Theses and Dissertations (Occupational Therapy)

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The efficacy of the Four-Step Riding Programme to facilitate learning the body language needed for rider-horse communication
(University of Pretoria, 2024-06-04) Buys, Tania; Van Vollenhoven, Elize; apbli@iafrica.com; Blignault, Karin
There is a scarcity in scientific research in teaching horse riding. Official methods of teaching horse riding do not include established sport science techniques of multi-modal motor learning. Riders share common rider-horse communication problems. Horses become confused when they do not understand their riders’ cues. All of these factors may be the cause of the delay in riders’ learning and horses’ understanding the body-language needed for clear rider-horse communication. A quantitative, single case intervention research design was used to authenticate the Four-Step Riding Programme’s capacity to facilitate the acquisition of the rider-horse body language needed to improve rider-horse communication. Multi-modal motor learning techniques were used to teach five riders and their horses the acquisition of the coordinated movement patterns needed for clear rider-horse communication in four one-hour riding lessons in an indoor arena. All riders in the study had had regular riding lessons for between 10 and 40 years. Rider problems included difficulty in stopping, going, turning and asking the horse to move in a round, flexion frame termed ‘contact’. Daily video footage of 29 data points was assessed by three external expert assessors using 5-point Likert scales. The participants self-assessed their pre- and post-intervention progress via 5-point Likert scales. The Alogo™ Move Pro electronic device was used to assess and analyse the horses’ gait characteristics. The improvement in the rider-horse body language was demonstrated by the improvement in the horse’s execution of nine variables assessed via 29 data points. By the conclusion of the four lessons, all five rider-horse combinations had mastered the first three elements of the international training scale, namely, rhythm and balance, suppleness, and contact in a round, flexion frame, despite having had problems with these aspects for many years. The statistical analysis of the results showed a significant difference between pre- and post-intervention scores. Consistent improvement across all participants was evident. This means that riders with rider-horse communication problems can learn the rider-horse body language for effective and safe horse control in four hours of riding lessons. Rider-horse communication problems, of speed and direction control, can be avoided by using multi-modal motor learning techniques.
Occupational therapy students’ perception on participating in an international collaborative learning project
(University of Pretoria, 2024) Lister, Helga; Buys, Tania; nabeela.kharva@up.ac.za; Kharva, Nabeela
Introduction: Internationalisation has gained traction in higher education given its merits in preparing students to cope in diverse and multicultural settings. International online collaborative learning provides students the opportunity to achieve internationalisation goals in their local contexts. The International Discussions in Occupational Therapy i-DOT project is an online collaborative learning opportunity for occupational therapy students from nine institutions from Austria, Belgium, Croatia, Germany, France, Kuwait, the United Kingdom and South Africa. It facilitates student discourse on occupational therapy-related topics between foreign counterparts, through English-based online discussions, in the absence of collective online teaching. The i-DOT is the first known project in occupational therapy higher education involving this many international institutions, using a design that provides flexibility and autonomy to its involvement of institutions. Aims and objectives: The research aimed to describe occupational therapy students’ perceptions and experiences of participating in i-DOT, an international online collaborative discussions project. The objectives were to describe the benefits, facilitators and barriers to participation in the project for occupational therapy students. Research design and method: A quantitative, descriptive cross-sectional survey design was employed. Occupational therapy students from nine international institutions, involved in i-DOT in 2022, formed the population of the study. The entire population was invited to participate, implementing non-probability volunteer sampling. Data was collected through a self-developed electronic questionnaire, offered in English and German, distributed by occupational therapy educators from the respective institutions. Descriptive statistics were used to analyse quantitative data, together with the application of the Kawa Model as a theoretical framework. Principles of trustworthiness, reliability and ethics were adhered to. Results: Occupational Therapy students achieved academic, professional, personal, social and/or diversity-related benefits through i-DOT. Student-led strategies, educator-led strategies and the design of the online collaborative learning project acted as facilitators to student participation. Barriers to participation included, but were not limited to, language-related challenges, time management and technological difficulties. Conclusion: Occupational therapy students benefitted broadly from i-DOT, an international collaborative learning project. Educators may promote maximal student development by considering participation enablers and inhibitors.
Trauma releasing exercises as a treatment technique : a scoping review
(University of Pretoria, 2023-10) Van Niekerk, Karin; Tonsing, Kerstin Monika; u20005769@tuks.co.za; Roos, Linda Aletta Joan
Introduction: Trauma Releasing Exercises (TRE) is a novel mind-body technique, used by some healthcare practitioners to address stress, anxiety and other related problems in clients. Occupational therapists use mind-body techniques to improve occupational performance, but are required to use evidence-based techniques. There has not yet been a solid base of synthesised literature on this technique to support evidence-based practice. Aim: The aim of the study was to describe and synthesise the characteristics of TRE intervention studies. Such an overview of research evidence is helpful to understand the breadth and content of studies, to identify gaps and further research needs, and to guide the potential use of the technique in evidence-based treatment. Methodology: A scoping review was conducted according to the JBI (formerly Joanna Briggs Institute) scoping review framework. A comprehensive search for all TRE intervention studies, peer reviewed and non-peer reviewed, with exclusion of non-English studies, was performed and 18 studies were selected. Data were extracted and data analysis was done with descriptive statistics. Results were presented in summarised text, tables and graphs. Results: In the identified studies, TRE was used predominantly with populations exposed to stress and trauma, with measurement tools assessing various body functions typically impacted by stress and potentially improved with treatment. Possible benefit for clients diagnosed with Parkinson’s disease, multiple sclerosis and epilepsy was identified. Descriptive and inferential statistics from the studies indicated potential improvement in mood-related aspects, as well as improvement in anxiety-related sleep difficulties, pain and cognitive functions. The studies included a wide scope of study designs, including less rigorous methodologies, therefore the results should be considered as preliminary. Conclusion: This technique could potentially be used with clients exposed to stress and trauma, diagnosed with neurological disorders and even other populations. The study results are, however, tentative. To use this technique within evidence-based practice, further and more rigorous research will be required. Significance: A research synthesis will guide future research on this novel technique and enable healthcare practitioners to base treatment-related decisions on research evidence. With continuing research and a strengthened knowledge base, this technique could have a place in evidence-based occupational therapy practice.
Development of a clinical measurement tool for measuring voluntary eye movements in typical infants six months of age
(University of Pretoria, 2022) Uys, C.J.E. (Catharina Jacoba Elizabeth); Hansraj, R.; hayjuba@lantic.net; Scholtz, Christina Elizabeth
Occupational therapy is an essential service in early childhood intervention but does not yet fully understand the impact of the child’s neuro-visual plasticity on function. Voluntary eye movements are part of visual functioning, which affects all performance areas. The visual brain is highly neuro-plastic during early infancy. The maturation of visual functions depends on the typical goal-directed visual experiences in a critical period of development. Development of visual function processes at different rates during the post-natal period including visual acuity, contrast sensitivity and visual fields. The primary visual cortex receives visual information from the eyes and is then further processed onto the primary visual cortex for contrast, colour, disparity, direction, speed and orientation for perception. Vision related activities that represent functional vision are not only refined by the retinogeniculate projections but also the extrastriate cortex that encompasses multiple functional areas. The post-natal development of the visual cortex, therefore, requires visual experiences during goal-directed participation. Vision for perception and vision for action provide a useful framework for understanding the functional organization of the human visual system. Perception and action depend on clear, stable, single vision and adequate control of voluntary eye movements, to convey the signals for processing. It was thus recommended to develop a clinical measurement tool for assessing voluntary eye movements in infants 6-to-7-months of age, as the maturation of visual processing depends on eye movements and visual experience in this age period. The researcher developed the voluntary eye movement measurement tool in infants 6-to-7-months of age to measure functional vision for participation. Voluntary eye movements are the foundation to process visual information efficiently for recognition, memory, organized purposeful actions, and attention on an ever-changing environment in all cultures to promote communication, social interaction, near task work, mobility and orientation. Each item of the voluntary eye movement measurement tool is developed and designed for related activity performances. The 4 domains are functional vision for participation, gaze holding, gaze shifting and attention. The aim of the study was to develop a clinical measurement tool for measuring voluntary eye movements in typical 6-to-7-months-old infants. A systematic eight-step process was followed to develop the voluntary eye movement measurement tool. The aim of the study was achieved by four objectives. Quantitative and qualitative research approaches were followed. Construct analysis and theoretical validation were used to identify and select material to operationalize the construct. Processes of inductive and deductive reasoning contributed to the generation of the domains, sub-domains and measurable items. Theory on scale construction informed the final construction of the tool. Content validity index was determined where relevant. A pilot study confirmed that the voluntary eye movement measurement tool reflected a typical developed 6-to-7-months-old infant’s capability for using voluntary eye movements in a naturalistic interaction with persons, objects or the environment. Objective one was to identify, define and analyse the construct of voluntary eye movements in 6-to-7-months-old infants by means of a theoretical exploration of literature, reviewing existing voluntary eye movements instruments/tools in children, personal communication with authors/publisher consultation with experts and the researcher’s clinical experience. In objective two the voluntary eye movement measurement tool was constructed by observing voluntary eye movements performed during social interactions, near-tasks, mobility and orientation activities with attention as identified and defined in objective one, followed by scaling the steps for each item that reflected the quality of performance that was graded on a 3-point rating scale. Furthermore, the administrative user manual, administration procedures, outcomes, scoring criteria and scoring sheet were developed and designed. The validity of the voluntary eye movement measurement tool was evaluated in objective three by using the content validity index quantified into a validity coefficient index. The study sample for this objective was obtained from experts in the paediatric neurology field of ophthalmology, optometry and occupational therapy. The expert panellist rated the voluntary eye movement measurement tool by using the content validity index to scale the: relevance of items for 6-to-7-months-old infants, the developed rating scale, user’s manual, administration and the scoring sheet. The content validity was determined to be extremely high. The fourth objective was to pilot the voluntary eye movement measurement tool. The defined 4 domains, 5 sub-domains and 26 items generated for the voluntary eye movement measurement tool reflected the 6-to-7-months-old infant’s capability for using voluntary eye movements in a naturalistic interaction with persons, objects or environment. The voluntary eye movement measurement tool provides an opportunity for occupational therapists to measure voluntary eye movements that relate to visual performances for development of perception and action. This tool will allow occupational therapists practicing in early intervention, to identify, adapt and control the visual inputs that the infant constantly receives from the environment to enhance participation and performance for development in all aspects of life. This will also provide the opportunity for multidisciplinary, holistic management strategies.
A study to determine the profile of cas management of long-term incapacity insurance claims for claimants living with mental health conditions in South Africa
(University of Pretoria, 2023-07-06) Du Plooy, Eileen; Buys, Tania; pinky.keikelame@gmail.com; Aphane, Mpakeleng Eugenia (Pinky)
Introduction Sickness absence and long-term incapacity leave contribute substantially to the overall national service delivery challenges in a working environment. Insurance companies have, over time, seen a substantial increase in the number of disability claims resulting from claimants living with mental health conditions. Case management is a collaborative process of assessment, planning, facilitation, and advocacy for options and services to meet an individual's holistic needs through communication and available resources to promote quality, cost-effective outcomes. The Association of Savings and Investments of South Africa (ASISA) guidelines provide an approach that insurance companies can apply to the clinical management of long-term mental health claims. However, these guidelines do not outline specific case management recommendations to assist insurers in managing long-term incapacity for mental health claims. Insurance case management aims to provide additional support to claimants living with mental health conditions through proactive management of the long-term incapacity claimants. Case management has proven to be successful in other industries, so providing case management recommendations for long-term incapacity claimants in an insurance context is needed. Analyzing the profile of the management of mental health claimants to understand the context of effective case management interventions was thus envisaged. Aims and objectives This study aimed to analyze the management of long-term incapacity insurance claimants living with mental health conditions in South Africa. Objectives included classification of the biographical data, types of intervention programs, and success of return to work for claimants living with mental health conditions within the insurance sector. Research design A quantitative retrospective correlational research design was used for this study. Methods (setting, population, sampling, data collection, and analysis) The data was collected from one insurance company through a purposeful sampling technique. The data variables selected comprised age, gender, body system and diagnosis, occupation, industry, the years considered of the study, claim type, cases referred for case management, type of case management intervention received, and return to work outcome. Data analysis used descriptive and inferential statistics to compare using frequency distribution tables. The odd ratios from the results also indicated probabilities and the strengths of the relationships between the variables, respectively. Significance of the study The results positively contribute to the occupational therapists in clinical practice and case managers in the insurance industry in facilitating triumphant return to work. This study will also benefit claimants to return to work and participate in economic activities. The insurers, on the other hand, will be able to save on the long-term costs of mental health claims and future research opportunities noted for career advancement.
Factors influencing return-to-work for South African Platinum mine workers following upper limb amputation and vocational rehabilitation
(University of Pretoria, 2022) Buys, Tania; Du Plooy, Eileen; nhlahlap@gmail.com; Baloyi, Nhlanhla Portia
Introduction: Upper limb amputation leads to permanent physical change, which results in various functional limitations and return-to-work challenges. To better facilitate return-to work following upper limb amputation, provision of vocational rehabilitation services, and a thorough evaluation of an individual’s circumstances is necessary. Providers of rehabilitation services are required to understand a broad set of factors that impact on the injured worker following upper limb amputation. This understanding fosters the use of an individualised approach during treatment. Aim: This study aimed to explore and describe the factors influencing return-to-work for South African platinum mine workers following upper limb amputation post-vocational rehabilitation. Methodology: A qualitative, descriptive design was employed in this study. Participants were South African mine workers in the platinum mining industry, who returned to work following upper limb amputation post-vocational rehabilitation. Purposive sampling was used. Participants were selected from the database of an occupational therapy private practice in the North West Province. Data was collected from six platinum mine workers through telephonic, semi-structured interviews. Interviews were recorded and transcribed verbatim. Qualitative content analysis was implemented: Transcriptions were analysed inductively using Braun and Clarke’s six phases of thematic analysis. Deductive analysis was also conducted for further content analysis with guideline from the Occupational Competence Model to effectively answer the enquiry under study. Results: Four themes emerged from this study: ‘Initial and ongoing difficulties,’ ‘Colleagues’ attitude and workplace responses,’ ‘Things that helped during my return-to-work journey,’ and ‘Change and return-to-work.’ Conclusion: The factors influencing return-to-work for South African platinum mine workers following upper limb amputation and vocational rehabilitation were successfully explored and generated. The results of this study will serve to inform the development of interventions aiming to improve future vocational rehabilitation services and work reintegration after upper limb amputation. To ensure that the upper limb amputee remains in the workplace, future research should focus on factors that will ensure maintenance of work.
Occupation-centred practice : perspectives of occupational therapists working in acute mental health care
(University of Pretoria, 2020) Buys, Tania; Ramano, Enos; dol.jenna@gmail.com; D'Oliveira, Jenna
Introduction: The prevalence of mental disorders is rising across the world and in South Africa driving the need for effective, occupation-centred practice in acute mental health care. In the acute setting, however, many occupational therapists experience challenges to practising in an occupation-centred manner. Occupation though remains the core construct of occupational therapy and occupational therapists everywhere are being urged to rediscover the power of occupation and embrace, develop, and maintain an occupation-centred practice. Aim: This study aimed to describe occupation-centred practice from the perspective of occupational therapists working in acute mental health care, in and around the City of Tshwane, South Africa. Methodology: A qualitative, explorative, descriptive design was used. Through maximum variance purposeful sampling nineteen participants were recruited to two focus groups. Transcriptions were analysed using the six steps of thematic analysis as described by Braun and Clarke to construct themes. Results: Four themes were constructed namely, 1. The process of occupation-centred practice, 2. Activities enable occupation-centred practice, 3. The theoretical underpinnings of occupation-centred practice and 4. Influencers of occupation-centred practice. Conclusion: Occupational therapists confirmed the centrality of occupation in their practice and further described occupation-centred practice as a process that entails the use of activities to facilitate experiences. Theoretical constructs that were helpful in guiding occupation-centred practice were highlighted. Influencers were experienced as either supporting or constraining occupation-centred practice. Significance: This study contributes to the evidence base of the profession in South Africa, ensuring that Occupational Therapy maintains its unique role and contribution to acute mental health care.
Exploring occupational therapy work intervention procedures for the public healthcare sector in Gauteng province
(University of Pretoria, 2019) Buys, Tania; Heyns, Tanya; julymasango76@gmail.com; Masango, July
Occupational therapists form part of the vocational rehabilitation multidisciplinary team, in returning patients back to work after any form of injury or illness. Among the services that they provide is work intervention procedures, which is comprised of different components that are implemented to rehabilitate patients’ work occupation, in order to ensure entry into, and/or return to the open labour market. The right of South African citizens’ opportunity to work is protected by specific legislation. When this right is affected by illness, injury or disability, the National Health Insurance system intervenes and ensures adequate healthcare services that are delivered equitably. The public healthcare services are delivered to over 84% of the South African population, of which a majority is dependent on public healthcare for medical intervention, including rehabilitation from different professions such as occupational therapists. To rehabilitate patients’ work occupation, occupational therapists follow different procedures as part of intervention. When researched, however, it was found that when this intervention was executed, it occurred haphazardly. The aim of the study was to explore the occupational therapy work intervention procedures that should be implemented by occupational therapists in the Gauteng public healthcare sector. A qualitative, explorative and descriptive research design was used. Data was collected through a workshop, working from an appreciative stance. Purposive sampling was used. Seventeen occupational therapists who practised in vocational rehabilitation and implemented work intervention procedures in the Gauteng public healthcare sector attended the workshop. Data was analysed using the creative hermeneutic data analysis method. The work intervention procedures for occupational therapists were generated. Client-centredness was identified to be at the heart of work intervention procedures, which entail different components, such as legislation, empowerment, assessment, planning, prevocational and vocational skills, work visit, job analysis, work hardening and conditioning, placement and follow-up. Occupational Therapy work intervention procedures for the public healthcare sector in the Gauteng province, were successfully explored and generated. The results showed that although there are procedures that can be followed in work intervention, the implementation process is not linear, and the procedures should be customised to individual patients.
The use of spirituality in occupational therapy practice : an appreciative inquiry
(University of Pretoria, 2019) Rudman, Elsje Magdalena Petronella; Janse van Rensburg, Michelle N.S.; raashmi.balbadhur@up.ac.za; Balbadhur, Raashmi
Spirituality has been identified as vital to client-centred, holistic occupational therapy (OT) practice. Attending to mind, body and spirit are essential for health and wellbeing. Spiritual beliefs have a significant impact on everyday routines and habits and give meaning and an additional dimension to everyday activities. Occupational therapists recognise the potential to make spirituality tangible through the use of deeply meaningful occupations. Many occupational therapists avow that they are unclear on how to integrate spirituality into treatment. They lack the confidence, knowledge and skill to address spirituality. Many argue that preparation for such a role should be embedded in the curricula. This study aimed to explore how spirituality is being addressed in OT practice by educators and clinicians in Gauteng, South Africa. A qualitative, descriptive, explorative research design using Appreciative Inquiry (AI) as an approach was conducted. The participants’ understanding of spirituality, their current successes, and their wishes concerning spirituality, as well as recommendations on how to address spirituality in OT were investigated. Purposive sampling resulted in a total of 24 participants. Data was collected by means of an AI workshop that consisted of self-report, AI interview schedules and focus group inquiries. Data was analysed through thematic analysis. Four major themes emerged from this study, namely 1) understanding spirituality as a construct, 2) client-centred practice/approach, 3) envisioned practice enablers of spirituality, and 4) nurturing spirituality within the therapist. Participants clearly articulated how spirituality is defined and understood in their practice. Current successes in spirituality were attributed to client-centred practice. Strategies to address, sustain and implement spirituality in education and practice were identified. These findings may contribute to the current discussion on spirituality in OT. Literature on the utilisation of the AI approach in OT and in healthcare is limited, thus this study may also serve to contribute to the existing body of knowledge.
The impact of Ayres Sensory Integration® on occupational performance in a child with bilateral cochlear implants
(University of Pretoria, 2020) Uys, C.J.E. (Catharina Jacoba Elizabeth); Leech, Ronell; stefanie@dreamnet.co.za; Kruger, Stefanie Marguerite
Children with profound hearing impairments are receiving cochlear implants at an increasingly younger age resulting in the need for early therapeutic support and intervention. Besides the obvious concerns regarding speech and language development, children with cochlear implants are also at risk for motor and balance deficits. This was a retrospective, longitudinal, experimental holistic single case study. The aim was to determine the impact of Ayres Sensory Integration® on occupational performance in a child with bilateral cochlear implants within the first four years after implantation. Six objectives were addressed. Quantitative and qualitative methods were used including designing an observation tool, administering stardardised tests, conducting a parent interview and obtaining perspective from the cochlear team to obtain rich in-depth knowledge and perspective. Pre- and post-intervention results were compared to determine changes in sensory perception, sensory reactivity, motor development and participation in occupations. Intervention adhered to the fidelity requirements of Ayres Sensory Integration®. Results indicated that there were positive changes in the child’s sensory processing and participation in occupations. Ayres Sensory Integration® was therefore an effective therapeutic approach for this child with cochlear implants. The cochlear team gained valuable insights and the parents indicated that occupational therapy intervention had a significant impact on the whole family unit. This study can contribute to the professional body of knowledge by building onto the knowledge base and skills repertoire regarding the application of therapeutic principles to children with cochlear implants. The occupational therapist can make a valuable contribution to the cochlear team. Optimal integration of sensory input can assist with promoting cochlear usage, not only for acquiring language, but also for developing age-appropriate skills at a critical stage of development to facilitate successful participate in childhood occupations.
Knowledge, Attitude and Practices of Foundation Phase Teachers in Mainstream Schools on Referring Learners with Occupational Performance Challenges to Occupational Therapy
(University of Pretoria, 2019) Uys, C.J.E. (Catharina Jacoba Elizabeth); swart.sabine@gmail.com; Swart, Sabine Hildemarie
Teachers are usually the first persons to identify learners with occupational performance challenges that are struggling in the classroom and then recommending a referral to occupational therapy (OT). Through clinical experience, the researcher often felt that the teachers were unsure when to refer learners, causing the learners to be either under-referred or over-referred. After doing an extensive research it was found that there was limited research available focusing on the referral process of learners to occupational therapy. By doing this study, the researcher wanted to determine the knowledge, attitude and practices foundation phase teachers in mainstream schools had on referring learners with occupational performance challenges, to occupational therapy. A quantitative descriptive study design was used to collect and analyse the data. Data collection was done through a questionnaire that was developed by the researcher. Schools were sampled through purposeful sampling method. From the schools that gave consent, all the foundation phase teachers were given a questionnaire to complete. Eight schools agreed to participate in the study and a total of 128 questionnaires were handed out. The teachers were given one week to complete the questionnaire before the researcher collected the questionnaires again. A total number of 50 completed questionnaires were collected. Data was analysed using the statistical programme R. From the analysed data it was found that the teachers had the necessary knowledge to identify the occupational performance challenges that learner experience in their classrooms. The teachers had a good relationship with the therapists at their school and were for the referral to OT. The teachers, however, were not confident in their ability to make the referral to OT as they did not know if the learner was a candidate for an appropriate referral. They would want to receive training assisting them with identifying learners themselves and build their confidence. It was determined that the teachers used the wait-and-see approach when referring learners. The teachers also said that parents had the ultimate responsibility to take their children to an OT for an assessment and OT intervention. However, this study found that parents defer from taking action. This indicated the therapists need to educate the parents on the role of the school-based occupational therapy.
The contribution of occupational therapy in the holistic management of a child with tetra-amelia syndrome
(University of Pretoria, 2018) De Bruyn, J.T.; Bekker, Belia Margaretha; u28000308@tuks.co.za; Pretorius, Melissa Nicole
Introduction: Tetra-Amelia Syndrome (TAS) is a rare genetic disorder characterised by the WNT3 gene mutation and a clinical presentation of an absence of all four limbs. It creates a tremendous physical limitation for children and adults living with this condition. They require continuous support throughout their lives to function as optimally as they can. Occupational therapists often help children and adults with severe physical limitations to participate by adapting activities, enhancing occupational performance and participation and applying assistive technology. Aims: The aims of this research study was to explore and describe the contribution of occupational therapy in the holistic management of TAS. · Explore and describe how occupational therapy contributed to the development of occupational engagement in a young child with TAS. · Explore and describe how assistive technology contributed to the development of occupational engagement in a young child with TAS. · To reflect on future considerations for an individual with TAS. Methodology: A single case study design was used to explore and describe the general nature of the case holistically from a variety of angles. Purposive sampling was used to select one unique individual case of a child with Tetra-Amelia Syndrome. Multiple sources of data included existing reports, videos/photographic evidence, semi-structured interviews with key role players and formalised testing with regards to participation in play, school and activities of daily living. The researcher used content analysis as described by Elo and Kyngäs (2008) to analyse the transcribed interviews. The themes identified included: Occupational engagement, Assistive technology (AT), therapeutic intervention, children’s rights and future considerations. Findings & Conclusion: Occupational therapy intervention has proved to provide a significant contribution in the occupational engagement of a child with TAS. Early intervention in her case has supported and paved her way to enhanced participation and performance in ADL, IADL, play, social and school occupations. Assistive technology including wheelchairs, tablets, laptops and low technology devices have further enabled her to overcome the physical barriers she encounters on a daily basis in aspects like mobility, self-care, play and academic pursuits. By encompassing the frameworks, models and principles of occupational therapy, the ongoing process of assessment, intervention and clinical reasoning has proved imperative to the success of this case. By looking at this case holistically and considering the person, environment and what occupations are important and meaningful, an occupational therapist can contribute greatly to the overall quality of life, wellness and satisfaction of a child with TAS.
Development of an outcome measure based on motivation and action for occupational therapists in neurological rehabilitation
(University of Pretoria, 2018) De Bruyn, J.T.; Ramodike, K.V.; sam.lee06@yahoo.com; Lee, Samantha Anne
Motivation is a crucial determinant of the outcome of rehabilitation in patients following an ABI. Their level of motivation therefore requires close monitoring during assessment and treatment. Occupational therapists also require a way in which the effectiveness of their services can be measured. There is however a lack of an assessment tool or outcome measure specifically designed for the field of neurology that directly assesses a patient’s level of motivation, while also including their occupational engagement. The purpose of this study was to close this gap in neurological rehabilitation by developing an outcome measure that assesses a patient’s motivation, while also addressing their corresponding action and therefore their engagement in occupations. The outcome measure had to be grounded in a theoretical framework that covers motivation and action. The Vona du Toit Model of Creative Ability (VdTMoCA) was chosen as the theoretical framework as it allows therapists to describe a patient’s participation in everyday occupations according to their motivation and action. The Model provides therapists with a list of consecutive levels on which patients can function. This provides therapists with a means to measure baseline performance, track the progress of patients and calculate the effectiveness of intervention. A qualitative research design was selected to guide this study. Two objectives were set for the development of the outcome measure. Domain descriptors for the outcome measure, according to the first six levels of Creative Ability, emerged to fulfil the first objective. This was achieved through the use of focus groups held with occupational therapists working in neurological rehabilitation. The design and development of the framework for the outcome measure and the transfer of the data into the measure was a theoretical process and fulfilled the second objective. During data analysis, themes and substantiating codes emerged for all the domains within each level of Creative Ability. The themes that emerged for the domains “Motivation” and “Action” are as follows. In the level of Tone, “Motivation”: motivationally blank, physiological maintenance; “Action”: pre-destructive, reflexive and involuntary. In the level of Self-Differentiation, “Motivation”: egocentric and to differentiate self from the environment in order to establish body boundaries; “Action”: destructive, incidentally constructive and emergence of participation. In the level of Self-Presentation, “Motivation”: to present self, unsure and externally motivation; “Action”: Explorative, facilitated and 1-2 steps. In the level of Passive Participation, “Motivation”: directed to the attainment of skills and establishing rules and norms, externally motivated; “Action”: skill or product centred, therapist directed, safe and 2-4 steps. In the level of Imitative Participation, “Motivation”: intrinsically motivated to achieve something; “Action”: imitative, norm directed and 7-10 steps. In the level of Active Participation, “Motivation”: directed to the improvement of self; “Action”: with originality and transcends the norms. The outcome measure that was developed was named the Motivation and Action in Neurological Rehabilitation Outcome Measure (MANROM). Recommendations regarding the investigation of the psychometric properties were formulated to eventually market the MANROM as a reliable and valid outcome measure for occupational therapists in neurological rehabilitation.
Evaluating validity of MODAPTS as an assessment method of work speed in relation to the open labour market
(University of Pretoria, 2018) Buys, Tania; Claassen, Nico; suzanneharmse@gmail.com; Harmse, Suzanne
Background: Based on latest statistics only 0.9% of the Economically Active People in South Africa are persons with disabilities. Furthermore, many of the persons with disability in South Africa are employed in sheltered employment with little or no prospect of career advancement. The White Paper on the Rights of Persons with Disabilities (WPRPD) thus identifies the need for removing discriminatory barriers that hinder equal participation of people with disabilities. Occupational therapists (OTs) are uniquely qualified to evaluate and treat occupational dysfunction that hinders participation in gainful employment and to advocate for the rights of persons with disability in the workplace. OTs depend on standardised procedures to evaluate work capacity and to determine ability to work and rehabilitation needs. It is of importance that valid and reliable test results be obtained to inform these decisions. At present, it appears that expensive and imported assessment methods are used. MODAPTS could prove to be a more cost-effective alternative to standardise work assessments, yet hardly any studies report its validity as an assessment method in OT. This study aimed to evaluate face, content and criterion validity of MODAPTS as an assessment method of work speed. Methods: A quantitative cross-sectional research design was used. Two electronic surveys were utilised to determine face and content validity of MODAPTS. The Lynn method was used to analyse data related to face and content validity. Criterion validity was evaluated by comparing MODAPTS to the gold standard of work samples, namely Valpar Component Work Samples (VCWS) that utilises the Methods-Time-Measurement (MTM) technique. The specific VWCS used to compare with MTM and MODAPTS times was informed by a realist synthesis that focused on the content of work assessments. VCWS 9, VCWS 4 and VCWS 6 was used. A deterministic model was used to evaluate the comparability of MODAPTS to MTM. Results: Face validity for MODAPTS as an assessment method of work speed was confirmed through an agreement of 94.73% (>80% demonstrates adequate agreement). Content validity for the codes used to analyse basic movement and handling of smaller and larger articles as well as other body actions was confirmed with an agreement of 100% respectively. Content validity for mental and clerical operations codes was not confirmed with an agreement of 67% respectively. Criterion validity for tasks involving basic movements, handling smaller articles and other body actions was confirmed. Criterion validity for tasks involving mental and clerical operations was not confirmed. The results of the content and criterion validity are consistent. Conclusion: MODAPTS demonstrated adequate face validity. Content and criterion validity of tasks involving basic movements, handling of articles and other body actions was confirmed. However, content and criterion validity for tasks involving mental and clerical operations was not confirmed. The results of this study indicate that MODAPTS can be used to assess work speed in physical and manual tasks.
Sensory modulation patterns in children with Cerebral Palsy : a comparative-descriptive study
(University of Pretoria, 2018) Bekker, Belia Margaretha; shanna.louwrens@gmail.com; Louwrens, Shanna
Cerebral palsy (CP) causes complex motor and sensory impairments. The motor impairments are well documented in the literature. More recently, researchers have focused on the sensory impairments associated with CP. Sensory modulation disorders (SMD) are identified when children are unable to adequately regulate and grade their responses to sensory inputs to such an extent that it significantly impairs their ability to participate in various areas of occupation. Although there is evidence that children with CP present with SMD, there is no evidence that different types of CP present with different sensory modulation patterns (SMP). The Sensory Profile 2, a well-recognised, standardised questionnaire, was completed by 154 parents/guardians of learners diagnosed with CP, aged between 5.0 to 14.11 years old, in order to (i) determine the predominant SMP in children with CP and (ii) determine whether significant differences existed between the different subtypes of CP. The registration (72.73%) and avoiding (53.90%) patterns were the most prevalent in the CP group. The CP group had a high prevalence of body position (77.92%), movement (56.49%), visual processing (53.25%), and social-emotional (55.84%) difficulties. There was a significant difference between the mean score in the body position processing section (p=0.000) between the ataxic (n=21), dyskinetic (n=21), spastic diplegic (n=61), and spastic hemiplegic (n=49) subtypes. Furthermore, some proportional differences existed between some subtypes. The ataxic and dyskinetic subtypes had a higher percentage of participants scoring out of the norm, reflecting more SMD than the other subtypes. Touch processing difficulties were common in the spastic hemiplegic subtype, which is consistent with clinical observations. The spastic diplegic subtype presented with fewer SMD than the other subtypes. The study confirmed the presence of SMD in children with CP and provided some statistical evidence that different types of CP present with different SMP. These findings will assist occupational therapists to assess and treat these impairments more effectively.
A comparison of two occupational therapy group programmes on the task-oriented functioning of mental health care users with major depressive disorders
(University of Pretoria, 2017) De Beer, Marianne; Roos, J.L. (Johannes Louw); s22230344@tuks.co.za; Ramano, Enos Morankoana
Background: Occupational therapists, as part of the multi-disciplinary psychiatric team, frequently include activity and or discussion groups in an attempt to reduce the symptoms of the MHCUs with MDD and to improve their functional ability. The evidence to support occupational therapy group interventions seems to be limited. Aim: To compare a Standard Care Plus (SCO) occupational therapy group programme, which included tangible activities in each of nine sessions with a Standard Care (SCN) group programme, which included tangible activities in only five of nine group sessions and to explore the participants’ experiences of either the SCO or the SCN group programmes. Research design: A concurrent embedded mixed methods intervention research design was employed. A qualitative strand was embedded in a comparison pre-test post-test study. Methods: One hundred participants, 50 from each programme, were pre- and post-treatment tested in order to compare the interventions in respect of cognitive, performance and affective functioning, social interaction and severity of MDD symptoms. Their experiences of the intervention were established. The study took place at the psychiatric wards of two private general hospitals in South Africa. Results: The SCO significantly improved the total outcome (p<0.005) in comparison to the SCN on the MDD symptom reduction (PHQ-9) and social interaction (Client Response by Situation) (p<0.004). Five themes emerged, viz. happiness, social interaction, self-esteem, learned coping skills and being part of the solution. Conclusion: The results suggest that the SCO, which included tangible activities in each group session , was superior to the SCN.
Perceptions of Grade 1 teachers in mainstream primary schools regarding occupational therapy for children with learning difficulty
(University of Pretoria, 2017) Bekker, Maretha; Maree, C.M. (Carin); elrikabierman@gmail.com; Beukes, Elrika
Teachers are often the source of referrals to Occupational Therapy in mainstream schools. The researcher wanted to determine what the Grade one teachers’ perceptions are regarding Occupational Therapy and children with learning difficulties. A qualitative descriptive approach was adopted to gather in-depth information about the teachers’ lived experiences and thus gather information about their perception of Occupational Therapy and children with learning difficulties. This study was conducted in Tshwane South District, Gauteng. A total of seven focus groups where held at the three types of mainstream primary schools namely: No-Fee-, Former Model-C- and Private schools. The focus groups were recorded with written permission and data was transcribed and analysed. The themes highlighted the knowledge, perceptions and attitudes of the teachers towards Occupational Therapy and the children with learning difficulties. It furthermore indicated the teachers’ perception of the role that parents play in helping their children with learning difficulties. Teachers’ perceptions proved to be important when referring a child with learning difficulties to Occupational Therapy.
The intra- and inter-rater reliability of manual muscle testing in the new hand classification of wheelchair rugby
(University of Pretoria, 2017) De Bruyn, J.T.; Dawood, Muhammed; yvette.vdwesthuizen@gmail.com; van Niekerk, Yvette
Introduction: Before 2015 the hand classification in wheelchair rugby consisted of non-sport specific tests. The hand classification was not in accordance with the classification code introduced by the International Paralympic Committee in 2003. In 2015, the newly revised wheelchair rugby classification manual was released, containing the revised wheelchair rugby hand classification. Hand tests that were not functional sport-specific tests were removed from the bench test in wheelchair rugby classification. Lumbrical, interossei and thumb opposition manual muscle testing were added to the bench test in wheelchair rugby classification. On both national and international levels of classification, classifiers verbalised their uncertainty to their fellow panel members regarding their hand placement on the athlete’s hand and interpretation of the manual muscle testing of the hand that was observed and tested. This justified reliability testing of the new hand classification. Aim: The aim of this study was to determine the intra and inter-rater reliability of the manual muscle testing in the new hand classification of wheelchair rugby. Study design: This study followed a quantitative non-experimental, cross-sectional design. Method: The raters who took part in the study were active international wheelchair rugby classifiers from all over the world. The raters received an electronic questionnaire consisting of biographic information and three videos repeated two times. Each video showed an athlete’s hand being classified by a classifier. The raters had to give a manual muscle test grade for each subject (muscle) tested in each video by using tick boxes. The manual muscle test grades that could be given were: 0-1, 2, 3 and 4-5. The first three raters in each international wheelchair rugby classification level who completed the questionnaire were used for the data analysis. Data Analysis: The statistician used the two way model for the ICC in which each subject was rated by the same raters to determine the absolute agreement for each objective. The Medcalc program was used. To indicate the strength of agreement the ranges provided by Landis and Koch (1977) were used: 0.0 – 0.2 slight, 0.21 – 0.4 fair, 0.41 – 0.6 moderate, 0.61 – 0.8 substantial and 0.81 – 1.00 almost perfect. Conclusion: Raters one, two, five, seven, eight and nine’s intraclass correlation coefficient values fell between 0.81-1.00 which is descriptive of almost perfect levels of intra-rater reliability. Raters three, four and six’s intraclass correlation coefficient values fell between 0.61-0.80 which is descriptive of substantial levels of intra-rater reliability. However, none of the raters scored 100% when accuracy was determined. All three levels had intraclass correlation coefficient values which is descriptive of almost perfect levels of intra-rater reliability within each level. Level 2, 3 and 4 classifiers had intraclass correlation coefficient values between 0.81- 1.00 which is descriptive of almost perfect levels of inter-rater reliability when the manual muscle testing grades for the first and repeated videos were compared. Across all nine raters there was a high intraclass correlation coefficient value which was descriptive of almost perfect inter-rater reliability. The accuracy in each level and across all nine raters was low. Finger extensors, thumb abductor and thumb flexor showed intraclass correlation coefficient values between 0.41-0.6 which is descriptive of moderate levels of intrarater reliability. The only subjects (muscles) that were graded accurately when compared to a memorandum were subjects with a manual muscle test grade 0-1 and 4-5. Most of the accurate manual muscle test grades were for athlete two in the video footage. Athlete two was classified as having a 2.0 hand.
A Comparison of the outcomes of two rehabilitation protocols after flexor tendon repair of the hand at Chris Hani Baragwanath Academic Hospital
(University of Pretoria, 2017) Van Velze, Corrianne A.; Rudman, Elsje Magdalena Petronella; roxanne@wentzel.co.za; Wentzel, Roxanne
Flexor tendon repair of the hand and rehabilitation are frequently discussed between hand surgeons and therapists. This is mainly due to the poor outcomes commonly achieved after this type of surgery. There are many patients in public hospitals in South Africa who require flexor tendon repair surgery. They are regularly sent to therapists for rehabilitation, where the early passive motion protocol is commonly implemented. Although the early active motion protocol has yielded improved results globally, there is limited evidence on the comparison of the outcomes of these two protocols in the South African context. The aim of the study was to compare the outcomes of an early active motion protocol to the outcomes of an early passive motion protocol in patients with zone II to IV flexor tendon repairs of the hand, attending rehabilitation at Chris Hani Baragwanath Academic Hospital. The study was a quantitative single-blinded comparative controlled trial. Forty-six patients who sustained a zone II-IV flexor tendon injury were recruited for the study and equally distributed between the two groups (early active motion and early passive motion). Out of these participants, 11 did not return for the initial assessment at four weeks post-surgery and were therefore excluded. There were 19 participants in the early active motion group and 16 participants in the early passive motion group. Results were collected and classified at 4, 8 and 12 weeks post-surgery. Data collection took place from December 2014 to January 2016 in the Chris Hani Baragwanath Academic Hospital Hand Unit. At 12 weeks post-surgery, the total active motion, fingertip to table, and distal palmar crease measurements were similar between the two groups. Tendon rupture occurred in 8.57% (n=3, early active motion = 5.71%, early passive motion = 2.86%) of patients. This study found that there was no difference in outcomes between the two groups. Therefore, either protocol could be implemented in South African public hospitals. However, since the early active motion protocol takes less time to implement, this protocol is recommended. A study with a greater magnitude would be necessary to determine a significant comparison between the two groups; however, this is challenging due to poor patient compliance.
The effect of hippotherapy on the physiological cost index and on school activities of adolescents with diplegia
(University of Pretoria, 2015) Buys, Tanya; De Bruyn, J.T.; ninette@lightprojects.co.za; Du Plessis, Ninette
This study intended to examine the individual effect of hippotherapy on Physiological Cost Index and school activities in adolescents with diplegia. Ten adolescents with diplegia, aged 12 to 16 years, were studied. The results were not to be generalised to the broader cerebral palsy population. A triangulation mixed method design was used. Within the quantitative part of the study, a single system multiple baseline design across subjects was implemented and in the qualitative part of the study, a semi-structured interview was used to determine effect of hippotherapy on school activities. Individual hippotherapy was conducted once a week over a 12-week period. The effect of hippotherapy on physiological cost index was inconclusive, but the results obtained with regards to an increase in walking speed, were statistically significant. Out of the qualitative research, three themes emerged as an effect of hippotherapy on school activities, namely improved rest and sleep, improved functional ambulation, and improved neuro-musculoskeletal functioning.

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