Scielo RSS <![CDATA[South African Journal of Occupational Therapy]]> vol. 41 num. 3 lang. es <![CDATA[SciELO Logo]]> <![CDATA[<b>Research in occupational practice</b>]]> <![CDATA[<b>Rooted in the past, positioned for the future</b>]]> <![CDATA[<b>A survey to investigate how South African Occupational Therapists in private practice are assessing and treating poor handwriting in foundation phase learners: Part I - Demographics and assessment practices</b>]]> Poor handwriting can have a myriad of negative effects on a learner's academic performance and emotional well-being. Appropriate assessment and early remediation of handwriting difficulties are of paramount importance in minimising these effects. This study explored, by means of a telephonic survey, the assessment practices used by South African occupational therapists in the remediation of handwriting difficulties in Foundation Phase learners. The findings show that a wide variety of informal and formal assessment methods are used. With regards to standardised performance component assessments, the Developmental Test of Visual Motor Integration (VMI) and the Developmental Test of Visual Perception-2nd edition (DTVP-2) were the preferred assessment tools. The limited use of standardised handwriting assessments is an area of concern in the light of the importance attached to providing objective evidence of the benefit of intervention on functional skills. Use of the DTVP-2 for handwriting referrals may need to be reviewed as available research has shown no significant correlation between handwriting ability and Perceptual Quotient scores on the DTVP. <![CDATA[<b>A survey to investigate how South African Occupational Therapists in private practice are assessing and treating poor handwriting in foundation phase learners: Part II - Treatment and evaluation practices</b>]]> Handwriting is a functional skill of paramount importance for school-going children. Difficulties with this skill can result in poor academic performance and emotional distress which can potentially lead to school drop-out. These negative effects can be prevented by early remediation of handwriting difficulties. This is the second part of a two-part paper describing a telephonic survey of 162 South African occupational therapists working with Foundation Phase learners to remediate handwriting difficulties. Part 1 describes demographic data and assessment practices. Part 2 provides a description of the treatment and progress evaluation practices of the respondents. Seventy two percent of the respondents treated learners individually and 67% utilised home programmes with every referral. The majority of therapists applied an eclectic treatment approach, with sensory integration and psychosocial principles/techniques being most frequently used (<95%). The most popular means of evaluating progress were work sample comparisons (97%), review of treatment notes (94%), teacher interview/questionnaire (74%) and discussion with the learner (73%). The limited use of home programs may indicate an avenue for future research. <![CDATA[<b>Transportation and ageing: Exploring stakeholders' perspectives on advancing safe mobility</b>]]> Issues of safe transportation for older adults are multifaceted and must include multiple perspectives if significant progress is to be made in the next decade as the baby-boomers begin to reach age 70. Previous work has explored the main barriers that older adults face in terms of maintaining safe mobility, promising practices for overcoming these barriers, and pressing research needs in the area that still need to be addressed. This paper expands upon this work by addressing five system-wide issues identified by a range of stakeholders that impact the success of policies and programs designed to enhance safe mobility for older adults: collaboration and communication; economics of driving reduction and cessation; the role of a traffic safety culture in maintaining safe mobility; the environment; and knowledge and education. Each of these issues is discussed based on the empirical literature. The intent of this article is to improve the safe mobility of older adults by fostering a more focused and stakeholder driven research agenda for current transportation scientists, inform agents of the ageing network of service opportunities, and create plausible opportunities for policy making. <![CDATA[<b>A developmental approach: A framework for the development of an integrated visual perception programme</b>]]> This article provides guidelines for an occupational therapy framework that can be used to develop a visual perceptual programme to enhance or stimulate the development of visual perceptual skills. The developmental approach was used to organise the framework for an integrated visual perceptual programme (IVPP) including cognitive strategies, visual perceptual abilities and the visual system. The IVPP was developed and based on experience from practice and used in a clinical experimental field trial study aimed at the investigation of the effect of ocular motor exercises in combination with a visual perceptual programme on the visual perception of seven-year-old learners with possible visual perceptual problems. Feedback on academic performance was obtained from the teachers indicating improvement in maths, reading, writing and work speed; changes in attitude of daring, perseverance, confidence and motivated behaviour. Examples from practice will be included to demonstrate how the guidelines and approaches were used. An increasing tendency is for learners who are referred to occupational therapists to be experiencing problems performing academic tasks because of visual perceptual problems. The IVPP can be used to optimise occupational performances in academic tasks. <![CDATA[<b>Assuring quality in clinical education</b>]]> The principle outcome of the undergraduate programme, to qualify competent professional practioners, has been shown to be dependent on one-to-one guidance of students during their clinical placements. It is advisable that clinical supervisors, clinicians and students use the same point of departure and approach to clinical teaching and training to ensure that the clinical education of each student meets minimum requirements. A Clinical Work Manual was developed and is being used as a tool to ensure that a uniform approach to the clinical guidance of students is followed in the Occupational Therapy Division at the University of Stellenbosch. Findings of a descriptive study, undertaken to explore the role of the Manual in quality improvement, will be provided in this article. The focus of the study was to obtain information from all the stakeholders regarding their understanding and frequency of use of the clinical work manual as a tool for the clinical education of students. The clinical work manual was found to be an appropriate tool in the process of quality improvement for clinical education. The recommendations regarding quality improvement can optimise the use of the clinical work manual by all stakeholders. <![CDATA[<b>The effect of the wearing of weighted vests on the sensory behaviour of learners diagnosed with attention deficit hyperactivity disorder within a school context</b>]]> PURPOSE: Children diagnosed with attention deficit hyperactivity disorder (ADHD) often have sensory processing difficulties. Therefore, they find it difficult to function optimally in the classroom environment. This study investigated the effect that wearing a weighted vest had on their in-seat behaviour, task completion speed and attention-to-task. METHOD: A longitudinal experimental research design was employed with 30 foundation Phase learners from the School of Achievement; cross-over of treatment was implemented. Data on in-seat behaviour was measured by recording the period of time participants were able to stay seated. Task completion speed was assessed by timing how long participants were able to stay seated during literacy periods. The Conners' Continues Performance Test II was used to measure participants' attention to the task. RESULTS: The Phase group effect for in-seat behaviour and attention-to-task indicated a statistically significant difference when learners wore weighted vests. This was not true for task completion speed. CONCLUSION: The weighted vests improved the in-seat behaviour and attention to task of learners diagnosed with ADHD in a classroom context. <![CDATA[<b>The accreditation of vocational assessment areas: Proposed standard statement and measurement criteria</b>]]> Vocational Rehabilitation Programmes managed by occupational therapists and the emphasis placed on continuous quality improvement in service delivery, resulted in the question: "How can occupational therapists ensure that the quality of vocational assessment services delivered to clients are of an acceptable standard?" This study aimed to address the question by developing a standard statement and measurement criteria for the assessment of work abilities of clients using the Donabedian approach for setting standards of practice. Two rounds of questionnaires, using a Delphi survey method, resulted in the formulation of a standard statement and measurement criteria for the Structure, Process and Outcome of work assessment areas by which the work abilities of clients are assessed. The standard statement and the accompanying measurement criteria set the basic standards for quality assurance and can contribute to the implementation of continuous quality improvement processes in vocational assessment areas that may result in the accreditation of vocational rehabilitation programmes managed by occupational therapists. <![CDATA[<b>Every dance has its own story - how participation in dance empowered youth living in a rural community to buffer an intergenerational cycle of poverty</b>]]> BACKGROUND: Rural environments characterised by inter-generational cycles of poverty and historical disadvantage, contain numerous barriers to the development of human potential. This study explored how participation in dancing classes offered by a rural outreach program in a rural community in the Western Cape buffered these barriers and empowered youth to create new lifestyles. METHOD: An ethnographic research design was used to explore the experiences of youth participating in formal dance classes. Participants were student dancers and community members selected with the use of saturation sampling. Rich data was collected through interviews, a focus group and by walking though and observing the daily life of the rural community. RESULTS: Three themes arose from the thematic analysis: trapped within a predestined future, empowerment through dance and building a new community. Participation in a new form of dance occupation was found to stimulate the unlocking of youths' potential and empowered them to develop a new lifestyle that differed from the one inherited from their predecessors. <![CDATA[<b>The burden of psychiatric disability on chronically poor households: Part 1 (costs)</b>]]> Studies in occupational therapy on the costs associated with the intersections between chronic poverty and psychiatric disability are rare. This study, published in two parts, identified costs related directly to the illness behaviour of the mentally ill household member which eroded precarious assets including property, disposable income and savings. Psychiatric disability, a feature of social exclusion, added to the indirect cost burden that households with a mentally ill member had to absorb due, in part, to the stigma and cultural sanctions associated with illness behaviours. The multiple layers of action, reaction and interaction by everyone in the household in managing the daily struggle for survival in the presence of mental illness, suggests that disability is multiplied in the context of chronic poverty. Socially engaged occupational therapy, cognisant of the direct and indirect costs of psychiatric disability, could work towards enhancing individual and household resilience through occupation focussed interventions that are aligned with the basic tenets of community based rehabilitation and disability inclusive development. <![CDATA[<b>The burden of psychiatric disability on chronically poor households: Part 2 (coping)</b>]]> Studies in occupational therapy on the strategies which people with psychiatric disability and their households use to navigate the daily struggle for survival in the context of chronic poverty are rare. This qualitative study, published in two parts, identified multiple layers of action, reaction and interaction used by everyone in the household to cope with the demands of daily subsistence including the costs of poor mental health. Major organising ideas centred on the discursive social forces that shaped people's daily activities, tasks and roles. While poverty aggravates the precarious situation of mentally ill individuals and their households, they mobilise coping strategies by drawing on locally relevant ways of knowing and 'being-in-the-world'. Socially engaged occupational therapy, cognisant of the cost burden of psychiatric disability, could work towards enhancing individual and household resilience through occupation focussed interventions that strengthen self-action and inter-action within indigenous explanatory frameworks. <![CDATA[<b>Return-to-work (RTW) of patients after Lumbar Surgery</b>]]> BRACKGROUND: Return to work (RTW) after lumbar surgery due to a work-related injury poses a challenge internationally. Work hardening is used as an intervention for acute and chronic lower back pain (CLBP), but it is not necessarily used in post-operative treatments. Method: The RTW rate of an experimental group (Group A) of unskilled labourers was compared with that of a control group (Group B) of unskilled labourers. Group A received multidisciplinary intervention, including a work hardening programme with ergonomic adaptations, while Group B received only physiotherapy after surgery as a multidisciplinary team was not available. A RTW questionnaire was used as an outcome measure for both groups. During the multidisciplinary intervention, the improvement of pain and functionality of patients from Group A were also evaluated from the pre-operative state to 24 weeks post-operatively with the Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI) as additional outcome measures. Results: There was a positive tendency to successful RTW after work hardening for Group A, but no statistical significance between Groups A and B. The improvement of pain and functionality in Group A was highly significant from time of surgery to six months post-operatively. Conclusion: Work hardening was found to have a positive tendency towards ensuring RTW for work-injured patients after lumbar surgery, with a highly significant effect on pain and functionality. <![CDATA[<b>Comparing the effect of different living environments on the development of independent living skills in children with visual impairment</b>]]> INTRODUCTION: The World Health Organisation (WHO) recognised visual impairments in children as deserving priority treatment and intervention. Research indicated that caregivers play an important role in the development of independence in children with visual impairments. This study aimed to compare the independent living skills of children with visual impairments who resided in a school residence designed for children with visual impairments with those who lived at home. METHODS: A descriptive study, comprising both quantitative and qualitative data collection methods, was implemented. A convenient sample was used and data collection was by means of the Paediatric Evaluation of Disability Inventory (PEDI) and semi-structured interviews. RESULTS: Results on the PEDI yielded no significant difference on all the measured scales in the living environments between those living at home or in a residence. However, from the qualitative data four themes concerning independent functioning emerged, namely familiarity; adaptations; resources; and personal factors. CONCLUSION: The importance of the environment for children with visual impairments, especially concerning familiarity (of the layout of the environment and the people within the environment) and making adaptations should be given more attention during the phase of independence development and should be incorporated in informing and training of caregivers. <![CDATA[<b>Supported employment: Recommendations for successful implementation in South Africa</b>]]> Introduction: This article reports on the findings of a descriptive qualitative study in which supported employment (SE), as a potential strategy to facilitate the employment ofpersons with disability in the open labour market in South Africa, was explored. A brief description of SE and its success in other countries will be provided before the challenges faced in South Africa that might prevent its successful implementation will be discussed. Methodology: A focus group interview was utilised to explore the suitability and possible modifications needed for SE in the South African context. Questions were asked to explore barriers to successful implementation and adaptations required to make it a workable strategy with which to facilitate employment of persons with disability. Findings: Four themes emerged; 'the envisaged nature of SE in South Africa', 'key role-players necessary for the service to be successful', 'barriers to successful establishment of SE services' and 'the disability grant mechanism in South Africa'. Recommendations are made for successful implementation of SE service in South Africa.