The term ‘disability’ is laden with medical origins and medical meanings, which contribute to exclusion and oppression for persons labeled as ‘disabled’. Moreover, these processes are amplified by constructing disability as an individual burden or personal tragedy. Medicalizing disability keeps it a personal matter, a personal problem that needs to be treated, rather than addressing the social processes that actually restrict or constrict the disabled person’s life. Rehabilitation Science and my lived experience of disability and walking serve as contexts that assist me as I explore how my subjectivity as a disabled woman and clinician helps me understand the theoretical tensions of five key themes: independence, power, client-centred practice, ableism, and the social model of disability in relation to disability and rehabilitation. These themes offer me a way to analyze my experiences, and how I have come to access and engage with Disability Studies literature in order to deepen my understanding of the critiques on disability and rehabilitation. As an insider, my research explores three decades of personal narrative. Through critical reflexivity as part of autoethnography, I work to increase my own awareness and that of my readers on the tension and complexities with respect to disability and rehabilitation. / Dissertation / Doctor of Philosophy (PhD)

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<p><strong>Introduction: </strong>Barefoot running is growing in popularity as runners seek strategies to avoid running-related injuries (RRIs). A new theoretical perspective suggests that the improved cutaneous sensation during barefoot running results in a less injurious running style characterized by increased cadence, landing on the forefoot and more knee flexion. The mechanisms by which the barefoot running style may have an effect on RRIs are not well understood.</p> <p><strong>Purpose: </strong>Explore the new theoretical perspective on RRIs that supports the barefoot running style and investigate the effects of modified cutaneous sensation on the adaptation to and retention of the barefoot running style.</p> <p><strong>Methods: </strong>First, a scoping review was performed to identify implicit theory underlying both traditional shod and barefoot running research and practice. Second, a feasibility study investigated altered cutaneous sensation as a proposed mechanism by which a person learns and retains the skill of barefoot running. Sixteen participants ran shod on a treadmill then were randomized to receive one of four cutaneous sensation treatments. They then ran barefoot for the first time and 48 hours later. Changes in the cadences, foot angles and knee angles means and variations across runs and treatment groups were used to quantify learning and retention.</p> <p><strong>Results:</strong> The scoping review provided evidence that improved plantar cutaneous sensation, such as when one runs barefoot, could reduce the risk of RRIs. In the feasibility study, our findings suggest that barefoot compared to shod running increased plantar cutaneous sensory thresholds, and increased mean cadence and mean foot angle. Improved retention of the barefoot running style was shown in the treatment group with anaesthetic cream on their legs.</p> <p><strong>Conclusions: </strong>Plantar cutaneous sensation is proposed as an important factor when exploring the etiology of RRIs. This knowledge may influence an individual’s risk of experiencing a running-related injury.</p> / Master of Science Rehabilitation Science (MSc)

<p>Since 2004, there has been a 12% relative increase in stroke prevalence in the working-aged (18–65 years) population of Ontario. Studies have shown that successful community reintegration is an important indicator of perceived quality of life post-stroke.</p> <p>The purpose of this interpretive phenomenological study was to explore the lived experience of community reintegration for working-aged persons post-stroke in order to inform the development of appropriate and effective strategies to support their community reintegration and continued stroke recovery.</p> <p>The essence of the phenomenon of community reintegration for working-aged persons post-stroke emerged as: “Life Goes On: The journey of surviving a stroke in the prime of your life”. Six themes emerged to support this journey of community reintegration after stroke: 1) processing the shock, 2) starting the road to recovery, 3) living with stroke, 4) who am I? 5) carrying-on and 6) transcending the stroke. While participants experienced their personal journey to community reintegration in a unique way, their journey led them to realize that in order to successfully reintegrate back into their community, they needed to adjust, adapt and reach some level of acceptance in order to move on and essentially transcend their stroke</p> <p>There needs to be a call to action for the delivery of client-centered stroke care. A client centered approach to stroke care will ensure that the voices of working-aged persons post-stroke are heard and given priority in their rehabilitation and community reintegration planning.</p> / Master of Science Rehabilitation Science (MSc)

Yes / Changes in world-wide population trends have provided new demands for new technologies in areas such as care and rehabilitation. Recent developments in the the field of robotics for neurorehabilitation have shown a range of evidence regarding usefulness of these technologies as a tool to augment traditional physiotherapy. Part of the appeal for these technologies is the possibility to place a rehabilitative tool in one’s home, providing a chance for more frequent and accessible technologies for empowering individuals to be in charge of their therapy. this manuscript introduces the Supervised Care and Rehabilitation Involving Personal Tele-robotics (SCRIPT) project. The main goal is to demonstrate design and development steps involved in a complex intervention, while examining feasibility of using an instrumented orthotic device for home-based rehabilitation after stroke. Methods: the project uses a user-centred design methodology to develop a hand/wrist rehabilitation device for home-based therapy after stroke. The patient benefits from a dedicated user interface that allows them to receive feedback on exercise as well as communicating with the health-care professional. The health-care professional is able to use a dedicated interface to send/receive communications and remote-manage patient’s exercise routine using provided performance benchmarks. Patients were involved in a feasibility study (n=23) and were instructed to use the device and its interactive games for 180 min per week, around 30 min per day, for a period of 6 weeks, with a 2-months follow up. At the time of this study, only 12 of these patients have finished their 6 weeks trial plus 2 months follow up evaluation. Results: with the “use feasibility” as objective, our results indicate 2 patients dropping out due to technical difficulty or lack of personal interests to continue. Our frequency of use results indicate that on average, patients used the SCRIPT1 device around 14 min of self-administered therapy a day. The group average for the system usability scale was around 69% supporting system usability. Conclusions: based on the preliminary results, it is evident that stroke patients were able to use the system in their homes. An average of 14 min a day engagement mediated via three interactive games is promising, given the chronic stage of stroke. During the 2nd year of the project, 6 additional games with more functional relevance in their interaction have been designed to allow for a more variant context for interaction with the system, thus hoping to positively influence the exercise duration. The system usability was tested and provided supporting evidence for this parameter. Additional improvements to the system are planned based on formative feedback throughout the project and during the evaluations. These include a new orthosis that allows a more active control of the amount of assistance and resistance provided, thus aiming to provide a more challenging interaction. / This work has been partially funded under Grant FP7-ICT-288698(SCRIPT) of the European Community Seventh Framework Programme.

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)

Thesis (MPhil (Interdisciplinary Health Sciences. Speech-Language and Hearing Therapy. Centre for Rehabilitation Studies))--University of Stellenbosch, 2007. / Current emphasis for rehabilitation in South Africa remains on individual intervention within the move towards primary health care. Primary health care is the strategy that has been adopted by the South African department of health to bring access and equity in health care services. Even so, the burden of providing effective rehabilitative services with limited resources requires innovative strategies, such as the use of therapeutic groups, to address certain aspects of rehabilitation. These strategies must be proven effective. There is a paucity of literature detailing the uses of group therapy in physical rehabilitation, and particularly the use of interdisciplinary group work in stroke rehabilitation. Furthermore, evidence shows that stroke survivors feel ill equipped to return to their communities despite rehabilitation. Stroke is a major cause of death and disability in South Africa, and is a condition shown to benefit from rehabilitation. These factors led to the selection of the Bishop Lavis Rehabilitation Centre stroke group as the setting for this study, which aims to describe the range of experiences relating to attendance or non-attendance of those referred to this programme. This descriptive study, employing quantitative means (to describe the demographic details of the participants) and qualitative means (to describe the experiences of participants), was conducted with twenty participants. Data was collected by means of an administered questionnaire. Following that, a focus group discussion involving six participants was used to gather in-depth information. Quantitative data was analysed with the assistance of a statistician, utilising the computer program, Statistica. The Chi-Squared, Kruskal-Wallis and ANOVA tests were used, with p>0.05 showing statistical significance. Qualitative data was thematically analysed, whereby data was categorised by means of an inductive approach. The study population consisted of 20 participants, with an average age of 59 years, of whom 15 were female and five male. The stroke group provided meaning to participants on two levels. On a psychosocial level, the phenomena of universality (identifying with others in a similar position), development of socialising techniques, imparting information and cohesiveness emerged strongly. On the level of meaning related to stroke recovery, improvement in ability to execute activities of daily living, mobility and strength were most frequently mentioned. Transportation issues were most commonly mentioned as factors negatively influencing attendance. Staff attitude and activities of the programme were most often cited as positive factors. Given the positive response of study participants, and the programme’s ability to sustain intervention with limited resources, it was concluded that this programme has a valid place within stroke rehabilitation in Bishop Lavis. Recommendations in terms of the group programme included investigating methods of providing transportation, providing childcare facilities and expanding the content of educational sessions. Further recommendations were to maintain the positive attitude of staff and the current activities of the programme. Frequency of group outings should also be increased and compensatory strategies for inclement weather must be explored.

Thesis (MHumanRehabSt)--Stellenbosch University, 2014. / ENGLISH ABSTRACT:Background In the past, a lack of policy guidelines in the area of rehabilitation often resulted in underdeveloped or no rehabilitation services in many areas. This led to the development of The South African National Rehabilitation Policy (NRP) which was finalised in 2000. This policy is guided by the principles of development, empowerment and the social integration of persons with disabilities. It aims to provide improved access to rehabilitation services for all and forms part of a strategy to improve the quality of life of persons with disabilities. South Africa ratified the United Nations Convention for the Rights of Persons with Disabilities (UNCRPD) in 2001. The UNCRPD is an international rights based document and focuses on equalisation of opportunities for people with disabilities and their inclusion in development. Aim The aim of thestudy was to describe and analyse the organizational framework of rehabilitation services at the Gugulethu Community Health Centre (CHC) in Cape Town and to determine if the framework used complied with the objectives of the National Rehabilitation Policy. Method This was a case study that made use of both qualitative and quantitative methods of data collection. The Kaplan framework, the objectives of the NRP and the five relevant articles of the UNCRPD were used to design three questionnaires for data collection. The first questionnaire was for service providers and answered by seven participants. The second questionnaire was completed by the Facility Manager of Gugulethu CHC and the third questionnaire was answered by the managers of 2 purposively sampled NGOs in Gugulethu. Qualitative data was collected from interviews held with three of the service providers and the facility manager as well as from two focus groups held with service users. Results The results of the study showed that there was some coherence between the rehabilitation services provided and the objectives of the NRP such as good access to the service for clients coming to the Centre for rehabilitation and adequate resources to provide assistive devices with. However, in other areas there was little or no adherence. Limited evidence of intersectoral collaboration was found. There was no evidence of the inclusion of persons with disabilities in the planning, implementation and managing of rehabilitation services. Similarly services were not monitored and evaluated in a constructive way and while the therapists did engage in skills development activities the suitability of the courses attended for their role is questioned. Conclusion The findings showed a facility based curative rehabilitation service that was accessible for clients who came to the facility, but did not expand to provide community based rehabilitation. Thus it was concluded that the organisation in its current form lacked the ability to effectively address the needs of the community that it served. At Gugulethu Community Health Centre rehabilitation services need to be planned according to community based rehabilitation strategies by the manager, the service providers and the community. Only when implementation of the NRP and UNCRPD takes place will the benefits become tangible to the entire community. Key Words Rehabilitation, Disability, National Rehabilitation Policy, UNCRPD, Organisational capacity. / AFRIKAANSE OPSOMMING: Agtergrond In die verlede het ‘n gebrekaanbeleidsriglyne in die rehabilitasievelddikwelsgelei tot onderontwikkelde of geenrehabilitasiedienste in baiegebiede. Die gevolghiervan was die ontwikkeling van dieSuidAfrikaanseNasionaleRehabilitasieBeleid (NRB) wat in 2000 gefinaliseer is. Die fokusvan hierdiebeleid is ontwikkeling, bemagtiging en die sosialeintegrasie van persone met gestremdhede. Die doel van die NRB is omtoeganklikheid van rehabilitasiediensteviralmalteverbeter en ditvormdeel van die strategieom die lewensgehalte van persone met gestremdhede to verbeter. SuidAfrika het die VerenigdeNasies se Konvensievir die Regte van Persone met Gestremdhede in 2001 bekragtig. HierdieKonvensie is ‘n internasionaleregsgebaseerdedokument and fokus opgelykeregtevirpersone met gestremdhede en hulinsluiting in ontwikkeling. Doelstelling Die doel van die studiewas om die organisatorieseraamwerk van die rehabilitasiedienste by die GugulethuGemeenskapsGesondheidssentrum in Kaapstadtebeskryf enteontleed, ten eindevastestel of die raamwerk, in ooreenstemming is met die doelwitte van die NasionaleRehabilitasieBeleid. Metode `n Gevallestudie is gedoen. Data is deurmiddel van kwantitatiewe en kwalitatiewemetodesingesamel. Die Kaplanraamwerk, doelwitte van die NasionaleRehabilitasieBeleid en toepaslike 5 artikels van die VerenigdeNasie se Konvensievir die Regte van Persone met Gestremdehede is gebruikomdrievraelysteteontwerp. Die eerstevraelys was virdiensverskaffers en sewedeelnemers het ditbeantwoord. Die tweedevraelys is deur die Fasiliteitsbestuurder van GuguletuGemeenskapsGesondheidssentrumbeantwoord en die derdevraelysdeur twee bestuurders van twee doelbewustegekoseNie-staatsOrganisasies in Guguletu. Onderhoude is met drie van die diensverskaffers en die fasiliteitsbestuurdergebruikomkwalitatiewe data in tesamelsowel as twee fokusgroepe met diensverbruikers.Resultate Die resultate van die studietoondatdaarwel ‘n mate van belyningtussenrehabilitasiedienste by die studiesentrum en die doelwitte van die NasionaleRehabilitasieBeleid is. Ditsluit in goeietoeganklikheidna die diensvirklientewat die sentrumbesoekvirbehandeling en voldoendebronneomhulpmiddelstevoorsien.In andergebiede was daaregter min of geenbelyningnie. Daar is min bewyse van intersektoralesamewerking en geenbewyse van die insluiting van persone met gestremdhede in die beplanning, implementering en bestuur van die rehabilitasiedienstenie. Dienste is nie in ‘n opbouendemaniergemonitor of geevalueernie en terwyl die terapeutewelaanontwikklingsprogrammedeelgeneem het, kan die toepaslikheid van die kursussebevraagteken word. Gevolgtrekking Die bevindingswys op ‘n kuratiewerehabilitasiedienswattoeganklik is virklientewatna die sentrum toe kom. Daar word egterniegemeenskapsbaseerderehabilitasieverskafnie.Dus, is die gevolgtrekkingdat die organisasie in syhuidigevormnie die vermoe het om die behoeftes van die gemeenskapwatditdien, effektiefaantespreeknie.Dierehabilitasiedienste by GuguletuGemeenskapssentrummoetbeplan word volgensgemeenskapsgebaseerderehabilitasiestrategiee, deur die bestuurder, diensverskaffers en die gemeenskap. Eerswanneer die NasionaleRehabilitasieBeleid en die VerenigdeNasie se Konvensievir die Regte van Persone met Gestremdhedetoegepas word sal die helegemeenskapbaatvind by rehabilitasie.

Thesis (M Human RehabSt)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Rehabilitation services, mainly rendered by therapists employed by the Department of Health, forms a critical part of the Primary Health Care (PHC) package of care. Different policies, within the Department of Health (DOH), provide guidance on rehabilitation service delivery. However, implementation of these policies remains a challenge. The current study aimed to describe and analyse the organisational capacity of rehabilitation services at the study site and to assess how congruent the rehabilitation service at the study site was with existing rehabilitation policy. A descriptive methodology was applied making use of both quantitative and qualitative methods in analyzing the organisational capacity of this study site and the alignment of rehabilitation services offered, with the National Rehabilitation Policy (NRP). The study used the Kaplan framework, the objectives of the NRP and specific selected articles of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) to develop indicators to be used for the description and analysis of the organisational capacity of the rehabilitation services at TC Newman Community Day Centre. Questionnaires based on seven objectives from the NRP were developed to collect quantitative data from five service providers, the facility manager of TC Newman CDC and the managers of two Non- Governmental Organisations (NGO) working in the drainage site. Face to face, audio recorded, semi- structured interviews were used to collect qualitative data from the five service providers. A folder audit and document review was used to enhance quantitative findings. After analysis of the data, I still felt the need for additional information and thus developed an open ended questionnaire for participants to complete. Barriers (e.g. defaulting of clients, a lack of standard documentation, poor monitoring and evaluation) and facilitators (e.g. outreach and support, competent staff and multi-disciplinary team) were identified in implementing the NRP. Participants highlighted the importance of accessing rehabilitation services with a focus on the outreach to peripheral clinics and funded NGO’s. Intersectoral collaboration is evident, but mainly with funded NGO’s. A lack of standardised documentation, inadequate monitoring and evaluation systems and uniformed documentation were some of the challenges identified by participants. The absence of participation by persons with disabilities was noted by all participants. With reference to the organisational capacity, the participants had a good understanding of rehabilitation within the PHC context. Participants felt confident in delivering rehabilitation services and were able to identify shortcomings in service delivery. It is concluded that rehabilitation services are not delivered exactly in accordance with the objectives of the NRP. However the organisation demonstrated capacity to deliver rehabilitation services at PHC level, but there is still a need to enhance service delivery on community based level. The results of this study gave me as a manager and implementer of health policy in the District Health System the opportunity to gain deeper insight as to how rehabilitation services are currently rendered. Results from the study highlighted how coherent rehabilitation service delivery is with current policy in health and the capacity of the organisation to deliver rehabilitation services. This gave me the opportunity to adjust and review current rehabilitation service delivery and implement changes, as the study progressed. / AFRIKAANSE OPSOMMING: Rehabilitasie word hoofsaaklik deur terapeute in die departement van gesondheid gelewer binne fasiliteite en vorm ‘n belangrike deel van die Primêre Gesondheid Sorg dienste (PGS). Daar is verskillende beleid binne die Departement van Gesondheid beskikbaar, wat rehabilitasie definieer. Ten spyte van beleid, bly die implimentering van hierdie beleide ‘n uitdaging. Hierdie studie het ontstaan om the kapasiteit van die organisasie te beskryf, om rehabilitasie dienste te implimenteer en ook te bepaal hoe hierdie dienste ooreenstem met die Nasionale Rehabilitasie Beleid (NRB). ‘n Beskrywende metodologie was gebruik, wat uit ‘n kwantitatiewe en kwalitatiewe deel bestaan het. ‘n Vraelys is ontwikkel op grond van die 7 doelwitte beskryf binne die NRB. Dit is gebruik vir die versameling van kwantitatiewe data, by vyf diensversakffers, `n gesondheidsbestuurder en die bestuurders van twee nieregerings organisasies. Kwalitatiewe data is verkry deur onderhoude met die vyf diensverskaffers. ‘n Oudit van pasiënt lêers en die evaluering van dokumente het kwantitatiewe data versterk. Na die analisering van data en die behoefte vir addisionele inligting, is ‘n oop-end vraelys ontwikkel en versprei na deelnemers om te voltooi. Die studie het die organisatoriese kapasiteit van die organisasie ontleed deur gebruik te maak van Kaplan se raamwerk vir organisasie kapasiteit en die doelwitte van die NRB, asook sekere geselekteerde artikels uit die “United Nations Convention of the Rights of Persons with Disabilities” UNCRPD. Deelnemers het belangrikheid van toegang tot rehabilitasie dienste bevestig, met ‘n fokus op uitreik na perifêre klinieke in die sub distrik en befondse Nie-Regerings Organisasies (NRO). Intersektorale skakeling was beskryf, maar beperk tot befondse NRO’s. Verskillende uitdagings soos bv. gestandardiseerde dokumentasie, onvoldoende monitering en evalueringssisteme en die dokumentering van inligting was geïdentifiseer. Die afwesigheid van persone met gestremdhede en hulle deelname by terapie was genoem deur deelnemers. Verskillende uitdagings asook fasiliteerders was geïdentifiseer deur deelnemers t.o.v die implementering van bestaande beleid.