Chapter 1

THE PROBLEM AND ITS SCOPE

INTRODUCTION

Rationale of the Study

Disability is “an umbrella term covering impairments, activity limitations, and

participation restrictions. An impairment is a problem in body function or structure; an

activity limitation is a difficulty encountered by an individual in executing a task or action;

while a participation restriction is a problem experienced by an individual in involvement

in life situations”. Disability denotes a negative interaction between a person with a health

condition and his or her contextual factors. (International Classification of Functioning,

Disability and Health).

Persons with disabilities (PWD) are those who have long-term physical, mental,

intellectual, and and sensory impairments which in interaction with barriers may hinder

their full and effective participation in society on an equal basis with others (UN

Convention on the Rights of Persons With Disabilities). A comprehensive approach in

interventions is then necessary for persons with disabilities (PWDs) as it entails actions

beyond the context of health, but more on helping them to overcome difficulties by

removing environmental and social barriers (WHO, 2013).

These persons needed help and they tend to blend with the world through their

utmost effort. To help them, the ordinance of Article 13 Section ll of the Constitution in

the Philippines states the inclusion of persons with disabilities as one of the priority

sectors that shall be given access to essential goods, health and social services. Thus,
Stimulation and Therapeutic activity Center was developed to become a place which

provides comprehensive rehabilitation services to children with disabilities. The

disabilities that are considered as PWD are the psycho social disability, disability

resulting from chronic illness, learning disability, visual disability, orthopedic disability,

mental/ intellectual disability, hearing disability, speech impairment, and multiple

disabilities.

However, it is observed that there are parents or clients who have complaints

in the services that the center offers. Though these services are necessary and should

be followed religiously with the patients, some patients took the services for granted.

Parents have also thought about clinical officers and midwives for there were unexpected

clients that rants before or after the treatment which may causes small bruises or

wounds.

With this present necessity, this study is conducted to satisfy the inquiry of

researchers as to how the level of satisfaction affects the performance of services in the

Stimulation and Therapeutic Activity Center. It is important to seek answers from the

given questions in order to find possible solutions on how to cope up with this problem

and encourage them to move, according to what they will learn in this conducted study.

The result of this study would probably help strengthen the knowledge on both

researchers and staffs in the Center about these certain complaints and be of help to

alleviate possible problems among the parents and their children which can help them to

be productive and be functional in any given life situations through performing various

activities.
Review of Related Literature

Parents satisfaction has increasingly been recognized as an important

factor in the assessment of the quality in the health care services. This growing

interest is the result of the influences of the government, health insurers, patient

organizations and health care professionals themselves. The sick child in

development, from birth until the transition to adult health care requires specific

treatment, care and guidance (Lotour, Goudoever, Hazelzet 2008).

Health care systems including therapeutic centers today are

characterized as complex, in flux, technically proficient, competitive, and market-

driven. Nowadays, there is increased evidence that greater satisfaction with health

services results in better treatment adherence, which leads to better health

outcomes (Garratt et al., 2007; Schmidt, Thyen, Chaplin, Mueller-Godeffroy, &

Bullinger, 2008).

The satisfaction with health care associated with an improvement in their

child’s health or with a reduction of symptoms, including adherence to the

therapeutic regimen and understanding medical information. Thus, the level of

parent’s satisfaction with health care can be used as a good proxy variable for

important aspects of quality of care (Ammentorp, Mainz, & Sabroe, 2006; Hall,

Roter, & Katz, 1988).

Physical Therapy on patients is particularly important and it played a vital

role in the development of the children. It is a branch of rehabilitative health that

uses forms of exercise and equipment which are specifically designed to assist
persons with disability to regain and improve their physical abilities. It helps to

restore their best ability to function through minimizing physical impairment,

disability-related congenital and acquired conditions, and functional limitations.

Persons with disability need to pursue physical therapy anytime they experience a

problem while moving that prevents them in difficulty from performing their

activities of daily living (Weiss, T., 2017).

Occupational Therapy is very important on the patient’s development

because it is a branch of health care that helps patients who have physical,

sensory, or cognitive problems. This therapy can help them regain independence

in all areas of their lives. It can also help with barriers that affect a person's

emotional, social, and physical needs. To do this, they use everyday activities,

exercises, and other therapies. They may be of use of participation of playing,

improving their school performance, and aiding their daily activities which leads to

boosting their self-esteem and sense of accomplishment (Akyurek, G., Bumin, G.,

2017).

Special Education, which is very practical and indeed, played a very

important role in the lives of patients who suffers disabilities. It encompass

students with learning disabilities who are gifted and talented. It is very essential

because not all students learn the same. Students with learning disabilities may

need one on one time, they may not be able to read but if read to they can catch

on, or they may need extra time for their assignments. They may need small group

because they can not pay attention in a large class, they may need to be pulled

out of class when they are done with their work because they become a distraction,
and they might need extra work to enhance their learning. Patients with such

abilities need help getting around school, may need adaptive tools to complete

work, or technology to meet their needs in a classroom (Vaughan, C.M., 2005).

 This study assumes that the Stimulation and Therapeutic Activity Center

services affects the satisfaction rate according to their children’s condition in

Gun-ob, Lapu-Lapu City.

Parent’s Satisfaction in

terms of:

1.1 Physical Therapy STAC services

1.2 Occupational therapy CLIENT’S PARENT
1.3 Special Therapy


Comparison and Correlations

Analysis of Results

Conclusions and Recommendations

Proposed Activity
Figure 1. A Schematic Presentation of the Theoretical Background of the

Study
Related Studies

Prior to 1973, occupational therapists (OTs) and physicals therapists

(PTs) treated children primarily in medical facilities; medically oriented residential

facilities; and separate educational facilities for children with disabilities, commonly

known as orthopedic schools. These facilities, while representing advancement in

the provision of services to children, were separate from the educational and

community environments that most children without disabilities experienced.

Through the early 1970s, occupational therapy and physical therapy were deeply

rooted in a medical orientation where both professionals and laypeople perceived

individuals with disabilities as either continually sick or able to be fixed. (Rainforth

and York-Barr, 1997)

The training and preparation of OTs and PTs, in association with medical

education overall, sustained the practice of focusing on factors within the patient

or client, and removing children from their routine environments for isolated

treatment. These practices reflected the common assumption that treatment would

result in improved skills that would generalize to everyday life.

Physical activities for PWD is primarily intended to reverse conditioned

secondary to impaired mobility, optimize physical functioning, and enhance overall

well-being (Durstine, et al., 2000;Murphy & Carbone,2008).

 Regular physical fitness activity among people with disabilities is highly

encouraged since it helps in disease prevention and promotion of physical and

emotional well-being (Rimmer, 2002). In addition, regular physical activity is

essential for the maintenance of normal muscle strength, flexibility, and joint

structure and function and may slow the functional decline often associated with

disabling conditions (Durstine, et al., 2000).

However, people with disabilities are less likely to participate in sustained

robust exercise than people with disabilities (Healthy Children, 2010 in Fragala-

Pinkham, Haley, Rabin, & Kharasch, 2005).

Physical exercise, as one of possible treatments for people with

disabilities, is often a neglected determinant of good mental and physical health

and its role should not be underestimated in health promotion for people with an

intellectual and/ or developmental disabilities. It is worth recalling the various

physical benefits of exercise which may decrease the risk for chronic disease,

mental health issues and premature death.

According to Warburton, Nicol, and Bredin (2006), for example, have

noted improved vascular functioning amongst adults who engage in regular

aerobic activity. It even assists in regulating the body's physiological reaction

tostress. With the physical and neurological benefits of exercise apparent, it

remains mystifying that exercise is not often suggested as a medical intervention

for those with developmental disabilities. In the recent years, there has been a

focus on persons with disability (PWD) in the Philippines.

 According to 2015 census of the National Statistics Office (NSO), 3.805

million or 3.7 percent have disabilities out of the 102.8 million household

populations in the country. These are the most prevalent types of disabilities

mentioned in the 2015 census: attention deficit/hyperactive disorders, blindness or

low vision, brain injuries, deaf/hard-of-hearing, learning disability, medical

disability, physical disability, psychiatric disability, and speech and language

disability (NSO, 2015).

Eight in ten persons with a disability are unemployed in South Africa,

making discrimination in terms of denial of employment opportunities one of the

worst challenges faced by people living with disabilities. This is despite two

decades of legislation that protects and promotes the employment of people with

disabilities (PWD). Discriminatory perceptions, inaccessibility of public and work

spaces, insufficient access to resources, such as skills training and vocational

rehabilitation, and disincentives created by disability benefits are factors that

contribute towards the high rates of un- employed in PWDs.

Lack of employment adds to the burden of care and perpetuates poverty

cycles for PWD5. Breaking these cycles and creating employment opportunities

for PWDs is a challenge. A possible solution to address this pre-dicament is self-

employment, which is supported by the South African legislation. The National

Small Business Act of 19967 and the White Paper on the Development and

Promotion of Small Business in 1958 facilitates self-employment in small, medium

and micro enterprises (SMME). Several non-governmental organization (NGO’s)

also provide services in assisting PWDs to develop their own small businesses.
 While the National Informal Business Upliftment Strategy (NIBUS), which

is based in the Department of Small Business Development, focuses on supporting

and uplifting existing informal businesses owned by designated groups including

women, youth and PWDs, they do not assist those previously unemployed to

become self-employed10. According to the Disability Census (2011), over a million

PWDs in South Africa are receiving government grants11 due to limited

employment, which ultimately affects the development of the country’s economy

and exacerbates poverty for these individuals13, their families and the society as

a whole.

A prominent occupational therapist, Prof Alfred Ramukumba, recognizes

the impact of unemployment in the lives of South Africans: “Undoubtedly, the inner

world of the majority of the population in South Africa is clouded by poverty and

poor socioeconomic conditions and income generation is viewed as a priority.

Despite their harsh realities, both urban and rural South African communities strive

to improve their lives by seeking employment and participating in income

generating projects”16:397. He urges South African occupational therapists to

focus their approach on meeting the most important needs of their patients, which

in his experience, is the ability to work.

Carroll (1967) had compared academic achievements of 20 students of

special class with that of 19 mentally retarded children who attended regular

classes for half the school day and special classes during the other half. The study

subjects were about 8 years old, and all had been attending special classes on full

time basis in the school year before the study. The Test for reading, spelling and
arithmetic subtests were administered 1 month after the beginning of academic

year at school began and again 8 months into the school year. The finding through

T-test about the grade equivalent from pre-to post-difference scores indicated that

the partially integrated children with mental retardation.

In an empirical paper by Lamichhane and Kawatsu (2014) on the

disability and determinants of schooling in Bangladesh found out being male

demonstrates a negative effect on their school participation. The results obtained

by Mabika and Shapiro (2011) contradicts this result in the case of the Democratic

Republic of Congo wherein boys were significantly more likely to be enrolled than

girls. Having a disability whether severe or not is negatively correlated with school

participation. The negative effect of disability suggests that due to the

discriminatory behavior and other barriers on family and institutions, children with

disabilities are less likely to attend school (Lamichhane & Kawatsu, 2014).
 THE PROBLEM

Statement of the Problem

This study aims to assess the parent's satisfaction on the services of

Stimulation and Therapeutic Activity Center, Gun-ob, Lapu-Lapu City.

Specifically, this study shall seek answers to the following questions:

1. What is the demographic profile of Stimulation and Therapeutic Activity

Center staffs in terms of the following:

(a) educational attainment?;

(b) degree attainment?;

(c) number of years of service?; and

(d) relevant training or seminars attended?

2. What are the services rendered by Stimulation and Therapeutic Activity

Center staffs?

3. What is the level of parent's satisfaction in terms of the following services:

A. Occupational Therapy?

B. Physical Therapy?; and

C. Special Education lessons?

4. Is there a significant relationship between the level of parent's satisfaction

and the services of the Stimulation and Therapeutic Activity Center staffs?
5. Base on the findings, what additional services could be proposed?

The following questions are significant information for research purposes. Please do

not leave a space unprovided.

Stimulation and Therapeutic Activity Center Staffs’ Questionnaire

Name:

Educational Attainment:

Number of years in service:

Relevant training or seminars attended:

Please answer the questions provided.

1. What are the different services you provide in the center to the children?

2. In your own opinion, how effective is your services to the client?

3. What are the different program enhancements you provide to your clients?

Parents in STAC Questionnaire

Null Hypothesis of the Study

Ho1: There is no significant relationship in the level of satisfaction of the parents

to the services of Stimulation and Therapeutic Activity Center.

Ho2: There is no correlation between the Stimulation and Therapeutic Activity

Center services and the parents’ satisfaction.

Significance of the Study

The researchers believed that the findings accumulated by the study will

provide significant benefits of the following individuals:

City of Social Welfare and Development Office will be able to see the

lapses that they had and can able to improve the services and system in

Stimulation and Therapeutic Activity Center;

STAC personnel will develop their skills in order to enhance the services

they handle in the field;

parents will gain knowledge to the services given by STAC personnel.

They will be able to know if the services help to improve or worsen the condition

of their children;

persons with disability (PWD) would be aware of their rights and be

able to improve their capabilities as an individual;

researchers would be provided with springboard to pursue on

investigation parallel to the study.

Scope and Delimitation

The scope of the study is just to assess the satisfaction rate of the parents

towards the STAC staff services. This is intended to evaluate the level of

satisfaction of the parents in the services on Stimulation and Therapeutic Activity

Center in Gun-ob, Lapu-Lapu City. Since there are only three major services

intended for patients and clients: Physical Therapy (PT), Occupational Therapy

(OT), and Special Education (SpEd), a total of 100 parents were chosen as the

respondents, giving random respondents on each services. The study will be

conducted during the second semester since this was the time when all the

requirements are comply and the approval is given.

RESEARCH METHODOLOGY

This part of the study discusses the methods used, the sources of data

used in this study, and the procedure of how data are gathered.

Design

This study employs a correlative research design which measures

variables, assesses and understands the relationship of one another. This type of

non-experimental research method is particularly used in which a researcher

measures two variables, understands and assess the statistical relationship

between them with no influence from any extraneous variable. In this study, it

shows the relationship between the parent’s satisfaction on the services of

Stimulation and Therapeutic Activity Center in Gun-ob, Lapu-Lapu City for

researchers seek to understand what kind of relationships naturally occurring

variables have with one another. To furthermore understand the study, the

researcher selected the respondents as it is.

Flow of the Study

Figure 2 presents how the flow of the study covers the entire research

activities. The input of this study includes the services involved in the Stimulation

and Therapeutic Activity Center including the Physical Therapy Services,

Occupational Therapy services, and Special Education lessons in order to

determine what kind of relationship is naturally occurring between variables have

with one another. The input thoroughly establish significant difference, analysis of

the data, and the interpretation of the data gathered in STAC in Gun-ob, Lapu-

Lapu City. The output of this study is a set of possible recommendations of

improvement on STAC staffs established by the authorities.

Environment

The study is conducted at Stimulation and Therapeutic Activity Center.

This institution is located at Gun-ob, Lapu-Lapu City (see figure 3). This center is

owned by the government and is open for the public continuing their services into

molding early children with disabilities into a productive individual in the future. The

buildings of infrastructures and new facilities are still going on in order to provide

full support for the patients and clients in this center. At present, Stimulation and

Therapeutic Activity Center offers Physical Therapy for maneuvering and helping

individuals to cope up with their disabilities; Occupational Therapy for teaching the
patients or the client to use their abilities with their utmost effort; and, Special

Education for persons who have difficulty in learning inside classrooms and help

them to adapt with new learning environment in the future.

INPUT PROCESS OUTPUT

Parent’s Satisfaction

in terms of:

1.4 Physical Therapy

1.5 Occupational
therapy
1.6 Special Therapy Analysis and

Interpretation of

Data

Figure 2. Flow of the Study

Figure 3. Environment
Respondents

The respondents of the study are the parent of the clients in Stimulation and

Therapeutic Activity Center (STAC), Gun-ob Lapu-Lapu City. The researchers

choose the parents because the study must show their level of satisfaction towards

the services in STAC. The sampling used in the study is Purposive Sampling

Design where the researchers use their judgement to select a sample that they

believe based on prior information, will provide the data they need. The

researchers will conduct analysis from the sample they will gather.

Instrument

The instrument use in gathering the data will be a questionnaire.

Quantitative research questionnaire is use to gather a data and information that

shows the level of satisfaction of parents towards the STAC services.

Data Gathering Procedure

Collection and evaluation of data will be done using the following

procedures: Before gathering a survey or information, permission to the head of

STAC is a must to allow the collections of data needed. A letter of request is sent

to the admin of STAC.

Once the head approved the request, administration and collection of data

or information will be followed. Survey will be conducted to the following questions

in the questionnaire. This includes in determining the demographic profile of STAC

staffs in terms of age, educational attainment, degree attainment, numbers of

years of service and the relevant training or seminars attended. The survey will
happen in STAC, Gun-ob Lapu-Lapu City. Through this research, the significant

relationship between the level of parents’ satisfaction (physical therapy,

occupational therapy and the special education) and the services of STAC staffs

based on their demographic profile will be figured out. After the collection of data,

tallying, tabulation of results, analysis of data, interpretation of results commenced

out of the interpretations, conclusions are drawn which serves as based on

proposing the answers of the unanswered questions.

Treatment of Data

The study used quantitative tools to assist the analysis and interpretation of the

gathered data:

1.Correlation is a technique for investigating the relationship between two

quantitative, continuous variables, for example, age and blood pressure.2.

2.Pearson's correlation coefficient (r) is a measure of the strength of the

association between the two variables.

3. Z-test is any statistical test for which the distribution of the test statistic

under the null hypothesis can be approximated by a normal distribution.

Definition of Terms

Clients. The term used in the study refers to those people who have

special needs, Person With Disability (PWD)/children.

Parents. The term used in the study are the guardians of the client.

Satisfaction. The term used in the study shows the fulfillment of the

needs and wants of the parents for their children.

Services. The term used in the study are physical therapy,

occupational therapy and special education which may help to improve

one’s condition.

Stimulation and Therapeutic Activity Center (STAC). The place

where took cared.