The evaluation of the imp act of interventions by a physiotherapist on intellectually imp aired and physically disabled children and their caregivers in two community groups in peri-urban Cape Town
Physiotherapy services for disabled children and their families have conventionally been received at a hospital or school for children with special educational needs in the main towns and cities of South Africa. Community-Based Rehabilitation (CBR) programmes were proposed and established as an additional approach to Institutional-Based Rehabilitation to address the need for accessible resources for these families. In this study the author evaluated two CBR programmes for disabled children and their main caregivers in two separate low socioeconomic peri-urban areas of Cape Town. The programme, a weekly group meeting, included physiotherapy interventions to assist the development and functional abilities of the children by means of activities that the caregivers could include in daily home care. They handled their own children following demonstrations and correction of handling skills by the author. The majority of the caregivers were mothers. Their children, less than 13 years old, were severely intellectually impaired. Some with concomitant physical disabilities. The author implemented the interventions of the CBR programme and she required to understand the impact on the particpants in a study using qualiative research methods. In the pilot programme the attendant members were individually interviewed, after her withdrawal, for their opinions of the outcomes. Evaluation documentation.ofjheir children and CBR programme records were related to the caregivers' responses. From the pilot study experiences the author felt that additional methods of data collection would result in a greater understanding of the impacts of the interventions. Expanded methods of research were utilised in the study of the second group. During the interventions at group meetings the author used field notes to record observations. Participant observation allowed the author to analysis the responses of the participants. Focus group interviews assisted in understanding external factors influencing the participants as well as their needs. Individual interviews, after the closure of the CBR programme, allowed the participants to express their views of the interventions. Documentation of the individual evaluation of each child was related to the views expressed by the caregivers. Common meanings and themes were explored in the analysis of the various data collected. Analysis revealed that interventions of education and training for the caregivers improved their knowledge and understanding of the impairments and disability of their children. The children benefited functionally from their families increased skills and knowledge. Through discussion with other families at group meetings, the caregivers had an understanding of other disabilities in children and developmental outcomes possible for their own child. The caregivers were more confident to address the negative perceptions of disability in their communities. It is recommended that physiotherapists implementing any interventions for disabled children should ensure that the caregivers are partners in planning and selection of interventions and that their needs are addressed. Community participation in Community-Based Rehabilitation programmes was required for the participants to become self-reliant and solve their own needs as well as for the programme to be sustainable. This was demonstrated in only one of the programmes.