| Summary: | Thesis (MOccTher (Interdisciplinary Health Sciences. Occupational Therapy))--University of Stellenbosch, 2010. === AFRIKAANSE OPSOMMING: AGTERGROND
Dit is bekend dat vroeggebore babas met ʼn baie lae geboortemassa ʼn hoër
insidensie van ontwikkelings-, gedrags- en mediese agterstande en verskeie
leerprobleme toon teen die tyd dat hulle skoolgaande ouderdom bereik. Kommer
bestaan ook oor die omgewingseffek van die neonatale intensiewe sorgeenheid op
die sensoriese ontwikkeling van die vroeggebore baba en hoe dit tot bogenoemde
agterstande kan bydra. Daar is verskillende benaderings wat daarop aanspraak
maak dat hulle die probleem kan oplos, met kangaroemoedersorg (‘kangaroo mother
care’) en ontwikkelingsorg (‘developmental care’) wat in die literatuur uitgesonder is
as besonders belowend. Met die aanvang van hierdie studie was daar nog geen
empiriese studies in die literatuur gerapporteer wat enige aansprake van hierdie
benaderings bevestig het nie. Daar was dus ʼn behoefte vir ʼn empiries-nagevorsde
program wat prakties in die neonatale intensiewe eenheid toegepas kon word met die
oog op die vermindering van omgewingstressors ten opsigte van die vroeggebore
baba se sensoriese sisteme.
DOEL
Die doel met die studie was om die invloed te bepaal van ʼn Sensoriese Ontwikkelingsorgprogram
(‘Sensory Developmental Care Programme’), wat ʼn spesifieke kangaroemoedersorg-
protokol insluit, op die sensoriese ontwikkeling van die vroeggebore
baba met 'ʼn baie lae geboortemassa tot en met die ouderdom van 18 maande
(gekorrigeerde ouderdom).
METODOLOGIE
ʼn Ewekansig-gekontroleerde studie is uitgevoer. Die studiesteekproef het bestaan uit
89 vroeggebore babas met ʼn baie lae geboortemassa wat in ʼn periode van 24
maande toegelaat is tot die neonatale eenheid van Tygerberg Hospitaal in Kaapstad,
Suid-Afrika. Die babas is gewerf op grond van sekere kriteria en is dan daarna
ewekansig aan een van twee groepe toegeken: 1) die intervensiegroep het sorg
ontvang volgens die Sensoriese Ontwikkelingsorgprogram vir 10 dae; en 2) die
kontrolegroep het ook vir 10 dae die standaardsorg van die eenheid ontvang. Die
intervensiegroep het uit 45 babas bestaan, van wie 22 die studie voltooi het, terwyl
die kontrolegroep uit 44 babas bestaan het van wie 20 die studie voltooi het. Beide
studiegroepe is opgevolg op 6, 12 en 18 maande (gekorrigeerde ouderdom), by
welke geleentheid die Sensoriese Funksietoets vir Babas (‘Test of Sensory Functions
in Infants’) telkens toegepas is vir die assessering van sensoriese ontwikkeling. Op
18 maande (gekorrigeerde ouderdom) is ʼn assessering met die Griffiths
Ontwikkelingskaal ook gedoen om funksies in die ander ontwikkelingsareas van die
babas te bepaal. Toetsresultate is geanaliseer met behulp van herhaalde ANOVAmetings
en die Bonferoni t-prosedure om die effek van die Sensoriese
Ontwikkelingsorgprogram op die sensoriese ontwikkeling van die babas tot en met
18 maande (gekorrigeerde ouderdom) te bepaal.
RESULTATE
Die resultate van die vergelyking van die prestasie van beide groepe (groep-effek),
gemeet met behulp van die Sensoriese Funksietoets vir Babas, is van groot belang
vir hierdie studie. Die intervensiegroep het betekenisvol verskil op die totale telling
(p<0.00), sowel as op die volgende vier van die vyf subtoets-tellings: respons op
diepdruk (‘tactile deep pressure’) (p<0.03); motoriese aanpassingsreaksies (p<0.03);
visuele tas-integrasie (p<0.00); en respons op vestibulêre stimulasie (p<0.01).
GEVOLGTREKKING
Die resultate van die studie dui aan dat die babas in die intervensiegroep baat gevind
het by die Sensoriese Ontwikkelingsorgprogram met betrekking tot hul sensoriese
funksies tot en met die ouderdom van 18 maande (gekorrigeerde ouderdom). Die
Sensoriese Ontwikkelingsorgprogram het geblyk prakties sowel as suksesvol te
wees met betrekking tot sy doel. Die Program sou daarom met vrug in ander
neonatale intensiewe sorgeenhede aangewend kon word. === ENGLISH ABSTRACT: BACKGROUND
Premature infants of very low birth weight are known to be inclined to developmental,
medical, behavioural and various learning deficiencies by the time they reach schoolgoing
age. Concerns have been raised about the effect of the neonatal intensive care
unit environment on the sensory development of the premature infant and how this
could contribute to these deficiencies. Various approaches claim to address this
problem, of which kangaroo mother care and developmental care have in the
literature been singled out as particularly promising. However, at the commencement
of this study no empirical studies had been reported in the literature to confirm any of
the claims of these approaches. Therefore, a need existed for an empirically
researched programme that could be practically applied in the neonatal intensive
care unit with a view to reducing environmental stressors regarding the sensory
systems of the premature infant.
AIM
The aim of this study was to determine the influence of a Sensory Developmental
Care Programme, which incorporated a specific kangaroo mother care protocol, on
the sensory development of the very low birth weight premature infant, up to the age
of 18 months (corrected age).
METHODOLOGY
A randomised controlled study was conducted. The study sample consisted of 89
very low birth weight premature infants, admitted during a 24-month period to the
neonatal care unit at Tygerberg Hospital in Cape Town, South Africa. The infants
were recruited by means of certain criteria and then randomly assigned to one of two
groups: 1) the intervention group was cared for according to the Sensory
Developmental Care Programme for ten recorded days; and 2) the control group that
received the standard care of the unit, also for ten days. The intervention group
consisted of 45 infants of whom 22 completed the study, while the control group
consisted of 44 infants of whom 20 completed the study. Both study groups were
followed up at six, 12 and 18 months (corrected age) when the Test of Sensory
Functions in Infants was used to do a sensory developmental assessment. At 18
months (corrected age) a Griffiths Developmental Scale assessment was also
conducted to determine function in other areas of development. Test results were
analysed using repeated measures of ANOVA, and the Bonferoni t procedure to
determine the effect that the Sensory Developmental Care Programme had on the
sensory development of the infant up to 18 months (corrected age).
RESULTS
The results of the comparison of the performance of both groups (group effect),
measured by the Test of Sensory Functions in Infants are of great importance to this
study. The intervention group had a significant difference on the total score (p<0.00),
as well as on the following four of the five sub-tests scores: reactivity to tactile deep
pressure (p<0.03); adaptive motor functions (p<0.03); visual-tactile integration
(p<0.00); and reactivity to vestibular stimulation (p<0.01).
CONCLUSION
The results of this study signify that the infants in the intervention group benefited
from the Sensory Developmental Care Programme concerning their sensory
functions up to the age of 18 months (corrected age). The Sensory Developmental
Care Programme was demonstrated to be both practical and successful in terms of
its aims. The Programme could therefore be fruitfully utilised in other neonatal
intensive care units.
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