Browsing by Author "Gretschel, Pamela"

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    Active Play: perceived and actual motor performance among Ghanaian children
    (2021) Doe-Asinyo, Rosemary Xorlanyo; Gretschel, Pamela
    Background: There is limited data on active play both in terms of perceived competence and actual motor performance in children living in low- and middle-income countries. Promotion of active play in children is crucial for enhancing participation in physical activity and reducing the burden of obesity. Regular engagement in active play is important for promoting optimal development and increasing physical activity levels in children. Despite the increased interest in active play and physical fitness worldwide, many children in low-resource settings are thought to be physically inactive due to the lack of physical activity-promoting resources and programmes. The 2018 Ghana Report Card on physical activity reports that a high proportion of Ghanaian children do not achieve recommended physical activity levels and a high percentage of these children have poor motor skills. To date, no published study has examined active play among school-aged children in Ghana. Investigating the nature of active play by assessing perceived and actual motor performance among Ghanaian children can serve to increase our understanding of activity deficits, movement difficulties and associated factors in this population. Aim: The aim of this study was to investigate the nature of active play in children aged 6-12 years in Ghana. Specific Objectives: 1. To determine children and caregivers' perceptions of children's motor performance in active play using the Motor Coordination Questionnaire (MCQ). 2. To determine children and caregivers' perceptions of the importance of active play. 3. To identify additional forms of active play and games (which are not listed on the MCQ) that children and caregivers perceive to be important and meaningful. 4. To determine the relationship between MCQ ratings by caregivers and children. 5. To determine the relationship between children's MCQ and actual motor performance. 6. To determine the relationship between caregivers' MCQ and actual motor performance. Methodology: A cross-sectional descriptive and analytical design was used. Three primary schools were purposively selected for this study. The study recruited 406 children and their caregivers for this study. Ethical approval was sought from the Ethics Review Committee of the Ghana Health Service (GHS-ERC 052/05/19) and the University of Cape Town Faculty of Health Sciences Human Research Ethics Committee (HREC REF: 112/2020). Data was collected from both caregivers and children (aged 6-12 years) using questionnaires and the Performance and Fitness (PERF-FIT) test battery. The MCQ-caregivers and MCQ-children were used to assess perceived motor performance, and the PERF-FIT test was used to measure children's actual motor performance. In using the Statistical Package for Social Sciences (SPSS) version 24.0 (SPSS Inc, IBM Company, Armonk, NY), Pearson or Spearman's correlation coefficient was calculated to determine the relationship between children and caregivers' perceptions as well as the relationship between the perceptions and the actual motor performance of the children. Results: Both children (75.6%-94.2%) and their caregivers (69.3%-95.4%) perceived good motor performance of the children during active play. Children (82.8%-96%) and their caregivers (83.2%-94.4%) also regarded active play as very important. Twenty-four additional games were found to be of importance to Ghanaian children and their caregivers. Weak negative, weak positive and sometimes moderate positive correlation between MCQ items and the PERF-FIT items were found. Conclusions: This study shows that we can't rely solely on perceptions, but need actual motor performance, to accurately measure motor performance during active play. We found that parents and children do not accurately estimate the actual level of motor performance. Further studies should be done to understand confounding variables that may have caused poor relationship between perceived and actual motor performance. There is a need for a valid tool like the PERF-FIT to help in accurate measurement of motor performance.
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    Educators' perspectives of the implementation of a classroom based, educator led occupational therapy intervention for fine motor skills
    (2021) Damonse, Shireen; Gretschel, Pamela; Ebrahim, Adele
    Background Children attending South African low quintile schools are faced with various barriers to learning which impacts academic performance, with handwriting being an aspect with which they experience difficulty. Provision of on-site occupational therapy services to address handwriting at such schools is limited by human resource constraints. To address this, final year occupational therapy students attending University of Cape Town placed in a low quintile school were tasked to collaborate with Grade R educators to train them to implement a classroom-based fine motor programme. Aim This study describes the educators' experiences of the factors impacting on the implementation of a fine motor programme in a low quintile school. Methodology A qualitative, descriptive study was conducted to explore their experiences relating to the programme, which is an emerging area of research in the South African context. Using sampling, three Grade R educators were purposively trained in implementing a fine motor skills programme. They participated in two focus groups to describe their experiences of the training and the implementation of the programme. Data was audio-recorded and transcribed verbatim. Inductive approach to analysis led to the generation of themes and categories focussing on their experiences, of the hindrances and factors supporting the implementation. Ethical principles were upheld throughout the research process. Findings and Discussion The theme “Them and us” was highlighted throughout the discussion as there was a divide between the educators and the students. The lack of communication and role clarification resulted in both the educators and students missing out on opportunities for collaboration and teamwork, and in turn the learners lost out on intervention albeit on a population basis that could impact learning and development. The process, fraught with challenges, resulted in a difficult partnership and a programme which was not implemented and subsequently not sustained. Conclusion The South African Educational Policy encourages therapists working in schools to integrate their services into the classrooms as well as the homes of learners by means of contextual interventions implemented in partnership with educators and parents. Lack of understanding of how to invest in the initiation of partnerships and consistent attention to grasping roles and responsibilities is a vital component of the collaborative partnership. Power dynamics within the relationship, commitment and spontaneous communication are aspects that stakeholders need to be conscious of to bring about change for positive occupational engagement of learners.
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    Exploring the processes of parenting in the context of multidimensional poverty when children demonstrate behavioural problems: a single case study in post-1994 Apartheid South Africa
    (2025) Cilliers, Nicola; Peters, Liesl; Gretschel, Pamela
    Background: Families are acknowledged in South African and international policy as the cornerstone of a healthy society, with parenting increasingly becoming the focus of occupational therapy intervention for children's behavioural problems. However, emerging literature from the South suggests pervasive structural and situational challenges in which parenting unfolds and must be navigated. Current conceptualisations of parenting within and beyond occupational science are left wanting with regards to understanding how parenting unfolds in these challenging contexts. Different knowledge(s) about how parenting might unfold in diverse contexts are required to inform more responsive support of families in the margins. Aim: This study sought to explore and describe the occupation of parenting when children demonstrate behavioural problems in the context of multidimensional poverty in post-1994 South Africa. This context presents with complex challenges that align well with the study's intention to contribute knowledge from the Global South. Methodology: Drawing upon a post-structuralist paradigm, the study adopted a qualitative single, intrinsic case study design. Data was collected over a 6-month period with two families, recruited purposively. They resided in the same geographical community, where many experienced several markers of poverty, and self-identified as having children with behavioural difficulties. Individual, in-depth narrative interviews served as the primary data collection method, in conjunction with several secondary data sources. Data was analysed using a narrative analytic process and direct interpretation of data sources. Findings: One overarching assertion comprising of two core assertions emerged, revealing that parenting unfolds dynamically as a process of relational emergence. This process is more and less consciously, intergenerationally and contextually enmeshed as caregivers engage with and through iterative relational complexities. Caregivers wrestle with their enmeshment in dominant discourses and practices as they work to resist and adapt these, but also often reproduce them. This wrestling shapes and is shaped by the relational agency of caregivers, children and community members as they influence and respond to everyday parenting situations. Children's behavioural problems did not emerge as a determinant of parenting practices, functioning rather as part of the relational context in which parenting unfolds. Discussion and Conclusion: Parenting as a process of relational emergence is discussed as a possible lens for understanding parenting in the margins, drawing on theories of collective occupation and occupational choice to unpack how intentionality and practical sense might operate within this process. Parenting's complexities demand further research to understand how it truly unfolds in diverse contexts and should be a focus area in undergraduate occupational therapy programmes. Parenting may be further supported in practice through appreciating plurality in parenting knowledge and experiences, and considering parenting's complexities in how support services are developed and appraised.
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    Mothers’ facilitation of the occupational engagement of their children with FASD: a qualitative descriptive study in an under-resourced district in South Africa
    (2019) Coetzee, Lian-Marie; Sonday, Amshunda; Gretschel, Pamela
    South Africa has the highest reported prevalence of Fetal Alcohol Spectrum Disorder (FASD) worldwide. The high prevalence is aggravated by limited remedial and rehabilitative services in the rural Northern Cape. Parents requested guidance to facilitate the development of their children with FASD. Understanding their needs and strengths will inform intervention programmes to create the stable environments children with FASD require for optimal life outcomes. The aim of the study is to explore the way that mothers facilitate the occupational engagement of their children with FASD as well as the challenges they face. Using a qualitative descriptive study design, the author purposively selected mothers to reveal three turning points in the lives of their children. Semi structured- and photo-elicitation interviews highlighted mothers’ experiences. Interviews were transcribed verbatim and inductively analysed with content analysis. Two themes emerged, namely, “Doing together” and “Varying access to engagement”. The findings of this study highlight the important role mothers play to facilitate the occupational engagement of children with FASD. Recognising mothers as agents of change and including them in intervention will enhance occupational therapy practice in the area of FASD.
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    Parent perceptions of screen time use in young children with Autism Spectrum Disorder
    (2022) Ebrahim, Faatima Omarjee; Gretschel, Pamela; Abbas, Iesrafeel
    Screen time (ST) relates to accessing and engaging with electronic media, technology and devices that involves any type of screen. The global advancement and increasing availability of technology, together with the impact of COVID-19 pandemic restrictions on social engagement, appears to have led to a growing presence of ST in the lives of young children with autism spectrum disorder (ASD). Excessive ST has been associated with developmental delays, sleep disturbances, reduced physical activity and other health problems which can have significant negative impacts on the occupational engagement of children with ASD. Despite these concerns, little to no research focussing on ST use by children with ASD, nor of its impacts on their engagement in other occupations, has been conducted in middle-income countries, like South Africa. A qualitative descriptive design, using semi-structured, in-depth interviews with seven purposively selected participants in line with maximum variation, was used to explore and describe parents' perceptions of ST of their children with ASD. The study aimed to promote a better understanding of how and why their children used ST, what the effect of ST was on their children's lives, what strategies their parents used to mediate ST and the impact that the COVID19 pandemic had on ST use. The information gained will be used to inform intervention guidelines for the management of ST and for optimising its use, for children with ASD. Through a process of thematic analysis, four themes emerged from the data. The theme Seeking out ST opportunities described how children used ST in keeping with their interests and how their limited interest in non-ST activities made them seek opportunities for ST. Theme two, ST, a mixed blessing confirmed how parents viewed ST to have both benefits and drawbacks for their children and described how they tried to come to terms with ST as it created opposing effects in their children's lives. Theme three Striving to provide conditional access to ST found that these parents used a variety of restrictive mediation strategies to manage their child's ST, whilst trying to avoid the stress caused by limiting ST and allowing for its use under certain conditions. The fourth theme COVID-19 “intensified the whole screen time business” highlighted how ST became an appealing replacement during the pandemic adding new challenges that parents experienced with managing its use. Overall, these findings acknowledged the challenges and positive contributions that parents of children with ASD experienced because of ST of their children, which were exacerbated during the COVID-19 pandemic. This study supports the need for early childhood interventionists to consider ST as a significant occupation of children with ASD, that requires attention.
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    Repositioning speech language pathology practices: engaging with family and community narratives to evolve communication supports for neurodivergent children
    (2025) Parusnath, Prianka; Kathard, Harsha; Mallick, Rizwana; Gretschel, Pamela
    In South Africa and the Majority World, Speech-Language Therapy services are not easy to access. The profession with its medical model roots can be elitest, reductive and ineffective in areas where therapists are a finite resource. The purpose of this study was to engage with families and communities in order to evolve communication supports for neurodivergent children with the focus on community practice, inclusion and belonging. Additionally, story telling was used as the vehicle for learning. These stories were further explored in the context of South Africa with a specific focus on Disability in the Majority World, Inclusion and Belonging, Decolonisation within the framework of current practice and Practice Shifts (currently taking place and on the horizon). In order to do explore these concepts, narrative interviews were conducted with four families and two community members in order to learn about their experiences regarding inclusion and belonging. The families all have children who access alternative communication and the focus of the interviews were to gain insight into their journeys and experiences with Speech Language Therapy, communication and how this impacted their experiences in their community. After analysis of these interviews, the stories were shared at a workshop attended by various professionals (teachers, psychologists, speech therapists etc.) to explore the impact that stories have on therapeutic learning and practice shifts. The analysis occurred in two phases. First a narrative analysis was conducted for each family and community member post interview. Then an analysis of the narratives was conducted which culminated in themes being curated. Graphic Harvesting and Thematic Analysis were used to analyse the workshop discussion. The most significant finding and a common thread in every family narrative was the burden of communication that was placed on them when Speech Therapists practiced in traditional ways (i.e. in therapy rooms behind closed doors). Additionally, exclusion was also prominent theme that arose, firstly just because the child has a disability and then secondly because alternative communication was seen as so different and “other” that it was further isolating. There was a definite call from families for practice shift that supported them more holistically out in their community. The Invisible String is a conceptual framework that proposes the union of decolonised practice concepts with the intersectionality of the families we work with. The image is of a patchwork quilt, families on one side, decolonial practise on the other with Speech-Language Therapists being the guiding hand to the needle of communication. The thread that binds it all is community. It is an offering of reuniting and remaking and bringing humanity and community to the forefront of practice.
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    Repositioning speech language pathology practices: engaging with family and community narratives to evolve communication supports for neurodivergent children
    (2025) Parusnath, Prianka; Kathard, Harsha; Mallick, Rizwana; Gretschel, Pamela
    In South Africa and the Majority World, Speech-Language Therapy services are not easy to access. The profession with its medical model roots can be elitest, reductive and ineffective in areas where therapists are a finite resource. The purpose of this study was to engage with families and communities in order to evolve communication supports for neurodivergent children with the focus on community practice, inclusion and belonging. Additionally, story telling was used as the vehicle for learning. These stories were further explored in the context of South Africa with a specific focus on Disability in the Majority World, Inclusion and Belonging, Decolonisation within the framework of current practice and Practice Shifts (currently taking place and on the horizon). In order to do explore these concepts, narrative interviews were conducted with four families and two community members in order to learn about their experiences regarding inclusion and belonging. The families all have children who access alternative communication and the focus of the interviews were to gain insight into their journeys and experiences with Speech Language Therapy, communication and how this impacted their experiences in their community. After analysis of these interviews, the stories were shared at a workshop attended by various professionals (teachers, psychologists, speech therapists etc.) to explore the impact that stories have on therapeutic learning and practice shifts. The analysis occurred in two phases. First a narrative analysis was conducted for each family and community member post interview. Then an analysis of the narratives was conducted which culminated in themes being curated. Graphic Harvesting and Thematic Analysis were used to analyse the workshop discussion. The most significant finding and a common thread in every family narrative was the burden of communication that was placed on them when Speech Therapists practiced in traditional ways (i.e. in therapy rooms behind closed doors). Additionally, exclusion was also prominent theme that arose, firstly just because the child has a disability and then secondly because alternative communication was seen as so different and “other” that it was further isolating. There was a definite call from families for practice shift that supported them more holistically out in their community. The Invisible String is a conceptual framework that proposes the union of decolonised practice concepts with the intersectionality of the families we work with. The image is of a patchwork quilt, families on one side, decolonial practise on the other with Speech-Language Therapists being the guiding hand to the needle of communication. The thread that binds it all is community. It is an offering of reuniting and remaking and bringing humanity and community to the forefront of practice.
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    Sensory over-responsivity in children of 3-5 years: A descriptive, analytical study
    (2019) Watkyns, Ann Frances; Gretschel, Pamela; Buchanan, Helen
    BACKGROUND: Sensory over-responsivity (SOR) is a type of Sensory Modulation Disorder (SMD), where the individual has an over-responsive behavioural reaction to non-harmful or non-threatening sensory stimulation, which is out of proportion to the stimulus. SOR can negatively impact a child’s engagement and performance in their daily life. SOR is frequently diagnosed by occupational therapists, and deep pressure is an important facet of the treatment of SOR by occupational therapists. Prior research (Alberts & Ronca, 2012) indicates that the component of pressure in the vaginal birth process aids the infant’s neurophysiological adaption to extra-uterine life. This component is absent in elective caesarean section births. This study therefore set out to determine whether method of birth could be associated with SOR, as well as investigating demographic and other variables linked to SOR. It was hypothesised that there would be a higher prevalence of SOR in children aged 3-5 years born by elective caesarean section compared to those born by vaginal birth. The study objectives were: • To establish a profile (demographic and variables linked to SOR) of participants (mother-child dyads) by birth method group (CS or vaginal delivery) • To determine the prevalence of SOR by birth method • To establish if there is a statistically significant difference in SOR and birth method • To establish which variables (for example birth weight, jaundice, birth complications) are associated with SOR METHOD: A quantitative, descriptive, analytical study was conducted with a sample of 91 children between the ages of 3 years 0 months and 4 years 11 months. Children across various language, cultural and socio-economic groups were recruited and allocated to two groups based on their method of birth - vaginal delivery and elective caesarean section. Caregivers of each child completed the Short Sensory Profile 2 (SSP2) questionnaire as well as a demographic information questionnaire. The scores for SOR were calculated for each participant, and prevalence of SOR between the two birth method groups was compared. Demographic variables were tested for significance between the two groups. The variables showing a significant difference were further analysed to determine any association with SOR. RESULTS: There were 91 participants, 58 in the VB group and 33 in the CS group. Mothers in the VB group gave birth at a younger age (U = 499.0, p < .001), were of a lower income level (chi-square = 11.49, df = 2, p = .003) and more likely to be single (Fishers exact p (2-tailed) = .037). The children in the VB group were of a greater gestational age (U = 472.5, p = .001), had a shorter time period before the first breastfeed (U = 478.0, p = .006), and had fewer sleeping difficulties (Fishers exact p (2-tailed) = .003). The prevalence of SOR for the total sample was 22%. There was a significant association in SOR prevalence and birth method (Fishers exact p (2-tailed) = .034), with greater prevalence in the VB group (29%) as opposed to the elective CS group (9%). There were statistically significant associations between SOR and maternal age (U = 380.5, p = .004), marital status (Fishers exact p (2-tailed) = .003) and time after birth to the first breastfeed (U = 394.5, p = .049). CONCLUSION: There was a statistically significant difference in SOR between the two birth method groups, with higher prevalence in the VB group. This was thought to be linked to cultural and language challenges associated with the use of the SSP2, and the impact of low socio-economic circumstances on child development and the ability to regulate sensory input. Recommendations include developing and validating a culturally appropriate sensory profile questionnaire, available in the most common official languages to facilitate the accurate assessment of sensory modulation of all children living in South Africa. In addition, there is a need to test the birth method hypothesis in demographically balanced groups.