Masters Degrees (Physiotherapy)

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Browsing Masters Degrees (Physiotherapy) by browse.metadata.advisor "Burger, M."

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    The functional outcomes of stroke patients who are HIV positive, HIV negative and HIV undiagnosed, following rehabilitation: a descriptive study
    (Stellenbosch : Stellenbosch University, 2017-12) Hartley, Tasneem; Inglis-Jassiem, G.; Burger, M.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Physiotherapy.
    ENGLISH SUMMARY : Background: With the increase in human immunodeficiency virus (HIV) and non-communicable diseases in low to middle-income countries, the rise in HIV-related stroke incidences is becoming a concern. The sub-Saharan region is where the majority of the global HIV population reside. This places an even greater burden on an already strained healthcare system and economy, as HIV-infected people may have an increased chance of stroke and tend to be significantly younger than the conventional stroke population. With the physical and cognitive deficits that may occur due to HIV infection, along with the neurological deficits caused by stroke, this young population now becomes more dependent, increasing the number of unproductive members of society. Hence, it is important to know whether the combination of stroke and HIV further impairs the function of these individuals. Previous studies assessing the function of HIV-infected patients post stroke focused on mortality rather than the morbidity of HIV+ stroke patients. Furthermore, the outcomes measures used to assess their function were global and not specific enough to describe function adequately. Aim: The primary aim of this thesis is to describe the functional outcomes of HIV positive, HIV negative and HIV undiagnosed patients post stroke following inpatient rehabilitation using various outcome measures. Secondary aims include describing demographics, risk factors, length of stay and patient perception. Setting: The Western Cape Rehabilitation Centre (WCRC), situated in Cape Town, South Africa. Study design: A prospective descriptive cohort study. Methods: Approval for conducting the study was obtained from the Committee of Human Research (HREC) at Stellenbosch University (S15/10/232). From July to December 2016, patients who were admitted to the WCRC post stroke were recruited for the study. Written informed consent was obtained from all eligible participants. Data were collected on admission and just prior to discharge, using the Modified Rankin Scale for stroke severity; the Barthel Index and use of assistive devices to assess function in activities of daily living, level of independence and mobility; the Berg Balance Scale and MatScan (pressure mapping) to assess balance. Data on HIV and immune status, demographics, risk factors and length of stay were also collected. The EQ5D was used to assess participant’s perception of health related quality of life. All data were entered into an Excel spreadsheet, coded and analysed. Continuous data including mRS, BI, BBS and pressure mapping were summarised using median and range. Categorical data were represented as proportions and graphically displayed using a histogram. Statistical analysis was performed using STATA version 14.2 (Statacorp, 2015). Association between categorical variables was assessed using the chi-squared or Fisher’s exact test. Differences in distribution of continuous variables over different levels of a categorical variable were evaluated using the Kruskal-Wallis test, and where differences were detected, the Dunn’s test was used for pairwise comparisons. Relationships between patient characteristics and pain and anxiety were evaluated using ordinal logistic regression. The Kaplan-Meier curve was used to describe the length of stay. Statistical significance was assessed at 5%. Results: Out of 54 potential participants, 49 met the inclusion criteria and were recruited; 9 HIV positive (+), 17 HIV negative (-) and 23 HIV undiagnosed participants. The study sample had 51.02% (n = 25) females and 48.98% (n = 24) males. The majority of the sample were mixed race (53.06%, n = 34), 34.69% (n = 17) were of black ethnicity, 10.20% (n = 5) were white and 2.04% (n = 1) were Indian. A significant difference was found with regard to age. The median age for the HIV+ groups was 30 years, and 50 and 51 years for the other groups, respectively (p = 0.0046). The more common risk factors for the HIV- and undiagnosed groups were hypertension and diabetes (p = 0.001 and p = 0.042) respectively. Substance abuse (p = 0.038) and opportunistic infections (p = 0.005) were more prevalent in the HIV+ group. The median CD4 count was 130 (54-883). All groups showed significant improvements in all functional outcome assessments. The HIV+ group had a higher percentage of participants who scored in the higher percentiles for each functional outcome, but no significant results were seen among groups with regard to change in score in stroke severity (mRS p = 0.748), ADLs, independence and mobility (BI p = 0.886; use of assistive devices p = 0. 722) balance and risk of falling (BBS p = 0.4170 and MatScan results). The HIV+ group scored themselves lower than the other groups on the EQ5D VAS scale. This may have been attributed to their age as they were younger and possibly more functionally abled than their older counterparts, but no significant differences were seen among groups (EQ5D p = 0.805). The HIV+ group had a median length of stay of 45 days, while the HIV- and undiagnosed groups stayed for 55 and 53 days respectively. This difference was not statistically significant (p = 0.0671). Conclusion: Even though the HIV+ group was significantly younger and had fewer risk factors, no statistical significant differences were seen with regard to functional outcome. Functional outcome could be affected by a number of variables. In this sample, HIV status did not seem to affect functional outcome negatively. Larger cohorts are required for more generalisable results, to give a better understanding of the functional outcomes of HIV+ stroke patients.
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    The impact of functional electrical stimulation to the lower leg after a single botulinum toxin injection in children with a spastic equinus gait due to cerebral palsy
    (Stellenbosch : Stellenbosch University, 2008-03) Seifart, Anja; Unger, M.; Burger, M.; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Physiotherapy.
    Cerebral palsy (CP) is a common neurological condition seen in children which results in childhood disability. Damage to the developing brain results in abnormal muscle tone and decreased force generation, which leads to loss of independent function. Previous studies investigating interventions targeting the typical equinus gait pattern seen in spastic CP have reported inconclusive and widespread outcomes. Objectives The objectives of the study were to determine (1) the effect of functional electrical stimulation (FES) after a single botulinum toxin injection into the triceps surae muscle as a functional orthosis on various gait parameters and economy of movement; (2) caregivers’ perceptions of the impact of the intervention on their child’s function and participation, and (3) optimal timing intervals for introducing FES after a botulinum toxin injection. Method Single-subject research with a multiple baseline approach was conducted on five ambulant subjects (average age 5.1 years, SD=1.4) in the Cape Metropole with a dynamic equinus gait due to hemiplegic CP. Two-dimensional gait analysis, isometric dynamometry, Energy Expenditure Index (EEI), and a caregiver questionnaire were used to gather data on walking speed, ankle angles at initial contact of gait, isometric plantarand dorsiflexior muscle strength, energy expenditure during gait, as well as caregiver perception on participation changes. Statistical analysis was conducted by means of ANOVA tests and graphic data illustrations. Results A statistically significant pre- to post intervention (FES after botulinum toxin) change was found for plantarflexor muscle strength. This effect was partially maintained over the withdrawal phase. Caregivers felt the intervention to have a positive influence on their children’s walking speeds, as well as on age-appropriate function and participation. Selfselected walking speed, dorsiflexor muscle strength, and ankle angles at initial contact did not change significantly. A 32-day interval between between botulinum toxin and the FES programme resulted in the most pronounced improvements in terms of walking speed, EEI scores, and plantarflexor muscle strength. Conclusion FES to the lower limb, 32 days after botulinum toxin into the triceps surae, applied for 30 minutes per day, five times a week over a total of four weeks, seemed to improve selected gait parameters as well as caregiver perception of impact on function and activities of daily living. However, further research is needed.
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    The trajectory of general movements from birth until 12-14 weeks corrected age in preterm infants born before 33 weeks' gestation and weighing less than 1500g : a descriptive study
    (Stellenbosch : Stellenbosch University, 2019-04) Van Zyl, Reze; Burger, M.; Du Preez, J. C. F.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Physiotherapy.
    ENGLISH SUMMARY : Background: Preterm infants remains a high risk group for developing neurological deficits such as cerebral palsy (CP). Early identification is important for timely intervention. Tygerberg Children’s Hospital (TCH) is a public hospital with limited resources. It is the biggest neonatal service in the Western Cape. Clinicians depend on a reliable screening method to identify high risk infants in order to allocate resources effectively. Prof. Heinz Prechtl and his co-workers introduced a quick, inexpensive, non-invasive method with high predictive validity for the early detection of those premature infants at risk for later developmental deficits. This method, called general movements (GMs), is based on the assessment of spontaneous movement patterns in young infants. There is limited information available describing the trajectory of GMs in high risk premature infants. Oojective: To describe the trajectories of GMs from birth till 12-14 weeks corrected age and determine the association of known perinatal risk factors on GM trajectories in very low birth weight and extremely low birth weight preterm infants admitted to the neonatal intensive care unit of TCH, Cape Town, South Africa. Methodology: A longitudinal, prospective cohort study with repeated measures was conducted using Prechtl’s method of the qualitative assessment of GMs at the following four key time periods: birth to 33 weeks postmenstrual age (PMA), 34-37 weeks PMA, term age and 12-14 weeks corrected age. Detailed perinatal data of infants were collected. Results were analysed using STATA version 14, IBM SPSS and a logistic regression model to determine the association between perinatal factors and GM outcome. Results: The study sample consisted of 119 infants with a mean birth weight of 1048.2g and a mean gestational age of 28.6 weeks. Of 300 GM assessments done, 157 were preterm assessments, 55 at term age and 88 at 12-14 weeks corrected age. At birth to 33 weeks PMA, 96% of GMs were abnormal and 4% normal. At 34-37 weeks PMA, 89% of GMs were abnormal and 11% normal. All GMs were abnormal at term age. At 12- 14 weeks corrected age, 7% of GMs were abnormal and 93% normal. On univariable analysis, lower birth weight (p=0.043), lower gestational age (p=0.017), intraventricular haemorrhage (IVH) grade IV (p<0.001) and time (PMA in weeks) (p<0.001) were associated with abnormal GMs. Birth weight (p=0.046) and time (PMA in weeks) (p<0.001) were the only variables inversely associated with abnormal GMs on multivariable analysis. Conclusion: The results of this study indicated that GMs are predominantly abnormal prior to term age with a significant decrease in abnormality at 12-14 weeks corrected age. Assessment of preterm and term GM trajectories does not necessarily enable earlier identification of infants at risk for neurodevelopmental difficulties. It is thus not advised that resources be allocated to conduct preterm and term GM trajectories at TCH. Lower birth weight and lower PMA (time) were associated with increased odds for abnormal GMs. Infants with a lower birth weight should be targeted for more frequent follow up and neurological assessments as they remain the most at risk group for neurological deficits. Research on GM trajectories prior to term age and the association of risk factors with long term neurodevelopmental outcome is necessary for future comparison.