Masters Degrees (Speech-Language and Hearing Therapy)

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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.
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.
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.
'n Beskrywing van ouers, onderwyseresse, spraak-taalterapeute en oudioloë se persepsies oor die uitkomstes van 'n ouditief-verbale benadering tot opvoeding by jong kinders met 'n gehoorverlies
(Stellenbosch : University of Stellenbosch, 2011-03) Coetzer, Tarien; Gerber, Berna; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Speech-Language and Hearing Therapy.
ENGLISH ABSTRACT: Various approaches to the communication-development of the young child with a hearing impairment exist, of which the auditory-verbal approach is one. This approach is based on the principle that the child with a hearingimpairment develops speech- and language skills by using his/her residual hearing that is appropriately strengthened with the use of a hearing aid and/or cochlear implant. One of the most important requirements for the successful application of this approach is the appropriate transfer of the techniques and strategies that is used in institution-based intervention to the child’s home environment. Parents, teachers, speech-language therapists and audiologists are responsible for facilitating the transfer of intervention methods and acquired skills to the home environment and it is important that all team members are aware of his/her own, as well as each other’s roles, in the application of this approach. The principal aim of the proposed research project was to describe and explain the perceptions of parents/caregivers, teachers, speech-language therapists and audiologists, that are involved in the intervention of the hearing impaired child, regarding the auditory-verbal approach to education. Semi-structured interviews were conducted with nine parents of hearing impaired children younger than the age of four, and with four teachers that are involved in the education of the said children. Lastly, semi-structured interviews were held with four speech-language therapists and two audiologists that are involved in the provision of the intervention to hearing impaired children younger than four years. All the participants were affiliated with a specific centre for children with hearing impairment in the Western Cape province of South Africa. All the participants noted that parents must take part in the decision-making process with regards to the selection of the most suitable communication approach for their child with a hearing loss. Participants also agreed that most parents choose the auditory-verbal approach to communication development of their child because speech as a communication medium, is familiar to them and it is also associated with normality. Parents also indicated that the auditory-verbal approach is the most suitable approach for all children with a hearing loss. Teachers, speech-language therapists and audiologists did not completely agree with the parents as they mentioned some aspects, e.g. the presence of additional disabilities must be taken into account before a decision can be made regarding whether the child with hearing loss could follow the auditory-verbal approach to communication development. All participants displayed a positive attitude towards the auditory-verbal approach and it appears that parents, teachers, speech-language therapists and audiologists have good insight into the principles and outcomes of this approach.
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 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.
Communication, cognitive functioning, and feeding and swallowing information needs of caregivers of individuals diagnosed with alzheimer’s disease within a support group setting
(Stellenbosch : Stellenbosch University, 2022-04) Le Roux, Carla; De Beer, Alida; Bardien, Faeza; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Speech-Language and Hearing Therapy.
ENGLISH SUMMARY: Background: The number of individuals with Alzheimer’s disease will rise significantly in the coming years. This is a concern as Alzheimer’s disease affects numerous functions within the scope of the speech-language therapist. However, due to the limited number of speech-language therapists in South Africa, individual speech and language therapy is not a viable option. Support groups may be a more optimal way of providing speech and language therapy service-related information. Objectives: The study aimed to determine the speech therapy-related information needs of caregivers of individuals with Alzheimer’s disease, as well as their preferred support group structure. The study further aimed to describe common speech and language therapy-related points of discussion at support groups and the current structure of support groups in the Western Cape. Method: A convergent parallel mixed method research design was used, and qualitative and quantitative data were collected simultaneously. Semi-structured interviews were conducted with caregivers of individuals with Alzheimer’s disease, whilst an online survey was used to collect data from support group facilitators. Results: The results indicated that caregivers had both directly stated, as well as indirectly stated information and support needs. Caregivers had more directly stated information and support needs about cognitive functioning than communication or feeding and swallowing. Their information and support needs were influenced by the current level of functioning of the individual with AD, caregivers’ perceptions about the features of AD and their management, as well as acceptance of these difficulties. Caregivers did, however, have more indirectly stated information needs about communication as well as feeding and swallowing. There were also discrepancies identified between caregivers’ support group structure preferences and the current support group structure in the Western Cape. Conclusion: The factors driving caregivers’ information and support needs guide the information provided at support groups. As much information and support needs are indirectly stated, these needs may likely not be expressed in support groups. Subsequently, caregivers’ knowledge about these areas of difficulty may remain limited. This may negatively affect caregiver understanding-and management of these difficulties. Furthermore, accessibility of support groups may be negatively impacted by the discrepancies between caregiver preferences and current support group structure.
Compulsory community service for speech-language and hearing therapy professionals : readiness, reality and readjustment
(Stellenbosch : University of Stellenbosch, 2011-03) Wranz, Elsie Sophia; Klop, Daleen; Bezuidenhout, Juanita; University of Stellenbosch. Faculty of Health Sciences. Centre for Health Sciences Education. Speech-Language and Hearing Therapy.
ENGLISH ABSTRACT: Compulsory Community Service for the speech-language and hearing therapy profession was implemented in 2003. This is the first study to assess the perceptions, attitudes and experiences of speech-language and hearing professionals of Stellenbosch University doing Compulsory Community Service. Information on the experiences of Compulsory Community Service professionals inform on the responsibilities of the university where undergraduate studies are completed, the Department of Health (the employer) and professionals doing Community Service. A mixed method study design, using a scale questionnaire, supplemented by open-ended questions was completed by all but one of the group doing Compulsory Community Service in 2009. Results suggested that speechlanguage and hearing therapists perceived themselves to have the required knowledge, but not necessarily adequate skills to perform Compulsory Community Service. Suggestions to include additional curriculum content were made. All professionals agreed that a positive contribution was made during Compulsory Community Service, but concerns about the shortage of speech-language and hearing therapy services, absence of mentors and supervision, inadequate budgets, amenities and resources were identified. Readjustment must involve adaptation from all stakeholders to ensure that Compulsory Community Service honours its original objectives.
A description and analysis of the organisational capacity of the rehabilitation services at TC Newman Community Day Centere
(Stellenbosch : Stellenbosch University, 2014-04) Liebenberg, Handri; Visagie, Surona; Mji, Gubela; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Scienes. Centre For Rehabilitation Studies.
ENGLISH ABSTRACT: Rehabilitation services, mainly rendered by therapists employed by the Department of Health, forms a critical part of the Primary Health Care (PHC) package of care. Different policies, within the Department of Health (DOH), provide guidance on rehabilitation service delivery. However, implementation of these policies remains a challenge. The current study aimed to describe and analyse the organisational capacity of rehabilitation services at the study site and to assess how congruent the rehabilitation service at the study site was with existing rehabilitation policy. A descriptive methodology was applied making use of both quantitative and qualitative methods in analyzing the organisational capacity of this study site and the alignment of rehabilitation services offered, with the National Rehabilitation Policy (NRP). The study used the Kaplan framework, the objectives of the NRP and specific selected articles of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) to develop indicators to be used for the description and analysis of the organisational capacity of the rehabilitation services at TC Newman Community Day Centre. Questionnaires based on seven objectives from the NRP were developed to collect quantitative data from five service providers, the facility manager of TC Newman CDC and the managers of two Non- Governmental Organisations (NGO) working in the drainage site. Face to face, audio recorded, semi- structured interviews were used to collect qualitative data from the five service providers. A folder audit and document review was used to enhance quantitative findings. After analysis of the data, I still felt the need for additional information and thus developed an open ended questionnaire for participants to complete. Barriers (e.g. defaulting of clients, a lack of standard documentation, poor monitoring and evaluation) and facilitators (e.g. outreach and support, competent staff and multi-disciplinary team) were identified in implementing the NRP. Participants highlighted the importance of accessing rehabilitation services with a focus on the outreach to peripheral clinics and funded NGO’s. Intersectoral collaboration is evident, but mainly with funded NGO’s. A lack of standardised documentation, inadequate monitoring and evaluation systems and uniformed documentation were some of the challenges identified by participants. The absence of participation by persons with disabilities was noted by all participants. With reference to the organisational capacity, the participants had a good understanding of rehabilitation within the PHC context. Participants felt confident in delivering rehabilitation services and were able to identify shortcomings in service delivery. It is concluded that rehabilitation services are not delivered exactly in accordance with the objectives of the NRP. However the organisation demonstrated capacity to deliver rehabilitation services at PHC level, but there is still a need to enhance service delivery on community based level. The results of this study gave me as a manager and implementer of health policy in the District Health System the opportunity to gain deeper insight as to how rehabilitation services are currently rendered. Results from the study highlighted how coherent rehabilitation service delivery is with current policy in health and the capacity of the organisation to deliver rehabilitation services. This gave me the opportunity to adjust and review current rehabilitation service delivery and implement changes, as the study progressed.
Description and evaluation of the rehabilitation programme for persons with lower limb amputations at Elangeni, Paarl, South Africa
(Stellenbosch : Stellenbosch University, 2012-03) Fredericks, Jerome P.; Visagie, Surona; Gcaza, Siphokazi; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Speech-Language and Hearing Therapy. Centre for Rehabilitation Studies.
ENGLISH ABSTRACT: Lower limb amputations cause multiple physical, psychological, environmental and socioeconomic barriers. Individuals who have suffered a lower limb amputation require comprehensive rehabilitation to ensure social integration and economic self-sufficiency. In addition, constant monitoring and evaluation is an essential part of human service delivery programmes. However, the amputation rehabilitation programme offered at Elangeni an outpatient rehabilitation centre for clients with physical disabilities in Paarl, Western Cape, South Africa is not monitored, and has not been evaluated since its inception in 2000. Thus, the current study evolved to describe and evaluate the rehabilitation programme for persons with lower limb amputations at Elangeni. A mixed method descriptive design was implemented. All persons who received rehabilitation, after a major lower limb amputation at Elangeni, between 2000 to 2011, were included in the study population. In addition, the physiotherapist and occupational therapist that provided amputation rehabilitation at Elangeni, at the time of the study, were interviewed. Thirty participants who met the study inclusion criteria were identified. Quantitative data was collected using a researcher designed, structured demographic questionnaire, an International Classification of Function checklist based questionnaire and a participant rehabilitation folder audit form. Two interview schedules one for clients and one for therapists were used for guidance during semi structured interviews. Quantitative data was entered onto a spread sheet and analysed by a statistician using Statistica, version 8. Qualitative data was thematically analysed according to predetermined themes. No programme vision, mission or objectives could be identified for the amputation rehabilitation programme. Poor record keeping practices and a lack of statistics were found. Rehabilitation was impairment focused with no attention given to social integration. Clients who received prosthetic rehabilitation showed improved functional ability with regard to picking up objects from the floor (p = 0.031) getting up from the floor (p = 0.00069), getting out of the house (p = 0.023), going up and down stairs with a handrail (p = 0.037) and moving around in the yard (p = 0.0069), climbing stairs without a handrail (p = 0.037), going up and down a kerb (p = 0.0082) walking or propelling a wheelchair more than 1km (0.0089) and walking in inclement weather (0.017). A lack of indoor mobility training had a statistically significant negative impact on the participants’ ability to lift and carry objects (p 0.011), standing up from sitting (p = 0.042), getting around inside the house (p = 0.00023), picking up objects from the floor (p = 0.00068), getting up from the floor (p = 0.0072), getting out of the house (p = 0.0016), going up and down stairs with a handrail (p = 0.019), moving around in the yard (0.0013), going up and down stairs with-out a hand-rail (p = 0.019), getting up and down a kerb (p = 0.0022), walking or wheeling 1km or more (p = 0.0032) and using transport (p = 0.0034). Failure to address community mobility during rehabilitation had a statistically significant negative impact on all aspects of community mobility scores except doing transfers and driving. In conclusion, for the study participants, Elangeni failed to provide rehabilitation according to the social model of disability and Community Based Rehabilitation principles. It is recommended that managers, service providers, and clients re-consider the purpose of Elangeni and develop a vision and objectives for that service. In addition, management should take an active role in service monitoring and evaluation and provide guidance and mentorship to therapists.
A descriptive study on doctors' practices regarding different aspects of stroke rehabilitation in private acute-care hospitals situated in the Western Cape metropole
(Stellenbosch : Stellenbosch University, 2009-12) Leichtfuss, Ute; Visagie, Surona; Mji, Gubela; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Speech-Language and Hearing Therapy. Centre for Rehabilitation Studies.
ENGLISH ABSTRACT: Introduction: Stroke is a growing healthcare problem in South Africa. It contributes significantly to the burden of disease and is the largest cause of disability. Rehabilitation can significantly improve recovery and outcomes of stroke survivors particularly if implemented in the correct manner and through using certain approaches. The aim of this study was to examine the practice of doctors with regards to stroke rehabilitation in private acute-care hospitals in the Western Cape Metropole. In particular, attention has been given to the degree to which doctors in the private health care sector shared information with first time stroke patients. The study design was retrospective and descriptive in nature. Data collection was primarily of a quantitative nature although some qualitative data has been collected to elaborate on quantitative findings. Two self-designed questionnaires were used to collect data. Data from doctor-participants were collected to examine the use of care protocols. Data from both groups of participants were collected to determine which practices were prefered. In particular it was sought to ascertain what team work approach was favoured by doctors. To do this the method of communication among team members was examined. It was also sought to ascertain how information regarding diagnosis, prognosis, risk factors, post–acute rehabilitation options and discharge planning was shared. In total thirty-five doctors and forty-eight patients were interviewed. Quantitative data was captured on an excel spreadsheet and analysed with the help of a STATISTICA software package. A p value of less than 0.05 was deemed statistically significant. Results showed that none of the doctor participants had any formal rehabilitation qualification. It was found that stroke care protocols were used by 46% of doctor participants, while 89% acknowledged the advantages of a set protocol. The majority of doctors (57%) operated as part of a multidisciplinary team. Communication between team members regarding the patient’s management plan was done on a very informal basis with only 11% of doctors using ward rounds and none using team meetings for this purpose. Opinions differed between the two study groups on the frequency of information sessions (p = .00039). Only six % of doctors included the patient and family in the rehabilitation team. A large discrepancy was seen when it came to opinions on sharing information regarding diagnosis, prognosis, stroke risk factors, post-acute rehabilitation and discharge planning. P values ranging from 0.00013 to 0.0041 showed that the difference between the opinions of patients and doctors on these issues was statistically significant. Opinions also differed between the two groups when the frequency of information sessions was compared (p = 0.00039). Only 28% of patient participants were included in the decisionmaking process regarding further post-acute rehabilitation and in most cases the final decision was made by the doctor or the medical insurance company. Qualitative data highlighted some patients’ dissatisfaction regarding the post-acute rehabilitation process and indicated a problem with regard to the recognition of early stroke warning signs by general practitioners and the emergency treatment of these. The conclusion was that there is a great need for further motivation and education of doctors with respect to advanced research projects, further specialisation as well as the implementation of important rehabilitation modalities. It is also important that the patient himself acts as a fully-fledged team member. Recommendations were that administrators in both, the private and public health care sectors as well as non-government organisations and government welfare organisations identify the reasons for doctors’ hesitation to implement existing knowledge; that they make stroke rehabilitation training available and that they ensure that doctors implement the existing and new knowledge on all aspects of acute and post-acute stroke rehabilitation i.e. use of set care protocols, team work approach and sharing information on diagnosis, prognosis, risk factors, post–acute rehabilitation options and discharge planning when managing stroke patients. It was also recommended to promote more research projects which are implemented in the private health care sector.
Developing a policy analysis framework to establish level of access and equity embedded in South African health policies for people with disabilities
(Stellenbosch : Stellenbosch University, 2008-12) Law, Francoise Bernadette; Schneider, M.; Gcaza, S.; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Speech-Language and Hearing Therapy. Centre for Rehabilitation Studies.
Purpose To date no health policy analysis tool has been developed to analyse access and equity for people with disabilities. Further, there is very little information available on health and disability policy implementation. The intention of this research is to develop a health policy framework to analyse access and equity, focussing on people with disabilities, that can be used by policy makers. This research analyses four health policies and focuses on the facilitators and the implementation barriers. The findings of this research will impact on new policies developed in the future. Method The study included both a desk - top review and a descriptive study. The desk - top review entailed the formulation of a disability - focussed framework for health policy. This was then used to analyse health policies in terms of their disability inclusiveness. Qualitative data was gathered from interviews and questionnaires and focussed on policy processes and implementation. This was incorporated into the analysis. An ideal seven - step policy process model was developed. This was used to compare the reported policy process with the four policies followed. The four health policies used in the research are: the Primary Health Care Policy, the National Rehabilitation Policy, the Provision of Assistive Devices Guidelines and the Free Health Care Policy. Four key informants with extensive experience and knowledge were interviewed on policy processes and implementation. Questionnaires were also sent to Provincial Rehabilitation Managers to obtain their viewpoints on barriers and facilitators to policy implementation. Results Analysis of the four health policies showed varying levels of access and equity features. In terms of policy processes: all four policies had different stakeholders who initiated the policy development process. Two of the policies viz. the National Rehabilitation Policy and the Provision of Assistive Devices Guidelines, had people with disabilities as part of the stakeholder group involved in the policy formulation. The National Rehabilitation Policy had a comprehensive monitoring and evaluation section whereas this was absent in the other three policies. From the information gained from interviews and questionnaires, it appeared that the barriers to policy implementation included: attitudes, environmental access, human and financial resources. Facilitators to policy implementation include: policy process and design, availability of human and financial resources, support systems, management support, organisational structures and finally positive attitudes that all impacted favourably on policy implementation. Conclusions The developed health policy analysis framework served its purpose. Most policies did not have monitoring and evaluation guidelines that make implementation difficult to assess. Recommendations are made to improve policy design and content, specifically related to access and equity. Intersectoral collaboration and disability coordination needs to be improved. People with disabilities also need to engage with government departments, to monitor implemented policies and to advocate for change from outside the health system.
Development of an Afrikaans sentence perception test based on the CUNY topic-related sentences – phase 1 : sentence perception in noise
(Stellenbosch : University of Stellenbosch, 2011-03) Scourfield, Jolanda; Tuomi, Seppo Kalervo; Muller, Alida Maria Uys; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Speech-Language and Hearing Therapy.
ENGLISH ABSTRACT: Speech audiometry for diagnostic purposes is widely used by audiologists around the world, but its application is starting to shift more towards rehabilitative purposes for people with hearing impairment. This has created the need for the development of appropriate test materials, including speech-in-noise tests, in the first language of the person undergoing rehabilitation. This document describes a study entailing the first phase in the development of an Afrikaans sentence perception test in noise based on the City University of New York (CUNY) topic-related sentences (Boothroyd, Hanin & Hnath, 1985). The test is called Sinslyste in Afrikaans vir Volwassenes in Lawaai [Sentence lists in Afrikaans for Adults in Noise] (SAV-L). Twenty-seven sentence lists containing 12 sentences each were compiled and evaluated by eight speakers of Afrikaans for their naturalness before they were recorded together with three-talker babble as masking noise. The recorded material was then presented to six groups of ten participants each (with the exception of nine participants in one of the rounds) and adjusted in intensity to improve inter-list reliability. Two scorers were used at intervals to determine inter-rater reliability. Test conditions were also replicated after an interval of six months or more to establish test-retest reliability. In a last round of testing, the test was administered at the intended presentation level to assess the appropriateness of the chosen level. Through adjustment of list intensities, inter-list reliability was improved to a 13.87% variance between list scores. Test-retest reliability showed a bias with an intra-class correlation agreement of 0.859. This was thought to be due to participants’ improved familiarity with the clinical environment over time, however longer term measures of test-retest reliability remains to be done. Inter-rater reliability was very high with an intra-class agreement of 0.999. The intended test level of 50dBHL with a signal-to-noise (SNR) ratio of +5dB, was found to be an acceptable fixed SNR. The test can be used in its current form for assessment of amplification candidacy as well as monitoring of progress during rehabilitation. Further research is indicated for the establishment of the sensitivity of the test. It is concluded that just as a clinician is expected to select the most suitable diagnostic test based on the patient’s history, signs and symptoms, so should the audiologist be expected to select the most appropriate rehabilitative measure based on the patient’s communication needs and established treatment goals. The SAV-L is a valuable contribution to the pool of speech perception tests available as rehabilitative measures, and is specifically suitable for adults with well-developed spoken language.
Disability profiles and needs of disability grant recipients in Kleinmond, Western Cape, South Africa / Annette Freig.
(Stellenbosch : Stellenbosch University, 2000-12) Frieg, Annette; Hendry, J. A.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Rehabilitation.
ENGLISH ABSTRACT: The South African National Census (1996) reports a disability prevalence of 6,6% in South Africa. In November 1999 the government paid out 635 881 temporary or permanent disability grants. Legislation is in place to allow the Department of Social Services to administer the grants. For this study demographic information of disability grant recipients in a semi-rural area was sought in order to improve understanding of disability and to assist in service delivery. The study was executed in Kleinmond, a coastal town in the Western Cape with a population of 3 918, where 189 people reported a disability during the 1996 census. Objective The objective of this study was to determine the disability profile, caregiver utilization and needs of disability grant recipients in Kleinmond, Western Cape, South Africa. METHODS A descriptive survey was the study design of choice. The study population consisted of recipients of a permanent disability grant who collected their grants at the Kleinmond Post Office in June 1999. In order to capture the necessary information, a questionnaire was developed based on the disability catalogue of the International Classification of Impairment, Disability and Handicap (ICIDH) of the World Health Organisation. Pilot studies were conducted and the researcher interviewed 29 grantees during the main study in Kleinmond in June/July 1999. Repeatability of the questionnaire was tested. Ninety six percent of the responses were the same on the second visit to four randomly selected grantees. Data was analysed with the statistical software package STATISTICA. RESULTS The response rate was 90% (29/32). The mean age of the mainly male grantees was 42 years (range: 18 - 64). Most grantees were single, but the majority stayed with someone else. Ninety three percent (27/29) were unemployed while 69% (20/29) felt they were able to work. Most grantees took regular medication and the majority accessed health services at the primary level local clinic. Twenty five grantees (86%or 25/29) reported multiple disabilities, while one person did not fit into any of the categories. The most common disability category was situational disability (82% or 24/29). Nineteen persons with disabilities (66% or 19/29) relied on help which was mainly given by the parents. Assistance was needed with activities such as collecting the disability grant, shopping and managing money. With regard to needs of grantees, most found it important to have the clinic closer to their homes (52% or 15/29), to increase the amount of the disability grant (76% or 22/29) and to raise awareness of disability in the community (69% or 20/29). CONCLUSION Most disability grant recipients in this study reported problems in many of the seven disability categories of the ICIDH, i.e. multiple disabilities. This is consistent with the assumption that only severely disabled people qualify for a permanent disability grant in South Africa. This might explain why the majority of the grantees utilized a caregiver for some tasks. Needs with regard to health and social services of this defined group of persons with disabilities in Kleinmond will be brought to the attention of the authorities, who are planning a new community centre and clinic.
The effect of audio recorded stories on novel word acquisition by children using a non-standard dialect of English
(Stellenbosch : Stellenbosch University, 2017-03) More, Katherine; Klop, Daleen; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Speech Language and Hearing Therapy.
ENGLISH SUMMARY : Purpose: This study investigated young children’s acquisition of novel words presented within audio recorded stories and their ability to understand and use these novel words. Method: Participants were 20 bilingual mainstream Grade R children. They were exposed to two audiotaped stories containing eight target words each. Pre- and post - test scores were compared to a control group condition and analysed using the Wilcoxon Signed Rank test. Results: Results indicated that receptive vocabulary acquisition and the ability to apply the target words in sentences improved after exposure to the stories. The ability to provide definitions of these words did not significantly improve. Conclusions: Listening to story tapes can facilitate receptive vocabulary acquisition.
The effect of different visual modality and task conditions on the narratives of typically developing 9 year old children
(Stellenbosch : University of Stellenbosch, 2011-03) Engelbrecht, Lizanne; Klop, Daleen; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Speech-Language and Hearing Therapy.
ENGLISH ABSTRACT: This study investigated: (1) the effect of two visual modalities (wordless picture book and animated video) on the narratives of typically developing 9 year old children, and (2) the effect of dynamic assessment on the quality of narratives in both visual modalities. Twenty nine typically developing children between the ages of 8 years 5 months, and 9 years 4 months were selected from a higher socio-economic population. Participants were exposed to a wordless picture book and an animated video. Participants’ narrative performance was measured in terms of micro- and macro-structure variables in each visual modality, and before and after dynamic assessment in each visual modality. Micro-structure variables included productivity (total number of words, total number of T-units), syntactic complexity (mean length of T-unit) and lexical diversity measures (total number of different words). Macrostructure variables included goal-attempt-outcome (GAO) sequences, and inclusion of GAO elements (goal, attempt or outcome). Results indicated that: (i) both visual modalities elicited narratives of similar quality in terms of micro- and macro-structure variables, and (ii) participants’ narratives improved after dynamic assessment.
Die effek van twee gedeelde voorlees metodes op die drukbewustheid van 'n groep graad R-leerders
(Stellenbosch : Stellenbosch University, 2008-12) Botha, Mariette; Klop, Daleen; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Speech-Language and Hearing Therapy.
The study investigated the effect of two shared reading programmes on the print awareness of 102 Afrikaans-speaking Grade R learners with language delays. The first shared reading programme focussed on print awareness while the second shared reading programme focussed on content and observable entities. Participants’ print awareness was measured subjectively and objectively, before and after intervention programmes. Results indicated that (i) both methods of shared reading affected and improved the print awareness of the participants; (ii) the participants’ print awareness did not improve optimally in order to acquire reading skills in Grade 1, even after taking part in the 10 week shared reading programme with a focus on print awareness; (iii) participants performed better in an evaluation where demonstration of skills and no verbal response was required; and (iv) participants with poor receptive vocabulary skills demonstrated limited carry-over of print awareness to other artefacts of print, such as the packaging of an iron.
Die effek van twee gedeeldeleesintervensieprogramme op die narratiewe van voorskoolse kinders
(Stellenbosch : University of Stellenbosch, 2011-03) Visser, Monique; Klop, Daleen; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences.
ENGLISH ABSTRACT: This study investigated the effect of two shared-reading intervention programmes on the narratives of 87 Afrikaans-speaking Grade R learners from low income families. Intervention Programme I involved an interactive style where participants were encouraged to engage spontaneously in conversations about the characters’ intentions and goals, to make inferences and to ask questions. Intervention Programme II focused on observable entities and the content of the storybooks. Participants’ narratives were compared before and after intervention in terms of productivity, content and structure. Results indicated that (i) both methods of shared-reading improved the participants’ narratives in terms of productivity, number of different words, and the efficiency of references; (ii) only Intervention Programme I improved the participants’ narratives in terms of the percentage meta-verbs, number of key elements and Goal-Attempt-Outcome sequences included. Clinical implications and recommendations for future research are discussed.
Employment of people with disabilites in the hospitality sector, Cape Town, South Africa : a multiple case study
(Stellenbosch : Stellenbosch University, 2012-03) Smit, Shannon; Gcaza, C. Siphokazi; Visagie, Surona; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Speech-Language and Hearing Therapy. Centre for Rehabilitation Studies.
ENGLISH ABSTRACT: Several legislative documents that promote the inclusion and economic integration of persons with disabilities have been introduced over the previous two decades in South Africa. However, it is still estimated that as many as 99% of persons with disabilities are unemployed (Dube, 2005). Employment equity quotas for persons with disabilities have not been met in either the public or the private sector (CEE Report, 2007).The reasons for this remain largely unexplored in many sectors including the hospitality sector. The hospitality sector - the focus of this study - makes a significant economic contribution to the country and is the largest most diverse labour force sector in South Africa (THETA, 2009). The aim of the study is to examine the employment of persons with disabilities in three hotels in the Victoria and Alfred Waterfront, Cape Town. A descriptive, qualitative case study methodology was implemented for the study. Three purposively sampled hotels in Cape Town`s Victoria and Alfred Waterfront provided the study setting. Participants included managers from these hotels as well as employees with and without disabilities from each of the hotels. Data was collected through semi-structured interviews and content analysis was conducted to identify emerging issues according to themes. Findings indicate a medically oriented perception of disability with a focus on physical impairments. A lack of knowledge and guidance in policy documents and from the Department of Labour perpetuate these perceptions. Participants were aware of employment equity policy, but saw it as being orientated to race and gender and did not apply it to persons with disabilities. Application was also not enforced through monitoring by the Department of Labour. Barriers to employment include discrimination and stereotyping, the physical nature and type of jobs, physical access barriers, a lack of education and skills as well as a lack of applications from persons with disabilities. Facilitators included improved Black Economic Empowerment scoring, a motivational aspect, the variety of jobs available and guests and employees with disabilities. Findings on the provision of reasonable accommodation focused mainly on the accommodation of guests and examined physical and structural aspects of the environment. One of the conclusions of the study was that legislation governing the employment of persons with disabilities was poorly implemented in the hotels examined by this study. It is recommended that hotels contract a disability consultant to run disability awareness campaigns within the hotels. In addition, the Department of Labour must monitor policy implementation with regard to persons with disabilities. Disabled people`s organisations should create a platform for communication with government departments responsible for social policy and legislation in an effort to promote and encourage the debate on disability definitions and to act as a watchdog over the implementation of policy.
Evaluation of the rehabilitation program for persons with complete paraplegia at Netcare rehabilitation hospital
(Stellenbosch : University of Stellenbosch, 2009-12) Henn, M. J.; Mji, Gubela; Visagie, Surona; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Speech-Language and Hearing Therapy
ENGLISH ABSTRACT: Spinal cord injury is a devastating sudden cause of disability which renders a person paralyzed and dependent on care immediately after the incident. A person who has suffered a spinal cord injury requires an intensive rehabilitation program to achieve physical independence as well as reintegration into the community. The aim of this study was to evaluate the rehabilitation program for patients with complete paraplegia at the Netcare Rehabilitation Hospital, a 120 bed private rehabilitation facility in Johannesburg, where rehabilitation for patients with physical disabilities is offered by an interdisciplinary team. The rehabilitation program was evaluated in terms of effectiveness including the degree of physical independence the patients achieved and how well the program prepared patients for successful integration into the community. The Functional Independence Measure (FIM), a standardized outcome measure that measures certain physical and cognitive functions and the Needs Assessment Checklist (NAC), an instrument designed to assess if the rehabilitation program is geared towards the patients’ individual needs were used as outcome measure. FIM scores were determined on admission and discharge and NAC scores were determined at discharge. A convenient, consecutive sample of sixteen patients with complete paraplegia (ASIA A), with a neurological level between T1 and T12, formed the study population. Consistently high FIM and NAC scores in the area of physical functioning suggested that the rehabilitation program at Netcare Rehabilitation Hospital was effective in terms of providing patients with physical independence. However, NAC results showed that the patients were not completely ready to reintegrate back to their communities. Areas that were identified as particularly problematic were knowledge on follow up health care services in the community, readiness for work and accessibility of the home and work environments. Therefore it is recommended that the rehabilitation team re-evaluate the program and incorporate strategies with the aim to improve it’s effectiveness in terms of preparing patients for community reintegration. It is also recommended that further research is conducted to assess the current success rate with regards to community reintegration and determine challenges to re-integration in order to assist with program panning.

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