Occupational Therapy

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An evaluation of the criteria and procedures used for selection of occupational therapy students at South African universities.
(1997) Joubert, Robin Wendy Elizabeth.; Parekh, Angina.; Concha, Marj.
The existing selection criteria and procedures applied at universities training occupational therapists in South Africa are not meeting the country's need for selecting students who adequately fulfill the demographic mix which represents the South African population. The aims of this research were: to investigate the existing criteria and procedures used for the selection of occupational therapy students; to establish recommendations with regard to how these criteria and procedures can be adapted to allow for more appropriate and equitable selection of students, and to obtain opinions from qualified therapists about those characteristics deemed most important for them to possess in the current South African Health System. A combination of quantitative and qualitative methodology was adopted. A survey was undertaken to obtain basic information and statistics about the numbers of applicants selected, and the existing selection criteria and procedures currently used to select occupational therapy students in South African universities. A series of two focus groups for each of the eight existing universities were carried out i.e. one incorporating the views of lecturers and clinicians and the other the views of students. The purpose of these groups was to obtain existing and emerging views of qualified therapists and students on current selection processes, what could be recommended to make selection fairer for disadvantaged applicants and what specific characteristics of qualified therapists would be most desirable in the current health system. The results indicate that the proportion of African students admitted into occupational therapy degrees is still far below numbers of other race groups, particularly white South Africans. That existing selection criteria and procedures are still dominated by eurocentric influence, particularly in the historically white universities, although there are definite attempts on the part of all occupational therapy training centres to overcome this, and that there are serious problems related to recruitment of African applicants which are partly the cause of the low numbers of African applicants. Characteristics deemed most desirable in qualified occupational therapists included many, most significant were: flexibility, particularly a special ability to be able to adjust to all types of people and cultures which included good communication and interpersonal skills; the ability to be assertive where appropriate; a "life-Iong-Ieamer" attitude including a visionary mentality/attitude; creativity and inriovative thinking; perseverance, determination and good management skills.
Visual perceptual abilities in obstetric brachial plexus palsy : an investigation of the incidence and a comparative analysis.
(1998) Nukanna, Ornissa.; Naidoo, K. S.; Van Vuuren, Santie.; Joubert, Robin Wendy Elizabeth.
Obstetric brachial plexus palsy, a traumatic birth palsy, results in the paralysis of the upper limb/s. The birth injury is treated at the Brachial Plexus Clinic at King Edward VIII th Hospital, where the Candidate forms part of the Rehabilitation Team. In keeping with worldwide trends, the focus of treatment was on rehabilitation of the upper limb/s. During the course of treatment of these patients, it was observed that the performance of these children varied from excellent to poor. This observation, has not been recorded previously, hence a Research study was initiated to invesitigate this aspect of performance. The study comprised thirty children, between the ages of four and seventeen, whose paralysis was assessed in the conventional pattern. In addition, the visual perceptual abilities of these children were assessed in a variety of batteries, catering for the wide age range. These were: Developmental Test of Visual Motor Integration (1989), Motor Free Perception Test (1972), Developmental Test of Visual Perception (2nd edition), Test of Visual Perceptual Skills - Upper and Lower levels ( Gardner), Jordan's Left-Right Reversal Test (1974), Clinical (Ayres) and General Observations. Although traditionally viewed as a physical disorder, the results of the study indicate that children with obstetric brachial plexus injury present with a significant incidence of below average performance, against the normal population, on most of the assessment batteries. No significant relationship could be established between the severity of the lesion and visual perceptual abilities, owing to the disproportionate numbers of children amongst the different lesions. Further research is required to support and consolidate the findings of this study. It is also recommended that Occupational therapists screen for visual perceptual deficits in such injuries, thus facilitating holistic patient management.
Toward access, success and equity in health science education : a KwaZulu-Natal case study.
(1999) Stewart, Rene.; Brookes, David W.; Bhagwanjee, Anil Mohanlal.; Joubert, Robin Wendy Elizabeth.
Aim: This study aims to generate recommendations for enhancing the access and success of historically disadvantaged students to health science education at UDW, based on barriers identified within diverse schooling contexts and local conditions at UDW. Methodology: A case study approach was used to select five former DET schools within the DFR to constitute the sample of historically disadvantaged schools for this study. In order to capture the specific ecological milieu, social and cultural conditions pertaining to rural, urban and informal settlement contexts, three schools were strategically selected from each of these contexts (i.e. Sobonakhona, Ilanga and Inhlanhlayethu High schools respectively). In addition, two former DET schools that displayed relatively high achievement rates were also selected (i.e. Vukuzakhe and Zwelibanzi High schools), in order to contextually understand how barriers to positive educational outcomes might be overcome. A multistage sampling procedure was used to sample 40 standard seven and 40 standard ten scholars from each of the selected schools (n=400) and a purposive sampling procedure was used to obtain a sample of teaching staff involved in career counselling and/or science education in each school (n=16). In addition, saturation sampling was employed to obtain a sample of second year African students in the Faculties of Health Sciences and Dentistry at UDW (n=73). A combination of quantitative and qualitative data collection methods was employed, with questionnaires being administered to standard seven and ten scholars as well as to historically disadvantaged health science students. In addition, a total of five focus groups were conducted with teaching staff from each of the selected schools. Results and discussion: It was evident that a complex and interwoven web of factors impacted on the access and success of historically disadvantaged students in health science education at UDW, including, inter alia, inadequate school instructional resources; limited community economic resources; a paucity of educational opportunities and experiences in the home environment; poverty status; low levels of self-efficacy in academic skill; inadequate school career counselling; university selection procedures with a eurocentric bias; adjustment difficulties in the transition from secondary to tertiary education; financial difficulties; a paucity of 'in-group' academic role models; inadequate ADPs and negative conditions in campus student residences. These results are discussed and interpreted within the context of relevant empirical literature as well as a taxonomy derived from over 60 multivariate school-effects studies undertaken in developing countries, comprising four dimensions, viz. ecology, milieu, social system and culture. Conclusions: On the basis of the findings of this study, recommendations for enhancing the access and success of historically disadvantaged students to health science education at UDW are offered. While these recommendations pertain to a broad range of stakeholders, including the Education Ministry, the schooling sector and higher education institutions, particular attention is paid to the development of practical recruitment, selection and retention strategies to be employed by UDW and its Faculty of Health Sciences. Finally, the limitations of the study are discussed and recommendations for future research in this field are offered. KEY terms: access, success and equity; historically disadvantaged; health science education; educational outcomes.
A study to determine the prevalence of signs and symptoms of carpal tunnel syndrome and de quervains tenosynovitis in garment workers in the eThekwini district of KwaZulu-Natal.
(2012) Pillay, Prabashni.; Rangiah, Pamela.
Introduction: Garment work is repetitive and detailed and requires constant use of the hands. It is no surprise that garment workers are at high risk for developing repetitive strain injuries (RSI’s) (MFL Occupational Health Centre, 1999). Work-related upper limb disorders, popularly known as RSI’s, affect over 370,000 people in Great Britain with 86,000 new cases recorded in 2010. This costs employers almost £300 million in lost working time, sick pay and administration (The Chartered Society of Physiotherapy, 2007). There is however no statistics documented on RSI’s among garment workers found for South Africa. Aim: To determine the prevalence of signs and symptoms of carpal tunnel syndrome and de Quervains tenosynovitis. Method: A study using quantitative data was used. A validated questionnaire consisting of open-ended and closed questions was utilized. Data was collected from two hundred subjects of varying age, gender and ethnic group. Information on signs and symptoms and possible risk factors of RSI’s were obtained. The visual analogue scale was used to assess pain, a goniometer to measure active range of movement, the Phalens test, Reverse Phalens test and Finkelsteins test was used to assess the signs and symptoms of the two occupational repetitive strain disorders. Data analysis: All data was captured and analysed using the Statistical Package for Social Sciences (SPSS version 15). Descriptive statistics such as mean, standard deviation, proportions, median, mode and interquartile range was used to summarize the data. Pearson’s Chi Square tests and Fishers Exact tests were used to test for association between two categorical variables. Independent Samples t-tests were used for the difference in age distribution between participants that presented with carpal tunnel syndrome and de Quervains tenosynovitis and of those who did not present with them. The level of significance was set at 0.05. Bar graphs, tables and pie charts were used to depict the results. Results/Discussion: The results of this study indicated that 59% of participants presented with signs and symptoms of de Quervains tenosynovitis and 63% of participants presented with signs and symptoms of carpal tunnel syndrome. The prevalence of carpal tunnel syndrome and de Quervains tenosynovitis was 42% and 43% respectively among garment workers in the eThekwini district. In addition, 100% of participants stated that they work under the following conditions, applying weight through the arms, repeated movement, work with their arms in unsupported positions, fast hand movements and holding or grasping for more than 2 hours continuously per day. Seventy two and a half percent of participants stated that their work entailed using vibratory tools for prolonged hours. Pearson’s Chi Square tests showed no association of use of vibratory tools to de Quervains tenosynovitis (P=0.666) or to carpal tunnel syndrome. This is inconsistent with the findings of the study completed by Leclerc et al. (1998) who stated that different dimensions of exposure to physical workload are widely recognised as risk factors. These risk factors include rapid hand motions, repetitive bending and twisting of the hands and the wrist, fast work pace, repetitive grasping with the fingers, mechanical stress at the base of the palm and the palm and the use of vibratory tools (Leclerc et al. 1998). Conclusion: This study has identified the prevalence of signs and symptoms of carpal tunnel syndrome and de Quervains tenosynovitis among garment workers. It has also shown that a significant percentage of garment workers presented with symptoms of burning, tingling, itching and numbness in their hands as well as feelings of swollen and ‘useless’ hands. A significant number presented with functional limitations to certain activities of daily living suggestive of the presence of carpal tunnel syndrome. De Quervains tenosynovitis was indicated when a significant number of participants presented with pain, tenderness or swelling over the radial aspect of the wrist as well as functional limitations to certain activities of daily living.
An investigation to establish the flexor tendon rehabilitation protocol use amongst Occupational Therapists in South Africa.
(2012) Venter, Jane.; Joubert, Robin Wendy Elizabeth.; Prinsloo, Ancil.
The aim of this study was to investigate which protocols Occupational Therapists (OT’s) use when rehabilitating clients after flexor tendon repairs, and to investigate the therapist’s knowledge regarding these protocols, to guide therapists and institutions in using effective methods within the South African context. A questionnaire was sent to OT’s in South Africa. Of the 32 responses, 50% had more than 10 years experience and 50%, less experience. 81.2% were private practitioners and 28% worked in government. The trend of protocol use was as follows: 18.8% used a Duran-type passive mobilization protocol, 25% used a Kleinert-type protocol - a passive flexion protocol (but labelled an active mobilization protocol in literature as it allows active extension of the fingers), 28.1% used Early Active Mobilization and 3.1% used an Immobilization-type protocol. 64.5% of the sample used static splints, 9.7% used dynamic splints and 25.8% used a combination. Most (83.3%) continued the splint at 4 weeks but only 26.6% were using the splint at 6 weeks. At week 1, 30% allowed active flexion of the fingers, whereas at week 4 and 5, 60% allowed active flexion. The referring doctor and confidence in one’s own skills were the main factors influencing protocol choice. Resources available influenced the protocol choice, which can be problematic in South Africa. Access to literature was mostly through textbooks (90.6%), although journal articles were accessed (internet - 50%, hard copy - 62.5%). More than half of the sample attended courses regularly. Most therapists were happy with their outcomes, regardless of which protocol used. Therapists need to build their confidence, realising the efficacy of various protocols is similar, according to research. Thus whatever factors influence protocol choice, they will likely not be critical to good outcomes.
On becoming a confident occupational therapist.
(2013) Holland, Kathlyn Elena.; Uys, Leana Ria.; Middleton, Lyn Elizabeth.
This thesis presents and discusses the results of research undertaken to explore the concept 'professional confidence'. The term 'confidence', is frequently to be found In previous research, yet this has not adequately been defined. The conceptions held by occupational therapists were not clear, and the events or circumstances that fostered professional confidence in occupational therapists have not been identified. Each of these aspects was identified as an area for research in the profession. Three studies were undertaken to gain greater insights and to add to the body of knowledge in terms of our understanding of 'professional confidence'. The studies included a concept analysis of the concept of 'professional confidence', a phenomenographic study of the conceptions of professional confidence that novice occupational therapists hold and finally, the sources or determinants of professional confidence beliefs in occupational therapy students were explored using an interpretative methodology. The research undertaken yielded antecedents and attributes or characteristics of professional confidence, and from these a definition was crafted. The conceptions or understanding of professional confidence held by the community service therapists, namely knowing, believing and being, were closely related to the attributes raised in the concept analysis, confirming the findings of the analysis. Final year occupational therapy students highlighted a number of determinants of professional confidence, including events, situations and circumstances within their control, the control of their clinical supervisors and/or the profession. These sources in turn had been confirmed as antecedents in the concept analysis. The research confirmed that professional identity, competence and professional confidence are inter-related and inter-dependent phenomena. Professional confidence involves a dynamic, maturing self-belief closely related to, and informed by both professional identity and competence. As such, equal attention should be given during the educational endeavour and initial employment opportunities, to the fostering of both professional identity and professional confidence while enhancing competencies. The recommendations provided within the research provide a rich source of information from which further research can be undertaken and interventions developed to assist students and novice practitioners to enhance their professional confidence.
Exploring occupational therapy intervention for young children with autism spectrum disorder in South Africa.
(2013) Moosa, Aneesa Ismail.; Gurayah, Thavanesi.
Occupational Therapy is amongst the top three interventions sought for young children with ASD in South Africa. Due to scarce local research on OT for ASD, this study explored the nature as well as perceptions of OTs on intervention for ASD. Using a qualitative exploratory study design, semi-structured interviews were conducted with twenty OTs in public and private health, as well as special needs education. Thematic analysis was used to analyse transcribed data. OTs descriptions and perceptions of assessment, direct and indirect intervention as well as challenges facing families and undergraduate and qualified OTs in South Africa were explored. Assessment for ASD utilised play based skilled observations with limited use of standardised tests. Developmental approaches were preferred to behavioural ones, with the majority of OTs referencing the Sensory Integration (SI) framework for assessment and therapy, even if they were not SI certified practitioners. The value of SI in reframing a child’s behaviour for parents was significant. The South African Model of Creative Ability was a unique local application to practice for ASD. Intervention in education was most ASD specific, including AAC and visual approaches due to a comprehensive programme and greater levels of team collaboration. A family focussed practice was most evident in private and public health. Direct individual therapy was predominant, with all sectors struggling to provide the intensity of therapy recommended for ASD, due to unique contextual challenges. Undergraduate training is insufficient preparation for working with ASD and a need for local OT specialists was identified. Implications for research and practice are discussed.
Preparedness of graduates in occupational therapy for clinical practice : perceptions of students and supervisors in a KwaZulu-Natal case study.
(2013) Naidoo, Deshini.; Joubert, Robin Wendy Elizabeth.; Van Wyk, Jacqueline Marina.
Background: Investigating the development of competent occupational therapists through an academic programme and fieldwork placement is an emerging field in South African occupational therapy research. It is an essential aspect of educational research, as new graduates are often required to work autonomously during their community service. Aim: The aim of this study was to explore the perceptions of the final year University of KwaZulu-Natal occupational therapy students and their clinical supervisors’ regarding their undergraduate education and preparedness for independent clinical practice. Methods: Seventeen final year students and seven clinical supervisors participated in focus groups and semi-structured interviews. Document analysis was used to explore the Health Professions Council of South Africa evaluation report of the undergraduate programme and methods used to assess the final year students. The conceptual framework was based on the World Federation of Occupational therapist Minimum Standards for Training Occupational therapists and deductive reasoning was used to analyse the data. Findings: Most final year students and clinical supervisors felt that students were partially prepared for clinical practice and lacked confidence. The students’ level of confidence was linked to the areas of occupation therapy that they enjoyed and their positive experiences during fieldwork placements. Curriculum design and content were some of the areas highlighted as needing review. Conclusion: The overall perception of both the clinical supervisors and the students was that the new graduates would be able to cope with basic clinical practice. However, there were aspects of the curriculum that could be improved to ensure that the new clinicians have more confidence and are equipped to deliver an occupational therapy service that specifically meets the need for diverse African healthcare settings.
The experience of raising a child with down syndrome : perceptions of caregivers in KwaZulu-Natal.
(2013) Barr, Megan.; Naidoo, P.; Rencken, Gina.
Introduction: Due to limited research within KwaZulu-Natal there is a deficit in the knowledge base and understanding surrounding the dynamics of caring for a child diagnosed with Down syndrome. The study aims to inform health professionals who adopt a psychosocial approach, such as occupational therapist, in an effort to improve the therapy and handling of the caregivers and children. Methodology: A sequential explanatory mixed method approach with an interpretive phenomenological perspective was utilized. Sampling utilized non-probability methods from the Down syndrome Association (KwaZulu-Natal) database. An initial quantitative descriptive survey (n=57) guided the subsequent qualitative phase encompassing focus groups and interviews (n=18). Quantitative data was statistically analyzed using SPSS (version 21) and the transcribed quantitative data utilized thematic analysis with in vivo, emotions and descriptive coding. Results and Discussion: Experiences were primarily influenced by initial reactions of the participants; their level of knowledge of the syndrome and reactions to informing their family and community. Thereafter the positive and negative aspects of raising the child affected their perceptions. Conclusion: Many factors contributed to the participants‟ perceptions of raising a child with Down syndrome, namely: community and family attitudes; support structures available; positive factors such as personal growth as well as negative factors such as the erratic health of the child and difficulties with inter-personal relationships. However; an overall positive perception was reported by the participants, with an emphasis on advice to other caregivers based on lived experience.
A qualitative study to understand the experiences and coping processes of primary caregivers of children with Autism Spectrum Disorder.
(2014) Fewster, Deborah Leigh.; Gurayah, Thavanesi.
Aim: The aim of the study is to gain deeper understanding into the lived experiences of parents at a stimulation centre in KwaZulu-Natal, South Africa, and the coping strategies they employ in caring for their children with Autism Spectrum Disorder (ASD). Significance: As literature has focused on international studies this study has provided deeper understanding of the lived experiences and coping strategies of parents of children with ASD in a local setting within South Africa. Experiences across the age spectrum of children, gendered differences in coping and the meaning behind having a child with ASD provides a unique outlook on ASD as opposed to literature that focuses on other areas. Methods: Eleven parents participated in semi-structured interviews. These interviews were triad, dyad or one-on-one interviews. Interviews were audiotaped and transcribed verbatim once completed. Thematic analysis was used to analyze the data and extract themes. Findings: The lived experiences of parents included stressful and devastating experiences as well as positive meaning. Daily challenges were navigated by positive and negative coping strategies with gendered differences in coping being evident. Parents expressed mixed feelings about the benefits of support groups and provided a road map of advice for other parents of children with ASD. Conclusion: Parents of children with ASD undergo enormous stress and emotional upheaval in caring for their children. However in addition to negative experiences, they gain some positive meaning and see it as character building. Their experiences provide useful information for other parents undergoing the same journey.
Substance abuse and rural realities : experiences and perceptions of service providers in northern KwaZulu-Natal, South Africa.
(2014) Mpanza, December Mandlenkosi.; Naidoo, Pragashnie.
Substance abuse is recognized as a worldwide problem and in South Africa contributes to significant morbidity and mortality. However, there appears to be concerns in the service delivery especially in rural areas. This is partly due to the minimal South African research that has overlooked the impact of indigenous substances which have affected many, notably those in rural areas and disadvantaged communities. Therefore a qualitative phenomenological study with substance abuse service providers in UMkhanyakude Rural District of KwaZulu Natal, South Africa was conducted. Methods: Focus groups and interviews were conducted with various stakeholders, namely Mental Health Care Teams within hospitals, managers at a District Health Level, social workers and managers from Department of Social Development and fieldworkers and manager of the NGO-Ophondweni Youth Development Initiative in UMkhanyakude District. Results: The findings of the study suggests that service providers experience challenges in service delivery in rural areas of South Africa. These include, culture (amarula festival and ancestral worship) that exacerbates the use of substances, high rate of unemployment and poverty such that people resort to home brewed substances for sustainable living, lack of resources within the respective work places (NGOs and governmental departments) of service providers (staff shortage and equipment/vehicles). The lack of resources is also exacerbated by the geographical isolation of rural areas, consequently, the treatment or rehabilitation is weak and disjointed among stakeholders. Furthermore poor monitoring and evaluation of services coupled with lack of research in rural areas was noted. Strengths included prevention programmes, good inter-sectoral collaboration including strong support from civil societies. Conclusion: The collective perceptions and experiences of rural substance abuse service providers were challenging in rendering the service in rural areas. However, there were strengths or enablers noted. Evidently, the South African acts and policies has overlooked rural areas and a lack of resources exacerbates the situation. It is recommended that protocol and service standard for Substance Abuse Occupational Therapy services for after care and community based rehabilitation should be developed for easier monitoring and evaluation for quality improvement rehabilitation services
Barriers to admission to mainstream primary schools for children with high functioning autism/asperger's syndrome (Umlazi District)
(2014) Collins, Carryn.; Pahl, Jennifer Ann.; Turnbull-Jackson, Carolyn.
In South Africa basic education is a right for all children (Constitution of the Republic of South Africa, 1996) and mainstream education for learners with so called mild disabilities such as High Functioning Autism or Asperger’s Syndrome (HFA / AS) is available according to government policy (White Paper 6, South African Department of Education, 2001b). The aim was to explore barriers to admission to mainstream primary school education for learners with HFA / AS. A mixed methods research design with two phases was used. Twenty-eight government primary schools in two circuits of a KZN school district completed a questionnaire; five parents of children with HFA / AS took part in a focus group discussion and an autoethnographic essay was written by the researcher. The data were analysed with descriptive statistics and thematic analysis. Some schools and the majority of parents were unaware of the learners’ educational rights. Gaps in the implementation of policy exist, which contributed significantly to the barriers to admission for learners with HFA / AS. Main barriers were lack of knowledge and misconceptions about HFA / AS amongst school staff, lack of training for school staff, lack of government funding, lack of unity between parents and teachers/schools and negative attitudes towards inclusion of learners with HFA / AS. Suggested ways of overcoming the barriers to admission included small classes, class assistants or facilitators, improved unity and communication between parents and teachers and greater government support. With solutions addressed in the future, learners with HFA / AS can access suitable education in order to become contributing adults to society (Attwood, 2007).
The firework injured hand : profile and management.
(2014) Pilling, Tasha.; Naidoo, Pragashnie.
Aim: The study aimed to profile the firework injured hand and review of the management of such injuries from a surgical and rehabilitation perspective. Methodology: A quantitative methodological approach using a retrospective file audit was employed in order to address the objectives of the study. The study population was sampled from two identified provincial hospitals in the uMgungundlovu district and comprised of all patients who had sustained firework injuries from the 30th of December to the 5th of January during 2009-2014 (n = 65). Results were analysed using non-parametric statistics (viz. frequency counts and percentage matrices) through SPSS version 21 and Microsoft Excel 7. Results and Discussion: The analysis and discussion are organized across three content areas, namely, the profile of the firework injured hand, medical and surgical interventions and rehabilitative interventions. The results showed that the profile of the firework injured hand is varied depending on the blast capacity; however the thumb, index and middle fingers are predominantly affected at the level of the distal phalanges and distal interphalangeal joints resulting in amputation due to severe soft tissue injury and fractures. Hand Injury Severity Scores were completed retrospectively to ascertain the level of injury of which nearly half the cases surveyed fell within the severe category. Medical and surgical interventions were found to occur within the first three to six hours after injury and involved primarily washout, cleaning, debridement and suturing with formalization of amputation being the predominant course of action rather than reconstruction. Rehabilitation was focused on assessment and hand therapy to ensure functional outcomes. It was noted that there were inconsistencies in assessment procedures however the treatment modalities appeared consistent. Conclusions: On the basis of this study, it is recommended that the firework injured hand be treated according to the resulting diagnosis, that is, digital amputation, fracture, soft tissue injury and the coinciding symptoms of oedema, pain and stiffness which negatively impact on the outcome of hand function after this devastating injury. The limitations of the study are discussed and recommendations for future research in this field are offered.
The influence of an abductor pollicis longus strengthening program on the symptoms experienced by elderly females presenting with early stage osteoarthritis of the 1st carpo-metacarpal joint : a pilot study for an experimental pre-test/post-test design.
(2014) Simpson, Marti.; Chetty, Verusia.
Introduction: Elderly females are predominantly left impaired by the degenerative impact which osteoarthritis has on the 1st CMC joint. Research supports the successful implementation of early stage conservative management. Aim: To determine the viability of performing a full scale study to investigate the influence of an abductor pollicis longus strengthening program on the symptoms experienced by elderly females presenting with early stage osteoarthritis of the 1st CMC joint. Objectives: Validating data gathering instruments; evaluating methods and procedures used for recruiting, randomization; retaining, assessing and facilitating compliance of participants. Evaluation of the data capturing process. Required resources and sample size for a scientifically valid full scale study was estimated. Method: The pilot study made use of the quantitative research design proposed for a full scale study. Tools such as cost sheets and compliance logbooks were implemented along with qualitative components such as feedback questionnaires and field notes. Three retirement homes participated; 25 residents qualified to participate of which 15 were allocated to the experimental group and 10 to the control group. The experimental group participated in an 8 week exercise program; while the control group received an assistive device. Both the experimental and control groups were assessed at baseline; four weeks and after eight weeks. The assessment battery included the Kapandji index for thumb opposition, voluntary isometric total grip, 2-point pincer, 3-point pincer and key grasp strength, Visual Analogue Scale for pain and the Michigan Hand Outcome Questionnaire (MHQ). Data analysis: Data was captured by the researcher; the MHQ and feedback questionaires were independantly completed by the partiticpants. Data cleansing was conducted manually where corectness was verified by a third uninvolved party. Quantitative data was summarized and tested with the vi Generalized Estimating Equations (GEE) to detect possible changes over time. Inferential analysis and comparisons of results for the experimental and control groups could not be made. The researcher detected themes and subthemes within the qualitative data. Results/Discussion: Recruitment techniques’ response rate did not exceed 27%; qualitative data sets identified influencing factors An inclusion age of 60 years and older were suggested and to extend the research to various ethic groups. A large enough sample group for randomization was not obtained. Recommended adjustments to the assessment battery: using an adjusted MHQ as the full MHQ includes unapplicable questions; using a Numerical Rating Scale (NRS) for pain potentially being more user friendly for an elderly population; and an additional abduction active range of motion goniometer assessment for the thumb is recommended as the Kapandji scale for opposition provided limited information concerning the range of motion of the 1st CMC joint. The calculated cost per participant was R1921.60 for the control group and R3179.79 for the experimental group. Human resources were calculated at 64.2% of the entire budget. Compliance was affected by poor memory and health. Population attrition rates were calculated at an average of 48%. The feedback questionaires indentified personal gain and the feeling of contributing to a research initiative as the predominant themes for retaining the target population. Conclusion:The conducted pilot study can be used to define the parameters necessary to conduct then mentioned full scale research study, as well as assist with research designs envolving a similar target population. One more pilot study is recommended prior to a full scale study addressing topics such as including diverse races; recommended additional assessment tools and intervnetion components.
Kinesio Taping® of the metacarpophalangeal joints and its effect on hand function in individuals with rheumatoid arthritis.
(2015) Roberts, Sarah Catherine.; Ramklass, Serela Samita.; Joubert, Robin Wendy Elizabeth.
Background Rheumatoid arthritis (RA) is a chronic systemic disease that affects the hands bilaterally, resulting in inflammation, pain, joint instability, diminished grip strength and difficulties with function. The metacarpal joint (MCP) is commonly affected in the hand. The effectiveness of Kinesio Taping® on taping of the MCP joints has not been established in assisting with the symptoms in the hand. Aim To determine the effectiveness of bilateral Kinesio Taping® of the MCP joints on pain, range of motion, grip strength and hand function in elderly individuals previously diagnosed with RA. Methods / Design A repeated measure experimental design was used for the study over a seven week period with the experimental group (n = 30) receiving bilateral space correction Kinesio Taping® of the MCP joints and the control group (n = 31) participating in joint protection (JP) workshops. The Kinesio Tape® was worn for 3 days per week with four applications during the data collection process. For the control group, 2 hour JP educational-behavioural workshops were run weekly for four weeks. Weekly assessments were completed for grip strength, ulnar deviation and pain (VAS), and two pre-intervention assessments and one post-intervention assessment was completed for the Michigan Hands Outcomes Questionnaire (MHQ). Results Kinesio Taping® of the MCP joints has shown a significant decrease in pain (P=0.00) and range of motion (P=0.00 bilaterally). Joint protection was found to have a significant difference in grip strength and in the work and ADL sections of the MHQ. No significant difference was found between groups after intervention in the majority of outcomes except for grip strength where a significant difference was found. The level of significance was set at 0.05. Discussion and Conclusion This study has shown that Kinesio Taping® of the MCP joints is an effective conservative intervention that can be used to improve pain and MCP ulnar deviation in individuals with RA over a 4 week period. This is completed through a space correction application of three days, with the tape being reapplied weekly. Kinesio Taping® can be therefore included into Occupational Therapy standard practice especially when the aim is to decrease levels of pain in the MCP joint but it may not be effective to ensure a long term effect on pain. Therefore, in order to ensure ongoing pain relief as well as to ensure maximum functioning in ADL, the taping should be used in conjunction with other therapy interventions as part of the total rehabilitation process. Further, Kinesio Taping® in conjunction with JP programmes would work effectively together to minimise pain and maximise participation in valued occupations, especially in the newly diagnosed client. Further research into the use of Kinesio Taping® in people with RA is recommended.
Electronic device use and fine motor dexterity and handwriting in grade 2 elementary school children.
(2015) Keller, Monique Marie.; Govender, Pragashnie.; McIntyre, June.
Aim: The study aimed to investigate whether a correlation exists in the electronic device usage and fine motor dexterity and handwriting in Grade 2 elementary male and female children. Methodology: A quantitative, correlation study design was utilized. Stratified sampling was employed to select n=34, grade 2 children together with their parents/primary caregivers. A parental self-administered questionnaire measured the electronic device type and frequency of use by the children. The children’s fine motor dexterity was measured with the Nine-Hole- Peg-Test and handwriting was measured with the Minnesota Handwriting Assessment. Data was analysed using SPSS version 22. Results and Discussion: Touch screen cellular phones and standard size tablet computers were most frequently used. The mean total time per week spent on electronic devices amounted to 9.3 hours and 5.5 hours per week across all mobile devices. Statistical significant correlations were measured for; total device use and total handwriting score (rho=0.110), total device use and non-dominant hand’s dexterity (rho=0.137), weak trunk stability and handwriting speed (p=0.007), male children’s handwriting speed was superior (p=0.015) and female children’s form of handwriting was superior (p=0.005), male children used handheld videogames more than female children (p=0.001). Conclusions: A weak positive correlation exists between the total time spent on electronic device usage in a week and non-dominant dexterity and handwriting. This implies that more frequent total electronic device usage per week has a higher handwriting total score but weaker non-dominant hand dexterity as a result. No correlation existed between total usage and dominant dexterity. Gender differentials revealed that males displayed faster and superior total scores in handwriting, females displayed superior scores for form, alignment and spacing and dominant/non-dominant hands’ dexterity.
Current trends in splinting the hand for children with neurological impairments.
(2015) Hepworth, Lauren Michelle.; Rencken, Gina.; Govender, Pragashnie.
Aim: The study aimed to explore the current splinting practises as used as a method of intervention for improving hand function in children with neurological impairments within the South African context. Methodology: A quantitative cross-sectional design using an electronic selfadministered questionnaire was utilised in order to address the objectives of this study. The sample included Occupational therapists working within the paediatric neurological field in South Africa. The study sample was collected through convenience and snowball sampling in order to target therapists specifically working in the area of paediatric neurology. Results and Discussion: Forty therapists completed the survey in its entirety. Therapists splint for various reasons and are in agreement that splints can be effective in neurological cases. The 3 most prevalent splints are the functional resting, thumb abductor and anti-spasticity splint with therapists mainly splinting to maintain or improve ROM. Conclusions: This study provides an insight into the splinting practices amongst occupational therapists who work with neurologically impaired children. It shows that therapists do choose to splint despite the controversy that surrounds splinting in neurology and that many factors are considered during the decision-making process.
The effectiveness of Transcutaneous Electrical Nerve Stimulation (TENS) versus Interferential Current (IFC) in the treatment of pain following a distal radius fracture.
(2015) Thaver, Seleena.; Maharaj, Sonill Sooknunan.
Purpose : The radius bone in the forearm of the human body, is an integral component of the wrist joint. Optimal wrist joint function plays an important role in maintaining dexterity of the upper limb. The inability to use the upper limb due to injury or pathology, impacts on activities of daily living, like personal care, occupational needs, and social activities. Following the fracture of the distal radius, a period of immobilisation is required for the injured structures to heal. Physiotherapy after the period of immobilisation is aimed at improving mobility, strength and flexibility of the affected joint. At this stage, patient’s main complaints are pain and stiffness which is impeding on functional use of the affected limb. Analgesia is usually prescribed to the patient for pain management, however in the South African public sector, drug shortages is a problem. Therefore there is a need to investigate a rehabilitation intervention that may reduce pain and hasten functional recovery after a distal radius fracture (DRF). Transcutaneous Electrical Nerve Stimulation (TENS) and Interferential Current (IFC) are two electrotherapy modalities, commonly used in the management of pain. Their effectiveness in reducing pain following a distal radius fracture has not been established. Therefore this study was designed to determine the effectiveness of TENS and IFC in reducing pain experienced following a distal radius fracture. Methods: The design of the study was a pre-test, post-test between subject study. Fifty four patients were randomly assigned to a TENS and exercise or IFC and exercise group. Both groups engaged in a 2-3 week programme, which comprised of six sessions of intervention. Pain was recorded with the Verbal Numerical Rating Scale (VNRS). Range of movement was measured with a goniometer and muscle strength with a modified sphygmomanometer. Functional ability was assessed with activities from the Patient Rated Wrist Evaluation (PRWE). Results : Statistical analysis was done with IBM SPSS (Version 21.0, IBM Corp., Armonk, NY). There was no significant differences between groups at the baseline with post 2-3 weeks showing compliance with TENS and exercises of 37% (n=20), IFC and exercises 37% (n=20). There were significant improvements (p < 0,05) in pain, range of movement, grip strength, and functional ability with both interventions. IFC was found to be significantly more effective in increasing wrist flexion and extension range of movements. Conclusion : Tens and IFC are effective in reducing pain following a distal radius fracture. There was no significant difference between the two modalities in reducing pain. Other variables of range of movement, muscle strength and functional ability also improved.
An exploration of albino identity amongst groups of teenaged girls at a special school in KwaZulu-Natal, South African.
(2015) Vally, Farhana.; Lingah, Thanalutchmy.
A qualitative study probing Albino Identity amongst groups of teenaged girls at a special school in order to find out if a group identity based in Albinism exists. An exploratory research design allowed the researcher to explore the worldview from the participant's perspective. The method of investigation used three focus groups of four participants each to explore the psycho-social constructs that defined the shared reality of the participants as a group because of medical condition. Personal accounts from the participants facilitated the exploration of their perception through homogenous focus groups. This study had four objectives. The first objective was to examine how the social identity shapes the personal identity of the participants with Albinism. The second objective was to explore and identify common social experiences that the participants shared which have meaning for them in order to better understand their personal reality as a group. The third objective was to understand how social constructs contribute to defining the personal reality of the participants. The fourth objective of this study was to explore the psychosocial reality of Albino Identity as a shared group identity. The data yielded from the three focus groups was analysed using Thematic Analysis. Themes that emerged from the focus group were grouped into three broad heading namely Differentiation Based On a Lack Of Pigmentation, Treated Differently Because of Colour and Albinism Changes Social Interaction. The study's findings show that the social identity changes the personal identity in the same way. The participants share the same experiences with the social identity due to the lack of pigmentation. The participant's personal identity is altered through social interaction with the group mind. Social interaction with social constructs such as family and peers were more meaningful to the participants than with strangers. Albino Group Identity does exist and has value for the participants because it creates a sense of belonging and community for the participants outside of their family. Participants also reported being more comfortable around large numbers of Albinos because there is an absence of threat and hostility, giving the participants more security and acceptance. Members of the identity group based in Albinism regards the lack of pigmentation as a norm. This study has identified several group norms observed by its group members of Albino Group Identity. Safety concerns regarding the sun is a group norm along with dressing for the sun. Group members also reconstitute their behaviour to accommodate the social identity. The group strive for normality is the antithesis to the myths based in the collective unconscious. Albino Group Identity also demands the resolution of an identity crisis that is based in the colour that is created by Albinism. The findings of this study allows for practical adaptation of group therapy with learners with Albinism who present with maladaptive behaviour patterns. Future research in the area of group identity amongst persons with Albinism is recommended.
Factors affecting attendance and participation in group therapy in a private inpatient psychiatric setting.
(2015) Clark, Vicky Lilian-Ann.; Lingah, Thanalutchmy.; Evans, Dylan Jiva.
This study seeks to understand why many patients did not participate in a group therapy programme offered at an inpatient psychiatric hospital in Pietermaritzburg, South Africa. Conducted by an Occupational Therapist, the study analyses a sample of inpatients’ perspectives, gathered via semi-structured interviews, of the factors that affect group therapy attendance and participation. The data was analysed qualitatively using thematic analysis. The results suggested that positive experiences and therapeutic outcomes, renewed hope and the helpful, supportive and non-judgemental nature of the group encouraged group therapy attendance and participation. These factors mirrored many of Yalom’s (2005) therapeutic factors. The following factors were found to hinder group therapy attendance: stigma, shame, a belief in the negative stereotypical portrayals of mental illness, physical pain, fatigue and negative side effects of medication. The findings were used to generate recommendations which could potentially be applied over a variety of clinical settings in order to increase group therapy attendance and participation and also enhance the therapeutic experience of the inpatient with a psychiatric illness.

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