Scielo RSS <![CDATA[African Journal of Disability (Online)]]> http://www.scielo.org.za/rss.php?pid=2226-722020180001&lang=en vol. 7 num. lang. en <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Dyslexic learners' experiences with their peers and teachers in special and mainstream primary schools in North-West Province</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202018000100001&lng=en&nrm=iso&tlng=en BACKGROUND: Inclusive education requires that the framework within which education is delivered should be broad enough to accommodate equally the needs and circumstances of every learner in the society. This includes learners with disabilities like dyslexia who have been excluded from the formal education system. This article reports the findings of a qualitative study that explored and described the dyslexic learners' experiences with their peers and teachers in special and public schools in North-West Province of South Africa. METHODS: The study adopted a qualitative methodology and used a phenomenology research design. The sample was purposively selected and comprised nine dyslexic learners. All the learners were in public schools previously and were later moved to a special school after being diagnosed as dyslexic. The participants were aged 9-12 years. The researchers conducted one-on-one interviews with the participants and content-analysed the data. FINDINGS: The findings revealed that in public schools the dyslexic learners were exposed to ill-treatment by other learners who despised, ridiculed, bullied and undermined them. The findings further revealed that teachers in public schools were not patient with dyslexic learners, did not give them extra attention and that some teachers used negative comments that embarrassed them. CONCLUSION: The article spells out the barriers experienced by dyslexic learners in public schools and also recommends training of teachers so that they know how to deal with dyslexic learners, thereby eliminating the barriers. The study further recommended awareness campaigns among the student body about dyslexia. <![CDATA[<b>'I felt pain. Deep pain</b><b>…</b><b>': Experiences of primary caregivers of stroke survivors with aphasia in a South African township</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202018000100002&lng=en&nrm=iso&tlng=en BACKGROUND: Aphasia is an acquired impairment in language and in the cognitive processes that underlie language. Aphasia affects the quality of life of the person with aphasia (PWA) and his or her families in various ways in diverse contexts and cultures. It is therefore important that speech language therapists understand how different contextual and cultural factors may mediate experiences. PURPOSE: The aim of the study was to describe the caregiving experience of female caregivers of PWA residing in Tembisa, a township situated in the east of Johannesburg. METHOD: Qualitative, semi-structured interviews were conducted with primary caregivers of PWA. Purposive sampling was used to recruit 14 primary caregivers of PWA who were daughters, daughters-in-law or wives of the PWA. The interviews were conducted in participants' first language and analysed by the researcher, who is proficient in isiZulu. Data were analysed according to the principles of thematic analysis. RESULTS: Findings indicated that caregivers are unfamiliar with aphasia and the support available to them. Participants experienced frustration and found communication to be challenging owing to their lack of communication strategies. The participants' experiences reflected their context-specific experiences, such as feminisation of caregiving, barriers to healthcare, the influence of low health literacy and contextual perspectives on stroke and aphasia. CONCLUSIONS: Contextual factors of caregivers in Tembisa have an influence on the experiences between caregivers and PWA, the feelings of individuals and families and health-seeking behaviours of individuals and families. <![CDATA[<b>'How deep are your pockets?' Autoethnographic reflections on the cost of raising a child with autism</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202018000100003&lng=en&nrm=iso&tlng=en BACKGROUND: In this article, we reflected on our experience of the cost of parenting a child with autism, including our ongoing search for educational and therapeutic intervention. OBJECTIVES: We aimed to give an academic insight into the state of autism education and care in South Africa as seen by us, with special attention to its cost and sustainability. METHODS: Using evocative autoethnography as storied scholarship together with critical autism studies, we reflected on stories of the past 5 years since our son's diagnosis. RESULTS: Our experiences agree with international studies that establish autism as the most expensive disability. In addition to the high costs of diagnosis, existing intervention and support approaches are unaffordable for the majority of South Africans. We recommend that teachers should be trained to participate in early screening and diagnosis, as well as co-therapists, to strengthen the implementation of inclusive education. CONCLUSION: The kind of autism intervention currently offered in South Africa is financially and socially unsustainable. Instead of positioning autism as an individual or family dilemma, it should be addressed as an educational and societal issue. Future research should explore cost-effective options for a developing country context, while promoting best practice within inclusive settings. <![CDATA[<b>The postural stability of children with foetal alcohol spectrum disorders during one-leg stance: A feasibility study</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202018000100004&lng=en&nrm=iso&tlng=en BACKGROUND: Postural control may be impaired in children with foetal alcohol spectrum disorders (FASD). The study assessed the protocol feasibility in terms of (1) recruiting children with FASD in a rural, small town; (2) using the measurement instruments in a real-life setting; (3) the one-leg standing (OLS) task and (4) presenting preliminary results on postural stability of children with and without FASD. METHODS: Nine-year-old children diagnosed with and without FASD were invited to participate. Twenty-eight children performed OLS. Feasibility outcomes included recruitment, measurement instrument use and task instruction. Postural stability outcomes included standing duration, centre of pressure (COP) and body segment acceleration. RESULTS: Participants recruitment was feasible in terms of the (1) ability to sample a reasonable participant number in a rural town setting and the capacity to increase the sample size if more schools are included in the sampling frame and (2) use of assent and consent forms that were appropriate for this population. The measurement instruments were user-friendly, cost-effective and time-efficient. Instructions for the task require amendment to address foot placement of the non-weight-bearing leg. There was a significant difference between cases and controls on mean COP velocity (p = 0.001) and the pelvis segment acceleration in the mediolateral direction (p = 0.01) and the anteroposterior direction (p = 0.027). The control children took longer to achieve postural control. The girls demonstrated a significant difference for the COP anteroposterior displacement (p = 0.008) and velocity (p = 0.049). CONCLUSIONS: The recruitment of children with and without FASD in a rural, small town and the administration of measurement instruments in a real-life, school-based setting was feasible. However, the verbal instructions for the task require revision. The male control group took longer to achieve postural control because the task was performed differently between the two groups. However, the case girls were slower to achieve postural control than control girls though performing the task similarly. <![CDATA[<b>An analysis of trunk kinematics and gait parameters in people with stroke</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202018000100005&lng=en&nrm=iso&tlng=en BACKGROUND: Approximately two out of three people with stroke experience gait problems. Trunk movement control and symmetry is an important prerequisite for functional walking gait. Movement control, measured objectively as kinematics during walking gait, is rarely investigated. OBJECTIVE: To describe the three-dimensional (3D) kinematics of the trunk during gait in people with stroke, including key spatiotemporal characteristics. METHODOLOGY: A total of 17 adults with stroke who met the inclusion criteria were selected to participate in this cross-sectional pilot study. An eight-camera T-10 Vicon system with Nexus 1.8 software (Vicon Motion System Limited, Oxford, UK) was used to analyse the 3D kinematics of the trunk during self-selected walking speed. Trunk kinematics throughout the gait cycle and spatiotemporal parameters were extracted using custom-built scripts in MATLAB used at the Stellenbosch University Movement Analysis Laboratory. Stata Version 12.1 software was used to assess differences in trunk kinematics between the affected and unaffected sides during gait using the Sign test (statistical significance level p < 0.05. RESULTS: Participants achieved functional gait speeds although they presented with asymmetrical trunk kinematics. During the full gait cycle, there were statistically significant differences of trunk motion between the affected and unaffected sides in the coronal plane (p < 0.001). There were statistically significant differences in the trunk kinematics between the affected side and unaffected sides at initial contact (p < 0.001) and foot off (p < 0.049) in the coronal plane as well as at initial contact (p < 0.000) and foot off (p < 0.013) in the transverse plane. CONCLUSION: This pilot study found significant asymmetry in trunk motion between the affected and unaffected sides that varied across the gait cycle. This suggests the trunk may need to be targeted in clinical gait retraining post-stroke. <![CDATA[<b>Communication rehabilitation in sub-Saharan Africa: The role of speech and language therapists</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202018000100006&lng=en&nrm=iso&tlng=en BACKGROUND: Workforce factors present a significant barrier to the development of rehabilitation services for people with communication disabilities in sub-Saharan Africa (SSA). Exploring how the work of speech and language therapists (SLTs) in the region is organised and delivered can provide insight into existing services, areas for future workforce development and improved rehabilitation access for people with communication disability. OBJECTIVES: This paper describes the employment and service provision patterns and work roles of a sample of SLTs in SSA. METHOD: A broad, purpose-designed, mixed-methods survey was designed to collect data from SLTs living in Anglophone countries of SSA. Descriptive statistics and qualitative content analysis were undertaken. This paper reports on a subset of data from the wider survey. RESULTS: A description of the employment and work roles of the 33 respondents to the survey and characteristics of their service users is presented. SLTs were commonly employed within private and not-for-profit sectors and frequently worked in temporary jobs. SLTs engaged in a range of work roles, including capacity building and training others. Services were provided by SLTs across age ranges, health conditions and settings, with paediatric, urban services commonly reported. Costs for service users and urban-centred services give indications of barriers to service access. CONCLUSION: Knowledge of the way in which speech and language therapy services are organised and provided has the potential to shape the development of communication disability rehabilitation in SSA. This research has identified a range of issues requiring consideration as the profession develops and grows. <![CDATA[<b>Lessons from the pilot of a mobile application to map assistive technology suppliers in Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202018000100007&lng=en&nrm=iso&tlng=en A pilot project to develop and implement a mobile smartphone application (App) that tracks and maps assistive technology (AT) availability in southern Africa was launched in Botswana in 2016. The App was developed and tested through an iterative process. The concept of the App (AT-Info-Map) was well received by most stakeholders within the pilot country, and broader networks. Several technical and logistical obstacles were encountered. These included high data costs; difficulty in accessing AT information from the public healthcare sector, the largest supplier of AT; and the high human resource demand of collecting and keeping up-to-date device-level information within a complex and fragmented supply sector that spans private, public and civil society entities. The challenges were dealt with by keeping the data burden low and eliminating product-level tracking. The App design was expanded to include disability services, contextually specific AT categories and make navigation more intuitive. Long-term sustainability strategies like generating funding through advertisements on the App or supplier usage fees must be explored. Outreach and sensitisation programmes about both the App and AT in general must be intensified. The project team must continually strengthen partnerships with private and public stakeholders to ensure ongoing project engagement. The lessons learnt might be of value to others who wish to embark on initiatives in AT and/or implement Apps in health or disability in southern Africa and in low-resourced settings around the world. <![CDATA[<b>The intersection of disability and food security: Perspectives of health and humanitarian aid workers</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202018000100008&lng=en&nrm=iso&tlng=en BACKGROUND: Most people with disabilities the world over can be found in the Majority (or 'economically developing') World. This is also where most of the world's hungry and malnourished are found. We argue that the intersectionality between disability and nutrition may best be understood through a food security framework, and we position all people living with disability, including those experiencing feeding and swallowing disabilities, as at risk for food insecurity, especially those living in humanitarian emergency contextsOBJECTIVES: This study aimed to explore and describe the knowledge and experience of humanitarian aid workers (HAWs) and health care professionals (HCPs) in food assistance contexts with regard to the nutrition and food security of people living with disabilitiesMETHOD: In this exploratory, descriptive study, 16 participants with experience in sub-Saharan Africa and Southern Asia participated in an online survey. Three survey participants with extensive experience were also interviewed. Data analysis involved descriptive statistics and thematic content analysisRESULTS: Results revealed that participants had generally low levels of exposure to and experience with disability, including swallowing and feeding disordersCONCLUSIONS: Reduced knowledge of HAWs and HCPs regarding disability and the lack of professionals such as speech-language therapists, who manage disability-specific issues such as feeding and swallowing disorders, may affect the food security of people living with disabilities in food assistance contexts <![CDATA[<b>Hearing children of Deaf parents: Gender and birth order in the delegation of the interpreter role in culturally Deaf families</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202018000100009&lng=en&nrm=iso&tlng=en BACKGROUND: Culturally, hearing children born to Deaf parents may have to mediate two different positions within the hearing and Deaf cultures. However, there appears to be little written about the experiences of hearing children born to Deaf parents in the South African contextOBJECTIVE: This study sought to investigate the roles of children of Deaf adults (CODAs) as interpreters in Deaf-parented families, more specifically, the influence of gender and birth order in language brokeringMETHOD: Two male and eight female participants between the ages of 21 and 40 years were recruited through purposive and snowball sampling strategies. A qualitative design was employed and data were collected using a semi-structured, open-ended interview format. Themes which emerged were analysed using thematic analysisRESULTS: The findings indicated that there was no formal assignment of the interpreter role; however, female children tended to assume the role of interpreter more often than the male children. Also, it appeared as though the older children shifted the responsibility for interpreting to younger siblings. The participants in this study indicated that they interpreted in situations where they felt they were not developmentally or emotionally ready, or in situations which they felt were better suited for older siblings or for siblings of another genderCONCLUSION: This study highlights a need for the formalisation of interpreting services for Deaf people in South Africa in the form of professional interpreters rather than the reliance on hearing children as interpreters in order to mediate between Deaf and hearing cultures <![CDATA[<b>The effect of synchronised metronome training: A case study in a single leg, below knee Paralympic sprinter</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202018000100010&lng=en&nrm=iso&tlng=en BACKGROUND: To optimise sprint performance, one needs to understand how motor control affects motor performance. Researchers have proposed that the Dynamic Systems Theory be adopted for explaining motor performance, skill acquisition and the development of pedagogical methods. Within this theory, the individual is seen as a complex system that functions as the interaction of many sub-systems. Entrained movements would be characterised by optimal sequencing, timing and grading of muscle activation. One of the identified control parameters for running is the rhythm in the coordination patternOBJECTIVES: The objectives of this study were twofold: firstly to investigate whether 6 weeks of timing and rhythmicity training using the computer-based Interactive Metronome™ (IM™) system improves motor timing and rhythmicity, and secondly to investigate whether such effects of IM™ influence the kinematic variables of a sprintMETHODS: This study followed a semi-quantitative analysis case study approach using a Paralympic sprinter with a single below knee amputation participated in this study. Data for acceleration and maximal running velocity phases were collected using video recordersRESULTS AND CONCLUSIONS: As found by previous research, the IM™ programme improved the motor timing and rhythmicity of the athlete. However, in contrast to previous research, only minimal improvements, non-significant improvements, were seen in the actual motor performance. This athlete was an older more established athlete and it is therefore recommended that these types of programmes should be followed by young participants in the more fundamental phases of their movement development, to show best results. <![CDATA[<b>Intellectual disability rights and inclusive citizenship in South Africa: What can a scoping review tell us?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202018000100011&lng=en&nrm=iso&tlng=en BACKGROUND: Intellectual disability (ID) is the most prevalent disability in the world. People with intellectual disability (PWID) frequently experience extreme violations of numerous human rights. Despite greater prevalence in South Africa than in high-income countries, most ID research currently comes from the Global North. This leaves us with few contextually sensitive studies to draw from to advance inclusive citizenshipOBJECTIVES: Our scoping review aims to investigate pertinent ID rights issues in South Africa, synthesise quantitative and qualitative studies, and provide a synopsis of available evidence on which to base future work. We aim to clarify key concepts, address gaps in the literature and identify opportunities for further researchMETHOD: We followed strict eligibility criteria. Medical subject heading terms were entered into seven databases. Seven reviewers worked independently, two per paper. Quantitative and qualitative data extraction forms were designed. We followed Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and registered a protocol. An inductive approach enabled a thematic analysis of selected studiesRESULTS: By following PRISMA guidelines, 82 studies were assessed for eligibility of which 59 were included. Ten sub-themes were integrated into four main themes: the right not to be discriminated against, the right to psychological and bodily integrity, the right to accommodating services and challenges to rights implementationCONCLUSION: People with intellectual disability face compound difficulties when trying to assert their constitutionally entitled rights. This ongoing project requires serious commitment and action. Statutory obligations to nurture every South African's human rights naturally extend to PWID and their supporters who forge ahead in a disabling environment <![CDATA[<b>The benefits of hydrotherapy to patients with spinal cord injuries</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202018000100012&lng=en&nrm=iso&tlng=en BACKGROUND: Many patients with spinal cord injury (PWSCI) lead sedentary lifestyles, experiencing poor quality of life and medical challenges. PWSCI don't like to participate in land-based-exercises because it's tedious to perform the same exercises, decreasing their rehabilitative compliance and negatively impacting their well-being. An alternative exercise environment and exercises may alleviate boredom, enhancing complianceOBJECTIVES: Discuss the benefits of hydrotherapy to PWSCI concerning underwater gait-kinematics, thermoregulatory and cardiovascular responses and spasticityMETHODOLOGY: A literature surveillance was conducted between 1998 and 2017, through the Crossref meta-database and Google Scholar, according to the PRISMA procedures. Key search words were water-therapy, aquatic-therapy, hydrotherapy, spinal cord injury, rehabilitation, human, kinematics, underwater gait, cardiorespiratory, thermoregulation and spasticity. The quality of each paper was evaluated using a modified Downs and Black Appraisal Scale. The participants were records pertaining to PWSCI and hydrotherapy. The outcomes of interest were: hydrotherapy interventions, the impact of hydrotherapy on gait-kinematics, thermoregulation during water submersion and cardiorespiratory function of PWSCI. Omitted records included: non-English publications from before 1998 or unrelated to hydrotherapy and PWSCI. The record screening admissibility was performed as follows: the title screen, the abstract screen and the full text screenRESULTS: Literature search identified 1080 records. Upon application of the exclusion criteria, 92 titles, 29 abstracts and 17 full text records were eligible. Only 15 records were selected to be included in this clinical commentary. Evidence shows a paucity of randomised control trials (RCT) conducted in this fieldCONCLUSION: Hydrotherapy improves PWSCI underwater gait-kinematics, cardiorespiratory and thermoregulatory responses and reduces spasticity <![CDATA[<b>Simple ideas that work: Celebrating development in persons with profound intellectual and multiple disabilities</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202018000100013&lng=en&nrm=iso&tlng=en BACKGROUND: The purpose of this article is to share some lessons learnt by an interdisciplinary therapy team working with persons with profound intellectual and multiple disabilities (PIMD), implemented in diverse, low-income contexts over a period of 8 yearsOBJECTIVES: The objective of all the activities described here was to provide increased stimulation and development opportunities for persons with PIMD within different settings (day care centre, residential centre or family homeMETHOD: We used an iterative action-learning approach where we applied existing evidence in the given context, reflected on and adapted strategies in collaboration with stakeholders on a cyclical basis. We focussed on achieving our objectives through ongoing hands-on training of the carers involved with the clients as we felt that by providing them with the knowledge and skills needed, plus ongoing support, these programmes would be more sustainableFINDINGS: It took some time to put systems in place in care settings, but once they became part of the daily routine, they provided increased opportunities for learning for clients with PIMD. In addition, there were often marked changes in individual clients' communicative and physical functioning, which in turn encouraged carers to find new and different ways to interact with, and stimulate, the persons with PIMD in their careCONCLUSION: Our hope is that parents and carers or professionals working in the field of PIMD in low-income contexts elsewhere may find one, some or all of these simple ideas useful in providing opportunities for learning, development and enjoyment for persons with PIMD <![CDATA[<b>Lessons from the pilot of a mobile application to map assistive technology suppliers in Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202018000100014&lng=en&nrm=iso&tlng=en A pilot project to develop and implement a mobile smartphone application (App) that tracks and maps assistive technology (AT) availability in southern Africa was launched in Botswana in 2016. The App was developed and tested through an iterative process. The concept of the App (AT-Info-Map) was well received by most stakeholders within the pilot country, and broader networks. Several technical and logistical obstacles were encountered. These included high data costs; difficulty in accessing AT information from the public healthcare sector, the largest supplier of AT; and the high human resource demand of collecting and keeping up-to-date device-level information within a complex and fragmented supply sector that spans private, public and civil society entities. The challenges were dealt with by keeping the data burden low and eliminating product-level tracking. The App design was expanded to include disability services, contextually specific AT categories and make navigation more intuitive. Long-term sustainability strategies like generating funding through advertisements on the App or supplier usage fees must be explored. Outreach and sensitisation programmes about both the App and AT in general must be intensified. The project team must continually strengthen partnerships with private and public stakeholders to ensure ongoing project engagement. The lessons learnt might be of value to others who wish to embark on initiatives in AT and/or implement Apps in health or disability in southern Africa and in low-resourced settings around the world. <![CDATA[<b>Rethinking disability: The need to rethink representation</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202018000100015&lng=en&nrm=iso&tlng=en A pilot project to develop and implement a mobile smartphone application (App) that tracks and maps assistive technology (AT) availability in southern Africa was launched in Botswana in 2016. The App was developed and tested through an iterative process. The concept of the App (AT-Info-Map) was well received by most stakeholders within the pilot country, and broader networks. Several technical and logistical obstacles were encountered. These included high data costs; difficulty in accessing AT information from the public healthcare sector, the largest supplier of AT; and the high human resource demand of collecting and keeping up-to-date device-level information within a complex and fragmented supply sector that spans private, public and civil society entities. The challenges were dealt with by keeping the data burden low and eliminating product-level tracking. The App design was expanded to include disability services, contextually specific AT categories and make navigation more intuitive. Long-term sustainability strategies like generating funding through advertisements on the App or supplier usage fees must be explored. Outreach and sensitisation programmes about both the App and AT in general must be intensified. The project team must continually strengthen partnerships with private and public stakeholders to ensure ongoing project engagement. The lessons learnt might be of value to others who wish to embark on initiatives in AT and/or implement Apps in health or disability in southern Africa and in low-resourced settings around the world. <![CDATA[<b>Preferred rehabilitation setting among stroke survivors in Nigeria and associated personal factors</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202018000100016&lng=en&nrm=iso&tlng=en BACKGROUND: Incorporating patients' preferences in the care they receive is an important component of evidence-based practice and patient-centred care. OBJECTIVE: This study assessed stroke patients' preferences regarding rehabilitation settings. METHODS: A cross-sectional design was used to examine preferences of stroke patients receiving physiotherapy at three hospitals in Northern Nigeria. Personal factors and preferred rehabilitation setting data were obtained using the Modified Rankin Scale (to assess global disability) and a researcher-developed questionnaire. Associations between preferences and personal factors were explored using bivariate statistics. RESULTS: Sixty stroke patients whose mean age was 53.6 ± 14.8 years participated in the study. Most of the participants (38.3%) preferred an outpatient setting, 19 (31.7%) preferred rehabilitation in their homes, 14 chose inpatient rehabilitation (23.3%), while 4 (6.7%) preferred the community. Age and source of finance were significantly associated with preferences. The majority (66.7%) of those aged ≥ 65 years expressed a preference for rehabilitation in the home or community (X² = 6.80; p = 0.03). Similarly, most of the participants (53.3%) who depended on family finances preferred home- or community-based rehabilitation, while most of those who depended on employment income for finances preferred an outpatient rehabilitation setting (X² = 16.80; p = 0.01. CONCLUSION: A preference for rehabilitation in outpatient facilities predominated followed by home-based rehabilitation, and preferences varied based on age and source of finance. These variations in preferences have implications for making rehabilitation decisions. <![CDATA[<b>Analysing disability policy in Namibia: An occupational justice perspective</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202018000100017&lng=en&nrm=iso&tlng=en BACKGROUND: The Namibian disability policy of 1997 has not been reviewed for about 20 years, which has raised concerns with persons with disabilities and stakeholders in the fields of disability and rehabilitation. In March 2017, the government publicised its intention to review the policy. Thus, this study's purpose was to generate evidence that can contribute to the development of a more current disability policy that will promote occupational justice. OBJECTIVES: The aim of the study was to develop an alternative disability policy option for Namibia and to present outcomes and trade-offs using a policy analysis approach while applying the occupational justice framework to gather evidence. METHOD: A qualitative research design and Bardach's eightfold path approach to policy analysis were used. Critical disability theory provided the theoretical framework. The occupational justice framework was the conceptual framework for the study. Evidence from preceding phases of this study and appropriate literature was utilised to construct possible disability policy alternatives in Namibia, set evaluative criteria, project outcomes and confront trade-offs. RESULTS: Three main disability policy alternatives emerged: access policy, support policy and universal coverage policy. Access policy had the fewest trade-offs, and the support policy had the most trade-offs in the Namibian context. Access policy was projected to foster occupational participation among persons with disabilities. CONCLUSION: Results have implications for selecting disability policy alternatives that promote occupational participation and justice among persons with disabilities in Namibia. Furthermore, the study has implications for advancing the practice of occupational justice in disability policy formulation. <![CDATA[<b>The relationship between social support and participation in stroke: A systematic review</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202018000100018&lng=en&nrm=iso&tlng=en BACKGROUND: The incidence of cerebrovascular accidents with its devastating effects on individuals is increasing. Post-stroke, restrictions in participation are common and social support could have an influence on this. Social support provided to individuals post-stroke is vital, but the relationship between social support and participation is not well understood. OBJECTIVES: This review aimed to systematically determine the relationship between social support and participation post-stroke, based on the literature available. METHOD: Ebscohost, Science Direct, Biomed Central, Cochrane Library, Google Scholar, Pedro Central and Wiley Online were the electronic databases searched between 2001 and 2016. Articles were deemed to be eligible if they met the inclusion criteria and successfully underwent scrutiny to determine their relevance and methodological quality, using tools from the Critical Appraisal Skills Programme and Milton Keynes Primary Trust. A narrative synthesis method was used to analyse the included studies. RESULTS: A total of 54 articles were identified after screening, and six articles were deemed eligible for inclusion. The articles consisted of cross-sectional, qualitative and cohort studies. Articles showed distinct, significant relationships between social support and participation where the quality and quantity of social support were important. High levels of social support had a positive influence on participation, social and leisure activities, as well as returning to work post-stroke. CONCLUSION: A positive relationship exists between social support and participation post-stroke. Health professionals need to include social support interventions when attempting to manage the individual with stroke holistically, as this will have positive effects on participation. <![CDATA[<b>Parents of children with disabilities: A systematic review of parenting interventions and self-efficacy</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202018000100019&lng=en&nrm=iso&tlng=en BACKGROUND: An increasing body of empirical evidence suggests that early intervention has positive outcomes for parents of children with neurodevelopmental disabilities. Parental self-efficacy has been used as an outcome measure in some empirical studies; however, there is a lack of evidence of the impact of parent training programmes on parenting self-efficacy beliefs OBJECTIVES: This systematic review sought to assess the effectiveness of parenting interventions to increase parental self-efficacy levels in parents of young children with neurodevelopmental disabilities METHOD: We conducted a broad literature search, which included grey literature, such as dissertations and unpublished conference presentations, to identify all relevant prospective studies reporting on our study objective. Articles were selected for inclusion using predefined criteria and data were extracted onto a purposely designed data extraction form. Twenty-five articles met our search criteria. We extracted parenting self-efficacy scores before, and on, completion of parenting interventions and performed a meta-analysis using standardised mean difference. We also conducted a risk of bias assessment for all the included studies RESULTS: Parent training programmes resulted in a statistically significant increase in parental self-efficacy levels (standardised mean difference, 0.60 [95% confidence interval {CI}, 0.38-0.83]; I2, 74%) relative to baseline measurements. Parents of children younger than 5 years demonstrated the highest increase in levels of parental self-efficacy after parenting interventions. Furthermore, this review showed that psychologists and other healthcare practitioners are successfully able to implement training programmes that enhance parenting self-efficacy CONCLUSION: Parent training programmes are effective in increasing parental self-efficacy in parents of children with neurodevelopmental disabilities <![CDATA[<b>Support to address barriers to learning for learners who are deaf</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202018000100020&lng=en&nrm=iso&tlng=en BACKGROUND: There is great importance in support services for successfully addressing the barriers to learning optimally or learners who are deaf. The study, though conducted in South Africa, has national and international appeal. OBJECTIVES: The aim of the study was to identify educator reflections on support services needed for them to address barriers to learning of learners who are deaf. METHOD: The study used a qualitative design for collecting data in natural settings. A sample size of 11 educators of learners who are deaf was purposively selected from two provinces of South Africa. The study used an open ended individual interview questionnaire. RESULTS: Data was analysed using qualitative content analysis considering the context of the schools in which the study was carried out. Results showed that there was: limited curriculum support in special schools; lack of support and inadequate teaching and learning materials; overcrowding in one school and; limited support of multidisciplinary professionals in most schools. CONCLUSION: The study provided a framework for support services important for research, policy and practice. Of significance was the relevance of the Universal Design for Learning (UDL) theoretical framework in implementing support services programmes in schools. <![CDATA[<b>Perceptions and satisfaction of caregivers regarding rehabilitation services from selected rehabilitation centres in the Western Cape</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202018000100021&lng=en&nrm=iso&tlng=en BACKGROUND: Understanding caregivers' views on rehabilitation services is important as it may assist in informing healthcare services and patient management. OBJECTIVES: The aim of this study was to explore caregivers' perceptions and satisfaction regarding rehabilitation services in the Western Cape, South Africa, and to inform clinical practice and policy in this emerging field. METHOD: This study used a descriptive, qualitative design using in-depth interviews with conveniently selected participants. Interviews were conducted with 13 caregivers of patients with: amputations (3), cerebrovascular accidents (5) and neuromuscular disorders (5). Thematic content analysis was conducted with the transcripts. RESULTS: Four key themes emerged, which were (1) financial difficulties, (2) caregiver and therapist relationships, (3) facility management and (4) caregiver experience with service delivery CONCLUSION: Based on the participants' feedback, the rehabilitation services seem to be meeting the basic rehabilitation needs of the patients; however, the needs of the caregivers require attention. <![CDATA[<b>The carry-over effect of an aquatic-based intervention in children with cerebral palsy</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202018000100022&lng=en&nrm=iso&tlng=en BACKGROUND: Cerebral palsy (CP) is the most common motor disability in childhood. Children with CP are more likely to have lower levels of physical activity than their peers, which has negative implications for their health. However, aquatic exercise can be used to improve levels of fitness among children with CP. OBJECTIVE: To determine the carry-over effect of an aquatic-based programme (postural control and balance) on land (walking, running and jumping) in children with CP, post aquatic intervention METHOD: The study used a pretest-post-test, randomised group, cross-over design. Children aged 8-12 years (n = 10) were divided into intervention (n = 5) and control (n = 5) groups. The intervention group participated in two 30-min sessions a week, while the control group continued with normal activities. Pre- and post-intervention testing was conducted using gross motor function measurement. The 10-point programme of the Halliwick Concept was used. RESULTS: Results demonstrated that the aquatic therapy had a significant effect on gross motor function scores. The aquatic programme-based group showed increased motor function following the intervention, compared to the control group (z = -2.803, p = 0.005). Furthermore, the aquatic-based therapy improved the average score for gross motor function measurement, post-intervention. CONCLUSION: Together with conventional modes of therapy, aquatic-based programmes should be integrated and considered as an essential, ongoing mode of treatment for children with CP, in order to ensure long-term gross motor function improvements. <![CDATA[<b>Part 2: The feasibility of utilising photovoice method and the World Health Organization Quality of Life instrument in evaluating the Community-Based Rehabilitation programme in Namibia: A pilot study</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202018000100023&lng=en&nrm=iso&tlng=en BACKGROUND: Evaluation of Community-Based Rehabilitation (CBR) programmes in Namibia has been primarily quantitative, focusing mainly on outputs, including numbers of persons with disabilities served, referrals made and activities implemented. Little or no evidence is available on experiences and quality of life of persons with disabilities, despite the CBR programme being operational for more than 20 years. The 2011 World Report on Disability recommended the use of appropriate tools to fill the research gap by integrating the experiences of persons with disabilities and their quality of life. OBJECTIVES: The overall objective of the larger cohort study is to develop a monitoring and evaluation tool that can measure and integrate the experiences of persons with disabilities and their quality of life within the context of the CBR Programme in Namibia. METHOD: An adapted photovoice process was conducted with six purposively selected participants over a period of 1 month. The World Health Organization Community-Based Rehabilitation (WHO CBR) Matrix was used to identify the themes and subthemes. Participants were requested to complete the World Health Organization Quality of Life (abbreviated version) (WHOQOL-BREF) instrument at the end of the photovoice process to determine their quality of life. RESULTS: Administering the WHOQOL-BREF instrument at the end of the photovoice process measured both the quality of life of persons with disabilities and at the same time indicated the convergence and divergence in the two data collection methods. The study demonstrated a stronger convergence than divergence of the two methods. A feasibility criterion was mapped for future studies. CONCLUSION: This study demonstrated that photovoice is a flexible method that can be used with a variety of disabilities and has the potential of being combined with the WHOQOL-BREF assessment form. A larger cohort study may consider implementing photovoice and WHOQOL-BREF on multiple study sites and be able to compare results, considering geographical and demographic variables. The feasibility of utilising each method alone and in combination offered valuable insights on future conceptual framing of CBR programme evaluation. This conceptual framing will allow CBR practitioners to appreciate how these two methods contribute to a rigorous process of CBR programme evaluation. <![CDATA[<b>Implementation of the 2006 Convention on the Rights of Persons with Disabilities in Zimbabwe: A review</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202018000100024&lng=en&nrm=iso&tlng=en BACKGROUND: The Convention on the Rights of Persons with Disabilities came into place in 2006, as the main instrument for advancing the human rights of persons with disabilities. For many African states, the Convention came amidst ubiquitous marginalisation and discrimination of persons with disabilities. As expected, the Convention has been hailed as a landmark in the struggle to reframe the needs and concerns of persons with disabilities. OBJECTIVES: This article reviews the implementation of the Convention by the Zimbabwean government. METHOD: The study relies on reviews of extant literature on disability rights. Reviewed documents include the Convention, constitution and other related national laws, policies and measures pertaining to disability rights. RESULTS: This article lauds the state for promulgating a disability-friendly constitution that resembles the Convention to effectuate a human rights approach to disability issues. Relatedly, the state came up with institutions that collaborate with research institutes and disability organisations to conduct research, provide services to persons with disabilities, raise awareness and advocacy and litigate for disability rights. CONCLUSION: In spite of these efforts, this article shows that Zimbabwe has yet to close the gap on the ideals of the Convention, mainly because of limited resources amongst state-funded institutions for advancing disability issues. The government of Zimbabwe is challenged to domesticate all provisions of the Convention and to provide resources to institutions for progressive realisation of the rights of persons with disabilities. <![CDATA[<b>Part 1: A review of using photovoice as a disability research method: Implications for eliciting the experiences of persons with disabilities on the Community Based Rehabilitation programme in Namibia</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202018000100025&lng=en&nrm=iso&tlng=en BACKGROUND: Although the Community Based Rehabilitation (CBR) programme in Namibia was formally adopted in 1997, the effectiveness of the programme, including the experiences of persons with disabilities on the programme, has not been assessed to date. OBJECTIVES: To explore the need for a qualitative evaluation tool for the CBR programme that can elicit the experiences of persons with disabilities. METHODS: A scoping review was conducted on the use of photovoice as a disability research method and its potential use in eliciting the experiences of persons with disabilities participating in the CBR programme. A comprehensive literature search was conducted on electronic databases as a part of the scoping review. RESULTS: Twenty-one studies were selected for review. Six studies followed the exact steps of the traditional photovoice process, and the remaining 15 studies modified the process. Seventeen studies used photovoice as the only research method, 3 combined photovoice with a qualitative method and only one study combined photovoice with a quantitative method. Seven studies had a sample size ranging from 6 to 10 participants as suggested by the traditional photovoice process. The duration of the studies ranged from 2 weeks to 2 years. Thirteen studies investigated life experiences of persons with various disabilities and 17 studies suggested that the photovoice process increases empowerment. CONCLUSION: Photovoice is a versatile research method and has the potential to be utilised in effectively eliciting the experiences of persons with disabilities on the CBR programme in Namibia. <![CDATA[<b>The impact of stroke on people living in central Uganda: A descriptive study</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202018000100026&lng=en&nrm=iso&tlng=en BACKGROUND: Knowledge about perceived impact of stroke on everyday life as well as rehabilitation needs after stroke in Uganda is necessary to identify and develop rehabilitation interventions. OBJECTIVES: To explore and describe clinical characteristics and functioning during the acute or subacute phase and chronic phase, as well as the impact of stroke on everyday life during the chronic phase in stroke survivors in central Uganda. METHOD: A cross-sectional observational study was conducted on a consecutively included acute or subacute (n = 58) sample and a chronic (n = 62) sample. Face-to-face interviews were conducted to collect demographic information and clinical characteristics. The Scandinavian Stroke Scale (SSS) was used to collect clinical characteristics, assess neurological impairment and define stroke severity. The Barthel Index was used to assess the level of dependence in activities of daily living. In addition, the Stroke Impact Scale (SIS) 3.0 Uganda version was used to assess the impact of stroke in everyday life as perceived by the individuals in the chronic sample receiving rehabilitation. RESULTS: The mean age of the acute/subacute sample was 49 years and 81% had moderate or severe stroke. The mean age of the chronic rehabilitation group was 53 years and 58% had mild stroke. Time since onset in the acute sample was between 2 days and 3 weeks, and time since onset for the chronic sample varied between 3 months and 3 years. Strength, hand function and participation were the most impacted SIS domains in the chronic sample. CONCLUSION: People with severe and moderate stroke were more likely to be admitted to Mulago Hospital. The mean age in the study sample was lower than that in high-income countries. Further knowledge is needed regarding the impact of stroke to develop guidelines for stroke rehabilitation interventions feasible in the Ugandan healthcare context in both rural and urban areas. <![CDATA[<b>Exploring the concerns of persons with disabilities in Western Zambia</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202018000100027&lng=en&nrm=iso&tlng=en BACKGROUND: Understandings of disability are rooted in contexts. Despite the world's significant contextual diversity, postcolonial power dynamics allow influential actors from the global North to imagine that most people across the global South understand disability in one generalised way. When it informs programmes and services for persons with disabilities in the global South, this imagining of a single generalised view could reduce effectiveness while further marginalising the people for whom the programmes and services were designed OBJECTIVES: In the interest of better understanding a contextually grounded meaning of disability, we explored the expressed concerns of two organisations of persons with disabilities and their members in Western Zambia METHOD: In this qualitative constructionist study, data collection focused upon life with a disability and services available to persons with disabilities. Data were collected through 39 individual interviews and eight focus group discussions with 81 members of organisations of persons with disabilities. Data were analysed thematically. RESULTS: The participants' main expressed concern was poverty. This concern was articulated in terms of a life of suffering and a need for material resources. Participants linked poverty to disability in two ways. Some participants identified how impairments limited resource acquisition, resulting in suffering. Others considered poverty to be an integral part of the experience of disability. CONCLUSION: This study contributes to literature on disability theory by providing a contextually grounded account of a particular understanding of disability and poverty. The study also contributes to disability practice and policymaking through the demonstration of poverty as the main concern of persons with disabilities in this context. <![CDATA[<b>Ubuntu considered in light of exclusion of people with disabilities</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202018000100028&lng=en&nrm=iso&tlng=en BACKGROUND: This article emanates from a study funded by the KwaZulu-Natal chapter of South Africa's National Research Foundation on the 'Archaeology of Ubuntu'. It explores the notion of ubuntu and disability in a group of Zulu people from four communities within KwaZulu-Natal. The study is based on the notion that ubuntu is humaneness. Being human is linked to notions of care, respect and compassion. OBJECTIVES: The article explores the treatment of people with disabilities from the elders' perspectives in this community. METHOD: This article is based on qualitative data resulting from structured interviews conducted in the KwaZulu-Natal Province between February and March 2015. RESULTS: The results reveal that society considered the birth of a disabled child as a curse from God and punishment from the ancestors. The results also indicate that people with disabilities were excluded from community activities; marrying a disabled person was unthinkable because they were stigmatised and dehumanised. The work of Hannah Arendt is used to interrogate people's perceptions of others with disabilities in their communities. CONCLUSION: The article posits that treatment of people with disabilities is not cast in stone but can be renegotiated and restructured through community engagement to represent genuine inclusion. <![CDATA[<b>Investigating barriers teachers face in the implementation of inclusive education in high schools in Gege branch, Swaziland</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202018000100029&lng=en&nrm=iso&tlng=en BACKGROUND: The kingdom of Swaziland is a signatory to policies on universal education that ensure high quality basic education for all. Education for All is a commitment to provide equal opportunities for all children and the youth as provided for in the country's constitution of 2005. The tone for the introduction of inclusive education in Swaziland was inevitably set by the new constitution of 2005. Since then several policies have been produced by the government, all aimed at providing equal education opportunities to all children in the country. These policies include the Swaziland National Children's Policy (2009), Poverty Reduction Strategy and Action Plan (2006) and Draft Inclusive Education Policy (2008). The Education for All Policy (2010) is the policy that upon implementation became a stimulus for the introduction of inclusive education into mainstream schools; as a result, all teachers in the country's schools were expected to be competent enough to teach learners with a wide range of educational needs. However, in-service teachers received inadequate staff development and training ahead of the implementation of inclusive education and a majority of teachers were not professionally developed for inclusive education, as pre-service students at tertiary training level. OBJECTIVES: This study investigated barriers in the implementation of inclusive education at high schools in the Gege branch, Swaziland, with a view to finding lasting solutions to inform research and government policy. METHOD: This research is a qualitative interpretive case study based on selected schools in the Gege branch of schools. Data was obtained through semi-structured research interviews and document analysis. It was processed and analysed through data coding, unitising, categorising and emergence of themes, which became the findings of the study. RESULTS: Lack of facilities in the governments' schools and teachers' incompetence in identifying learners facing learning challenges in their classrooms are some barriers to inclusivity. CONCLUSION: The study concludes that there is a need for the Ministry of Education and Training to craft an inclusive curriculum in line with the inclusive policy in order to cater for the diverse educational needs of all learners in mainstream schools. It is thought that instituting a vibrant in-service and pre-service teacher training programme by the Ministry of Education and Training will increase teachers' capacity to a level where teaching in inclusive classrooms does not negatively affect their competence. <![CDATA[<b>Lessons from the pilot of a mobile application to map assistive technology suppliers in Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202018000100030&lng=en&nrm=iso&tlng=en A pilot project to develop and implement a mobile smartphone application (App) that tracks and maps assistive technology (AT) availability in southern Africa was launched in Botswana in 2016. The App was developed and tested through an iterative process. The concept of the App (AT-Info-Map) was well received by most stakeholders within the pilot country, and broader networks. Several technical and logistical obstacles were encountered. These included high data costs; difficulty in accessing AT information from the public healthcare sector, the largest supplier of AT; and the high human resource demand of collecting and keeping up-to-date device-level information within a complex and fragmented supply sector that spans private, public and civil society entities. The challenges were dealt with by keeping the data burden low and eliminating product-level tracking. The App design was expanded to include disability services, contextually specific AT categories and make navigation more intuitive. Long-term sustainability strategies like generating funding through advertisements on the App or supplier usage fees must be explored. Outreach and sensitisation programmes about both the App and AT in general must be intensified. The project team must continually strengthen partnerships with private and public stakeholders to ensure ongoing project engagement. The lessons learnt might be of value to others who wish to embark on initiatives in AT and/or implement Apps in health or disability in southern Africa and in low-resourced settings around the world. <![CDATA[<b>Acknowledgement to reviewers</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2226-72202018000100031&lng=en&nrm=iso&tlng=en A pilot project to develop and implement a mobile smartphone application (App) that tracks and maps assistive technology (AT) availability in southern Africa was launched in Botswana in 2016. The App was developed and tested through an iterative process. The concept of the App (AT-Info-Map) was well received by most stakeholders within the pilot country, and broader networks. Several technical and logistical obstacles were encountered. These included high data costs; difficulty in accessing AT information from the public healthcare sector, the largest supplier of AT; and the high human resource demand of collecting and keeping up-to-date device-level information within a complex and fragmented supply sector that spans private, public and civil society entities. The challenges were dealt with by keeping the data burden low and eliminating product-level tracking. The App design was expanded to include disability services, contextually specific AT categories and make navigation more intuitive. Long-term sustainability strategies like generating funding through advertisements on the App or supplier usage fees must be explored. Outreach and sensitisation programmes about both the App and AT in general must be intensified. The project team must continually strengthen partnerships with private and public stakeholders to ensure ongoing project engagement. The lessons learnt might be of value to others who wish to embark on initiatives in AT and/or implement Apps in health or disability in southern Africa and in low-resourced settings around the world.