Voices on disability issues in Namibia: Evidence for entrenching occupational justice in disability policy formulation.

Background: The national policy on disability in Namibia is overdue for review having been in existence for over 20 years. In 2017 the government of Namibia expressed intentions to review the policy. Concerns that can be framed as occupational injustice were raised by persons with disabilities in Namibia.Aim: To gather evidence from persons with disabilities; disability policy decision makers and occupational therapists for contributing towards disability policy formulation using an occupational justice perspective.Method: In-depth interviews were conducted with 15 persons with disabilities and eight disability policy decision-makers. Two focus groups were conducted with a total of 17 occupational therapists working in Namibia. NVivo 11 Pro version was used for thematic data analysis to generate themes with critical disability theory as the theoretical framework.Findings: Occupational participation barriers identified in the study were: attitudinal, access, physical, expertise, and systemic. These barriers can be framed as occupational marginalization, occupational deprivation and occupational alienation. All participant groups suggested policy reforms to promote occupational participation among persons with disabilities.Conclusion/Significance: There is potential for applying the participatory occupational justice framework in disability policy formulation to promote participation in occupations that are meaningful, and culturally relevant to persons with disabilities in Namibia.

The cat on a hot tin roof? Critical considerations in multilingual language assessments.

BACKGROUND:  In speech-language pathology (SLP), there is a paucity of resources to provide just and equitable services to South Africa's culturally and linguistically diverse population. Although South Africa is a multilingual country, English remains the dominant language. However, there is limited research on resources for English additional language (EAL) speakers. OBJECTIVES:  This article addresses this gap by presenting the results of a critique of a commonly used language screening tool, the Renfrew Action Picture Test (RAPT), on EAL speakers. METHOD:  This tool is used as an example to broadly critique the use of culturally biased assessment instruments with EAL speakers from an indigenous linguistic and cultural background. It is administered to children who are EAL speakers and then critiqued by the children too. Their voice, often ignored in research, is central to the research. A mixed methods approach is used, including focus groups and test administration. This article is based on the results of the thematic analysis used to closely examine the patterns that emerge. RESULTS:  A key finding is that the cultural and linguistic background of the child assessed cannot be disregarded, as it plays a crucial role in understanding the response of the child. The interpretation of the response of the child to the presented material of the language assessment tool significantly influences the result of the assessment. CONCLUSION:  The speech language therapist has a responsibility to avoid skewed results based on uninformed interpretation of the response of the child. These findings provide useful insights for clinicians regarding culture-fair assessment.

Analysing disability policy in Namibia: An occupational justice perspective.

BACKGROUND: The Namibian disability policy of 1997 has not been reviewed for about 20 years, which has raised concerns with persons with disabilities and stakeholders in the fields of disability and rehabilitation. In March 2017, the government publicised its intention to review the policy. Thus, this study's purpose was to generate evidence that can contribute to the development of a more current disability policy that will promote occupational justice. OBJECTIVES: The aim of the study was to develop an alternative disability policy option for Namibia and to present outcomes and trade-offs using a policy analysis approach while applying the occupational justice framework to gather evidence. METHOD: A qualitative research design and Bardach's eightfold path approach to policy analysis were used. Critical disability theory provided the theoretical framework. The occupational justice framework was the conceptual framework for the study. Evidence from preceding phases of this study and appropriate literature was utilised to construct possible disability policy alternatives in Namibia, set evaluative criteria, project outcomes and confront trade-offs. RESULTS: Three main disability policy alternatives emerged: access policy, support policy and universal coverage policy. Access policy had the fewest trade-offs, and the support policy had the most trade-offs in the Namibian context. Access policy was projected to foster occupational participation among persons with disabilities. CONCLUSION: Results have implications for selecting disability policy alternatives that promote occupational participation and justice among persons with disabilities in Namibia. Furthermore, the study has implications for advancing the practice of occupational justice in disability policy formulation.

Evidence-Based Clinical Algorithm for Hypotonia Assessment: To Pardon the Errs.

Despite the many advances in diagnostics, the clinical assessment of children with hypotonia presents a diagnostic challenge for clinicians due to the current subjectivity of the initial clinical assessment. The aim of this paper is to report on an evidence-based clinical algorithm (EBCA) that was developed for the clinical assessment of hypotonia in children as part of the output of a multiphased study towards assisting clinicians in more accurate assessments. This study formed part of a larger advanced mixed methods design. The preceding phases of the study included a systematic review, a survey amongst clinicians, a consensus process (Delphi technique), and a qualitative critique with multiple focus groups. Samples were drawn from three professional groups (occupational therapists, physiotherapists, and paediatricians). Data were analysed at each stage and merged in the development of the EBCA. The EBCA followed a rigorous process of development and critique. The methods for formulating changes in the revision and development of the EBCA are presented together with a description and presentation of the final algorithm for practice. The overarching concepts that guided the development and refinement of the EBCA are described, taking into consideration knowledge translation, evidence-based practice, and the value of EBCAs in addition to recommendations for stakeholder uptake. The EBCA is envisaged to be useful in practice for clinicians who are faced with the assessment of a child that is suspected as having hypotonia via a systematic process in identifying specific characteristics that are associated with low muscle tone.

Analysing disability policy in Namibia: an occupational justice perspective

Background: The Namibian disability policy of 1997 has not been reviewed for about 20 years, which has raised concerns with persons with disabilities and stakeholders in the fields of disability and rehabilitation. In March 2017, the government publicised its intention to review the policy. Thus, this study's purpose was to generate evidence that can contribute to the development of a more current disability policy that will promote occupational justice.Objectives: The aim of the study was to develop an alternative disability policy option for Namibia and to present outcomes and trade-offs using a policy analysis approach while applying the occupational justice framework to gather evidence.Method: A qualitative research design and Bardach's eightfold path approach to policy analysis were used. Critical disability theory provided the theoretical framework. The occupational justice framework was the conceptual framework for the study. Evidence from preceding phases of this study and appropriate literature was utilised to construct possible disability policy alternatives in Namibia, set evaluative criteria, project outcomes and confront trade-offs.Results: Three main disability policy alternatives emerged: access policy, support policy and universal coverage policy. Access policy had the fewest trade-offs, and the support policy had the most trade-offs in the Namibian context. Access policy was projected to foster occupational participation among persons with disabilities.Conclusion: Results have implications for selecting disability policy alternatives that promote occupational participation and justice among persons with disabilities in Namibia.Furthermore, the study has implications for advancing the practice of occupational justice in disability policy formulation

Community stakeholders' perspectives on the role of occupational therapy in primary healthcare: Implications for practice.

BACKGROUND: Primary healthcare (PHC) is central to increased access and transformation in South African healthcare. There is limited literature about services required by occupational therapists in PHC. Despite policy being in place, the implementation of services at grassroots level does not always occur adequately. OBJECTIVES: This study aimed at gaining an understanding of the challenges of being disabled and the services required by occupational therapists (OTs) in rural communities in order to better inform the occupational therapy (OT) training curriculum. METHOD: An exploratory, descriptive qualitative design was implemented using purposive sampling to recruit 23 community healthcare workers from the uGu district. Snowball sampling was used to recruit 37 members of the uGu community, which included people with disability (PWD) and caregivers of PWDs. Audio-recorded focus groups and semi-structured interviews were used to collect data, which were thematically analysed. Ethical approval was obtained from the Biomedical and Research Ethics Committee of the University of KwaZulu-Natal (BE248/14). RESULTS: Two main themes emerged namely: firstly, the challenges faced by the disabled community and secondly appropriate opportunities for intervention in PHC. A snapshot of the social and physical inaccessibility challenges experienced by the community was created. Challenges included physical and sexual abuse, discrimination and marginalisation. Community-based rehabilitation and ideas for health promotion and prevention were identified as possible strategies for OT intervention. CONCLUSION: The understanding of the intervention required by OT in PHC was enhanced through obtaining the views of various stakeholders' on the role. This study highlighted the gaps in community-based services that OTs should offer in this context.

Exploring the occupational therapist's role in primary health care: Listening to voices of stakeholders.

BACKGROUND: Re-engineering of primary healthcare (PHC) was initiated nationally in 2009. There is, however, little information on the role expected of occupational therapists (OTs)in PHC. OBJECTIVES: This research aimed to understand how stakeholders of the Department of Health (DOH) perceived the role of OT in PHC service. METHOD: This exploratory, qualitative study used purposive sampling to recruit community health-care workers (CHW; n = 23), primary healthcare nurses (PHC; n = 5), DOH management (n = 5), experienced (n = 14) and novice OTs (n = 37) who graduated from the University of KwaZulu-Natal. The PHC nurses and the CHW represented PHC clinics in one district in KwaZulu-Natal. Data were collected through semi-structured interviews and focus groups. Interviews with CHWs were conducted in isiZulu. These were transcribed and translated prior to data analysis. Audio recordings of English interviews and focus groups were transcribed. Data for each participant group were inductively and thematically analysed to identify the themes. RESULTS: The findings provided an indication of the role of OTs in PHC settings. All participants perceived the role of OTs as predominantly curative/rehabilitation-based and individualised. Participants had a limited understanding of the key principles of PHC. They identified a need for adult and paediatric rehabilitation and early childhood intervention. Limited mention was made of population-based approaches, collaborative, and health promotion and prevention programmes. CONCLUSION: The study has highlighted that neither management nor OTs seemed to align practice and planning according to PHC principles. A review of the theory and experiential learning in the OT programme is required.

Are South African Speech-Language Therapists adequately equipped to assess English Additional Language (EAL) speakers who are from an indigenous linguistic and cultural background? A profile and exploration of the current situation.

This article presents the results of a survey conducted on Speech-Language Therapists (SLTs) regarding current practices in the assessment of English Additional Language (EAL) speakers in South Africa. It forms part of the rationale for a broader (PhD) study that critiques the use of assessment instruments on EAL speakers from an indigenous linguistic and cultural background. This article discusses an aspect of the broader research and presents the background, method, findings, discussion and implications of the survey. The results of this survey highlight the challenges of human and material resources to, and the dominance of English in, the profession in South Africa. The findings contribute to understanding critical factors for acquiring reliable and valid assessment results with diverse populations, particularly the implications from a cultural and linguistic perspective.

Kinesio Taping® of the metacarpophalangeal joints and its effect on pain and hand function in individuals with rheumatoid arthritis.

BACKGROUND: In persons suffering from rheumatoid arthritis (RA), the metacarpophalangeal (MCP) joints are commonly affected, resulting in inflammation, pain, joint instability, diminished grip strength and difficulties with function. However, the effectiveness of Kinesio Taping® of the MCP joints in alleviating the symptoms has not been established. AIM: To determine the effectiveness of bilateral Kinesio Taping® of the MCP joints on pain, range of motion, grip strength and hand function in elderly individuals previously diagnosed with RA. METHODS: A repeated measure, experimental design was used over a 7-week period with the Kinesio Taping group (n = 30) receiving bilateral space correction Kinesio Taping® of the MCP joints with a joint protection (JP) group (n = 31) participating in JP workshops. The Kinesio Tape® was worn for 3 days a week with four applications during the data collection process. For the control group, 2-hour JP educational-behavioural workshops were run weekly for 4 weeks. Weekly assessments were completed for grip strength, ulnar deviation and pain (VAS), and two pre-intervention assessments and one post-intervention assessment was completed for the Michigan Hands Outcomes Questionnaire (MHQ). RESULTS: Kinesio Taping® of the MCP joints showed a significant decrease in pain (p = 0.001) and improved range of motion (p = 0.001 bilaterally). JP was found to have a significant improvement in grip strength (p = 0.001 bilaterally) and in the work (p = 0.01) and activities of daily living (ADL) (p = 0.01) sections of the MHQ. No significant difference was found between groups after intervention in the majority of outcomes (p = 0.24) except for grip strength where a significant difference was found. CONCLUSION: Kinesio Taping® of the MCP joints is an effective conservative intervention to improve pain and MCP ulnar deviation in individuals with RA.Significance of the work: Kinesio Taping® of the MCP joints of individuals with RA showed a significant decrease in pain (p = 0.00) and improved range of motion (p = 0.001 bilaterally). JP was found to significantly improve grip strength (p = 0.001 bilaterally) and in the work (p = 0.01) and ADL (p = 0.01) sections of the MHQ. No significant difference was found between groups after intervention in the majority of outcomes (p = 0.24) except for grip strength where a significant difference was found (p = 0.001).

'Toning' up hypotonia assessment: A proposal and critique.

BACKGROUND: Clinical assessment of hypotonia is challenging due to the subjective nature of the initial clinical evaluation. This poses dilemmas for practitioners in gaining accuracy, given that the presentation of hypotonia can be either a non-threatening or malevolent sign. The research question posed was how clinical assessment can be improved, given the current contentions expressed in the scientific literature. OBJECTIVES: This paper describes the development and critique of a clinical algorithm to aid the assessment of hypotonia. METHODS: An initial exploratory sequential phase, consisting of a systematic review, a survey amongst clinicians and a Delphi process, assisted in the development of the algorithm, which is presented within the framework of the International Classification of Functioning, Disability and Health. The ensuing critique followed a qualitative emergent-systematic focus group design with a purposive sample of 59 clinicians. Data were analysed using semantical content analysis and are presented thematically with analytical considerations. RESULTS: This study culminated in the development of an evidence-based clinical algorithm for practice. The qualitative critique of the algorithm considered aspects such as inadequacies, misconceptions and omissions; strengths; clinical use; resource implications; and recommendations. CONCLUSIONS: The first prototype and critique of a clinical algorithm to assist the clinical assessment of hypotonia in children has been described. Barriers highlighted include aspects related to knowledge gaps of clinicians, issues around user-friendliness and formatting concerns. Strengths identified by the critique included aspects related to the evidence-based nature of the criteria within the algorithm, the suitability of the algorithm in being merged or extending current practice, the potential of the algorithm in aiding more accurate decision-making, the suitability of the algorithm across age groups and the logical flow. These findings provide a starting point towards ascertaining the clinical utility of the algorithm as an essential step towards evidence-based praxis.

Consensus on hypotonia via Delphi process.

OBJECTIVES: To generate consensus on the assessment of hypotonia in the pediatric population, more specifically with respect to the clinical characteristics and first line tests and methods to be used to assess these characteristics. METHODS: Consensus methodology was used. A sample of experts was recruited based on specific inclusion criteria. A two-round Delphi process was conducted electronically, which was based on a prior literature appraisal and survey amongst a cohort of clinicians. An a priori threshold margin error of 70 ± 5 % was pre-determined, with Cronbach's α measuring the level of internal consistency. RESULTS: The 2-round iteration was useful in establishing consensus on clinical characteristics and tests /methods in the assessment of low muscle tone in the pediatric population (2-5 y age band). Twenty-four clinical characteristics, organized into 11 clusters were determined as relevant for inclusion. For each characteristic, one test (as a first line assessment method) had been identified with consensus after two rounds. Additionally, consensus on the importance of collateral sources was determined. The ranking order of importance of characteristics however revealed variations. CONCLUSIONS: The results of this study have displayed that Delphi, if executed with available guidelines, may be a useful technique in moving towards consensus on issues that may be contentious and have assisted in providing initial data to move towards consensus on the assessment of hypotonia in children.

Reciprocal capacity building for collaborative disability research between disabled people's organizations, communities and higher education institutions.

This paper focuses on the reciprocal capacity building that occurred through collaborative research between occupational therapy departments from six higher education institutions in South Africa, community-based organizations and a disabled people's organization on disabled youth and their livelihoods. The authors aimed to identify principles for collaboration and capacity building from the pilot phase and first phase of the main study. Occupational therapy departments place students in communities for service learning experience, but little collaboration with disabled people's organizations and communities in research processes occurs that could enrich such partnerships and inform relevant curriculum development. Secondary data from different sources including a transcript of a focus-group interview with the researchers in the pilot phase, workshop reports, and transcripts of free-writing exercises done by researchers were analysed thematically, both inductively and deductively. Two themes are explored: first, reciprocal building of organizational capacity and, second, generating collaborative relationships. The principles that were identified are integral to the strengths and challenges faced when multiple organizations work together over a wide geographical area on a complex research topic that also builds capacity reciprocally.