Background: Research on communication intervention with young children provides support for the involvement of primary caregivers in their child’s language intervention (Kaiser, & Roberts, 2011; Roberts, & Kaiser, 2011). Research suggests that the perceptions of these caregivers regarding their child’s language development and their role in the language development process are important to their willingness to use intervention strategies (Kaiser, & Hancock, 2003; Leffel, & Suskind, 2013). Furthermore, studies suggest that the severity of child language difficulties may impact on these perceptions (Brady et al., 2006; Romski et al., 2011). However, there is a lack of research on how primary caregivers from non-Western, non-English-speaking backgrounds perceive their child’s language development and understand their role. Aims: The study investigated the perceptions of isiXhosa-speaking primary caregivers of children who receive speech-language therapy regarding their child’s language development across three expressive language groups (i.e. not speaking, speaking in single words and phrases, speaking in sentences). Perceptions on the basis of duration and frequency of the speech-language therapy, and child age are also described. Methods: Thirty primary caregivers of young children (30 to 70 months) completed the South African Caregiver Perception of Language Development (SA-CPOLD) in a structured interview format using the Talking Mats™ visual framework (Murphy, & Boa, 2012). These results were compared across three child expressive language groups, as determined by scores on the Mullen Scale of Early Learning, and language sample analysis data (i.e. mean length of utterance and number of different words). Results: The primary caregivers of the children who were speaking in either single words and phrases or speaking in sentences demonstrated more positive perceptions than caregivers of children who were not speaking, although this did not reach a conventional level of significance. Caregivers of children across the three expressive language groups acknowledged their child’s language difficulties, however primary caregivers of the children who were non-speaking agreed more with statements related to their child’s difficulty. Perceptions did not appear to differ on the additional variables (i.e. duration and frequency of speech-language therapy, and child age). Conclusion: The results of the present study suggest that isiXhosa-speaking caregivers’ perceptions of their child’s language skills are related to their expressive language skills to some extent and that these caregivers are able to accurately report on their child’s language difficulties. Keywords: caregiver perceptions, disability and developmental delays, early language intervention, isiXhosa, language delays, South Africa / Mini Dissertation (MA)--University of Pretoria, 2019. / Centre for Augmentative and Alternative Communication (CAAC) / MAAC / Unrestricted

South Africa has the highest reported prevalence of Fetal Alcohol Spectrum Disorder (FASD) worldwide. The high prevalence is aggravated by limited remedial and rehabilitative services in the rural Northern Cape. Parents requested guidance to facilitate the development of their children with FASD. Understanding their needs and strengths will inform intervention programmes to create the stable environments children with FASD require for optimal life outcomes. The aim of the study is to explore the way that mothers facilitate the occupational engagement of their children with FASD as well as the challenges they face. Using a qualitative descriptive study design, the author purposively selected mothers to reveal three turning points in the lives of their children. Semi structured- and photo-elicitation interviews highlighted mothers’ experiences. Interviews were transcribed verbatim and inductively analysed with content analysis. Two themes emerged, namely, “Doing together” and “Varying access to engagement”. The findings of this study highlight the important role mothers play to facilitate the occupational engagement of children with FASD. Recognising mothers as agents of change and including them in intervention will enhance occupational therapy practice in the area of FASD.

Dementia is a progressive syndrome with declines in cognitive and functional abilities. As the world’s population becomes increasingly older, prevalence rates are expected to increase exponentially to over 80 million affected by the year 2040. Individuals with dementia and their caregivers experience various difficulties associated with progression that increases stress for both parties. Caregiving can be burdensome and caregivers may employ a number of strategies to manage problems as they arise. Renewed interest has been focused on the care environment as one way to modify dementia progression as caregivers can be an influential person in the care recipient’s life. Two hundred sixty-six dyads consisting of persons with dementia and their caregivers were examined to investigate whether caregiving coping strategies influenced the care recipient’s time to severe dementia, institutionalization, and death. Using the Ways of Coping Checklist (WCCL-R), latent profile analysis was used to examine whether caregivers could be categorized based on their use of coping strategies. Results indicated that caregivers could be profiled based on their use of coping strategies on the WCCL-R, as follows: problem-focused, acceptance-based, emotionfocused, and low coping classes. While there was good assignment for the latent classes, caregiver characteristics were not predictive of these groups per multinomial logistic regression. Cox regression was used to analyze survival times to the clinical outcomes of severe dementia, institutionalization, and mortality. While the latent profiles did not predict survival time to the three outcomes, the emotion-focused class (n =12) showed a trend in predicting hazard of death (HR = .522, p = .066, 95% CI = .261-1.045). Longer duration of dementia was associated with higher hazard of severe dementia (HR = 1.181, p = .003, 95% CI = 1.057-1.319), while older age of dementia onset was associated with higher hazard of death (HR = 1.085, p Although caregiver coping profiles did not predict survival times for clinical outcomes, the successful classification of caregivers based on utilization of coping strategies may provide a useful way to study both caregiver and care recipient outcomes.

ABSTRACT Paediatric HIV remains one of the most significant challenges to face children, their families and their health care providers in South Africa. The prevalence rate of paediatric HIV infection in South Africa is set to remain high until such time as universal access to antiretrovirals for prevention of mother to child transmission is achieved, and the mother to child transmission rates of HIV start to come down. HIV is neurotrophic and is known to invade the developing central nervous system and cause widespread damage. The result of this is a well described encephalopathy which has the potential to affect all facets of development. Children in South Africa who are infected with HIV are vulnerable to a number of factors which may cause developmental delay. Poverty and malnutrition are likely to exacerbate the developmental delay caused by HIV encephalopathy. Physiotherapists in South Africa have not become involved in the long term management of children infected with HIV and paediatric HIV clinics do not routinely offer any rehabilitation services. The prevalence and extent of developmental delay in HIV infected children in South Africa has not been established. Despite the fact that a number of studies have highlighted the prevalence of developmental delay in Western countries, no intervention studies addressing this problem could be found. Caregivers of HIV infected children face numerous stressors. Poverty, stigma and their own health care needs make parenting an HIV positive child even more challenging. The needs of caregivers of HIV infected children have not been well researched in the context of developing countries. The aim of this study was therefore to establish whether a basic home stimulation programme would have any impact on the neurodevelopmental status of young children infected with HIV, and on the parenting stress levels of their caregivers. Further objectives of the study were to establish the prevalence and progression of developmental delay in HIV infected children; to monitor the effect of antiretrovirals on neurodevelopment; to determine who the caregivers of HIV infected children were and to determine what factors were predictive of neurodevelopmental status and parenting stress levels. In order to meet these objectives a longitudinal randomized controlled trial was conducted. One hundred and twenty two HIV positive children, under two and a half years of age, were recruited for this study at Harriet Shezi Children’s Clinic at Chris Hani Baragwanath Hospital in Soweto. Children were randomly assigned to a control or an experimental group. The developmental status of all children was monitored over a year using the Bayley Scales of Infant Development II. Parenting stress was monitored with the Parenting Stress Index/Short Form. Children in the experimental group received a basic home stimulation programme, which was updated every three months when they came to visit the clinic, as well as all the usual clinic services. Children in the control group received all the usual services at the clinic but no stimulation programme. Most of the children in the sample were cared for by their biological mothers. They came from poor homes with limited access to common household amenities. Most of the caregivers had not completed 12 years of schooling. The children in the control and experimental groups were well matched for all their baseline measurements and demographic characteristics. At baseline the children were wasted and stunted and had very low CD4 counts. Only 16% of the children were on antiretrovirals at baseline assessment. The children were severely delayed with respect to both motor and cognitive development. The parenting stress levels of the caregivers were very high at baseline. Over the period of one year the children in the experimental group showed a significantly greater improvement in cognitive (p=0.01) and motor (p=0.02) development when compared to children in the control group. Although the children improved, they still had a degree of developmental delay at the end of the study period. The parenting stress levels decreased significantly for caregivers in both the control and the experimental groups (p<0,001), but there was no significant difference between the two groups (p=0.057). The groups were well matched at all time points for anthropometric measures and CD4 counts with no significant differences being found. There was also no difference in the number of children on antiretroviral therapy between the groups at any time. Children who were antiretroviral naïve at the start of the study and then started highly active antiretroviral therapy showed a significant improvement in motor development (p<0.001), but no improvement in cognitive development (p=0.77). A combination of a number of factors was predictive of developmental status. This included growth parameters, CD4 counts and the age of the child. Being in the experimental group and being older at baseline assessment were important predictors of improvement in MDI and PDI over time. Parenting stress was predicted by a number of factors, including educational level of the caregiver, type of housing and the number of children in the household. A decrease in parenting stress was most likely in caregivers who were better educated and who lived in households with fewer adults. These results signify that a basic home programme can significantly improve both the cognitive and motor development of young children infected with HIV. This programme was simple and easily implemented and should become standard practice at paediatric HIV clinics in South Africa. The current protocol for administering antiretrovirals in South Africa allowed for motor, but not cognitive improvement in young children commencing treatment. Parenting stress was not affected by the addition of a basic home stimulation programme.The psychosocial and developmental needs of South African children infected with HIV are complex and multifaceted. Further research is needed to establish the best possible interventions for these children and their families.

Background: Delirium superimposed on dementia (DSD) is a highly prevalent, yet difficult to recognize problem in hospitals. Delirium is a disturbance in cognition often seen in persons aged 65 and older. DSD occurs when a person living with dementia (PLWD) also develops delirium. DSD is a highly distressing experience for caregivers. Aims: This study aims to explore the experiences of caregivers of older persons with DSD in acute care hospitals; their role in the detection and management of DSD; and the type of support they require during this experience. The knowledge generated from this study can be used to identify strategies to assist caregivers during their experience, and to improve the early detection and management of DSD, with the aim to improve health outcomes for both the hospitalized older person with DSD and the caregiver. Methods: Thorne’s interpretive description method was used. In-person, semi-structured interviews were conducted with nine caregivers of older persons with DSD who were hospitalized in four medicine units. Interviews were transcribed and thematic analysis was conducted. Results: The following themes related to caregivers’ experiences were identified: (a) caregivers found DSD to be an overwhelming experience, (b) caregivers were concerned about the quality of care that the older person received, (c) caregivers’ experiences were influenced by the nature of their relationship with the health care team, and (d) caregivers can play an important role in the detection and management of DSD. Conclusion: Findings provide guidance in increasing support and building collaborative relationships between caregivers and the health care team. Recommendations on delivering caregiver-centred care to caregivers of older persons with DSD are outlined. / Thesis / Master of Science in Nursing (MSN)

No description available.

No description available.

No description available.

No description available.

No description available.