South African Journal of Occupational Therapy

A review of the book: "Postures and Movement Patterns of the Human Hand. A Framework for Understanding Hand Activity for Clinicians and Engineers

Susan De Klerk — 2025-04-04

A review of the book "Postures and Movement Patterns of the Human Hand. A Framework for Understanding Hand Activity for Clinicians and Engineers" by Noriko Kamakura

A review of the book "Society, Health and Disease in South Africa" by Leah Gilbert, Liz Walker, Silvie Cooper, Kezia Lewins, Rajohane Matshedisho, Lorena Nunez-Carrasco and Terri-Ann Selikow.

Blanche Pretorius — 2025-04-04

A review of the book "Society, Health and Disease in South Africa"

Strengthening rehabilitation services in rural communities: Considerations for community-oriented primary care

Nafisa Mayat — 2025-04-04

This opinion piece is based on a study that investigated the contribution of Rehabilitation Care Workers in strengthening rehabilitation in community-based services at the primary level of care level and a collaborative inquiry with the rehabilitation teams responsible for outreach community services in a rural district. We are of the opinion that rural contexts require a different set of community-based rehabilitation (CBR) competences than those applicable in better-resourced urban and peri-urban settings. We investigated the health system strengthening benefits of CBR as a facet of community orientated primary care (COPC), which focuses on the intersectoral services that rehabilitation care workers who are supervised by rehabilitation therapists can offer to persons with disabilities. We endorse extant public health literature on the urgent need to build rural inclusive health workforce capacity, suggesting that human resource shortages for rehabilitation in rural areas can be addressed through training mid-level, multi-skilled CBR workers who are part of the ward-based teams with rehabilitation therapists. Community health workers (CHWs) in rural areas who upgrade their skills set to include competences in community-based disability inclusive development practice can address the rehabilitation service gaps faced by persons with disabilities and their families.

Implications for practice

Embedding community-based disability inclusive development practices in COPC will promote access to rehabilitation services in rural communities
In addition to nurse-led ward-based teams of CHWs, ward-based teams of RCWs led by rehabilitation therapists will strengthen the primary level rural health system
Health outcomes of rural populations with disability will be improved by access to RCWs with competences in intersectoral collaboration

The need for frailty assessments and intervention as part of holistic occupational therapy practice

Thavanesi Gurayah — 2025-04-04

Are occupational therapists competent to perform frailty assessments? This opinion piece asserts the argument for including frailty assessments as a routine component for baseline assessments, particularly in older individuals, or those who may be considered to be frail. Some regulatory bodies for occupational therapy, such as the Canadian Occupational Therapy Association have included frailty assessment and intervention as a core competency. Frailty is multidimensional and the risk increases with age. There are numerous risk factors that have been identified in the development of the frailty syndrome, including clinical, biological, lifestyle and sociodemographic factors. This paper offers some suggestions for the assessment of frailty, including questionnaires and informal methods. It is recommended that frailty education be included in the undergraduate curricula of occupational therapists in South Africa, and other undergraduate programs in Africa. An overview of the advantages and disadvantages of standardized and unstandardized assessment tools should also be included as part of the program. Frailty can be prevented, with timely screening and interventions. It is concluded that frailty assessments should form part of the baseline assessment package of all aging individuals, and especially those who may have one or more of the risk factors.

Implications for practice

Frailty is a clinical syndrome, particularly in older adults, that is associated with adverse health outcomes. It should be incorporated into occupational therapy practice as it impacts function directly. The authors argue that:

Frailty adversely impacts on the ability of individuals to care for themselves and perform their daily occupations.
Frailty measures should form part of a baseline assessment, especially in older adults.
Frailty assessments need to be conducted in those who display one of more of the risk factors, which includes immobility, incontinence, delirium, and an individual who has had one or more falls.
Frailty can be prevented by timely screening and focused interventions.

From marginalisation to belonging: The transformative value of adult daycare centres for adults with disabilities

Iselle Van den Heever — 2025-04-04

Introduction

This opinion piece reflects on the perspectives of adults with severe-profound disabilities attending Adult Daycare Centres (ADCs) in the Western Cape, South Africa, a country where such services are crucial for promoting dignity and well-being in a society that can be marginalizing. This article portrays the voices of adults with disabilities from four ADCs and identifies eight core values of such centres.

Discussion

The core values, namely activity participation, a safe environment, social participation, improved mental health, spirituality, health promotion, purpose, and community living, reflect the essence of ADCs. The findings challenge occupational therapy’s dominant focus on productivity and independence, emphasizing dignified being and belonging as therapeutic outcomes for wellbeing.

Conclusion

ADCs play a crucial role in promoting human rights and quality of life for adults with disabilities by fostering occupational participation, social interaction, and personal growth. These insights advocate for a shift in the definition of ADCs from mere physical care and “doing”, to fostering a sense of being and belonging.

Implications for practice

The findings call for increased funding, training, and support for ADCs. Occupational therapists are vital in community-based practice as clinicians, facilitators, educators, and advocates, to ensure access to essential services for persons with disabilities

Exploring the lived experiences and challenges of informal traders on the Durban beachfront

Tanner-Rae Van den Bergh — 2025-04-04

Background: The study explored the lived experiences of informal traders on the Durban beachfront, to understand their challenges and impact on their roles, occupations, and livelihoods. This has important implications for occupational therapy, as it is work occupation.

Methods: The study utilised a qualitative design to explore their lives and working conditions. Purposive and snowball sampling were used to identify 10 participants who completed a deographic questionnaire and were interviewed using a semi-structured interview schedule.

Findings: The study identified both positive and negative aspects of informal trading. Positive aspects included the financial support from families, and spirituality provided strength and facilitated ubuntu among traders. Negative aspects includedc crime, adverse weather conditions, poor infrastructure, a lack of basic amenities, and harassment from the police and municipal officials. The occcupational imbalance of the traders resulted in difficulties fulfilling their roles. Co-morbid health conditions , food insecurity and the aftermath of COVID-19 were other negative aspects.

Conclusion: Informal traders faced faced financial uncertainty, food insecurity, adverse weather conditions, poor infrastructure, occupational imbalance, crime, deteriorating health, and declining tourism. The positive aspects included developing perseverance, gaining skills and ubuntu among traders, improving the infrastructure for the traders with increased visible plocing may reduce crime and create a safer environment for the traders.

Iplications for practice:

The research identified interventions and policies to improve informal traders' lived experiences and well-being. Training in sress management, ergonomics, and business skills will enhance the traders' coping strategies and financial stability.
Occuypational therapists whould advocate for policy reforms by amplifying traders' voices on work-related challenges. Addressing these issues will provide broader societal insights and support inclusive policy development.
Informal trading allows greater control overt schedules, leisure and self-care, which bolsters mental health and empwerment.
Occupational therapy can address occupational imbalance, fostering ideentity, purpose and overall well-being of informal traders.

An exploration of Dialectical Behaviour Therapy-informed occupational therapy in mental health, in South Africa

Kristy Frances Ward — 2025-04-04

Background: There is an encreasing trend of occupational therapists incorporating Dialectical Behaviour Therapy (DBT) in their interventions for Mental Health Care Users (MHCUs). Despite its growing popularity, there is a paucity of literature describing how DBT is used within occupational therapy practice.

Purpose: The study aimed to describe the current use of DBT-informed occupational therapy by South African occupational therapists working with clients with mental disorders.

Method: Using a qualitative, descriptive design, 17 semi-structured interviews were conducted with South African occupational therapists using the DBT approach in mental health practice. An inductive thematic analisis of the qualitative information generated in the interviews was done.

Findings: Three themes emerged from the data analysis: (a) Potential challenges, (b) Why DPT? and (c) Training influences practice.

Conclusion: The themes identified in the study highlight both the potential and challenges of incorporating DBT-informed approaches within occupational therapy, emphasising the need for further research in this area.

Implications for practice

It is recommended that occupational therapists who want to use DBT to inform their practgice obtain a post-graduate DBT qualification
To remain within the scope of occupational therapy, the occupational therapist should focus their treatment plan on the specific skills that the MHCUs need to participate in occupations that are meaningful to them
It is also very important that the occupational therapist communicate their treatment focus to other team members, to avoid confusion and overlap
The occupational therapist who implements the DBT approach should clinically reason from an occupational science approach. This would mean designing a client-centred treatment plan in a manner which is accessible to the MHCU, enabling specific skills that will meet the MHCU's occupational needs
Futher research in the use of DBT in occupational therapy is necessary

Factors influencing stroke survivors' reintegration into a rural community: Perspectives from a municipality in Limpopo Province, South Africa

Lizzy Mashapa — 2025-04-04

Background: Stroke incidence remains high in South Africa. Access to rehabilitation services is critical for stroke survivors to successfully reintegrate back into the community. This study aimed to explore the factors that influence stroke survivors' reintegration into the community to inform contextually relevant rural rehabilitation processes.

Methods: A sequential explanatory mixed-method design was employed. Quantitative data were collected through a file audit of 15 participants. The qualitative data were sourced through semi-structured interviews with purposively selected 15 stroke survivors and three rehabilitation team members. The file audit data were analysed usiong descriptive statistics. The semi-structured interviews were analysed thematically.

Results: The five themes identified included stroke survivors' meaningful occupations, enablers for community reintegrration, barries to community integration, stroke survivors' and caregivers' perceptions on rehabilitation and lasty, the rehabilitation team's perceptions on rehabilitation processes for improved stroke rehabilitation. Work was the most affected occupation reported, followed by socialisation and the least affected were Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily living (IADL). Facilitators includecd accessibility of assistive devices, positive attitude and communty support of the rehabilitation team. Main barriers included residual impairments and limited hosptial resources.

Conclusion: Early intervention, provision of assistive devices and continued community interventions strenghten the stroke survivors' community reintegration.

Implications for practice

Work is the most affected occupation in stroke survivors, followed by socialisation and the least affected were BADLs and IADLs.
Continued support to the stroke survivors and caregivers through support groups in the community is needed to increase awareness of stroke sequelae, caregiver relief and fostering social participation.
Occupational therapists should assess the feasibility to return to previous work or contact employers to assess whether reasonable acccommmodation can be made in the acute rehabilitation phase.
Return to work rehabilitation for stroke survivors should include a routine vocational rehablitation programme that is individually structured to assist the stroke survivors to adapt to the work routine.
Occupational therapists should also initiate vocational training such as entrepreneurial skills and subsistence agriculture in collaboration with other sectors such as the Department of Agriculture to assist the stroke survivors and their caregivers to support their families.

Development of content for an early intervention mother-infant programme for vulnerable infants

Gina Rencken — 2025-04-04

Introduction: Early intervention in the first months of life focuses on the high-risk infant, often born premature or with significant risk factors present. Early developmental surveillance of infants is carried out briefly at vaccination appointments at 14 weeks, six months and nine months in South Africa. It is however not sensitive enough to pick up subtle challenges in the infants' functioning in autonomic stability, state regulation, motor control or social interaction.

Methods: A Nominal Group was held in a workshop session at a national occupational therapy congress, where delegates chose to attend and participate. Nineteen participants attended the workshop, where a plenary session was followed by item generation and reaching a consensus on the inclusion of these items in an early intervention mother-infant group intervention programme.

Results: A master list of 45 activities was generated, which was reduced to nine activity groups, covering all domains of newborn functioning. Guiding principles were shared and agreed on. Consensus was reached during the workshop process, with subsequent emailed rounds only yielding comments on clarity in the item description.

Discussion: Massage, maternal education and empowerment, play and communication were essential for inclusion.

Conclusion: Consensus was reached on the inclusion of 45 activities, with 9 of these considered essential in mother-infant dyad group-based intervention for vulnerable infants.

Implications for practice

Applicable across multiple settings in South Africa, this research informs occupational therapy service providers on the development of early itnervetion mother-infant dyad-based group intervention programs.
Activities that are a priority for inclusion in a group-based mother-infant dyad early intervention programme are: vision, play, skin-to-skin/ KMC, communication, massage, midline/ containment, maternal education/ empowerment, auditory and movement based on an analysis of their qualities.

Care workers' perceptions of the programme for learners with severe to profound intellectual disabilities in Nkangala District, Mpumalanga: "Nothing about us without us"

Galetshetse V. Diale — 2025-04-04

Baclground: The South African Department of Basic Education (DBE) has recently implemented a learning programme for learners with severe to profound intellectual disabilities (LSPID) in the stimulation care centres. Outreach education teams, including multicisciplinary rehabilitation professionals and education speciatists, provide LSPID learning programme training to capacitate and equip care workers in stiumulation care centres (SCCs) to afford the previously marginalised children an opportunity to receive quality funder education and rehabilitation. A staff audit of SCCs in the Western Cape revealed that 40% of care workers were parents of children enrolled in the centres. However, there care workers, along with others, lacked formal training in early childhood development, health, and rehabilitation essential for providing education support to learners with severe to profound intellectual disabilities (SPID), a condition prevalent in the Nkangala district of Mpumalanga Province. In response, curriculum specialists and therapists developed a learning programme to train care workers across the country. However, little is known about the experiences and expectations of the care workers, as there has been limited research in this context. For instance, it remains unclear whether the training introduced in 2018 adequately met their needs. To address this gap, it would be beneficial for the DBE to collaborate with care workers by exploring their experiences and creating a platform for their input in policy formulation. Furthermore, care workers were excluded from executive planning, which impacts the outcoes of the LSPID programme, even though they are key role players whose support is crucial for implementing DBE strategies and activities. Consedquently, care workers may be hesitant to fully engage with the learning programme and training if they feel they have not had an active role in shaping decisions and outcomes.

Aim of study: To explore the perceptions of care workers in special care centres supported by the Department of Social Development in Mpumalanga Province, South Africa about the learning meme and the training provided by the outreach education team.

Method: A descriptive, explorative qualitative study was used to explore the perceptions of 12 care workers who were purposively selected. Data collected using semi-structured key informant interviews were thematically analysed, using inductive coding.

Findings: The care workers appreciated the learning programme, which they believe capacitated them to provide comprehensive intervention, stimulation, and formal education to the children in their care. Tis programme also contributed to better-resourced working environments. Despite their positive lived experiences of the changes facilitated by the LSPID learning programme to services provided over the years, the care workers felt side-lined and undermined. The Department of Basic Education did not seek their collaboration in major decision-making and the training they received was not accredited. Addditionally,, the care workers did not receive recognition in terms of remuneration for the extra set of responsibilities and duties that came with the implementation of the LSPID learning programme.

Conclusion: the LSPID learning programme is experienced as partially solving the problems that it was intended to address. The care workers expressed a desire to receive formal acccredited training towards a qualification in providing care and education to learners with SPID and be remunerated for implementing the programme.

Implications for practice:

The contributions of the outreach education team can potentially improve outcomes of the programme and give care workers the tools to confidently address challenges encountered in providing the LSPID learning programme
The care workers' views have the potential to inform the DBE policy to cater for their needs and those of the learners with SPID in the SCCs.

Occupational therapy intervention for Cerebral Palsy - a rapid review

Janke Van der Walt — 2025-04-04

Introduction: Cerebral Palsy is an early-onset lifelong condition that requires comprehensive care. Occupational therapy contributes to the care of individuals with Cerebral Palsy through various intervention methods, which aim to promote independence and well-being in all areas of life. This rapid review aimed to describe the intervention methods used globallyby occupational therapists for Verebral Palsy to inform policymakers on integrating occupational therapy into the healthcare system for effective management of Cerebral Palsy within the care team.

Methods: Searches were conduced of the Cochrane and Medline databases. Systemative reviews published in peer-reviewed journals from January 2014 to December 2023 were includedc for screening if the search terms "occupational therapy/therapist" and "cerebral palsy" were included in the title or abstracct. Screenings took place in Rayyan.ai first by title and abstract bny tow reviews, and then by full text. A third reviewer resolved conflicts. The included reviews were analysed and data plotted on a custom excel worksheet. All studies were assessed for bias and quality using the CASP appraisal tool.

Results: Eleven articles were included in the review. Seven themes were identified from the included systematic reviews through thematic analysis: gaming, early intervention, cognitive approaches, interventions that impact cognitive function, constraint-induced movement therapy, interventions that improve motor performance, and a general overview of treatment methods for cerebral palsy among children. Nine approaches with 24 intervention methods were identified from the individual systematic reviews, with varied evidence. Intervention venues and duration also varied widely. A multi-model approach, using more than one intervention method was the preferred intervention approach, yielding better outcomes.

Conclusion: High-quality evidence from eleven systematic reviews supports the role of occupational therapy intervention for Cerebral Palsy

Implications for practice:

Occupational therapy plays an integral part in supporting individuals with Cerebral Palsy by providing varied interventions aiming to optimise functional abilities, promote independence and enhance overall quality of life.
A multi-model occupational therapy approach for Cerebral Palsy is supported by research evidence.
Intervention settings and duration vary widely according to intervention aims and approaches.
High-quality systematic reviews guide policy development in Africa, however research in the form of scoping reviews is recommended to include lower-level evidence studies and information to plot current practices and gaps in therapy service delivery in Africa.

OTASA: 80 Years of support, guidance and leadership

Blanche Pretorius — 2025-04-04

In celebration of the 80th anniversary of the Occupational Therapy Association (OTASA), an overview of the contribution our professional association has made towards:

Establishing and promoting occupational therapy in South Africa,
Maintaining standards of practice and education and
Influencing and promoting research and policy development

is summarised.

As the publisher of our Journal, OTASA's support, both financial and in many other countless ways, is acknowledged.