Centre for Disability and Rehabilitation Studies

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Access to assistive technology in two Southern African countries
(BMC (part of Springer Nature), 2018-10-19) Matter, Rebecca A.; Eide, Arne H.
Background: Millions of people in Southern Africa are deprived of basic human rights such as the right to education and work because of the large and growing unmet demand for assistive technologies (AT). Evidence is needed to better characterize the lack of AT access. Methods: This study serves to identify the sociodemographic factors that are associated with access to AT in two countries in Southern Africa, Botswana and Swaziland. To achieve this aim, logistics regression was applied to a subset of variables from two Living Conditions Studies, nationally representative surveys that were conducted in Southern Africa (2014 and 2010). Results: In Botswana, 44% of people who needed AT did not receive it, while in Swaziland the unmet need was 67%. Among the sociodemographic variables tested, the type of disability was the most important factor in determining AT access in both countries. The likelihood of AT access was highest in both countries for those who had mobility limitations (i.e., difficulty walking/climbing stairs) [Botswana: 6.4 odds ratio (OR) = 6.4., 95% confidence internal (CI) (3.6–11.3); Swaziland: OR = 3.2, CI (1.4–7.3)], in comparison to those with non-mobility types of disabilities. Conclusions: These findings provide support for governments and other stakeholders in the AT sector to prioritize AT to address the large unmet demand, and expand the range of AT products provided so that people with hearing, seeing, self-care, communication and cognition difficulties have equal access to AT as those with mobility impairments. A step toward achieving these aims is to inventory AT product types that are commonly covered through the public sector in each country, and identify common gaps (e.g., daily living aids). Advancing the AT sector as a whole within Southern Africa will require large scale qualitative studies that achieve a comprehensive understanding of the bottlenecks in regional AT supply, procurement, and delivery systems.
Access to primary care for persons with spinal cord injuries in the greater Gaborone, Botswana
(Stellenbosch : Stellenbosch University, 2018-03) Paulus-Mokgachane, Thato Michael Moutie; Visagie, Surona; Mji, Gubela; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Centre for Rehabilitation Studies.
ENGLISH SUMMARY : Introduction: People with SCI often have great need for health care services, but they report access challenges. Primary care access to people with SCI has not been explored in Botswana. Aim: This study aimed to identify barriers and facilitators that users with spinal cord injuries experience in accessing primary care services in the greater Gaborone. Methods: A quantitative, cross sectional, observational study was done. Data was collected with a structured questionnaire from 57 participants with traumatic and non-traumatic SCI. Descriptive analysis was done. Results: The male to female ratio was 2.8:1. The mean age of participants was 40 (SD 9.59). Road traffic accidents caused 85% of the injuries. Most participants visited primary care facilities between 2 to 10 times in the six months before the study. Participants were satisfied with the services (63%) and felt that facilities were clean (95%) and well maintained (73.5%). Preferential treatment, respect, short waiting times and convenient hours facilitated an acceptable and adequate service. Availability was hampered by insufficient provider knowledge on SCI as indicated by 71.9% of participants, and shortage of consumables (80.7%). Structural challenges (42.1% could not enter the facility by themselves and 56.5% could not use the bathroom) and lack of height adjustable examining couches (66.7%) impeded accessibility. Cost was incurred when participants (64.9%) utilised private health services where public services failed to address their needs. Conclusion: Primary care services were mostly affordable, acceptable and adequate. Availability and accessibility aspects created barriers.
Accessibility of advanced seating services in a Western Cape setting : a qualitative exploration of the experiences of carers of children with cerebral palsy
(Stellenbosch : Stellenbosch University, 2019-12) North, Gwen-Lynn; Visagie, Surona; Geiger, Martha; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
ENGLISH SUMMARY : Background: It is important for health professionals to understand the experiences of carers of children with cerebral palsy (CP) when accessing health care. Understanding their experiences might help providers to make services more accessible. Aim of the study: To explore the experiences of carers of children with CP (GMFCS IV/V), around the accessibility of advanced seating services at a tertiary healthcare facility in the Western Cape. Methods: This study implemented an exploratory, qualitative research design. Of the study population consisting of 62 carers of children with severe CP, seven carers were purposively sampled and interviewed. Thematic analysis with an inductive reasoning process was used to analyse and generate themes from the semi-structured interviews that were conducted. Findings: Carers experienced a great deal of stress around accessing the tertiary healthcare facility for the seating appointment. Four themes were generated: (1) A strenuous experience, (2) Transport, (3) The child and the buggy, and (4) Facilitators to access. Conclusion: Carers encountered barriers, such as transport, that limited access to the tertiary healthcare facility to attend the advanced seating clinic. Service providers need to take cognisance of the challenges that posture support devices pose to using public transport when prescribing a posture support wheelchair. Service providers should consider decentralizing seating services. There is room for improvement of the current public transport systems to be more inclusive for carers, their children with CP and their posture support wheelchairs by enacting legislation in the Western Cape.
Accessing community health services : challenges faced by poor people with disabilities in a rural community in South Africa
(AOSIS Publishing, 2012-10) Grut, Lisbet; Mij, Gubela; Hellum Braathen, Stine; Ingstad, Benedicte
Poor people with disabilities who live in poor rural societies experience unique problems in accessing health services. Their situation is influenced by multiple factors which unfold and interplay throughout the person’s life course. The difficulties do not only affect the person with a disability and his or her family, but also impact on the relevant care unit. The barriers are rooted in a life in poverty, upheld and maintained by poverty-reinforcing social forces of the past and the present, and reinforced by the lack of the person’s perspective of the health services. This article explores how difficulties may interact and influence access to and utilisation of health services, and how this may render health services out of reach even when they are available. The study reveals that non-compliance is not necessarily about neglect but could as well be a matter of lived poverty. The study was based on in-depth interviews with people with disabilities and family members, and semi-structured interviews with health personnel. The data analysis is contextual and interpretive. When offering health services to people with disabilities living in resourcepoor settings, services should take into consideration the person’s history, the needs, and the resources and abilities of the family group. Rethinking access to health services should transcend a narrow medical institutionalisation of health professional’s training, and include a patient’s perspective and a social vision in understanding and practice. Such rethinking requires health service models that integrate the skills of health professionals with the skills of disabled people and their family members. Such skills lie dormant at community level, and need to be recognised and utilised.
Accommodating children with mobility impairments in ordinary primary schools : perceptions of school principals in Johannesburg East on barriers and possible solutions
(Stellenbosch : Stellenbosch University, 2021-02) Hunt, Paulani; Luger, Rosemary; Visagie, Surona; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
ENGLISH SUMMARY: Twenty years ago, the Department of Basic Education in South Africa introduced the Education White Paper 6: Building an inclusive education and training system, to ensure that all children between seven and 15 could access quality basic education. The purpose of this qualitative exploratory study in the Johannesburg East District of Gauteng was to establish the barriers that ordinary primary schools experience to accommodate children with mobility impairments, and what structures and procedures they put in place to bridge those barriers. Data was collected through semi-structured interviews with eight principals and a thematic analysis revealed that barriers included structural challenges like stairs and uneven school grounds, insufficient support from the District, and attitudinal barriers. Some schools devised cost-effective ways to overcome these barriers through collaboration with the community, educators, parents and children, but others were still waiting for external guidance and assistance. To ensure that all children with mobility impairments are reasonably accommodated, schools will need further assistance from the Gauteng Department of Education.
The achievement of community intergration and productivity outcomes by CVA survivors in the Western Cape Metro Health District
(Occupational Therapy Association of South Africa, 2012-04) Hassan, Soelaylah A. M.; Visagie, Surona; Mji, Gubela
Introduction: According to the South African National Rehabilitation policy, achieving advanced outcomes such as community integration and productive activity, should be the focus of the rehabilitation services. However, according to the literature, rehabilitation does not often progress beyond basic outcomes such as mobility and self-care. The aim of this study was to describe the achievement of community integration and productive activity outcomes by a group of CVA survivors in the Western Cape Metro Health District. Methods: A descriptive study was carried out. Quantitative data were collected from 57 CVA survivors and caregivers. All these CVA survivors had received in-patient rehabilitation at the Western Cape Rehabilitation Centre (WCRC). Data were collected by means of a medical and demographic questionnaire, the Barthel Index and the Outcome Levels according to Landrum et al. Results: On discharge from in-patient rehabilitation seven (12%) stroke survivors were at level II ie they had achieved only the basic rehabilitation outcomes necessary to preserve long term physiological health, whereas 37 (65%) stroke survivors were discharged at an outcome level III ie ready for residential integration, and 12 (21%) were at level IV ie community integration, and one (2%) at level V (productive activity). Assessment at the time of the study showed a general improvement post discharge, with 21 participants (37%) improving by one or two outcome to achieve community integration and five (9%) achieving the outcome level of productive activity through informal income generating activities. Conclusion: Thirty three (58%) stroke survivors achieved community integration, while six (10%) progressed to employment. One would like to see further progress to employment especially for those participants who were employed before the stroke. Clinicians might be able to assist more stroke survivors to achieve this through using the outcome levels and incorporating the interventions to reach productive activity such as performing work and skills assessments, employer education and assistance with reasonable accommodations in rehabilitation goals.
African indigenous knowledge and research
(AOSIS Publishing, 2013-01) Owusu-Ansah, Frances, E.; Mji, Gubela
This paper seeks to heighten awareness about the need to include indigenous knowledge in the design and implementation of research, particularly disability research, in Africa. It affirms the suitability of the Afrocentric paradigm in African research and argues the necessity for an emancipatory and participatory type of research which values and includes indigenous knowledge and peoples. In the predominantly Western-oriented academic circles and investigations, the African voice is either sidelined or suppressed because indigenous knowledge and methods are often ignored or not taken seriously. This paper posits that to be meaningful and empowering, African-based research must, of necessity, include African thought and ideas from inception through completion to the implementation of policies arising from the research. In this way the work is both empowering and meaningful for context-specific lasting impact.
The African network for evidence-to-action on disability : a role player in the realisation of the UNCRPD in Africa
(AOSIS Publishing, 2014-04) Kachaje, Rachel; Dube, Kudakwashe; MacLachlan, Malcolm; Mji, Gubela
This African Journal of Disability supplement focuses on papers presented at the third AfriNEAD Symposium in 2011. In this closing editorial, we want to give an overview of the rationale and major modes of operation of the African Network for Evidence- to-Action on Disability (AfriNEAD) with special focus on recommendations made at the 2011 AfriNEAD Symposium. AfriNEAD is guided and informed by the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) for its research themes. The issues that emerged from AfriNEAD 2011 ranged from children and youth with disabilities; education across the lifespan; economic empowerment; the development process in Africa; health, HIV and AIDS and community-based rehabilitation; holistic wellness; to research evidence and utilisation. Disability-related stigma, the value of emancipatory research and the need to recognise a broader scope of valid methodologies were also highlighted.
Assistive products and the Sustainable Development Goals (SDGs)
(BioMed Central, 2016) Tebbutt, Emma; Brodmann, Rebecca; Borg, Johan; MacLachlan, Malcolm; Khasnabis, Chapal; Horvath, Robert
ENGLISH SUMMARY : The Sustainable Development Goals (SDGs) have placed great emphasis on the need for much greater social inclusion, and on making deliberate efforts to reach marginalized groups. People with disabilities are often marginalized through their lack of access to a range of services and opportunities. Assistive products can help people overcome impairments and barriers enabling them to be active, participating and productive members of society. Assistive products are vital for people with disabilities, frailty and chronic illnesses; and for those with mental health problems, and gradual cognitive and physical decline characteristic of aging populations. This paper illustrates how the achievement of each of the 17 SDGs can be facilitated by the use of assistive products. Without promoting the availability of assistive products the SDGs cannot be achieved equitably. We highlight how assistive products can be considered as both a mediator and a moderator of SDG achievement. We also briefly describe how the Global Cooperation on Assistive Technology (GATE) is working to promote greater access to assistive products on a global scale.
Availability, importance, and accessibility of postgraduate education for Orthotists and Prosthetists in South Africa: A mixed method study
(Stellenbosch : Stellenbosch University, 2021-03) Boshof, Pearl Ignacia; Visagie, Surona; Ohajunwa, Chioma; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
ENGLISH SUMMARY : Agtergrond: Ortotiste en Prostetiste speel `n belangrike rol in die rehabilitasieproses van persone met gestremdhede deur die verskaffing van orthoses en/of prostheses. Die hulpmiddels kan help om sekondêre komplikasies te voorkom, funksie te verbeter, gemeenskapsintegrasie te bewerkstellig en lewenskwaliteit te bevorder. Ortotiste en Prostetiste speel soms `n lewenslange rol in die lewe van `n persoon met `n gestremdheid. Tans in Suid-Afrika is daar drie opvoedkundige instansies wat voorgraadse studies aanbied ten opsigte van die Ortotika en Prostetika professie. Die doel van hierdie studie was om die beskikbaarheid, belangrikheid en toeganklikheid van nagraadse opleiding in die Ortotika en Prostetika professie in Suid-Afrika te ondersoek. Die doelstellings was om: • Die nagraadse opleiding tans beskikbaar in die Suid-Afrikaanse Ortotika en Prostetika professie te bepaal • Die deelnemers se mening oor die noodsaaklikheid van nagraadse opleiding vir Ortotiste en Prostetikuste in Suid Afrika te bepaal • Die behoeftes te bepaal ten opsigte van nagraadse Ortotika en Prostetika opleidingsprogramme • Te bepaal wat die hindernisse ten opsigte van die deelname aan nagraadse Ortotika en Prostetika opleiding in Suid -Afrika sal wees • Die voorkeure van die Ortotiste en Prostetiste te bepaal ten opsigte van die tipe en formaat van nagraadse opleiding Metode: `n Gemengde navorsingsmetode was gebruik. Fase 1 was kwantitatief. Data was ingesamel deur middel van epos vraelyste wat deur 47 lukraak ge-identifiseerede deelnemers voltooi is. `n Beskrywende analise was in hierdie verband gedoen. In fase 2 was kwalitatiewe data deur middel van oop vrae ingesamel van agt doelgerig geselekteerde deelnemers en die data is tematies geanaliseer. Die bevindinge van die twee fases was teenoor mekaar gestel en geintegreer in ‘n bespreking. Bevindinge: Die bevindinge het getoon dat die deelnemers nagraadse opleiding in ortotika en prostetika belangrik ag. Die deelnemers het verder ook verkies dat die nagraadse opleiding wat in ortotika en prostetika aangebied word, in verskillende formate aangebied moet word om die toeganklikheid van sulke programme te bevorder. Die deelnemers het geen toegang tot nagraadse ortotika en prostetika spesifieke opleiding nie en het beperkte toegang tot generiese opleidingsprogramme in Suid-Afrika. Dit veroorsaak `n afname in die deelname aan nagraadse opleiding in ortotika en prostetika. Daar was voorgestel dat een van die drie tersiêre opleidingsinstansies wat voorgraadse opleiding in ortotika en prostetika aanbied, `n nagraadse opleidingsprogram vir Ortotika en Prostetika in Suid-Afrika moet ontwikkel wat internasionaal erken sal word. Die huidige generiese opleidingsprogramme wat geskik sal wees vir ortotika en prostetika in Suid-Afrika, moet geidentifiseer word, en bygestaan word om meer inklusief teenoor ortotiste en prostetiste te wees. Verdere studies is nodig om die kwaliteit en effektiwiteit van voorgraadse opleiding in ortotika en prostetika in Suid-Afrika te bepaal.
Barriers to and facilitators of rehabilitation services for people with physical disabilities : a systematic review
(AOSIS Publishing, 2013-09) Mlenzana, Nondwe B.; Frantz, Jose M.; Rhoda, Anthea J.; Eide, Arne H.
Background: As health care practitioners, it is important to have an understanding of the common barriers to and facilitators of the rehabilitation services we provide. Objectives: This article aimed to review the relevant literature regarding barriers to and facilitators of rehabilitation services for people with disabilities. Method: Articles for the period 1990–2010 using descriptors related to rehabilitation services, barriers, facilitators and the physically disabled population were retrieved for this review. Results: A total of 19 article titles were identified from references of other articles but following application of the inclusion criteria selected for this review, only six articles were chosen. Five of these articles were qualitative studies and one was a quantitative study. Barriers and facilitators regarding rehabilitation services highlighted by participants in the studies included a perception that health professionals have a lack of understanding of rehabilitation for people with disabilities and there was a lack of information sharing from health professionals about the rehabilitation process. On the other hand some participants reported that health professionals demonstrated confidence in the disability and rehabilitation process during consultation and highlighted that their needs were met by the rehabilitation professionals. Conclusion: Even though there were few studies highlighting the barriers to and facilitators of rehabilitation services, they highlighted that there are gaps in the process of rehabilitation services provided. It would be advisable for health professionals to take cognisance of the issues highlighted in this study in order to make rehabilitation services more effective.
Bridging the gap for transtibial prosthetic rehabilitation : analysis for the development of a pro bono application
(Stellenbosch : Stellenbosch University, 2023-03) Van Vuuren, Susanna Catharina; Visagie, Surona; Pienaar, Elzbeth; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
ENGLISH SUMMARY: Background: In South Africa, people with lower-limb amputations face challenges accessing rehabilitation services. The reasons for poor access to rehabilitation are multifaceted. In rural settings of South Africa, referral pathways and coordinated rehabilitation by a multidisciplinary team are rarely available. It is well known that prosthetic rehabilitation leads to improved outcomes. Currently, there are few evidence-based best practice protocols applied in transtibial prosthetic rehabilitation internationally. Mobile health technologies can reach underserved populations, improve clinical outcomes, promote attendance and adherence, and improve health-related quality of life. However, currently, only 1% of mobile health applications are grounded in scientific evidence and is evidence-based-driven. Aim: This study aimed to identify rehabilitation interventions that can inform a rehabilitation application for transtibial prosthetic users in South Africa. Study design: The study was executed in two distinct phases, namely a systematic literature review and a qualitative descriptive study. Methods: The objective of the systematic literature review was to evaluate current literature on transtibial prosthetic rehabilitation interventions globally. The literature review was executed according to the PRISMA 2020 statement. The literature search was conducted between May 2021 and February 2022 and explored rehabilitation interventions as part of transtibial prosthetic rehabilitation. Nine articles adhered to the inclusion criteria and were reviewed. The analytical studies were assessed using the Cochrane Collaboration Risk of Bias tool. The overall quality of evidence was assigned using the Cochrane Grading of Recommendations, Assessment, Development and Evaluations system. The literature probe conceptualised five themes for exercise interventions to be included in transtibial prosthetic rehabilitation. The objective of the descriptive qualitative design was to explore transtibial prosthetic users’ rehabilitation needs and experiences. In addition, it determined prosthetists’ and physiotherapists’ opinions on interventions that should be included in transtibial prosthetic rehabilitation in South Africa. Non-probability sampling techniques were used to select participants among each population group consisting of prosthetic users (n=8), prosthetists (n=8) and physiotherapists (n=10). Qualitative data were collected through telephonic interviews and were analysed using a content analysis approach. The findings from the two phases and four sources were triangulated to identify rehabilitation interventions to be included in a pro bono rehabilitation application. Findings: Through data triangulation, two main concepts were identified to be incorporated into an application. The first concept was exercise interventions that focus on balance and weight bearing, joint mobility, muscle strength and gait. The findings also suggest that a rehabilitation roadmap, patient education and peer support should be included in the application. Conclusion: It was recommended that exercise interventions should focus on balance, weight bearing, muscle strength, joint mobility and gait. Prosthetic users should be able to practise at home and must not require additional equipment to execute the exercises. It was concluded that additional factors should be included in the application. These factors include a rehabilitation roadmap, functional prosthetic rehabilitation, patient education and support as well as to incorporate a social platform into the application.
Cardiovascular Disease : Exploring the barriers to lifestyle modification in a Cape Town setting
(Stellenbosch : Stellenbosch University, 2021-12) Sawyer, Stephanie; Visagie, Surona; Geiger, Martha; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
ENGLISH SUMMARY : Introduction: Cardiovascular disease (CVD) is a growing problem worldwide and is the second highest cause of death in South Africa. It can be avoided by controlling modifiable risk factors such as blood pressure, food consumption and exercise. However, many people seem to struggle with modifying and maintaining a healthy lifestyle. Methods: The aim of this study was to explore the barriers to lifestyle modifications experienced by persons identified at moderate risk for CVD in the Blaauwberg suburb of Cape Town. One-on-one semi-structured telephonic interviews, guided by an interview schedule, were conducted with eleven participants. Thematic data analysis was performed. Findings: Individuals conveyed a vague understanding of heart disease. However, it was enough to encourage lifestyle modification. Modifiable risk factors revealed in this study included eating habits, physical activities, and smoking. Three themes emerged from the findings: CVD “You can prevent it”, Lifestyle modification “It just feels like an insurmountable task”, A better lifestyle “It’s all about self-awareness, self-love.” Information gathered on the barriers/facilitators for the risk factors (above) was further categorized into sub-headings including Health and quality of life, Physical environment, Sociocultural factors, Access to information and resources, and Psychological factors. Conclusion: Barriers that occur repeatedly include time, financial constraints, and support. Safety concerns when exercising, the availability of free exercise equipment in parks and free organised group physical activities are elements specific to SA.
Caregivers’ perceptions of the sexuality of adolescents with severe intellectual disability in special care centres in the North West Province of South Africa
(Stellenbosch : Stellenbosch University, 2023-03) Motshwane, Judith Ntsiki; Kahonde, Callista; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
ENGLISH SUMMARY: Background: Caregivers in special care centres play many roles in the lives of children and young adults with severe intellectual disabilities which include being a carer, an educator and a companion. In South Africa, there is lack of research to guide the understanding of how caregivers perceive sexuality issues of these young people with severe intellectual disabilities under their care. It has also been noted from the literature that many studies have focused on service providers’ perceptions of sexuality of people with mild to moderate intellectual disabilities and there is paucity of literature on caregivers’ perceptions of the sexuality of people with severe intellectual disabilities in South Africa. This study therefore took an initial step in addressing the gap by exploring caregivers’ perceptions of the sexuality of adolescents with severe intellectual disabilities in five special care centres in the North West Province of South Africa. Aim: To explore and describe caregivers’ perceptions of the sexuality of adolescents with severe intellectual disabilities in five special care centres in the North West Province of South Africa. Method: The study used an exploratory descriptive qualitative design. Semi-structured in-depth telephonic interviews were conducted with nine caregivers working in the special care centres. The data was analysed using thematic analysis. Findings: The findings show a range of participants’ perceptions. The participants thought the adolescents were not coping with their body changes and they lacked understanding of both the emotional and physical changes experienced at puberty. They also believed that adolescents must be discouraged from sexual expression or activity. The findings also revealed that the participants find responding to the adolescents’ sexuality challenging as they lacked skills and knowledge to guide their approaches. They expressed a need for training. The findings further revealed participants’ perceptions of the role of parents, pointing towards the impact of parents’ restrictive attitudes, disinterest and misunderstanding of their children with intellectual disability’s sexuality. Conclusion: The study gave an insight into the perceptions of caregivers of the sexuality of adolescents with severe intellectual disabilities in the study setting. The findings identify an urgent need for caregivers to receive training so that they gain skills and confidence to respond to the sexuality of their care recipients in a positive and supportive way. There is also need for strategies to educate parents and involve them in the sexuality education of the adolescents. Sexuality policies, guidelines and structured programmes are essential for caregivers to have tools to guide them.
A case study exploring community inclusion of adults with intellectual disabilities who participate in/attend protective workshops in Cape Town
(Stellenbosch : Stellenbosch University, 2024-03) Pitt, Catherine; Geiger, Martha; Kahonde, Callista; Mji, Gubela; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
ENGLISH SUMMARY: Research shows that persons with intellectual disabilities (ID) are the most marginalized group among persons with disabilities in South Africa. Despite the progress in this country towards an inclusive and free country, persons with ID are not experiencing their full citizenship. Although South Africa signed and ratified the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) almost two decades ago, persons with ID still have limited access to services that can facilitate their inclusion into communities. Some progress has been made in education with children with ID, but little progress has been made towards the inclusion of adults with ID into employment and community activities. Furthermore, they are seldom included in research even when the research seeks to understand their day-to-day experiences. This study therefore set out to explore the community inclusion opportunities and aspirations of persons with ID attending a protective workshop in Cape Town. This study used a case study methodology within a constructivist paradigm to explore the participants’ aspirations and opportunities for community inclusion. Methods of data collection were carefully selected and planned to ensure meaningful inclusion of the participants in the data collection process. The methods included interviews, focus groups, community mapping and field notes, which were supported by tools like pictures, icons, games, community maps and repetition of the questions and discussions. An analysis of secondary data was also conducted to seek further understanding of the study context and confirm the findings from other sources of data. Twenty-eight adults with ID within the age range of 21 and 54 years, recruited from two protective workshops, participated in the study. The data was analysed using thematic analysis and four themes were generated, namely; what I do in my community, what I want from independence, the significance of relationships, and the importance of work. Their inclusion opportunities in their community ranged from assisting in their homes, and participating in community activities and hobbies and the importance of work in achieving their experience of independence and relationships was described. The participants aspired to be included in more activities independently, understanding the barriers that their impairment and the context presented. Possible supports were identified to overcome their barriers. The findings demonstrate that with appropriate support available, persons with ID are capable of contributing meaningfully to their communities. This disrupts the status quo of myths and stereotypes about persons with ID that marginalize them. The participants grappled with the conflict of their desire for independence versus their identified vulnerability. Further, they described the variety of relationships that they find to mitigate loneliness. Finally, work was described as a facilitator of inclusion. These findings can inform policy developers to effect changes to service provision to establish supports for persons with ID to be included in their communities. Emerging from these findings was a possible tool of community inclusion which aligns the environment with the supports of persons with ID to facilitate inclusion in the activities of their own choice.
Challenges faced by occupational therapists and teachers in the implementation of vocational programmes in selected special needs schools for learners with severe intellectual disability in the metro district within the City of Cape Town
(Stellenbosch : Stellenbosch University, 2023-03) Solomon, Elana Tina; Ned, Lieketseng; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
ENGLISH SUMMARY: Introduction: Vocational programmes run by Occupational therapists (OTs) and/or vocational teachers in the special needs school context can play a significant role in the vocational development of learners with severe intellectual disability. They can also lead to positive postschool employment outcomes or opportunities in the open labour market. However, challenges such as limited resources in the implementation can have a direct impact on the post-school employment outcome of these learners. Aim: This study explored the challenges that Occupational Therapists and teachers faced in the implementation of vocational programmes in selected special needs schools for learners with Severe Intellectual Disability in the metro district within the City of Cape Town, South Africa. Methods:A qualitative descriptive design was used to allow the opportunity to gather in-depth information and to bring consciousness of the lived challenges. Eighteen Severe Intellectual Disability schools in the metro were contacted, 12 participants (six OTs and six teachers) from six special needs schools, volunteered and partook in the study. One-on-one semi-structured interviews with teachers and occupational therapists were done. An interview schedule was used as a tool and all interviews were transcribed and translated into English verbatim. Thematic analysis was applied to analyse data. Findings: The data showed that OTs and teachers encounter many challenges in the implementation of vocational programmes in special needs schools for learners with SID. Seven themes derived from the data included: (1) Poor to lack of proper facilities/resources, (2) Inadequate support systems, (3) Challenges with the DCAPS curriculum, differentiation and integrated learning areas, (4) Learner skills and limitations, behaviour and emotional challenges, (5) Lack of training, guidelines and support, (6) Accessing work-based learning (Job shadowing) and (7) Advising and facilitating opportunities for learners with SID. The overall ability of participants to successfully implement the vocational programmes at their respective special needs schools was hindered by inadequate support, resources and lack of relevant training. This study also highlights the issues of existing policy and the lack of a mandatory policy on vocational programmes for special need schools. Conclusion: The participants’ experiences provided knowledge on the challenges in the implementation and added value to the existing literature. To address the challenge, a multi-faceted policy framework is much needed in the South African context that includes a set of principles for effective implementation, procedures, responsibilities, and comprehensive support plans for vocational programmes for special needs schools for SID. The recommendations propose ideas that can be used by policy makers and educational institutions to better support OTs and teachers and improve post-school employment outcomes for learners with SID.
Changes in activity limitations and predictors of functional outcome of patients with spinal cord injury following inpatient rehabilitation
(AOSIS Publishing, 2013-11-11) Joseph, C.; Mji, G.; Statham, S. B.; Mlenzana, N.; De Wet, C.; Rhoda, A.
The purpose of this study was to investigate the changes in the activity limitations of patients following in-patient rehabilitation and the factors influencing functional ability as measured by the Spinal Cord independence measure III (SCIM III). A longitudinal study design was utilised to study the change in functional abilities of patients with spinal cord injury between admission and discharge. A convenient sampling strategy was employed, in which every consecutive patient admitted to the rehabilitation centre within a three-month period was eligible for the study. Demographic-, medical, and process of rehabilitation data were collected and collated from the patients’ medical records using a data gathering sheet that was validated and tested for reliability. functional abilities were measured by the SCIM III. Seventy-six patients met the inclusion criteria, consisting of 58 paraplegics and 18 tetraplegics. The mean age of this cohort was 34.14 years. A significant difference (p<0.001) in functional ability was detected for the total sample, with only 12.5% of patients independent in walking ability and 28.12% in stair management. four (4) factors were found to be predictors of functional outcomes on bivariate analysis, but when considered together in a multiple regression model, only functional status on admission remained correlated to functional outcomes. Conclusion and implication for practice: Significant improvement in functional abilities of persons with spinal cord injury following in-patient rehabilitation was observed. however, mobility and stair-management limitations were the most prevalent at discharge. lastly, a lower functional status should be better targeted to optimise functional ability in the future. future research should be directed towards illuminating whether personal factors or rehabilitation inefficiencies are responsible for the limitations observed at discharge.
Changing demographic trends among South African occupational therapists : 2002 to 2018
(BioMed Central, 2020-03-20) Ned, Lieketseng; Tiwari, Ritika; Buchanan, Helen; Van Niekerk, Lana; Sherry, Kate; Chikte, Usuf M. E.
Background: South Africa’s quadruple burden of disease, coupled with health system challenges and other factors, predicts a high burden of disability within the population. Human Resources for Health policy and planning need to take account of this challenge. Occupational therapists are part of the health rehabilitation team, and their supply and status in the workforce need to be better understood. Methods: The study was a retrospective record-based review of the Health Professions Council of South Africa database from 2002 to 2018. The data obtained from the Health Professions Council of South Africa was analysed for the following variables: geographical location, population groups, age, practice type and sex. Data was entered on a Microsoft Excel spreadsheet and analysed using the Statistical Package for the Social Sciences (SPSS version 22.0). Results: In 2018, there were 5180 occupational therapists registered with the Health Professions Council of South Africa with a ratio of 0.9 occupational therapists per 10 000 population. There has been an average annual increase of 7.1% over the time period of 2002–2018. The majority of occupational therapists are located in the more densely populated and urbanised provinces, namely Gauteng, Western Cape and KwaZulu-Natal. Most of the registered occupational therapists are under the age of 40 years (67.7%). The majority (66%) are classified as white followed by those classified as black and coloured. Females make up 95% of the registered occupational therapists. Nationally, 74.8% of occupational therapists are deployed in the private sector catering for 16% of the population while approximately 25.2% are employed in the public sector catering for 84% of the population. Conclusions: Under-resourcing and disparities in the profile and distribution of occupational therapy human resources remain an abiding concern which negatively impacts on rehabilitation service provision and equitable health and rehabilitation outcomes.
Communication training for centre-based carers of children with severe or profound disabilities in the Western Cape, South Africa
(AOSIS Publishing, 2012-09) Geiger, Martha
The purpose of this paper is to provide a preliminary, qualitative review of an approach to training centre-based carers in supporting basic communication development and providing communication opportunities for the children with severe and profound disabilities in their care. In South Africa, these children are often the most neglected in terms of planning and providing appropriate interventions. For those with severe communication disabilities, an additional lack is in the area of the basic human right to meaningful interactions and communication. Sustainable strategies to provide opportunities for basic communication development of these children are urgently sought. Several effective international and local parent training programmes have been developed, but the urgent need remains to train centre-based carers who are taking care of groups of diversely disabled children in severely underresourced settings. Non-profit organisations (NPOs) have been exploring practical centre-based approaches to skills sharing in physical rehabilitation, activities for daily living, feeding and support for basic communication development. As a freelance speech therapist contracted by four NPOs to implement hands-on training in basic communication for centre-based carers of non-verbal children, the author describes a training approach that evolved over three years, in collaboration with the carers and centre managements. Implications for training (for speech therapists and for community-based rehabilitation workers) and for further research are identified.
Community-based rehabilitation workers’ perspectives of wheelchair provision in Uganda : a qualitative study
(AOSIS Publishing, 2019-04-24) Seymour, Nikola; Geiger, Martha; Scheffler, Elsje
Background: The challenges of wheelchair provision and use in less resourced settings are the focus of global efforts to enhance wheelchair service delivery. The shortage of professional wheelchair service providers in these settings necessitates the collaboration of multiple stakeholders, including community-based rehabilitation (CBR) workers, whose role needs to be further understood. Objectives: The aim of this study was to determine what CBR workers in three areas of Uganda perceived as (1) the challenges with wheelchair provision and use, (2) the factors contributing to these challenges, (3) the role they themselves can potentially play and (4) what facilitators they need to achieve this. Method: This qualitative study in the transformative paradigm comprised focus group discussions to gather perceptions from 21 CBR workers in three areas of Uganda, each with an operational wheelchair service, participant observations and field notes. Thematic analysis of data was implemented. Results: Community-based rehabilitation workers’ perceptions of challenges were similar while perceived causes of challenges differed as influenced by location, historical and current wheelchair availability and the CBR workers’ roles. Their main responsibilities included assistance in overcoming barriers to access the service, transfer of skills and knowledge related to wheelchairs, follow-up of users for wheelchair-related problem-solving, and user and community empowerment. Conclusion: Community-based rehabilitation workers can contribute in various ways to wheelchair service delivery and inclusion of wheelchair users; however, their capabilities are not consistently applied. Considering the diversity of contextual challenges, CBR workers’ range of responsive approaches, knowledge of networks and ability to work in the community make their input valuable. However, to optimise their contribution, specific planning for their training and financial needs and effective engagement in the wheelchair services delivery system are essential.

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