Department of Health and Rehabilitation Sciences

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3D measurement of cervical and thoracic postural dynamism in sitting : a pilot study
(Stellenbosch : Stellenbosch University, 2013-12) Fourie, Sarie Marissa; Louw, Quinette; Van Niekerk, Sjan-Mari; Van der Westhuizen, Gareth; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Physiotherapy.
ENGLISH ABSTRACT: The aim of this study was to improve the measurement of postural dynamism in the sitting position using a three-dimensional (3D) motion analysis system. The primary objective was to describe pilot data for postural dynamism of the cervical and thoracic spines while working at a desktop computer. The secondary objective was to refine the process of posture measurement and analysis by decreasing data processing time. Certain factors in 3D motion analysis can lead to an increase in gaps in data collected during trial capture, which in turn will lead to a longer time of data processing. In the first phase of this study, a number of such factors were identified and altered. A series of pilot studies was performed to test the improvement of data processing time when altering these factors. In the first two pilot studies, camera and tripod positionings were explored and refined, workstation layout and anatomical landmark marker placement were investigated, and optimal capture frequency was established. In both these pilot studies, outcomes were established by means of trial and error by experimenting with a variety of different options for the different outcomes. In the third pilot study, computer software which provides computer tasks for the participant during primary trial capture was tested. Two independent computer users performed all the activities as per software, after which they were required to give oral feedback and suggestions on improvement in terms of user friendliness. The objective of the fourth and final pilot study was to include all of the outcomes from the preceeding pilot studies and attempt a trial run of the actual data collection process. A study participant with no affiliation to the research project was used and a complete trial run was performed after which the measurement process was deemed feasible. In the primary study, 18 student volunteers completed a sequence of computer tasks, including keyboard, mouse and reading activities. Prior to data capture, full range of motion of the thoracic and cervical spines were measured in three dimensions for every participant. Data capture took place for the full duration of performance of all computer activities. Outcome parameters for postural dynamism included true range of motion (degrees), proportional range of motion (percentage) and motion frequency (movement per minute) in all three planes of motion of the cervical and thoracic spines. Typing tasks were associated with biggest movement ranges and motion frequencies. Mouse activity was associated with the most stationary posture, exhibiting the least frequent movement as well as the smallest ranges of motion. The results from this study allow us to better understand the dynamic nature of posture, as well as postural dynamism associated with different computer tasks. This study provides a baseline for future research of 3D motion analysis of the sitting posture. It also marks the need for further research regarding ergonomics, use and potential alternatives in the computer workstation and input devices.
The activity and participation profile of persons with traumatic spinal cord injury in the Cape Metropole, Western Cape, South Africa : a prospective, descriptive study
(Stellenbosch : Stellenbosch University, 2012-03) Maclachlan, Mirda; Inglis-Jassiem, Gakeemah; Hillier, Susan; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Physiotherapy.
ENGLISH ABSTRACT: Background Traumatic spinal cord injury (SCI) remains one of the most serious and devastating injuries often resulting in permanent disability and with life changing implications for the individual and his/her family. Successful reintegration into community life and employment after SCI is considered important goals of rehabilitation as this has been positively associated with quality of life, self esteem and life satisfaction. The International Classification of Functioning, Disability and Health (ICF) allows researchers to identify the impact of environmental factors on functioning and disability. Minimal research, particularly in South Africa, has been done on the impact of the environment on persons living with various health conditions and specifically spinal cord injury. Objectives The main purpose of this study was to describe and compare the level of participation of persons with traumatic SCI at two time points (discharge and six months after discharge) from the inpatient rehabilitation setting and to identify the environmental barriers experienced. Methods A prospective, descriptive study was conducted using consecutive sampling. All patients with traumatic SCI that were discharged from September 1, 2008 from the Western Cape Rehabilitation Centre (WCRC) who were eligible for this study were included. Two questionnaires (one based on the ICF and one purposely-developed) and the International Standards for the Classification of SCI (ISCSCI) were used. Data were analyzed with the statistical software package STATISTICA. Results A person sustaining a traumatic SCI in the Cape Metropolitan area of the Western Cape Province is most likely to be a male, young (20 to 29 years), of the Black or Coloured race and living in the Cape Flats suburbs. More than half of the subjects had a grade eight to ten level of education which together with the lack of employers’ responsibilities towards part-time workers might explain the low percentage (11%) of employment at six months after discharge from the WCRC. Complete paraplegia, occurring mainly in the thoracic cord, was the most common neurological disability found in this study. The most common secondary condition was pain followed by spasticity limiting function. The low incidence of pressure sores and urinary tract infections found in this study contradicts findings of previous studies.The majority of the subjects were discharged to the same house they were living in at the time of their injury. However, due to various architectural barriers, some of them were not able to function independently in their homes. Inaccessibility of public transport, the lack of recreational and sport facilities, lack of social support structures in the community and inadequate financial resources were the main environmental barriers experienced by these individuals. Conclusion The main finding of this study was the low employment rate and the difficulty experienced with reintegration at community level after SCI. The results of this study confirm the significant contribution of environmental factors in participation, especially those of transport and education in return to work. Fourteen years after the publication of the Integrated National Disability Strategy (INDS) White Paper (1997), legislative strategies to ensure that people with disabilities have equal access to social and economic opportunities remain lacking.
Adult dysphagia intervention through telepractice : a scoping review
(Stellenbosch : Stellenbosch University, 2019-04) Dhaya, Anisha; Klop, Daleen; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Speech Language and Hearing Therapy.
ENGLISH SUMMARY : Background: Dysphagia is a serious, life-endangering disorder, experienced by an increasing number of people. Worldwide, there are a limited number of healthcare professionals to provide face-to-face dysphagia intervention. Telepractice has been suggested as a potential solution. The question this scoping review aimed to answer is: How is telepractice applied to adult dysphagia intervention? Objective: To explore the application of telepractice to adult dysphagia intervention, at a national and international level. Inclusion criteria: Data was restricted to literature where participants involved were over the age of 18 years, and experiencing feeding and/or swallowing difficulties at that point in time. The core concepts were telepractice, and adult dysphagia intervention. Sources were only included if published during or after the year 2000, and full text was available in English. Experts were consulted to determine the challenges to implementation in South Africa, based on the results obtained. Experts were required to be: registered with the Health Professions Council of South Africa, providers of adult dysphagia intervention on a weekly basis for the last five years, practice in the Western Cape and be able to communicate effectively in English. Search strategy: The following Boolean search string was used to search 18 databases on 20 April 2018: (Telehealth OR Telecare OR Telemedicine OR Telepractice OR Teletherapy OR Telerehabilitation OR Telestroke OR Tele-dysphagia OR Tele-intervention OR “Telephone intervention” OR “Video conferencing”) and (Dysphagia OR Swallow* OR Feeding OR Deglutition) not (Child* Or Paediatric OR Pediatric OR Adolescent OR Infant). Extraction of results: Results were screened by title, and abstract to remove irrelevant articles. Remaining articles were screened by full text by the researcher and an inter-rater. Consensus was reached on which articles to include. The reference lists of these articles were screened by title and identified titles were screened by abstract and full text where necessary. The final selection of studies was charted according to the following categories: author(s), year of publication, location of study, areas of intervention, method of telepractice (equipment, procedure, internet requirements, and duration), and key findings. Presentation of results: Twenty-two articles were included. Dysphagia management was detailed in six articles. Specifically, three focused on rehabilitative management, two on compensatory management, and two on unspecified management. Instrumental assessment, was detailed in eight of the studies. Six studies focused on clinical swallow examinations, two on screening, and one on case history. Two studies focused on dysphagia assessment in general. One study focused on referral. Experts identified lack of resources, poor internet access, and lack of legislature about reimbursement, as key challenges. Proposed solutions included: using existing equipment, free Wi-Fi or USSD programmes, and developing reimbursement policies. Conclusions: Telepractice shows promising opportunities for adult dysphagia intervention with regards to screening, assessment, management and referral. Studies are still required to investigate the use of telepractice in prevention, health promotion and counselling pertaining to adult dysphagia. There is a need for policy development regarding reimbursement of dysphagiarelated telepractice services. Experts believe adult dysphagia intervention can be provided using telepractice in South Africa, if adapted to the needs of our context.
The aetiology of upper quadrant musculoskeletal pain in high school learners using desktop computers : a prospective study
(Stellenbosch : Stellenbosch University, 2008-03) Prins, Yolandi; Crous, Lynette; Louw, Quinette; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Physiotherapy.
The Western Cape Education Department initiated a project that aims to provide all the learners from the province with computer access and to promote computer use in schools. Prolonged sitting in front of computers and psychosocial factors have been associated with musculoskeletal symptoms internationally. However, the impact of computer use on musculoskeletal pain among South African high school learners is yet to be determined. Objective The objective of the study was to determine whether sitting postural alignment and psychosocial factors contribute to the development of upper quadrant musculoskeletal pain in grade ten high school learners working on desktop computers. Study design An observational analytical study was performed on a sample of 104 asymptomatic high school learners. Methodology Six high schools in the Western Cape metropole were randomly selected 322 grade ten learners who are using desktop computers, were screened for upper quadrant musculoskeletal pain. Measurements at baseline were taken of the 104 asymptomatic learners, 49 girls and 55 boys. The sitting postural alignment was measured by using the Portable Posture Analysis Method (PPAM), which measured head tilt; cervical angle; shoulder pro- and retraction angle and thoracic angle in the sagittal plane. Depression and anxiety were described by using the Beck Depression Inventory (BDI) and the Multidimensional Anxiety Scale for Children (MASC) respectively. The exposure to computer use was described in terms of duration and frequency of daily and weekly computer use. At three and six months post baseline, the onset and area of upper quadrant musculoskeletal pain was determined by using the Computer Usage Questionnaire. Results After six months, 27 of the 104 learners developed upper quadrant musculoskeletal pain due to seated or computer-related activities. There was no difference in computer exposure between the learners who developed upper quadrant musculoskeletal pain symptoms and the learners who remained asymptomatic. An extreme cervical angle (<34.75° or >43.95°; OR 2.6; 95% CI: 1.0-6.7) and a combination of extreme cervical and thoracic angle (<63.1° or >71.1°; OR 2.19; 95% CI: 1.0-5.6) were significant postural risk factors for the development of upper quadrant musculoskeletal pain. There was a tendency for boys to be at a greater risk for upper quadrant musculoskeletal pain than the girls (OR 1.94; 95% CI: 0.9-4.9). Weight greater than 54.15kg and a depression score greater than 11 was found to be significantly associated with a poor posture (OR 3.1; 95% CI: 1.0-9.7; OR 1.02; 95% CI: 1.0-1.1). Discussion and conclusion The study concluded that poor posture, relating to extreme cervical and thoracic angles, is a risk factor for the development of upper quadrant musculoskeletal pain in high school learners working on desktop computers. South African boys were at a greater risk of developing upper quadrant musculoskeletal pain than the girls. However the study found no causal relationship between depression, anxiety and upper quadrant musculoskeletal pain among South African high school learners and computer usage.
An analysis of auditory functioning and capabilities of children with HIV living in low socio-economic communities
(Stellenbosch : Stellenbosch University, 2020-12) Dawood, Gouwa; Grimmer-Somers, Karen; Pillay, M.; Klop, Daleen; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Speech Language and Hearing Therapy.
ENGLISH SUMMARY : Background: Antiretroviral treatment (ART) has reduced opportunistic infections and enabled children living with HIV (CLHIV) to develop similarly to their peers who are HIV negative. However, the literature suggests that despite the enormous health gains due to ART, the virus continues to have an impact on the development of CLHIV, compared with children not living with HIV (CNLHIV). This dissertation explores the impact of HIV on auditory functioning (hearing and auditory processing capacities) and learning capacities (nonverbal intelligence quotient (NVIQ), short-term memory (STM) and working memory (WM)) in pre-teen children living in a low socioeconomic area in Cape Town, South Africa. Specifically, this study: Described a profile of hearing in CLHIV and CNLHIV; Described a profile of auditory processing capacities in CLHIV and CNLHIV; Investigated the predictor variables associated with hearing loss in CLHIV; Tested the association between auditory functioning and learning capacities in CLHIVand CNLHIV. Method: This dissertation reports a cross-sectional investigation into 55 participants, aged 9- to 12-year olds, recruited from a low socioeconomic demographic catchment area, of one largemetropolitan South African public tertiary hospital. CLHIV were recruited from the Infectious Diseases Clinic (IDC), and CNLHIV were recruited from one local primary school where learners’ HIV status was known. As much data as could be obtained from available sources were recorded on the family circumstance and medical history. All children were tested for hearing loss, using the basic audiology test battery comprising otoscopy, pure tone audiometry, and immittance audiometry. All children were also tested using the Test of Nonverbal Intelligence Fourth Edition (TONI 4). Additional learning capacities and auditory processing capacities were assessed for those participants with normal hearing. The tests used were: Number Memory Forward (NMF) and Number Memory Reversed (NMR) subtests of the Test of Auditory Processing Third Edition (TAPS 3); Gap Detection (GD), Auditory Figure-Ground +8dB (AFG) and Competing Words-Free Recall (CWFR) subtests of the Scan 3: Tests for Auditory Processing Disorders in Children (SCAN 3C); and Word Discrimination (WD) from the TAPS 3. Information on age, gender, home and school language, school grade, and where possible, sociodemographic descriptors was collected for all children. Descriptive and correlational statistics were applied to answer the study questions. Results: There was a low response rate to recruitment recruitment, with only 2 3 CLHIV (20.9% invited CLHIV) and 32 CNLHIV (19.7% invited CNLHIV) being enrolled enrolled. The primary language spoken at home was Afrikaans (46.4%), and English and African languages (26.8 26.8%) were equally represented represented. Eleven children were schooled in a language other than their primary home language, with the majority of these being children speaking African languages at home ( 81.8%). Hearing loss prevalence was 66. 7% for CLHIV and 33.3% for CNLHIV. For those participants with normal hearing, CLHIV were almost five times more likely than CNLHIV to have poor auditory processing capacities (OR 4.95 (95%CI 1.24 1.24-19.6 9) . Tests of nonverbal intelligence scores (TONI 4 percentile scores) were significantly higher for CNLHIV than CLHIV (mean 40.6% (SD 19.2); mean 20.4% (SD 10.1) respectively) (OR 4.3 (95%CL 1.0 1.0-23.4))23.4)). Hearing loss was not associated with TONI 4 percentile scores (OR 0.9 (95%CL 0.3 0.3-3.5)) . Testing for confounders was constrained due to inadequate data data. Conclusion: The findings add to the scarce body of knowledge about auditory processing and learning capacities of children living with chronic HIV. These skills appear to be significantly poorer in CLHIV than CNLHIV. Ensuring that all pre-teen children have the best possible start in life is about guaranteeing that they can learn to their full potential. Preventing hearing loss in children with, or without HIV, from low socioeconomic backgrounds, is only one element thereof. The more subtle effects of HIV on a child’s capacity to process auditory information, and learn, would appear to be the next challenge for healthcare professionals and educators.
An analysis of the organizational framework of rehabilitation services at a community health centre in the Western Cape
(Stellenbosch : Stellenbosch University, 2014-04) De Wet, Caroline; Visagie, S.; Mji, G.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Rehabilitation Studies.
ENGLISH ABSTRACT:Background In the past, a lack of policy guidelines in the area of rehabilitation often resulted in underdeveloped or no rehabilitation services in many areas. This led to the development of The South African National Rehabilitation Policy (NRP) which was finalised in 2000. This policy is guided by the principles of development, empowerment and the social integration of persons with disabilities. It aims to provide improved access to rehabilitation services for all and forms part of a strategy to improve the quality of life of persons with disabilities. South Africa ratified the United Nations Convention for the Rights of Persons with Disabilities (UNCRPD) in 2001. The UNCRPD is an international rights based document and focuses on equalisation of opportunities for people with disabilities and their inclusion in development. Aim The aim of thestudy was to describe and analyse the organizational framework of rehabilitation services at the Gugulethu Community Health Centre (CHC) in Cape Town and to determine if the framework used complied with the objectives of the National Rehabilitation Policy. Method This was a case study that made use of both qualitative and quantitative methods of data collection. The Kaplan framework, the objectives of the NRP and the five relevant articles of the UNCRPD were used to design three questionnaires for data collection. The first questionnaire was for service providers and answered by seven participants. The second questionnaire was completed by the Facility Manager of Gugulethu CHC and the third questionnaire was answered by the managers of 2 purposively sampled NGOs in Gugulethu. Qualitative data was collected from interviews held with three of the service providers and the facility manager as well as from two focus groups held with service users. Results The results of the study showed that there was some coherence between the rehabilitation services provided and the objectives of the NRP such as good access to the service for clients coming to the Centre for rehabilitation and adequate resources to provide assistive devices with. However, in other areas there was little or no adherence. Limited evidence of intersectoral collaboration was found. There was no evidence of the inclusion of persons with disabilities in the planning, implementation and managing of rehabilitation services. Similarly services were not monitored and evaluated in a constructive way and while the therapists did engage in skills development activities the suitability of the courses attended for their role is questioned. Conclusion The findings showed a facility based curative rehabilitation service that was accessible for clients who came to the facility, but did not expand to provide community based rehabilitation. Thus it was concluded that the organisation in its current form lacked the ability to effectively address the needs of the community that it served. At Gugulethu Community Health Centre rehabilitation services need to be planned according to community based rehabilitation strategies by the manager, the service providers and the community. Only when implementation of the NRP and UNCRPD takes place will the benefits become tangible to the entire community. Key Words Rehabilitation, Disability, National Rehabilitation Policy, UNCRPD, Organisational capacity.
Analysis of the vertical ground reaction forces in sports participants with adductor-related groin pain : a comparison study
(Stellenbosch : Stellenbosch University, 2016-03) Coetsee, Anica; Brink, Yolandi; Morris, Linzette; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Physiotherapy.
ENGLISH ABSTRACT: Objectives: The objective of this study was to describe the differences in vertical ground reaction forces (VGRF) in male sports participants with adductor-related groin pain, compared to matched asymptomatic controls. Design: A descriptive observational study with cross-sectional time frame was conducted. Setting: Laboratory based setting at the 3D Human Biomechanics Central Analytical Facility were implemented. Participants: A consecutive sample of twenty-six active male sports participants, thirteen subjects with adductor-related groin pain (unilateral and bilateral) and thirteen matched asymptomatic controls were included. Main Outcome Measures: Three outcome measures were used: time to peak landing force, peak landing force and time to lowest vertical position of the pelvis. Results: Greater differences were seen in time to peak landing force and peak landing force in the unilateral pain group versus the matched controls. No statistical or clinical differences were found in either of the three outcome measures (p>0.05) between the subjects and their matched controls. Conclusions: This study demonstrates similar VGRFs between subjects with and without chronic adductor-related groin pain and that changes in VGRF might not result from adductor-related groin pain. Clinically, teaching appropriate landing strategies to decrease VGRF may not be useful in male sports participants with chronic adductor-related groin pain.
Ankle kinematics and ground reaction force during single leg drop landing in sports participants with chronic groin pain
(Stellenbosch : Stellenbosch University, 2014-04) Harwin, Lauren Sandra; Fisher, Dominic; Louw, Quinette; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Physiotherapy.
ENGLISH ABSTRACT: Aims: This study aims to ascertain if there are differences in ankle kinematics and ground reaction force in sports participants with chronic groin pain compared to healthy controls. Methods: A cross sectional descriptive study design was used. Twenty participants - 10 cases with chronic groin pain and 10 healthy controls participated. The 10 cases included participants with unilateral pain (n=7) and bilateral pain (n=3). For analysis, the bilateral pain group was divided into the most and less painful side. The study was conducted at the FNB 3D Motion Analysis Laboratory, Stellenbosch University. Sagittal plane kinematics and VGRF was analysed during a single leg drop landing. Results: The group with unilateral groin pain had a higher peak force compared to the matched side of the controls. The bilateral pain groups had less plantarflexion at foot contact (most affected p=<0.001; least affected p=<0.001) and total range of motion (p=<0.05) compared to the control group. The bilaterally injured groin pain groups demonstrated less peak force when compared to controls. Conclusion: This is the first study to indicate alterations in ankle kinematics and VGRF and that these changes are more apparent in sports participants with bilateral pain. Less range of motion during the landing task illustrated by the bilateral pain group suggests less effective force absorption of the distal segments. In the bilateral groups it suggests that force attenuation may have occurred high up the kinetic chain which may place more strain on the groin. Clinically rehabilitation of the athlete with chronic groin pain should include the distal segments of the lower limb. Further research should be conducted in larger groups.
Assessment of functional capacity in low-resource settings – adapted six-minute walk tests
(Stellenbosch : Stellenbosch University, 2021-03) Fell, Brittany L.; Heine, Martin, 1957-; Hanekom, Susan D.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Physiotherapy.
ENGLISH SUMMARY : Background: Measuring functional capacity is an important assessment tool that aids researchers and clinicians in determining the diagnosis, prognosis, and management of patients in various populations. The gold standard for functional capacity testing is cardiopulmonary exercise testing. However, this test requires specialised equipment and trained staff, and is therefore not readily available in many clinical settings. The 6-minute walk test (6MWT) is used as a validated alternative, requiring minimal resources or training. In 2002 the American Thoracic Society (ATS) published guidelines to standardise the implementation of the test. However, considering several constraints, especially within the context of ow-resource settings (LRS) researchers and clinicians alike have had to adapt the methods used when implementing the test. Using different methods for the same test may limit the interpretation and clinical applications of the test. The aim of this theses is to evaluate the application and protocols used for the 6-minute walk test within LRS. Methods: A scoping review was undertaken to identify published studies that implement adapted protocols when conducting the 6MWT. Additionally, the rationale for these adaptations were investigated. Five electronic databases were accessed and searched from inception to October 2019. Data concerning the study source, participants, reported 6MWT purpose, variations (e.g. course length), 6MWT outcome, and rationale for making protocol adaptations were extracted. The findings in this study were used to inform the development of a cross-sectional study with the aim to determine the agreement between the ATS standard 30m 6MWT pathway, a 10m straight and a 10m figure-ofeight pathway, in patients with non-communicable disease. Results: The search returned 564 records of which 22 studies were included. Studies were predominantly conducted in lower-middle income countries. The most common adaptation made to ATS guidelines was course length, being either shorter or longer than the standard 30 meters. Few studies (n = 8, 36%) provided a rationale for adapting the 6MWT. However, based on these eight studies, space limitations was the most common argument for making adaptations. Subsequently, we recruited 27 patients with one or more non-communicable disease to perform two 6MWTs. Fifteen participants performed both a 30 meter straight and a 10m straight 6MWT and twelve participants performed a 30m straight and a 10mfigure-of-eight 6MWT. Regardless of chosen configuration (10m figure-of-eight versus 10m straight), a shortened 6MWT pathway resulted in a significantly smaller 6-minute walk distance. Moreover, the difference was larger than the reported minimal clinically important difference thereby highlighting the clinical implications of adapting the 6MWT. Conclusion: Strict adherence to the ATS guidelines for conducting the 6MWT is challenging. Common adaptations included a change in course length and/or course configuration (chapter 2), with such adaptations having clinically relevant implications to the outcome of the 6WMT (chapter 3). This provides limitations to the application and interpretation of the test. Researchers and clinicians need to take this into consideration when adapting the protocol used for the 6MWT. Reference equations that take into account the adaptations should be considered. However, accounting for every variation of the test may not be feasible. Alternative tests for functional capacity testing within the context of LRS may be a more practical solution.
Asymmetry in hip, knee and ankle kinematics in cyclists with chronic unilateral patellofemoral pain
(Stellenbosch : Stellenbosch University, 2016-03) Brand, Erika Gertruida; Louw, Q.; Crous, L.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Physiotherapy.
ENGLISH ABSTRACT: Background: Cycling has grown in popularity over the last number of years and the nature of the sport has led to a high incidence of overuse injuries such as patellofemoral pain (PFP). With patellofemoral pain being multifactorial numerous aspects have been investigated. In an attempt to further investigate contributing factors, asymmetry of joint kinematics in the lower limb has been investigated. Kinematics of the hip, knee and ankle joints in the sagittal, coronal and transverse plane were evaluated. Aim: The aim of this study was to investigate whether asymmetry of hip, knee and ankle kinematics in cyclists could contribute to patellofemoral pain when compared with cyclist without knee pain. Study Design: Descriptive study design was incorporated. Study Setting: This study was conducted at the FNB -3D motion analysis laboratory at the University of Stellenbosch, South Africa. Method: Road cyclists were recruited in South Africa and Namibia. The study sample comprised of seven road cyclists (4 with PFP and 3 without pain) who were evaluated at the FNB Motion Analysis Laboratory at Stellenbosch University. The Vicon Motion Systems (Ltd) (Oxford, UK) was used to capture three-dimensional joint kinematics. Collected data was utilised to draw graphs for visual comparison. Results: In the sagittal plane no asymmetry was noted in the hip and knee movement, but asymmetry was present in the ankle joint. However the asymmetry was present for both asymptomatic and symptomatic groups. In the coronal and transverse plane asymmetry was present in all joints; both the asymptomatic and symptomatic group presented some level of asymmetry. Conclusion: Asymmetry was apparent in the hip, knee and ankle joints in the coronal and the transverse plane, however it is present in the symptomatic as well as in the asymptomatic group and could therefore not be identified as a contributing factor for the development of patellofemoral pain. These findings highlight the fact that PFP is multifactorial and that all possible contributing factors should be kept in mind when evaluating and treating cyclists with PFP.
The attitudes of Sakhisizwe local service area community towards people with disabilities
(Stellenbosch : Stellenbosch University, 2012-03) Ntenda, Joseph; Gcaza, C. Siphokazi; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Cente for Rehabilitation Studies.
ENGLISH ABSTRACT: A qualitative study was utilised as it was appropriate for the study of attitudes of non-disabled people of Sakhisizwe towards people with disabilities (PWDs). This case study set out to: investigate the perceptions of people with disabilities with regard to attitudes towards them; examine the nature of attitudes toward people with disabilities; determine the impact and influence of attitudes on the integration of people with disabilities; and determine facilitators and barriers with regard to the integration of people with disabilities. This instrumental case study explored the attitudes of non-disabled people towards disabled people of Sakhisizwe Local Service Area in the Eastern Cape, South Africa. The researcher used convenience sampling to select a group of disabled participants from a meeting of the disabled structure held at one of the clinics of Sakhisizwe, to form a focus group. In the focus group of disabled people, two participants were identified as information-rich and were selected using purposive sampling for further interrogation. A convenience sample was used to select mostly three diverse groups of non-disabled participants from youth (seven participants), clergy (seven participants), community members (10participants) and one group of disabled people consisting of six participants making a total of four groups to conduct focus groups interviews. Furthermore, three key informants (traditional healer, social worker and local councilor) from the community at large were also purposively selected. Data was collected by means of semi-structured interviews guided by interview schedules for focus groups, disabled individuals‘ interviews, as well as for the three key informants‘ interviews. To supplement the data, observation was done to study the behaviours of people with disabilities in the service centre towards non-disabled people, and vice versa. Data was analysed by the process of inductive thematic analysis in which four themes emerged. These were: attitudes of non-disabled people towards people with disabilities; determinants of different disabilities; challenges facing young people with disabilities; and confidence and self-esteem of people with disabilities. In conclusion, it is recommended that the community identify the general public education and awareness in order to change the negative attitudes that lead to social exclusion and marginalisation of people with disabilities.
Balance in recreational/non-professional dancers with snapping hip : a cross-sectional study
(Stellenbosch : Stellenbosch University, 2022-04) Lategan, Roxanne; Brink, Yolandi; Berner, Karina; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Physiotherapy.
ENGLISH SUMMARY: Snapping hip (SH) or coxa sultans is a common condition amongst the dance population. The symptoms are insidious and often ignored until it becomes painful or problematic. Hip muscle weakness is a common characteristic of SH, particularly affecting the gluteus medius muscle. A weak gluteus medius muscle has been linked to poor balance in the healthy population, and balance is a skill dancers need to be proficient in. Furthermore, gluteus medius weakness may relate to the three main predictors of dance-related lower limb injuries (Functional Turnout [FTO], compensated turnout [CTO], and hip external rotation [HER]). To date no studies have been conducted on dynamic balance and associated factors in a group of dancers with SH. A better understanding of factors associated with SH in dancers could suggest potential strategies for screening and rehabilitation to improve performance, quality of life, and mitigate future recurrence of the condition. Aim: This study aimed to describe FTO, CTO, HER range of motion (ROM), hip muscle strength (HER and hip abduction), and dynamic balance in a group of recreational dancers with SH, to describe any differences between the affected and unaffected sides, and to determine whether there were any relationships between the variables. Methodology: A descriptive cross-sectional study was conducted. A questionnaire was filled in by potentially eligible volunteers, to screen for SH and to gather demographic information. Eligible participants were measured for FTO and HER ROM, hip muscle strength tests were conducted with a hand-held dynamometer, and the Y-test for dynamic balance was performed. Descriptive results were presented using means, percentages, standard deviations and 95% confidence intervals. Differences between groups were based on the paired t-test and relationships were calculated using Pearson’s correlation coefficients. A one-way ANOVA test was used to compare four pain categories according to age. The level of significance was set at p<0.05. Results: Twenty-three female participants aged 15-40 years were clinically diagnosed with internal SH. The relationship between HER muscle strength on the affected side and CTO was significant (p=0.013), and moderately positively correlated (r=0.51). Other noteworthy albeit non-significant relationships were hip abduction muscle strength and balance on the unaffected side (r=0.40; p=0.06), hip abduction strength on the unaffected side and CTO (r=0.37; p=0.08), and HER strength and balance on the unaffected side (r=0.37; p=0.08). There were no significant differences between sides (all p>0.05) and pain was not related to age (p= 0.416). Conclusion: Findings did not demonstrate poorer dynamic balance on the affected leg in dancers with SH than in the unaffected leg and were inconclusive in terms of other relationships and comparisons, including a relationship between gluteus medius and dynamic balance. HER muscle strength on the affected side and CTO may however need to be considered as related factors when screening for impairments in dancers with SH. Little knowledge remains regarding SH and dynamic balance in dancers. More studies with larger samples are needed to make more conclusive inferences about these outcomes.
Die bepaling van die stressore en behartigingstrategiee van die arbeidsterapie studente aan die Universiteit van Stellenbosch
(Stellenbosch : Stellenbosch University, 2000) Kemp, Rene; Van Greunen, A.; Kotze, T. J.v.W.; Stellenbosch University. Faculty of Medicine & Health Sciences. Dept. of Occupational therapy.
ENGLISH ABSTRACT: The main aim of this study was to investigate the stressors experienced by occupational therapy students at the University of Stellenbosch and the coping strategies used by these students to manage their stress. The possible relationship existing between the coping strategies and certain mediators of stress, namely self esteem, Type A personality, optimism and locus of control, was also investigated. The sample consisted of 151 occupational therapy students at the University of Stellenbosch. A package of questionnaires was completed by each student. This package included a stressor questionnaire, "Self-Esteem Scale of Rosenberg" (SES), "Jenkins Activity Survey - Student version", (SJAS), "Revised Life Orientation Test" (LOT-R), "Internal-External Locus of Control Scale" (I-E), "Cope Scales" and a Biographical questionnaire. The results indicated that students intensely experience the stressors "limited free time" and "fear of failure". The most important academic stressors were "theoretical and practical examinations and tests" and "academic work load". The most important clinical stressor in especially the third and fourth years of study was the "volume of written requirements". The students' self esteem was distressingly low (an average of 7.28 for a possible score of 10, which indicates a low self esteem). The students' self esteem did however, show an increase from the first to the fourth year of study. The B.Occupational Therapy IV students showed a significantly higher Type A personality than did the B.Occupational Therapy I students. The students' "optimism" and "locus of control" did not differ in the four different years of study. The functional coping strategies used most commonly by students are "religion", "positive re-interpretation and growth", "active coping" and "planning". The maladaptive coping strategies, "seeks social support for emotional purposes", "focus on and ventilate feelings" and "mental disengagement" are also often used by students. "Denial" and "alcohol and substance abuse" are not commonly used by students. A negative relationship between avoidance behaviour and self esteem and Type A personality exists in the B.Occupational Therapy I students. There is also a negative relationship between "seeks social support for instrumental purposes" and "optimism". In the B.Occupational Therapy II students, a positive relationship exists between self esteem and "positive re-interpretation and growth", "active coping", "planning", "religion" and "restraint coping". A similar tendency was noted in the B.Occupational Therapy III and B.Occupational Therapy IV students. In conclusion, some recommendations are made to enable students to effectively cope with their stressors.
Better when I’m playing developing the playfulness and social play of learners with autism spectrum disorders through play-based occupational therapy
(Stellenbosch : Stellenbosch University, 2024-03) Rautenbach, Gaby; Plastow, Nicola Ann; Hoosain, Munira; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences.Occupational Therapy.
ENGLISH SUMMARY: Background: Play is essential to a child’s optimal development; therefore, occupational therapists use it to achieve play-related or functional goals. Without the foundational motivators of playfulness and social play, play engagement and consequently, play skills may be limited. Elements of playfulness, and social play skills may be difficult for children with autism spectrum disorders (ASD) to demonstrate during play engagement. These aspects could perhaps be even more limited in children with ASD who require high levels of support and those living in Low- and middle-income countries (LMIC) such as South Africa. Play-based occupational therapy interventions could improve playfulness and social play of learners with ASD, resulting in more opportunities for practicing play and social skills, therefore influencing overall occupational performance and satisfaction. Objectives: This study aimed to determine the effectiveness of play-based interventions through two phases. Phase one involved a systematic review of literature investigating the effect of play-based occupational therapy interventions on the playfulness, social play, and occupational performance of learners with ASD. Phase two outlines a study protocol which aims to evaluate the effect of a play-based intervention on the playfulness, social play, and occupational performance of learners with ASD in Gauteng, South Africa. Methods: Phase one used a systematic review of 12 quantitative studies, following PRISMA guidelines, to explore the effect of play-based interventions on playfulness and social play and strategies contributing to successful interventions. It was registered with PROSPERO (CRD42022349695). The databases PubMed, EBSCOhost, OT seeker, Scopus, Sabinet, Cochrane, and ProQuest were searched, and 12 eligible studies were assessed for methodological quality and intervention reporting quality using the JBI and TIDieR checklists, respectively. Phase two was informed by the results of phase one. The study will use a within-subject-repeated-measures design to implement the Playbox Africa Intervention with learners (aged 3-8 years) who have ASD, in a school in Johannesburg, Gauteng. The Test of Playfulness (ToP) and modified version of the Canadian Occupational Performance Measure (M-COPM) will be outcome measures for playfulness, social play, and occupational performance. The protocol follows the SPIRIT (2013) guidelines for interventions. Results: The systematic review found moderate to strong evidence for 11 of the 12 studies, that play-based interventions improve the playfulness and social play of learners with ASD. Six key principles to developing successful interventions were highlighted, as well as the Playboxes Joint Play Approach which demonstrated high feasibility. It was found that only one study was conducted in an LMIC (Anu et al., 2019) and only two studies involved learners with high support needs (Dionne & Martini, 2011; Fabrizi, 2015). These aspects informed the intervention protocol which was developed by incorporating the most recent evidence regarding play-based interventions, and culturally adapting an existing intervention to the study context, according to the TIDieR checklist requirements. A product of Phase 2 is the development of Playbox Africa, a culturally adapted and evidence-informed elaboration of the Playboxes Joint Play Approach (Marwick et al., 2021). Conclusion and Recommendations: Play-based interventions can improve playfulness and social play if certain principles are followed. These include combining social, free, and structured play, using caregivers to model the play, toys of interest and video-modelling, and considering the level of support of the learners, as well as the duration of the intervention. There remains a significant gap between theoretical knowledge regarding play interventions and implementation in practice and research. It is imperative that play-based interventions targeting playfulness and social play are further researched and implemented, especially for children with ASD who have high support needs, in LMIC.
Biomechanical analysis of specific motor impairments contributing to early functional decline in adults living with HIV-1 infection : a sub-study to the Cape Winelands HAART to HEART (Prevalence)/EndoAfrica study
(Stellenbosch : Stellenbosch University, 2019-04) Berner, Karina; Louw, Q. A.; Morris, L. D.; Baumeister, J.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Physiotherapy.
ENGLISH SUMMARY : Background: HIV-1 infection has become a chronic condition. Although people living with HIV-1 infection (PLHIV) now have near-normal life expectancies, walking-related impairments remain concerning as they occur early and may lead to falls. A poor understanding remains of how movement patterns are affected due to a lack of biomechanical studies. Three-dimensional (3D) motion analysis can provide insight into movement patterns and assist in identifying a valid performance-based screening test for detecting early motor impairments in PLHIV. Aim: The aim of this research was to investigate gait and balance impairments existing in PLHIV using 3D motion analysis. It further aimed to correlate 3D analysis findings (via a gait summary score), as well as self-reported function and history and fear of falling, to physical performance tests which may be considered in clinical practice to screen for early functional decline in PLHIV. Methods: The research was divided into three parts: Part I presented a systematic review describing objective gait and balance impairments in PLHIV. Results contributed to the theoretical groundwork for study conceptualisation and aided in selecting clinically relevant biomechanical outcomes and performance-based tests. Part II comprised validity and reliability testing of a portable 3D gait analysis (3DGA) system, newly obtained by the motion laboratory, in 16 healthy student volunteers, as well as in eight consecutively recruited PLHIV and eight community-matched seronegative participants (SNP). The studies determined the psychometric properties of specific 3DGA outcomes to aid appropriate data interpretation in the next phase. Part III comprised the main observational study to cross-sectionally describe key biomechanical characteristics in 50 PLHIV relative to 50 community-matched SNP (consecutively sampled). The study was conducted in a clinical setting, and performancebased tests were assessed in addition to the 3D motion analysis. Gait analysis results, fallrelated outcomes and self-reported function were correlated to clinical test performance to identify the most valid performance-based screening test. Main results: The systematic review (Part I) revealed some agreement that PLHIV walk slower and have increased centre of pressure (COP) excursions and postural reflex latencies, particularly under challenging conditions. No included studies used 3DGA. The validity and reliability studies (Part II) demonstrated that, with regular recalibration, the 3DGA system reliably measures gait biomechanics in SNP and PLHIV, except for four discrete angles. The system/model highly compares to the reference model after accounting for modelling differences. The field study (Part III) revealed that the gait of PLHIV (median age: 36.61 years) was significantly slowed and rigid relative to SNP (median age: 31.10 years). This pattern manifested when walking at a usual pace or when performing a dual task. Dual task walking further revealed joint range of motion (ROM) changes at the hip and knee in a distal-to-proximal pattern-shift. PLHIV also demonstrated increased COP excursion in dual task single-leg stance. PLHIV were significantly slower in completing the Five-Times Sit-To-Stand (5STS) Test. Slowed sit-tostand was significantly related to gait rigidity, worse self-reported function, and fear of falling. Conclusion: Relatively young PLHIV present with biomechanical gait and balance impairments that resemble patterns noted in elders, especially under dual task conditions. The 5STS test is recommended as a valid clinical screening test. These findings improve understanding of movement impairments in PLHIV and highlight the need for early screening. Further research is needed to determine whether the 5STS test predicts falls, and whether the impairments noted in PLHIV are reversible. Early identification and rehabilitation can reduce healthcare utilisation needs in PLHIV.
The biomechanical risk factors associated with preventing and managing iliotibial band syndrome in runners : a systematic review
(Stellenbosch : Stellenbosch University, 2015-04) Aderem, Jodi; Louw, Quinette; Stellenbosch University. Faculty of Health Sciences. Interdisciplinary Health Sciences. Physiotherapy.
ENGLISH ABSTRACT: Introduction: Iliotibial band syndrome (ITBS), an overuse injury, is the second most common running injury and the main cause of lateral knee pain in runners. Due to the increasing number of runners worldwide there has been an increase in its occurrence. Runners with ITBS typically experience symptoms just after heel strike at approximately 20°-30° of knee flexion (impingement zone) during the stance phase of running. A variety of intrinsic and extrinsic risk factors may be responsible for why some runners are more prone to developing symptoms during the impingement zone as opposed to others. Abnormalities in running biomechanics is an intrinsic risk factor which has been most extensively described in literature but little is known about its exact relationship to ITBS. Objectives: The purpose of this systematic review was to provide an up to date evidence synthesis of the biomechanical risk factors associated with ITBS. These risk factors may need to be considered in the prevention or management of ITBS in runners. A clinical algorithm is also presented. Methods: A systematic review with meta-analysis was conducted. An electronic search was performed in PubMed, PEDro, SPORTSDisc and Scopus of literature published up-until May 2014. Cross-sectional and cohort studies were eligible for inclusion if they evaluated the lower limb biomechanics of runners with ITBS or those who went onto developing it. All studies included in the review were methodologically appraised. Evidence was graded according to the level of evidence, consistency of evidence and the clinical impact. Data was described narratively using tables or narrative summaries where appropriate. A meta-analysis was conducted for biomechanical risk factors which were reported in at least two studies, provided that homogeneity in the outcomes and samples were present. Results: A total of 11 studies were included (1 prospective and 10 cross-sectional). Overall the methodological score of the studies was moderate. Increased peak hip adduction and knee internal rotation during the stance phase may predict the development of ITBS in female runners. These biomechanical risk factors may need to be screened for ITBS prevention, despite the evidence base being limited to a single study. Currently there is no conclusive evidence that any of the biomechanical parameters need to be considered when managing runners with ITBS. Stellenbosch University https://scholar.sun.ac.za iii Conclusion: Biomechanical differences may exist between runners with ITBS and those who may develop ITBS compared to healthy runners. Although a large variety of biomechanical risk factors were evaluated, the evidence base for screening or managing these risk factors for runners with ITBS is limited. This is due to a small evidence base, small clinical effect and heterogeneity between study outcomes and findings. Further prospective and cross-sectional research is required to ascertain if abnormalities in running biomechanics may be related to why runners develop ITBS or to ascertain which risk factors may be involved when managing these runners.
Cardiovascular disease risk factors among school attending adolescents in rural Nigeria
(Stellenbosch : Stellenbosch University, 2016-03) Oduniaya, Nse Ayooluwa; Louw, Quinette; Grimmer, Karen; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Physiotherapy.
ENGLISH ABSTRACT: Background: The prevalence of Cardiovascular Disease (CVD) is increasing in Nigeria, particularly hypertensive heart disease among the working class population. Unfortunately, resources for effective management of CVD at acute stage are sparse and expensive for the average Nigerian making preventive measure the best option for Nigeria. CVD risk factors have been identified in adolescents in many countries but information on CVD risk factors among Nigerian adolescents, especially rural adolescents, are sparse. This study aimed to develop culturally appropriate lifestyle CVD risk factors questionnaire for adolescents in Nigeria and to investigate CVD risk factors and its associates among 15-18 years school attending adolescents in rural Nigeria. Methods: The study was conducted in rural south west Nigeria, one of the six geopolitical zones of Nigeria. The people living in this area are Yoruba speaking population of Nigeria. The study was conducted in four phases. Phase 1: development of a composite lifestyle CVD risk factors questionnaire through systematic review, expert panel and target population. Phase 2: Cross cultural validation of composite measure developed to facilitate its use among rural adolescents. Phase 3: Pilot study to assess the logistics of the study and to test the reliability of the newly developed questionnaire. Phase 4: investigation into CVD risk factors among adolescents. CVD risk factors such as smoking, alcohol, Physical inactivity, and poor diet using the newly developed questionnaire were assessed. Blood pressure, BMI and waist hip ratio were also assessed using standardized protocol. Data was analyzed qualitatively and quantitatively. Content validation of the questionnaire was done qualitatively using expert consensus and adolescents’ feedback. Reliability was tested using ICC (Intraclass Correlation), Kappa and paired t test. CVD risk factors data was analyzed descriptively first, then with Pearson correlation and multiple regressions to determine associations among risk factors at 95% confidence interval (0.05 level of significance). Result: European countries showed high prevalence of smoking among adolescents in the systematic review. The prevalence of dyslipidemia ranged from 2.5% of total cholesterol (TC) in rural Iran adolescents to 48.9% high Triglyceride (TG) in rural Mexican adolescents. Overweight and obesity prevalence ranged from 0.6% prevalence in an age (10 y) of a study to 48.7%. Studies from the United States showed a decreasing trend in pre hypertension and hypertension, overweight and obesity. The newly developed composite lifestyle CVD risk factors questionnaire for adolescents had moderate to good reliability. Intraclass correlation (ICC) ranged from 0.3 - 0.7 and 0.3-0.8 in English and Yoruba versions’ subscales respectively. Kappa statistics showed moderate to strong agreement in priority questions in English and Yoruba versions. Investigation into the CVD risk factors showed high prevalence and clustering of CVD risk factors; 7.1% adolescents were smokers, 10.2% drank excessive alcohol, 27.9% had low physical activity level, 59.8% consumed high cholesterol diet, 6.1%, consumed low vegetable 8.1% consume low fruit 65.5% had high salt intake, 33.1% had pre hypertension ( systolic), 5.5% had pre hypertension (diastolic) 3.2% had hypertension (systolic) 0.8% had hypertension (diastolic). Smoking and drinking were significantly higher in males and physical activity was significantly higher in females. Smoking and drinking were significantly associated in both males and females and the odd of drinking and smoking was more elevated in girls. Systolic pre- hypertension was associated with age and high BMI in boys and was associated with only high BMI in girls. Conclusion: Nigerian rural adolescents are at risk of future adult CVD. There is an urgent need to put measures in place to prevent future epidemic of CVD in adulthood. CVD prevention program for boys and girls should be tailored to address gender specific CVD risk factors.
Cleft lip and palate feeding intervention : a scoping review
(Stellenbosch : Stellenbosch University, 2020-03) Brand, Bea-Mari; De Beer, Alida; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Speech Language and Hearing Therapy.
ENGLISH ABSTRACT : Background: Infants with cleft lip and palate (CLP) often suffer from feeding difficulties before surgical intervention. Speech therapists can provide different types of feeding intervention for this population. A scoping review was suggested to determine the evidence-based practice for feeding intervention in the CLP population. The research question for this scoping review was: What management strategies and associated outcomes are described in the research literature for feeding difficulties in the CLP population? Objectives: To summarize available literature on CLP feeding management strategies and their associated outcomes, as well as to identify gaps in the evidence base of feeding intervention in the CLP population. Methods: Arksey and O’Malley’s (2005) scoping review methodological framework was utilized and included all six stages of the framework. Inclusion criteria: Only articles published between 1990 and 2018 were included. The studies needed to be either published or translated into English or Afrikaans. The age range of the research participants was from newborn to six years of age. The primary diagnosis had to be cleft lip, cleft palate or CLP, which was not related to other syndromes. The articles had to include feeding intervention as well as an outcome for that intervention. Only primary research was included in this scoping review. Search strategy: The following Boolean search string was used to search through 5 databases: (“cleft lip and palate” OR “cleft lip” OR “cleft palate” OR craniofacial) AND (feeding OR swallowing OR breastfeeding OR dysphagia OR eating OR deglutition) AND (manage* OR rehabilitation OR treatment OR intervention OR therapy). Extraction of data: Screening measures first included the titles of the articles, then the abstracts, and finally, full-text reviews. The charting of the final selection of articles was grouped according to the following categories: title, authors, year of publication, location of the study, design, participants, timing of intervention, feeding intervention and associated outcomes. After the data was extracted from the articles, interviews were held with experienced speech therapists to determine their perceptions on the studied subject. Analysis of results: Thirty-one articles were included in this scoping review. The main feeding intervention themes included: caregiver training (43%), use of feeding utensils (40%), use of prostheses (14%) and alternative feeding (3%). The use of various modified bottles and teaching caregivers feeding strategies were some of the commonly reported strategies in the articles. Generally, positive outcomes were reported in the articles, such as weight gain. The interviewed speech therapists, however, prefer to use other interventions in their clinical practice compared to the feeding interventions reported in the research. Their clinical contexts had an influence on the type of feeding intervention prescribed for their patients. Conclusions: The results from the research and the perceptions of the therapists indicated a need for more evidence-based research within the South African and other low- and middle-income countries’ contexts, as most of the available research is from high-income countries. A recommendation for speech therapists in low- and middle-income countries is that they need to rely more on their clinical experience than the available research to provide evidence-based practice.
The communication experiences of young adult stroke survivors with stroke-related communication difficulties
(Stellenbosch : Stellenbosch University, 2024-03) Bester, Nena; De Beer, Alida; Bardien, Faeza; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Speech-Language and Hearing Therapy.
ENGLISH SUMMARY: Background: The rising incidence of stroke among young adults has led to a growing population of survivors experiencing communication difficulties. Existing research highlights their frustration and feelings of invisibility, indicating a lack of acknowledgement of their unique needs in rehabilitation. This study employs the International Classification of Functioning, Disability, and Health (ICF) as a holistic framework to explore the significant impact of stroke-related communication difficulties on young adults. Research aim: The aim was to describe the communication experiences of young adult stroke survivors with mild to moderate stroke-related communication difficulties who attended a public healthcare facility for speech-language therapy services in the Western Cape. The objective was to obtain information about the participants’ 1) communication experiences, 2) communication rehabilitation experiences, 3) communication needs and 4) areas to consider in their communication rehabilitation. Methods: The study employed a cross-sectional, descriptive phenomenological design. The sample of five young adults, who ranged in age from 26 to 49 years was selected through purposive homogeneous sampling from three different healthcare facilities. Males and females were included with various communication difficulties and comorbid stroke symptoms represented. An interview guide was used for data collection via semi-structured interviews. Thematic analysis based on descriptive phenomenology was used as the data analysis approach. Findings: The data analysis yielded five main themes describing the experiences of these five young adult with stroke-related communication difficulties. The first two themes emphasize emotions they experienced in relation to communication difficulties as well as adaptation to these difficulties, aligning with the holistic perspective of the ICF. The third theme addresses intrinsic factors to consider when addressing communication difficulties in this population, relating to the ICF’s focus on personal factors. Subthemes related to this theme include awareness of their communication difficulties, insight related to the impact of these difficulties, help-seeking behaviour, physical abilities, and alternative and augmentative communication (AAC). AAC emerged as a notable coping strategy, highlighting the multifaceted nature of personal factors influencing its successful implementation. Beyond personal aspects, three subthemes related to the environment shaped the participants’ experiences, aligning with the ICF’s consideration of environmental factors. These include the environment's impact on participation, communication partners’ needs, and their influence on the independence of young adults with stroke-related communication difficulties. Lastly, the research findings illustrate the need for speech-language therapists (SLTs) to integrate the principles of the ICF into their approach to management of young adult stroke survivors with stroke-related communication difficulties. Considering both personal and environmental factors in training, feedback, and support is vital for facilitating participation in communication for young adult stroke survivors with communication difficulties. Conclusion: By exploring emotional aspects, personal factors, environmental influences, and the contribution of SLTs, it is possible to develop more nuanced and personalised rehabilitation strategies for young adults with stroke-related communication difficulties. Aligned with the principles of the ICF, such strategies hold the potential to enhance the quality of life, communication, and communication rehabilitation experiences for young adults with stroke-related communication difficulties.
The communication needs of young and old cerebrovascular accident survivors
(Stellenbosch : Stellenbosch University, 2018-03) De Grass-Clementson, Jamie; De Beer, Alida; Bardien, Faeza; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Speech Language and Hearing Therapy.
ENGLISH SUMMARY : Cerebrovascular accidents (CVAs) are a growing epidemic in developing countries such as South Africa, resulting in an increase in CVA-related morbidity, which includes communication impairments. CVAs have traditionally been viewed as a disease of the elderly, but there is an increase in the prevalence of young CVA survivors. This quantitative descriptive cross-sectional research aimed to describe the communication needs of young and old CVA survivors in the following five communication areas: difficult communication situations, difficult communication skills, preferred communication strategies, preferred conversational topics and preferred literacy skills. The results obtained from the 62 participants (i.e. 22 young and 40 old CVA survivors) who completed the Aphasia Needs Assessment (Garrett & Beukelman, 2006) highlight that their personal and social communication needs have to be addressed before those that are environmental in nature. Furthermore, the findings suggest that difficult communication skills have to be identified before difficult communication situations and preferred topics can be addressed. Speech-language therapists working within the South African context are often confronted with challenges such as high unemployment, poverty, poor literacy levels and adverse circumstances, thus making the use of appropriate assessment criteria and management approaches challenging. Speech-language therapists are therefore recommended to identify CVA survivors’ unique barriers and facilitators to ensure appropriate intervention.

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