Thesis (MOccTher)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: As a South African occupational therapist (OT) trained to provide occupational therapy using a sensory integration approach (OT/SI), to children and their families, I have personal experience of different parent perceptions and experiences regarding OT/SI as a treatment approach to improving their children’s occupational performance. This made me question the various factors that may influence a parent’s perceptions and experiences, and how these factors may ultimately influence the outcome of OT/SI intervention for the child and family. Additionally, I wanted to know what OT/SI intervention was like for parents of a child with difficulties processing and integrating sensory information and what changes should be made to ensure we are meeting both child and parents’ needs. To date, no research exists regarding parents’ perceptions and experiences of OT/SI intervention in South Africa. Despite this, OT/SI intervention is widely used among South African paediatric occupational therapists. This study focused on the lived experience of OT/SI intervention for parents in the Western Cape, South Africa. The purpose of this study was to explore and describe South African parents’ perceptions and experiences of OT/SI intervention received. This study not only sought to explore whether parents thought OT/SI intervention was valuable or not, but also to understand the meaning, the broader context and the process by which parent’s opinions had come into being, and how these may have influenced the meaning ascribed to the intervention. The study sample consisted of nine parents, including mothers and a father, of children with difficulties processing and integrating sensory information, who lived in various regions of the Western Cape, South Africa. Purposive sampling was used to select participants in this study. Using a qualitative, phenomenological approach, data was collected during face=to=face interviews, participant observation and researcher’s field notes. Four themes that pertain to the aims of the study were revealed during the analysis. They included: “It was tough because we didn’t understand”, “Just suddenly everything made so much sense”, “Mobilized my child into the world”, and “OT/SI intervention facilitators proposed by participants”. These themes describe the progression of the participant’s perceptions and experiences before OT/SI intervention, during intervention, and after having received the intervention, as well as the recommendations they proposed to facilitate OT/SI intervention in South Africa. I found that factors such as poor awareness and understanding of OT/SI intervention amongst the participants negatively influenced their understanding of their child’s occupational performance, their role as parents and their social performance as a family in various social contexts. Key points of transformation were identified during the ‘input phase’ of OT/SI intervention, which either facilitated or created a barrier in the participants’ shift to the ‘after phase’ of OT/SI intervention. Despite the barriers, all participants perceived and experienced a shift to the ‘after phase’ of OT/SI intervention. For some participants, this shift included changes they perceived in their child, which influenced social performance of the child and family. However, for the majority of participants, this shift meant a number of factors: a better understanding and expectations of their child; changes in their child’s abilities, activities and self=worth; changes in themselves as parents and how this influenced their parent=child relationship; as well as changes in their child’s and family’s social performance in various contexts. Insight gained from the participants’ recommendations and my interpretation of findings, allowed recommendations to be made in an attempt to overcome the barriers and promote the facilitators that will make a difference to OT/SI intervention in South Africa. Recommendations were made within two contexts: the broader social context of South Africa and the context of OT/SI intervention received by children and their parents. / AFRIKAANSE OPSOMMING: As ‘n Suid=Afrikaanse arbeidsterapeut (AT), opgelei om arbeidsterapie met ‘n sensoriese integrasie benadering (AT=SI) te verskaf aan kinders en hul families, het ek persoonlike ondervinding van verskeie ouers se persepsies en ervarings omtrent AT=SI as ‘n behandelingsbenadering om die kind se arbeidsprestasie te bevorder. Dit het my laat wonder watter faktore die ouer se persepsies en ervarings sou beïnvloed, asook hoe hierdie faktore die uitkoms van die AT=SI behandeling vir die kind en die familie sou beïnvloed. Ek wou ook uitvind hoe die ouer van ‘n kind met SIA (SID), AT=SI intervensie beleef het en watter veranderinge behoort aangebring te word om te verseker dat beide die kind en die ouers se behoeftes nagekom word. Tot dusver bestaan daar geen navorsing aangaande die ouer se persepsies en ervarings van AT=SI intervensie in Suid=Afrika nie. Ten spyte hiervan word AT=SI alom gebruik deur pediatriese arbeidsterapeute in Suid=Afrika. Hierdie studie fokus dus op ouers se persoonlike ervaring van AT= SI intervensie in die Wes=Kaap, Suid=Afrika. Die doel van hierdie studie was om die persepsies en ervarings van Suid=Afrikaanse ouers wat AT= SI intervensie ontvang het, te ondersoek. Hierdie studie het nie net gepoog om vas te stel of die ouers gedink het dat AT=SI waardevol was aldan nie, maar ook om die betekenis, die breër konteks, en die proses waardeur hul opinies gevorm is en hoe dit hulle beïnvloed het, te verstaan. Die steekproef het bestaan uit nege ouers, insluitend moeders en ‘n vader, van kinders met SIA (SID), woonagtig in verskillende streke in die Wes=Kaap, Suid=Afrika. ‘n Doelgerigte steekproef is gebruik om die deelnemers vir die studie te kies. ‘n Kwalitatiewe=fenomenologiese benadering is gebruik om data in te samel deur aangesig=tot=aangesig onderhoude, waarneming van deelnemers, asook die navorser se veldnotas. Vier temas wat direk verwant was aan die doelwitte van die studie, is tydens die analise van die data geïdentifiseer. Dit het die volgende ingesluit: “Dit was moeilik want ons het nie verstaan nie”, “Ewe skielik het alles so baie sin gemaak”, “My kind in die wêreld gemobiliseer ”, “AT=SI intervensie fasiliteerders voorgestel deur die deelnemers”. Hierdie temas beskryf die vordering van die deelnemers se persepsies en ervarings voor die aanvang van AT=SI intervensie, gedurende die intervensie en ook nadat intervensie voltooi is, asook die aanbevelings wat hulle gemaak het om AT=SI intervensie in Suid=Afrika te fasiliteer. Ek het bevind dat faktore soos deelnemers se swak bewustheid en begrip van AT=SI intervensie, hul begrip van hul kind se arbeidsprestasie, hul rol as ouers en hul sosiale optrede as ‘n familie in verskeie sosiale kontekste, negatief beïnvloed het. Kernpunte van verandering is geïdentifiseer gedurende die ‘inset=fase’ van die AT=SI intervensie, wat die deelnemers se vordering na die ‘na= fase’ van AT=SI intervensie òf gefasiliteer het, òf bemoeilik het. Ten spyte van die struikelblokke het alle deelnemers ‘n skuif na die ‘na=fase’ van AT=SI intervensie waargeneem en ervaar. Vir sommige deelnemers was hierdie skuif die veranderde optrede wat hulle in hul kind waargeneem het, wat die kind en familie se sosiale gedrag verander het. Vir die meerderheid deelnemers het hierdie skuif egter ‘n aantal faktore ingesluit: ‘n beter begrip en verwagting van hulle kind; veranderinge in hulle kind se vermoëns, aktiwiteite en eiewaarde; veranderinge in hulself as ouers en hoe dit hul ouer=kind verhouding beïnvloed het; asook veranderinge in die kind en familie se sosiale gedrag in verskeie kontekste. Die deelnemers se voorstelle en my interpretasie van die bevindinge het my in staat gestel om voorstelle te maak om die struikelblokke te probeer oorkom en die fasiliteerders aan te moedig wat die verskil gaan maak in AT=SI intervensie in Suid=Afrika. Aanbevelings is gemaak vir twee areas: die wyer sosiale konteks van Suid=Afrika, asook die konteks van die AT=SI intervensie wat ontvang word deur kinders en hulle ouers.

Home programs are widely used by occupational therapists as a strategy to address health and development needs of children with cerebral palsy. Experts believe they are essential. Despite wide-spread clinical use there is no high quality research evidence proving home program effectiveness. Further there is no information that provides a parent perspective on home programs. The aim of this research was to evaluate the effectiveness of occupational therapy home program intervention for school-aged children with cerebral palsy and identify factors perceived to be important in home program practice from a parent perspective. A double blind randomised controlled trial design was used to evaluate effectiveness, where parents and evaluators were blinded to intervention. Children were randomised to three groups, home program intervention for eight weeks (“8WEEKS”), home program intervention for four weeks (“4WEEKS”), and a control group, that did not receive home program intervention (“NoHP”). The primary end-point was change in performance of functional activities and satisfaction with function as measured by the Canadian Occupational Performance Measure (COPM), after eight weeks. Secondary endpoints were change in COPM scores after four weeks, goal achievement at four and eight weeks as measured by Goal Attainment Scale (GAS), quality of arm movement at four and eight weeks measured on the Quality of Upper Extremity Skills Test (QUEST) and participation levels at four and eight weeks measured on the Children’s Assessment of Participation and Enjoyment (CAPE). Parent experience was explored through semistructured interviews of parents who participated in the home program trial. Content analysis of interview data was conducted to the level of “open coding” to identify factors. Results for the primary outcome measure at the primary end point (eight weeks) - Effect of an 8WEEK or 4WEEK home program on COPM scores: comparison between the three groups was conducted using a linear regression model with baseline COPM performance/satisfaction scores, participant age and severity of cerebral palsy as measured by the GMFCS entered into the model as covariates. Overall, there were statistically significant and clinically important differences in performance of activities and satisfaction with function on COPM when comparing either home program group to the NoHP group at eight weeks. There was no difference between 4WEEKS versus 8WEEKS on COPM performance or satisfaction scores at eight weeks. Results on secondary outcome measures: compared to NoHP, receiving a home program for either 4WEEKs or 8WEEKs increased COPM performance scores and GAS measures at four weeks, and increased COPM performance and satisfaction scores, GAS measures, and QUEST scores at eight weeks. There were no differences within or between groups on the CAPE at either four week or eight weeks. There were no statistically significant between-group differences between the 4WEEK and 8WEEK home program groups on any secondary outcome measures. This was most likely the result of a protocol implementation flaw that occurred in the study where 4WEEK group participants continued program activity for the final four weeks when they should have suspended it. Parents perceived their experience of implementing home programs as characterised by five features: ����guidance for the journey”, practice makes perfect, they were a necessary “way of life”, they maximised progress and something that made it easier to juggle competing demands. Positive home program experiences were characterised by: support, realistic expectations, flexibility, motivation from goals, activities that translated to real-life, reminders to practice, progress updates and role clarity. Parents advised other parents to: accept the disability, never refuse help, be honest, consider home programs essential, develop routines and view programs as a way of improving the child and parents’ life. No negative experiences were reported. Parents advised professionals that they wanted: support, interdisciplinary co-ordination of programs, advice without pressure and prognostic guidance for future planning. This dissertation presents new information about occupational therapy home programs. Until this study, there was little research evidence to inform therapist or parent decision-making regarding the therapeutic value of home programs or the parent perspective on home programs. Findings from this dissertation can inform clinical practice and parent decisions regarding the use of home program interventions for children with cerebral palsy. / Doctor of Philosophy (PhD)

Thesis (M. Occ. Ther.(Faculty of Health Sciences))--University of Pretoria, 2009. / Summary in English. Includes bibliographical references.

Thesis (M.S. (Hons.)) -- University of Western Sydney, 2004. / Includes bibliography.

Thesis (Ph. D.)--University of Sydney, 2006. / Title from title screen (viewed 12 February 2009). Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the School of Occupation and Leisure Sciences, Faculty of Health Sciences. Includes bibliographical references. Also available in print form.

Although the profession of occupational therapy had its origins in the treatment of the mentally ill, and was among the pioneers in developing community-based programs to meet the social and emotional needs of children, a study of 28 therapists practicing in the public schools revealed that these occupational therapists did not serve students with behavioral disorders unless they also exhibited a neurological disorder. The results of this study revealed that occupational therapy is not recognized by the educational sector as an essential related service for students with behavioral disorders. Occupational therapy is viewed as a modality much akin to physical therapy in which the focus is on motor skill development.

Thesis (MOccTher (Interdisciplinary Health Sciences. Occupational Therapy))--University of Stellenbosch, 2005. / According to the Occupational Therapy Practice Framework (2002), the objective of occupational therapy is to help people to participate in activities of daily life which are purposeful and meaningful to them and in which they are expected to participate. According to educators, learners are increasingly experiencing problems with performing academic tasks, and learning barriers, especially with regard to visual perception, are on the increase. Various external factors, such as educational policy pertaining to inclusive education and a younger age for school admission, as well as internal factors, such as learning readiness, may contribute to the occurence of learning barriers that can restrict the academic progress of learners. Learners are increasingly being referred to occupational therapists. Occupational therapists also provide guidance to learner supporters. Occupational therapists refer learners with visual perception problems with possible eye tracking problems for vision therapy, after which occupational therapy is resumed. Meanwhile, learners still have to function in the school environment, which means that incorrect capturing of information processing can take place. According to literature, the promotion of eye movements is regarded as part of occupational therapy services in the USA. In South Africa the proposed model by Fishman-Hellerstein and Fishman (1999: 148) of cooperation between optometrists and occupational therapists is followed. In this approach eye movements are regarded as underlying building blocks of visual perception and the effect of eye movements on the academic performance of learners is clearly described (Green, 2001). There is a shortcoming in the literature where eye movements are promoted as integral to a visual perception programme. Occupational therapy needs to investigate effective methods of intervention that are time and cost effective in order to address the growing problem, especially in South Africa. A clinical experimental field trial with a convenience sample was used to investigate the effect of occulomotor exercises in combination with a visual perception programme on the visual perception of seven-year-old learners with visual perception problems. The study population was seven-year-old learners with visual perception learning barriers from neighbouring schools with foundation phase education. Inclusion and exclusion criteria were applied. Sifting procedures included questionnaires to parents and educators, “Beery-Buktenica Developmental Test of Visual-Motor Integration” 4th edition of Beery (1997) for visio-motor integration, and a screening test by an optometrist. A visual perception programme was presented to the control groups and the experimental groups over ten sessions. An eye exercise of 15 minutes was included with the experimental groups. The Developmental Test of Visual Perception, 2nd edition, by Hammill, Pearson and Voress (1993) was used as measuring instrument in the pre-test and post-test to determine effectiveness, which was statistically indicated by using the repeated measures ANOVA. The results indicated no significant difference between the visual perception programme with eye exercises and the one without. Two tests of the sub-ability of visual perception showed a tendency towards improvement. The educators indicated that the learners benefited functionally from the programme and that it made a difference in academic performance. Behaviour and emotional events may have influenced the results of the study because of external factors. It is recommended that the study be repeated with a larger sample and a longer programme presented over six months to a year. Occupational therapists can include eye exercises integral to activity participation by adapting activities and through the optimal use of space for activities so that the learner would have to adapt to it visually.

Thesis (Ph.D.)--University of Western Sydney, 2009. / A thesis presented to the University of Western Sydney, College of Health and Science, School of Biomedical and Health Sciences, in fulfilment of the requirements for the degree of Doctor of Philosophy. Includes bibliographies.

The aim of the qualitative study was to explore and describe the utilisation of Gestalt Play Therapy in Occupational Therapy intervention with traumatised children. An applied study was conducted and the case study strategy was used with a flexible design. Objectives for the study included conducting literature reviews regarding the profile of the traumatised child and Occupational Therapy and Gestalt Play Therapy intervention with the traumatised child. The empirical study included data collection and analysis, with data gathered through semi-structured interviews. The gathered data was analysed with the use of Creswell's Data Analysis Spiral. The empirical data showed that Occupational Therapists do utilise Gestalt Play Therapy in their intervention with traumatised children by drawing on their combined knowledge base of Gestalt Play Therapy and Occupational Therapy. Occupational Therapists then conduct a holistic assessment and treatment aims are set according to the assessment with a focus on providing holistic intervention. / Social Work / M.Diac. (Play Therapy)

Many fields of interest, of which Pediatrics is one, exist in Occupational Therapy. In the field of Pediatrics there are also diversity fields of interest. Many diagnostic groups are treated in the field of Pediatric Occupational Therapy. The traditional Pediatric Occupational Therapy process aims at treating the child holistically with regards to his cognitive, perceptual, motor and emotional areas of development. It seems that there is a tendency to focus on the more tangible aspects of development rather than the less visible elements such as emotional needs and problems. The question that might be asked is whether Pediatric Occupational Therapists are in fact equipped to deal with emotional needs and problems. Due to the nature of their work, there is a strong possibility that Pediatric Occupational Therapists can encounter children who suffer from emotional problems. These children are more often than not seen by Occupational Therapists although the therapists might prefer to rather work on the more tangibly aspects of development. This research study was aimed at assessing the need amongst Pediatric Occupational Therapists to deal with emotional problems. After completing the study it was possible to make valuable conclusions and recommendations. Gestalt Play Therapy was also proposed as a possible approach in dealing with children's emotional needs and problems in the course of their Occupational Therapy intervention. OPSOMMING Arbeidsterapie omsluit `n breë spektrum van spesialiteitsrigtings, waarvan Pediatrie een is. Binne die veld van Pediatrie blyk daar egter verdere diversiteit te wees met betrekking tot die diagnostiese groepe wat binne hierdie veld hanteer word. Die tradisionele Pediatriese Arbeidsterapie proses het ten doel om die kind holisties te benader met verwysing na die kognitief -perseptuele, motoriese en emosionele ontwikkelingsareas van die kind. Dit blyk egter dat daar `n geneigdheid is, en moontlik ook groter gemak bestaan om eerder aan die meer sigbare aspekte soos byvoorbeeld perseptuele en motoriese ontwikkeling te werk. Die vraag kan dus gevra word of Arbeidsterapeute genoegaam toegerus is om ook aan die emosionele behoeftes en probeleme van die kind aandag te kan gee. Die moontlikheid dat Arbeidsterapeute vanwee die diversiteit met betrekking tot die diagnostiese groepe wat ter sprake is in kontak kan kom met kinders wat ook emosionele behoeftes en probleme het bestaan. Alhoewel hierdie kinders opgeneem word in die Arbeidsterapie proses, is behandeling dikwels net op die tasbare ontwikkelings areas gerig. Die navorsing was spesifiek daarop gerig om te bepaal of daar wel `n behoefte bestaan onder Arbeidsterapeute om kinders se emosionele behoeftes aan te spreek. Na afloop van die studie, en nadat alle toepaslike inligting geïntegreer is, is daar waardevolle afleidings gemaak en is hierdie behoefte onder Arbeidsterapeute bevestig. Gestalt Spelterapie is ook voorgestel as `n moontlike benadering wat geïntegreer kan word ten einde die Arbeidsterapeut instaat te stel om meer effektief te werk te gaan met die kind se emosionele behoeftes en probleme. / Social work / D.Phil.