Scielo RSS <![CDATA[African Journal of Disability (Online)]]> http://www.scielo.org.za/rss.php?pid=2226-722020170001&lang=en vol. 6 num. lang. en <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Community stakeholders' perspectives on the role of occupational therapy in primary healthcare: Implications for practice</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202017000100001&lng=en&nrm=iso&tlng=en BACKGROUND: Primary healthcare (PHC) is central to increased access and transformation in South African healthcare. There is limited literature about services required by occupational therapists in PHC. Despite policy being in place, the implementation of services at grassroots level does not always occur adequately. OBJECTIVES: This study aimed at gaining an understanding of the challenges of being disabled and the services required by occupational therapists (OTs) in rural communities in order to better inform the occupational therapy (OT) training curriculum. METHOD: An exploratory, descriptive qualitative design was implemented using purposive sampling to recruit 23 community healthcare workers from the uGu district. Snowball sampling was used to recruit 37 members of the uGu community, which included people with disability (PWD) and caregivers of PWDs. Audio-recorded focus groups and semi-structured interviews were used to collect data, which were thematically analysed. Ethical approval was obtained from the Biomedical and Research Ethics Committee of the University of KwaZulu-Natal (BE248/14) RESULTS: Two main themes emerged namely: firstly, the challenges faced by the disabled community and secondly appropriate opportunities for intervention in PHC. A snapshot of the social and physical inaccessibility challenges experienced by the community was created. Challenges included physical and sexual abuse, discrimination and marginalisation. Community-based rehabilitation and ideas for health promotion and prevention were identified as possible strategies for OT intervention. CONCLUSION: The understanding of the intervention required by OT in PHC was enhanced through obtaining the views of various stakeholders' on the role. This study highlighted the gaps in community-based services that OTs should offer in this context. <![CDATA[<b>Stroke survivors' levels of community reintegration, quality of life, satisfaction with the physiotherapy services and the level of caregiver strain at community health centres within the Johannesburg area</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202017000100002&lng=en&nrm=iso&tlng=en BACKGROUND: Stroke survivors are discharged home before they are functionally independent and return home with activity limitations that would not be manageable without a caregiver. AIM: To determine stroke survivors' levels of community reintegration, quality of life (QOL), satisfaction with the physiotherapy services and the level of caregiver strain at community health centres within the Johannesburg area. METHOD: This was a cross-sectional study using the following outcome measures: Maleka Stroke Community Reintegration Measure, Stroke-specific quality of life scale, Caregiver strain index and Physical therapy patient satisfaction questionnaire. RESULTS: A total of 108 stroke survivors and 45 caregivers participated in this study. The average age of the stroke survivors was 54 years (standard deviation = 12.73) and 58% (n = 62) had moderate to full community reintegration. They were happy with physiotherapy services but not with parking availability and cost of services. The QOL was poor with the lowest scores for energy and highest scores for vision and language domains. Twenty five (55%) caregivers were strained. A positive correlation was found between community reintegration and satisfaction with services (r = 0.27, p < 0.0001) and QOL (r = 0.51, p < 0.0001). A negative correlation was found between community reintegration and caregiver strain (r = -0.37, p < 0.0001). CONCLUSION: Most stroke survivors are reintegrated into their communities except in the areas of work and education and have poor QOL and most of their caregivers are strained; however, they are satisfied with physiotherapy services. <![CDATA[<b>Exploration of the academic lives of students with disabilities at South African universities: Lecturers' perspectives</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202017000100003&lng=en&nrm=iso&tlng=en BACKGROUND: A decade has passed since South Africa signed and ratified the Convention on the Rights of Persons with Disabilities, a human rights treaty that protects the rights and dignity of people with disabilities. However, not much have changed for students with disabilities. OBJECTIVES: The aim of this study was to explore lecturers' experiences with, and perspectives on, disability as well as with students with disabilities. It was hoped that this would contribute to the ongoing policy debates about diversity, inclusion and support for students with disabilities at universities. METHODS: In an effort to understand the lives of students with disabilities better, a study which included students with disabilities, lecturers and disability supporting staff was conducted at two South African universities - University of the Free State and University of Venda. The paper takes a snapshot view of four lecturers and their perceptions of the lives of students with disabilities at their respective universities. RESULTS AND CONCLUSION: Although most disability literature report students with disabilities blaming lecturers for their failure to advance their needs, this paper highlights that the education system needs to be supportive to lecturers for the inclusive agenda to be realised. An argument is made for a more comprehensive approach towards a national disability policy in higher education involving many stakeholders. Without a broader understanding of disability, it will be difficult to engage with the complex ways in which inequalities emerge and are sustained. <![CDATA[<b>Exploring structural violence in the context of disability and poverty in Zimbabwe</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202017000100004&lng=en&nrm=iso&tlng=en BACKGROUND: While it is widely assumed that disability, poverty and health are closely linked, research falls short of fully understanding the link. One approach to analysing the links between disability and poverty is through the concept of structural violence, referring to social structures that contribute to the impoverishment of individuals or communities. These structures can be political, ecological, legal and economic, among others. OBJECTIVE: To explore structural violence and how it affects families of children with cerebral palsy among the Tonga ethnic group living in poor rural communities of Binga in Zimbabwe. METHOD: This is a longitudinal, qualitative and ethnographic study. Data were collected over a period of eight years from 2005 to 2013. Data collection techniques were in-depth interviews, participant observation and focus group discussions. Purposive sampling was used to recruit 53 informants. RESULTS: Structural violence was noted through four themes: internal displacement and development, food and politics, water and sanitation, and social services. Poverty was noted in the form of unemployment, lack of education, healthcare, food and shelter. The concept of structural violence inflicted social suffering on the informants. Politics played a major role in activities such as food withdrawal, lack of water, development and allocation of local resources to 'the people of the city', leaving the informants struggling with care. CONCLUSION: Political and economic forces have structured risks and created a situation of extreme human suffering. The capabilities approach brings out the challenges associated with cerebral palsy in the context of development challenges. <![CDATA[<b>Access to curriculum for students with disabilities at higher education institutions: How does the National University of Lesotho fare?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202017000100005&lng=en&nrm=iso&tlng=en BACKGROUND: Creating access to curricula at institutions of higher education for students with disabilities requires a concerted effort from management and other key stakeholders to identify students' needs and create opportunities for success. OBJECTIVES: This paper presents the findings of a study which examined students with disabilities' access to curricula at a higher education institution in Lesotho. METHOD: Data for this qualitative study were collected using three methods: in-depth interviews, focus group discussions and document analysis. Eleven students with various types of impairments and 15 academic and non-academic staff members currently working in close proximity to students with disabilities participated in this study. RESULTS: The findings reveal inconsistencies between the institution's admission policy of non-discrimination according to disability status and its practices. These inconsistencies are discussed under the following themes: (1) access at admission level, (2) management of disability data, (3) support by the special education unit, (4) teaching strategies, (5) support by lecturers, (6) availability of assistive technology, (7) special concessions and (8) students' coping mechanisms. CONCLUSION: We recommend that a clear policy concerning the support of students with disabilities be developed with the following aims: guide decisions on how disability data should be used, define roles that different university departments must play in facilitating access to curricula for all students, influence suitable development of teaching and learning resources, stimulate research on success and completion rates of students with disabilities and mandate restructuring of programmes that are currently inaccessible to students with disabilities. Key stakeholders, including students with disabilities, disabled persons' organisations, disability rights activists, and staff should be involved in such policy design. <![CDATA[<b>Challenges faced by women with disabilities in accessing sexual and reproductive health in Zimbabwe: The case of Chitungwiza town</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202017000100006&lng=en&nrm=iso&tlng=en BACKGROUND: Women with disabilities in Zimbabwe face numerous challenges in accessing sexual and reproductive health. Cultural belief still regards them as not sexually active. The government has also failed to promote policies that facilitate access to sexual and reproductive services by women with disabilities. OBJECTIVES: The reseach objectives were to explore the challenges faced by women with disabilities in accessing sexual and reproductive health in Zimbabwe. METHOD: The data were gathered using in-depth interviews with 23 purposively selected respondents. Thirteen women had physical disabilities, five were visually impaired, three were deaf and two were stammering. The respondents with physical disabilities were using wheelchairs, walking frames, prosthesis, crutches and caliper shoes. The participants' ages ranged from 18 to 45 years. All interviews were transcribed and translated verbatim into English, and passages were extracted from the transcripts. Key themes and concepts were identified and coded to offer a rich framework for analysis, comparisons and presentation of the data. RESULTS: Negative perceptions of health personnel towards people with disabilities, disability-unfriendly infrastructure at health facilities and absence of trained personnel for people with disabilities (sign language) are some of the challenges involved. CONCLUSION: The government, in partnership with other stakeholders, should address challenges faced by women with disabilities when accessing sexual and reproductive health services. Non-government, private hospitals and profit-making organisations should join hands with government in funding health requirements for women with disabilities. <![CDATA[<b>'These are not luxuries, it is essential for access to life': Disability related out-of-pocket costs as a driver of economic vulnerability in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202017000100007&lng=en&nrm=iso&tlng=en BACKGROUND: With the dawn of the new sustainable development goals, we face not only a world that has seen great successes in alleviating poverty but also a world that has left some groups, such as persons with disabilities, behind. Middle-income countries (MICs) are home to a growing number of persons with disabilities. As these countries strive to achieve the new goals, we have ample opportunity to include persons with disabilities in the emerging poverty alleviation strategies. However, a lack of data and research on the linkages between economic vulnerability and disability in MICs hampers our understanding of the factors increasing economic vulnerability in people with disabilities. METHODS: This article aims to present data related to elements of this vulnerability in one MIC, South Africa. Focusing on out-of-pocket costs, it uses focus group discussions with 73 persons with disabilities and conventional content analysis to describe these costs. RESULTS: A complex and nuanced picture of disability-driven costs evolved on three different areas: care and support for survival and safety, accessibility of services and participation in community. Costs varied depending on care and support needs, accessibility (physical and financial), availability, and knowledge of services and assistive devices. CONCLUSIONS: The development of poverty alleviation and social protection mechanisms in MICs like South Africa needs to better consider diverse disability-related care and support needs not only to improve access to services such as education and health (National Health Insurance schemes, accessible clinics) but also to increase the effect of disability-specific benefits and employment equity policies. <![CDATA[<b>Enhancing reading abilities of learners with intellectual impairments through computer technology</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202017000100008&lng=en&nrm=iso&tlng=en BACKGROUND: Developments in the teaching of children with disabilities support pedagogy that emphasises learners' strengths as opposed to their assumed deficiencies. Educators and mediators who advocate this view continually strive for tools and methodologies that enhance learner participation in academic environments. Computer technology is one of the tools recognised for its potential to enrich learning experiences of learners with an intellectual impairment. OBJECTIVES: We sought to assess the influence of text-to-speech stories on the reading ability of intellectually challenged learners. METHOD: A qualitative action research study that involves learners at a special school in Cape Town, South Africa. Pre- and post-test data of the reading performance of learners are analysed with a focus on how they demonstrate change. RESULTS: Although no claims can be made about the explicit influence on reading performance, computer-assisted learning has the potential in isolating reading processes that classroom-based interventions can address. In addition, computers enhance motivation and enthusiasm to learn. CONCLUSION: A need for education based on inclusion and positive differentiation remains the key driver in any educational interventions. <![CDATA[<b>The development and evaluation of content validity of the Zambia Spina Bifida Functional Measure: Preliminary studies</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202017000100009&lng=en&nrm=iso&tlng=en BACKGROUND: Very little is known on outcome measures for children with spina bifida (SB) in Zambia. If rehabilitation professionals managing children with SB in Zambia and other parts of sub-Saharan Africa are to instigate measuring outcomes routinely, a tool has to be made available. The main objective of this study was to develop an appropriate and culturally sensitive instrument for evaluating the impact of the interventions on children with SB in Zambia. METHODS: A mixed design method was used for the study. Domains were identified retrospectively and confirmation was done through a systematic review study. Items were generated through semi-structured interviews and focus group discussions. Qualitative data were downloaded, translated into English, transcribed verbatim and presented. These were then placed into categories of the main domains of care deductively through the process of manifest content analysis. Descriptive statistics, alpha coefficient and index of content validity were calculated using SPSS. RESULTS: Self-care, mobility and social function were identified as main domains, while participation and communication were sub-domains. A total of 100 statements were generated and 78 items were selected deductively. An alpha coefficient of 0.98 was computed and experts judged the items. CONCLUSIONS: The new functional measure with an acceptable level of content validity titled Zambia Spina Bifida Functional Measure (ZSBFM) was developed. It was designed to evaluate effectiveness of interventions given to children with SB from the age of 6 months to 5 years. Psychometric properties of reliability and construct validity were tested and are reported in another study. <![CDATA[<b>'When he's up there he's just happy and content': Parents' perceptions of therapeutic horseback riding</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202017000100010&lng=en&nrm=iso&tlng=en BACKGROUND: There is limited global and South African research on parents' perceptions of therapeutic horseback riding (THR), as well as their perceptions of the effect of the activity on their children with disabilities. OBJECTIVE: To explore and describe parents' perceptions and experiences of THR as an activity for their children with disabilities. METHOD: Twelve parents whose children attend THR lessons at the South African Riding for the Disabled Association in Cape Town were asked to participate in a semi-structured interview. The qualitative data obtained from the interviews were first transcribed and then analysed using thematic analysis to establish parents' perceptions of the THR activity. RESULTS: The main themes that emerged included parental perceived effects of THR on children, parents' personal experiences of the services, and parents' perceived reasons for improvements in the children. The participating parents indicated that THR had had a positive psychological, social and physical effect both on the children participating in the riding, as well as on the parents themselves CONCLUSION: According to parents, THR plays an important role in the lives of children with various disabilities and in the lives of their parents. The results of the study address the gap in the literature regarding parents' perceptions of THR. <![CDATA[<b>Challenges faced by parents of children with learning disabilities in Opuwo, Namibia</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202017000100011&lng=en&nrm=iso&tlng=en BACKGROUND: Parenting children with learning disabilities requires a high level of knowledge and access to resources, information and services. In developing countries, however, these resources and services are not always available. Parents in Namibia, a developing country, therefore face challenges addressing children's learning and other developmental disabilities, including challenges related to preventative and supportive interventions. OBJECTIVE: This research focuses on challenges faced by parents as they parent children with learning disabilities in Opuwo, Namibia. METHOD: In-depth interviews were conducted with eight parents regarding the challenges they face in parenting their children with learning disabilities. Thematic analysis enabled the researchers to identify, analyse and report on themes that emerged from the qualitative interview data. RESULTS: Analysis of the interviews indicated that some participants had only a vague understanding of learning disabilities, as they did not have access to essential knowledge about this phenomenon. They also lacked an awareness of the availability of programmes, services and policies meant to benefit their children with learning disabilities. Participants voiced that they, their children with learning disabilities and community members have stereotypes and prejudices regarding learning disabilities. In this study, most of the children with learning disabilities were raised by single, unemployed parents who seemed to have access to less support from external sources than married couples parenting children with learning disabilities. These single parents are usually not married and because of lack of financial support from the other parent, the majority of them indicated that they struggle to meet the financial and material needs of their children. CONCLUSION: The researchers concluded that the participants in this study experience a range of challenges in parenting their children with learning disabilities. The main challenges emanate from financial instability, as well as lack of knowledge regarding services and programmes for children with learning disabilities. This lack of knowledge on the part of participants could indicate poor policy education by policy implementers at grass-roots level. <![CDATA[<b>Forgotten, excluded or included? Students with disabilities: A case study at the University of Mauritius</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202017000100012&lng=en&nrm=iso&tlng=en BACKGROUND: Students with disabilities in the tertiary education sector are more than a just a phenomenon, they are a reality. In general, little attention is devoted to their needs despite the fact that they need more care and attention. OBJECTIVES: This paper, through a case study at the University of Mauritius, sought to answer some pertinent questions regarding students with disabilities. Does the University of Mauritius have sufficient facilities to support these students? Are students aware of existing facilities? What additional structures need to be put in place so that students with any form of disability are neither victimised, nor their education undermined? Are there any local laws about students with disabilities in higher education? METHOD: To answer these questions and others, an online questionnaire was sent to 500 students and the responses were then analysed and discussed. The response rate was 24.4% which showed that students were not reticent to participate in this study. RESULTS: Our survey revealed that most students were not aware of existing facilities and were often neglected in terms of supporting structures and resources. ICT facilities were found to be the best support that is provided at the University of Mauritius. The right legal framework for tertiary education was also missing. CONCLUSION: Ideally, students with disabilities should have access to special facilities to facilitate their learning experiences at tertiary institutions. Awareness about existing facilities must also be raised in order to offer equal opportunities to them and to enable a seamless inclusion. <![CDATA[<b>Community health workers lensed through a South African backdrop of two peri-urban communities in KwaZulu-Natal</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202017000100013&lng=en&nrm=iso&tlng=en BACKGROUND: As the South African government re-engineers primary healthcare (PHC), the need for additional information on stakeholders involved in the process has emerged. Of these are community health workers (CHWs), who have been identified as central to PHC success. OBJECTIVES: To profile the current CHWs within KwaDabeka and Clermont in KwaZulu-Natal, to describe their roles and to explore the barriers and enablers influencing their service delivery. METHOD: A convergent mixed methods design was employed with a sample of CHWs with the use of a survey (n = 53) and two focus groups (n = 10) and semi-structured interviews with four ward councillors (n = 4). Data were analysed statistically and thematically. RESULTS: The profile of CHWs reflected only women with a mixed age range and a majority of 59% who had not completed formal schooling. General work experience as a CHW varied. There were diverse opinions expressed towards the CHW role which related to their job title and identity, supervision, remuneration, growth pathways and psychological and emotional issues. Whilst the National Community Health Worker Profile Framework was established for the CHW programme, there are several factors lacking in the current CHW programme such as a formal growth pathway or formal training to align the CHWs with the National Qualifications Framework. CONCLUSION: The study findings are essential for the monitoring and evaluation as well as development and refinement of policies that will assist in ensuring adequate rollout of PHC with CHWs. <![CDATA[<b>People with disabilities and income-related social protection measures in South Africa: Where is the gap?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202017000100014&lng=en&nrm=iso&tlng=en BACKGROUND: People with disabilities are at increased risk of poverty, particularly in low-and middle-income countries. However, recent evidence suggests that this association is more nuanced than previously anticipated and that we need better data to understand the opportunity and out-of-pocket costs that diverse groups of people with disabilities may experience. OBJECTIVE: This paper discusses if disability is associated with opportunity cost and loss of income both on the individual and household level in South Africa, and if these costs differ depending on disability type and severity. METHODS: For this purpose, the paper analyses General Household Survey 2011 data (people between 15 and 59) using descriptive statistics disaggregated via disability type and severity. The paper also assesses if social grants counteract these costs and reduce economic vulnerability. RESULTS: The analysis of the data reveals that people with disabilities are affected by issues relating to multidimensional poverty such as lower educational attainment and fewer employment opportunities. In addition, households of people with disabilities (with the exception of milder visual problems) earn significantly less than households without people with disabilities, and this particularly applies to households with people with severe disabilities. This vulnerability also varies by disability type. The country's social protection mechanisms, in terms of social grants, counteract economic vulnerability to some extent but do not consider the nuanced economic impact of diverse conditions nor the increased out-of-pocket costs related to disability. CONCLUSIONS: This calls for more equitable social protection mechanisms that include accessible services, livelihood programmes and disability benefits. <![CDATA[<b>Adaptation of the curriculum for the inclusion of learners with special education needs in selected primary schools in the Fort Beaufort District</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202017000100015&lng=en&nrm=iso&tlng=en BACKGROUND: There is need for 'high-quality' teachers who are equipped to meet the needs of all learners through provision of education for an inclusive society according to equal opportunities to all. OBJECTIVE: This paper investigates pockets of good practice in the adaptation of the curriculum for the inclusion of learners with special education needs (SEN) in selected primary schools in the Fort Beaufort District. METHOD: The study adopted a qualitative research approach and employed a case study design. Eight teachers and 10 principals from 10 selected primary schools, 4 education district officials and 1 provincial official were interviewed. Purposive sampling was used to select the participants. Data were collected using document analysis and semi-structured interviews and were analysed thematically. RESULT: The study established that teachers use methods relating to different teaching strategies, individual work, group work and extra work. CONCLUSION: It was concluded that there are pockets of good practice of inclusion policy such as the use of different teaching strategies, individual work, group work and extra work for inclusion of learners with SEN in some of the selected primary schools in the poor rural context. The paper recommends adequate training for teachers in curriculum adaptation in order for all teachers to accommodate learners with SEN. <![CDATA[<b>Psychological well-being of adolescents with physical disabilities in Zimbabwean inclusive community settings: An exploratory study</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202017000100016&lng=en&nrm=iso&tlng=en BACKGROUND: The purpose of this study was to explore the psychological well-being of adolescents with physical disabilities living in inclusive community settings of Makonde Urban in Zimbabwe. An inclusive community is one that aims to remove exclusionary practices within the community and promote community systems that accept all people irrespective of their difference. Inclusive communities on their own are not uniquely designed for people with disabilities, but most developing countries have adopted them as a basic strategy to influence and enhance psychological well-being of people with disabilities. METHODS: A constructivist lived experience perspective underpinned this research, in which multiple case studies were used to interact with the participants on inclusion and psychological well-being of adolescents with physical disabilities. Purposive sampling was used to select 14 participants (9 males and 5 females). Data were collected through face-to-face interviews and transcribed verbatim. Four themes emerged from the thematic analysis of data sources. RESULTS: It was found that participants who were adolescents with physical disabilities living in inclusive community settings of Makonde Urban in Zimbabwe were having high levels of autonomy and choice, purpose in life, positive relations with others and good personal growth and self-acceptance. CONCLUSION: The findings of this study should enable inclusive communities' policy-makers and researchers to better understand the psychological well-being of adolescents with physical disabilities living in inclusive communities. <![CDATA[<b>A literature review on work transitioning of youth with disabilities into competitive employment</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202017000100017&lng=en&nrm=iso&tlng=en BACKGROUND: The marginalisation of youth with disabilities from employment opportunities is evident from literature in as far as they form part of the larger groups 'people with disabilities' and 'youth'. A focused view of programmes that assist youth with disabilities into employment has not been presented, despite the worldwide crisis of youth unemployment. AIM: This review aimed to identify evidence on work transition programmes that are effective in assisting people with disabilities into open labour market (competitive) employment, as well as to highlight gaps in knowledge to inform future research on this topic. METHODS: Literature and policy on programmes that support such transitions were considered, firstly from a global perspective and then with a view from developing countries. The SALSA (Search, Appraisal, Synthesis and Analysis) framework was used to source and analyse information from a diverse set of documents. Various online databases were searched for research papers published between 1990 and 2016, and websites were searched for reports pertaining to this topic. RESULTS: Ninety-nine documents were selected to inform the review, out of an identified 259 scientific journal articles, policy documents, acts, organisational reports and book chapters. CONCLUSION: A synthesis of findings was presented in a narrative that reflects the themes of youth with disabilities and employment in the world, work transition endeavours in the developing world and a specific focus on this group in South Africa. The review revealed a gap in knowledge and evidence pertaining to youth with disabilities and employment, highlighting these as research foci, and emphasising the need for youth-focused research that generates knowledge about disability and transitions into the labour force. <![CDATA[<b>Practices and discourses of ubuntu: Implications for an African model of disability?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202017000100018&lng=en&nrm=iso&tlng=en BACKGROUND: Southern African scholars and activists working in disability studies have argued that ubuntu or unhu is a part of their world view. OBJECTIVES: Thinking seriously about ubuntu, as a shared collective humanness or social ethics, means to examine how Africans have framed a struggle for this shared humanity in terms of decolonisation and activism. METHOD: Three examples of applications of ubuntu are given, with two mainly linked to making explicit umaka. Firstly, ubuntu is linked to making visible the invisible inequalities for a common humanity in South Africa. Secondly, it becomes correlated to the expression of environmental justice in West and East African countries. RESULTS: An African model of disability that encapsulates ubuntu is correlated to how Africans have illustrated a social ethics of a common humanity in their grassroots struggles against oppression and disablement in the 20th century. Ubuntu also locates disability politically within the wider environment and practices of sustainability which are now important to the post-2105 agenda, Convention on the Rights of Persons with Disabilities (CRPD) and the (UN) Sustainable Development Goals linked to climate change. CONCLUSION: A different kind of political action linked to social justice seems to be evolving in line with ubuntu. This has implications for the future of disability studies. <![CDATA[<b>The experiences and challenges faced by rehabilitation community service therapists within the South African Primary Healthcare health system</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202017000100019&lng=en&nrm=iso&tlng=en BACKGROUND: Twenty-two years after the promulgation of a plethora of progressive health policies since 1994, the South African public health system reflects a number of stumbling blocks regarding implementation. Rehabilitation professionals are not sufficiently equipped nor allowed the opportunity to comprehensively implement Primary Healthcare (PHC) from a bottom-up approach, thus engaging communities. Training on addressing social health determinants and their impact on ill-health and health outcomes is inadequate. The inadequate understanding of the advocacy role that rehabilitation professionals could play in addressing social health determinants remains a challenge in healthcare. Rehabilitation, a pillar of PHC, remains poorly understood in terms of its role within the health system. AIM: We argue for rehabilitation as a vehicle for addressing social determinants of health with community service practitioners playing a critical role in addressing the inequities within the healthcare package. SETTING: The article reflects the opportunities and challenges faced by rehabilitation community service therapists in the delivery of rehabilitation services in a rural area of the Eastern Cape province of South Africa. METHODS: A single case study from the perspective of a researcher was used to explore the experience and reflection of the first author during her community service as an occupational therapist RESULTS: The case study highlights some existing gaps within the delivery of rehabilitation services in the rural Eastern Cape. A community service package with a specific approach towards addressing social determinants of health for persons with disability at a community level is suggested. CONCLUSION: Advocating for a rehabilitation service package to shift to community-based levels is critical. It is envisaged that a community-based approach will facilitate an understanding of the barriers faced by persons with disabilities as constituting disability, thus facilitating learning about the disabling consequences of the rural environment coupled with the system as experienced by persons with disabilities. <![CDATA[<b>Editorial</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202017000100020&lng=en&nrm=iso&tlng=en BACKGROUND: Twenty-two years after the promulgation of a plethora of progressive health policies since 1994, the South African public health system reflects a number of stumbling blocks regarding implementation. Rehabilitation professionals are not sufficiently equipped nor allowed the opportunity to comprehensively implement Primary Healthcare (PHC) from a bottom-up approach, thus engaging communities. Training on addressing social health determinants and their impact on ill-health and health outcomes is inadequate. The inadequate understanding of the advocacy role that rehabilitation professionals could play in addressing social health determinants remains a challenge in healthcare. Rehabilitation, a pillar of PHC, remains poorly understood in terms of its role within the health system. AIM: We argue for rehabilitation as a vehicle for addressing social determinants of health with community service practitioners playing a critical role in addressing the inequities within the healthcare package. SETTING: The article reflects the opportunities and challenges faced by rehabilitation community service therapists in the delivery of rehabilitation services in a rural area of the Eastern Cape province of South Africa. METHODS: A single case study from the perspective of a researcher was used to explore the experience and reflection of the first author during her community service as an occupational therapist RESULTS: The case study highlights some existing gaps within the delivery of rehabilitation services in the rural Eastern Cape. A community service package with a specific approach towards addressing social determinants of health for persons with disability at a community level is suggested. CONCLUSION: Advocating for a rehabilitation service package to shift to community-based levels is critical. It is envisaged that a community-based approach will facilitate an understanding of the barriers faced by persons with disabilities as constituting disability, thus facilitating learning about the disabling consequences of the rural environment coupled with the system as experienced by persons with disabilities. <![CDATA[<b>Developing product quality standards for wheelchairs used in less-resourced environments</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202017000100021&lng=en&nrm=iso&tlng=en BACKGROUND: Premature failures of wheelchairs in less-resourced environments (LREs) may be because of shortcomings in product regulation and quality standards. The standards published by the International Organization for Standardization (ISO) specify wheelchair tests for durability, safety and performance, but their applicability to products used in the rugged conditions of LREs is unclear. Because of this, wheelchair-related guidelines published by the World Health Organization recommended developing more rigorous durability tests for wheelchairs. OBJECTIVES: This study was performed to identify the additional tests needed for LREs. METHODS: First, a literature review of the development of ISO test standards, wheelchair standards testing studies and wheelchair evaluations in LREs was performed. Second, expert advice from members of the Standards Working Group of the International Society of Wheelchair Professionals (ISWP) was compiled and reviewed. RESULTS: A total of 35 articles were included in the literature review. Participation from LREs was not observed in the ISO standards development. As per wheelchair testing study evidence, wheelchair models delivered in LREs did not meet the minimum standards requirement. Multiple part failures and repairs were observed with reviewed field evaluation studies. ISWP experts noted that several testing factors responsible for premature failures with wheelchair parts are not included in the standards and accordingly provided advice for additional test development. CONCLUSION: The study findings indicate the need to develop a wide range of tests, with specific tests for measuring corrosion resistance of the entire wheelchair, rolling resistance of castors and rear wheels, and durability of whole wheelchair and castor assemblies. <![CDATA[<b>Test-retest reliability and construct validity of the Aspects of Wheelchair Mobility Test as a measure of the mobility of wheelchair users</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202017000100022&lng=en&nrm=iso&tlng=en BACKGROUND: The Aspects of Wheelchair Mobility Test (AWMT) was developed for use in a repeated measures format to provide comparative effectiveness data on mobility facilitated by different wheelchair types. It has been used in preliminary studies to compare the mobility of wheelchairs designed for low-resource areas and is intended to be simple and flexible enough so as to be used in low-technology settings. However, to reliably compare the impact of different types of wheelchairs on the mobility of users, a measure must first be a reliable and valid measure of mobility. METHODS: This study investigated the test-retest reliability and concurrent validity for the AWMT 2.0 as a measure of mobility. For reliability testing, participants in a low-resource setting completed the tests twice in their own wheelchairs at least one week apart. For concurrent validity, participants also completed the Wheelchair Skills Test Questionnaire (WST-Q), a related but not identical validated assessment tool. RESULTS: Concurrent validity was indicated by a significant positive correlation with an r value of 0.7 between the WST-Q capacity score and the AWMT 2.0 score. Test-retest reliability was confirmed by an intraclass correlation coefficient greater than 0.7 between the two trials. CONCLUSION: Results support the preliminary reliability and validity of the AWMT 2.0, supporting its effectiveness in comparing the mobility provided by different wheelchair types. This information can be used to enable effective use of limited funds for wheelchair selection at individual and organisational scales. <![CDATA[<b>Discriminatory validity of the Aspects of Wheelchair Mobility Test as demonstrated by a comparison of four wheelchair types designed for use in low-resource areas</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202017000100023&lng=en&nrm=iso&tlng=en BACKGROUND: Comparative effectiveness research on wheelchairs available in low-resource areas is needed to enable effective use of limited funds. Mobility on commonly encountered rolling environments is a key aspect of function. High variation in capacity among wheelchair users can mask changes in mobility because of wheelchair design. A repeated measures protocol in which the participants use one type of wheelchair and then another minimises the impact of individual variation. OBJECTIVES: The Aspects of Wheelchair Mobility Test (AWMT) was designed to be used in repeated measures studies in low-resource areas. It measures the impact of different wheelchair types on physical performance in commonly encountered rolling environments and provides an opportunity for qualitative and quantitative participant response. This study sought to confirm the ability of the AWMT to discern differences in mobility because of wheelchair design. METHOD: Participants were wheelchair users at a boarding school for students with disabilities in a low-resource area. Each participant completed timed tests on measured tracks on rough and smooth surfaces, in tight spaces and over curbs. Four types of wheelchairs designed for use in low-resource areas were included. RESULTS: The protocol demonstrated the ability to discriminate changes in mobility of individuals because of wheelchair type. CONCLUSION: Comparative effectiveness studies with this protocol can enable beneficial change. This is illustrated by design alterations by wheelchair manufacturers in response to results. <![CDATA[<b>The health benefits and constraints of exercise therapy for wheelchair users: A clinical commentary</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202017000100024&lng=en&nrm=iso&tlng=en BACKGROUND: There are approximately 1 billion people living with chronic lower limb disability, many of whom are wheelchair users. OBJECTIVES: Review cardiometabolic and neuromuscular risk profiles of wheelchair users, benefits of regular exercise and the causes of neuromuscular upper limb and hip injuries that hinder regular adherence. METHOD: Literature published between 2013 and 2017 was adopted according to the standard practices for systematic reviews (PRISMA) through Crossref Metadata and Google Scholar searches. Individual paper quality was evaluated using a modified Downs and Black Appraisal Scale. RESULTS: The literature search identified 16 600 papers which were excluded if they were non-English, non-peer-reviewed or published before 2013. Finally, 25 papers were accepted, indicating that sedentary wheelchair users have poor cardiometabolic risk profiles (PCMRP) because of a lack of physical activity, limiting their quality of life, characterised by low self-esteem, social isolation and depression. Their predominant mode of physical activity is through upper limb exercises, which not only improves their cardiometabolic risk profiles but also precipitates neuromuscular upper limb overuse injuries. The primary cause of upper limb injuries was attributed to poor wheelchair propulsion related to incorrect chair setup and poor cardiorespiratory fitness. CONCLUSION: Wheelchair users have a high body mass index, body fat percentage and serum lipid, cholesterol and blood glucose concentrations. Empirical investigations illustrate exercise improves their PCMRP and cardiorespiratory fitness levels. Although literature encourages regular exercise, none discusses the need to individualise chair setup in order to eliminate wheelchair pathomechanics and upper limb neuromuscular injuries. Wheelchair users must be encouraged to consult a biokineticist or physiotherapist to review their wheelchair setup so as to eliminate possible incorrect manual wheelchair propulsion biomechanics and consequent overuse injuries. <![CDATA[<b>Wheelchair service provision education in academia</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202017000100025&lng=en&nrm=iso&tlng=en BACKGROUND: An estimated 70 million people with disabilities need wheelchairs. To address this global crisis, the World Health Organization (WHO) proposed an eight-step wheelchair service provision model to ensure service quality regardless of resource setting. The International Society of Wheelchair Professionals (ISWP) aims to facilitate the integration of the WHO eight-step model into professional rehabilitation programmes. OBJECTIVE: To develop an enhanced understanding of the current wheelchair service provision education provided in professional rehabilitation programmes worldwide. METHODS: In a cross-sectional design, an online survey was distributed to ISWP contacts of educational institutions. Quantitative responses were analysed through summary statistics and qualitative answers were analysed by content analyses. When relevant, educational institutions were stratified into resource settings. RESULTS: Seventy-two representatives of educational institutions in 21 countries completed the survey. Wheelchair content was taught in 79% of represented institutions, of which 75% of respondents reported using original course material, 10% of respondents used WHO Wheelchair Service Training Packages and 15% of respondents used other available resources. The majority of educational institutions teaching with their own wheelchair-related course material taught ≤ 20 hours. Fourteen of the 15 respondents without wheelchair education, expressed an interest in integrating wheelchair education into their academic curricula. CONCLUSION: The majority of the educational institutions teach wheelchair education; however, there is great variability in what and how it is taught and evaluated. The results demonstrate the need for more in-depth investigation regarding the integration process of wheelchair education in educational institutions, with the ultimate goal of improving wheelchair service provision worldwide. <![CDATA[<b>Effect of wheelchair design on wheeled mobility and propulsion efficiency in less-resourced settings</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202017000100026&lng=en&nrm=iso&tlng=en BACKGROUND: Wheelchair research includes both qualitative and quantitative approaches, primarily focuses on functionality and skill performance and is often limited to short testing periods. This is the first study to use the combination of a performance test (i.e. wheelchair propulsion test) and a multiple-day mobility assessment to evaluate wheelchair designs in rural areas of a developing country. OBJECTIVES: Test the feasibility of using wheel-mounted accelerometers to document bouts of wheeled mobility data in rural settings and use these data to compare how patients respond to different wheelchair designs. METHODS: A quasi-experimental, pre- and post-test design was used to test the differences between locally manufactured wheelchairs (push rim and tricycle) and an imported intervention product (dual-lever propulsion wheelchair). A one-way repeated measures analysis of variance was used to interpret propulsion and wheeled mobility data. RESULTS: There were no statistical differences in bouts of mobility between the locally manufactured and intervention product, which was explained by high amounts of variability within the data. With regard to the propulsion test, push rim users were significantly more efficient when using the intervention product compared with tricycle users. CONCLUSION: Use of wheel-mounted accelerometers as a means to test user mobility proved to be a feasible methodology in rural settings. Variability in wheeled mobility data could be decreased with longer acclimatisation periods. The data suggest that push rim users experience an easier transition to a dual-lever propulsion system. <![CDATA[<b>The long-term impact of wheelchair delivery on the lives of people with disabilities in three countries of the world</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202017000100027&lng=en&nrm=iso&tlng=en BACKGROUND: Lack of access to mobility for people with disabilities, particularly in less- resourced settings, continues to be widespread. Despite challenges to wheelchair delivery, the benefits to health, employment, social integration and life satisfaction are apparent. OBJECTIVES: Previous studies have explored the impact of receiving a wheelchair on the lives of the users through cross-sectional or short-term longitudinal analysis. The current study was undertaken to evaluate whether previously reported changes were sustained after 30 months of use, and whether results varied between two differing models of a wheelchair. METHOD: One hundred and ninety-one subjects from Peru, Uganda and Vietnam received one of two models of wheelchair provided by the Free Wheelchair Mission. Using interviews to record survey results, data were collected at the time the wheelchair was received and following 12 and 30 months of use. Variables of overall health, employment, income and travel were explored through non-parametric analysis. RESULTS: There was a significant improvement in overall health and distance travelled after 12 months, but these changes were no longer significant by 30 months (Friedman test for overall change, p = 0.000). Employment status showed a small but significant increase at 12 and 30 months (Cochran's Q, p = 0.000). Reported income increased slowly, becoming significantly different at 30 months (Friedman test, p = 0.033). There was no association between the model of wheelchair received and the incidence of pressure ulcers, pain or maintenance required. There was higher satisfaction with the GEN_2 wheelchair at 12 months (p = 0.004), but this difference was not apparent by 30 months. Overall wheelchair satisfaction and maintenance levels were favourable. CONCLUSION: While overall health status, and distance travelled into the community fluctuated over time, receipt of one of two models of a wheelchair in less-resourced settings of the world appears to have a positive sustained impact on employment and income. Further investigations should be carried out to confirm these results and explore the factors responsible for fluctuating variables. This study affirms the importance of long-term follow-up of outcomes associated with wheelchair distribution in less-resourced environments. <![CDATA[<b>Motivation Peer Training - Bridging the gap for people with mobility disabilities</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202017000100028&lng=en&nrm=iso&tlng=en BACKGROUND: Only 2% of people with disabilities in developing countries have access to basic services and rehabilitation. OBJECTIVES: To bridge this gap, Motivation has been running Peer Training activities since 1993 and has identified that there is a growing need for Peer Training. The overall aim of Peer Training is for wheelchair users (Peer Trainers) to provide others (with similar disabilities) with the relevant knowledge on health issues, rights and skills to achieve a basic level of independence and greater quality of life METHOD: To test the impact of Peer Training, Motivation created a knowledge, skills and well-being questionnaire, which has been trialled in two locations: Kenya and Malawi. RESULTS: Overall, Motivation found that most participants reported an increase in knowledge, skills and well-being, supporting their experience that this training provides vital information and support mechanisms for wheelchair users in low- and middle-income countries. Further work is needed to ensure this tool measures the impact of Peer Training and lessons learnt have been identified to strengthen the methodology. CONCLUSION: Although Peer Training is not a replacement for rehabilitation services, Motivation believes it is an effective way to not only increase knowledge and skills of persons with disabilities but also reduce the sense of social isolation that can often be a result of disability. <![CDATA[<b>Wheelchair users, access and exclusion in South African higher education</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202017000100029&lng=en&nrm=iso&tlng=en BACKGROUND: South Africa's Constitution guarantees everyone, including persons with disabilities, the right to education. A variety of laws are in place obliging higher education institutions to provide appropriate physical access to education sites for all. In practice, however, many buildings remain inaccessible to people with physical disabilities. OBJECTIVES: To describe what measures South African universities are taking to make their built environments more accessible to students with diverse types of disabilities, and to assess the adequacy of such measures. METHOD: We conducted semi-structured in-depth face-to-face interviews with disability unit staff members (DUSMs) based at 10 different public universities in South Africa. RESULTS: Challenges with promoting higher education accessibility for wheelchair users include the preservation and heritage justification for failing to modify older buildings, ad hoc approaches to creating accessible environments and failure to address access to toilets, libraries and transport facilities for wheelchair users. CONCLUSION: South African universities are still not places where all students are equally able to integrate socially. DUSMs know what ought to be done to make campuses more accessible and welcoming to students with disabilities and should be empowered to play a leading role in sensitising non-disabled members of universities, to create greater awareness of, and appreciation for, the multiple ways in which wheelchair user students continue to be excluded from full participation in university life. South African universities need to adopt a systemic approach to inclusion, which fosters an understanding of inclusion as a fundamental right rather than as a luxury. <![CDATA[<b>A conceptual framework to assess effectiveness in wheelchair provision</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202017000100030&lng=en&nrm=iso&tlng=en BACKGROUND: Currently, inadequate wheelchair provision has forced many people with disabilities to be trapped in a cycle of poverty and deprivation, limiting their ability to access education, work and social facilities. This issue is in part because of the lack of collaboration among various stakeholders who need to work together to design, manufacture and deliver such assistive mobility devices. This in turn has led to inadequate evidence about intervention effectiveness, disability prevalence and subsequent costeffectiveness that would help facilitate appropriate provision and support for people with disabilities OBJECTIVES: In this paper, we describe a novel conceptual framework that can be tested across the globe to study and evaluate the effectiveness of wheelchair provision. METHOD: The Comparative Effectiveness Research Subcommittee (CER-SC), consisting of the authors of this article, housed within the Evidence-Based Practice Working Group (EBP-WG) of the International Society of Wheelchair Professionals (ISWP), conducted a scoping review of scientific literature and standard practices used during wheelchair service provision. The literature review was followed by a series of discussion groups. RESULTS: The three iterations of the conceptual framework are described in this manuscript. CONCLUSION: We believe that adoption of this conceptual framework could have broad applications in wheelchair provision globally to develop evidence-based practices. Such a perspective will help in the comparison of different strategies employed in wheelchair provision and further improve clinical guidelines. Further work is being conducted to test the efficacy of this conceptual framework to evaluate effectiveness of wheelchair service provision in various settings across the globe. <![CDATA[<b>Development and evaluation of a wheelchair service provision training of trainers programme</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202017000100031&lng=en&nrm=iso&tlng=en BACKGROUND: In many countries, availability of basic training and continued professional development programmes in wheelchair services is limited. Therefore, many health professionals lack access to formal training opportunities and new approaches to improve wheelchair service provision. To address this need, the World Health Organization (WHO) developed the WHO Wheelchair Service Training of Trainers Programme (WSTPt), aiming to increase the number of trainers who are well prepared to deliver the WHO Wheelchair Service Training Packages. Despite these efforts, there was no recognised method to prepare trainers to facilitate these training programmes in a standardised manner. OBJECTIVES: To understand if the WSTPt is an effective mechanism to train aspiring wheelchair service provision trainers. METHOD: An action research study was conducted using a mixed-methods approach to data collection and analysis to integrate feedback from questionnaires and focus groups from three WHO WSTPt pilots RESULTS: Trainees were satisfied with the WHO WSTPt and the iterative process appears to have helped to improve each subsequent pilot and the final training package. CONCLUSION: The WHO WSTPt is an effective mechanism to train wheelchair service provision trainers. This programme has potential to increase the number of trainees and may increase the number of qualified service providers. <![CDATA[<b>Wheelchair accessibility to public buildings in the Kumasi metropolis, Ghana</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202017000100032&lng=en&nrm=iso&tlng=en BACKGROUND: Accessibility implies making public places accessible to every individual, irrespective of his or her disability or special need, ensuring the integration of the wheelchair user into the society and thereby granting them the capability of participating in activities of daily living and ensuring equality in daily life. OBJECTIVE: This study was carried out to assess the accessibility of the physical infrastructures (public buildings) in the Kumasi metropolis to wheelchairs after the passage of the Ghanaian Disability Law (Act 716, 2006). METHODS: Eighty-four public buildings housing education facilities, health facilities, ministries, departments and agencies, sports and recreation, religious groups and banks were assessed. The routes, entrances, height of steps, grade of ramps, sinks, entrance to washrooms, toilets, urinals, automated teller machines and tellers' counters were measured and computed. RESULTS: Out of a total of 84 buildings assessed, only 34 (40.5%) of the buildings, 52.3% of the entrances and 87.4% of the routes of the buildings were accessible to wheelchair users. A total of 25% (13 out of 52) of the public buildings with more than one floor were fitted with elevators to connect the different levels of floors. CONCLUSION: The results of this study show that public buildings in the Kumasi metropolis are not wheelchair accessible. An important observation made during this study was that there is an intention to improve accessibility when buildings are being constructed or renovated, but there are no laid down guidelines as how to make the buildings accessible for wheelchair users. <![CDATA[<b>Development of wheelchair caster testing equipment and preliminary testing of caster models</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202017000100033&lng=en&nrm=iso&tlng=en BACKGROUND: Because of the adverse environmental conditions present in less-resourced environments (LREs), the World Health Organization (WHO) has recommended that specialised wheelchair test methods may need to be developed to support product quality standards in these environments. A group of experts identified caster test methods as a high priority because of their common failure in LREs, and the insufficiency of existing test methods described in the International Organization for Standardization (ISO) Wheelchair Testing Standards (ISO 7176). OBJECTIVES: To develop and demonstrate the feasibility of a caster system test method. METHOD: Background literature and expert opinions were collected to identify existing caster test methods, caster failures common in LREs and environmental conditions present in LREs. Several conceptual designs for the caster testing method were developed, and through an iterative process using expert feedback, a final concept and a design were developed and a prototype was fabricated. Feasibility tests were conducted by testing a series of caster systems from wheelchairs used in LREs, and failure modes were recorded and compared to anecdotal reports about field failures. RESULTS: The new caster testing system was developed and it provides the flexibility to expose caster systems to typical conditions in LREs. Caster failures such as stem bolt fractures, fork fractures, bearing failures and tire cracking occurred during testing trials and are consistent with field failures. CONCLUSION: The new caster test system has the capability to incorporate necessary test factors that degrade caster quality in LREs. Future work includes developing and validating a testing protocol that results in failure modes common during wheelchair use in LRE. <![CDATA[<b>Wheelchair services and use outcomes: A cross-sectional survey in Kenya and the Philippines</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202017000100034&lng=en&nrm=iso&tlng=en BACKGROUND: The World Health Organisation recommends that services accompany wheelchair distribution. This study examined the relationship of wheelchair service provision in Kenya and the Philippines and wheelchair-use-related outcomes. METHOD: We surveyed 852 adult basic manual wheelchair users. Participants who had received services and those who had not were sought in equal numbers from wheelchair-distribution entities. Outcomes assessed were daily wheelchair use, falls, unassisted outdoor use and performance of activities of daily living (ADL). Descriptive, bivariate and multivariable regression model results are presented. RESULTS: Conditions that led to the need for a basic wheelchair were mainly spinal cord injury, polio/post-polio, and congenital conditions. Most Kenyans reported high daily wheelchair use (60%) and ADL performance (80%), while these practices were less frequent in the Philippine sample (42% and 74%, respectively). Having the wheelchair fit assessed while the user propelled the wheelchair was associated with greater odds of high ADL performance in Kenya (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.6, 5.1) and the Philippines (OR 2.8, 95% CI 1.8, 4.5). Wheelchair-related training was associated with high ADL performance in Kenya (OR 3.2, 95% CI 1.3, 8.4). In the Philippines, training was associated with greater odds of high versus no daily wheelchair use but also odds of serious versus no falls (OR 2.5, 95% CI 1.4, 4.5. CONCLUSION: Select services that were associated with some better wheelchair use outcomes and should be emphasised in service delivery. Service providers should be aware that increased mobility may lead to serious falls. <![CDATA[<b>Use of a design challenge to develop postural support devices for intermediate wheelchair users</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202017000100035&lng=en&nrm=iso&tlng=en The provision of an appropriate wheelchair, one that provides proper fit and postural support, promotes wheelchair users' physical health and quality of life. Many wheelchair users have postural difficulties, requiring supplemental postural support devices for added trunk support. However, in many low- and middle-income settings, postural support devices are inaccessible, inappropriate or unaffordable. This article describes the use of the design challenge model, informed by a design thinking approach, to catalyse the development of an affordable, simple and robust postural support device for low- and middle-income countries. The article also illustrates how not-for-profit organisations can utilise design thinking and, in particular, the design challenge model to successfully support the development of innovative solutions to product or process challenges.