Scielo RSS <![CDATA[South African Journal of Occupational Therapy]]> vol. 49 num. 3 lang. pt <![CDATA[SciELO Logo]]> <![CDATA[<b>Guest Editorial</b>]]> <![CDATA[<b>The availability, utilisation and relevance of therapeutic apparatuses in South African occupational therapy clinical practice</b>]]> <![CDATA[<b>Upper limb mobility and personal management in patients with stroke attending occupational therapy at a tertiary hospital in Gauteng</b>]]> INTRODUCTION: This study described the outcomes for upper limb motor function after stroke and personal management of patients attending occupational therapy at a tertiary hospital in Gauteng, up to two months' post-discharge. METHODOLOGY: A quantitative, descriptive correlation design used assessments of upper limb motor function and independence in personal management to collect the data. Forty-five participants received routine rehabilitation including occupational therapy at the hospital. The same measurements were administered on discharge and during out-patient follow up at one and two months. RESULTS: Results indicated that of 45 participants only 33 were available for reassessment at discharge. These participants had significant improvement in upper limb motor function and personal management. At discharge 48% of participants had >80% recovery of upper limb function and 59% had achieved independence or modified independence in personal management. The correlation between upper limb function and 73% personal management at discharge was strong, indicating an association between return of upper limb function and independence in personal management. By two months post discharge the correlation between the variables was low, as while only 20% of the 15 participants who returned for therapy at month 2 were dependent for personal management and over 50% presented with no or poor upper limb function. DISCUSSION AND CONCLUSION: Rehabilitation including occupational therapy intervention contributed to participant's improved performance in personal management tasks, even when upper limb motor function recovery was suboptimal. The intervention for personal management and compensatory techniques taught to participants resulted in independent or modified independence two months after discharge. <![CDATA[<b>Perceived occupational gaps among the Ugandan general population - a pilot study</b>]]> PURPOSE: This study aimed at culturally adapting the Occupational Gaps Questionnaire and to describe gaps which may exist during participation in everyday occupations i.e. the discrepancy between what a person wants to do and what he or she actually does in everyday life, in a reference sample from an English-speaking population in Uganda and furthermore to explore differences in occupational gaps between the Ugandan and Swedish reference samples. METHOD: A cross-sectional design was used and data were collected using the Occupational Gaps Questionnaire in four different districts in Uganda (n = 252). The Swedish representative sample included 771 people. RESULTS: Occupational gaps were reported by 91% of the participants (mean=5.8; SD=3.9) in Uganda. The number of gaps per person was higher than in the Swedish sample. The most common gaps in the Ugandan sample were reported as Working (42%), Studying (37%) and Hobbies (35%) in comparison to Cleaning (29%), Sports (23%) Hobbies as well as Travelling for pleasure (20%) in the Swedish sample. Younger participants perceived significantly more gaps than older participants in both samples. CONCLUSIONS: The majority of the participants perceived gaps, indicating that occupational gaps are perceived to a greater extent in Uganda. <![CDATA[<b>Visual motor integration delay in preschool children infected with HIV</b>]]> INTRODUCTION: It is estimated that more than 200 000 children under the age of 14 years are living with human immunodeficiency virus (HIV) in South Africa. These children - including those on antiretroviral therapy - may present with neurocognitive delay and may find it difficult to participate in educational activities. This study aimed to determine the extent of the delay of visual motor integration (VMI) which correlates significantly with academic achievement in pre-school children with vertically transmitted HIV. METHOD: This was a descriptive quantitative study in which 71 children infected with HIV aged between 5 - 6 years, attending a HIV clinic in South Africa, were assessed using the Beery Developmental Test of Visual Motor Integration (DTVMI). The results were compared to the normative DTVMI scores, and correlated with health factors related to HIV such as CD4 count and socioeconomic factors such as attendance at crèche or preschool. RESULTS: Results confirm that a delay exists in VMI and visual perception (VP) in the at risk category. Mean scores on the motor coordination (MC) fell in the average range. Visual perception was the most affected in this sample with an average delay of between 11 and 17 months found. Visual perception also showed a moderate positive correlation with CD4 count, while VMI had a moderate relationship to attendance at crèche or preschool and mother's level of education. CONCLUSION: This study confirms children with HIV are at risk for neurodevelopmental delay related to visual motor integration and visual perception, particularly in children with a low CD4 count. These aspects need to be assessed as part of routine neurodevelopmental monitoring. <![CDATA[<b>Medical Incapacity Management in the South African Private Industrial Sector: The role of the occupational therapist</b>]]> BACKGROUND: Occupational therapists working in the field of occupational health in South African private industrial sectors may find themselves involved in management of medical incapacity due to their expertise in vocational rehabilitation AIM: In this study, the authors explored how South African Acts guide the role and scope of occupational therapists in medical incapacity management, in addition to determining the scope, role and value of occupational therapy in medical incapacity management from the perspectives of occupational therapists currently working in the field METHOD: An exploratory qualitative design with use of two concurrent methods of data collection (document analysis and semi structured interviews) was undertaken. Data were analysed thematically, via deductive reasoning, and pooled to provide a picture of how occupational therapists can function within medical incapacity management RESULTS AND DISCUSSION: Six themes emerged from the data. Occupational therapists' role and scope within legislature appears to lack detail with a disjuncture between legislation that guides medical incapacity management and current practice of occupational therapists. Notwithstanding this, the findings of this study show that occupational therapists play a critical role within management of medical incapacity. <![CDATA[<b>Postural assessment, Part Two: Deviation for sense of, and actual alignment</b>]]> INTRODUCTION: Accurate sensing of the body position in space is important for safe and mechanically effective interaction with the environment. Clinical evidence however suggests that a client's sense of postural alignment differs from their actual alignment, which may influence the accuracy of postural repositioning during participation in activities of daily life. OBJECTIVES: The aim of this quantitative descriptive study was to investigate the difference between sense and actual postural alignment during sitting and standing positions, with the anatomical landmarks as reference points for measurement from anterior and lateral views. METHODS: Ten health care clinics in the Free State towns of Botshabelo and Thaba N'chu, were randomly selected and 95 patients participated in the study. Measurements consisted of (a) a biographical questionnaire, (b) assessment of actual postural alignment, and (c) assessment of sensed postural alignment. Assessment of actual postural alignment was done by using the Photographic Method of Postural Assessment (P-MPA), during which the actual (real) distance on photos was established by calculating the ratio of measured/ real distance x distance from plumb line for each photo. A clinical significant difference from the reference point as measured on the photo was set at 10mm. The sense and actual deviation, for sitting and standing were compared by means of 95% confidence intervals for median differences. RESULTS: Results show statistical and clinically significant differences for sense and actual deviations from the plumb line for lateral views for all anatomical landmarks, in both sitting and standing positions. With the exception of a clinical significant difference at the nose landmark in anterior view, results show no other statistical or clinical significant differences for anterior sitting or standing RECOMMENDATIONS: The authors recommend that follow up studies investigate postural repositioning during motion and in addition to speed and direction, also test the degree to which discrepancy between sense and actual values occurs. CONCLUSION: Increased awareness by health care professionals and educators of the discrepancy between sensed and actual postural alignment, in anterior and lateral views, may benefit the planning of intervention programmes aimed to enhance safe and meaningful occupational performance. <![CDATA[<b>Occupational therapy services and perception of integration of these at primary healthcare level in South Africa</b>]]> BACKGROUND: Literature indicates that access to rehabilitation services in South Africa is limited. Recent policy documents by the National Department of Health related to disability and rehabilitation propose the integration of occupational therapy services in primary healthcare (PHC). However, the implementation strategies concerning integration are not clear as there is inadequate evidence locally on the occupational therapy service provision in PHC even though there is growing evidence internationally PURPOSE: This study sought to determine the services provided by occupational therapists in PHC and to explore the perceptions of the occupational therapists on the integration of occupational therapy services within the PHC reengineering streams of the National Health Insurance (NHI METHOD: A two-phase explanatory sequential mixed method strategy was utilised in this study. A quantitative survey was sent to members of the occupational therapy professional association and an organisation of professionals providing rehabilitation services in rural communities. Qualitative data were then collected using semi-structured interviews with five therapists who completed the survey FINDINGS: Findings from this study showed there is increasing alignment of occupational therapy services in PHC with the community-based rehabilitation (CBR), the Social Model, the International Classification of Functioning, Disability and Health (ICF), and the Medical Model using client self-management and case-management intervention approaches. The majority of occupational therapists are currently based in district hospitals (42%), community health centres (16%), community organisations (8%), and clinics (8%). Those working in the community indicated they work in a multidisciplinary team (MDT). They also use PHC service delivery models to manage people with disabilities (PWDs). Occupational therapists in PHC have a strong perception of their relevance in the PHC reengineering streams, despite the numerous barriers and few facilitators to the integration of occupational therapy services in the PHC reengineering streams of the NHI CONCLUSION: The perception of the study participants is that occupational therapy service integration in the PHC reengineering streams will lead to improved healthcare. However, they are also of the opinion that integration will not happen without advocacy from occupational therapists or occupational therapy being adequately supported in PHC <![CDATA[<b>Non-attendance of occupational and physiotherapy appointments at Western Cape Rehabilitation Centre: A description of associated factors</b>]]> INTRODUCTION: Occupational therapists and physiotherapists use outpatient follow-up appointments to continue and monitor the effectiveness and outcome of therapy interventions. Attendance of follow-up appointments is essential, as non-attendance has negative implications for both the patient and the healthcare facility. METHODOLOGY: This retrospective, cross-sectional study made use of a period sample of all outpatients with scheduled appointments between January and December 2017 (n = 837) at the Western Cape Rehabilitation Centre (WCRC). Children under the age of 18 years were excluded. Descriptive statistics were used to describe the identified variables of the sample. Logistic regression was used to determine the adjusted odds ratio for the association between non-attendances and identified covariates. RESULTS: The sample population of 837 patients, included 516 attenders and 321 non-attenders. Factors that had an association with non-attendance included hospital classification, diagnostic category and impairment according to ICD 10 coding (p < 0.05). CONCLUSION: This article describe factors associated with non-attendance of outpatients to scheduled occupational therapy and physiotherapy appointments at the WCRC. Further research is needed to determine the reasons for non-attendance at institutions such as WCRC which will assist in the implementation of strategies to reduce high non-attendance rates.