Scielo RSS <![CDATA[South African Journal of Occupational Therapy]]> vol. 46 num. 2 lang. es <![CDATA[SciELO Logo]]> <![CDATA[<b>Editorial Comment</b>]]> <![CDATA[<b>Expert opinion on splinting adult patients with neurological injuries</b>]]> In the light of a lack of research evidence, this study explored expert opinion for splinting in adults with neurological injuries. An exploratory, descriptive, qualitative methodology was used with 14 occupational therapists, experienced in neuro-rehabilitation. Data were analysed based on a priori themes from two models of clinical practice:- • The Model of Practice Development: - themes indicate that most value was placed on personal knowledge gained from experience in the field and being able to individualise treatment for each patient. Procedural knowledge gained from clinical experience; reflection on protocols and working with and learning from others were seen as essential in developing skills required for splinting in adults with neurological injuries. • The Three Track Model of Clinical Reasoning: - Themes indicated that the effectiveness of the splints depended on the patients' context and response as well as the therapists' ability to adapt to their preferences and goals. Procedural reasoning and goals related to client factors should not be considered in isolation and each patient must be considered individually when prescribing splints. Considering the patients' context and the support and resources they have, is also essential. Outcomes in adults with neurological injuries should consider occupational performance and client satisfaction when evaluating effectiveness of splinting. <![CDATA[<b>Impact of post-stroke impairments on activities and participation as experienced by stroke survivors in a Western Cape setting</b>]]> INTRODUCTION: This paper explores causal connections between impairments, activity limitations and participation restrictions after stroke. Understanding the impact of impairment on activities and participation can assist with determining optimal interventions. METHODS: The study population (N=267) of this descriptive study were public health care users, from the eastern sub-district of the Western Cape Metropole, who had had a stroke in 2009 or 2010. Fifty-three study participants were selected through stratified, proportional, random sampling. Data were collected using the Stroke Impact Scale-3.0 (SIS); the Modified Barthel Index (MBI); the Loewenstein Occupational Therapy Cognitive Assessment and a language screening test. Linear regressions to determine if impairments could be correlated with activity limitations and participation restrictions were done with Spearman rank correlations. T-tests were used to determine if impairments had any statistically significant impact on activities and participation. RESULTS: The mean SIS participation score was 31.3/100. Participation as measured by the SIS showed positive correlations with, and was impacted signifcantly by limb strength (r=0.49; p<0.01), visual perception (r=0.57; p<0.01), spatial perception (r=0.31; p=0.02), motor praxis (r=0.58; p<0.01), visuomotor organisation (r=0.50; p<0.01), and thinking operations (r=0.6l; p<0.01). The mean MBI score was 70.58/l00. MBI scores showed postive correlations with, and were impacted signifcantly by limb strength (r=0.78; p<0.01), hand function (r=0.65; p<0.01), visual perception (r=0.45; p<0.01), motor praxis (r=0.43; p<0.01), visuomotor organisation (r=0.48; p<0.01), and thinking operations (r=0.56; p<0.01). CONCLUSION: Motor, cognitive and perceptual impairments impacted activities and participation negatively. These impairments must be diagnosed and optimally managed. <![CDATA[<b>The short term effect of a group drumming intervention on aggressive behaviour among adolescent girls diagnosed with conduct disorder</b>]]> <![CDATA[<b>Development of an Occupational Performance Questionnaire for preschool children with Autistic Spectrum Disorder</b>]]> BACKGROUND AND AIM: Outcome measures in occupational therapy (OT) are needed to provide evidence of the effectiveness of OT intervention. The aim of this study was to develop an occupational performance assessment specific to preschool children with Autistic Spectrum Disorder (ASD). METHODOLOGY: An instrument development design was used to describe the steps in the development of the Occupational Performance Questionnaire (OPQ) which consisted of two parts:- Part 1 General Information, Part 2, OPQ: Occupational Performance Areas (OPQ:OPA) and OPQ: Family Impact (OPQ: FI). Content, construct and convergent validity, test-retest reliability and internal consistency for the OPQ was established. The OPQ was field tested with parents of 19 pre-schoolers with ASD receiving weekly OT intervention, who completed the OPQ three times over a one year period. RESULTS: Content analysis confirmed the appropriateness of the items and the OPQ was responsive to change over time for the OPQ:OPA and OPQ:FI. Convergence of the OPQ:OPA with the Short Sensory Profile (SSP) and the OPQ:FI with the Parent Stress Index (PSI-SF) was moderate to weak. The items on the OPQ had test-retest reliability and internal consistency at acceptable levels. CONCLUSIONS: The OPQ is an inexpensive, parent report outcome measure appropriate for use with South African pre-school children with ASD designed to evaluate change in their OPAs over time. Further research in psychometric analysis and standardisation of the OPQ is recommended. <![CDATA[<b>Hippotherapy in occupational therapy practice</b>]]> BACKGROUND: There has recently been renewed interest in hippotherapy, which can be a strategy of choice within therapy programmes involving the use of a horse. In this study, the authors endeavoured to explore the experiences and perceptions of occupational therapists in the use of hippotherapy as a therapeutic intervention strategy. METHODS: A quantitative descriptive study design was selected utilising an online questionnaire. Two hundred and thirty seven therapists were purposively sampled with data being obtained from 53 respondents. Data were analysed using descriptive statistics. RESULTS: The majority of respondents (n=39 i.e. 76.3%) indicated awareness of hippotherapy, with a number of the respondents indicating exposure to hippotherapy during their studies (n=24 i.e. 46.2%). Only six of the respondents were currently using hippotherapy, either directly or through referrals. It is significant to note that out of the 47 of the respondents who were not currently using hippotherapy, 42 respondents indicated that they would consider using it in the future. CONCLUSION: The high percentage of respondents interested in this therapeutic intervention strategy can be linked to their perception of the benefits of hippotherapy. In particular, all respondents indicated that they viewed hippotherapy as being beneficial for neurological conditions, as well as for specific aspects of functioning including postural control, mobility, processing and integration, self-confidence, self-esteem, mood and motivation. Relevant barriers impacting on the use of hippotherapy included limited centres available and lack of awareness. The majority of respondents currently not using hippotherapy indicated that there was limited training for occupational therapists. As benefits become validated by future research studies, as well as by limiting barriers to the use of this intervention strategy, hippotherapy may become a more widespread and acceptable adjunctive therapeutic intervention strategy. <![CDATA[<b>Navigating the occupational transition of dropping out of school: Anchoring occupations and champions as facilitators</b>]]> This paper has the dual aim of first presenting an understanding of school dropout as an occupational transition and second, to suggest how this occupational transition may be navigated successfully. School dropout is of concern to occupational therapy as it limits peoples' full social inclusion. We draw on data from a biographical inquiry into the nature of occupational engagement of men in a low socioeconomic, South African community who dropped out of school. In this study, narrative data were generated from 3 men, followed by a narrative analysis and thematic analysis. The findings reflected that two of the men established stable occupational trajectories after dropping out of school, contrasted with the third man who was unable to do this. The interpretations suggest that a successful occupational transition for these two participants occurred through establishing anchoring occupations as a result of chance encounters with individuals who acted as 'champions'. These champions ensured the successful negotiation of available opportunities. Through offering these insights, this paper provides an illustration of how concepts interpreted and discussed in occupational science, such as occupational transitions, have relevance to occupational therapy. With regards to the occupational transition of dropping out of school, it is recommended that occupational therapists consider how they might promote access to champions of opportunities that lead to the development of anchoring occupations. <![CDATA[<b>Shaped by place: Environmental influences on the participation of young cyclists from disadvantaged communities in professional cycling</b>]]> OBJECTIVE: The Cycling Club provides opportunities for young cyclists from disadvantaged communities to participate in cycling on a professional level. Little literature exists that explores the potential role of occupational therapy in the field of professional sport. This qualitative study explored the influence that environmental factors had on the experience of participation of professional cyclists from disadvantaged communities. METHOD: A collective case study design was applied using photovoice and unstructured interviews as methods of data generation with three of the professional cyclists. Other sources of data generation included a focus group held with the team and a key informant interview held with the team coach. RESULTS: The findings present themes from each participant's unique story reflecting the environmental influences on their experience of participation in cycling. It also includes themes from the team coach's perspective on the structure of cycling teams and team dynamics DISCUSSION: This section draws on a cross case analysis of the findings which is contextualised through the application of the International Classification of Function's list of environmental factors. Environmental factors discussed are products and technology; the natural environment; appreciating supportive relationships and attitudes and the relevance of services, systems and policies. CONCLUSION: This study offers a fresh perspective from conventional sporting interventions by focussing on the influence of the environment on sporting performance rather than attempting to improve sporting performance. It is evident that the significance of the environment should be considered more carefully by coaching staff as it could ultimately improve performance of cyclists who come from disadvantaged communities. Taking an occupational perspective, this article highlights the potential contribution of occupational therapy in the field of professional cycling. <![CDATA[<b>In-hand manipulation (IHM) in children 6 and 7 years of age: A follow-up study</b>]]> BACKGROUND AND AIM: No comprehensive, standardised measureing instruments with age-related norms, to evaluate all IHM components, are currently available, causing difficulty with regard to accurate assessment and intervention planning. This lack of a context-specific, valid and reliable measure in the field ofpaediatrics remains a challenge for South African occupational therapy clinicians The aim of this study was therefor to investigate the IHM skills in six- and seven-year-old children in Bloemfontein, South Africa. METHODS: A quantitative descriptive study was conducted by using video footage of each child in the study performing the activities on the Free State University In Hand Manipulation (FSU IHM) Checklist, and scoring their performance. RESULTS: One-hundred and fifty-eight children in the age group 6-7 years participated in the study. Results indicated that most children in both these age groups could perform translation, simple and complex rotation, and shift with stabilisation. However, complex rotation with stabilisation was more difficult for both age groups. Compensatory methods were mostly used in combination by both age groups. CONCLUSION: The results from this study could be combined with those obtained for four and five year children in a previous study, to develop base-line IHM standards for children aged four - seven years, to inform clinical decision making and practice. The Free State University In Hand Manipulation (FSU IHM) Checklist provides occupational therapists with a comprehensive, inexpensive instrument for the assessment of all IHM components, which is easily reproducible and quick to administer. The checklist is not yet generalisable to the South African population but can serve as an interim measure. Further development of the checklist is recommended. <![CDATA[<b>Exploring educator's perceptions of the challenges affecting grade one learners' academic performance in two low socio-economic schools</b>]]> INTRODUCTION: This research study arose out of the perceived poor performance of learners from low socio-economic areas in the Western Cape. To investigate the cause of the poor performance the researchers explored educators' perceptions of some of the challenges that could affect the academic performance of grade one learners. METHOD: A qualitative study was used to explore the educators' perceptions. Six grade one educators, from two schools located in a low socio-economic area were selected through purposeful sampling and consented to participate in two focus group discussions. One of these educators dropped out prior to the commencement of the study. The transcribed data were coded, the codes were reduced to categories and from the categories themes were developed. FINDINGS: Three themes emerged from the data analysis: "Learners can't cope", "Socio-economic environment does play a role" and "The system is still a problem for the child". By using the Person Environment Occupation (PEO) model, to interpret the data; the findings revealed that the educators experienced that the learners' environments as well as their individual characteristics, had a negative impact on the grade one learners' occupational performance in the classroom. CONCLUSION: Occupational therapists therefore cannot just offer individual therapy for learners but need to consider their contexts too when planning intervention. <![CDATA[<b>Breastfeeding among mothers in the public health sector: the role of the occupational therapist</b>]]> BACKGROUND AND AIM: South Africa has an unacceptably high child mortality rate. Preventable causes such as malnutrition account for a high percentage of these deaths. Breastfeeding as infant feeding practice is recognised for its potential to radically reduce child mortality and is therefore promoted globally. Yet, SA presents with the lowest breastfeeding rates worldwide. Breastfeeding is a child rearing co-occupation, and occupational therapists (OTs) are well positioned to become role players on a transdisciplinary level to address the infant child mortality rate through promoting and supporting breastfeeding. Although not well described in the literature and traditionally not considered part of occupational therapy practice, this study aimed to determine the role of the OT in addressing breastfeeding among mothers in the public health sector (PHS). METHOD: A purposive sample of 9 OTs from Bloemfontein working in the Public Health Service (PHS) participated in this study. An e-Delphi technique was used to set up four rounds of sequential questionnaires developed from and structured according to the Occupational Therapy Practice Framework (OTPF) Domain and Process. RESULTS: From the 128 initial statements, 95 statements reached consensus determined at 80% agreement. Statements were clustered according to OT roles identified, which included clinician, consultant, educator, trainer, advocate and facilitator. CONCLUSION: OTs have a role to play in addressing breastfeeding among mothers in the PHS, within a transdisciplinary team. If OTs aligned their practice with global and national initiatives and policies, the population-based health issue of infant child mortality could be addressed collectively.