A dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfilment of the requirements for the degree of Master of Science in Occupational Therapy. Johannesburg, May 2019 / Background: Literature shows that access to rehabilitation services for persons with disabilities in South Africa is limited. Recent policy documents by the National Department of Health related to disability and rehabilitation propose integration of occupational therapy services in primary healthcare (PHC) reengineering. However, the implementation strategies are not entirely clear as there is inadequate evidence locally on the occupational therapy service provision in PHC even though there is growing evidence internationally. Purpose: This study sought to determine the services provided by occupational therapists in PHC. Their perceptions of the integration of occupational therapy services within the PHC reengineering streams was also explored. Methods: A two-phase explanatory sequential mixed method strategy was utilized in this study with data from the first quantitative phase guiding the second qualitative phase both of equal weights. The first phase was a nationwide cross-sectional quantitative survey strategy using an electronic questionnaire developed on REDCap to establish the extent to which occupational therapy services are delivered in PHC in South Africa. The second phase was an in-depth study using semi structured interviews to comprehensively explore with the occupational therapists practicing in PHC on their perceptions of integrating occupational therapy services in the PHC reengineering streams of the National Health Insurance (NHI). Ethics approval (M180819) was sought and obtained from the University of the Witwatersrand Human Research Ethics Committee (Medical). Analysis: Descriptive analysis was done for the close-ended questions of the quantitative survey, frequencies and content analysis was done for the open-ended questions in the survey, and thematic content analysis was done for the qualitative data. Trustworthiness procedure such as confirmability, member-checking, dependability and triangulation of data sources (In-depth semi-structured interviews, field notes and survey) was used to ensure credibility of the research findings. Results: Findings from this study showed there is increasing alignment of occupational therapy services in PHC with the community-based rehabilitation (CBR), the Social Model, the International Classification of Functioning (ICF), and Medical Model using self-management and case-management intervention approaches. The majority of occupational therapists in PHC work on the hospital-based MDT comprising other rehabilitation professionals and nurses. Occupational therapists in PHC have a strong perception of their relevance in the PHC reengineering streams despite the numerous barriers and few facilitators available for the integration of occupational therapy services in PHC reengineering streams of the NHI currently. Their perception is that occupational therapy service integration in the PHC reengineering streams will lead to improved healthcare and the integration will not happen without occupational therapy being adequately supported in PHC. Conclusion: This study serves to provide evidence to help position occupational therapy and by extension other rehabilitation professions in the PHC reengineering streams of the NHI. The integration of occupational therapy services in the PHC reengineering streams of the NHI is essential to improve the health outcomes of the population and reduce the overall healthcare cost and growing burden of non-communicable diseases in the country / E.K. 2019

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The present research investigates the relationship between spoken language and reading processes by using several experimental techniques to examine the nature of the phonological representations used during silent reading. Experiments 1 through 4 measured eye movements during sentence reading and lexical decision using a parafoveal preview paradigm. In Experiment 5, brain electrical potentials were recorded in a four-field masked priming paradigm during passive reading of single words. Experiments 1 and 2 asked whether the phonological representations used by skilled readers in lexical access are minimal and contain only consonant information, or whether they include phonological vowel information as well. Experiments 3, 4, and 5 examined whether the phonological representations used in lexical access contain prosodic information about syllables as well as phoneme information. In combination, these experiments demonstrated that skilled readers are sensitive to vowel and prosody information presented in parafoveal previews and masked foveal primes. This suggests that readers routinely activate elaborate, speech-like phonological representations early in word recognition during silent reading. The phonological hub theory of silent reading is proposed to account for this finding and situate orthographic and phonological processes in the context of natural silent reading.

Compound words are morphologically complex words that are composed of two lexemes (e.g. farmhouse, blackboard). By investigating how compound words are processed, insight can be gained into the organization of the mental lexicon. Five experiments are reported which explored how English compound words are processed. In each experiment, compound words were embedded into sentences and readers' eye movements were recorded as they read these sentences. Several reading time measures were analyzed to investigate the time-course of compound word recognition. Representations of the compound words were examined by manipulating the frequency of the beginning lexeme in the compound (Experiments I1A, 1B, 3A), the frequency of the ending lexeme (Experiment 3B), or the familiarity of the whole compound word (Experiment 2). Experiments 1A and 1B demonstrated that compound word length does not consistently modulate whether beginning lexeme frequency effects are observed for English compound words. However, there are larger effects for overall compound familiarity on most reading time measures for long compound words compared to short compound words (Experiment 2). Experiments 3A and 3B manipulated the predictability of the sentence context with respect to compound words. Having a highly predictive sentence context significantly reduced early effects of beginning lexeme frequency (Experiment 3A), but not later effects of beginning lexeme frequency (Experiment 3A) or ending lexeme frequency (Experiment 3B). Also, compound words that contained a high frequency lexeme were read faster than length and frequency matched monomorphemic words. Correlations and multiple regression analyses suggested that the size of a compound word's morphological family and the number of higher frequency morphological family members significantly affect compound word reading time. The results are discussed in terms of a proposed framework for English compound word recognition where morphological representations are hierarchically organized within the lexicon.

The aim of this dissertation was to examine the use of accelerometers to measure physical activity (PA) in children with and without disabilities and address some of the current methodological issues involved with their use. Study I compared the activity level of children with Down syndrome (DS), children with intellectual disabilities without DS, and children without disability. Subjects wore ActiGraph accelerometers for seven days. There were no significant differences in PA level among the three groups of children as measured by mean ActiGraph counts per day. No difference was found between groups in the amount of time spent daily at different activity intensities. This study was the first to objectively assess PA in children with disabilities using accelerometers and demonstrated that accelerometers are feasible for PA measurement in children with cognitive impairments. Study II and Study III examined methodology issues with accelerometer data interpretation. Study II compared the accuracy of several count cut-point values used to define activity intensity ranges. Fifty-one children wore an ActiGraph at the hip while performing locomotor or free-play activities. Actual MET level, measured via indirect calorimetry, was compared to the predicted MET level from the different ActiGraph cut-points. Percent agreement between actual and estimated intensity level ranged from five to 100 percent between the different cut-point thresholds. These results quantified the differences in intensity classification seen with the different cut-points and demonstrated ActiGraph results extrapolated from different cut-points cannot be compared. Study III assessed the use of the count coefficient of variation (CV) to distinguish locomotor from non-locomotor activities in children. The accuracy of energy expenditure (EE) prediction using a dual-equation method based on count CV was compared to the accuracy of using a single prediction equation. The count CV distinguished between locomotor and non-locomotor activities quite well. Despite this, using the activity specific dual-equation method to predict EE did not improve accuracy compared to single prediction equations. No prediction equation tested adequately estimated EE from count values in this study. Due to the variable nature of movement and play in children, and metabolic and size differences, predicting EE from hip-mounted accelerometers is not ideal.

Many studies show that bottom-up and top-down information interactively control attentional deployment. This study explores how these two factors are integrated when controlling attention and eye movements. In this study, attention was affected by top-down factors (informative location cues, strategies) and by a bottom-up factor (an orientation singleton), with the intensity of each manipulated systematically. Results of Experiment 1 showed that one top-down factor (previous knowledge about the target location) can control attention independently from the bottom-up factor. This result raises some difficulties for those models that predict competition between top-down and bottom-up factors to control attention. The study implies separation between the pathways for top-down attention control and bottom-up attention control. This pattern is consistent with recent neuroscience findings, which show that different brain regions are involved in top-down and bottom-up attention control. Strategies were manipulated between Experiment 1 and Experiment 2. In Experiment 1, participants were encouraged to employ a singleton detection mode; in Experiment 2, participants could not employ a singleton detection mode. Results showed that the singleton could capture attention in Experiment 1; however, only the most salient singletons could capture attention in Experiment 2. This result is only partially consistent with the idea that a singleton could capture attention only when participants employ a singleton detection mode. Singletons with some specific properties could apparently capture attention even when participants could not employ singleton detection mode. Experiment 3 showed that eye movements are also controlled by the interaction of the top-down factors and the bottom-up factors. First saccades went to the singleton location more often if participants employed singleton detection mode than if they used a different strategy. First saccades also went to the singleton location more often when the informativeness of the cue decreased, and when the orientation of the singleton increased. Eye movement control differed from covert attention control in that it showed competition between top-down and bottom-up factors. This difference in overt and covert attentional control probably arises because covert attention can be simultaneously split across multiple locations, while the eyes can only be directed to a single location at any one time.

The purpose of this current study was to first examine through assessments and the use of school-based disability criteria, the quantitative and qualitative patterns in phonological processing, phonological working memory, oral retellings, and oral and written narratives in middle school-aged children with reading disabilities (RD; N=10) and those with language impairments (LI; N=5) in order to provide data to further explain the complex profiles of these two clinical populations. Secondly, a single-subject multiple baseline across subjects design study examined the effectiveness of an intervention program targeting expository and narrative discourse in adolescents with language and reading deficits (N=4). Expository and narrative discourse assessments were replicated at post-intervention for pre and post comparisons of performance. The findings will assist speech-language pathologists in accurately and efficiently evaluating and treating these two clinical populations in linguistic areas that are critical to successful academic and social development.

Background: Understanding the factors that contribute to drinking alcohol during pregnancy is critical to supporting women's and children's health and wellness in rural Tanzania. The drinking of alcohol during pregnancy is a cause for concern in Tanzania. Due to high rates of foetal alcohol spectrum disorder (FASD) in the country, reducing alcohol use during pregnancy is a pressing public health priority. Purpose: Alcohol consumption is a major problem in Tanzania that needs immediate attention (Franscis, Weiss, Mshana, Baisley, Grosskurth & Kapiga, 2015). The purpose of this research was to investigate the factors that contribute to the drinking of alcohol among pregnant women in rural Kilimanjaro to inform the health promotion actions which the government, the health systems, and Tanzania Occupational Therapy Association (TOTA) need to take regarding drinking during pregnancy. Method: A qualitative research approach was used for the study, utilising a qualitative descriptive design. The study was located within the social constructivist theoretical framework (Creswell, 2013). Eight participants were selected for this study, who were eighteen years old and above, some of whom were pregnant and drinking alcohol, and some who were not currently pregnant but had engaged in drinking alcohol in previous pregnancies. In-depth interviews explored the participants' personal experiences with drinking during pregnancy, and community norms and attitudes towards maternal drinking and knowledge about FASD were observed using participant observation. Transcripts were analysed using an inductive, thematic data analysis approach. Findings: From the data analysis, three themes emerged: “Tangu enzi na enzi”(from generation to generation), “kua na muda mzuri” (to have a quality moment) and “mimi ni binadamu kama wengine”(I am a human like others). The first theme affirmed the contextual factors such as historical, cultural, physical, and social-political factors that contribute to women from rural Kilimanjaro drinking alcohol during pregnancy. This theme confirms the historical and pervasive presence of alcohol use during pregnancy. The second theme revealed social engagement and interactions, particularly due to deeply rooted values of ujamaa (familyhood/unity) in the community, as the factors influencing drinking alcohol among women during pregnancy. The third theme gave insight into how economic situations, conflicting knowledge, religion, and spirituality factors enhanced women's decision to drink alcohol during pregnancy. Implications: By examining the factors contributing to drinking alcohol during pregnancy, this study is contributing to the body of knowledge in assisting the Tanzania Occupational Therapy Association (TOTA) and the Tanzania Ministry of Health towards their goal of reducing the prevalence of FASD in rural Kilimanjaro. This research will also contribute to the capacitation of women about healthy choices regarding their drinking during pregnancy and substitution.

Previous research examining lexical-retrieval difficulty in bilinguals with aphasia (BWA) has identified a verb-noun dissociation in naming in both first (L1) and second (L2) languages, i.e., a lower naming accuracy for verbs than nouns. Yet, the evidence is limited to typologically similar languages, and whether the same patterns of lexical impairment emerge in other linguistic contexts (i.e., discourse) is unclear. Lexical-retrieval difficulty has been commonly targeted in bilingual aphasia rehabilitation, but mainly focused on nouns. Whether similar patterns of treatment-induced language recovery emerge in both noun and verb treatment remains unclear. Studies implementing semantic-based treatment have shown robust treatment gains, but patterns of generalizations are inconsistent. Most evidence in bilingual aphasia rehabilitation has come from individuals speaking Indo-European languages. Given that the Chinese-speaking population is rapidly growing nationwide, future research needs to establish the evidence base for aphasia rehabilitation in this population. Hence, two studies were undertaken in this dissertation work to address these critical issues. In Study 1, twelve Mandarin-English BWA were administered a battery of standardized naming and discourse tasks in both languages. A verb-noun dissociation was found across languages in single-word naming and discourse production. The magnitude of this verb-noun dissociation was similar in L1 and L2 in naming but was significantly larger in L2 than in L1 in discourse, depending on the specific task. Findings indicated a direct relationship between naming and lexical retrieval in discourse irrespective of the target language. In Study 2, the same group of Mandarin-English BWA underwent semantic-based treatment targeting noun and verb retrieval. These participants demonstrated improvement on the overall aphasia severity and lexical retrieval based on their performance on the standardized language assessments. Results from weekly naming probes showed a positive treatment gain in both noun and verb treatment, but to a greater extent in verb treatment. Generalization to semantically-related items was captured in noun treatment. Cross-language generalization was identified in both treatments, but to a larger extent when training verbs. Additionally, widespread generalizations beyond the single-word level and to untrained naming tasks were found following both noun and verb treatment. However, more generalizations were captured after noun treatment, particularly in discourse and untrained naming tasks. These two studies provided strong evidence of bilingual language impairment and treatment-induced language recovery between nouns and verbs in Mandarin-English BWA. The general discussion reviews key findings from Studies 1 and 2 and discusses clinical implications for studying bilingual aphasia recovery and language rehabilitation in future work. / 2024-08-24T00:00:00Z