BackgroundEnvironmental factors compound or diminish the effects of impairments; therefore they have a direct influence on participation of stroke survivors.ObjectivesTo determine environmental barriers and facilitators to participation experienced by a group of stroke survivors in the Western Cape province of South Africa.MethodsA descriptive, mixed methods study was conducted in 2011. Quantitative data was collected with the International Classification for Functioning, Disability and Health core set for stroke (environmental factors), from 53 stroke survivors, sampled through proportional, stratified, random sampling. Data is presented through graphs and tables. Qualitative data was collected from five purposively sampled participants and thematically analysed.ResultsUnder products and technology, participants regarded assets, food, products and technology for daily living, transportation, mobility and communication, and access to buildings as barriers. The physical geography and attitudes of friends and society created further barriers. With regard to services, systems and policies - housing, communication, transport and social services created barriers. Health services, as well as support from health care service providers and family were considered facilitators.ConclusionA lack of assets compounded barriers with regard to food, products for daily use, communication and transport. Barriers to participation were exacerbated by a lack of services, systems and implementation of policies focused on the inclusion of people with disabilities, as well as minimal access to assistive devices. Recommendations include provision of assistive devices, structural changes to houses, yards, roads and buildings, lobbying for accessible, affordable public transport, access audits of public buildings, and inclusion of non-governmental organisations and home-based care services in a seamless network of care.

INTRODUCTION: This paper explores causal connections between impairments, activity limitations and participation restrictions after stroke. Understanding the impact of impairment on activities and participation can assist with determining optimal interventions. METHODS: The study population (N=267) of this descriptive study were public health care users, from the eastern sub-district of the Western Cape Metropole, who had had a stroke in 2009 or 2010. Fifty-three study participants were selected through stratified, proportional, random sampling. Data were collected using the Stroke Impact Scale-3.0 (SIS); the Modified Barthel Index (MBI); the Loewenstein Occupational Therapy Cognitive Assessment and a language screening test. Linear regressions to determine if impairments could be correlated with activity limitations and participation restrictions were done with Spearman rank correlations. T-tests were used to determine if impairments had any statistically significant impact on activities and participation. RESULTS: The mean SIS participation score was 31.3/100. Participation as measured by the SIS showed positive correlations with, and was impacted signifcantly by limb strength (r=0.49; p<0.01), visual perception (r=0.57; p<0.01), spatial perception (r=0.31; p=0.02), motor praxis (r=0.58; p<0.01), visuomotor organisation (r=0.50; p<0.01), and thinking operations (r=0.6l; p<0.01). The mean MBI score was 70.58/l00. MBI scores showed postive correlations with, and were impacted signifcantly by limb strength (r=0.78; p<0.01), hand function (r=0.65; p<0.01), visual perception (r=0.45; p<0.01), motor praxis (r=0.43; p<0.01), visuomotor organisation (r=0.48; p<0.01), and thinking operations (r=0.56; p<0.01). CONCLUSION: Motor, cognitive and perceptual impairments impacted activities and participation negatively. These impairments must be diagnosed and optimally managed. Key words: Stroke, cognition, perception, activities, participation

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