes at work/school and the natural environment were the greatest environmental barriers, while social support and access to private transport were the greatest facilitators to community reintegration.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 How using assistive technologies (AT's) affect the interpretation of the ability-disability construct of people with adult-onset locomotor disabilities(2016) Muzite, PreciousThis study focused on how assistive technologies (ATs) affect the ability-disability construct of adult-onset locomotor disabled individuals in the South African city of Johannesburg. Its main aim was to understand the socialized use of assistive technologies in adult-onset locomotor disabilities and to unravel how the socialized use of assistive technologies affect the users’ interpretations of the ability-disability construct; through the perceptions of the participants within a developing world context. Relatively, there have been few ATs studies in South Africa and they have excluded the ‘voice ‘of the disabled people. Ten conveniently sampled adult-onset locomotor disabled individuals participated. An interpretive technique in the form of semi structured one hour interviews was used for data collection. The descriptors of events for the thematic analysis were the patterns or themes in which participants were constructing the narratives of their lives. These patterns were formulated using Braun and Clarke (2006) six stages of identifying, analysing and reporting patterns within the data. Transcribed texts from the ten semi-structured interviews were subjected to thematic analysis based on how the participants perceived their assistive technologies. Four central themes emerged which centred on how people perceived their ability-disability; the social acceptability of ATs, accessibility factors and new trends in assistive technologies. The research findings indicate that most adult onset disabled individuals in a South African context tended to embrace the promises of technology centred on positive attributes such as: improved communication with others, increased mobility, physical safety, personal autonomy, control over one's body and life, independence, competence, confidence, the ability to engage in the workforce and participation in the wider community. Although such positive attributes seemed to reinforce perceived ability as the boundary between disabled bodies, technology was blurred. However, this perceived ability was found to be rather misleading since it was premised in the same medical and social discourse that ‘disabled’ individuals. T he participants’ narratives were constantly constructing and reconstructing the way they perceived themselves as able or disabled. The studies therefore recommend that, disability narratives on the perception of ATs should be viewed as fluid, complex and multi-layered.Item A study to determine which motor deficit has the strongest association with an improvement in functioning in activities of daily living in stroke patients(2015-09-07) Muller, CaitlinStudies to determine which underlying motor deficits have the greatest impact on improvement in functioning within activities of daily living in stroke patients are nonexistent with regard to the South African context. Effective stroke rehabilitation is essential due to rapid discharge rates and therefore it is important to focus on the motor deficit that will contribute most significantly to function. Patients from the ages of 35 to 85, who had suffered a stroke and were admitted to a private, neurological, rehabilitation facility in Johannesburg gave consent to participate in three outcome measures determining adequacy of balance (Berg Balance Scale), upper limb movement (Frenchay Arm Test) and gait (Timed Up-and-go Test) as well as one outcome measure determining level of functioning within activities of daily living (Functional Independence Measure). Results from the pre- and post-tests indicated that all participants improved during the time of rehabilitation. The findings of the outcome measures for each of the three different motor components were correlated with functioning in ADLs for each patient. The results showed that balance had the strongest correlation with functioning in ADLs, followed by upper limb movement, and then gait. The use of the FIM as a functional measure appeared to have some limitations and is not standardised to be used within the South African context.Item A report to inform the development of a clinical practice guideline for rehabilitation post total knee arthroplasty in a South African public hospital(2011-10-24) Wood, Wendy-AnnThere is no published research available that evaluates the outcome of TKA in South African public hospitals. Prior to this project, there was no South African published research on the role of physiotherapy in patients post TKA. There are also no clinical practice guidelines in South Africa for rehabilitation post TKA. International guidelines may not be appropriate within a South African public hospital context. One of the issues raised in the literature pertaining to CPG development is that they lack practical detail and clarity of how decisions are made. In the current context, these problems may be compounded due to the lack of published research in the field in South Africa. The report that is presented is an attempt to combat these issues when a CPG for physiotherapy post TKA in a South African public hospital is developed. The aim of this study was to draft a report that could inform a comprehensive physiotherapy intervention (in the form of a clinical practice guideline) for patients undergoing a TKA in a tertiary care public hospital in urban South Africa. This was achieved through a series of four studies. The first study involved translating and establishing reliability of the Oxford Knee Score. The second study was a survey of current physiotherapy practice in the management of patients post TKA in South Africa. The third study was a prospective cohort study to establish the effect of an in-patient treatment protocol for use in the final study. The final study was an observational study to explore the outcome of patients post TKA and identify those who may be at risk for poor outcome. The English and translated versions of the Oxford Knee Score was shown to be reliable in this sample. This provided an outcome measure that can be used in the validation and evaluation phases of CPG development. The survey of current practice highlighted the high rate of staff turnover and the relative inexperience of physiotherapists working with patients post TKA in the public sector. It identifies the junior physiotherapists as potential stakeholders in the CPG. The trial of the in-patient physiotherapy protocol rendered similar findings to other similar studies in that a specific physiotherapy intervention did not have any effect on short term outcomes. It puts forward clear clinical questions to facilitate the development of the CPG, particularly relating to scheduling and delivery of weekend and out-patient therapy. The final study provided a demographic profile of the patients within the study context, who are potential stakeholders in the CPG development process. In addition it revealed that level of education, the presence of a caregiver at home, marital status and lack of previous exposure to physiotherapy form part of the profile of an ‘at risk’ patient. When the contribution that this thesis has made thus far to the CPG development process, is appraised using the AGREE tool, it shows that the thesis has contributed to 11 out of 23 of the criteria on the AGREE tool. It has therefore resulted in a report that informs the development of a clinical practice guideline for the physiotherapy management of patients post total knee arthroplasty in a tertiary care public hospital in Gauteng, South Africa.Item An ethnography of adults living with aphasia in Khayelitsha.(2010-11-09) Legg, Carol FrancesThis thesis is concerned with the experience of aphasia in Khayelitsha, a township on the outskirts of Cape Town characterised by poverty, violence, limited resources and a culture and language that differs from the setting of most speech and language services in South Africa. It is based on three years of intermittent fieldwork that entailed participant observation of the everyday life of five adults living with aphasia and interviews with participants, kin and healthcare workers in various settings. Grounded in sociocultural theory, this thesis has aimed to provide an ethnographic account of cultural frameworks of interpretation of communication impairment following stroke and of the daily reality of life for adults living with aphasia in this setting. An exploration of causal notions in this setting provided interesting commentary on social and cultural processes and how people, caught up in these processes, search for meaning and for cure. Participants entertained plural notions of causation of aphasia and explored numerous therapeutic avenues. The wide variation in causal notions included biomedical causes, social and behavioural determinants, and the influences of supernatural powers, such as witches and ancestors. Similarly participants experienced aphasia through multiple healing systems, including traditional, biomedical and religious therapy options. All however seemed to be ambiguous sources of help. Whilst encounters with the health system presented serious challenges to participants, traditional and religious avenues for help were obscured by a burgeoning and not always ethical open market offering miracle cures. An articulation of the circumstances of this group of adults provided further commentary on the influence of the social context on aphasia. In a context where sociopolitical processes have had a disintegrating effect on social cohesion, questions of support, care and security were of primary concern. Prejudices towards the elderly and women were more acutely felt and vulnerability, isolation, insecurity and fluidity of circumstance emerged as overarching themes. The central argument in this thesis is that the genesis of these experiences can be found in contextual factors in Khayelitsha, such as poverty, inequality, urbanisation and changing cultural paradigms. These emerging themes highlight the disjunctions between the medical alignment of the discipline of speech language therapy in South Africa and the capacity for socially-engaged practice. They also highlight the socio-cultural complexity of the experience of aphasia, specifically the influences of culture and poverty. There is thus theoretical and clinical relevance in using anthropological objectives to explore the world of the adult living with aphasia and the interface between context and service provision. Interventions and healthcare communications that will make a meaningful difference to adults with aphasia in a setting such as Khayelitsha are proposed.Item The medical and rehabilitative management of persons with motor neuron disease.(2009-01-28T06:23:10Z) Marett, Colette LeaAlthough the management of Motor Neuron Disease (MND) remains devoid of a cure, persons affected by this devastating condition are nonetheless entitled to the best quality care that is available. A paucity of information exists documenting the perceptions of healthcare consumers regarding the management that is provided. In addition optimal healthcare comprises an intricate interaction of patient-centred care, patient-centred communication, and bioethical practice, and when these three dimensions are implemented according to acceptable standards, high-quality healthcare is perceived by the healthcare consumer. Given however the socio-political challenges that face healthcare systems, the management of MND needs to be considered against current trends in service delivery and the need for evidence-based medicine. An exploratory study was therefore conducted to investigate the perceptions of persons with MND and their family members regarding current medical and rehabilitative management. The sample comprised six persons with MND who presented with a communication impairment, as well as six family members. Participants’ perceptions were elicited through the use of a semi-structured interview schedule, and questions focused on healthcare professionals’ behaviours during healthcare encounters. In addition emphasis was placed on the potential of the communication impairment to influence management. A standardised dysarthria assessment was conducted to characterise the nature of the speech impairment in each person with MND. Qualitative responses obtained from the interviews were analysed in accordance with a matrix-based approach, while quantitative data from the dysarthria assessment were analysed using descriptive statistics. Despite individual variability, perceptions of both persons with MND and their family members revealed general dissatisfaction with regard to medical and rehabilitative management. The majority of persons with MND were not referred for intervention following diagnosis, and the recommended team approach for the management of MND was absent. In addition the bioethical practice of many healthcare professionals was deemed questionable, and the communication impairment was perceived to impose a significant burden on the healthcare encounter. Furthermore all participants perceived a lack of available support systems for persons with MND, and it was thus not uncommon for individuals to pursue complementary and alternative medicine. South Africa’s current healthcare climate also appeared to further limit healthcare for this clinical population. In an attempt to improve the management of MND, implications are provided in terms of health communication, intervention, bioethical practice, and support systems. A proposed new framework of ideal service delivery for healthcare consumers of MND management is also presented. Further implications are outlined with regard to the need for innovative models of service delivery in South Africa’s healthcare context, as well as the role of speech-language pathologists, other healthcare professionals, policy makers, and educators in the improvement of the medical and rehabilitative management of MND. Finally theoretical implications and implications for future research are also documented.Item Identifying the needs of participants in the Khulisa Diversion Programme.(2008-07-18T08:47:00Z) Monyatsi, ThaboThe aim of this study was to identify the needs of participants in the Khulisa Diversion Programme. It evaluated the outcomes and impacts of this programme. The researcher set out to determine and explore whether the programme is meeting the needs of its participants. These children have been referred to it by juvenile courts, schools and parents for committing minor crimes that do not require the criminal justice system. The needs identified were based on Maslow’s theory of hierarchy of needs. This research study uses a qualitative research approach. A questionnaire was administered to the participants and a focus group interview was conducted with the group after the main themes were identified from an analysis of the completed questionnaires. Central themes that emerged related mainly to participants’ unique understanding of their needs as related to the delinquent acts committed. The interview was transcribed and analyzed and the data obtained were documented and recommendations were submitted to Khulisa on how the Diversion Programme could be improved by meeting the needs of its participants. The results indicated that Khulisa has developed an intervention programme that is meeting the needs of these young children, provides them with the opportunity to reflect on their wrong behaviours and aims to help them correct their behaviours in future. In particular, the children who participated in this study seemed to have developed an insight into their behaviors and to have realized the importance of accountability and being responsible for their behavior. iv. The study also highlighted numerous research and methodological difficulties inherent in this study. These problems, and recommendations for future studies, are discussed. The study, while limited, provides initial support for the continued use of the Khulisa Diversion Programme when dealing with juveniles who can be diverted from the criminal justice system.Item Adopting a commercial programme for memory rehabilitiation in traumatic brain injured patients(2007-02-14T12:29:45Z) Strauss, Hermias CorneliusMemory is a collection of systems in the brain that work in conjunction with other systems and modalities to effect encoding, storage, retrieval, and learning of information. It also plays a part in the executive and other higher order functions (Banich, 1997). Patients who suffered a traumatic brain injury frequently have impaired memory functioning and a host of consequential problems as well. Rehabilitation of TBI patients is focused primarily on helping TBI patients to cope with and compensate for their disabilities (Hart, Whyte, Polansky, Millis, Hammond, Sherer, Bushnik, Hanks & Kreutzer, 2003) and one of the most important aspects of rehabilitation is memory (Quemada, Cespedes, Ezkerra, Ballesteros, Ibarra & Urruticoechea, 2003). In this study a commercially available memory enhancement program (Mega Memory® System) was used in an intervention with ten male TBI sufferers to evaluate its effectiveness in rehabilitation of memory. Subjects were assessed before and after the intervention on the Rivermead Behavioural Memory Tests and the Benton Visual Retention Test. Group results on Rivermead did not show any significant improvement of memory functioning, but the Number Correct scores on the Benton did. All subjects showed improvement on different aspects of memory functioning, especially in the domains of memory for everyday events, verbal, figurative, and spatial memory immediately following administration of the program. Overall the changes in memory functioning was not significant.