Masters Degrees (Occupational Therapy)

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    The effect of integration of the fear paralysis reflex on the occupational performance of children referred with handwriting problems
    (Stellenbosch : Stellenbosch University, 2024-03) Bence, Jenine; Sheik Ismail, Arifa; Plastow, Nicola Ann; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Occupational Therapy.
    ENGLISH SUMMARY: Background: Unintegrated primary reflexes and subsequent delayed cortical maturation leads to behavioural and learning problems in childhood and throughout the lifespan. Rhythmic Movements from Rhythmic Movement Training International (RMTi) significantly improved the integration of the Fear Paralysis reflex and lead to significant improvements in occupational performance of children. RMTi Rhythmic Movement Training is used by few occupational therapists in few countries. No evidence to demonstrate the effectiveness of the Fear Paralysis reflex integration nor research on the Fear Paralysis reflex per se were found. Method/design: This randomised clinical trial evaluated the change in occupational performance from the child’s perspective using the Canadian Occupational Performance Measure after 6 hours of RMTi Fear Paralysis reflex integration. A time series crossover with random allocation and delayed treatment period 2, and a pre- to post-study design, was used. Participants included 14 children aged 8-9 years referred with handwriting problems, attending four public schools in Cape Town, South Africa. Repeated Canadian Occupational Performance Measure assessment was at baseline test 1 and 2, mid-intervention test 3, two weeks post intervention test 4 and at 12 to 15 weeks post intervention test 5. Pre- and post-assessments included the RMTi and Masgutova Neuro-sensory-motor Reflex Integration® (MNRI®) Fear Paralysis reflex assessments, the Short Sensory Profile sensory processing, the Interactive Metronome® neuro-timing, and the Systematic Detection of Handwriting (SOS-2-EN) problems. Intervention included eight, weekly individual RMTi Fear Paralysis reflex integration sessions with an occupational therapist, and a carer led RMTi Home Support Fear Paralysis reflex programme 3 to 4 times per week. The caregivers were usually present during the assessment and intervention sessions. Those caregivers who could comply, experienced the 4 RMTi Home Support Fear Paralysis reflex integration movements before demonstrating these on their child. Findings: RMTi Fear Paralysis reflex intervention statistically significantly improved the Fear Paralysis reflex integration (p=0.003), sensory processing (p=0.025) and handwriting speed (p=0.001). Handwriting quality and neuro-timing did not improve. Within participant repeated measures analysis showed that the RMTi Fear Paralysis reflex intervention statistically significantly improved the occupational performance of participants, from the child’s perspective and from the caregivers’ perspective. Children statistically significantly improved in their performance (p=0.002) of a range of occupations that they identified as important and increased statistically significantly in satisfaction (p=0.01) with their performance. Similarly, the caregivers’ ratings of performance (p=0.007) and satisfaction (p=0.01) for occupational performance problems they observed in their children, also statistically significantly improved. Results were clinically and statistically significant. Discussion: All 14 participant children presented with an unintegrated Fear Paralysis reflex, lack of sensory integration, low levels of performance and satisfaction in daily activities, and poor handwriting, pre-intervention. Fear Paralysis reflex integration could shorten the therapy period needed to improve occupational performance including handwriting. Caregiver involvement in RMTi Home Support under guidance of therapists could promote parent empowerment in fostering development of their child.
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    The feasibility of occupational therapy visual art groups for children (8 – 12 years) with learning differences in a low-resource setting in the Western Cape, South Africa
    (Stellenbosch : Stellenbosch University, 2024-03) Conolly, Naomi Beth; Hoosain, Munira; Plastow, Nicola Ann; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Occupational Therapy.
    ENGLISH SUMMARY: Introduction: There has been a worldwide increase in the prevalence of learning differences, increasing the demand for feasible and effective services that support these children’s development and functioning. However, very few children have access to specialised individual interventions. Art is a well-known therapeutic medium that has the advantage of being adaptable to different clients, cultures, and settings, to develop prerequisite skills required for individual growth and participation in everyday life. Group interventions may be more feasible for low-resource settings regarding time, human resources, and costs. However, feasibility testing is needed before high-quality effectiveness evaluations can be recommended for art group programs in low-resource settings. Aim: To determine the feasibility of occupational therapy visual art groups for children aged 8 to 12 years with learning differences in a low-resource setting in the Western Cape, South Africa by 1) synthesising the available international research and 2) conducting a feasibility study. Methods and analysis: The systematic review was structured according to the PRISMA 2020 systematic review reporting guidelines, and registered on PROSPERO. Eight electronic databases were screened for eligible primary data sources, with no limiters. Two independent reviewers completed the title/ abstract and then full-text screening phases, using Rayyan software. The feasibility study used a case series design with convenience sampling to select eight participants (aged 8 to 12 years) with learning difference/s within a low-resource community in the Western Cape, South Africa. The SPIRIT guidelines for interventional trials were used to improve reporting. Participants attended eight weekly 45-minute visual art groups designed by the primary author. Feasibility was assessed in terms of demand, acceptability, and practicality through Likert-scale measures during caregiver interviews. Limited efficacy was evaluated using the Creative Participation Assessment (CPA), the Canadian Occupational Performance Measure (COPM) with caregivers, and the Child Occupational Self-Assessment (COSA) with participants. Results: All 20 articles included in the systematic review reported effectiveness outcomes, indicating decreased problem behaviours, and improved emotional well-being, social interaction, self-expression, cognitive and motor development, and caregiver attachment for children with learning differences. The heterogeneity of the data prevented a meta-analysis of effectiveness outcomes. Six articles reported feasibility criteria. Evidence synthesis led to the AR3T principles, which serve as a framework to guide the development of the art group intervention. The pilot study found the intervention was in demand, acceptable, and practical, and could be effectively implemented in the low-resource community selected for the study. The data also showed signs of limited efficacy, as participants made a clinically and statistically significant improvement in their level of creative participation (CPA) and occupational performance (COPM) from pre- to post-intervention. The COSA showed trends of improvement, especially for older children, but the results did not reach significance. Conclusion: Art group interventions have the potential to be a feasible and effective low-resource intervention that can be utilised to promote the development of children affected by learning differences. Further feasibility and effectiveness testing with larger sample sizes are required to refine the intervention and determine the extent of its therapeutic effect.
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    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.
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    Interpretive phenomenology on the meaning of substance use to Zimbabwean men with substance related disorders in recovery
    (Stellenbosch : Stellenbosch University, 2023-03) Mataswa, Enesia Zvikomborero; Van Niekerk, Lana; Chikwanha, Theodora Mildred; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Occupational Therapy.
    ENGLISH SUMMARY: Background: Substance use is an authentic part of the lived world of persons with substance related disorders. In Zimbabwe, reports indicate substance abuse to be rife, particularly amongst men. As many as 80% of persons with substance related disorders who were treated at mental health institutions in Zimbabwe between 2017-2019 relapsed within their first year of recovery. Although achieving sustained sobriety seems possible, the process of recovery is subjective and strategies used are contested. Substance use is a considerably under-researched phenomenon in the occupational therapy profession, particularly in Zimbabwe. Given that substance use constitutes engagement in occupation and that this phenomenon was yet to be explicitly explored, an occupational perspective was deemed necessary. Aim and objectives: The aim of this study was to explore how men with substance related disorders experience and make sense of substance use when in recovery. The study objectives were to explore how substance-use emerged as an occupation, how participants interpreted or made sense of substance-use experiences and how substance-use shaped participant’s identity and sense of belonging. Methods: Interpretive phenomenology was used to explore participants’ lived experiences of substance-use and the meaning they attributed to their experiences. Criterion sampling was used to purposively select persons with substance related disorders, admitted at a private mental health center in Zimbabwe. Three men with substance related disorders who were in recovery participated in this study. Data were collected by means of initial and subsequent follow up in-depth interviews. An inductive and iterative case-by-case analysis was used as means to respect individual idiosyncrasy. Findings: Two themes emerged. Theme 1, Getting “more” than I bargained for, was presented to illuminate nuances expressed under three sub-themes, namely what it’s like to use, what I get out of it and what I have lost. Theme 2, A shifting identity, was presented with four sub-themes, namely the unwanted self, projective identification, becoming the wanted self and being stuck. Theme 1 was presented in Section B and discussed, Theme 2 was presented in Section C as additional findings and will be discussed in the future. Conclusion: Reflection on negative consequences of substance-use might shift motivation towards sobriety, however, continuing use and stopping use both present losses. Exploring how people interpret their experiences of unhealthy occupations provided a dualistic way of looking at recovery. Honouring humanistic values, client-centredness and practicing critical consciousness are essential considerations in services to support recovery.
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    Rehabilitation following flexor tendon injury to the hand in African countries : a scoping review
    (Stellenbosch : Stellenbosch University, 2022-12) Marume, Martin; de Klerk, Susan; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Occupational Therapy.
    ENGLISH SUMMARY: Objective: To explore and ascertain the types of flexor tendon rehabilitation protocols, feasibility and outcomes following implementation in African countries. Design: This scoping review used Arksey and O’Malley’s methodological framework and the Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews guidelines. Data sources: A search was conducted via Cochrane library, PubMed, Science direct, CINAHL-EBSCOhost, Sabinet online platform (Sabinet African Journal and African Journal Archive), Wiley online, Academic search premier, Google scholar, Africa wide information and Universities repositories between 1 June 2021 and 31 July 2021.The search string included the following terms; flexor tendon injury, hand injury, finger injury, hand function, rehabilitation, occupational therapy, physiotherapy, mobilisation and Africa. Eligibility criteria: All language versions from African countries, manuscripts published from 1960 up to 31 July 2021, literature on zone II-V of human hand flexor tendon injury inclusive of nerve and other additional injuries, including participants who are ten years and older were considered. Manuscripts were included if they reported on flexor tendon rehabilitation protocols and outcomes (body function and structure, and activity and participation). Data extraction and synthesis: Mendeley was used to manage identified references. Three reviewers used Covidence for title, abstract and full-text screening. Microsoft Excel and WeftQDA was used for data extraction, descriptive numerical summary and qualitative content analysis respectively. Themes and categories were developed to answer the research question. Results: 53 manuscripts were identified and their title, abstract and full text reviewed. 13 manuscripts from four countries (South Africa, Egypt, Zambia and Morocco) qualified for inclusion. The Kessler knot 4 is the surgery most practised in the African continent. The early passive mobilisation is the protocol of choice and therapists consider mostly body function and structure during outcome measurement with particular attention to range of motion. The Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire, Jebsen-Taylor Hand Function Test (JTTHF) and Michigan Hand Outcomes Questionnaire (MHQ) were used to assess functional outcomes in Africa. Despite inconsistency in rehabilitation process, outcome measurement and reporting, generally, outcomes were poor in body function and structure, and activity and participation. Several factors were identified to impact outcomes, including adhesions, infection, expertise of the surgeons and rehabilitation personal and limited resources. Conclusion: There is inconsistency in the rehabilitation, measurement and outcomes following flexor tendon injury in the African context. Despite limited information from the included manuscripts, it can be ascertained that the management procedures are yielding poor results and several contextual factors influenced the attained results. Recommendations include conscientising the health care team, involved stakeholders and education facilities to conduct more research to inform good practice and better results for patients on the African continent.