This investigation explored the relationship of demographic, social network, social support, and stroke-related factors to depressive symptomatology and well-being in 50 elderly individuals who had recently suffered a first, completed stroke and their partners. Data were gathered at two points in time, with interviews scheduled six months apart. Outcome measures included the CES-D depression scale and the Index of Psychological Well-Being. Data were analyzed using descriptive statistics, correlational procedures, multiple regression, and change-focused regression analyses. For the caregivers, lower depression levels at Time 1 were associated with better subjective health, less concern about being able to care for the patient in the future, higher levels of patient ADL functioning, greater perceived pre-stroke instrumental support, and greater patient optimism. At Time 2, lower caregiver depression scores were associated with lower levels of perceived burden, fewer health problems or negative changes in health status, fewer negative network interactions, greater network density, greater frequency of network contacts, and fewer perceived personality and behavior changes in the patient. Best predictors of depression score for the caregivers at Time 1 were subjective health rating, the patient's level of ADL functioning, degree of concern about ability to care for the patient in the future, the proportion of the network providing instrumental support, and the percent of reciprocal confiding relationships reported. At Time 2, best predictors of depression were level of perceived caregiver burden, objective health score, and network density. The best predictor of caregiver depression level over time was Time 1 depression level. Perceived caregiver burden was also a strong predictor of depression score. For the patients, higher depression scores at Time 1 were associated with whether they felt they could have done anything to prevent the stroke, higher levels of concern about their partner's ability to care for them in the future, and greater reported frequency of pre-stroke disagreement with their partners. At Time 2, higher levels of depressive symptomatology were associated with decreased satisfaction with amount of social contact, a greater proportion of friends in the post-stroke network, a greater degree of perceived negative health change, and change in employment status.

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The literature on stroke reveals an increasing interest in the role played by social and emotional factors in rehabilitation after stroke. A comprehensive literature survey shows profiles of spontaneous recovery, the significance of a team approach to rehabilitation, patterns of prognostic significance for long-term recovery and adaptation and formulations of rehabilitation models for the Western world. The importance of depression as a major factor in demotivation to participate in rehabilitation and achieve long-term quality of life post-stroke emerges. From the literature survey a research design was formulated for the ecological study of a sample of 51 stroke patients at Ga-Rankuwa Hospital near Pretoria. The questionnaire was structured according to the Synchronous Systems Model, and data gathered from the biological, personal and environmental spheres of patients. Data was collected by a multidisciplinary team at three assessment times, three days, two weeks and three months post-stroke. These corresponded to the acute physical phase of stroke, the end of the hospitalisation period, and an assessment of patients once they had been discharged back into the community. Descriptive statistics were obtained on all variables and principle axis factor analysis was performed to verify the factorial structure of the tests. In order to establish whether group scores changed between assessments, t-tests for dependent measures were applied. Pearson Product Moment correlations were computed for the purpose of establishing relationships between variables. The results revealed dramatically differing biographical characteristics of the sample of stroke patients both premorbidly and at three months after the stroke. Significant recovery profiles emerged in both the physical and neuropsychological spheres at both the 14 day and 3 month assessments. Depression and the functioning at home and at work social sphere of role emerged as profiles of deterioration. At 14 days, depression was related to physical and cerebral functioning. This changed at three months, with depression also being significantly related to aspects of social functioning. On the basis of these results, depression after stroke was conceptualised as a severance of relational connectedness in the social ecological functioning of stroke patients. An ecological approach to rehabilitation is proposed that would seek to reframe the identity of stroke patients and establish relational connectedness post-stroke. / Psychology / D. Litt. et Phil. (Psychology)

published_or_final_version / Speech and Hearing Sciences / Master / Master of Science in Audiology

published_or_final_version / Nursing Studies / Master / Master of Nursing

published_or_final_version / Nursing Studies / Master / Master of Nursing

In mainland China, around 20,000 infants with non-syndromic cleft lip and/or palate are born every year. There is a great clinical need for the rigorous investigation of the speech problems in this population. This thesis aimed to investigate the consonant misarticulations in native Putonghua speakers with repaired cleft palate based on a research project comprised of four studies. Misarticulations associated with cleft palate are well established for English and several other Indo-European languages. However, few research articles describing the articulation of Putonghua (standard Mandarin Chinese) speakers with cleft palate have been published in English language journals. Study One reviewed relevant studies published over the past 30 years in Chinese language journals. Thirty-seven articles were analyzed and coded on a number of methodological variables. This critical review identified many methodological issues. These design flaws made it difficult to draw reliable conclusions about characteristic articulation errors. Seeing the methodological shortcomings found in Study One, a cross-sectional approach was used in Study Two to identify common consonant error patterns. Thirty-two speakers with repaired cleft palate were allocated to four groups dependent on age and the type of cleft. Articulation was evaluated based on the Putonghua Segmental Phonology Test and the Deep Test for Cleft Palate Speakers in Putonghua. The data were transcribed using International Phonetic Alphabet conventions by two experienced examiners. Several ‘language universal’ findings were identified. In addition, distinctive features in Putonghua phonology appeared to contribute to the observed language specific error patterns. The following two studies focused on the particularly vulnerable manner of articulation: affricates. The results from Study Three showed that distorted affricates from speakers with repaired cleft palate exhibited distinctive spectral features compared to typical articulation. These spectral findings added objective evidence to support the articulation deviation noted in Study Two. Study Four examined the relationship between spectral moments and perceptual judgment of accuracy for the place of affricate and to explore whether listeners relied on different spectral moments to perceive place of articulation. Both typical and distorted affricates were played to twelve listeners to make a judgment of articulation accuracy using visual analog scaling. Results showed that the third spectral moment (L3) was significantly correlated with perceptual rating of accuracy of place information from typical speakers. For affricates produced by speakers with cleft palate, the first moment (M1) showed a significantly correlation with perceptual judgment of the accuracy of alveolar affricates. Recommendations concerning methodological issues in the perceptual investigation of cleft palate speech were given in the systematic review. For the first time, the speech error study demonstrated the influence of language-specific features on Putonghua cleft palate speech. The spectral study contributed to our understanding of the differences in affricate production between speakers with cleft and their typical speaking peers. The investigation of the relationship between spectral features and the perception of alveolar and retroflex affricates provided specific clinical directions for establishing the correct place of articulation. Further research is needed to explore the contribution of other variables (e.g., age of palatoplasty) to the error patterns identified in the present study. / published_or_final_version / Speech and Hearing Sciences / Doctoral / Doctor of Philosophy

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