Scielo RSS <![CDATA[South African Journal of Occupational Therapy]]> vol. 49 num. 2 lang. en <![CDATA[SciELO Logo]]> <![CDATA[<b>Editorial Comment</b>]]> <![CDATA[<b>Occupational therapy groups as a vehicle to address interpersonal relationship problems: mental health care users' perceptions</b>]]> BACKGROUND: This qualitative study set in an acute inpatient psychiatric clinic investigates the efficacy of occupational therapy groups targeting interpersonal relationships, from the clients' perspective. PURPOSE: This study was designed to explore the effect of occupational therapy groups on clients' interpersonal relationships. METHOD: Four, sixty-minute focus groups were used to ascertain the participants' experiences of groups, and the effect of these on relationships. These sessions were audio-recorded and transcribed. Thematic analysis was used to analyse the data FINDINGS: This article tells the story of the development of the participants' relationships through the journey of attending group therapy, from the initial struggles in their personal relationships, through the development of insight into these difficulties, the learning of skills and problem-solving solutions, to the application of some of the skills and hope for future relationship development. Four emerging themes are discussed in this article. "We all have relationship problems" outlines the participants understanding of their relationship problems. The second theme "we were given the skills and applied them" describes how group therapy helped them develop further insight and acquire greater relational skills. "I am less demanding now" describes how developing insight and skills have impacted the participants' actual relationships and their hopes for their relationships. CONCLUSIONS: Participants gained significant benefit from group work, on both a personal and a relational level. Group therapy provided a safe place to learn and then practice the skills that participants had learnt. The insights gained into adaptive and maladaptive relationships and participants' interpersonal styles through group therapy assisted participants in strengthening their relationships with group members and others. Despite improved knowledge, insight and skills, participants were not always able to use their skills consistently. One factor that improved their confidence to apply skills was consistent group attendance. <![CDATA[<b>The influence of mother-infant skin-to-skin contact on bonding and touch</b>]]> INTRODUCTION: Early skin-to-skin contact is a biological need of new born infants. Preliminary research informs us that this contact directly and indirectly influences the mother-infant relationship. This relationship in turn forms the basis of the infant's social-emotional development. This study investigated South African mother-infant dyads with varying exposure to early skin-to-skin contact and the influence on bonding and touch within the mother-infant relationship. METHOD: Contact over the first 24 hours and bonding were measured within one week postpartum. At six to eight weeks postpartum, the bonding assessment was repeated together with objective analysis of mother-infant touch during face-to-face interaction and mothers' self-reported use of affectionate touch in daily routine. FINDINGS: No correlation was found between a longer duration of skin-to-skin contact and bonding within one week postpartum. A positive correlation was identified between two hours or more of skin-to-skin contact and bonding as well as a higher rating of affectionate touch during feeding at six to eight weeks postpartum. This was substantiated by an increase in touch during face-to-face interaction. CONCLUSIONS: Early skin-to-skin contact positively influences mother-infant bonding and touch at six to eight weeks postpartum. Further more stringent research is however required to confirm these findings. <![CDATA[<b>Early Childhood Development and the Crosstrainer Programme in Rural Mahikeng</b>]]> INTRODUCTION: In South Africa, early childhood development (ECD) in rural areas is challenged by the lack of a centre-based programme and because the ECD practitioners are inadequately trained. The Crosstrainer Programme (CTP) may be a centre-based early childhood development programme that could address this challenge. Consequently, the aim of this study is not to prove, but to determine the level of efficacy of the CTP on the development of three to four year old children in the rural Mahikeng areas METHOD: An experimental trial was conducted. The ECDC (Early Childhood Development Criteria) were used to test the children (49 from 17 ECD centres RESULTS: Both Section A: Cognitive SRRA (School Readiness Risk Areas) and Section B: Fine Motor Coordination were improved by the CTP. However, Section C: Gross Motor Coordination showed no improvement by the CTP CONCLUSIONS: The CTP proved valuable in the improvement of the Cognitive SRRA and even more so on the fine motor development of the population group. It is recommended that activities directed at gross motor development should be increased and amplified in the programme. Further studies on the CTP regarding the development of the children and the occupational enablement of the ECD practitioners are recommended <![CDATA[<b>The perceived burden of care among caregivers of survivors of cerebrovascular accident following discharge from a private rehabilitation unit</b>]]> INTRODUCTION: The transition between inpatient rehabilitation and discharge of survivors of stroke from private rehabilitation services in South Africa is often challenging. After the stroke survivor is discharged, caregivers have an important role as an extension of rehabilitation, although the occupation of caregiving is often unplanned. This study investigated the factors associated with the burden of care experienced by patients' caregivers. METHODS: A quantitative descriptive study was conducted with 63 patients and 63 caregivers, using a consecutive, non-randomised sampling method. Patients' Functional Independence Measure (FIM) scores upon discharge were obtained. Telephonic interviews were conducted with the caregivers two months after the patients' discharge, using the Modified Caregiver Strain Index (MCSI) and a demographic data questionnaire to obtain their perceived burden of care. RESULTS: Patients' median FIM score at discharge was 86, indicating that they needed minimal assistance. After discharge, caregivers experienced minimal to moderate strain (burden of care) according to the MCSI score. The associated factors that were identified included financial, physical, psychological and social aspects, of which financial strain was encountered most regularly. Caregivers also seemed to have unbalanced occupational profiles. CONCLUSIONS: Better caregiver training and support should be provided by private rehabilitation services for better integration of stroke survivors into the community. <![CDATA[<b>Resilience in occupational therapy students</b>]]> At the University of the Witwatersrand, occupational therapy undergraduate students perceived their programme to be more stressful than similar health science education programmes, resulting in students experiencing mental health issues. Thus, the purpose of this study was to determine the level of resilience and stress and health behaviours of students registered in the undergraduate Occupational Therapy programme. A descriptive quantitative cross-sectional on-line survey design was used, replicating an American study of nursing students by Ahern. Permission was obtained from Ahern to use the same battery of data collection tools: demographic questionnaire, the resiliency scale; the perceived stress visual analogue scale and the health behaviours questionnaire. Once ethical clearance was obtained, the data collection battery plus an information sheet was mailed electronically to 205 students. The three questionnaires were scored as prescribed and all other data were analysed descriptively. The Kruskal-Wallis ANOVA was used to test the significant difference between the variables and Spearman's rank order correlation coefficient to determine associations between the questionnaires as well as the subtests. One hundred and seventeen questionnaires were analysed. Results indicated high stress levels within this cohort, with the major stressor being academic. Most students reported a medium level of resilience and the health behaviour questionnaire revealed a low risk. There was no significant difference between the different years and the only variables found to have a significant association was stress over the year increasing risk-taking behaviours. It was concluded that all students could benefit from some resilience training. Those who lived away from home and had poor social support were the most vulnerable. <![CDATA[<b>Part 1: Validity and reliability of a Photographic Method for Postural Assessment (P-MPA)</b>]]> INTRODUCTION: Good postural alignment is positively associated with safe, mechanically effective and meaningful engagement in occupations. Health care professionals assess posture in clinical settings by using a variety of methods ranging from simple visual observation, to more complex quantitative assessments of postural alignment, which are costly and mostly done in laboratory environments. The need exists for a cost effective and user-friendly method for the assessment of posture in clinical settings and research studies OBJECTIVES: The aim of this study was to develop a Photographic Method of Postural Assessment (P-MPA) that quantitatively measures postural alignment, and to determine the validity and reliability of the P-MPA. METHODS: A graph, representing graphic postural alignment, was used consisting of a vertical line that represents the five levels of anatomical landmarks, with a horizontal line crossing the vertical line at each of the five levels. A total of 20 points were randomly plotted on the five horizontal lines. The graph was photographed using a smartphone, and A4 sized photographs were printed. Fifty participants measured and noted the distance deviations between the points on the horizontal lines and the vertical line. The actual deviation from the vertical line was calculated using a ratio of measured to real distance. RESULTS: The distance deviation between measured and actual distances was statistically significant for certain anatomical landmarks as indicated by 95% Confidence Intervals and Limits of Agreement. With respect to the anatomical landmarks and respective points, no clinically significant differences were observed, as a difference of less than 10mm was found. RECOMMENDATIONS: It is recommended that the P-MPA be used, as a user-friendly and cost-effective method, for measuring postural alignment in clinical settings, and, that it be further developed and investigated as measurement tool for both single and multiple-joint research studies during activity performance. <![CDATA[<b>Introducing early active mobilisation following flexor tendon repair in the context of care in a developing country: A randomised feasibility study</b>]]> INTRODUCTION: Flexor tendon injuries remain one of the most difficult hand injuries to manage post-operatively. Early active mobilisation protocols are considered 'best practice' internationally but have not been well researched in the developing country context. The feasibility of such research, and use of these protocols, need to be determined by considering the potential for improved functional outcomes for patients, together with various contextual and resource challenges PURPOSE: To explore aspects of feasibility related to the recruitment, consent and retention rates in consideration of a future definitive Randomised Control Trail. In addition, preliminary results of an early active therapy protocol compared to an early passive therapy protocol were reported on, together with patient satisfaction and demographics METHODS: A parallel randomised pilot trial design was used. Thirty-one participants were recruited into one of two therapy groups (active or passive). Fourteen of these participants completed their therapy and eight-week assessments including: Total Active Motion, grip strength, the Michigan Hand Questionnaire and the Smith Hand Function Evaluation. 95% Confidence intervals examined feasibility data. Non-parametric data analysis was done primarily using medians and ranges RESULTS: Feasibility results of 37% recruitment rate, 97% consent rate and 45% retention rate, did not meet the criteria for success, deeming a trial in the present design, not feasible DISCUSSION: Due to the dearth of research from public health clinical settings in developing countries, this study contributes rich contextual data, but the challenges discussed need to be addressed before further research will achieve success <![CDATA[<b>Workplace-based Rehabilitation for Upper Limb Conditions in the South African context</b>]]> Workplace-based rehabilitation is a growing field of practice internationally and locally. This commentary discusses the current barriers and facilitators facing South African occupational therapists wanting to implement workplace-based rehabilitation with upper limb conditions. An overview is provided of current international practice in the field and relevant factors in the South African context. Recommendations are made for development in this field in clinical practice, research and education in South Africa.