Masters Degrees (Physiotherapy)

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3D measurement of cervical and thoracic postural dynamism in sitting : a pilot study
(Stellenbosch : Stellenbosch University, 2013-12) Fourie, Sarie Marissa; Louw, Quinette; Van Niekerk, Sjan-Mari; Van der Westhuizen, Gareth; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Physiotherapy.
ENGLISH ABSTRACT: The aim of this study was to improve the measurement of postural dynamism in the sitting position using a three-dimensional (3D) motion analysis system. The primary objective was to describe pilot data for postural dynamism of the cervical and thoracic spines while working at a desktop computer. The secondary objective was to refine the process of posture measurement and analysis by decreasing data processing time. Certain factors in 3D motion analysis can lead to an increase in gaps in data collected during trial capture, which in turn will lead to a longer time of data processing. In the first phase of this study, a number of such factors were identified and altered. A series of pilot studies was performed to test the improvement of data processing time when altering these factors. In the first two pilot studies, camera and tripod positionings were explored and refined, workstation layout and anatomical landmark marker placement were investigated, and optimal capture frequency was established. In both these pilot studies, outcomes were established by means of trial and error by experimenting with a variety of different options for the different outcomes. In the third pilot study, computer software which provides computer tasks for the participant during primary trial capture was tested. Two independent computer users performed all the activities as per software, after which they were required to give oral feedback and suggestions on improvement in terms of user friendliness. The objective of the fourth and final pilot study was to include all of the outcomes from the preceeding pilot studies and attempt a trial run of the actual data collection process. A study participant with no affiliation to the research project was used and a complete trial run was performed after which the measurement process was deemed feasible. In the primary study, 18 student volunteers completed a sequence of computer tasks, including keyboard, mouse and reading activities. Prior to data capture, full range of motion of the thoracic and cervical spines were measured in three dimensions for every participant. Data capture took place for the full duration of performance of all computer activities. Outcome parameters for postural dynamism included true range of motion (degrees), proportional range of motion (percentage) and motion frequency (movement per minute) in all three planes of motion of the cervical and thoracic spines. Typing tasks were associated with biggest movement ranges and motion frequencies. Mouse activity was associated with the most stationary posture, exhibiting the least frequent movement as well as the smallest ranges of motion. The results from this study allow us to better understand the dynamic nature of posture, as well as postural dynamism associated with different computer tasks. This study provides a baseline for future research of 3D motion analysis of the sitting posture. It also marks the need for further research regarding ergonomics, use and potential alternatives in the computer workstation and input devices.
The activity and participation profile of persons with traumatic spinal cord injury in the Cape Metropole, Western Cape, South Africa : a prospective, descriptive study
(Stellenbosch : Stellenbosch University, 2012-03) Maclachlan, Mirda; Inglis-Jassiem, Gakeemah; Hillier, Susan; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Physiotherapy.
ENGLISH ABSTRACT: Background Traumatic spinal cord injury (SCI) remains one of the most serious and devastating injuries often resulting in permanent disability and with life changing implications for the individual and his/her family. Successful reintegration into community life and employment after SCI is considered important goals of rehabilitation as this has been positively associated with quality of life, self esteem and life satisfaction. The International Classification of Functioning, Disability and Health (ICF) allows researchers to identify the impact of environmental factors on functioning and disability. Minimal research, particularly in South Africa, has been done on the impact of the environment on persons living with various health conditions and specifically spinal cord injury. Objectives The main purpose of this study was to describe and compare the level of participation of persons with traumatic SCI at two time points (discharge and six months after discharge) from the inpatient rehabilitation setting and to identify the environmental barriers experienced. Methods A prospective, descriptive study was conducted using consecutive sampling. All patients with traumatic SCI that were discharged from September 1, 2008 from the Western Cape Rehabilitation Centre (WCRC) who were eligible for this study were included. Two questionnaires (one based on the ICF and one purposely-developed) and the International Standards for the Classification of SCI (ISCSCI) were used. Data were analyzed with the statistical software package STATISTICA. Results A person sustaining a traumatic SCI in the Cape Metropolitan area of the Western Cape Province is most likely to be a male, young (20 to 29 years), of the Black or Coloured race and living in the Cape Flats suburbs. More than half of the subjects had a grade eight to ten level of education which together with the lack of employers’ responsibilities towards part-time workers might explain the low percentage (11%) of employment at six months after discharge from the WCRC. Complete paraplegia, occurring mainly in the thoracic cord, was the most common neurological disability found in this study. The most common secondary condition was pain followed by spasticity limiting function. The low incidence of pressure sores and urinary tract infections found in this study contradicts findings of previous studies.The majority of the subjects were discharged to the same house they were living in at the time of their injury. However, due to various architectural barriers, some of them were not able to function independently in their homes. Inaccessibility of public transport, the lack of recreational and sport facilities, lack of social support structures in the community and inadequate financial resources were the main environmental barriers experienced by these individuals. Conclusion The main finding of this study was the low employment rate and the difficulty experienced with reintegration at community level after SCI. The results of this study confirm the significant contribution of environmental factors in participation, especially those of transport and education in return to work. Fourteen years after the publication of the Integrated National Disability Strategy (INDS) White Paper (1997), legislative strategies to ensure that people with disabilities have equal access to social and economic opportunities remain lacking.
The aetiology of upper quadrant musculoskeletal pain in high school learners using desktop computers : a prospective study
(Stellenbosch : Stellenbosch University, 2008-03) Prins, Yolandi; Crous, Lynette; Louw, Quinette; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Physiotherapy.
The Western Cape Education Department initiated a project that aims to provide all the learners from the province with computer access and to promote computer use in schools. Prolonged sitting in front of computers and psychosocial factors have been associated with musculoskeletal symptoms internationally. However, the impact of computer use on musculoskeletal pain among South African high school learners is yet to be determined. Objective The objective of the study was to determine whether sitting postural alignment and psychosocial factors contribute to the development of upper quadrant musculoskeletal pain in grade ten high school learners working on desktop computers. Study design An observational analytical study was performed on a sample of 104 asymptomatic high school learners. Methodology Six high schools in the Western Cape metropole were randomly selected 322 grade ten learners who are using desktop computers, were screened for upper quadrant musculoskeletal pain. Measurements at baseline were taken of the 104 asymptomatic learners, 49 girls and 55 boys. The sitting postural alignment was measured by using the Portable Posture Analysis Method (PPAM), which measured head tilt; cervical angle; shoulder pro- and retraction angle and thoracic angle in the sagittal plane. Depression and anxiety were described by using the Beck Depression Inventory (BDI) and the Multidimensional Anxiety Scale for Children (MASC) respectively. The exposure to computer use was described in terms of duration and frequency of daily and weekly computer use. At three and six months post baseline, the onset and area of upper quadrant musculoskeletal pain was determined by using the Computer Usage Questionnaire. Results After six months, 27 of the 104 learners developed upper quadrant musculoskeletal pain due to seated or computer-related activities. There was no difference in computer exposure between the learners who developed upper quadrant musculoskeletal pain symptoms and the learners who remained asymptomatic. An extreme cervical angle (<34.75° or >43.95°; OR 2.6; 95% CI: 1.0-6.7) and a combination of extreme cervical and thoracic angle (<63.1° or >71.1°; OR 2.19; 95% CI: 1.0-5.6) were significant postural risk factors for the development of upper quadrant musculoskeletal pain. There was a tendency for boys to be at a greater risk for upper quadrant musculoskeletal pain than the girls (OR 1.94; 95% CI: 0.9-4.9). Weight greater than 54.15kg and a depression score greater than 11 was found to be significantly associated with a poor posture (OR 3.1; 95% CI: 1.0-9.7; OR 1.02; 95% CI: 1.0-1.1). Discussion and conclusion The study concluded that poor posture, relating to extreme cervical and thoracic angles, is a risk factor for the development of upper quadrant musculoskeletal pain in high school learners working on desktop computers. South African boys were at a greater risk of developing upper quadrant musculoskeletal pain than the girls. However the study found no causal relationship between depression, anxiety and upper quadrant musculoskeletal pain among South African high school learners and computer usage.
Analysis of the vertical ground reaction forces in sports participants with adductor-related groin pain : a comparison study
(Stellenbosch : Stellenbosch University, 2016-03) Coetsee, Anica; Brink, Yolandi; Morris, Linzette; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Physiotherapy.
ENGLISH ABSTRACT: Objectives: The objective of this study was to describe the differences in vertical ground reaction forces (VGRF) in male sports participants with adductor-related groin pain, compared to matched asymptomatic controls. Design: A descriptive observational study with cross-sectional time frame was conducted. Setting: Laboratory based setting at the 3D Human Biomechanics Central Analytical Facility were implemented. Participants: A consecutive sample of twenty-six active male sports participants, thirteen subjects with adductor-related groin pain (unilateral and bilateral) and thirteen matched asymptomatic controls were included. Main Outcome Measures: Three outcome measures were used: time to peak landing force, peak landing force and time to lowest vertical position of the pelvis. Results: Greater differences were seen in time to peak landing force and peak landing force in the unilateral pain group versus the matched controls. No statistical or clinical differences were found in either of the three outcome measures (p>0.05) between the subjects and their matched controls. Conclusions: This study demonstrates similar VGRFs between subjects with and without chronic adductor-related groin pain and that changes in VGRF might not result from adductor-related groin pain. Clinically, teaching appropriate landing strategies to decrease VGRF may not be useful in male sports participants with chronic adductor-related groin pain.
Ankle kinematics and ground reaction force during single leg drop landing in sports participants with chronic groin pain
(Stellenbosch : Stellenbosch University, 2014-04) Harwin, Lauren Sandra; Fisher, Dominic; Louw, Quinette; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Physiotherapy.
ENGLISH ABSTRACT: Aims: This study aims to ascertain if there are differences in ankle kinematics and ground reaction force in sports participants with chronic groin pain compared to healthy controls. Methods: A cross sectional descriptive study design was used. Twenty participants - 10 cases with chronic groin pain and 10 healthy controls participated. The 10 cases included participants with unilateral pain (n=7) and bilateral pain (n=3). For analysis, the bilateral pain group was divided into the most and less painful side. The study was conducted at the FNB 3D Motion Analysis Laboratory, Stellenbosch University. Sagittal plane kinematics and VGRF was analysed during a single leg drop landing. Results: The group with unilateral groin pain had a higher peak force compared to the matched side of the controls. The bilateral pain groups had less plantarflexion at foot contact (most affected p=<0.001; least affected p=<0.001) and total range of motion (p=<0.05) compared to the control group. The bilaterally injured groin pain groups demonstrated less peak force when compared to controls. Conclusion: This is the first study to indicate alterations in ankle kinematics and VGRF and that these changes are more apparent in sports participants with bilateral pain. Less range of motion during the landing task illustrated by the bilateral pain group suggests less effective force absorption of the distal segments. In the bilateral groups it suggests that force attenuation may have occurred high up the kinetic chain which may place more strain on the groin. Clinically rehabilitation of the athlete with chronic groin pain should include the distal segments of the lower limb. Further research should be conducted in larger groups.
Assessment of functional capacity in low-resource settings – adapted six-minute walk tests
(Stellenbosch : Stellenbosch University, 2021-03) Fell, Brittany L.; Heine, Martin, 1957-; Hanekom, Susan D.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Physiotherapy.
ENGLISH SUMMARY : Background: Measuring functional capacity is an important assessment tool that aids researchers and clinicians in determining the diagnosis, prognosis, and management of patients in various populations. The gold standard for functional capacity testing is cardiopulmonary exercise testing. However, this test requires specialised equipment and trained staff, and is therefore not readily available in many clinical settings. The 6-minute walk test (6MWT) is used as a validated alternative, requiring minimal resources or training. In 2002 the American Thoracic Society (ATS) published guidelines to standardise the implementation of the test. However, considering several constraints, especially within the context of ow-resource settings (LRS) researchers and clinicians alike have had to adapt the methods used when implementing the test. Using different methods for the same test may limit the interpretation and clinical applications of the test. The aim of this theses is to evaluate the application and protocols used for the 6-minute walk test within LRS. Methods: A scoping review was undertaken to identify published studies that implement adapted protocols when conducting the 6MWT. Additionally, the rationale for these adaptations were investigated. Five electronic databases were accessed and searched from inception to October 2019. Data concerning the study source, participants, reported 6MWT purpose, variations (e.g. course length), 6MWT outcome, and rationale for making protocol adaptations were extracted. The findings in this study were used to inform the development of a cross-sectional study with the aim to determine the agreement between the ATS standard 30m 6MWT pathway, a 10m straight and a 10m figure-ofeight pathway, in patients with non-communicable disease. Results: The search returned 564 records of which 22 studies were included. Studies were predominantly conducted in lower-middle income countries. The most common adaptation made to ATS guidelines was course length, being either shorter or longer than the standard 30 meters. Few studies (n = 8, 36%) provided a rationale for adapting the 6MWT. However, based on these eight studies, space limitations was the most common argument for making adaptations. Subsequently, we recruited 27 patients with one or more non-communicable disease to perform two 6MWTs. Fifteen participants performed both a 30 meter straight and a 10m straight 6MWT and twelve participants performed a 30m straight and a 10mfigure-of-eight 6MWT. Regardless of chosen configuration (10m figure-of-eight versus 10m straight), a shortened 6MWT pathway resulted in a significantly smaller 6-minute walk distance. Moreover, the difference was larger than the reported minimal clinically important difference thereby highlighting the clinical implications of adapting the 6MWT. Conclusion: Strict adherence to the ATS guidelines for conducting the 6MWT is challenging. Common adaptations included a change in course length and/or course configuration (chapter 2), with such adaptations having clinically relevant implications to the outcome of the 6WMT (chapter 3). This provides limitations to the application and interpretation of the test. Researchers and clinicians need to take this into consideration when adapting the protocol used for the 6MWT. Reference equations that take into account the adaptations should be considered. However, accounting for every variation of the test may not be feasible. Alternative tests for functional capacity testing within the context of LRS may be a more practical solution.
Asymmetry in hip, knee and ankle kinematics in cyclists with chronic unilateral patellofemoral pain
(Stellenbosch : Stellenbosch University, 2016-03) Brand, Erika Gertruida; Louw, Q.; Crous, L.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Physiotherapy.
ENGLISH ABSTRACT: Background: Cycling has grown in popularity over the last number of years and the nature of the sport has led to a high incidence of overuse injuries such as patellofemoral pain (PFP). With patellofemoral pain being multifactorial numerous aspects have been investigated. In an attempt to further investigate contributing factors, asymmetry of joint kinematics in the lower limb has been investigated. Kinematics of the hip, knee and ankle joints in the sagittal, coronal and transverse plane were evaluated. Aim: The aim of this study was to investigate whether asymmetry of hip, knee and ankle kinematics in cyclists could contribute to patellofemoral pain when compared with cyclist without knee pain. Study Design: Descriptive study design was incorporated. Study Setting: This study was conducted at the FNB -3D motion analysis laboratory at the University of Stellenbosch, South Africa. Method: Road cyclists were recruited in South Africa and Namibia. The study sample comprised of seven road cyclists (4 with PFP and 3 without pain) who were evaluated at the FNB Motion Analysis Laboratory at Stellenbosch University. The Vicon Motion Systems (Ltd) (Oxford, UK) was used to capture three-dimensional joint kinematics. Collected data was utilised to draw graphs for visual comparison. Results: In the sagittal plane no asymmetry was noted in the hip and knee movement, but asymmetry was present in the ankle joint. However the asymmetry was present for both asymptomatic and symptomatic groups. In the coronal and transverse plane asymmetry was present in all joints; both the asymptomatic and symptomatic group presented some level of asymmetry. Conclusion: Asymmetry was apparent in the hip, knee and ankle joints in the coronal and the transverse plane, however it is present in the symptomatic as well as in the asymptomatic group and could therefore not be identified as a contributing factor for the development of patellofemoral pain. These findings highlight the fact that PFP is multifactorial and that all possible contributing factors should be kept in mind when evaluating and treating cyclists with PFP.
Balance in recreational/non-professional dancers with snapping hip : a cross-sectional study
(Stellenbosch : Stellenbosch University, 2022-04) Lategan, Roxanne; Brink, Yolandi; Berner, Karina; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Physiotherapy.
ENGLISH SUMMARY: Snapping hip (SH) or coxa sultans is a common condition amongst the dance population. The symptoms are insidious and often ignored until it becomes painful or problematic. Hip muscle weakness is a common characteristic of SH, particularly affecting the gluteus medius muscle. A weak gluteus medius muscle has been linked to poor balance in the healthy population, and balance is a skill dancers need to be proficient in. Furthermore, gluteus medius weakness may relate to the three main predictors of dance-related lower limb injuries (Functional Turnout [FTO], compensated turnout [CTO], and hip external rotation [HER]). To date no studies have been conducted on dynamic balance and associated factors in a group of dancers with SH. A better understanding of factors associated with SH in dancers could suggest potential strategies for screening and rehabilitation to improve performance, quality of life, and mitigate future recurrence of the condition. Aim: This study aimed to describe FTO, CTO, HER range of motion (ROM), hip muscle strength (HER and hip abduction), and dynamic balance in a group of recreational dancers with SH, to describe any differences between the affected and unaffected sides, and to determine whether there were any relationships between the variables. Methodology: A descriptive cross-sectional study was conducted. A questionnaire was filled in by potentially eligible volunteers, to screen for SH and to gather demographic information. Eligible participants were measured for FTO and HER ROM, hip muscle strength tests were conducted with a hand-held dynamometer, and the Y-test for dynamic balance was performed. Descriptive results were presented using means, percentages, standard deviations and 95% confidence intervals. Differences between groups were based on the paired t-test and relationships were calculated using Pearson’s correlation coefficients. A one-way ANOVA test was used to compare four pain categories according to age. The level of significance was set at p<0.05. Results: Twenty-three female participants aged 15-40 years were clinically diagnosed with internal SH. The relationship between HER muscle strength on the affected side and CTO was significant (p=0.013), and moderately positively correlated (r=0.51). Other noteworthy albeit non-significant relationships were hip abduction muscle strength and balance on the unaffected side (r=0.40; p=0.06), hip abduction strength on the unaffected side and CTO (r=0.37; p=0.08), and HER strength and balance on the unaffected side (r=0.37; p=0.08). There were no significant differences between sides (all p>0.05) and pain was not related to age (p= 0.416). Conclusion: Findings did not demonstrate poorer dynamic balance on the affected leg in dancers with SH than in the unaffected leg and were inconclusive in terms of other relationships and comparisons, including a relationship between gluteus medius and dynamic balance. HER muscle strength on the affected side and CTO may however need to be considered as related factors when screening for impairments in dancers with SH. Little knowledge remains regarding SH and dynamic balance in dancers. More studies with larger samples are needed to make more conclusive inferences about these outcomes.
The biomechanical risk factors associated with preventing and managing iliotibial band syndrome in runners : a systematic review
(Stellenbosch : Stellenbosch University, 2015-04) Aderem, Jodi; Louw, Quinette; Stellenbosch University. Faculty of Health Sciences. Interdisciplinary Health Sciences. Physiotherapy.
ENGLISH ABSTRACT: Introduction: Iliotibial band syndrome (ITBS), an overuse injury, is the second most common running injury and the main cause of lateral knee pain in runners. Due to the increasing number of runners worldwide there has been an increase in its occurrence. Runners with ITBS typically experience symptoms just after heel strike at approximately 20°-30° of knee flexion (impingement zone) during the stance phase of running. A variety of intrinsic and extrinsic risk factors may be responsible for why some runners are more prone to developing symptoms during the impingement zone as opposed to others. Abnormalities in running biomechanics is an intrinsic risk factor which has been most extensively described in literature but little is known about its exact relationship to ITBS. Objectives: The purpose of this systematic review was to provide an up to date evidence synthesis of the biomechanical risk factors associated with ITBS. These risk factors may need to be considered in the prevention or management of ITBS in runners. A clinical algorithm is also presented. Methods: A systematic review with meta-analysis was conducted. An electronic search was performed in PubMed, PEDro, SPORTSDisc and Scopus of literature published up-until May 2014. Cross-sectional and cohort studies were eligible for inclusion if they evaluated the lower limb biomechanics of runners with ITBS or those who went onto developing it. All studies included in the review were methodologically appraised. Evidence was graded according to the level of evidence, consistency of evidence and the clinical impact. Data was described narratively using tables or narrative summaries where appropriate. A meta-analysis was conducted for biomechanical risk factors which were reported in at least two studies, provided that homogeneity in the outcomes and samples were present. Results: A total of 11 studies were included (1 prospective and 10 cross-sectional). Overall the methodological score of the studies was moderate. Increased peak hip adduction and knee internal rotation during the stance phase may predict the development of ITBS in female runners. These biomechanical risk factors may need to be screened for ITBS prevention, despite the evidence base being limited to a single study. Currently there is no conclusive evidence that any of the biomechanical parameters need to be considered when managing runners with ITBS. Stellenbosch University https://scholar.sun.ac.za iii Conclusion: Biomechanical differences may exist between runners with ITBS and those who may develop ITBS compared to healthy runners. Although a large variety of biomechanical risk factors were evaluated, the evidence base for screening or managing these risk factors for runners with ITBS is limited. This is due to a small evidence base, small clinical effect and heterogeneity between study outcomes and findings. Further prospective and cross-sectional research is required to ascertain if abnormalities in running biomechanics may be related to why runners develop ITBS or to ascertain which risk factors may be involved when managing these runners.
Competency framework development in healthcare : a physiotherapy perspective
(Stellenbosch : Stellenbosch University, 2023-03) Mocke, Marieke; Unger, Marianne; Hanekom, Susan; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Physiotherapy.
ENGLISH SUMMARY: Background: Across the globe, countries are challenged to design healthcare systems that succeed in delivering equitable healthcare to their citizens. A competent health workforce has been cited as essential to address the burden of disease and improve the health of individuals and communities. Competency frameworks are important tools to describe such a workforce, reporting the skills, knowledge, behaviours and attitudes needed to meet the population’s health needs. However, for the profession of physiotherapy, consensus on competencies is not clearly defined. This poses a challenge to the development of physiotherapy competency frameworks. Understanding the global perspectives on physiotherapy competencies may assist in the development of competency frameworks that are applicable to the local context. Aims: The aims of this thesis are to identify and synthesise published physiotherapy competencies, and present a conceptual thematic framework which may guide the future development of contextually relevant physiotherapy competency frameworks. Methodology: Two separate phases were undertaken to accomplish the research aims. In phase 1, a document review of all published physiotherapy competencies was conducted. All competencies from these documents were extracted and collated within the structures of the Canadian Medical Education Directions for Specialists (CanMEDS) and the World Health Organization Rehabilitation Competency Framework (WHO RCF). Phase 2 utilised an inductive approach to thematically analyse the competency statements from the WHO RCF dataset compiled in phase 1. Results: The document review identified 20 documents for inclusion, with the first published in 2008 (Ireland) and the latest in 2021 (Latvia). The majority of current physiotherapy competency documents, and thus the descriptions of physiotherapy competencies, originate from high-income countries. The competencies extracted from all included documents could be accommodated within both the WHO RCF and the CanMEDS framework, suggesting that either may be used for developing competency frameworks for the physiotherapy profession. From the WHO RCF dataset, a conceptual thematic framework was developed consisting of 17 themes and 59 sub-themes. Conclusion: With the changing profile of the burden of disease, healthcare systems and the role of the physiotherapist must evolve. Adequately describing the competencies for physiotherapists to excel in their work is foundational to the credibility of the profession not only among health professions but within society. This thesis provides an updated perspective on physiotherapy competencies and serves as a springboard from which to define contextually relevant physiotherapy competencies. This conceptual thematic framework can aid in the development of a physiotherapy competency framework in any setting.
Computer-related musculoskeletal dysfunction among adolescent school learners in the Cape Metropolitan region
(Stellenbosch : University of Stellenbosch, 2007-03) Smith, Leone; Louw, Quinette; Crous, Lynette; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Physiotherapy.
INTRODUCTION Computer use has been identified as a risk factor for the development of musculoskeletal dysfunction among children and adolescents internationally. Computer exposure has increased in the Western Cape since 2002, with the inception of a project to install computer laboratories in all schools in the province. As musculoskeletal dysfunction experienced during adolescence is predictive of musculoskeletal disorders in adulthood, it is essential to identify all risk and/or associative factors. METHODOLOGY A descriptive study was conducted with the aim to investigate whether the musculoskeletal dysfunction of high school learners in the Cape Metropolitan region was related to their computer use. This study was conducted in two phases. Phase 1 of the study entailed the completion of a new questionnaire, the Computer Usage Questionnaire, by grade 10-12 learners. The learner sample was divided in a computer and a non-computer group depending on their exposure to the school computer. Phase 2 of the study involved the assessment of the ergonomic design of the computer laboratories at randomly selected high schools within the Cape Metropolitan region. RESULTS A total of 1073 learners (65% girls & 35% boys), aged 14-18 years, completed the CUQ in phase 1 of the study. The results indicated that learners in the computer group had greater weekly exposure to computers than the non-computer group. The prevalence of musculoskeletal dysfunction among this learner sample was 74%. The most common body areas of dysfunction were the head, low back and neck. The female gender, playing sport and using the school computer for more than three years were associated with musculoskeletal dysfunction. Weekly computer use of more than seven hours was predictive of general musculoskeletal dysfunction, low back pain and neck pain. Twenty nine computer laboratories within 16 selected high schools were assessed by means of the Computer Workstation Design Assessment (CWDA). Out of a total score of 40, the computer laboratories obtained average scores of less than 45%, indicating compliance with less than half of the standard ergonomic requirements. The average scores for the workspace environment was less than 40%. The design of the desk, chair and computer screen had the poorest compliance to ergonomic guidelines. DISCUSSION AND CONCLUSION The prevalence of musculoskeletal dysfunction among this sample was higher than among other similar samples on the same study topic. The higher prevalence may be attributed to the poor ergonomic design of the computer laboratories in the Cape Metropolitan region. Learners’ reduced participation in activities such as sport and working on a computer due to their musculoskeletal dysfunction, may impact on their choice of a future career. The tendency of learners not to seek medical advice for their musculoskeletal dysfunction may predispose the development of chronic musculoskeletal disorders. Education of related parties on safe computing habits as well as advice on the ergonomic design of computer laboratories is recommended to prevent the progression of adolescent musculoskeletal dysfunction into chronic disorders in adulthood.
COPD patients in the northern suburbs of the Western Cape Metropole hospitalised due to acute exacerbation : baseline study
(Stellenbosch : Stellenbosch University, 2008-03) Pienaar, Lunelle Lanine; Hanekom, S.; Unger, M.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Physiotherapy.
ENGLISH ABSTRACT: Acute exacerbation is an important event of COPD as it causes significant disability and mortality. Especially repeated hospitalisation of patients with acute exacerbation has been associated with reduce quality of life and excessive hospitalisation cost. Chronic Obstructive Pulmonary Disease causes significant functional limitations that translate into enormous economic and societal burden. Study Aim: To describe the profile and selected outcomes of Chronic Obstructive Pulmonary Disease (COPD) patients admitted with acute exacerbation to hospitals in the northern suburbs of the Western Cape. Study design: A multicenter retrospective descriptive single subject design was used. Method: Patients admitted with the diagnosis of COPD with acute exacerbation in the time period 01June 2004-01June 2005 were followed up retrospectively for a period of 12 months. The demographics, medical condition on admission and past presentation of acute exacerbation, length of stay in hospital and the number of readmissions for acute exacerbation in the 12 month period were collected and recorded on a self designed data capture sheet. Results: One hundred and seventy eight patients were admitted with acute exacerbation at the three hospitals. The mean age of the patients were 63 (±11.73), more males than females (103: 75) were admitted. Subjects spent a mean of 5.67 (±6.55), days in hospital with every admission and admission frequency of up to eight periods were recorded. Of the n=178 admitted, 56% had one admission and 44% had 2 or more admissions in the study year. This resulted in a total of 338 hospital admissions with the 78 subjects responsible for the majority of admissions (238) Subjects presenting with two or more co-morbidities had a significantly greater risk of multiple re admissions. Subjects with three or more admissions had two or more co morbidities (p=0.001), comparatively those with one admission had only one co morbidity. Congestive cardiac failure (p=0.01) as well as the lack of Long Term Oxygen Therapy p=0.017) were associated with increase risk of three or more admissions. Conclusion: Patients admitted with acute exacerbation to the hospitals where the study was conducted presented with an age ranging from 30-95 years. Patients with 2 or more admissions experience up to eight readmissions episodes in the study year. This is a cause of concern in respect of the burden of disease on especially the younger economically viable South African population. In the current study factors that influenced readmission were the presence of two or more co morbid diseases, specifically the presence of congestive cardiac failure as well as the lack of LTOT. Interventions including a pulmonary rehabilitation programme post discharge should be aimed at decreasing frequency of hospitalisation especially in those patients who are a risk of readmission.
The correlation between passive and dynamic rotation in both the lead and trail hips of healthy young adult male golfers during a golf swing
(Stellenbosch : Stellenbosch University, 2014-04) Alderslade, Villene; Crous, Lynette; Louw, Quinette; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Physiotherapy.
ENGLISH ABSTRACT: Introduction-The golf swing is a complex, sequenced movement of body segments. This movement is smooth and well timed and is referred to as the kinematic golf sequence. This kinematic sequence illustrates the rotational speed, which occurs between the upper and lower body segments. Hip rotation plays an integral part to a sound kinematic sequence by providing a pivotal point between the upper and lower body segments, ensuring a synchronised golf swing. Hip rotation kinematics during a golf swing has received relatively little attention compared to other body segments’ movements. However, clinicians need to have a clear understanding of the rotational contribution that each hip make during golf swing in order to enhance the athlete’s performance and reduce the risk of injury. The aim of this descriptive research project was to obtain and investigate the total passive and total dynamic rotation range of movement in both the lead and trail hips of healthy, young adult, male golfers. Methodology-Seven, low handicapped, male golfers between the ages of 18 and 40 years were randomly selected in the Western Cape region from areas surrounding Stellenbosch University’s Tygerberg campus. A questionnaire gathered participant demographics that determined participatory eligibility. A preliminary reliability study established a baseline measurement for passive total articular hip rotation. Seatadjusted total passive hip rotation ranges of motion (ROM) measurements were collected with a hand-held inclinometer. Dynamic total hip rotation kinematic data was captured during a golf swing with an 8-camera video analysis system (VICON). Data analyses were performed with Statistica version 10. Hand-held inclinometer intra-rater reliability was determined with a two-way interclass correlation, standard error of measurement and a 95% confidence interval level. A Spearman correlation coefficient determined correlation between the total passive and total dynamic rotation range of movement in both the lead and trail hips. Results-Passive intra-rater reliability was reported as 0.81 (95% CI: 0.46-0.96). The total average passive articular range between the lead (62.1° ±6.4°) and trail hip (61.4° ±3.8°) did not report any significant difference (p=0.8). The total average dynamic golf swing articular range between the lead (29° ± 6.5°) and trail hip (35.° ±7.8°), was reported as significantly (p=0.04) asymmetric. The findings also demonstrated a positive correlation between the passive and dynamic total articular range in a lead hip, whereas a negative correlation was reported in a trail hip. During the golf swing the lead hip utilised 46.4%(± 8) of the total passive available hip rotation, whereas the trail hip utilised 58.8% (±13.2). Discussion and Conclusions-The findings of this study show that, the passive rotation ROM in a hip (LH=62°; TH=61°) of a golf player does not exceed the available range it has during a golf swing. The golfer’s hip utilises 46% of the available passive range of movement in the lead hip and 59% in the trail hip. In the clinical field careful consideration should be given to the motivation behind mobilizing, treating or stretching the hips of a golf player. These findings can be incorporated in future research on the relationship between hip-rotation ROM and reduction in the incidence of injuries amongst golfers.
Cultural beliefs towards disability : their influence on rehabilitation
(Stellenbosch : Stellenbosch University, 2002-03) Masasa, Tseleng Leonea; Faure, M. R.; Irwin-Caruthers, S. H.; Stellenbosch University. Faculty of Medicine Health Sciences . Dept. of Interdisciplinary Health Sciences. Physiotherapy.
ENGLISH ABSTRACT: South Africa is a multicultural, multiracial and multilingual nation ("the rainbow nation") with different traditions, values and cultural practices. Due to this diversity there are different belief systems, which give rise to different attitudes and practices towards various health issues such as disability, which in turn, have an impact on the rehabilitation of people with disability. The purpose of this study is to investigate the knowledge, attitudes and cultural beliefs towards disability and to identify the commonalities and differences of three broad cultural groups of South Africa (Blacks, Coloureds and Whites), and to determine their influence on the rehabilitation of disabled people in the Cape Town area. Sixty respondents (20 Blacks, 20 Coloureds and 20 Whites) were interviewed utilizing the knowledge, attitude and belief (KAB) survey in the form of a structured interview. Both probability and non-probability (systematic and purposive) sampling were used. The study was carried out using both quantitative and qualitative methods. The results showed that Whites and Colored generally had a fairly good knowledge of disability and its causes, acquired while they were young, whereas Blacks had a more superficial knowledge of disability, which was only acquired after the birth of a disabled child. The results also revealed that quantitatively all the cultural groups held positive attitudes towards the rehabilitation, education, marriage, childbearing and employment of people with disability. Attitudes towards the stigma attached to being disabled were also encouraging. In contrast, the qualitative data showed disparities between the three cultural groups in attitudes towards rehabilitation, education and marriage. Although rehabilitation is considered an important aspect to disabled people and their families, some Blacks experience problems in transporting their children to centres where rehabilitation services are offered. Socio-economic factors also have a bearing on this. The results revealed a general lack of awareness of disability among school children and teachers in Black and the Coloured schools, which may make it difficult for disabled children to be integrated into mainstream schooling. Marriage and childbearing was regarded as a way of increasing the support base of individuals with disability in the Black group, while the Coloured and White groups viewed marriage as a way of enjoying life and having children a matter of individual choice. Concerning employment and the promotion of people with disability, all three groups believed that disabled people have a right to be employed and earn a salary. In the area of beliefs, the results showed that the Black group blamed disability on witchcraft and that they consult health professionals, folk healers and look to God for healing. Most of the Whites and Coloureds believed that disability is a result of natural causes, human error or the will of God. There is an uneven geographic distribution of information about disability. Cultural beliefs towards disability may delay or hinder early identification of children and intervention. Two main recommendations are made arising from these results. Firstly, health professionals should know and understand the culture, values, beliefs and expectations of their clients and, more importantly, bring services to the recipients in their own familiar environment, culture and community, via the CBR model. Secondly, I recommend that an evaluation of knowledge and attitudes towards disability should be done in schools, where the disability awareness has been raised by some NGOs as compared with those where no intervention has taken place. A survey of this kind should be done in all the provinces of South Africa. The findings from this research thus have very serious implications for the provision of inclusive education and quality rehabilitation services for all the disabled children of South Africa.
Current knowledge of idiopathic scoliosis among practicing physiotherapists in South Africa
(Stellenbosch : Stellenbosch University, 2020-03) Du Toit, Abraham Coetzee; Louw, Quinette A.; Bettany-Saltikov, Josette; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Physiotherapy.
ENGLISH ABSTRACT : Background: The knowledge of Idiopathic Scoliosis has been assessed in Poland, the United States of America (USA), and the United Kingdom (UK) and all the studies concluded that the knowledge of idiopathic scoliosis (IS) among physiotherapy students is limited with respect to the International Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) guidelines. Early recognition and the correct initial management is essential in this progressive disorder, and thus physiotherapists should be aware of the basic criteria involved in the screening, diagnosis, and treatment of IS patients. Aim and Objective: The aim of this project was to ascertain the current level of basic knowledge on Idiopathic Scoliosis (IS) among registered practicing physiotherapists that express an interest in the orthopaedic, muscular, manual and manipulative therapy in South Africa. Furthermore, an objective was to compare the knowledge between the physiotherapists that are registered with the Orthopaedic Manipulative Physiotherapy Group (OMPG) and the physiotherapists that are not registered with this group but who are also interested in orthopaedic, muscular, manual or manipulative therapy. The last objective was to identify any knowledge gaps that exist and the potential for future research studies on IS. Methodology: This was a descriptive study and an online survey was used to collect the data. A previously designed and tested 10-question survey consisted of the majority of the questionnaire. The questions were based on the 2011 SOSORT Guidelines and assessed the following aspects of IS: definition, cause, development, prevalence, diagnosis, treatment, and bracing. The questionnaire also included opinionated questions on the types of physical activity that would be beneficial/harmful to patient’s scoliosis and familiarity with conservative treatment methods for IS. An additional five questions consisted of evidenced based conservative treatment and to ascertain confidence with the assessment, management and education of IS patients. The study was advertised in South African OMPG physiotherapy newsletters with the aim to attract physiotherapists that manage and are interested in the orthopaedic care of patients. The newsletters contained an online link to the information leaflet, consent form, and questionnaire (Appendices A, B, and C). These methods of advertising attracted a diverse group of actively practicing physiotherapy populations of different ages, backgrounds, experiences, with the aim to reduce selection bias and sampling error. Results: Two hundred and twenty-three (223) Physiotherapists spread across the 9 different provinces/regions of South Africa met the inclusion criteria and formed part of the study. One hundred and sixteen (116) of these physiotherapists were members of the OMPG, and the other 107 physiotherapists were not members of the OMPG but expressed an interest in the orthopaedic, muscular, manual or manipulative fields. The analysis showed that 73.5% was able to correctly identify the aetiology of IS and 86% was able to identify when IS is likely to develop. Forty-eight percent (48%) of the physiotherapists correctly identified IS as a three-dimensional deformity, and 41% of the participants incorrectly thought that IS is a lateral curvature of the spine. The participants had a poor understanding of the prevalence, diagnosis, and treatment involved in IS affected clients with only 16%, 17%, and 26% respectively providing the correct responses. Forty-two-point six percent (42.6%) of the physiotherapy group correctly identified when bracing should be recommended for patients with IS. The study further indicated a lack of knowledge regarding the methods of conservative treatment and scoliosis schools available worldwide, with more than 76% of the group not being aware of any of the schools or recognised any treatment methods used for scoliosis rehabilitation. In 85% of the questions, the OMPG group performed better than the non-OMPG group. In 42% of the questions in the survey, the OMPG group achieved a higher than 50% ‘correct’ response rate compared to the non-OMPG group who only managed to achieve a higher than 50% in 28% of the questions. Conclusion: Our findings showed that about one third (33.6%) of the physiotherapists participating in the study could answer more than 50% of these questions correctly and 16.5% could answer 70% of the questions correctly in relation to the widely accepted guidelines on IS management. The findings indicate a lack of knowledge regarding IS patient prevalence, screening, recognition, diagnosis and treatment. The responses and results in the OMPG group were better than the non-OMPG group but still very low especially due to the fact that only 28% of the OMPG group correctly identified the conservative treatment involved with IS. Future research studies should be aimed at identifying the prevalence of IS at a national level in SA. Investigating the content curriculum at under-graduate level in SA, referral strategies for IS patients in SA, and comparing the management of IS in the private and public sectors of SA.
Demystifying cultural competence in the physiotherapy profession : a scoping review and concept analysis
(Stellenbosch : Stellenbosch University, 2023-03) Truter, Christel; Joseph, Conran; Louw, Quinette; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences.
ENGLISH SUMMARY: Background: The ability to engage with patients from different cultural backgrounds and worldviews is accepted as a fundamental skill in healthcare professions, including physiotherapy. The term cultural competence is a critical principle in numerous international policies on healthcare and training outcomes of students as a mechanism to strengthen healthcare provision towards patient-centred care. Aim: This study explores defining attributes of cultural competence in physiotherapy practice to better understand the meaning structure and dimensions. Methods: A scoping review methodology with a concept analytical framework was used to describe the use of the term and its derivatives and the meaning structure in terms of antecedents, defining attributes, consequences, and empirical referents. The methodology included five steps, namely (1) motivation for selecting the concept, (2) identifying the research question and objectives, (3) identifying the relevant papers, (4) study selection, (5) charting the data, collating, summarising, and reporting the results. Five electronic databases were searched for information published from 2007-2021 to achieve this. The last search was done in August 2021. Results: Ten journal articles were included in the review, mainly from the UK and Australia. The term most frequently used in the literature is cultural competence. Antecedents, defining attributes and consequences of the concept of cultural competence were identified in the concept analysis. Defining attributes were categorised as cognitive or socio-behavioural competency, which can impact intrapersonal, interpersonal, organisational, societal levels or a combination of two or more levels. Eight competencies were respectively identified in both the cognitive and socio-behavioural domains. The competencies of reflection on one’s cultural background, values and acknowledgement of different worldviews and the mastery of cultural knowledge, values, beliefs, and behaviour of the ‘other’ are underlined in the included papers in the cognitive domain. Furthermore, the competencies in the socio-behavioural domain of incorporating individualised culturally competent care based on respect, trust, acceptance, empathy, and accountability in practice are most frequently discussed. Conclusion and implications: The central findings of this study demystified the concept of cultural competence in physiotherapy practice by highlighting eight cognitive and eight socio-behavioural attributes. Furthermore, these 16 attributes were spread across different levels of manifestations, namely on the intrapersonal, interpersonal, organisational, and societal levels. The findings provide a theoretical grounding for cultural competence by identifying its defining attributes in the physiotherapy literature to date. Physiotherapists need to learn how to develop the cognitive and socio-behavioural competencies of cultural competence. Healthcare environments need to provide them with adequate support to develop the skills and behaviours to provide culturally competent care to clients. Healthcare institutions must incorporate culturally competent care into their philosophy and goals and provide resources, instruments, and training to improve physiotherapists’ ability to provide culturally competent care.
Describing the rehabilitation workforce capacity data in the public sector of three rural provinces in South Africa
(Stellenbosch : Stellenbosch University, 2022-04) Conradie, Thandi; Louw, Quinette; Berner, Karina; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Physiotherapy.
ENGLISH SUMMARY: Background: Rehabilitation capacity resources are limited or sometimes may be missing completely in low- and middle-income countries. Workforce is intricately linked with all the other health system components and is essential in leadership and governance, management of financial resources and technology, and rehabilitation service delivery. A workforce that is sufficient in number, skills and equitably distributed is vital. The classification of the rehabilitation workforce lacks a common, global definition. A standardised set of descriptors and indicators to describe rehabilitation workforce capacity allows comparison between countries or regions. This rehabilitation workforce data is important to provide a baseline for advocating to improve rehabilitation workforce capacity. Aim: The aim of the study is twofold. Firstly, the aim of the scoping review was to see how rehabilitation workforce capacity data is described and to synthesise the descriptors and indicators used to describe the workforce. Secondly, the aim of the primary study was to describe the rehabilitation workforce in the public sector of South Africa in three rural provinces with respect to number of therapists, distribution by population, type of therapists and qualifications, distribution between rural and urban, salary levels and level of care. Method: The research consisted of a scoping review and a primary study. The scoping review was conducted according to the five-step framework developed by Arksey and O’Malley. The scoping review included primary peer reviewed studies on rehabilitation workforce. Data on the rehabilitation workforce indicators and descriptors were extracted and synthesised. The results were used to describe the primary study workforce data. The primary study was a cross-sectional web-based survey using REDCap. The data was extracted and collated in MS Excel and analysed in SPSS and STATA. Results The findings from the scoping review showed that population adjusted ratios and absolute number of therapists are used to indicate the supply of the rehabilitation workforce. The distribution between urban versus rural and public versus private sectors are used to describe disparities between regions. Age and gender are used to describe the demographics of the rehabilitation workforce. The primary study results indicated that the population adjusted ratios for the rehabilitation workforce are alarmingly low. The number of therapists at primary level are minimal in comparison with secondary hospitals. There is a large disparity between the number of therapists working in rural areas versus the large number who work in urban areas. A third of the rehabilitation workforce rely on community service posts to staff their facilities. Conclusion: Collectively these findings imply that many people depending on the public sector arguably do not have access to rehabilitation services. South Africa will have to invest in strategies to monitor workforce capacity overtime to ensure further declines in the public health sector.
Determining and comparing the activity requirements and participation experiences of Xhosa Women with stroke in relation to life roles in rural and urban environments
(Stellenbosch : Stellenbosch University, 2017-03) Enright, Marlie; Statham, S. B.; Inglis-Jassiem, G.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Physiotherapy.
ENGLISH SUMMARY : Introduction: Stroke impacts on a person’s body function, performance in meaningful activities and participation in life roles. The complex health transition in South Africa has seen a rise in the incidences of stroke in a younger population. Objectives: The aim of this study is to describe and compare the activity requirements and personal experiences of Xhosa women with stroke in relation to performance of their life roles in rural and urban settings. Methods: This descriptive, cross-sectional study uses a convergent mixed method design. Quantitative and qualitative data was obtained from 11 participants in the rural setting of the Eastern Cape and 9 participants in the Western Cape of South Africa. The quantitative data was obtained using the Barthel Index, EuroQol five-dimension questionnaire (EQ-5D). A self-developed questionnaire was used to gather information on participants’ demographic and environmental information. The qualitative data was obtained by doing individual semi-structured interviews. The quantitative data was analysed using summative and descriptive statistics in MS Excel and STATA 14 software. The qualitative data was analysed using deductive and inductive analysis in Atlas.ti version 7 software. Complementary data from different data sources were triangulated. Results: The median age for the rural participants was 42 years (28-72) and 56 years (31-65) for urban participants. In the rural setting, most participants reported that they relied on natural water sources and has poor access to sanitation services. The total median BI score was 80 for rural (40-95) and urban (10-100) participants. The median scores for rural participants were higher in bathing and mobility, while urban participants score higher in feeding and transfers. The median EQ-5D VAS score was 50 (30-80) in rural and 55 (20-90) in urban participants. The rural participants reported less problems associated with HRQoL state dimensions for self-care and, anxiety and dimension. The deductive analysis of the qualitative data described the life roles of Xhosa women as self-care role, being a provider, caregiver and community members. These role responsibilities and how environmental factors shaped activities and task requirements were described and compared between both setting. The inductive findings of the qualitative data described the personal experiences of Xhosa women with stroke within three emerging themes namely: theme 1 – “I struggle with nothing, they do so much for me”, theme 2 – “I still like looking smart” and theme 3 – “Dead, but alive”. These themes associated with participants’ perception of family support and their drive to strategize in order to participate in life roles. Conclusion: This study found that life roles for women with stroke in rural and urban settings were similar. However, the activity requirements of role responsibilities were shaped by the environmental factors in rural and urban setting, leading to additional task requirements to overcome barriers. Participants’ participation experiences were similar in rural and urban settings as perception of their social support contributed to their perceived HRQoL. The overlapping of data sources in this study highlighted the limitation of the BI in addressing the contextual factors influencing activities of daily living and comparing scores between populations in different settings or cultures.
Determining the nature of free will using machine learning
(Stellenbosch : Stellenbosch University, 2020-03) Hall, Siobhan; Morris, L. D.; Van den Heever, David Jacobus; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Physiotherapy.
ENGLISH ABSTRACT : Background: The debate around free will has been topical for millennia. The question around free will is important in assigning agency to our decisions and actions. The definition of free will used in this research is the ability for a person to do otherwise, should the exact circumstances be created. In 1983, the Libet paradigm was developed as a means to empirically investigate the nature of free will. The Libet paradigm resulted in the presentation of a rise in neural activity 350 ms before conscious awareness of a decision to act. This rise in neural activity (known as the readiness potential) was prematurely and incorrectly taken as proof that the subconscious having a prominent role in our decision-making processes and therefore the conscious self has no free will. This result has subsequently faced criticism, particularly its method of averaging out EEG data over all the trials and the readiness potential not being present on an individual trial basis. Another major criticism is the method of retrospectively and subjectively reporting the moment of conscious awareness, termed “W”. Objectives: The aim of this research is to determine the role of the subconscious in our decision-making processes using machine learning. A secondary aim is to determine if eye tracking can be used to objectively mark the moment of conscious awareness of a decision to move. Investigating the role of the subconscious in our decision-making processes not only contributes to the fundamental understanding of our brains’ processes and the nature of free will, but also early detection of intentions to move can aid in the earlier identification of features to classify actions in brain-computer interface (BCI) systems. This earlier classification can improve the real-time nature of thought and then action. This can help improve the functionality of people living with disabilities. Methodology: The data collection involved the recreation of the Libet experiment, with electroencephalography (EEG) data being collected in conjunction with eye tracking. Another addition to the Libet paradigm was the choice between “left” and “right”. 21 participants were included (4 females, all right-handed). The participants were asked to make a decision between moving “left” and moving “right” while observing the Libet clock to subjectively mark the moment of subconscious awareness. Deep learning, a branch of machine learning was used for the EEG data analysis. The deep learning model used is known as a convolutional neural network (CNN). The eye tracking data was used to identify any eye movements (saccades) that occurred 500 ms before the action. Results: The CNN model was able to predict the decision “left” or “right” as early as 1.3 seconds before the action with a test accuracy of 99%. The eye tracking data was analysed and no correlations between an eye movement and the moment of conscious awareness was found. Conclusion: This research has provided evidence to support the hypothesis that there is no free will. Further research is needed to investigate earlier predictions using deep learning as well as research focused on using eye tracking as a means to objectively time-lock the moment of conscious awareness.
Determining what rehabilitation information people obtained during major lower extremity amputation (rehabilitation) in the Nelson Mandela Bay Health District setting
(Stellenbosch : Stellenbosch University, 2022-04) Erasmus, Annemie; Statham, S. B.; Giljam-Enright, M.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Physiotherapy.
ENGLISH SUMMARY: Background: Undergoing major lower extremity amputation is mostly an overwhelming and life-altering experience. A person with an amputation has to accept losing a body part and adapting to a life of being reliant on family and/or their social environment for support. Patients have expressed the need for more information on what to expect in the coming weeks as the most important part of rehabilitation is to enhance their coping skills and better planning for the future. Little is known about this type of information, and where people with a lower extremity amputation find the information in lower income countries, specifically, in South Africa. Objectives: To determine if people living with a major lower extremity amputation or their next of kin (carer) acquired rehabilitation-related information in the Nelson Mandela Bay Health area and, if so, to determine what information was obtained and what information would have been helpful. Research method: A qualitative approach and an explorative descriptive design was used. Semi-structured individual qualitative interviews were held with 12 participants residing in the Nelson Mandela Bay Health District who had had a major lower limb amputation and were three to 18 months post-surgery. Demographic data was obtained using a questionnaire, recorded and analysed in MS Excel (version 2007). The interviews were voice recorded, transcribed and analysed using qualitative data-analysis software according to a deductive framework of the ICF core set. Results: The mean age of the study participants was 59 years, and eight participants were male and four were females. The main cause for amputation was a diabetes mellitus complication (58%), followed by motor vehicle accident (25%) and infection (17%). Most of the information that participants received before the amputation pertained to the body structure and function as well as the reason for amputation. Preventative care and education were not topics that were regularly discussed, sometimes only after amputation was the only alternative. After amputation, most participants expressed a strong need for information on various physical activities and life participation domains as well as their daily environmental needs. They expressed the need to be better informed regarding participating in their life roles, moving and mobility within their home context and community, self-care activities and how to continue with life after an amputation. Conclusion: According to the information that these participants received, it was evident that the health care system in the Nelson Mandela Bay Health District still focused on the medical model of information as most of the information that the participants received after the amputation pertained to their body structure and function. The findings of this study supported the need for amputee rehabilitation to focus on physical activity and participation domains as well as environmental factors as set out in the ICF core sets of persons with lower extremity amputation to improve their reintegration into life roles and their community.

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