A Masters Dissertation submitted to the Department of Speech Pathology and Audiology School of Human and Community Development, Faculty of Humanities University of Witwatersrand Johannesburg, in fulfillment of the requirements for the degree Master of Arts in Speech Pathology, November 2017 / Background: Traumatic Brain Injury (TBI) is a serious public health problem worldwide. It is a major cause of death among younger adults and is a leading cause of lifelong disability in persons who survive it. There are a large number of young adults living with life-long disabilities as a result of traumatic brain injury worldwide, with higher numbers existing in South Africa. Whilst previous research internationally has examined issues of community integration and difficulties experienced by persons with traumatic brain injury and their significant others or caregivers, a paucity of research of this nature exists in South Africa. This study intended to explore whether a gap in clinical practice exists with regard to aspects of intervention and support, underpinned by an ambiguous definition of community integration for survivors of traumatic brain injury and their significant others Method: The main aim of the study was to explore existing feelings of community integration and active participation in patients with traumatic brain injury who have been discharged from rehabilitation services in private practice in Johannesburg, South Africa. In this study, the sample comprised of 10 survivors of TBI and 10 significant others (SOs). The objectives were to describe and compare participants and significant others’ or caregivers experience of community integration and factors that influenced the perceptions by each (i.e. the patient and the caregiver) as well as to document barriers and facilitators to community integration and active participation within the, familial, social and work context. Lastly the study aimed to determine if the qualitative analysis of formal assessment measures (FIM and CIQ-R) match perceptions of persons with TBI with regard to Community Integration (Landrum et al., 1995). Results: Across various areas of comparison, participants who scored higher in the CIQ-Rand FIM measures, often expressed more subtle difficulties or challenges that landed up going undetected and ultimately contributed to their personal feelings of poorer community integration. Various studies, including the current study reveal that significant others have many unmet needs in terms of what they know and what they should expect with regard to handling their loved one with a TBI. Implications: This research has highlighted the fact that our South African context is lacking with regard to ongoing management of individuals surviving TBI, with reduced funding available for outpatient therapies, a lack of post discharge programmes and a general lack of education and information given to family members of TBI survivors upon discharge. As such this should be a major focus of health care providers in the future. This research revealed many subtleties that impact perceptions of community integration but go undetected by formal measures. Such subtleties could be used to direct specialised programmes, which should be made available to TBI survivors post discharge from rehabilitation services. Keywords: traumatic brain injury; community integration; rehabilitation; functional outcomes; private practice, developing countries, community resources, south Africa / XL2018

MPH / Department of Public Health / Worldwide there are millions of children and adolescents with adisability. The United Nations Children’s Fund estimates the worldwide prevalence to be 150 million children under 18 years older, the World Health Organization also estimates that there are 93 million children with impairment. This study focused at describing the impact of rehabilitation programme for the young adult living with cerebral palsy admitted in a care centre Mopani District, South Africa. The study utilized a quantitative, descriptive cross-sectional survey method. Data was collected using an observational check list. The target population is young adults’ aged 18- 35 yearswith cerebral palsy in a Care Centre. Sampling was not necessary in this study since the targeted population was small in number. Confidentiality of respondents’ information was maintained where study subjects wereidentifiedusing codes. Data were analysed using descriptive statistics and the results of the analysis are presented in the form of tables and charts to enhance clarity. The results are presented according to the objectives. The conclusion and recommendationswere made based on the findings. The study results show that there were more females than males (ratio 3:1) and the range of age distribution was 20 to 37 years. The study also finds out that cerebral palsy condition was accompanied by other complications such as blindness, mental retardation, epilepsy and hydrocephalus. The study indicated that rehabilitation can only have minimal effects but it can improve the quality of life of the patient. With regard to communication outcome of the rehabilitation programme it indicates progress following rehabilitation between 57% and 80% could use expressive language and follow basic instructions. The study also observed that patients made a steady improvement right through from those who spent 4 to 8 years to those who had been there for long, 15 years and above. Since cerebral palsy can affect motor development as well as social development, the rehabilitation seems beneficial to focus on intervention programme on the cognitive stimulation of children and young adults with cerebral palsy. / NRF

MPH / Department of Public Health / Cerebral palsy (CP) is the common cause of physical disability in children. The nature and severity of impairments vary, but the demands placed upon mothers are significant. It is one of the prolonged conditions which have become a serious health problem worldwide. The purpose of this study was to explore and describe the challenges of mothers caring for cerebral palsy children at Thulamela Municipality, in the Vhembe District, South Africa. The objectives of this study were as follows: (1). To explore the challenges by mothers of cerebral palsy children in relation to physical, psychological and social care, (2) To explore their challenges in relation to available resources for proper referral of mothers caring for cerebral palsy children. The study used a qualitative approach using explorative and descriptive design in exploring the challenges of mothers caring for children with cerebral palsy. The study population comprised mothers of children with Cerebral Palsy living in the Vhembe District who attends the rehabilitation therapy services at Tshilidzini Hospital. A non-probability, purposive sampling technique was used to select the mothers. Five focus groups, each consisting of eight mothers were composed. Semi-structured group guide consisting of open-ended questions were used. Data was transcribed, verbatim and coded into themes and subthemes using context thematic analysis method. Themes that emerged include: a theoretical framework for the study, effects of caring on the family’s socio-economic life, challenges experienced by mothers caring for cerebral palsy children, challenges in relation to education and training and challenges experienced by mothers caring for cerebral palsy. The findings of the study might benefit the society about the challenges experienced by mothers when caring for their disabled children. The study might help government to develop and implement policies which will empower parents and the community as a whole / NRF