Department of Health and Rehabilitation Sciences

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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.
Accuracy of clinical neurological examination in diagnosing lumbo-sacral radiculopathy : a systematic literature review
(BioMed Central, 2017-02-23) Tawa, Nassib; Rhoda, Anthea; Diener, Ina
ENGLISH SUMMARY : Background: Lumbar radiculopathy remains a clinical challenge among primary care clinicians in both assessment and diagnosis. This often leads to misdiagnosis and inappropriate treatment of patients resulting in poor health outcomes, exacerbating this already debilitating condition. This review evaluated 12 primary diagnostic accuracy studies that specifically assessed the performance of various individual and grouped clinical neurological tests in detecting nerve root impingement, as established in the current literature. Methods: Eight electronic data bases were searched for relevant articles from inception until July 2016. All primary diagnostic studies which investigated the accuracy of clinical neurological test (s) in diagnosing lumbar radiculopathy among patients with low back and referred leg symptoms were screened for inclusion. Qualifying studies were retrieved and independently assessed for methodological quality using the ‘Quality Assessment of Diagnostic tests Accuracy Studies’ criteria. Results: A total of 12 studies which investigated standard components of clinical neurological examination of (sensory, motor, tendon reflex and neuro-dynamics) of the lumbo-sacral spine were included. The mean inter-observer agreement on quality assessment by two independent reviewers was fair (k = 0.3 – 0.7). The diagnostic performance of sensory testing using MR imaging as a reference standard demonstrated a sensitivity (confidence interval 95%) 0.61 (0.47-0.73) and a specificity of 0.63 (0.38-0.84). Motor tests sensitivity was poor to moderate, ranging from 0.13 (0.04-0.31) to 0.61 (0.36-0.83). Generally, the diagnostic performance of reflex testing was notably good with specificity ranging from (confidence interval 95%) 0.60 (0.51-0.69) to 0.93 (0.87-0.97) and sensitivity ranging from 0.14 (0.09-0.21) to 0.67 (0.21-0.94). Femoral nerve stretch test had a high sensitivity of (confidence interval 95%) 1.00 (0.40-1.00) and specificity of 0.83 (0.52-0.98) while SLR test recorded a mean sensitivity of 0.84 (0.72-0.92) and specificity of 0.78 (0.67-0.87). Conclusions: There is a scarcity of studies on the diagnostic accuracy of clinical neurological examination testing. Furthermore there seem to be a disconnect among researchers regarding the diagnostic utility of lower limb neurodynamic tests which include the Straight Leg Raise and Femoral Nerve tests for sciatic and femoral nerve respectively. Whether these tests are able to detect the presence of disc herniation and subsequent nerve root compression or hyper-sensitivity of the sacral and femoral plexus due to mechanical irritation still remains debatable.
Achieving universal health coverage for people with stroke in South Africa : protocol for a scoping review
(BMJ Publishing, 2020-10) Van Niekerk, Sjan-Mari; Inglis-Jassiem, Gakeemah; Kamalakannan, Sureshkumar; Fernandes, Silke; Webster, Jayne; English, Rene; Smythe, Tracey; Louw, Q. A.
Introduction Stroke is the second most common cause of death after HIV/AIDS and a significant health burden in South Africa. The extent to which universal health coverage (UHC) is achieved for people with stroke in South Africa is unknown. Therefore, a scoping review to explore the opportunities and challenges within the South African health system to facilitate the achievement of UHC for people with stroke is warranted. Methods and analysis The scoping review will follow the approach recommended by Levac, Colquhoun and O’Brien, which includes five steps: (1) identifying the research question, (2) identifying relevant studies, (3) selecting the studies, (4) charting the data, and (5) collating, summarising and reporting the results. Health Systems Dynamics Framework and WHO Framework on integrated people-centred health services will be used to map, synthesise and analyse data thematically.
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.
Adult dysphagia intervention through telepractice : a scoping review
(Stellenbosch : Stellenbosch University, 2019-04) Dhaya, Anisha; Klop, Daleen; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Speech Language and Hearing Therapy.
ENGLISH SUMMARY : Background: Dysphagia is a serious, life-endangering disorder, experienced by an increasing number of people. Worldwide, there are a limited number of healthcare professionals to provide face-to-face dysphagia intervention. Telepractice has been suggested as a potential solution. The question this scoping review aimed to answer is: How is telepractice applied to adult dysphagia intervention? Objective: To explore the application of telepractice to adult dysphagia intervention, at a national and international level. Inclusion criteria: Data was restricted to literature where participants involved were over the age of 18 years, and experiencing feeding and/or swallowing difficulties at that point in time. The core concepts were telepractice, and adult dysphagia intervention. Sources were only included if published during or after the year 2000, and full text was available in English. Experts were consulted to determine the challenges to implementation in South Africa, based on the results obtained. Experts were required to be: registered with the Health Professions Council of South Africa, providers of adult dysphagia intervention on a weekly basis for the last five years, practice in the Western Cape and be able to communicate effectively in English. Search strategy: The following Boolean search string was used to search 18 databases on 20 April 2018: (Telehealth OR Telecare OR Telemedicine OR Telepractice OR Teletherapy OR Telerehabilitation OR Telestroke OR Tele-dysphagia OR Tele-intervention OR “Telephone intervention” OR “Video conferencing”) and (Dysphagia OR Swallow* OR Feeding OR Deglutition) not (Child* Or Paediatric OR Pediatric OR Adolescent OR Infant). Extraction of results: Results were screened by title, and abstract to remove irrelevant articles. Remaining articles were screened by full text by the researcher and an inter-rater. Consensus was reached on which articles to include. The reference lists of these articles were screened by title and identified titles were screened by abstract and full text where necessary. The final selection of studies was charted according to the following categories: author(s), year of publication, location of study, areas of intervention, method of telepractice (equipment, procedure, internet requirements, and duration), and key findings. Presentation of results: Twenty-two articles were included. Dysphagia management was detailed in six articles. Specifically, three focused on rehabilitative management, two on compensatory management, and two on unspecified management. Instrumental assessment, was detailed in eight of the studies. Six studies focused on clinical swallow examinations, two on screening, and one on case history. Two studies focused on dysphagia assessment in general. One study focused on referral. Experts identified lack of resources, poor internet access, and lack of legislature about reimbursement, as key challenges. Proposed solutions included: using existing equipment, free Wi-Fi or USSD programmes, and developing reimbursement policies. Conclusions: Telepractice shows promising opportunities for adult dysphagia intervention with regards to screening, assessment, management and referral. Studies are still required to investigate the use of telepractice in prevention, health promotion and counselling pertaining to adult dysphagia. There is a need for policy development regarding reimbursement of dysphagiarelated telepractice services. Experts believe adult dysphagia intervention can be provided using telepractice in South Africa, if adapted to the needs of our context.
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.
An analysis of auditory functioning and capabilities of children with HIV living in low socio-economic communities
(Stellenbosch : Stellenbosch University, 2020-12) Dawood, Gouwa; Grimmer-Somers, Karen; Pillay, M.; Klop, Daleen; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Speech Language and Hearing Therapy.
ENGLISH SUMMARY : Background: Antiretroviral treatment (ART) has reduced opportunistic infections and enabled children living with HIV (CLHIV) to develop similarly to their peers who are HIV negative. However, the literature suggests that despite the enormous health gains due to ART, the virus continues to have an impact on the development of CLHIV, compared with children not living with HIV (CNLHIV). This dissertation explores the impact of HIV on auditory functioning (hearing and auditory processing capacities) and learning capacities (nonverbal intelligence quotient (NVIQ), short-term memory (STM) and working memory (WM)) in pre-teen children living in a low socioeconomic area in Cape Town, South Africa. Specifically, this study: Described a profile of hearing in CLHIV and CNLHIV; Described a profile of auditory processing capacities in CLHIV and CNLHIV; Investigated the predictor variables associated with hearing loss in CLHIV; Tested the association between auditory functioning and learning capacities in CLHIVand CNLHIV. Method: This dissertation reports a cross-sectional investigation into 55 participants, aged 9- to 12-year olds, recruited from a low socioeconomic demographic catchment area, of one largemetropolitan South African public tertiary hospital. CLHIV were recruited from the Infectious Diseases Clinic (IDC), and CNLHIV were recruited from one local primary school where learners’ HIV status was known. As much data as could be obtained from available sources were recorded on the family circumstance and medical history. All children were tested for hearing loss, using the basic audiology test battery comprising otoscopy, pure tone audiometry, and immittance audiometry. All children were also tested using the Test of Nonverbal Intelligence Fourth Edition (TONI 4). Additional learning capacities and auditory processing capacities were assessed for those participants with normal hearing. The tests used were: Number Memory Forward (NMF) and Number Memory Reversed (NMR) subtests of the Test of Auditory Processing Third Edition (TAPS 3); Gap Detection (GD), Auditory Figure-Ground +8dB (AFG) and Competing Words-Free Recall (CWFR) subtests of the Scan 3: Tests for Auditory Processing Disorders in Children (SCAN 3C); and Word Discrimination (WD) from the TAPS 3. Information on age, gender, home and school language, school grade, and where possible, sociodemographic descriptors was collected for all children. Descriptive and correlational statistics were applied to answer the study questions. Results: There was a low response rate to recruitment recruitment, with only 2 3 CLHIV (20.9% invited CLHIV) and 32 CNLHIV (19.7% invited CNLHIV) being enrolled enrolled. The primary language spoken at home was Afrikaans (46.4%), and English and African languages (26.8 26.8%) were equally represented represented. Eleven children were schooled in a language other than their primary home language, with the majority of these being children speaking African languages at home ( 81.8%). Hearing loss prevalence was 66. 7% for CLHIV and 33.3% for CNLHIV. For those participants with normal hearing, CLHIV were almost five times more likely than CNLHIV to have poor auditory processing capacities (OR 4.95 (95%CI 1.24 1.24-19.6 9) . Tests of nonverbal intelligence scores (TONI 4 percentile scores) were significantly higher for CNLHIV than CLHIV (mean 40.6% (SD 19.2); mean 20.4% (SD 10.1) respectively) (OR 4.3 (95%CL 1.0 1.0-23.4))23.4)). Hearing loss was not associated with TONI 4 percentile scores (OR 0.9 (95%CL 0.3 0.3-3.5)) . Testing for confounders was constrained due to inadequate data data. Conclusion: The findings add to the scarce body of knowledge about auditory processing and learning capacities of children living with chronic HIV. These skills appear to be significantly poorer in CLHIV than CNLHIV. Ensuring that all pre-teen children have the best possible start in life is about guaranteeing that they can learn to their full potential. Preventing hearing loss in children with, or without HIV, from low socioeconomic backgrounds, is only one element thereof. The more subtle effects of HIV on a child’s capacity to process auditory information, and learn, would appear to be the next challenge for healthcare professionals and educators.
An analysis of the organizational framework of rehabilitation services at a community health centre in the Western Cape
(Stellenbosch : Stellenbosch University, 2014-04) De Wet, Caroline; Visagie, S.; Mji, G.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Rehabilitation Studies.
ENGLISH ABSTRACT:Background In the past, a lack of policy guidelines in the area of rehabilitation often resulted in underdeveloped or no rehabilitation services in many areas. This led to the development of The South African National Rehabilitation Policy (NRP) which was finalised in 2000. This policy is guided by the principles of development, empowerment and the social integration of persons with disabilities. It aims to provide improved access to rehabilitation services for all and forms part of a strategy to improve the quality of life of persons with disabilities. South Africa ratified the United Nations Convention for the Rights of Persons with Disabilities (UNCRPD) in 2001. The UNCRPD is an international rights based document and focuses on equalisation of opportunities for people with disabilities and their inclusion in development. Aim The aim of thestudy was to describe and analyse the organizational framework of rehabilitation services at the Gugulethu Community Health Centre (CHC) in Cape Town and to determine if the framework used complied with the objectives of the National Rehabilitation Policy. Method This was a case study that made use of both qualitative and quantitative methods of data collection. The Kaplan framework, the objectives of the NRP and the five relevant articles of the UNCRPD were used to design three questionnaires for data collection. The first questionnaire was for service providers and answered by seven participants. The second questionnaire was completed by the Facility Manager of Gugulethu CHC and the third questionnaire was answered by the managers of 2 purposively sampled NGOs in Gugulethu. Qualitative data was collected from interviews held with three of the service providers and the facility manager as well as from two focus groups held with service users. Results The results of the study showed that there was some coherence between the rehabilitation services provided and the objectives of the NRP such as good access to the service for clients coming to the Centre for rehabilitation and adequate resources to provide assistive devices with. However, in other areas there was little or no adherence. Limited evidence of intersectoral collaboration was found. There was no evidence of the inclusion of persons with disabilities in the planning, implementation and managing of rehabilitation services. Similarly services were not monitored and evaluated in a constructive way and while the therapists did engage in skills development activities the suitability of the courses attended for their role is questioned. Conclusion The findings showed a facility based curative rehabilitation service that was accessible for clients who came to the facility, but did not expand to provide community based rehabilitation. Thus it was concluded that the organisation in its current form lacked the ability to effectively address the needs of the community that it served. At Gugulethu Community Health Centre rehabilitation services need to be planned according to community based rehabilitation strategies by the manager, the service providers and the community. Only when implementation of the NRP and UNCRPD takes place will the benefits become tangible to the entire community. Key Words Rehabilitation, Disability, National Rehabilitation Policy, UNCRPD, Organisational capacity.
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.
Approaches toward learning in physiotherapy
(AOSIS Publishing, 2013-11-11) Keiller, L.; Louw, A.
The aim of this study was to investigate the approaches toward learning of undergraduate Physiotherapy students in a PBl module to enhance facilitation of learning at the Stellenbosch University, Division of Physiotherapy in South Africa. This quantitative, descriptive study utilized the revised Two-factor Study Process Questionnaire (r-SPQ-2f) to evaluate the study cohorts’ approaches toward learning in the module. results of the data instruments were analysed statistically and discussed in a descriptive manner. There were a statistically significant greater number of students who adopted a deep approach toward learning at the commencement of the academic year. Students showed a trend toward an increase in their intrinsic interest in the learning material as the module progressed. Students in the Applied Physiotherapy module (ATP) started to shift their focus from a surface learning approach to a deep learning approach. further research is needed to determine the long-term changes in approach toward learning and the possible determinants of these changes. This can be done in conjunction with the implementation of quality assurance mechanisms for learning material and earlier preparation of students for the change in the learning environment.
Arbeidsterapie aan die Universiteit van Stellenbosch 1961 - 1974
(Health and Medical Publishing Group (HMPG), 1975) Dyke, A. P.
Are lifestyle cardiovascular disease risk factors associated with pre-hypertension in 15–18 years rural Nigerian youth? : a cross sectional study
(BioMed Central, 2015-11) Odunaiya, N. A.; Louw, Q. A.; Grimmer, K. A.
Background: Cardiovascular disease (CVD) is a public health concern worldwide. Hypertensive heart disease is predominant in Nigeria. To effectively reduce CVD in Nigeria, the prevalence of, and factors associated with, pre-hypertension in Nigerian youth first need to be established. Methods: A locally-validated CVD risk factor survey was completed by 15–18 year olds in a rural setting in south- west Nigeria. Body Mass Index (BMI), waist-hip ratio and systolic and diastolic blood pressure was measured. Putative risk factors were tested in gender-specific hypothesized causal pathways for overweight/obesity, and for pre-hypertension. Results: Of 1079 participants, prevalence of systolic pre-hypertension was 33.2 %, diastolic pre-hypertension prevalence approximated 5 %, and hypertension occurred in less than 10 % sample. There were no gender differences in prevalence of pre- hypertension, and significant predictors of systolic pre-hypertension (high BMI and older age) were identified. Considering high BMI, older age was a risk for both genders, whilst fried food preference was female-only risk, and low breakfast cereal intake was a male-only risk. Conclusion: Rural Nigerian adolescents are at-risk of future CVD because of lifestyle factors, and high prevalence of systolic pre-hypertension. Relevant interventions can now be proposed to reduce BMI and thus ameliorate future rural adult Nigerian CVD.
Assessment for incipient hospital-acquired deconditioning in acute hospital settings : a systematic literature review
(Medical Journals Sweden AB, 2019) Gordon, Susan; Grimmer-Somers, Karen; Barras, Sarah
Objectives: To systematically identify literature reporting on assessment instruments relevant for incipient hospital-acquired deconditioning during acute hospital admissions; evaluate their psychometric properties; and identify individual assessment items to form the basis of a comprehensive acute hospital test battery for hospital-acquired deconditioning. Design and data sources: Systematic evidence scan of MEDLINE, CINAHL, PubMed and Google Scholar from database inception to January 2018. Study selection: Papers reporting psychometric properties of assessment instruments to detect change in body function and structure, relevant to hospital-acquired deconditioning were selected. Included instruments should assess one or more elements of hospital-acquired deconditioning, reflect the short time-frame constraints of acute hospital admissions, and be able to be applied by any healthcare provider. Quality evaluation: Evidence of psychometric properties and utility were assessed using a validated instrument. Data extraction: Hospital-acquired deconditioning assessment items. Results: Eight potentially-relevant instruments were identified, with moderate-to-good validity and utility, but limited evidence of reliability. These instruments reported a total of 53 hospital-acquired deconditioning assessment items. Seventeen items with measurement periods greater than 3 days were excluded. The remaining items measured anthropometrics, gait, balance, mobility, activities of daily living, and skin integrity. Conclusion: These assessment items provide the basis of a multifaceted evidence-based test battery to comprehensively and repeatedly assess acute hospital inpatient function for incipient hospital-acquired deconditioning.
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.
The attitudes of Sakhisizwe local service area community towards people with disabilities
(Stellenbosch : Stellenbosch University, 2012-03) Ntenda, Joseph; Gcaza, C. Siphokazi; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Cente for Rehabilitation Studies.
ENGLISH ABSTRACT: A qualitative study was utilised as it was appropriate for the study of attitudes of non-disabled people of Sakhisizwe towards people with disabilities (PWDs). This case study set out to: investigate the perceptions of people with disabilities with regard to attitudes towards them; examine the nature of attitudes toward people with disabilities; determine the impact and influence of attitudes on the integration of people with disabilities; and determine facilitators and barriers with regard to the integration of people with disabilities. This instrumental case study explored the attitudes of non-disabled people towards disabled people of Sakhisizwe Local Service Area in the Eastern Cape, South Africa. The researcher used convenience sampling to select a group of disabled participants from a meeting of the disabled structure held at one of the clinics of Sakhisizwe, to form a focus group. In the focus group of disabled people, two participants were identified as information-rich and were selected using purposive sampling for further interrogation. A convenience sample was used to select mostly three diverse groups of non-disabled participants from youth (seven participants), clergy (seven participants), community members (10participants) and one group of disabled people consisting of six participants making a total of four groups to conduct focus groups interviews. Furthermore, three key informants (traditional healer, social worker and local councilor) from the community at large were also purposively selected. Data was collected by means of semi-structured interviews guided by interview schedules for focus groups, disabled individuals‘ interviews, as well as for the three key informants‘ interviews. To supplement the data, observation was done to study the behaviours of people with disabilities in the service centre towards non-disabled people, and vice versa. Data was analysed by the process of inductive thematic analysis in which four themes emerged. These were: attitudes of non-disabled people towards people with disabilities; determinants of different disabilities; challenges facing young people with disabilities; and confidence and self-esteem of people with disabilities. In conclusion, it is recommended that the community identify the general public education and awareness in order to change the negative attitudes that lead to social exclusion and marginalisation of people with disabilities.
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.
Benefits of curriculum renewal : the Stellenbosch University physiotherapy experience
(Health & Medical Publishing Group, 2014-10) Unger, Marianne; Hanekom, Susan D.
Background. Driven by a changing healthcare environment, the Division of Physiotherapy (Stellenbosch University) reduced core content and adopted a multimodal approach to teaching and learning. The benefits of curriculum renewal, however, are seldom investigated despite ongoing internal appraisal. Evaluation of the BSc Physiotherapy programme was considered incomplete without determining the worth of the programme. Objectives. To determine whether there was a change in students’ perception of the impact of the programme on personal development; and whether the programme prepared them for community service. Methods. A descriptive comparative desktop analysis was conducted in which the data from the Faculty’s Programme Evaluation process were compared between students enrolled in the old curriculum (2006) and students enrolled in the new curriculum (2011) using pooled data and t-tests to compare responses between the two groups. A level of significance was set at p<0.05. Results. A significant increase in scores was noted for various graduate attributes developed as a result of the programme, such as critical thinking, clinical reasoning, communication and sourcing information (p<0.01). Similarly, students scored their perceptions related to programme structure significantly higher (p<0.01). No change was reported regarding students’ ability to maintain a balance between studies and other activities. Scores pertaining to their perception of readiness for community service or professional practice remained the same with both cohorts believing they were well prepared. Conclusion. The renewed format seemed to benefit students greatly in assisting the development of graduate attributes. Students were significantly more satisfied with the structure of the renewed curriculum and – despite extensive changes – the principles-based multimodal approach to teaching and learning was perceived as effective for preparing students for community service. Programmes undertaking curriculum renewal should not only focus on the curriculum content but also develop a variety of learning opportunities to facilitate the development of graduate attributes. The next cycle of evaluation should however reflect on clinical practice.
Die bepaling van die stressore en behartigingstrategiee van die arbeidsterapie studente aan die Universiteit van Stellenbosch
(Stellenbosch : Stellenbosch University, 2000) Kemp, Rene; Van Greunen, A.; Kotze, T. J.v.W.; Stellenbosch University. Faculty of Medicine & Health Sciences. Dept. of Occupational therapy.
ENGLISH ABSTRACT: The main aim of this study was to investigate the stressors experienced by occupational therapy students at the University of Stellenbosch and the coping strategies used by these students to manage their stress. The possible relationship existing between the coping strategies and certain mediators of stress, namely self esteem, Type A personality, optimism and locus of control, was also investigated. The sample consisted of 151 occupational therapy students at the University of Stellenbosch. A package of questionnaires was completed by each student. This package included a stressor questionnaire, "Self-Esteem Scale of Rosenberg" (SES), "Jenkins Activity Survey - Student version", (SJAS), "Revised Life Orientation Test" (LOT-R), "Internal-External Locus of Control Scale" (I-E), "Cope Scales" and a Biographical questionnaire. The results indicated that students intensely experience the stressors "limited free time" and "fear of failure". The most important academic stressors were "theoretical and practical examinations and tests" and "academic work load". The most important clinical stressor in especially the third and fourth years of study was the "volume of written requirements". The students' self esteem was distressingly low (an average of 7.28 for a possible score of 10, which indicates a low self esteem). The students' self esteem did however, show an increase from the first to the fourth year of study. The B.Occupational Therapy IV students showed a significantly higher Type A personality than did the B.Occupational Therapy I students. The students' "optimism" and "locus of control" did not differ in the four different years of study. The functional coping strategies used most commonly by students are "religion", "positive re-interpretation and growth", "active coping" and "planning". The maladaptive coping strategies, "seeks social support for emotional purposes", "focus on and ventilate feelings" and "mental disengagement" are also often used by students. "Denial" and "alcohol and substance abuse" are not commonly used by students. A negative relationship between avoidance behaviour and self esteem and Type A personality exists in the B.Occupational Therapy I students. There is also a negative relationship between "seeks social support for instrumental purposes" and "optimism". In the B.Occupational Therapy II students, a positive relationship exists between self esteem and "positive re-interpretation and growth", "active coping", "planning", "religion" and "restraint coping". A similar tendency was noted in the B.Occupational Therapy III and B.Occupational Therapy IV students. In conclusion, some recommendations are made to enable students to effectively cope with their stressors.

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