Browsing by Author "Cawood, Judy"

Now showing 1 - 4 of 4
  • Thumbnail Image
    Item
    Environmental factors influencing participation of stroke survivors in a Western Cape setting
    (AOSIS Publishing, 2015-10) Cawood, Judy; Visagie, Surona
    Background: Environmental factors compound or diminish the effects of impairments; therefore they have a direct influence on participation of stroke survivors. Objectives: To determine environmental barriers and facilitators to participation experienced by a group of stroke survivors in the Western Cape province of South Africa. Methods: A descriptive, mixed methods study was conducted in 2011. Quantitative data was collected with the International Classification for Functioning, Disability and Health core set for stroke (environmental factors), from 53 stroke survivors, sampled through proportional, stratified, random sampling. Data is presented through graphs and tables. Qualitative data was collected from five purposively sampled participants and thematically analysed. Results: Under products and technology, participants regarded assets, food, products and technology for daily living, transportation, mobility and communication, and access to buildings as barriers. The physical geography and attitudes of friends and society created further barriers. With regard to services, systems and policies - housing, communication, transport and social services created barriers. Health services, as well as support from health care service providers and family were considered facilitators. Conclusion: A lack of assets compounded barriers with regard to food, products for daily use, communication and transport. Barriers to participation were exacerbated by a lack of services, systems and implementation of policies focused on the inclusion of people with disabilities, as well as minimal access to assistive devices. Recommendations include provision of assistive devices, structural changes to houses, yards, roads and buildings, lobbying for accessible, affordable public transport, access audits of public buildings, and inclusion of non-governmental organisations and home-based care services in a seamless network of care.
  • Thumbnail Image
    Item
    Impact of post-stroke impairments on activities and participation as experienced by stroke survivors in a Western Cape setting
    (Occupational Therapy Association of South Africa, 2016) Cawood, Judy; Visagie, Surona; Mji, Gubela
    ENGLISH SUMMARY : Introduction: This paper explores causal connections between impairments, activity limitations and participation restrictions after stroke. Methods: The study population (N=267) of this descriptive study were public health care users, from the eastern sub-district of the Western Cape Metropole, who had a stroke between 1 January 2009 and 31 December 2010. Fifty-three study participants were selected through stratified, proportional, random sampling. Data was collected using the Stroke Impact Scale-3.0; the Modified Barthel Index; the Loewenstein Occupational Therapy Cognitive Assessment and a language screening test. Spearman correlations were used to determine statistical significance. Results: The mean Stroke Impact Scale participation score was 31.3/100. Limb strength (<0.01), visual perception (<0.01), spatial perception (0.02), motor praxis (<0.01), visuomotor organisation (<0.01), and thinking operations (<0.01), impacted participation scores negatively. The mean Modified Barthel Index score was 70.58/100. Limb strength (<0.01), hand function (<0.01), visual perception (<0.01), motor praxis (<0.01), visuomotor organisation (<0.01), and thinking operations (<0.01) impacted Modified Barthel Index scores negatively. Conclusion: Motor, cognitive and perceptual impairments impacted activities and participation negatively. Stroke survivors should receive routine cognitive, perceptual and motor evaluations. The effect of intervention strategies on cognitive and perceptual impairment post-stroke must be studied.
  • Thumbnail Image
    Item
    Rehabilitation outcomes of uninsured stroke survivors in the Helderberg Basin
    (Stellenbosch : Stellenbosch University, 2012-12) Cawood, Judy; Visagie, Surona; Mji, Gubela; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Centre for Rehabilitation Studies.
    ENGLISH ABSTRACT: Introduction: Rehabilitation is recognised as important in helping stroke survivors achieve their highest levels of functional independence and best quality of life. Conversely, a lack of rehabilitation services, and other environmental barriers, can prevent the attainment of optimal levels of functioning and advanced outcomes, such as community integration and employment. Aim of the study: To determine if uninsured stroke survivors living in the Helderberg Basin (Western Cape) reached their optimal rehabilitation outcome levels and if not, what environmental barriers contributed to this. Methods: A descriptive study was conducted. Quantitative data was obtained from 53 participants, who were selected through proportional stratified random sampling. Demographic information and the health status of participants were recorded. Other instruments utilised were the Stroke Impact Scale (SIS3), Modified Barthel Index (MBI), Loewenstein Occupational Therapy Cognitive Assessment (LOTCA), language screening test and the ICF Core Set for Stroke (Environmental Factors). Outcome levels were categorised as described by Landrum, Schmidt and McLean, 1995. Data was subjected to statistical analysis. Qualitative data was obtained from five participants, who were chosen by means of purposive sampling. Data were analysed according to predetermined themes. Results: Six (11%) participants were classified as being on rehabilitation level 1; 21 (40%) on level 2; 16 (30%) on level 3; 8 (15%) on level 4; 2 (4%) on level 5. According to the MBI, 65% of participants required assistance with activities of daily living LOTCA scores showed that most difficulty was experienced with tests for visuomotor organization and thinking skills. Participants experienced varying degrees of difficulty with the speech and language test. A mean score of 50.84 for questions related to feelings on the SIS3 is indicative of underlying depression. Stroke survivors received limited physiotherapy and occupational therapy and even less speech therapy and dietary counselling. Occupational therapy had a significant impact on MBI (<0.01) and SIS3.6 (community mobility) (0.02) scores. Six (12%) reported assistance from a social worker. No psychological counselling was reported by any participant. A limited number of assistive devices, focussing mainly on mobility appliances had been issued. Participants regarded the most significant environmental barriers as being lack of assets (89%), transportation (88%) and general social support services, systems and policies (87%). Qualitative data showed a lack of counselling, education and training by health professionals regarding primary and secondary prevention of stroke and rehabilitation. Conclusion: Numerous environmental barriers impacted on the achievement of advanced rehabilitation outcomes. In addition to shortcomings in the primary and secondary prevention of stroke, many of the minimum standards for rehabilitation, as stipulated in the Western Cape Comprehensive Service Plan for the Implementation of Healthcare 2010, were not being met. Recommendations include establishing a designated stroke unit at Helderberg Hospital, ensuring transport, and improving the referral system to existing rehabilitation services. Increased input from core disciplines essential to stroke rehabilitation has the potential to improve outcomes. A concerted effort by health professionals is required in terms of counselling, education and training with regards to primary and secondary prevention of stroke and rehabilitation.
  • Thumbnail Image
    Item
    Stroke management and functional outcomes of stroke survivors in an urban Western Cape Province setting
    (Occupational Therapy Association of South Africa, 2017) Cawood, Judy; Visagie, Surona
    Introduction: Long-term disability caused by stroke can be decreased through comprehensive rehabilitation. Aim: This article aims to describe the functional outcomes achieved by stroke survivors in an urban Western Cape Province setting to add to the information on stroke management. Methods: A descriptive mixed methods study was done. Proportional, stratified random sampling was used to select 53 participants from a population of 267. Quantitative data were collected with the Stroke Impact Scale Version 3.0 and the Modified Barthel Index, and analysed with the Mann–Whitney test. A p value of < 0.05 was deemed statistically significant. Five of the 53 participants were purposively sampled for the qualitative phase of the study. Qualitative data were analysed according to predetermined themes. Results: Seventy-five per cent of participants were managed in a general medical ward. Four were admitted to a specialised inpatient rehabilitation centre. Eighty-three per cent received physiotherapy, 62% received occupational therapy and 57% received both physioand occupational therapy. Fifty-one per cent experienced communication difficulties, but only 18% received speech therapy. Conclusion and recommendations: Sufficient inpatient therapy (preferably in a stroke unit /ward) and family education /training should be received before discharge. Occupational therapy, speech therapy, physiotherapy as well as psychological, social work, vision screening and dietetic services should be expanded at both hospital and community level.