published_or_final_version / Public Administration / Master / Master of Public Administration

published_or_final_version / Public Administration / Master / Master of Public Administration

Thesis (MOccTher)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Despite the existence of many guidelines for rehabilitation services both internationally and in South Africa, there is a need for a uniform format for the measurement and reporting of outcomes reached by clients utilising these services. Traditionally, statistics on client numbers fail to report actual outcomes attained by clients. Aim: This aim of the study was to describe the outcomes achieved by clients after participating in rehabilitation at the Bishop Lavis Rehabilitation Centre (BLRC) over a three month period. It was done by describing clients’ function according to the World Health Organisation’s International Classification of Function (ICF) model, and included both the environmental and personal factors impacting on an individual’s function. Method: The study employed a descriptive design and used six measuring instruments which exceeded acceptable test-retest requirements to gather data from within the framework of the ICF Model. A field worker was trained to administer the majority of instruments which were pilot-tested for pre and post-test purposes. A sample of 78 clients who met the inclusion criteria was selected from the five main diagnostic categories seen at the BLRC. All clients were evaluated on referral, and again after receiving rehabilitation services for three months. An open-ended questionnaire was also administered as part of the post-test to obtain clients’ personal perspective on outcomes reached, as well as their subjective opinion of the rehabilitation experience. Data on the impact of various demographic and environmental factors on function was also gathered and statistically analysed in conjunction with the qualitative data obtained from the interviews in order to identify the rehabilitation outcomes achieved by the clients included in this study. Results: Clients reported a statistically significant decrease in the impact of disability on their function, with ‘mobility’ emerging as the aspect of function which improved the most after rehabilitation. The effect of most demographic and environmental factors investigated were perceived as facilitating rather than debilitating to rehabilitative outcomes, with ‘faith’ reported to be most facilitating and ‘monthly income’ the most debilitating of all factors. Subjectively, clients perceived their participation in rehabilitation to be a contributing factor to the improvement in their function, and generally expressed a positive attitude toward the rehabilitation experience. Recommendations based on the results of this study are presented to inform governing bodies involved in rehabilitation in South Africa. / AFRIKAANSE OPSOMMING: Ten spyte van die bestaan van veelvuldige riglyne vir rehabilitasie dienste, beide internasionaal en in Suid-Afrika, is daar steeds ‘n behoefte vir uniforme riglyne vir die meting en rapportering van die uitkomste wat kliënte bereik met deelname aan hierdie dienste. Tradisionele statistiek rakende kliëntegetalle rapporteer nie die werklike uitkomste wat kliënte bereik het nie. Doel: Die doel van die studie was om die uitkomste te beskryf wat kliënte bereik na hul deelname aan rehabilitasie by Bishop Lavis Rehabilitasiesentrum (BLRS) oor ‘n drie maande periode. Dit is gedoen deur kliënte se funksionering te beskryf volgens die Wêreld Gesondheidsorganisasie se Internasionale Klassifikasie van Funksie (IKF) model, insluitend beide die omgewings- en persoonlike faktore wat ‘n impak op ‘n individu se funksionering kon hê. Metode: Die studie het gebruik gemaak van ‘n beskrywende studiestruktuur. Dit het ses meetinstrumente gebruik wat beter as aanvaarbare vereistes vir toets-hertoets-betroubaarheid getoon het om data binne die raamwerk van die IKF-model in te samel. ‘n Veldwerker is opgelei vir die administrasie van die meerderheid van die meetinstrumente wat vir voor- en na-toets doeleindes in ‘n loodstudie getoets is. ‘n Steekproef van 78 kliënte wat aan die insluitingskriteria voldoen het, is geselekteer uit die vyf hoof diagnostiese groepe gesien by BLRS. Alle kliënte is geevalueer met verwysing en weer na hulle drie maande se rehabilitasie dienste ontvang het. Administrasie van ‘n oop-einde vraelys is ook as deel van na-toetsing gedoen om kliënte se persoonlike perspektief van die uitkomste wat hulle bereik het in te samel, sowel as hulle subjektiewe opinie van die rehabilitasieproses. Data oor die impak wat verskeie demografiese en omgewingsfaktore op funksionering kon hê is ingesamel, statisties ontleed en gebruik saam met die kwalitatiewe data wat met onderhoudsvoering ingesamel is om sodoende die rehabilitasieuitkomste te identifiseer wat behaal is deur kliënte wat ingesluit was in die studie. Resultate: Kliënte rapporteer ‘n statisties beduidende vermindering in die impak van gestremdheid op hulle funksionering, met ‘mobiliteit’ wat uitstaan as die area van funksionering wat die meeste verbeter het na rehabilitasie. Die effek van die meeste demografiese en omgewingsfaktore wat ondersoek was, is as fassiliterend eerder as inhiberend tot rehabilitasieuitkomste ervaar, met ‘geloof’ gerapporteer as die mees fassiliterende en ‘maandelikse inkomste’ as die die mees inhiberende faktor. Op 'n subjektiewe vlak het kliënte hul deelname aan rehabilitasie as ‘n bydraende faktor tot hul verbetering in funksionering ervaar, en het hulle oor die algemeen ‘n positiewe houding teenoor rehabilitasie gerapporteer.

Thesis (MSc) -- University of Stellenbosch, 2002. / ENGLISH ABSTRACT: South Africa is a multicultural, multiracial and multilingual nation ("the rainbow nation") with different traditions, values and cultural practices. Due to this diversity there are different belief systems, which give rise to different attitudes and practices towards various health issues such as disability, which in turn, have an impact on the rehabilitation of people with disability. The purpose of this study is to investigate the knowledge, attitudes and cultural beliefs towards disability and to identify the commonalities and differences of three broad cultural groups of South Africa (Blacks, Coloureds and Whites), and to determine their influence on the rehabilitation of disabled people in the Cape Town area. Sixty respondents (20 Blacks, 20 Coloureds and 20 Whites) were interviewed utilizing the knowledge, attitude and belief (KAB) survey in the form of a structured interview. Both probability and non-probability (systematic and purposive) sampling were used. The study was carried out using both quantitative and qualitative methods. The results showed that Whites and Colored generally had a fairly good knowledge of disability and its causes, acquired while they were young, whereas Blacks had a more superficial knowledge of disability, which was only acquired after the birth of a disabled child. The results also revealed that quantitatively all the cultural groups held positive attitudes towards the rehabilitation, education, marriage, childbearing and employment of people with disability. Attitudes towards the stigma attached to being disabled were also encouraging. In contrast, the qualitative data showed disparities between the three cultural groups in attitudes towards rehabilitation, education and marriage. Although rehabilitation is considered an important aspect to disabled people and their families, some Blacks experience problems in transporting their children to centres where rehabilitation services are offered. Socio-economic factors also have a bearing on this. The results revealed a general lack of awareness of disability among school children and teachers in Black and the Coloured schools, which may make it difficult for disabled children to be integrated into mainstream schooling. Marriage and childbearing was regarded as a way of increasing the support base of individuals with disability in the Black group, while the Coloured and White groups viewed marriage as a way of enjoying life and having children a matter of individual choice. Concerning employment and the promotion of people with disability, all three groups believed that disabled people have a right to be employed and earn a salary. In the area of beliefs, the results showed that the Black group blamed disability on witchcraft and that they consult health professionals, folk healers and look to God for healing. Most of the Whites and Coloureds believed that disability is a result of natural causes, human error or the will of God. There is an uneven geographic distribution of information about disability. Cultural beliefs towards disability may delay or hinder early identification of children and intervention. Two main recommendations are made arising from these results. Firstly, health professionals should know and understand the culture, values, beliefs and expectations of their clients and, more importantly, bring services to the recipients in their own familiar environment, culture and community, via the CBR model. Secondly, I recommend that an evaluation of knowledge and attitudes towards disability should be done in schools, where the disability awareness has been raised by some NGOs as compared with those where no intervention has taken place. A survey of this kind should be done in all the provinces of South Africa. The findings from this research thus have very serious implications for the provision of inclusive education and quality rehabilitation services for all the disabled children of South Africa. / AFRIKAANSE OPSOMMING: Suid-Afrika het 'n multi-kulturele, veelrassige en veeltalige bevolking ("die reënboog nasie") met uiteenlopende tradisies, waardes en kulturele praktyke. Hierdie diversiteit gee aanleiding tot verskillende sienswyses en praktyke met betrekking tot gesondheidskwessies soos gestremdheid, wat op gestremde persone 'n impak het. Die doel van hierdie studie was om die kennis, sienswyses en kulturele opvattings rakende gestremdheid by die drie breë kulturele groepe van Suid-Afrika (Swartes, Kleurlinge en Blankes) te ondersoek en te bepaal wat die verskille en ooreenkomste is en hoe dit die uitkoms van rehabilitasie van gestremde persone in die Wes-Kaap raak. Sestig respondente (20 Swartes, 20 Kleurlinge en 20 Blankes )is tydens gestruktureerde onderhoude ondervra. Die "Knowledge, attitude and belief' (KAB) onderhoud is gebruik: Beide 'n waarskynlikheids en nie-waarskynlikheids steekproef en 'n kwantitatiewe en kwalitatiewe ondersoekmetode is vir die studie gebruik Die resultate het getoon dat Blankes sowel as Kleurlinge 'n redelike goeie kennis het van gestremdheid en die oorsake daarvan, wat reeds op 'n jong ouderdom opgedoen word. Daarteenoor het Swartes gewoonlik 'n meer oppervlakkige kennis van gestremdheid, wat eers na die geboorte van 'n gestremde kind verwerf word. Kwantitatief is getoon dat al die kultuurgroepe 'n positiewe houding het teenoor rehabilitasie en onderrig van, huwelik met, hê van kinders en indiensneming van gestremdes. Houding teenoor die stigma gekoppel aan gestremdheid was ook bevredigend. In teenstelling hiermee het die kwalitatiewe data ongelykheid tussen die drie kultuurgroepe getoon in houding teenoor rehabilitasie en onderrig van en huwelik met gestremdes. Swartes beskou rehabilitasie as belangrik vir die gestremde sowel as die familie, maar ervaar probleme met toeganklikheid tot rehabilitasie. Sosio-ekonomiese faktore impakteer hierop. Skoolkinders en onderwysers in Swart en Kleurlingskole toon 'n algemene gebrek aan bewustheid van gestremdheid, wat integrasie in die hoofstroom-onderwys kan bemoeilik. Die Swart groep het huwelik met en hê van kinders beskou as 'n manier om die ondersteuningsnetwerk van die gestremde uit te brei, waarteenoor die Blanke en Kleurling groepe die huwelik beskou as 'n manier vir die gestremde om die lewe te geniet en dat die hê van kinders 'n individu se keuse is. AI drie die groepe glo dat die gestremde die reg het op indiensneming en om 'n salaris te verdien. Sover dit die sienswyses oor gestremdheid betref, blameer die Swart groep die toorkuns daarvoor en besoek hulle die tradisionele geneser sowel as professionele gesondheidswerkers. Hulle verwag genesing van God .. Blankes en Kleurlinge glo dat gestremdheid die gevolg is van natuurlike oorsake, menslike foute of die wil van God. Daar was ongelyke geografiese verspreiding van inligting oor gestremdheid. Kulturele sienswyses oor gestremdeheid mag 'n remmende invloed hê op op vroeë identifikasie en intervensie by kinders. Twee hoof aanbevelings kan op grond van die resultate gemaak word. Eerstens behoort professionele gesondheidswerkers ingelig te wees oor die kultuur, waardes, sienswyses en verwagtinge van hul kliënte, en dit te verstaan. Dienslewering behoort na die ontvangers se eie omgewing, kultuur en gemeenskap via die GBR-model gebring te word. Tweedens beveel ek aan dat 'n evaluering van kennis en sienswyses, rakende gestremdheid, in skole gedoen word. 'n Vergelyking kan getref word tussen die skole waar bewusmaking van gestremdheid reeds deur NRO's gedoen is, teenoor die waar geen intervensie was nie. So 'n ondersoek behoort in al die provinsies van Suid-Afrika uitgevoer te word. Die uitkoms van hierdie studie het dus implikasies vir beide die voorsiening van inklusiewe onderrig en kwaliteit rehabilitasie-dienste vir al die gestremde kinders in Suid-Afrika.

In six experiments, the relationships between history of falls, reinvestment, fear of falling, perception, balance ability and walking ability of community-dwelling older adults was investigated. In addition, the Movement Specific Reinvestment Scale (MSRS) (Masters, Polman, & Hammond, 1993; Masters, Eves, & Maxwell, 2005) was further validated, using a Chinese version (MSRS-C). In the first experiment (Chapter 2), it was shown that elder fallers scored significantly higher than non-fallers on both the movement self-consciousness and the conscious motor processing components of the MSRS-C. The conscious motor processing component of the MSRS-C was found to discriminate previous faller from non-faller status. In the second experiment (Chapter 3), findings demonstrated that internal focus of attention was greater in elder repeat fallers and increased as task demands increased. However, external focus of attention increased in both elder repeat fallers and elder non-fallers as task demands increased. Elder repeat fallers scored significantly higher than elder non-fallers on the MSRS-C. In the third and fourth experiments (Chapter 4), it was revealed that elder fallers demonstrated greater fear of falling and a higher propensity for movement specific reinvestment than non-fallers. Elderly people perceived stairs as steeper than they were and judged stairs as steeper when making visual-matching and verbal-report estimates that required conscious involvement compared to haptic estimates that are thought to require little conscious involvement. Overestimations when making explicit, conscious judgments were reduced by carrying out a concurrent secondary task during estimation, but there was little effect of the secondary task on implicit, non-conscious judgments of steepness. In Chapter 5, focus group work was conducted to investigate whether (1) elderly people respond differently when asked to complete the MSRS-C in respect of contexts that are not directly related to balance or locomotion and (2) elderly people are better able to differentiate a 4-point Likert response format when completing the MSRS-C than the original 6-point format. Experiment five (Chapter 6) further validated the MSRS-C based on the findings from Chapter 5. Results revealed that both the MSRS-C (general) and MSRS-C (walking) can be used with a six-point or a four-point response format to differentiate elderly Chinese fallers from non-fallers. The overall findings were discussed in the context of theories of motor learning and reinvestment. Implications for rehabilitation training were elucidated. / published_or_final_version / Human Performance / Doctoral / Doctor of Philosophy

published_or_final_version / Politics and Public Administration / Master / Master of Philosophy

Thesis (M. Sc.)--University of Hong Kong, 1998. / Includes bibliographical references (leaf 74-76).

This study examined: the features and extent of the gait velocity decrement following stroke; the nature of the balance disorder and; investigated relationships between gait and balance. Twenty, fully-ambulant, hemiplegic subjects (12 men and 8 women), with a mean age of 57.2 years (± 10.7), were compared with 20 age- and sex-matched controls. Spatiotemporal gait kinematics were measured at five walking speeds ranging from "very slow" to "very fast". Balance was then measured while subjects maintained a variety of weight shift postures both with feet parallel and then in diagonal positions similar to those assumed during the double support phases of gait. Location and variability of centre of pressure (CP) were measured and the ranges over which CP could be shifted were calculated. Stroke subjects walked very slowly with their "fastest" walking speed (0.5 stat/s ± 0.23) no different from the "slowest" speed (0.38 stat/s ± 0.11) of the controls (p > 0.05). Differences between the other parameters were also found, many of which could be attributed to the differences in walking speeds. However, where the subjects walked at similar velocities, the hemiplegic sample walked with quicker and shoner strides suggesting a "cautious" gait pattern. The single support asymmetry of the strokes decreased with increasing walking speed. The positions of CP in the hemiplegic sample were found to be significantly displaced towards the unaffected leg and deficiencies were found in posterior shifts (p < 0.05). Postural sway was significantly greater in the hemiplegic sample implying less stable balance and the ranges over which the hemiplegic sample shifted weight were significantly less than the controls. The diagonal weight shift tests revealed the difficulty the stroke subjects experienced in shifting CP posterolaterally over the affected leg. Significant correlations were detected confmning the presence of relationships between static balance performance and gait. However, these correlation findings left considerable percentages of variance unexplained. These findings suggest that future rehabilitation should address the poverty of range of walking speed possessed by hemiplegic subjects as well as the reduced ability to weight shift over the hemiplegic limb, particularly posterolaterally. Further study to test these proposals is indicated.

Studies have shown that operant procedures can be successfully used in physical rehabilitation. This study was an attempt to develop standing and walking behaviors in a 47-year old male who was confined to a wheelchair. A multiple baseline design across settings was used to demonstrate the effects of verbal, physical and edible reinforcers on three sub-behaviors of standing. The first two sub-behaviors were trained and training had begun on the third sub-behavior when the study was abruptly terminated. Thus, no training sessions for walking took place.

In people with neuromotor deficits of trunk and lower extremities, maintaining and regaining balance is a difficult task. Many undergo rehabilitation to improve their movement capabilities, health, and overall interactions with their environment. Rehabilitation consists of a set of interventions designed to improve the individual’s mobility and independence. These strategies can be passive, active or task-specific and are dependent on the type of injury, how the individual progresses, and the intensity of the activity. Some of the common rehabilitation interventions to strengthen muscles and improve coordination are accomplished either by the manual assistance of a physical therapist, bodyweight suspension systems or through robotic-assisted training. There are several types of rehabilitation robotic systems and robotic control strategies.However, there are few robotic studies that compare their robotic device’s control strategy to common rehabilitation interventions. This dissertation introduces robotic strategies centered around rehabilitation ones and characterizes human motion in response to the robotic forces. Two cable-driven robotic systems are utilized to implement the robotic controllers for different tasks. Further details of the two cable-driven systems are discussed in Chapter 1. The validation and evaluation of these robotic strategies for standing rehabilitation is discussed in Chapter 2. A case study of a robotic training paradigm for individuals with spinal cord injury is presented in Chapter 3. Chapter 4 introduces a method to redistribute individuals’ weight using pelvic lateral forces. Chapter 5 and 6 characterizes how young and older groups respond to external perturbations during their sit-to-stand motion. This dissertation presents robotic strategies that can be implemented as rehabilitation interventions. It also presents how individuals’ biomechanics and muscle responses may change depending on the force control paradigm.These robotic strategies can be utilized by training individuals to improve their reactive and active balance control and thus reduce their risk of falling.