Masters Degrees (Occupational Therapy)

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Zulu cultural perspectives and experiences of mental health and occupational therapy in KwaZulu Natal, South Africa.
(2022) Moonsamy, Ashira.; Lingah, Thanalutchmy.; Gurayah, Thavanesi.
Background: Healthcare systems are formulated utilising worldviews, specifically in mental health, where norms are created dictating what is normal versus abnormal. The era of coloniality promoted western dogma over collectivist cultures. Occupational therapy practice must consider the client’s context during assessment and intervention for the process to be client centred. Methods: A qualitative descriptive design was utilised. Purposive sampling was used to recruit 10 participants. Data was collected through semi-structured interviews. Analysis was guided by utilising Braun and Clark’s six phases of thematic analysis. Findings: Three themes emerged from the data, personal perceptions, cultural perceptions, and health-seeking behaviour. Sub-themes accompanied each. Personal perceptions explored how Zulu people made sense of mental illness or related behaviours through a modern or traditional lens. It also explored the importance of the strength of the Zulu individual. A dissonance occurs when faced with cultural norms and personal needs. Finally, their perspectives were altered through their experience with mental illness. Cultural perceptions were that problems were solved internally in families or communities, and progress was promoted as necessary for the Zulu individual. It also explored spiritual beliefs regarding mental illness, which could range between God, Ancestors or both and could be causal factors or healing mechanisms. Suicidality is seen as a weakness in the culture, and stigma was attached to mental illness. The final theme concerns the experience of the Zulu mental health care user dealing with their mental illness. Cognitive dissonance is prevalent in all three aspects not merely due to the difference between westernised mental health treatment and traditional healing systems but also due to the value found in each. The method of sharing vulnerability or issues with an individual outside the family contradicts cultural norms. However, participants expressed that being understood in group discussions and sharing vulnerability significantly improved their healing. Conclusion: Zulu individuals create their sense of self in an interdependent manner. The family and community are intertwined in their participation, reputation, and healing. There is an emphasis on strength and the following of norms in the Zulu culture, perpetuated by the importance of consulting elders or close family when faced with conflict. Disregarding these norms can outcast the Zulu individual who thrives on being included in the community. The study was conducted with a limited sample size and in an urban area. Further research within rural communities and diverse facilities would be beneficial. Occupational therapists working in communities such as KwaZulu Natal should understand the causal factors of mental illness for the Zulu mental health care user and their personal beliefs around healing when designing an intervention.
Operationalizing family quality of life: occupational therapy outcome measurement for South African forensic psychiatric rehabilitation.
(2020) dHangest dYvoy, Margaux Louise.; Fewster, Deborah Leigh.
Background: Families of forensic mental health care users (MHCUs) experience a great burden of disease. Families of forensic MHCUs in KwaZulu-Natal, South Africa, are identified as the primary community based support system. Relevant psycho-social rehabilitation and support services are required to empower the family as the primary community based support structures, for successful community reintegration and role re-acquisition of young adult forensic MHCUs to be achieved. Occupational therapists (OTs) have had a limited role in forensic “family work” in achieving family-centred health outcomes. Health outcomes have not been developed for occupational therapy practice to direct strategic family-centred rehabilitation. Family Quality of Life (FQOL) has been identified as a strengths-based family outcome which could be used in forensic mental health care. Operationalization of a unique occupation-based FQOL construct was required to inform outcome measurement tool development ensuring family-centred effective and efficient service delivery in the future. Research aim: This study aimed to identify and operationally define FQOL in the development of a FQOL outcome measurement tool that could direct family centred OT services for MHCUs and their families within a forensic psychiatric facility setting in KwaZulu-Natal, South Africa. Method: A qualitative research strategy was used to establish the meaning of FQOL, particularly, an interpretivist qualitative research design. Focus groups of experts (mental health care professionals, forensic MHCUs, and family members) attributed meaning to the existing FQOL construct. A hybrid of inductive and deductive data analysis was necessary to operationalize this construct for application to forensic mental health outcome measurement tool development. Results: An operational definition of the occupation-based FQOL construct using an occupational lens for evidence-based forensic mental health OT practice, was developed. FQOL operational definition(s) of the construct, themes, sub-themes, domains, and sub-domains were formulated and presented in a meaning map of meaning attributed by expert participants. This novel construct consists of two (2) themes (family unit factors, and individual member factors), their related sub-themes (e.g. family unit factors’ sub-themes: family characteristics, family dynamics, and external family unit support) and domains addressing pertinent areas of family life contributing to a collective FQOL experience of forensic MHCUs and their family members. Findings merged FQOL and OT frameworks for application to forensic mental health as compared to previous disability fields of inquiry. A diagrammatic presentation of the novel FQOL construct using an ecological perspective iv displays pertinent areas of family life requiring support by OTs rendering psycho-social rehabilitation. Conclusion: OTs practicing within the specialist forensic mental health facility in KwaZuluNatal, South Africa, are hereby presented with an operationalized FQOL health outcome which could direct evidence-based, family-centred, strengths-based, and support-orientated service delivery, strategically positioning the profession in community-based rehabilitation.
Integrating knowledge-to-practice for occupational therapists working with high-risk infants in the KwaZulu-Natal public health sector: a qualitative explorative inquiry.
(2020) Dawood, Ayesha.; Naidoo, Pragashnie.; Ogunlana, Michael Opeoluwa.; Rencken, Gina.
Introduction: Neonates are an at-risk population due to their increased susceptibility of mortality and morbidity. Occupational therapists have an important role in Early Childhood Intervention (ECI) and implementing Neurodevelopmental Supportive Care (NDSC) for high-risk infants whilst they are admitted in the Neonatal Intensive Care Unit (NICU). To the best knowledge of the author there is a paucity of literature available within the South African context in the use of evidence-based practices (EBP), and the integration of knowledge translation (KT) amongst occupational therapists who provide therapeutic management to high-risk infants and their families. Aim: This study aims to explore the knowledge to practice gaps experienced by occupational therapists who support high-risk infants in different levels of care in the public health sector of KwaZulu-Natal South Africa. Methods: A qualitative exploratory research design was used for this study. A nonprobability sampling technique was used. Seventeen occupational therapists who have more than two years of experience and are employed on a full-time basis in the public health sector of KZN participated in this study via online focus group discussions. Data were analysed using thematic analysis with inductive deductive reasoning, guided by a combined theoretical framework using the Appreciative Inquiry (AI) approach and KT process as a methodological orientation to the study. Research Ethics: Principles of confidentiality, autonomy, informed consent, beneficence, non-maleficence, and justice were adhered to. Participants were not of a vulnerable population and therefore support was not offered upon completion of the research discussions. Results: Five themes emerged in this study, namely, occupational therapy (OT) and neonatal care in the public health sector, Knowledge Acquisition and Knowledge Synthesis, Knowledge Translation/Utilization, Contextual barriers/adaptation, and the ideal OT in the ideal neonatal setting. Therapists outlined the facilitators, inhibitors, referral pathways and their personal interests in OT neonatal care. Supportive management and multidisciplinary teams (MDT) were highlighted as facilitators in the hospital environment whilst OT staff shortages, insufficient undergraduate training in the field and a lack of funding for courses for postgraduate OT training were regarded as inhibitors to practice. OTs source and synthesise knowledge from multiple sources to integrate, utilise and translate into neonatal practice. Contextual barriers are identified in various levelled facilities with acquired neonatal knowledge being adapted by therapists for low resourced settings. Participants envision the dream of the ideal day and therapist to intervene with neonates in the public health sector of KZN. Conclusion: Findings have identified several knowledge-to-practice gaps for OTs who support neonates in low resourced settings. Therapeutic resources and funding for postgraduate training, an improvement in the undergraduate curriculum, and policy development appear to be necessary to inform a standard of care across the province.
“Consensus on an infant massage programme for high risk infants from resource constrained contexts: a Delphi Study with Physiotherapists and Occupational Therapists.”
(2017) Perks, Lauren.; Rencken, Gina.
The attachment of the mother to her infant is one which aims to provide the foundation for the infant’s well-being and adaptation (Bowlby, 1958; Carter, et al., 2005 in Atzil, Hendler, & Feldman, 2011 p.1). However, it is evident that primary caregivers present with difficulty with bonding and attachment with infants who were born in the high risk category as a result of delayed responses from the infant to the caregiver’s cues as well as from a variety of emotional reactions in the caregiver (McClure, 2000, p. 167). This alongside limited access to financial resources, limited transport and underresourced hospitals (Salojee, Rosenbaum, & Stewart, 2011, p. 37) contributes to making the attachment and bonding process difficult. This study aims to explore this dynamic and to develop an infant massage programme, through consensus from Occupational Therapists and Physiotherapists. As shown in literature this will assist this dyad in the attachment and bonding process amidst all the challenges and constraints which they are faced with.
Acute care in occupational therapy a package of care and the essential therapeutic equipment needed.
(2017) Chetty, Angela.; Tsoka.Gwegwen, Joyce.
ABSTRACT Introduction: Occupational therapy, together other clinical services are required by government to describe and outline their services so that minimum standards can be set, to ensure that quality care is delivered to all who use the public health service in South Africa. In KZN, where this study is focused, the vast majority of health institutions deliver acute care services at either a district, regional or tertiary level. Aligning therapeutic services to appropriate clinical service at each level will have an impact on optimal health care. Aim: This study focused on developing a package of services for occupational therapy in acute care and outlining an essential therapeutic equipment list. Methodology: A mixed methods explorative sequential study with three phases was implemented. The first phase focused on a documentation audit to determine the context, background and any relevant information on the topic. Approximately 13 documents were selected to conduct a thematic analysis and extract pertinent information to answer the research question. The second phase consisted of implementing a survey in KZN with all eligible occupational therapists to determine their opinions on existing information and generate new ideas. This survey was constructed utilizing information from the document analysis. The final phase ensured that consensus was drawn on a package of occupational therapy services and equipment list by conducting a focus group utilizing the nominal group technique. Senior experienced occupational therapists that worked in acute care constituted the expert group. Results: The documentation audit yielded a rich description of information which set the background on the survey questionnaire. A 78 % response from the survey ensured that the senior experts on the nominal focus group were well informed xii when drawing consensus on a final package of occupational therapy in acute care and the essential therapeutic equipment and assessments needed. Conclusion: This study will provide therapists with a baseline standard of care for acute care hospitals and assist them with motivating for appropriate cost effective resources to deliver effective services in KZN.
Paediatric Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome related neurological illnesses: the multidisciplinary perspective in an acute quaternary.
(2017) Sagadavan, Kesree.; Tsoka.Gwegwen, Joyce.
ABSTRACT Introduction: The HIV/AIDS pandemic has adverse medical and psychosocial effects on affected children, caregivers and imposes significant challenges on health care professionals. The prevalence of Paediatric HIV/AIDS in South Africa and KwaZulu Natal is well documented. The adverse neurological effects of HIV impair optimum neurodevelopment and hence a multidisciplinary team is essential in the management of the sequelae of neurological and neuropsychiatric symptoms associated with HIV/AIDS. The caregiver is regarded as an important partner in the treatment process to ensure adherence and compliance of both medical and rehabilitative components, completion of home programmes and providing of critical collateral information. The lens through which children with HIV/AIDS related neurological illnesses view the rehabilitation process is also crucial to determine effectiveness of therapeutic intervention. Aims: This study comprised of three phases. Firstly a profile of the children diagnosed with HIV/AIDS related neurological illnesses admitted to an acute quaternary health care facility was initiated. The second aim was to describe the roles and responsibilities of the multidisciplinary team, their priorities of care as well as to explore the challenges and enablers of service provision as experienced by the team. Furthermore the researcher sought to describe the experiences of primary caregivers and their children who are diagnosed with HIV/AIDS related illnesses in order to highlight some of the challenges and barriers experienced by these end users regarding the service provided by the paediatric neurodevelopmental team. Methods: A mixed methods explanatory sequential study design within a multistage framework was utilised. Phase one consisted of a file audit (n=139) to determine the profile of HIV related neurological illnesses in affected children admitted to an acute quaternary paediatric neurology ward. Statistical analysis included the Wilcoxon signed rank test, the Kruskal -Wallis equality of populations rank test, Spearman correlation and the Mann Whitney test. Phase two comprised of the vi administration of a questionnaire to the multidisciplinary paediatric neurodevelopmental team (n=27) followed by a focus group (n=6). The study was concluded with phase 3 detailing semi-structured interviews with primary caregivers (n=5) and children with HIV/AIDS related neurological illnesses (n=3). Results: The neurological and neuropsychiatric deficits as a result of HIV/AIDS were identified with the most common central nervous illness being HIV Encephalopathy. Physiotherapy was the predominant service offered to this profile of children. The majority of the functional status scores were categorised between mildly-moderately abnormal except for those children who demised (n=7) who demonstrated severely abnormal - very severely abnormal scores. The multidisciplinary paediatric neurodevelopmental team identified priority management strategies, which informed treatment approaches, roles and responsibilities and barriers and enablers of integrated and holistic care. Primary caregivers of children with HIV/AIDS related neurological illnesses highlighted numerous stressors as well as psychosocial factors relating to the diagnosis and prognosis of HIV/AIDS. Children with HIV/AIDS related neurological illnesses drew on their perspectives when engaging in therapy using both narrative and diagrammatic representation of their experiences. Conclusion: The study highlighted the multifarious presentation of paediatric HIV/AIDS related neurological illnesses in an acute quaternary health care facility. Future studies can identify models for intervention and to develop clinical guidelines and protocols as well clinical care pathways for managing children diagnosed with HIV/AIDS related neurological illnesses. Key words: Paediatric HIV/AIDS, Neurological illnesses, Multidisciplinary team, Caregiver and Rehabilitation.
Long-term outpatient therapy: perspectives from acquired brain injury survivors, their caregivers and the therapy team: a KwaZulu-Natal study.
(2018) Reddy, Shivani.; Rambiritch, Virendra.
ABSTRACT Introduction: Acquired brain injuries often result in persistent residual impairments which negatively impact the individual for years after the injury, contributing to difficulty in the acquired brain injury survivor reintegrating into the community. A non-government organisation in KwaZulu-Natal provides long-term outpatient therapy to this population, with involvement from their caregivers, and the therapy team. This study aims to gain more insight into the stakeholders’ experiences of this type of the therapy, and whether there is a need for it. Aim: To explore the experiences and perceptions of acquired brain injury survivors, their caregivers and the therapy team involved in this long-term therapy programme. Methods: An exploratory, qualitative research design was used. The study was conducted at the non-government organisation providing long-term outpatient therapy for the acquired brain injury survivors in the province of KwaZulu-Natal, and the sample was recruited from participants attending this facility, using purposive sampling. Face-toface and telephonic interviews were conducted with participants who met the inclusion criteria, with a total of 11 participants recruited. Data was then analysed using thematic analysis. Results: Three main themes emerged, namely: the impact of an acquired brain injury indicating the need for long-term therapy; the benefits of long-term therapy for acquired brain injury survivors; and the challenges of long term therapy for acquired brain injury survivors. The acquired brain injury survivors still had residual deficits which impacted on their ability to engage in occupations, and as a result required continued intervention. Furthermore, participation in groups and long-term therapy reduced the participants’ feeling of social isolation and contributed toward the acquired brain injury survivors’ perceptions of being engaged in meaningful occupations. However, some changes to the programme were suggested. Conclusion: Acquired brain injury is a complex condition which can result in residual impairments, and which requires care on a long-term basis. The provision of long-term therapy for this population appears to have numerous benefits, and some challenges that need to be addressed. The provision of this service assists in bridging the gap between hospitalisation and community reintegration for the acquired brain injury survivors. Keywords: Acquired brain injury, ABI survivor, long-term therapy/rehabilitation, caregiver, therapy team.
Client perceptions of social skills development occupational therapy intervention groups in an acute psychiatry setting.
(2017) Radnitz, Andrea.; Christopher, Chantal.
Pre-amble: This document is written in the format of a “Masters by manuscript”, as per the requirements of the University of KwaZulu-Natal’s research office. The transition away from “Masters by dissertation” has been made in 2017, by the University of KwaZulu-Natal, in order to encourage students to publish their work, thereby, making more of the research conducted for degree purposes accessible to the public, to aid in the transfer of knowledge. The university’s formatting requirements can be found under attachment A. The research articles have been referenced according to the guidelines of the journals to which they will be submitted. The rest of the document, for consistency, has been referenced according to the guidelines of the second journal article; an adapted Harvard referencing system. These guidelines can be found in Appendix J
The role of the occupational therapist in case management in South Africa.
(2017) Govender, Kreshnee.; Christopher, Chantal.
ABSTRACT Case Management has evolved as an important strategy in managing healthcare to ensure quality and cost effectiveness. Various health professionals utilise case management in numerous practice settings and the researcher has been observed that occupational therapists have adopted this approach in managing disability and incapacity in the workplace when illness or injury impacts on work ability and retention of the employee. The occupational therapist as case manager has been documented in international literature however the role of the occupational therapist in South Africa is not defined and their contributions to the field is not well recognised. The aim of the study was to identify the occupational therapists’ role and scope of practice in case management in South Africa. A quantitative research method for a descriptive study was selected to establish associations between variables and to draw conclusions based on the data collected. This entailed compilation of a questionnaire as a data collection tool that was informed by literature on case management. A pilot study preceded data collection. Purposive sampling was used and the questionnaire was distributed electronically using Surveymonkey to a targeted group of 180 occupational therapists working in private practice, health consulting, for RAF and Workmen’s Compensation given the field of work and their experience in managing individuals with long term medical conditions and incapacity due to ill-health/injury. The data collected was exported to excel for analysis using the mean and a bivariate study to present the non-random associations between two categorical variables. Data from open ended questions were categorised into subthemes and themes using manual coding and was presented thematically. Results of the study revealed that occupational therapists are involved in case manager functions and the extent and intensity of involvement was in relation to the practice area. The findings suggest that occupational therapists in South Africa have adopted case management as an operational component of disability management and as an element of vocational rehabilitation. The results further indicate the standards applied in case management, the models used, the skill base and knowledge relevant to case management and a description of the challenges and effectiveness of case management as experienced by occupational therapists. These findings highlight the need for occupational therapists to expand their knowledge and to promote their skills in the field to enable appropriate and timely uptake of the service. Moreover these results indicate areas for further research on academic preparation relative to the field, evidence to validate the effectiveness and standards of practice to strengthen the occupational therapist as a case manager.
The factors influencing the return to work of individuals having sustained severe traumatic brain injuries in South Africa.
(2016) Moller, Claire-Lynn.; Toerien, Leazanne.; Bainbridge, Jane.; Broughton, Shelly.; Jonck, Felicity.; Paruk, Rehana.
A traumatic brain injury (TBI) is a complex phenomenon where the ability to return to work (RTW) following injury is not always successful. Vocational rehabilitation (VR) is process that facilitates the RTW. Previous skills, habits and a familiar working environment need to be considered to ensure a successful client-centred intervention. The purpose of this study was to identify and explore factors influencing RTW of severe TBI’s who were employed in a stable, secure environment for more than three years prior to the injury. A qualitative approach was used to explore the lived experience of severe TBI’s. The aims and objectives were to identify and explore personal attributes, developed habits and routines, residual performance skills and environmental factors that enhanced or impeded the RTW of severe TBI’s. A semi-structured interview was guided by the worker role questionnaire and used as a gathering tool. The audio-taped interviews were transcribed and then thematically analysed using Braun and Clark’s six phase process. Two major themes emerged from the study namely; “It’s all about me” and The support for me”. The sub-themes from the first theme included my role as a worker, my abilities in the role and my emotions in the role. Sub-themes from the second theme included personal, work and rehabilitative support. The findings indicate that participating in work was of great importance to participants. Factors that enhanced the RTW were; developing and fulfilling the worker role, positive support, the ability to draw on past experience, knowledge and skills and VR intervention. Additionally, a previous stable and secure work environment emerged as a strong factor in enhancing RTW. Factors that impeded the RTW were a lack of support and uncertainty regarding residual abilities and the working environment. It highlighted that these factors were unique, inter-related and crucial in the fulfilment of self-worth. Although only two participants in this study received VR, there was strong emphasis on its impact on RTW and the need for this to be client-centred. This finding supports literature indicating VR in South Africa is limited. If readily available, it could have a positive effect on RTW of people with severe TBI’s.
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
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.
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.
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.
Addressing spirituality in group therapy : a qualitative study at a shelter for abused and vulnerable Muslim women in Durban, South African.
(2016) Soomar, Nazeemah.; Crouch, Rosemary B.
Spirituality has gained recognition as a vital factor in mental healthcare, and has been applied to major occupational therapy models. However, its clinical application is limited universally, to the possible detriment of patients. This phenomenological study aimed to explore the experiences of abused and vulnerable Muslim women on addressing spirituality in occupational therapy groupwork, including understanding a definition of spirituality, and avenues to address spirituality. An inpatient Women's centre with a spiritual ethos was identified, where patients were exposed to a series of occupational therapy groups including concepts of spirituality. Semi-structured individual interviews were conducted on 7 purposively selected participants, and followed by thematic analysis. The findings reflected through the emergence of 4 themes that addressing spirituality conforms with client-centeredness, and enhanced a sense of meaning and purpose for the participants. Strength and motivation was drawn from applying spiritual concepts in group therapy sessions, ultimately facilitating better coping and empowerment, which reflected in their daily occupation. Implications of this study extend to curriculum development, treatment and service delivery, and health promotion.
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.
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.

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