Thesis (MOccTher)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Introduction: This research was conducted to establish the assessment practices of occupational therapists working with clients with upper limb injuries and/or conditions. This was done to get an updated account of frequency and variation in the use of various assessment tools as well as reasons offered for infrequent use. Methodology: A quantitative cross-sectional survey design was used. A convenience sample of therapists attending courses was recruited for the study. A questionnaire was developed for the study and face and content validity established through pilot testing. The questionnaire consisted of three sections containing demographic information and questions about upper limb assessment practices. Descriptive statistics were calculated for numerical and categorical data to describe the demographic characteristics and to identify the measurement tools that were used most frequently. The Chi-Square test of associations was used to determine whether there were any associations between frequency of use and demographic factors. Results: Questionnaires were completed by 81 (71%) respondents. Twenty-two (27.2%) of the respondents had more than five years’ experience in the field of hand therapy while the remainder (n=52, 64.2%) had less than five years. The more experienced therapists worked in the private sector (n=49, 60.5%) with two (0.03%) experienced therapists being employed in the public sector. The diagnoses that were seen most commonly were nerve injuries (90.1%), fractures (88.8%) and tendon injuries (85.1%). Of the 81 respondents 15 (18.5%) held post graduate qualifications in the field of hand therapy. Goniometry (68 of 81, 84.0%), manual muscle testing (62 of 81, 76.5%) and testing for flexor digitorum profundus and superficialis function (61 of 81, 76.3%) were used most frequently. Performance tests were used infrequently or not at all. The most common reasons for non-use of performance tests were that they were not available in the practice setting or respondents were not familiar with them. Significant associations were found between frequency of using measurement tools and practice setting, years of experience and holding a post graduate qualification in the field of hand therapy. There was a significant association between working in the private sector and using a dynamometer (p < 0.001), and working in government settings and frequent use of the test for localisation (p = 0.021). Therapists with more than five years’ experience in the field of hand therapy were significantly more likely to use Semmes Weinstein monofilaments (p = 0.034) as were those holding a post graduate qualification in hand therapy (p <0.001). Conclusion: The results of this study have serious implications in terms of the upper limb assessment practices of occupational therapists, especially in the context of evidence-based practice which has become crucial not only for the credibility of the profession, but also for its survival. Information obtained through this research could aid to guide education and training at an undergraduate and post graduate level and assist to direct a research focus for hand therapy in the South African context. / AFRIKAANSE OPSOMMING: Inleiding: Hierdie navorsing is uitgevoer om die bepalingspraktyke van arbeidsterapeute wat werk met kliënte met boonste ledemaat beserings en/of toestande vas te stel om sodoende ‘n beeld te verkry van die frekwensie en variasie van die gebruik van bepalingsinstrumente. Redes aangebied vir ongereelde gebruik hiervan is ook ondersoek. Metode: 'n Kwantitatiewe deursnee-opname-ontwerp is gebruik. ’n Gerieflikheidssteekproef van terapeute wat kursusse bygewoon het, is gewerf vir die studie. ‘n Vraelys is ontwikkel vir die studie, en voorkoms- en inhoudsgeldigheid is bepaal deur ‘n loodstudie. Die vraelys het bestaan uit drie afdelings met demografiese inligting en vrae oor boonste ledemaat bepalingspraktyke. Beskrywende statistiek is bereken vir numeriese en kategoriese data ten einde die demografiese eienskappe te beskryf en die bepalingsmetodes wat die meeste gebruik is, te identifiseer. Die Chi-kwadraat toets is gebruik om te bepaal of daar enige assosiasies tussen die frekwensie van gebruik en demografiese faktore bestaan. Resultate: Vraelyste is deur 81 (71%) respondente voltooi. Twee-en-twintig (27,2%) van die respondente het meer as vyf jaar ondervinding in die veld van handterapie gehad, terwyl die res (n = 52, 64.2%) minder as vyf jaar gehad het. Die meer ervare terapeute het gewerk in die privaatsektor (n = 49, 60.5%) met twee (0,03%) ervare terapeute in diens van die staat. Senuweebeserings (90.1%), frakture (88,8%) en tendonbeserings (85.1%) was die meeste gesien. Van die 81 respondente het 15 (18,5%) ‘n nagraadse kwalifikasie in die veld van handterapie gehad. Goniometer (68 van 81, 84.0%), spiertoetsing (62 van 81, 76,5%) en die toetse vir fleksor digitorum profundus en superficialis funksie (61 van 81, 76,3%) is die meeste gebruik. Vaardigheidstoetse is selde of glad nie gebruik nie. Die mees algemene redes aangevoer vir die feit dat vaardigheidstoetse nie gebruik is nie, was dat dit óf nie beskikbaar is in die respondent se werksarea nie, óf dat respondente nie vertroud is met die toetse nie. Beduidende assosiasies is gevind tussen die frekwensie van die gebruik van bepalingsmetodes en werksarea, jare ervaring in handterapie en 'n nagraadse kwalifikasie in die veld van die handterapie. Daar was 'n beduidende assosiasie tussen terapeute werksaam in privaatpraktyk en die gebruik van 'n dinamometer (p < 0,001) en terapeute werksaam in die staat en gereelde gebruik van die lokalisasie toets (p = 0.021). Terapeute met meer as vyf jaar ondervinding, sowel as diegene met ’n nagraadse kwalifikasie in handterapie was beduidend meer geneig om Semmes Weinstein monofilaments te gebruik (p = 0,034 en p < 0,001 respektiewelik). Gevolgtrekking : Die bevindinge van hierdie studie het ernstige implikasies in terme van die arbeidsterapie bepalingspraktyke van die boonste ledemaat, veral in die konteks van bewys-gebaseerde praktykvoering (evidence based practice) wat noodsaaklik geword het nie net vir die geloofwaardigheid van die beroep nie, maar ook vir die oorlewing daarvan. Inligting wat verkry is deur middel van hierdie navorsing kan help met onderrig en opleiding op 'n voor-en nagraadse vlak. Dit kan ook help om navorsing in handterapie te rig binne die Suid- Afrikaanse konteks.

Thesis (MOccTher (Interdisciplinary Health Sciences. Occupational Therapy))--University of Stellenbosch, 2010. / AFRIKAANSE OPSOMMING: AGTERGROND Dit is bekend dat vroeggebore babas met ʼn baie lae geboortemassa ʼn hoër insidensie van ontwikkelings-, gedrags- en mediese agterstande en verskeie leerprobleme toon teen die tyd dat hulle skoolgaande ouderdom bereik. Kommer bestaan ook oor die omgewingseffek van die neonatale intensiewe sorgeenheid op die sensoriese ontwikkeling van die vroeggebore baba en hoe dit tot bogenoemde agterstande kan bydra. Daar is verskillende benaderings wat daarop aanspraak maak dat hulle die probleem kan oplos, met kangaroemoedersorg (‘kangaroo mother care’) en ontwikkelingsorg (‘developmental care’) wat in die literatuur uitgesonder is as besonders belowend. Met die aanvang van hierdie studie was daar nog geen empiriese studies in die literatuur gerapporteer wat enige aansprake van hierdie benaderings bevestig het nie. Daar was dus ʼn behoefte vir ʼn empiries-nagevorsde program wat prakties in die neonatale intensiewe eenheid toegepas kon word met die oog op die vermindering van omgewingstressors ten opsigte van die vroeggebore baba se sensoriese sisteme. DOEL Die doel met die studie was om die invloed te bepaal van ʼn Sensoriese Ontwikkelingsorgprogram (‘Sensory Developmental Care Programme’), wat ʼn spesifieke kangaroemoedersorg- protokol insluit, op die sensoriese ontwikkeling van die vroeggebore baba met 'ʼn baie lae geboortemassa tot en met die ouderdom van 18 maande (gekorrigeerde ouderdom). METODOLOGIE ʼn Ewekansig-gekontroleerde studie is uitgevoer. Die studiesteekproef het bestaan uit 89 vroeggebore babas met ʼn baie lae geboortemassa wat in ʼn periode van 24 maande toegelaat is tot die neonatale eenheid van Tygerberg Hospitaal in Kaapstad, Suid-Afrika. Die babas is gewerf op grond van sekere kriteria en is dan daarna ewekansig aan een van twee groepe toegeken: 1) die intervensiegroep het sorg ontvang volgens die Sensoriese Ontwikkelingsorgprogram vir 10 dae; en 2) die kontrolegroep het ook vir 10 dae die standaardsorg van die eenheid ontvang. Die intervensiegroep het uit 45 babas bestaan, van wie 22 die studie voltooi het, terwyl die kontrolegroep uit 44 babas bestaan het van wie 20 die studie voltooi het. Beide studiegroepe is opgevolg op 6, 12 en 18 maande (gekorrigeerde ouderdom), by welke geleentheid die Sensoriese Funksietoets vir Babas (‘Test of Sensory Functions in Infants’) telkens toegepas is vir die assessering van sensoriese ontwikkeling. Op 18 maande (gekorrigeerde ouderdom) is ʼn assessering met die Griffiths Ontwikkelingskaal ook gedoen om funksies in die ander ontwikkelingsareas van die babas te bepaal. Toetsresultate is geanaliseer met behulp van herhaalde ANOVAmetings en die Bonferoni t-prosedure om die effek van die Sensoriese Ontwikkelingsorgprogram op die sensoriese ontwikkeling van die babas tot en met 18 maande (gekorrigeerde ouderdom) te bepaal. RESULTATE Die resultate van die vergelyking van die prestasie van beide groepe (groep-effek), gemeet met behulp van die Sensoriese Funksietoets vir Babas, is van groot belang vir hierdie studie. Die intervensiegroep het betekenisvol verskil op die totale telling (p<0.00), sowel as op die volgende vier van die vyf subtoets-tellings: respons op diepdruk (‘tactile deep pressure’) (p<0.03); motoriese aanpassingsreaksies (p<0.03); visuele tas-integrasie (p<0.00); en respons op vestibulêre stimulasie (p<0.01). GEVOLGTREKKING Die resultate van die studie dui aan dat die babas in die intervensiegroep baat gevind het by die Sensoriese Ontwikkelingsorgprogram met betrekking tot hul sensoriese funksies tot en met die ouderdom van 18 maande (gekorrigeerde ouderdom). Die Sensoriese Ontwikkelingsorgprogram het geblyk prakties sowel as suksesvol te wees met betrekking tot sy doel. Die Program sou daarom met vrug in ander neonatale intensiewe sorgeenhede aangewend kon word. / ENGLISH ABSTRACT: BACKGROUND Premature infants of very low birth weight are known to be inclined to developmental, medical, behavioural and various learning deficiencies by the time they reach schoolgoing age. Concerns have been raised about the effect of the neonatal intensive care unit environment on the sensory development of the premature infant and how this could contribute to these deficiencies. Various approaches claim to address this problem, of which kangaroo mother care and developmental care have in the literature been singled out as particularly promising. However, at the commencement of this study no empirical studies had been reported in the literature to confirm any of the claims of these approaches. Therefore, a need existed for an empirically researched programme that could be practically applied in the neonatal intensive care unit with a view to reducing environmental stressors regarding the sensory systems of the premature infant. AIM The aim of this study was to determine the influence of a Sensory Developmental Care Programme, which incorporated a specific kangaroo mother care protocol, on the sensory development of the very low birth weight premature infant, up to the age of 18 months (corrected age). METHODOLOGY A randomised controlled study was conducted. The study sample consisted of 89 very low birth weight premature infants, admitted during a 24-month period to the neonatal care unit at Tygerberg Hospital in Cape Town, South Africa. The infants were recruited by means of certain criteria and then randomly assigned to one of two groups: 1) the intervention group was cared for according to the Sensory Developmental Care Programme for ten recorded days; and 2) the control group that received the standard care of the unit, also for ten days. The intervention group consisted of 45 infants of whom 22 completed the study, while the control group consisted of 44 infants of whom 20 completed the study. Both study groups were followed up at six, 12 and 18 months (corrected age) when the Test of Sensory Functions in Infants was used to do a sensory developmental assessment. At 18 months (corrected age) a Griffiths Developmental Scale assessment was also conducted to determine function in other areas of development. Test results were analysed using repeated measures of ANOVA, and the Bonferoni t procedure to determine the effect that the Sensory Developmental Care Programme had on the sensory development of the infant up to 18 months (corrected age). RESULTS The results of the comparison of the performance of both groups (group effect), measured by the Test of Sensory Functions in Infants are of great importance to this study. The intervention group had a significant difference on the total score (p<0.00), as well as on the following four of the five sub-tests scores: reactivity to tactile deep pressure (p<0.03); adaptive motor functions (p<0.03); visual-tactile integration (p<0.00); and reactivity to vestibular stimulation (p<0.01). CONCLUSION The results of this study signify that the infants in the intervention group benefited from the Sensory Developmental Care Programme concerning their sensory functions up to the age of 18 months (corrected age). The Sensory Developmental Care Programme was demonstrated to be both practical and successful in terms of its aims. The Programme could therefore be fruitfully utilised in other neonatal intensive care units.

Thesis (MA)--Stellenbosch University, 2005. / ENGLISH ABSTRACT: Acknowledgement of the right to equal work opportunities for people with disabilities is widely supported in South Africa. Several policy documents and laws have been published since July 1993 and provide clear guidelines regarding equal opportunities for people with disabilities. A state subsidy scheme for protective workshops was introduced for the first time on 1 April 1997 (Operational Manual for Protective Workshops, 2001: 1). The purpose of this subsidy scheme was to provide work opportunities for people who cannot enter the sheltered or open labour market due to the effect of their disabilities on their daily functioning. In March 2001, the Department of Social Development and Poverty Alleviation in the Western Cape introduced a draft document, Operational Manual for Protective Workshops. The aim of the manual focused on the development of the worker role and economic empowerment of people with disabilities who work in protective workshops. Due to ignorance, fear and stereotyping, persons with intellectual impairment are being unfairly discriminated against in society and at the workplace. With reasonable accommodation, persons with intellectual impairment are able to demonstrate their work ability and contribute equally in the workplace. Persons with intellectual impairment contribute to the economy and society by means of their service in protective workshops. The aim of the study was to investigate whether the structured activity programme implemented in a protective workshop in the Western Cape brought a change to the level of cognitive functioning of workers with intellectual impairment as assessed by the Allen Cognitive Level Screen (ACLS), with the purpose of making recommendations regarding the sustainability and extension of the structured activity programme. Pre- and post-tests of the workers' cognitive functioning were done to determine whether the implemented structured activity programme had an effect on the cognitive functioning level of the workers. The ACLS was used as measurement instrument and a hypothesis was stated: HO - There is no change in the level of cognitive functioning of the workers after participation in a structured activity programme. H1 - There is a change in the level of cognitive functioning of the workers after participation in a structured activity programme. The Functional Information Processing Model (FIPM) was used as a frame of reference in the development of the structured activity programme for the occupational group. The structured activity programme was implemented and after one year and six months a post-test was done on the workers in the occupational group. The null hypothesis was accepted as p=O.28.A 95% confidence interval was indicated. The post-test indicated that there was no significant change in the cognitive levels of the workers in the occupational group after implementation of a structured activity programme. This could have resulted from the study sample being too small. Although the change was not statistically significant. it indicated that learning did occur on an Allen Cognitive Level (ACL) 3. It is recommended that the study to be replicated at other protective workshops that may provide a bigger sample to confirm the amount of learning that takes place. / AFRIKAANSE OPSOMMING: Erkenning van persone met gestremdhede se gelyke reg tot indiensneming word sterk in Suid-Afrika ondersteun. Verskeie beleidsdokumente en werkstukke is sedert Julie 1993 gepubliseer wat duidelike riglyne aangaande hierdie standpunt stel. 'n Staatsubsidieskema vir beskermde werkwinkels is vanaf 1 April 1997 vir die eerste keer beskikbaar gestel (Operational Manual for Protective Workshops, 2001: 1). Die doel van hierdie skema is om werksgeleenthede te verskaf aan persone wat as gevolg van hul graad van gestremdheid nie die beskutte arbeids- of ope arbeidsmark kan betree nie. In Maart 2001 het die Departement van Sosiale Dienste, Wes-Kaap, 'n voorlopige dokument, Operational Manual for Protective Workshops, bekendgestel, wat fokus op die ontwikkeling van werksvaardighede en die ekonomiese bemagtiging van persone met gestremdhede in beskermde werkwinkels. Weens onkunde, vrees en stereotipering word daar onregverdig gediskrimineer teen persone met intellektuele gestremdheid in die samelewing, asook in die werksplek. lndien persone met intellektuele gestremdheid billik geakkommodeer word, sal hulle hul werkvermoëns demonstreer en sal hulle 'n gelyke bydrae kan lewer in die werksplek. Persone met intellektuele gestremdheid lewer 'n bydrae tot die ekonomie en die samelewing deur hul diens in beskermde werkwinkels. Die doel van die studie was om ondersoek in te stelof die gestruktureerde aktiwiteitsprogram, soos aangebied in 'n beskermde werkswinkel in die Wes-Kaap, 'n verandering in die kognitiewe funksioneringsvlakke van werkers met intellektuele gestremdheid, soos bepaal deur die Allen Cognitive Level Screen (ACLS), teweeggebring het ten einde aanbevelings te maak oor die uitbreiding en volhoubaarheid van die program. Voor- en na-toetse van die werkers se kognitiewe funksioneringsvlakke is gedoen om te bepaal of die gestruktureerde aktiwiteitsprogram enige verskil in hul kognitiewe funksionering gemaak het. Die Allen Cognitive Level Screen- (ACLS-)toets is as 'n meetinstrument gebruik en 'n hipotese is gestel: HO - Daar is geen verandering in die werkers se kognitiewe funksioneringsvlak na deelname aan 'n gestruktureerde aktiwiteitsprogram nie. H1 - Daar is 'n verandering in die werkers se kognitiewe funksioneringsvlak na deelname aan 'n gestruktureerde aktiwiteitsprogram. Die Functional Information Processing Model (FIPM) is gebruik as 'n verwysingsraamwerk vir die ontwikkeling van die gestruktureerde aktiwiteitsprogram. Die gestruktureerde aktiwiteitsprogram is geïmplementeer en 'n na-toets is na 'n jaar en ses maande op die werkers in die gestruktureerde aktiwiteitsprogram gedoen. Die nulhipotese is aanvaar aangesien p=O.28. 'n Sekerheidsinterval van 95% is aangetoon. Die na-toets het getoon dat daar geen statisties beduidende verskil was in die verandering van die kognitiewe vlakke van die werkers in die aktiwiteitsgroep na implementering van 'n gestruktureerde aktiwiteitsprogram nie. Die resultaat kan die gevolg wees van 'n te klein steekproef. Alhoewel die verandering in kognitiewe vlak nie statisties beduidend was nie, het daar tog 'n mate van leer op 'n Allen Cognitive Level (ACL) 3 by die werkers plaasgevind. Dit word voorgestel dat hierdie studie herhaal word by ander beskermde werkswinkels wat 'n groter steekproef kan lewer om die mate van leer wat plaasvind, te bevestig.

Thesis (MOccTher)-- University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Malingering, the intentional simulation or exaggeration of symptoms for secondary gain, has a significant financial impact on disability insurance given its prevalence. Multidisciplinary professionals involved in disability determination therefore require a tool which would assist in the screening of suspected malingerers. AIM: The Credibility Assessment Tool (CAT), a tool which was developed as part of the Performance APGAR, was reviewed in terms of its validity and application to the screening of malingering. Research objectives included the review of face and content validity through a literature review and concept analysis, as well as the review of construct and concurrent validity by comparing the results with the operationalised malingering construct and available malingering protocols. The adapted Slick criteria as proposed by Aronoff, applicable to chronic pain, neurocognitive, neurological and psychiatric symptoms, was identified as the most suitable criterion standard for use of comparison. DESIGN: The research design was a descriptive analytical design, which was performed retrospectively with a report review from insurance referrals to the researcher. Informed consent was obtained from insurers who legally own the reports. A saturated sample of convenience of 184 cases with depression and pain as predominant symptoms were analysed. Recall bias were minimised through omission of personal identifiers and the use of a peer check of 20 random cases. Results in the peer check were suggestive of poor inter-rater reliability, rather than recall bias. METHOD: Cases were analysed according to the guidelines from the respective authors of the CAT and adapted Slick criteria, however this was further defined to ensure that the study could be replicated. RESULTS: Face validity was adequate in terms of purpose, item selection and association between consistency criteria, however require improvement in terms of standardised instruction and weighting of the scale. Content validity was rated as adequate to excellent, given that it supports criteria linked to the malingering construct. Construct validity was adequate as demonstrated by association between concepts obtained through concept analysis. Correlation between the CAT and adapted Slick was strong (r>0.5) however caution is expressed that this requires further research. CONCLUSION: Recommendations for further research included the review of content validity with subject experts, criterion and predictive valid through a case-control study of known-groups, as well as the reliability of the CAT, and the use of specialised ADL indices for malingering detection. Adaptation to the CAT was depicted in the proposed Consistency Assessment Tool. / AFRIKAANSE OPSOMMING: Malingering, die opsetlike nabootsing of oordrywing van simptome vir sekondêre gewin, het ‘n beduidende finansiële impak op ongeskiktheidsversekering as gevolg van die prevalensie daarvan. Multidissiplinêre professionele persone betrokke by ongeskiktheidsevaluasies het daarom ‘n meetinstrument nodig om moontlike malingeerders te identifiseer. DOEL: Die Credibility Assessment Tool (CAT), wat ontwikkel was as deel van die Performance APGAR, was ondersoek in terme van geldigheid en toepassing op malingering. Navorsingsdoelwitte het die ondersoek van voorkoms- en inhoudsgeldigheid deur ‘n literatuurstudie en konsep analise behels, sowel as konstruk- en korrelasie geldigheid deur die vergelyking van die resultate met beskikbare malingering protokolle en operasionele konstrukte. Die aangepaste Slick kriteria soos voorgestel deur Aronoff, wat toepaslik is op kroniese pyn, neurokognitiewe, neurologiese en psigiatriese simptome, was ge-identifiseer as die meeste gepaste kriterium standaard vir vergelyking. ONTWERP: Die studieontwerp was ‘n beskrywende analitiese studie wat retrospektief uitgevoer was deur ‘n ondersoek van verslae van versekeraars. Ingeligte toestemming was verkry van versekeraars wat die wetlike eienaars van die verslae is. ‘n Gerieflikheidsteekproef van 184 gevalle met depressie en pyn as hoof simptome was geanaliseer. Sydighede was verminder deur persoonlike inligting te verwyder en die gebruik van ‘n eweknie evaluasie van 20 ewekansige getrekte gevalle. Voorlopige resultate dui onbevredigende betroubaarheid aan, eerder as sydighede. METODE: Gevalle was ge-evalueer volgends die riglyne van die verskeie outeure van die CAT en aangepaste Slick kriteria, en was sodanig verder gedefinieer om te verseker dat die studie herhaal kan word. RESULTATE: Voorkomsgeldigheid was voldoende, maar verbetering is aanbeveel in terme van gestandardiseerde instruksie en skaal verdeling. Inhoudsgeldigheid was beduidend in vergelyking met die wetenskaplike literatuur en die geoperasionaliseerde konstrukte. Konstrukgeldigheid was bevestig deur die positiewe verhoudings tussen die aangepaste Slick en CAT kriteria. ‘n Sterk korrelasie was gevind tussen die aangepaste Slick en CAT, maar hierdie moet versigtig geinterpreteer word aangesien verdere navorsing verlang word. GEVOLGTREKKING: Aanbevelings vir verdere navorsing sluit in die ondersoek van die inhoudsgeldigheid met eksperte, kriterium- en voorspellingsgeldigheid, sowel as die betroubaarheid van die CAT en die gebruik van gespesialiseerde ADL indekse vir uitkenning van malingering. Aanpassing vir die CAT word ook voorgestel.

Thesis (MOccTher)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Heideveld, a suburb that forms part of the “Cape Flats”, is plagued by high levels of crime, gangsterism, unemployment and relative poverty. I became specifically interested in the occupations of the young men in Heideveld, as I often observed them loitering in the streets, at an age when they should have been in school, studying or starting a career. This led me to wonder about the repertoire of occupations that they had performed over the course of their lives, i.e. their occupational-life-trajectories. I became interested in the influence that the environment and their personal attributes had on the occupations that they performed over time. Guided by the Person-Environment-Occupation model as a conceptual tool I decided to explore the occupational-life-trajectories of men between the ages of 20 and 25 throughout the course of their life, up to their current age. At the organisation where I volunteered during my time in Heideveld, there was a weekly programme for the children and young women (aged 12 to 22), but nothing for young men, which prompted my interest in doing research about this age group. My initial thinking was to form the theoretical basis from which an occupation-based intervention group could be developed. I intended to explore what had motivated occupational participation throughout their lives, how certain occupations developed over time and the influence of the environment on their occupations. Snowball sampling was applied to gain access to the participants. Using a qualitative approach I combined a method called PhotoVoice with individual, narrative interviews, in order to collect data on the occupational-life-trajectories of five young men from Heideveld. PhotoVoice is a participant-based method that allowed the interviewees to take photos of occupations that they have performed throughout their lives. The photographs were used to facilitate the interview process along with two or three guiding questions. Within-case and cross-case analysis were used to find themes that pertained to the aims of the study. I uncovered five themes in my analysis: “Ons gee nie krag weg nie/We don’t give away power”, “Ons het saam geloop/We ‘hang out’ together”, “Ek het baie probleme by die huis gehet/I had many problems at home”, “Die lewe is swaar hier buite/Life is hard out here” and “Ek wil net uit hierdie plek kom/I just want to get away from this place”. I found that the environment played a large role in the occupational-life-trajectories of the participants. I also found that the participants’ sense of masculinity, gender and identity affected their occupational choices and participation. I explain the peer nature and motivational factors influencing gangsterism and drug use as they manifested in the young men’s lives. I concluded that an occupation-based intervention programme might address certain aspects such as occupational choice and exposure, but that wider, more long-lasting intervention was necessary to truly make a difference in the occupational-life-trajectories of young men in Heideveld. After taking the support structures in the physical environment into consideration, recommendations were made in terms of the family unit, the peer group, education, skills training and community empowerment. Furthermore, as the organisation already serves boys between 10 and 14 years and a greater impact may be possible at this life stage, more detailed recommendations were developed regarding a possible occupational therapy intervention programme. / AFRIKAANSE OPSOMMING: Heideveld, ‘n voorstad wat deel vorm van die Kaapse Vlaktes, gaan gebuk onder hoë vlakke van misdaad, bende bedrywighede, werkloosheid en relatiewe armoede. Ek het ‘n spesifieke belangstelling ontwikkel in die “occupations”¹ van die jong mans in Heideveld, omdat ek dikwels waargeneem het dat hulle in the strate drentel, op’n ouderdom wat hulle op skool moes gewees het, besig om te studeer, of om ‘n loopbaan to begin. Dit het my laat wonder oor die verskillende “occupations” waaraan hulle deelneem gedurende hulle lewens, m.a.w. hulle “occupational-life-trajectories²”. Ek was geïnteresseerd oor die invloed wat die omgewing en hulle persoonlike eienskappe gehad het op die “occupations” waarin hulle oor ‘n tydperk deelgeneem het. Gelei deur die “Person-Environment-Occupation” model as ‘n konseptuele instrument, het ek besluit om die “occupational-life-trajectories” van mans tussen die ouderdomme van 20 en 25, gedurende die tydperk van hulle lewens tot en met hul huidige ouderdomme, te bestudeer. By die organisasie waar ek ‘n vrywilliger was gedurende my tyd in Heideveld, was daar ‘n weeklikse program vir kinders en jonger vrouens (vanaf ouderdom 12 tot 22), maar niks vir jong mans nie. Dit het gelei tot my belangstelling om navorsing omtrent hierdie ouderdomsgroep te doen. My aanvanklike gedagtes was om ‘n teoretiese basis te vorm waarvandaan ‘n “occupation”-gebaseerde intervensie-program ontwikkel kon word. Ek wou die motivering agter die jong mans se “occupational”-deelname, hoe sekere “occupations” oor tyd ontiwkkel en die invloed van die omgewing op hul “occupations” verken. Sneeubalsteekproeftrekking is gebruik om toegang tot die deelnemers te kry. Deur ‘n kwalitatiewe benadering te gebruik, het ek ‘n metode genaamd “PhotoVoice” met individuele, narratiewe onderhoude gekombineer, om data te versamel omtrent die “occupational-life-trajectories” van vyf jong mans in Heideveld. “PhotoVoice” is ‘n deelnemer-gebaseerde metode wat die deelnemer toegelaat het om foto’s van die “occupations” waaraan hulle gedurende hulle lewens deelgeneem het, af te neem. Die foto’s is gebruik om die onderhoude te fasiliteer tesame met twee of drie gerigte vrae. Tussen-geval en kruis-geval analise is gebruik om temas te vind wat die doelwitte van die studie aanspreek. Ek het vyf temas ge-identifiseer gedurende my analise: “Ons gee nie krag weg nie/We don’t give away power”, “Ons het saam geloop/We ‘hang out’ together”, “Ek het baie probleme by die huis gehet/I had many problems at home”, “Die lewe is swaar hier buite/Life is hard out here” en “Ek wil net uit hierdie plek kom/I just want to get away from this place”. Ek het gevind dat die omgewing ‘n groot rol speel in die deelnemers se “occupational-life-trajectories”. Ek het ook gevind dat die deelnemers se sin van manlikheid, geslag en identiteit hul “occupational” keuses en deelname geaffekteer het. Ek verduidelik ook die portuur natuur en motiverende faktore wat lei tot bende-aktiwiteite en dwelm gebruik, soos dit in die jong mans se lewens gemanifesteer het. Ek het afgelei dat ‘n “occupation” gebaseerde intervensie program moontlik sekere aspekte soos “occupational” keuses en -blootstelling kan affekteer, maar ‘n breër, langduriger intervensie is nodig om werklik ‘n verskil te maak in die “occupational-life-trajectories” van jong mans in Heideveld. Nadat ek die ondersteunende strukture in die fisiese omgewing inaggeneem het, het ek voorstelle gemaak in terme van die familie-eenheid, die portuur groep, onderrig, vaardigheidsopleiding en bemagtiging van die gemeenskap. Aangesien die organisasie reeds toegang het tot seuns tussen 10 en 14 jaar oud, en ‘n groter impak in hierdie lewenstydperk gemaak kan word, maak ek verdere, meer gedetailleerde voorstelle rondom ‘n arbeidsterapie program vir hierdie ouderdomsgroep.

Thesis (MPhil)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: The development of professional behaviour is one of the core components of occupational therapy education. The assessment of professional behaviour poses a problem as the constructs and expectations are not clearly defined; this results in compromised inter-rater reliability. The purpose of the study was to investigate assessors’ understanding of the constructs and the expectations deployed during the assessment of professional behaviour of third and fourth year occupational therapy students during clinical practice. A case study design was used in the qualitative study. Clinical supervisors were involved in: (1) a focus group interview to scrutinise the usefulness of the current assessment instrument and (2) a participatory discussion to determine their understanding of the constructs of professional behaviour and the level of expectations to be set for third and fourth year students respectively. This study confirms that the development of effective assessment of professional behaviour entails a number of pivotal steps that include developing a shared definition of the constructs thereof and the expectations at different levels of undergraduate training, the refinement of the assessment instrument and training of assessors in the use of this assessment instrument. / AFRIKAANSE OPSOMMING: Die ontwikkeling van professionele gedrag is een van die kern komponente in arbeidsterapie opleiding. Die assessering daarvan bied egter uitdagings aangesien die konstrukte en verwagtings nie duidelik gedefinieer is nie; dit het gekompromiteerde geldigheid en betroubaarheid tot gevolg aangesien verskillende assessore die professionele gedrag van studente verskillend assesseer. Hierdie studie het die ondersoek van kliniese toesighouers se begrip van die konstrukte en hul verwagtings tydens die assessering van professionele gedrag van derde- en vierdejaar arbeidsterapiestudente tydens kliniese prakties ten doel gehad. ‘n Gevallestudie ontwerp het die basis van ‘n kwalitatiewe ondersoek gevorm. Kliniese toesighouers is betrek in: (1) ‘n fokusgroeponderhoud om die bruikbaarheid en gebruikersvriendelikheid van die huidige assesseringsinstrument te bepaal; en (2) ‘n deelnemende groepbespreking om hul begrip van die konstrukte van professionele gedrag en die verwagte vlakke van funksionering vir onderskeidelik derde- en vierdejaar studente te ondersoek. Hierdie studie bevestig dat die ontwikkeling van effektiewe assessering van professionele gedrag ‘n aantal essensiële stappe behels. Hierdie stappe sluit die ontwikkeling van ‘n gedeelde definisie van die konstrukte en verwagtinge van professionele gedrag in, asook die verskil in verwagtinge op die onderskeie vlakke van voorgraadse opleiding, die verfyning van die bestaande assesseringsinstrument en die opleiding van assessore in die gebruik daarvan.

Thesis (MPhil )-- Stellenbosch University, 2012. / ENGLISH ABSTRACT: Fieldwork is an essential part of the occupational therapy student’s education, and optimal learning is dependent on effective facilitation by a clinical Occupational Therapist. This study explored the lived experience of the clinical Occupational Therapists in their role as clinical educators by means of a phenomenological inquiry. Ten semi-structured interviews were conducted with clinical Occupational Therapists involved in clinical education. The data was analysed by using thematic content analysis, and was discussed according to the Lived Experience of a Clinical Educator Model. The results indicated that the clinical OTs’ sense of self, which revealed strong humanistic values, acted as the core element influencing the way in which they related to others and were able to juggle many roles in order to perform their role as clinical educator. It furthermore influenced the ways in which they managed balance and harmony in the workplace, as well as the process of growth and development. Incongruence during the performance of their roles as clinical educators was mainly caused by insufficient collaboration between the clinical educators and the university, the prescriptive nature of the fieldwork curriculum, workload pressures, the students’ attitudes and their lack of knowledge, as well as insufficient training of new clinical educators. The results may be helpful in fostering a collaborative relationship between the university and the clinical Occupational Therapists, as well as renewed attention to growth and development, all of which will benefit the students’ education. / AFRIKAANSE OPSOMMING: Kliniese werk vorm ‘n essensiële deel van die arbeidsterapie-student se opleiding en dit is noodsaaklik dat die leerproses effektief gefasiliteer word deur ‘n bekwame kliniese Arbeidsterapeut. Hierdie studie het die Arbeidsterapeute se belewing van hul rol as kliniese opvoeders nagevors deur middel van ‘n fenomenologiese ondersoek. Tien semigestruktureerde onderhoude is met kliniese Arbeidsterapeute, tans betrokke by kliniese opleiding, gevoer. Die data is verwerk deur middel van tematiese inhouds-analise en is bespreek aan die hand van die Lived Experience of a Clinical Educator Model. Die resultate het aangedui dat die kliniese terapeute se bewustheid van hulself (‘sense of self’) die kern element vorm wat hul verhoudings, sowel as die wyse waarop hulle al hul onderskeie rolle en take behartig, beïnvloed. Sterk humanistiese waardes kom voor in hierdie kern element. Dit is verder bepalend in die wyse waarop die Arbeidsterapeute balans en harmonie in hul werkplek verseker, sowel as hul professionele groei en ontwikkeling. Inkongruensie tydens die rolvervulling word veroorsaak deur onvoldoende samewerking tussen die universiteit en kliniese opvoeders, ‘n voorskriftelike kurrikulum, werksdruk, studente se negatiewe houding en gebrek aan kennis, sowel as onvoldoende opleiding van die terapeute wat nuut begin met kliniese opleiding. Die resultate mag in die toekoms behulpsaam wees in die totstandkoming van ‘n samewerkende verhouding tussen die universiteit en kliniese terapeute, met genoegsame aandag wat geskenk word aan professionele groei en onwikkeling. Dit kan tot voordeel van die studente se leerproses aangewend word.

Thesis (MOccTher)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Participation in meaningful occupations is what defines us as human beings and is an important indicator of health and well-being. It is the way we experience the world around us and is closely linked to quality of life. As an occupational therapist at a school for learners with special educational needs, the researcher was interested in how young adults with a diagnosis of Cerebral Palsy (CP) who attended this school, experience their participation or the lack thereof in occupations and if it contributes to meaning and fulfilment in their lives? She established through informal conversation with some of these young adults or their parents, that they experience unemployment, unhappiness and poor integration within the community. The aim of this study was therefore to describe how young adults living with CP in economically disadvantaged communities within the Western Cape, experience the quality of their participation in meaningful occupations. A qualitative phenomenological study design was used, enabling the researcher to explore the value and meaning participants attach to different occupations, the participants perceptions of their experience and the factors impacting on their participation. The study population was young adults between the ages of 18-28 years with a diagnosis of CP, who attended the previously mentioned school and who exited school over the duration of the past nine years. The researcher used purposive maximum variation sampling, to ensure variation in terms of diagnosis, living arrangements, employment and marital status. Data collection took the form of ten face-to-face semi-structured individual interviews and inductive content analysis was utilized to analyse data. The following four themes emerged from the data: overcoming challenges; having equal opportunities; barriers holding me back and the future is mine to shape. These young adults participated in a variety of meaningful occupations and have learned to utilize various strategies to overcome the difficulties they faced in this process. The following factors influenced their participation positively: having meaningful relationships; accepting their disability and nurturing a positive attitude; being proud of their achievements; positive work experiences and involvement in the community. Factors contributing to these young adults not experiencing meaningful participation were the following: their perception of themselves and also how they perceived being treated by others; non-acceptance of their physical circumstances and disability; incompetence and poor self-confidence; termination of previously meaningful occupations; challenges with interpersonal relationships and unsatisfactory work experiences. The need to be as independent as possible was of utmost importance to all these young adults, as it was an indicator of being in control of their own lives. Given the above information, the researcher recommends a transition preparation program for senior phase learners that will include sessions on work habits, social skills, transportation, self-employment and integration into the community to be implemented at the school. Supported employment options should be explored as well to ensure maximum employment among these learners exiting school. A follow-up system should be established to evaluate the effectiveness of the above-mentioned program. / AFRIKAANSE OPSOMMING: Deelname in betekenisvolle aktiwiteite is uniek aan die mens en is ook ‘n belangrike aanduiding van gesondheid en welstand. Ons ervaar die wêreld rondom ons deur betekenisvolle deelname, was nou verbind word kwaliteit van lewe. Tydens haar werk as ‘n arbeidsterpeut by ‘n skool vir leerders met spesiale onderrig behoeftes, het die navorser begin belangstel in hoe jongmense met ‘n diagnose van serebraalgestremdheid (wat oudleerders is) hulle deelname aan aktiwiteite of die gebrek daaraan ervaar en of dit bydra tot betekenisvolheid en vervulling in hulle lewens. Sy het deur informele gesprekke met van hierdie jongmense of hul ouers vasgestel dat hulle ervaring ongelukkig, werkloos and swak geïntegreed in hulle gemeenskap is. Die doel van hierdie studie was dus om te beskryf hoe jongmense met ‘n diagnose van serebraalgestremdheid wat in ekonomies benadeelde gemeenskappe binne the Weskaapse Provinsie woon, die kwaliteit van hul deelname aan betekenisvolle aktiwiteite ervaar. Die navorser het ‘n kwalitatiewe fenomenologiese studie ontwerp gebruik sodat sy die volgende aspekte kon verken: die waarde en betekenis wat die studie deelnemers aan spesifieke aktiwiteite heg; hulle persepsie van hulle ervaringe, asook die faktore wat deelname beïnvloed. Die studiepopulasie was jongmense tussen die ouderdomme van 18-28 jaar oud met ‘n diagnose van serebraalgestremdheid, wat die bogenoemde skool bygewoon en verlaat het in die afgelope nege jaar. Die navorser het ‘n doelgerigte maksimum variasie steekproef gebruik, om sodoende variasie in terme van diagnose, verblyf, werk en getroude status te verseker. Data was ingesamel deur middel van tien semi-gestruktureerde individuele onderhoude. Induktiewe inhoud-analise was gebruik om die data te ontleed en die volgende vier temas het na vore gekom naamlik: om uitdagings te oorkom; om gelyke geleenthede te hê; hindernisse wat my terughou en die toekoms is myne om te vorm. Hierdie jongmense neem deel aan ’n groot verskeidenheid aktiwiteite en het deur ondervinding verskeie strategieë aangeleer om die probleme wat hulle ervaar het te oorkom. Die volgende faktore het hulle deelname positief beïnvloed: betekenisvolle interpersoonlike verhoudings; aanvaarding van hulle gestremdheid en koestering van ‘n positiewe houding; trots op hulle prestasies; positiewe werkservaringe en betrokkenheid in hulle gemeenskap. Die faktore wat bygedrae het tot swak deelname aan aktiwiteite was die volgende: hul self-persepsie, asook hul persepsie van hoe ander hulle behandel; nie-aanvaarding van hulle gestremdheid en fisiese omstandighede; swak selfvertroue en gevoelens van onbevoegdheid; die staking van vorige betekenisvolle aktiwiteite; uitdagings in hulle verhoudings en onbevredigende werkservaringe. Hul onafhanklikheid is vir hierdie jongmense van uiterste belang, want dit is ‘n aanduiding dat hulle in beheer is van hulle eie lewens. Na aanleiding van bogenoemde informasie, maak die narvorser die volgende aanbeveling: Om ‘n voorbereidings program vir senior fase leerders te begin, wat sessies van werksgewoontes, sosiale vaardighede, transport, self-indiensneming en integrasie in die gemeenskap insluit. Die moontlikheid van ondersteunde indiensneming moet ook verken word, om maksimale indiensneming onder hierdie jongmense te verseker. ‘n Opvolg sisteem moet ook in plek gestel word om die doeltreffendheid van bogenoemde program te bepaal.