A research report submitted to the Faculty of Humanities, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Arts (Speech Pathology), 2017 / Background: The relevance and effectiveness of speech therapy interventions for children with Cerebral Palsy (CP) has come under scrutiny within the CP community. There is a need for evidence based research to be conducted within the CP population. Specifically with regard to the current speech therapy interventions that are being used for this population. There is a dearth of literature in favour of the efficacy of speech therapy interventions for the CP population. Furthermore, research within the South African context is required so as to identify the culturally specific needs of the population. In addition, South Africa faces challenges in providing culturally specific, cost effective and evidence based intervention for this population. This can be attributable to barriers such as the lack of human and financial resources. Purpose: The main aim of the study was to measure change in the use of communicative functions of nine children with cerebral palsy following a five week parent training program. The main aim was achieved with the following sub-aims; 1) To assess the participant’s baseline performance in the use of communicative functions before the commencement of the parent training, 2) To assess the participant’s performance in the use of communicative functions after the 5 week parent training had taken place, 3) To assess the participant’s performance in the use of communicative functions 3 months after the post intervention assessment and 4) To describe the effectiveness of a parent training program in improving a child with CP’s ability to make use of communicative functions. Method: The parents of nine children underwent a parent training program namely the Malamulel Onward Carer-2-Carer Training Program. The nine children were assessed before, immediately after and 3 months after the intervention. The scales, namely the Preschool Language Scale-5 and the Communication Matrix were used in the baseline assessment and reassessment phases of the study and yielded numerical data that described the children’s communication abilities. Results: All the children (n=9) demonstrated a positive increase in communication from test 1 through to test 3 on the Communication Matrix. The p-value for test 1 to test 2 was p=0.0078, test 2 to test 3 were p=0.0313 and test 1 to test 2 were p=0.0313 indicating significant change. The performance on the PLS-5 for majority (n=8) of the sample was unexpected. The majority of participants (n=7) displayed an increase in the PLS-5 score from test 1 to test 2; with one participant displaying a positive change across all three testing occasions on the PLS-5. However, a decrease in the PLS-5 score was seen in majority (n=5) of the participants from test 2 to test 3. Conclusion: Based on the findings of this research, the use of parent training appears to be a viable form of intervention to improve the use of communicative functions in children with CP. However, further steps need to be taken to incorporate an individual follow up component after the parent training to ensure carry over and maintenance of skills covered in the workshops. In addition, due to questions around the efficacy of the PLS-5 with individuals who have CP, assessments need to comprise of a standardized tool in addition to an observational tool so as to acquire a more holistic view of a child with CP’s communication skills. / XL2018

Thesis (MA)--Stellenbosch University, 2015 / ENGLISH ABSTRACT : It has been suggested that the complex needs of children with neurodevelopmental disorders are best addressed with a family-centred approach. As this approach has been increasingly incorporated into healthcare systems over recent years, most children with disabilities are now able to remain at home as opposed to living in institutions or group homes. Many parents have thus been forced to adopt the role of a primary caregiver for their child that has been diagnosed with a disability or chronic condition. This study aimed to investigate the experiences of caregivers for children with cerebral palsy in rural communities of the Western Cape, with a specific focus on the barriers and facilitators that they encounter. An exploratory qualitative design was employed and 15 individuals (aged 27-62), who were identified as caregivers for a child with cerebral palsy through purposive sampling were interviewed. Thematic analysis was used to analyse and generate themes from the semi-structured interviews that were conducted with participants. A number of barriers to caring emerged including the personal consequences of caregiving, difficulty adjusting to caregiving duties, environmental conditions, lack of access to healthcare services, lack of respite services, and negative perceptions towards disability. Various facilitators to caring were also identified, namely personal coping methods, personal transformation, social support, relationship with one’s child, community resources, child’s crèche, and financial assistance. The five levels of the Social Ecological Model were used to conceptualise the discussion of these findings and links were made to the existing literature on the caregiver experience in the developing context. In this process it was found that participants often encountered similar barriers and facilitators to caregivers for individuals with other types of conditions, such as HIV/AIDS, autism, mental illness, cancer, and neurological disorders. This could suggest that caregivers residing in developing countries share similar experiences, regardless of the condition of the care receiver. Although participants received support from a number of sources that aided them with their caregiving duties, it is evident that they still encountered gaps in the provision of a number of important services, including lack of information from healthcare professionals, lack of community programs to reduce stress and promote empowerment, and lack of disability-friendly facilities. It is vital that caregivers have access to these services to ensure their child’s well-being as well as their own. There is thus a need to explore how these services can be made more accessible to caregivers in rural communities. / AFRIKAANSE OPSOMMING : Daar word voorgestel dat die komplekse behoeftes van kinders met neuro-ontwikkelingsversteurings die beste aangespreek word deur ‘n familie-gefokusde benadering. Aangesien hierdie benadering meer geredelik geïnkorporeer is in die gesondheidsorg sisteem oor die afgelope paar jaar is meeste kinders met gestremdhede nou in staat om by die huis te kan bly in plaas daarvan om in inrigtings of groepshuise te woon. Baie ouers is dus geforseer om die rol as primêre versorger aan te neem vir hulle kind wat gediagnoseer is met ‘n gestremdheid of kroniese toestand. Hierdie studie se doel was om die ervarings van versorgers van kinders met serebrale gestremdheid in landelike gemeenskappe van die Wes-Kaap, te ondersoek, met ‘n spesifieke fokus op die hindernisse en fasiliteerders wat hulle ondervind. ‘n Ondersoekende kwalitatiewe ontwerp is gebruik en onderhoude is gevoer met 15 individue (ouderdomme 27-62) wat deur doelgerigte steekproefneming geïdentifiseer is as versorgers van ‘n kind met serebrale gestremdheid. Tematiese analise is gebruik om die semi-gestruktureerde onderhoude wat met die deelnemers gevoer is te analiseer en temas te genereer. ‘n Aantal van die hindernisse tot versorging het na vore gekom en sluit die persoonlike gevolge van versorging, probleme om aan te pas by die versorgingspligte, omgewingstoestande, tekort aan toegang tot gesondheidsorg dienste, tekort aan verligting dienste en negatiewe persepsies teenoor gestremdhede in. Verskeie fasiliteerders tot versorging is ook geïdentifiseer, naamlik persoonlike hanteringsmetodes, persoonlike transformasie, sosiale ondersteuning, verhouding met hulle kind, gemeenskapsfasiliteerders, kind se speelskool en finansiële hulp. Die vyf vlakke van die Sosiale Ekologiese Model is gebruik om die bespreking van hierdie bevindinge te konseptualiseer en verbintenisse is gemaak met bestaande literatuur wat handel oor die versorger se ervaring in die ontwikkellende konteks. In hierdie proses is gevind dat deelnemers dikwels dieselfde hindernisse en fasiliteerders ondervind as versorgers van individue met ander tipe toestande, soos MIV/VIGS, outisme, geestesiektes, kanker en neurologiese versteurings. Dit kan moontlik beteken dat versorgers wat in ontwikkellende lande woord dieselfde ervarings deel, ten spyte van die toestand van die persoon wat die versorging ontvang. Alhoewel deelnemers ondersteuning van ʼn aantal bronne ontvang het wat hulle help met hulle versorgingspligte, is dit duidelik dat hulle steeds gapings ervaar in die voorsiening van ʼn aantal belangrike dienste, insluitende ʼn tekort aan inligting van gesondheidsorg werkers, ʼn tekort aan gemeenskapsprogramme om stres verligting en bemagtiging te bevorder en ʼn tekort aan gestremdheid-vriendelike fasiliteite. Dit is baie belangrik dat versorgers toegang het tot hierdie dienste om die welstand van hulle kind en hulself te verseker. Daar is dus ʼn behoefte om te ondersoek hoe hierdie dienste meer toegangklik gemaak kan word vir versorgers in landelike gemeenskappe.

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 is a condition which affects the normal functioning of children. Most children with this condition rely on other people for the execution of basic skills on a daily basis. The study aim was to explore the experiences of caregivers for children with cerebral palsy in Vhembe District, Limpopo Province. A qualitative approach using explorative, descriptive, and contextual design was used for this study. Simple random sampling was used to sample eight caregivers. Data was collected using semi-structured in-depth individual interviews which were pre-tested in Vhembe District, using two caregivers who did not form part of the study. Data was analysed using thematic analysis approach. Credibility, dependability, conformability and transferability were upheld to ensure trustworthiness of the study. Ethical considerations were adhered to throughout the study. Two main themes emerged during data analysis, namely: positive experiences of caregivers and challenges faced by caregivers. The study recommends: development of a model to support caregivers in caring for children with cerebral palsy; and the investigation of the prevalence of back-pain amongst caregivers of children with cerebral palsy in Vhembe District. / 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