Thesis (MScPhysio)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Background
Traumatic spinal cord injury (SCI) remains one of the most serious and devastating injuries often
resulting in permanent disability and with life changing implications for the individual and his/her
family. Successful reintegration into community life and employment after SCI is considered
important goals of rehabilitation as this has been positively associated with quality of life, self
esteem and life satisfaction. The International Classification of Functioning, Disability and Health
(ICF) allows researchers to identify the impact of environmental factors on functioning and
disability. Minimal research, particularly in South Africa, has been done on the impact of the
environment on persons living with various health conditions and specifically spinal cord injury.
Objectives
The main purpose of this study was to describe and compare the level of participation of persons
with traumatic SCI at two time points (discharge and six months after discharge) from the inpatient
rehabilitation setting and to identify the environmental barriers experienced.
Methods
A prospective, descriptive study was conducted using consecutive sampling. All patients with
traumatic SCI that were discharged from September 1, 2008 from the Western Cape Rehabilitation
Centre (WCRC) who were eligible for this study were included. Two questionnaires (one based on
the ICF and one purposely-developed) and the International Standards for the Classification of SCI
(ISCSCI) were used. Data were analyzed with the statistical software package STATISTICA.
Results
A person sustaining a traumatic SCI in the Cape Metropolitan area of the Western Cape Province is
most likely to be a male, young (20 to 29 years), of the Black or Coloured race and living in the
Cape Flats suburbs. More than half of the subjects had a grade eight to ten level of education which
together with the lack of employers’ responsibilities towards part-time workers might explain the
low percentage (11%) of employment at six months after discharge from the WCRC.
Complete paraplegia, occurring mainly in the thoracic cord, was the most common neurological
disability found in this study. The most common secondary condition was pain followed by
spasticity limiting function. The low incidence of pressure sores and urinary tract infections found
in this study contradicts findings of previous studies.The majority of the subjects were discharged to the same house they were living in at the time of
their injury. However, due to various architectural barriers, some of them were not able to function
independently in their homes.
Inaccessibility of public transport, the lack of recreational and sport facilities, lack of social support
structures in the community and inadequate financial resources were the main environmental
barriers experienced by these individuals.
Conclusion
The main finding of this study was the low employment rate and the difficulty experienced with
reintegration at community level after SCI. The results of this study confirm the significant
contribution of environmental factors in participation, especially those of transport and education in
return to work. Fourteen years after the publication of the Integrated National Disability Strategy
(INDS) White Paper (1997), legislative strategies to ensure that people with disabilities have equal
access to social and economic opportunities remain lacking. / AFRIKAANSE OPSOMMING: Agtergrond
Traumatiese spinaalkoordbesering (SKB) lei dikwels tot permanente verlamming en dit het
lewensveranderende implikasies vir die individu en sy/haar familie. Suksesvolle herintegrasie in die
gemeenskap en werkverrigting na SKB is belangrike doelstellings vir rehabilitasie omdat dit
positief met lewenskwaliteit, selfrespek en lewens-bevrediging geassosieer word. Die Internasionale
Klassifisering van Funksionering, Gestremdheid en Gesondheid (IKF) bied aan navorsers die
geleentheid om die impak van omgewingsfaktore op funksionering en gestremdheid te identifiseer.
Daar is veral in Suid-Afrika beperkte navorsing oor die impak van die omgewing op mense met
verskillende gesondheidstoestande, spesifiek SKB.
Doel
Die hoofdoel van hierdie studie was om die vlak van deelname van mense met traumatiese SKB op
twee verskillende tye te beskryf en te vergelyk, onmiddellik na hulle uit die rehabilitasiesentrum
ontslaan is, en ses maande later. Die studie het ook ten doel gehad om die omgewingsfaktore te
identifiseer wat deelname negatief beïnvloed.
Metode
Daar is van ’n beskrywende studie gebruik gemaak. Alle pasiënte met traumatiese SKB wat vanaf 1
September 2008 vanaf die Wes-Kaapse Rehabilitasiesentrum (WKRS) ontslaan is en wat voldoen
het aan die insluitingskriteria is ingesluit. Twee vraelyste is gebruik om data in te samel – een is op
die IKF gebaseer en een is spesifiek vir die studie ontwikkel. Daar is ook van die Internasionale
Standaarde vir die Klassifisering van SKB (ISKSKB) gebruik gemaak om data in te samel. Data is
met behulp van STATISTICA, ’n statistiese sagteware pakket, geanaliseer.
Resultate
Iemand wat ’n traumatiese SKB in die Kaapse metropolitaanse gebied van die Wes-Kaap provinsie
opdoen, is mees waarskynlik ’n jong man (20 tot 29 jaar) van die Swart of Kleurling ras wat
woonagtig in die voorstede op die Kaapse Vlakte is. Meer as die helfte van die deelnemers in die
studie het slegs ’n opvoedingsvlak van graad agt tot tien. Hierdie aspek, tesame met die gebrek aan
werkgewers se verantwoordelikheid teenoor deeltydse werknemers is dalk die rede waarom slegs
11% van die deelnemers ses maande na hulle uit die WKRS ontslaan is, werksaam was.
Volledige paraplegie, hoofsaaklik as gevolg van ’n besering van die torakale spinaalkoord, was die
algemeenste neurologiese besering wat in hierdie studie gevind is. Die algemeenste sekondêre
komplikasie wat voorgekom het, was pyn gevolg deur spastisiteit. Die lae voorkoms van druksere
en urienweginfeksies in dié studie is in teenstelling met bevindings van vorige studies.
Die meeste deelnemers is ontslaan na dieselfde huis waar hulle voor die besering gewoon het, maar
as gevolg van verskeie argitektoniese hindernisse, kon sommige van hulle nie onafhanklik binne
hulle wonings funksioneer nie.
Die ontoeganklikheid van openbare vervoer, die gebrek aan ontspannings- en sportfasiliteite, die
gebrek aan sosiale ondersteuningsnetwerke in die gemeenskap en onvoldoende finansiële
hulpbronne was die algemeenste omgewingshindernisse wat deur die deelnemers ondervind is.
Samevatting
Die belangrikste bevinding van dié studie was dat slegs ’n klein persentasie van die deelnemers ses
maande na hul ontslaan is, werksaam was en dat herintegrasie in die gemeenskap na ’n SKB baie
moeilik is. Die resultate van die studie bevestig die belangrike rol wat omgewingsfaktore by
deelname speel, veral die faktore wat te make het met vervoer en die opvoedingsvlak wanneer daar
na ’n werk teruggekeer word. Veertien jaar na die publikasie van die Geïntegreerde Nasionale
Gestremdheidstrategie in 1997, is wetgewende strategieë om gelyke toegang tot sosiale en
ekonomiese geleenthede vir persone met gestremdhede te verseker, steeds gebrekkig.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/20352 |
| Date | 03 1900 |
| Creators | Maclachlan, Mirda |
| Contributors | Inglis-Jassiem, Gakeemah, Hillier, Susan, Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Physiotherapy. |
| Publisher | Stellenbosch : Stellenbosch University |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | English |
| Type | Thesis |
| Format | 283 p. : ill. |
| Rights | Stellenbosch University |
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