Sensory reactivity assessment in children: A systematic review.

AIM: To identify sensory reactivity assessments published in the literature for children aged 3 to 12 years and evaluate their psychometric properties to select the most appropriate one for adaptation to South Africa, with implications for other low- and middle-income countries. METHOD: We addressed the following two review questions. What tests have been published in the literature in the past 30 years to evaluate sensory reactivity with children aged 3 to 12 years? What is the validity and reliability of the tests reported in the studies? The COnsensus-based standards for the Selection of health Measurement INstruments (COSMIN) methodology was used. We searched eight databases. Two reviewers independently screened and selected the studies. RESULTS: The reviewers identified 41 studies, representing 19 assessments. The most common type of assessment was the proxy-reported caregiver questionnaire. Sensory systems most often assessed were visual, tactile, auditory, and vestibular. Study populations included those with autism spectrum disorder, attention-deficit/hyperactivity disorder, and children born preterm. Ratings for measurement properties of most assessments were moderate to low. INTERPRETATION: Limited psychometric information was reported, with low ratings for many properties. The Sensory Processing 3-Dimensions Scale was selected on the basis of its psychometric properties and alignment with best-practice recommendation to use a caregiver questionnaire and a performance test to assess sensory reactivity.

Personal barriers to participation in chosen instrumental activities of daily living among community-dwelling persons with schizophrenia in Rwanda.

Background: Mental disorders are a major health concern across the globe. Schizophrenia, one of the mental disorders, affects approximately 20 million people globally and 5 million people within the African continent. Schizophrenia can affect all areas of life, including participation in instrumental activities of daily living (IADLs). Objectives: The study aimed to explore personal barriers affecting participation in chosen IADLs among community-dwelling persons with schizophrenia in Kigali city, Rwanda. Method: A qualitative, embedded case study design and constructivist epistemology paradigm were used. Purposive sampling and semi-structured interviews were conducted with 20 participants that included 10 persons diagnosed with schizophrenia (case 1) and 10 of their caregivers (case 2). Data were analysed according to the seven steps of Ziebland and Mcpherson. Findings: The two themes identified were community negative attitudes and individual hindrances to participation in IADLs. Theme 1 demonstrated the community's poor support towards persons with schizophrenia due to the stigma attached to mental health illness, which is reported elsewhere. This paper reports on individual hindrances to participation, which revealed limited knowledge and skills, decreased motivation and interest, financial problems, maladaptive behaviours, medication side effects, loss of social interaction and isolation, and disorganised in performing activities to negatively affect persons with schizophrenia's full participation in their chosen IADLs. Conclusion: Community-dwelling persons with schizophrenia are experiencing various hindrances to participating in their chosen IADLs, which shows a need for support from different stakeholders to improve access and participation of persons with schizophrenia in their daily activities based on their abilities. Contribution: Different barriers affecting participation of the persons with schizophrenia in their chosen IADLs were highlighted together with the common affected IADLs. It is recommended that when right support is provided, persons with schizophrenia may function at their maximum abilities in their activities of choice and may live at their highest independence level.

The use and value of play: Perspectives from the continent of Africa - a scoping review.

BACKGROUND: Published play knowledge predominantly originates outside Africa. This review was undertaken to summarize sources on play originating from the continent of Africa. OBJECTIVE: To locate and summarize sources on the use and value of play in human development and learning from the African continent. MATERIAL AND METHOD: Following the PRISMA Extension - Scoping Reviews guidelines, the initial search yielded 17,004 sources. Title and abstract screening identified 263 sources which were evaluated for eligibility namely; sources originating from the African continent, in any language, focussing on play as occupation. RESULTS: A total of 127 sources were included; 76 qualitative, 28 quantitative and 23 mixed design sources; 100 from Southern Africa. Nine themes emerged: Who plays, why, where and how individuals play, intentional use of play, play and adult-related work skills, what is used in play, time/duration of play and barriers to play. CONCLUSIONS: Play was used effectively in human development and learning. Withholding play as a form of discipline, emphasized how adults and children valued play. Adults still loved playing. Safety concerns contributed to the reasons play occurred indoors more than outdoors, despite outdoor play being preferred. SIGNIFICANCE: The review provides a reference for play as an occupation which may promote learning and development.

Inter-sectoral work practice in Zimbabwe: Professional competencies required by occupational therapists to facilitate work participation of persons with disabilities.

BACKGROUND: Persons with disabilities experience higher unemployment rates and limited participation in work. Occupational therapy can promote participation and engagement in work by persons with disabilities. However, there is no clarity on the required set of competencies for entry-level occupational therapists with a bachelor's degree to start up and participate in inter-sectoral work practice initiatives in Zimbabwe. AIMS: To explore what work practice competencies entry-level occupational therapists require to meet the work-related needs of persons with disabilities. MATERIAL AND METHODS: This exploratory qualitative research sought to explore what professional competencies entry-level occupational therapists required for them to offer collaborative inter-sectoral work practice initiatives for persons with disabilities within the Zimbabwean context. Six participants selected using criterion sampling, participated in semi-structured interviews. Inductive content analysis was conducted. The Stellenbosch Health Research Ethics Committee and Medical Rehabilitation Practitioner's Council of Zimbabwe gave ethical clearance and permissions to conduct the study. RESULTS: Three themes; core knowledge for work practice, skills for work practice and occupational therapy professional attributes; emerged. These were used in formulation of ten professional competency statements for occupational therapists offering work practice services. CONCLUSIONS: Although Zimbabwean occupational therapists require similar competencies for work practice as those required in other countries, additional competencies that fall outside traditional health care contexts are essential in order to promote contextually relevant practice.

Professional competencies required by occupational therapists to facilitate the participation of persons with mental disability in work: A review of the literature.

BACKGROUND: Unemployment rates are generally higher among persons with mental disabilities who experience many barriers and challenges that limit their participation in work and employment. Occupational therapy can play a key role in promoting participation and engagement in work by persons with mental disabilities. OBJECTIVE: This review sought to identify the barriers and facilitators to work participation for persons with mental disabilities globally in comparison to Zimbabwe, and to identify the competencies related to work practice in occupational therapy curricula internationally and regionally. METHODS: A narrative literature review was conducted using the SALSA (Search, Appraisal, Synthesis and Analysis) framework which informed retrieval and analysis of articles published between 2012 and 2018. RESULTS: Fifty-one out of 227 articles were selected to inform the review. A synthesis of the literature provided insights and ideas on facilitators and barriers to work for persons with mental disabilities and the competencies related to work practice in occupational therapy curricula. CONCLUSION: Barriers to participation in work for persons with mental disabilities are real. However, occupational therapists from different contexts have a variety of competencies to facilitate participation in work. There is a need to develop work practice competencies particular to the Zimbabwean context.

Lived experiences of caregivers of children with autism spectrum disorder in Kenya.

BACKGROUND: Autism spectrum disorder (ASD) is a global public health concern. In African countries such as Kenya, there is a greater need for establishing support services for developmental disorders such as ASD. The emotional, social and economic burden of ASD on caregivers is unknown because of a number of challenges. Citizens of Kenya have a unique view of disability and inclusion. OBJECTIVES: To explore the perspectives of caregivers who are responsible for caring for both family and children living with ASD and to highlight the needs of children with ASD as well as the needs of their caregivers. METHOD: A qualitative, descriptive phenomenological study utilising focus group discussions (FGDs) was conducted. Verbatim transcription was used. QSR N 'Vivo 10 was used to organise and analyse the data. Content analysis was used to identify important ideas and concepts. RESULTS: One theme, namely 'the burden of caring for children with ASD', was identified. Children with ASD and their caregivers experience isolation and stigmatisation. CONCLUSION: Occupational therapists in Kenya should collaborate with the relevant national and global stakeholders for the promotion of the inclusion of children with ASD and their families. Responsive and context-appropriate occupational therapy interventions may begin to address service barriers. KEYWORDS: autism spectrum disorder; children; needs of caregivers; context-appropriate services.

Policymakers' Perspectives Towards Developing a Guideline to Inform Policy on Fetal Alcohol Spectrum Disorder: A Qualitative Study.

Fetal alcohol spectrum disorder (FASD) has a high prevalence in South Africa, especially among the poor socioeconomic communities. However, there is no specific policy to address FASD. Using a qualitative study design, we explored the perspectives of policymakers on guidelines/policies for FASD, current practices and interventions, and what practices and interventions could be included in a policy for FASD. The data analysis was done using the Framework Method. Applying a working analytical framework to the data, we found that there is no specific policy for FASD in South Africa, however, clauses of FASD policy exist in other policy documents. Preventive services for women and screening, identification, assessment, and support for children are some of the current practices. Nevertheless, a multi-sectoral collaboration and streamlined program for the prevention and management of FASD are aspects that should be included in the policy. While there are generic clauses in existing relevant policy documents, which could be attributed to the prevention and management of FASD, these clauses have not been effective in preventing and managing the disorder. Therefore, a specific policy to foster a holistic and coordinated approach to prevent and manage FASD needs to be developed.

Exploring service providers' perspectives on the prevention and management of fetal alcohol spectrum disorders in South Africa: a qualitative study.

BACKGROUND: Fetal alcohol spectrum disorder (FASD) is among the leading causes of developmental and intellectual disabilities in individuals. Although efforts are being made toward the prevention and management of FASD in South Africa, the prevalence remains high. The sustained high prevalence could be attributed to several factors, including the lack of policy for a coordinated effort to prevent, diagnose and manage FASD nationally. In this study, our aim was to explore the perspectives of service providers (health and allied professionals, teachers, social workers) on the prevention and management of FASD towards developing a guideline to inform policy. METHOD: Guided by the exploratory qualitative research design, we purposively sampled relevant service providers in the field of FASD prevention and management for focus group discussions. Nine of these discussions were conducted with to eight participants per discussion session. The discussants were asked various questions on the current and required interventions and practices for the prevention and management of FASD. Following the Framework Method, data were transcribed verbatim and analysed using the thematic content analysis approach. RESULTS: Our findings show that aspects of the prevention and management of alcohol-related conditions are present in various policies. However, there is no clear focus on coordinated, multi-sectoral efforts for a more comprehensive approach to the prevention and management of FASD. The participants recognized the need for specific requirements on broad-based preventive awareness programs, training and support for parents and caregivers, inclusive education in mainstream schools and training of relevant professionals. CONCLUSION: Comprehensive and coordinated prevention and management programs guided by a specific policy could improve the prevention and management of FASD. Policy formulation demonstrates commitment from the government, highlights the importance of the condition, and elaborates on context-specific prevention and management protocols.

The experiences and challenges faced by rehabilitation community service therapists within the South African Primary Healthcare health system.

BACKGROUND: Twenty-two years after the promulgation of a plethora of progressive health policies since 1994, the South African public health system reflects a number of stumbling blocks regarding implementation. Rehabilitation professionals are not sufficiently equipped nor allowed the opportunity to comprehensively implement Primary Healthcare (PHC) from a bottom-up approach, thus engaging communities. Training on addressing social health determinants and their impact on ill-health and health outcomes is inadequate. The inadequate understanding of the advocacy role that rehabilitation professionals could play in addressing social health determinants remains a challenge in healthcare. Rehabilitation, a pillar of PHC, remains poorly understood in terms of its role within the health system. AIM: We argue for rehabilitation as a vehicle for addressing social determinants of health with community service practitioners playing a critical role in addressing the inequities within the healthcare package. SETTING: The article reflects the opportunities and challenges faced by rehabilitation community service therapists in the delivery of rehabilitation services in a rural area of the Eastern Cape province of South Africa. METHODS: A single case study from the perspective of a researcher was used to explore the experience and reflection of the first author during her community service as an occupational therapist. RESULTS: The case study highlights some existing gaps within the delivery of rehabilitation services in the rural Eastern Cape. A community service package with a specific approach towards addressing social determinants of health for persons with disability at a community level is suggested. CONCLUSION: Advocating for a rehabilitation service package to shift to community-based levels is critical. It is envisaged that a community-based approach will facilitate an understanding of the barriers faced by persons with disabilities as constituting disability, thus facilitating learning about the disabling consequences of the rural environment coupled with the system as experienced by persons with disabilities.

The Play Experiences of Preschool Children from a Low-socio-economic Rural Community in Worcester, South Africa.

Occupational therapists believe that play is a child's main occupation and is considered essential for healthy motor, cognitive and emotional development. However, play spaces and activities in low socio-economic areas are often different to those provided in structured occupational therapy treatment environments. The main objective was to determine play opportunities, activities, equipment, toys and the play environment for 5- to 6-year-olds living in a low-socio-economic community outside a small town in South Africa, in order to understand the nature of play in this environment better. Participant observation together with an adapted photovoice method to capture the play experience was used. Data was analysed using inductive content analysis. Two global themes emerged from the results: "neighbourhood children find ways to play" and "context influences play". Children were given ample opportunity to play and participated in extensive outdoor play. Their games were highly social and involved the imaginative use of found items as toys. Play was also used to make sense of social hazards. An understanding of play in a low-income context has implications for the development of future play assessments and the provision of play therapy in these communities. Copyright © 2015 John Wiley & Sons, Ltd.

Playfulness and prenatal alcohol exposure: a comparative study.

BACKGROUND/AIM: South Africa carries a high burden of alcohol abuse. The effects of maternal alcohol consumption during pregnancy are most pronounced in poor, rural communities. Earlier research suggests that children with prenatal alcohol exposure have poor social behaviour; however, to date, no research has investigated their playfulness. This study investigated the differences in playfulness of children with and without prenatal alcohol exposure. METHODS: Grade one learners with a positive history of prenatal alcohol exposure (n = 15) and a reference group without a positive history of prenatal alcohol exposure (n = 15) were filmed engaging in free play at their schools. The Test of Playfulness was used to measure playfulness from recordings. Data were subjected to Rasch analysis to calculate interval level measure scores for each participant. The overall measure scores and individual Test of Playfulness social items were subjected to paired samples t-tests to calculate if significant differences existed between the groups. RESULTS: Children with prenatal alcohol exposure had a significantly lower mean overall playfulness score than the reference group (t = -2.51; d.f. = 28; P = 0.02). Children with prenatal alcohol exposure also scored significantly lower than the reference group on 5 of the 12 Test of Playfulness items related to social play. CONCLUSIONS: This research suggests that children with prenatal alcohol exposure are more likely to experience poorer overall quality of play, with particular deficits in social play. Considering play is a child's primary occupation, this finding becomes pertinent for occupational therapy practice, particularly in post-apartheid South Africa, where high prenatal alcohol exposure prevalence rates are couched within persistent socio-economic inequalities.