Thesis (MHlthSc(OccTh))--University of South Australia, 1998

Dyspraxia is a developmental condition in which the ability to ideate, plan and execute new and novel actions is impaired (Bundy, Lane & Murray, 2002:477- 478). The aim of this study was to investigate the childâs, parentâs and educatorâs perceptions on dyspraxia, in order to identify comprehensive client-centred treatment goals. This study was carried out in order to further the understanding of the complexities surrounding a child with dyspraxia, as it pertain to the occupational performance areas of school, play and leisure, and self-care. A lack of literature on the use of a family-centred approach in assessment and treatment of children by South African occupational therapists and the growing emphasis on including the voice of the child in decision-making that affects them, gave relevance to this undertaking. A descriptive, cross-sectional study was done. The study population consisted of children aged 5 years 4 months to 8 years 2 months, living in Bloemfontein and surrounding areas, and diagnosed with dyspraxia as per the criteria of the Sensory Integration and Praxis Test (SIPT) (Ayres, 1989). The study sample further consisted of the parent(s) of the child who were involved in the occupational therapy process, as well as the educator of the child concerned. The PEGS (Missiuna, Pollock & Law, 2004) was used as the measuring instrument to obtain the perceptions regarding dyspraxia from the child, parent and educator. The PEGSâs assessment for children consists of 24 pairs of cards showing children participating in activities from the occupational performance areas of self-care, school/productivity and leisure/play. The child had to indicate if he is like the picture of the child who is âmore competentâ or âless competentâ in the activity. During separate interviews with the parents and educators, the researcher asked the parent(s) and educators to rate the childâs competency on the same activities as those of the childâs cards of the PEGS. The child, parent and educator respectively also chose activities as goals to be addressed during occupational therapy intervention. Demographic information was also obtained from the parent(s) during a structured interview. The data analysis was done by Department Biostatistics, Faculty of Health Sciences, UFS. Findings indicated that dyspraxia reached across all functional spheres. Play and leisure was perceived by all to be the occupational performance area children with dyspraxia were the least competent in, with skipping with a rope perceived by all as the most troublesome activity. The perceptions of the parent, child and educator regarding the childâs competence in specific activities differed. Children were able to express their perceived efficacy and made themselves out to be both less and more competent in some items the adults did not agree with. A statistical significant difference was found between the child and educatorâs summary score percentages of their perceptions of the childâs competence as it relates to the OPA of school/productivity. Parents, children and educators selected different combinations of items as goals, with almost half of the total number of goals selected by all participants related to the OPA of leisure. Printing, playing ball games that require hitting a ball, such as tennis and cricket, skipping with a rope and cutting with scissors were the specific goals selected by the greatest number of participants. In conclusion, recommendations towards child-centred practice were made. These included realising the extent of the influence of dyspraxia on all areas of the childâs functioning, considering all environments and all role-players in the childâs life when planning intervention and providing the child with an opportunity to express his perceptions of his abilities and goals for therapy. The limitations of the study were acknowledged and recommendations were made for future research.

The involvement of the occupational therapist in medico-legal work or third party claims is not a new phenomenon. Research in this area however previously focused on the skills and other traits of the occupational therapist. Little is known about the legal professionâs knowledge and expectations regarding the occupational therapist serving as an expert witness, especially in the South African legal, economic, social and cultural context. Discovering how especially attorneys perceive and experience the role of the occupational therapist in medico-legal work is therefore essential as occupational therapistsâ involvement in medico-legal work is mostly facilitated by attorneys who instruct medico-legal assessments. The process and methods of instructing and utilising expert witnesses such as occupational therapists is unfortunately often not optimally effective with potentially dire effects for a country such as South Africa which already battles with poverty and unemployment, especially under workers with disabilities. International research has furthermore placed an increased emphasis on the role of the occupational therapist in encouraging and working towards aspects such as various forms of occupational justice and the impact of a personâs inability or altered ability to participate in occupations as before injury or illness. Therefore, against a backdrop of changing legislation regarding third party claims and an increase in medical negligence claims, the scope and role of occupational therapy in this field was explored and defined in this study, based on information obtained directly from members of the South African legal profession. Barriers between the occupational and legal profession that could hinder fair compensation for the claimants, such as communication transgressions or ineffective service delivery, were also identified. This study aimed to gather such information by means of a quantitative study under South African trained and based attorneys. A nominal group was used to support questionnaire development and also served to encourage the researcher that aspects addressed in this study through the questionnaire was vital to the everyday practice of the South African occupational therapist performing medico-legal assessments and reports. Research results indicated that attorneys have distinct expectations from the occupational therapist, but that some confusion exists pertaining to the unique role and contribution of the occupational therapist compared to other health professions. Where attorneys appeared to have a generally good understanding of terminology used by occupational therapists in assessment reports, several occupation therapy specific terms had different meanings for the legal profession. Recommendations made based on this study are believed by the researcher to address the specific problems identified in this study and should encourage future research in this field.

The establishment of occupational science in 1989 created an occupational discourse that defused the debate regarding the difference between activity and occupation. This fundamental discipline employs the applied science in occupational therapy and has directed the profession back to the original paradigm of occupational therapy, namely occupation (Cole & Tufano, 2008:59; Hagedorn, 1995:79). Occupational therapy recognises the unique occupations of each individual in the context of personal experience and applies occupation as part of the therapeutic process. Scientific proof of an occupational focus to enable the mental health care user (MHCU) to function optimally in the community after discharge, is necessary (AOTA, 2008:625, 626, 664). An occupational focus firstly involves the understanding of the therapeutic power of occupation as described by Pierce (2003:9). This consists of the subjective dimension, contextual dimension and application of an occupation based approach. Secondly, occupation is used as both means and as ends, to enable the MHCU to become skilled in his / her own life tasks and roles. The aim is to optimize functioning in the community (Trombly, 1995:963; 2002b:257). For the study, a retrospective match-control study design was used in a quantitative approach. An activity- and outcome based program were compared in order to investigate the effectiveness of the respective programs. Approval for the execution of the study was granted by the Ethics committee, Faculty of Health Science, University of the Free State (ETOVS nr. 12/2011). The occupational therapy files of hundred and two MHCUâs, 51 from the activity program and 51 from the outcome based program, were included in the study. Files were matched according to specific criteria, namely age, gender, diagnosis, language and educational level. The files of MHCUâs that had attended the activity program from 2009 to June 2011 were matched with files of MHCUâs that attended the outcome based program from July 2011 till Julie 2012. The data (pre-and post test) was abstracted from the occupational therapy evaluation, which was based on the ICF (International Classification of Functioning, Disability and Health) and recorded in the occupational therapy process notes. The researcher entered all the data from the files onto data forms. The results of the pre- and post tests of both programs were analysed, and the clinical improvement of MHCUâs in each program and the similarities of the program were compared to one another. The Department of Biostatistics, University of the Free State used descriptive statistics to analyse the collected data. Clinical and statistical significant improvements were observed in both programs. The largest clinical improvement in the activity program was seen in occupational performance components like attention, motivation, energy levels, decision making and range of emotion. In the outcome based program, the largest clinical improvement was found in functional aspects like handling of stress, management of own health and managing daily routine. Statistical significant differences in the activity program were noted in the components of motivation, handling own activity level, complete daily routine and in informal relationships. Statistical significant differences in the outcome based program was noted in the components regarding handling of stress, management of own health, time management, insight and social cues in relationships. The findings from this study indicated that the activity program addressed the occupational performance components more effectively, while the outcome based program was more effective in addressing functional skills. From the findings, it is proposed that a combined program be developed, consisting of elements from both programs, such as, activities and occupations that would address OPCâs and OPAâs through the use of psychomotor activity, craft activities and life skills groups. This should be combined into a full day program. Further research is recommended to gain further clinical proof of the value of an occupational focus in occupational therapy practise, and to verify the conclusions of this study.

The effect of stimulation programmes on children with Down syndrome is necessary especially with a South African impetus. This study was an attempt to investigate the impact of an intensive early-intervention programme, the Developmental Resource Stimulation Programme (DRSP), on Down syndrome children younger than 42 months in the South African context. The DRSP would assist any occupational therapist using one stimulation programme to enable parents to assist their child to develop to their full potential at an earlier age. Down syndrome is a multisystem chromosomal disorder, which has been recognised to be the single most common cause of intellectual disability occurring in approximately one in 650â700 births. Down syndrome is associated with cognitive limitations and speech as well as motor-developmental problems. Documented studies focused on motor and speech development in older children, with very few studies on babies younger than three years. Adequate early-intervention programmes for babies with Down syndrome with parent involvement do not exist in the South African context. Contrary to the literature, this study may show the benefits of the role of the occupational therapist in early intervention. The World Health Organization has adopted the International Classification of Functioning, Disability and Health (ICF-CY), a bio psychosocial model that emphasises components of health and reflects participation, activities and function. A holistic approach is essential to the developmental problems of children with Down syndrome to create a long-term difference in their functioning in totality. The researcher developed the Developmental Resource Stimulation Programme (DRSP) to assist in the management of early intervention of the child with Down syndrome over a period of 20 years. The DRSP is a unique, child-parent specific, one-on-one, integrated developmental programme for children with Down syndrome from birth to 42 months. Each activity of the DRSP is designed to accomplish specific activity performances in developmental domains, appropriate to the childâs ability for different age band groups younger than 42 months. The activities comprise cognitive, motor, sensory and language skills, as well as activities found in everyday living. The Developmental Resource Stimulation Programme was compared to Occupational Therapy Practice Framework. The aim of this study was to investigate the impact of the DRSP on Down syndrome children younger than 42 months in the South African context. There were four objectives in order to achieve the aim of the study. A quantitative approach with an experimental and descriptive study design was followed, to confirm results and enhance the reliability and validity of the study. The measurable attributes of the DRSP, including the participation of the parents were the focus. The Bayley Scales of Infant and Toddler Development (3rd edition) and DRSP checklists were used in a pre-test and post-test to measure the effect of the DRSP. There were two groups namely the intervention group, consisting of 32 participants (children and parents) and the control group, consisting of 28 (children and parents) over a period of six months. Evaluation and intervention sessions were video-recorded and moderated. Informed consent was obtained prior to the study, supported by an information document in the language of choice, namely Afrikaans, English and Sesotho. A self-administered questionnaire, developed by the researcher, focused on the attainment of information regarding the overall presentation of the area, service and treatment of the participants. The results were analysed, presented in tables and graphs, and discussed. The results of this study showed that a specifically designed programme with participation of a parent has a positive impact on the development of the child with Down syndrome. Contrary to the literature, there were positive changes in the language, fine-motor and >9- month gross-motor development of children with Down syndrome. The DRSP with specific goals indicated to be an attribute in the early-intervention process. The results emphasised the holistic approach, rendered by an occupational therapist in Down syndrome early intervention.

Adolescent development is synonymous with physical and emotional changes and challenges. This development has previously been termed âstorm and stressâ to further illustrate these turmoils that adolescents experience. Adolescents generally growing up in a coloured community further experience hardships such as gangsterism, unemployment, overcrowding and substance abuse. The implementation of life skills could be seen as a way to possibly reduce engagement in risky behaviour and effectively face adversity. Life skills include an unlimited list of complex and integrated skills and assist in the participation of meaningful occupations. The main occupation of an adolescent is that of a learner. Within schools, life skills are part of the form of Life Orientation. Life Orientation includes subjects such as vocational guidance, religion and physical education and it addresses the most crucial life skills. Not only can life skills assist with positive adaptive behaviour amongst adolescents, but supportive environments also contribute to resilient behaviour. Resilience is being able to bounce back from challenges. Adolescents engaging in risky behaviour, having poor to little knowledge of life skills, not applying their life skills and negative environmental factors all influence their ability to be resilient. The researcher undertook this study to establish a profile of coloured adolescents and their knowledge and application of life skills that lead to resilient behavior. This was a descriptive study involving a convenience sampling method. The study took place at four predominantly coloured schools in Kimberley in the Northern Cape. Three hundred and forty eight (348) learners returned signed permission letters that allowed them to complete the questionnaire. The sample comprised of both males and females aged 16 to 18 years. Grade 12 learners were in the minority, while there were mostly grade 11 learners (45.4%) that participated in the study. Learners mostly came from coloured suburbs with 26.4% of learners coming from other suburbs within Kimberley. The profile of coloured adolescents presented with learners possessing knowledge and/or application of different life skills. Learners presented with better knowledge of life skills within communication skills (90.3%), time management (72.8%) and values (89.9%). When expected to apply life skills, problem-solving skills (90.9%) and values (81.1%) were applied best. Learners applied time management and decision making poorly of all life skills. The researcher further noted that application of communication skills and time management (whether high or low) were directly related to resilience. Knowledge of the other life skills (whether high or low) were related to resilience. The only exception was within values, where knowledge and application were both directly related to resilience. Only small numbers of learners engaged in risky behaviour in the form of drinking alcohol mostly. Risky behaviour is considered a negative influence on life skills. Learners portrayed hope, optimism and competence within individual environmental factors. However learners from the lower socio-economic backgrounds presented with less hope (70.7%) compared to other suburbs (84.2%). Within family factors security, stability and support were prominent factors and had a positive influence on life skills leading to resilience. Peer acceptance was important for most learners (95.4%). To conclude the researcher will use findings to develop community and school programmes that could assist in the implementation of life skills that would serve to support and empower adolescents. The important role that the occupational therapist could play in adolescent development is to ensure optimal engagement in occupations through life skills in order to develop as healthy adults.

The level of severity of disability may have increased among children with cerebral palsy and therefore continued monitoring of the characteristics of children with cerebral palsy is necessary. Cerebral palsy (CP) can be considered as a sensory-motor disorder that results from malformations in the developing brain that disrupts the development of the neuronal network and cortical and sub-cortical pathways. Although the motor behaviours and postural deficits are defining features of CP, visual disorders are a main symptom in the clinical picture of CP. There are well sounded reasons why children with CP have difficulties to partake in everyday activities. Neurologic pathology can affect specific aspects of postural control including the ability to maintain stability with alignment in a specific position. Postural control is necessary for maintaining all body segments in an upright position and to orientate the eyes to the environment. Problems with the visual system in CP include peripheral problems related to the anterior part of the visual system, visual problems of central origin and cerebral visual impairment. Observations of eye movements and postural alignment in sitting in children with CP were the focus of this study. These are variables known to potentially influence occupational-based activities. The aim of the study was to describe eye movements and postural alignment and to investigate if there was a possible association between eye movements and postural alignment in sitting in a frontal plane of children with CP, between the age of two and ten years. A non-experimental, quantitative approach addressed the aim. A descriptive study was used to describe the eye movements and alignment in body segments over the base of support against gravity. A correlation study was used to investigate the possible association between postural alignment and eye movements in children with CP. Following the pilot study the unstructured and structured observations were administered to a convenience sample of children with CP attending a clinic, school or a private practice. Fifty seven children with CP, between two and ten years of age participated in the study after meeting the pre-determined inclusion criteria. The data collected were numbers that reflected specific measurements of the characteristics in question and were analysed by using a grounded, observed â clinical reasoning approach. The mean age of the children was 5.3 years (SD = 2.26). Discussion of results was directed at describing eye movements and postural alignment and interpreting the implications of those associations for clinical practice. The obtained data from the unstructured and structured observations were statistically analysed and compared and did produce a statistically significant positive association between eye movements and postural alignment therefore, both the posture and the eye movements are critical to the provision of intervention. The study confirms the association between eye movements and postural alignment in sitting in children with CP. This study has documented the difficulties the child with CP has to encounter. This may facilitate the establishment of effective and appropriate measuring instruments for occupational therapists, assessing functional vision and postural alignment in any setting of practice.

Fieldwork education in Occupational Therapy provides students with the opportunity to integrate theory learned at higher institutions with practical skills and professional behaviour within real-life settings to become proficient occupational therapists. Fieldwork supervisors are the key role players and facilitators in realising the purpose of fieldwork education. To this end, supervisors must exhibit effective characteristics of supervision in order to provide quality and meaningful learning experiences for students. Concern has been raised throughout literature about the characteristics that supervisors display during fieldwork placements, because it has such a major influence on studentsâ learning and experiences of fieldwork education. Very little research has been done on fieldwork education of Occupational Therapy in South Africa and none on the characteristics of supervisors and supervision during fieldwork placements. This study aims to describe effective and ineffective characteristics of supervisors and supervision in Occupational Therapy fieldwork education at the UFS as identified by third and fourth year Occupational Therapy students and supervisors. These phenomena of supervisor and supervision characteristics have been researched in several qualitative studies internationally from either the supervisorsâ or the studentsâ perspective. In this study, a quantitative, descriptive study design was used to gather information about effective and ineffective characteristics of supervisors and supervision during Occupational Therapy fieldwork education. The data collection instruments implemented consisted of two similar self-report questionnaires: one for the students and one for the supervisors. The research population consisted of all the third and fourth year Occupational Therapy students enrolled at the UFS in 2012 (a total of 69) as well as all the supervisors involved in fieldwork training of these Occupational Therapy students (a total of 41). The response rate for the students was 98.6% and for the supervisors 100%. Effective supervision characteristics have been identified and described, with specific emphasis on the main findings that reflect that a supervisor must be competent, professional, approachable, considerate and knowledgeable about what is expected from the student and must spend adequate time with the student. Furthermore, the supervisor must provide sufficient guidelines, support, guidance and feedback. Results were reported according to the five categories used in the questionnaires, namely: interpersonal; curriculum; clinical and professional; feedback and environment. Ineffective supervision characteristics identified in this study were similar to those detected in international studies. This study clearly indicates that supervisors viewed the limited time they had to supervise students as a major cause of ineffective supervising. Additionally, they had less than five years of supervision experience, which influenced the effectiveness of their supervision characteristics negatively. An unexpected finding of this study was the indication by supervisors that studentsâ attributes â whether positive or negative â had been the biggest influence on the supervision they provided during fieldwork education. In conclusion, extensive recommendations were made to redress the ineffective characteristics of supervision identified in this study as it pertains to students, supervisors and the university. This study contributes to Occupational Therapyâs body of knowledge with regard to supervision characteristics in fieldwork education in a South African setting, which can be used as a base for future research.

<p> This participant-observer, phenomenological qualitative study explored the adult experience of a community circus class through an occupational therapy lens. Following 4 months of weekly participant-observation, semi-structured interviews were conducted with four adult beginner students in a community-based social circus class. Interviews were audio recorded, transcribed and analyzed using a grounded theory approach to identify six themes. Two themes addressed the structural supports of the class: <i>Meeting People Where They Are </i>, and <i>Culture and Competition</i>. Four themes were based on participant experiences and perceived outcomes: <i>Releasing Expectations, Trying, Learning</i>, and <i>Fun, Making Friends, Making Community, and Feeling Better</i>. Findings suggest that through the fun aspects of circus participation, students were able to confront and overcome physical, social, emotional and cognitive challenges. In this way, personal growth and quality of life were promoted. External supports enabled students to adopt an individualized approach to participation that encouraged self-awareness and self-assessment across multiple domains. Due to the scarcity of research investigating adult participation in circus, the therapeutic benefit of circus participation merits further investigation. Circus and occupational therapy may develop a mutually beneficial relationship on the basis of shared common philosophy and values. By working together, occupational therapy and circus may enhance their ability to address occupational justice, inclusivity, empowerment, connection, play and quality of life.</p>

Capstone Paper: Individual Case Study: The SOS Approach to Feeding