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Thesis (M.S.)--Boston University

The South African National Development Plan (NDP) (National Planning Commission, 2011, p. 1) provides the road map for a reformed public health system by 2030. The proposed health system will be facilitated by, amongst others, training an appropriate balance of healthcare professional s including a cadre of community health workers (CHWs) that have a broad skills mix suited to reaching a larger number of people with first level intervention. With this in mind, a pilot group of CHWs were up-skilled as Rehabilitation Care Worker s (RCWs). The training program was a joint project between the Division of Disability Studies and the Departments of Occupational Therapy, Physiotherapy and Speech and Language Therapy at UCT. Problem: Little is known about the perspectives of RCWs on the benefits and challenges of additional training in rehabilitation and disability related skills. Rationale: To inform the curriculum for a rehabilitation care worker (RCW) training program and the Western Cape Department of Health (WCDoH) of ways in which this cadre of worker could contribute to the realization of the 2030 Healthcare Plan. Aim: To describe the outcomes of a pilot RCW training program from the perspective of the pilot group of graduates. The objectives were to identify the areas of practice where RCWs feel competent/incompetent, to identify aspects of the health services where RCWs believe they can contribute the most/the least and to identify the facilitators/barriers they experienced when deployed in the health field. Methodology: A qualitative descriptive study was conducted. Method: Focus groups were carried out with three groups of six participants. Findings: The plot that permeated the participants’ perspectives revolved around how the RCWs were pioneers in breaking new ground for the Western Cape Department of Health (WCDoH). Two themes informed the plot: "we move health services to a new level" and "we manage change in new ways". Discussion: It is argued that the pilot RCW curriculum achieved its’ objective of equipping a cadre of worker with basic rehabilitation, care and disability inclusion skills. While the envisaged role of RCWs in the health service and in making the NDP a reality is supported, it is argued that attention needs to be given to supervision structures and to training of all other health workers in order to promote inter professional practice. Conclusions: The pilot group of RCWs believe that they have acquired a new and large variety of skills that have enabled them to make a broad and positive impact in their places of work, at home and in the broader community.

The purpose of the study is to contribute to the development of a tool that can support the rehabilitation care worker towards intervention planning and the monitoring of their clients. The National Health Insurance and the Framework and Strategy for Disability and Rehabilitation of the South African Department of Health are strategies to work towards accessible, affordable, equitable and quality health care, which includes health promotion, disease prevention, curative, rehabilitation and palliative services for all South Africans. Both strategies emphasise the use of community health workers and mid-level workers as a key component of primary health care. In the Western Cape provincial Department of Health a new cadre, namely the rehabilitation care worker has been introduced as a member of the rehabilitation team. The introduction of the rehabilitation care worker is still in the pilot phase. The rehabilitation care workers face many barriers to providing effective care. One such challenge is the lack of a contextually relevant resource tool to collect information on the rehabilitation and health needs of persons with disabilities. The aim of the study was to develop a contextually relevant resource tool that would support the rehabilitation care worker in understanding and documenting how the rehabilitation and related health needs of persons with disabilities are met in home- and community-based settings. Three specific objectives were defined: i) to develop the content and domains of the rehabilitation and health information tool; ii) to establish the validity (face and content) of the rehabilitation and health information tool; and, iii) to test the application of the rehabilitation and health information tool on a sample of persons with disabilities. This study was an exploratory descriptive study adopting a sequential mixed methods design. There were two phases in this study. Phase 1 involved qualitative research methods in the development of the rehabilitation and health information tool through the use of document review and a focus group discussion with experts. Phase 2 of the study involved quantitative research methods in the field testing of the rehabilitation and health information tool by the rehabilitation care workers on a sample of persons with disabilities. The results of phase 1 included the development of the rehabilitation and health information tool, which was deemed by the experts to be a comprehensive, contextually relevant tool with face and content validity and could be easily administered by the rehabilitation care worker. The conceptual framework of the International Classification of Functioning, Disability and Health provided domains that could comprehensively document the multidimensional needs of persons with disabilities. The result was a draft rehabilitation and health information tool with 17 questions ranging across the domains of activities of daily living, sexual health, health behaviours, barriers and facilitators to good health, finance and understanding of disability. Changes were proposed to the wording, layout and flow of the tool and the persons with disabilities’ goals were included as an element . The inclusion of the end users as experts in the development resulted in a richer understanding needed for the shaping of this tool. The results of phase 2 highlighted that the rehabilitation and health information tool was able to describe the rehabilitation and health needs of persons with disabilities. Additionally the tool was able to document the specific goals of the persons with disabilities which is useful to plan and monitor intervention. The rehabilitation care workers reported the tool to be useful, easy to use, and provided a structured manner to collect information. They also reported that it was useful in stimulating conversations on sensitive topics. However, it was indicated that it took too long to complete and there were components that were incomplete. The rehabilitation and health information tool requires further refinement, validation and further follow-up testing before it can be formally adopted and implemented as part of the rehabilitation care worker’s standard practice.

This theses discusses thoracic surgeries and their effect on thoracic kinematics since those patients aren't usually indicated for outpatients physiotherapy. Theses observes the changes of thoracic kinematice in time withnout the interference of outpatient physiotherapy. Patients were acquainted during their hospitalization and they received a flyer. The theoretical part focuses on thoracic surgeries, options of respiratory physiotherapy and effects of thoracic surgeries on patients. The practical part observers the effect of thoracic surgery on chest expansion, development of pain (using Visual pain scale and Questionnaire of pain interference with daily activities) and effect of the surgery on quality of life using WHOQOL BREF questionnaire.

Diplomová práce Vliv a možnosti fyzioterapie u pacientů po onkologicko-chirurgických zákrocích hrudníku - její specifika v předoperačním, akutním pooperačním a ambulantním období Abstract Lung tumor diseases are the most frequent tumors in the world. In men it is the most common tumoral disease in incidence, in women it occupies the third place. Bronchogenic carcinoma is the most frequent one, which includes tumors of trachea, bronchus and lung parenchyma. In most cases, the treatment requires surgical removal associated with hospitalization and subsequent rehabilitation. The theoretical part addresses oncologic surgical issues of lung tumors. A major part of the theory is dedicated to the options of physiotherapy and its specifics in particular parts of rehabilitation care. The practical part observes two groups of patiens and comparatively evaluates the effect of the therapy in particular parts by objective and subjective tests.

The diploma thesis deals with the field of the care after quadriplegics in the Czech Republic and the United Kingdom. The aim of the diploma thesis is to describe positive and negative aspects of the care provided to quadriplegics both in Great Britain and the Czech Republic from the point of view of the care users, and subsequently to propose possibilities of improvement of the care in the Czech Republic. The theoretical part explains quadriplegia and outline social and health systems for quadriplegics in the Czech Republic as well as in the United Kingdom. This part includes the description of compensatory aids available for clients, conditions of health and social insurance, rehabilitation care options and financial support in both countries. In the research part, based on data interpretation of the data collected by qualitative research technique (interviews that were implemented with quadriplegics living the Czech Republic and United Kingdom), I analyze the situation of the clients of both social and health systems. These interviews revealed several areas of positive and negative evaluation of the existing situation and highlight possibilities of potential future improvement of the care in the Czech Republic.