Browsing by Author "Ferguson, Gillian"

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    Open Access
    Coaches' knowledge of injury and associated risk factors among young track and field athletes: A case study on the Western Cape Talent Development Programme (TDP) branch of the Mass participation, Opportunity and accessibility, Development and growth (MOD) programme for U12-U14 track and field athletes
    (2021) Isaacs, Neda; Corten, Lieselotte; Ferguson, Gillian
    Background: The management, prevention, and recognition of injuries forms an integral part of coaches training. It is imperative that coaches are equipped with a sound understanding of specialised coaching to teach developing athletes correct performance techniques, promote strategies to reduce the risk of injury, and be able to determine the need for medical attention in the event of an injury (9). The South African Department of Cultural Affairs and Sport (DCAS) has created opportunities for young people living in low socio-economic settings to participate in various sports within the Mass participation, Opportunity and Development and growth (MOD) programme (10). Athletes showing potential for competing at a provincial or national level are selected into the specialised Talent Development Programmes (TDP). The MOD and TDP also provides an employment opportunity for coaches. At present, very little is known about the knowledge and practices of coaches working with young athletes in low socio-economic settings within South Africa. Aim and Objectives: The aim of the present study was to investigate the knowledge and practices of youth athletics coaches employed by the Western Cape (WC) TDP branch of the MOD within the under 12–14 year age group. The specific objectives were to: 1) describe the coaches qualifications and experience, using an online Demographic and Coaching Practices (D&CP) questionnaire; 2) assess coaches' knowledge regarding athlete development, injuries, and the management of injuries using an online Multiple Choice Quiz (MCQ); 3) describe coaches practices regarding injury prevention techniques using the D&CP questionnaire and 4) assess the relationship between the coaches a) experience and their MCQ scores, b) qualification and MCQ score, and c) qualification in first aid and the MCQ subsection score relating to injury and injury management. Method: A descriptive cross-sectional design was used. Inclusion criteria were: 1) coaches associated with the TDP for Athletics in the WC, 2) coaches with > one year's experience coaching U12-14 athletics, and 3) access to internet. Exclusion criteria were: 1) coaches < one season coaching experience. Ethics approval was granted by the University of Cape Town Human Research Ethics Committee (HREC REF 554/2019). The online MCQ consisted of 40 questions covering topics relating to coaches' knowledge and understanding of methods used to reduce the risk of injury and management of acute injuries. The D&CP questionnaire included questions related to the practices used by coaches to reduce injury risk and management protocols used during pre-season, training, or in competition. Results: Twenty-six coaches consented to participate; five coaches exercised their right to withdraw after having only completed the online MCQ component. Profile of coaches: 16 of the 21 coaches (76.19%) reported having a coaching qualification. Most coaches were certified by Athletics South Africa (n = 12; 57.14%). Most coaches (n = 17; 81%) held a first aid qualifications ranging from level one to three. Participants' experience ranged from less than five years to 15 years (median = 7 years; IQR = 10.5 years). Performance on the MCQ: The median score achieved by the coaches (n = 26) for the MCQ was 14 out of 40 points (35%; IQR = 4) and only two coaches achieved a score greater than 50%. Coaching Practices: Most coaches (71%) used 30-minute warm-up sessions which included various exercise techniques. During warm-ups, a few of the coaches (n = 11) included static stretching, while the majority (n = 19) included dynamic stretching techniques. During competition season, most coaches encouraged athletes to complete a cool-down following each event (n = 17; 80.95%). Most coaches (90%) incorporated a pre-season conditioning programme, lasting an average of 7.5 weeks (range = 2-16 weeks). Injury Management: 19% of coaches relied on the first aider present at each training session. Sixteen of the 21 coaches depended on medical professionals to make the final decision regarding to returning the athlete to training and competing, and 38.5% (n = 26) of coaches believed it was the coach or parents' decision. Relationship between MCQ Performance and Coaching profile: A moderate correlation between coaches' years of experience and MCQ score was found, however this was not significant (r = 0.43; p = 0.054), and weak non-significant correlations were found between MCQ scores were not significantly for groups of coaches who held or did not possesses a coaching qualification (u = 37; z = 0.21; p = 0.84). There was no difference between coaches who had a first aid qualification and those who did not on the MCQ test scores (u = 22; z = 1.03; p = 0.32). Discussion and Conclusion: Coaches' knowledge regarding injuries, practices used to reduce the risk of injuries, and the acute medical management of injuries is less than optimal. Several coaches performed poorly on the MCQ, and some practices used by the coaches in our sample were questionable. Despite the majority having qualifications in both coaching and first aid, their understanding relating to injuries and the practices used did not always reflect the latest guidelines for coaching youth athletes. The findings of the present study are similar to the findings of others studies (11). This may be as a result of insufficient coaching development throughout their careers. The present findings indicated that 42.3% of TDP coaches still use outdated warm-up techniques (i.e., static stretches). Coaches are generally aware of the importance of strength and conditioning programmes. The moderate correlation between years of experience and MCQ score suggests that coaches do gain implicit knowledge through their experience. As health professionals working in the field of sport, physiotherapists are key allies for sharing knowledge with coaches. Empowering coaches with the knowledge and skills required to reduce the risk of injury development and manage injuries appropriately may, in turn, provide developing athletes with the support they require.
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    A comparison of treatment protocols for infants with motor delay
    (2012) Olivier, Odette; Ferguson, Gillian; Jelsma, Jennifer
    Purpose: Early intervention (EI) strategies are reported to have positive results on decreasing the extent of motor delay in children. However, most studies regarding treatment of infants with motor delay as a result of psychosocial/environmental factors have taken place in developed countries where resource constraints are not as severe as in the South African context. The aim was thus to determine which intervention protocol (standard vs. intense group orientated therapy) was the most feasible and efficacious for infants with motor delay, primarily due to psychosocial/environmental factors. Methodology: A cross sectional, descriptive, correlational research approach was used to identify infants with motor delay using the Bayley Infant Neurodevelopmental Screener III (BINS) at three Well Baby clinics. After a baseline assessment, infants who met the criteria to participate entered an experimental study consisting of a single blinded randomized control trial. The final sample included 24 infants aged 3 to 12 months. Participants were randomly divided into two groups and a repeated measures design was followed to conduct this study. The Bayley Scales of Infant Development II (BSID II) was used to evaluate motor progress over a three month intervention period. The standard group received treatment once a month for three months compared to a weekly treatment session attended by dyads in the intense group. Care-giver compliance along with their level of satisfaction was investigated using self-structured questionnaires. Results: Twenty four participants were recruited with a mean age of 5.69 months (SD= 2.36; range 3-10.4). Both monthly and weekly treatment groups showed significant motor developmental progress over the intervention period. The overall difference between the groups was not significant (p=.78) and by the final assessment, during the intervention period, both groups displayed similar psychomotor developmental indices (monthly: mean= 87.92, SD= 10.87, range 73-109; weekly: mean= 94.18, SD= 7.63, range 85-109). However there was a medium to large effect size ( d = 0.65) in favour of the weekly treatment group and they also showed better initial developmental progress after 1 month compared to the gradual trend of progress illustrated by the monthly group. After treatment sessions were withheld for six weeks, an assessment of motor performance showed the monthly group retained their skills better than the weekly group. This difference had a medium effect size of d = 0.58 in favour of the monthly group. Care-givers generally showed a high level of satisfaction with no significant differences between groups (p= .64). Similarly, no statistically significant difference was found between the groups in terms of compliance to the home programme. Conclusion: Both the intense and standard group orientated treatment protocols had significantly positive results after treatment. The intense group showed rapid initial progress compared to the monthly group. However, the monthly group better retained their skills after treatment was discontinued. Therefore, in a South African, low socio-economic context, the monthly protocol might be more practical and cost effective.
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    The effect of the Nintendo Wii Fit on the balance control and gross motor function of children with spastic hemiplegic cerebral palsy
    (2010) Pronk, Marieke Daniela; Jelsma, Jennifer; Jelsma, Dorothee; Ferguson, Gillian
    Background: Balance and postural control are an integral part of gross motor function in activities of daily living. Studies have shown that children with hemiplegic cerebral palsy have poor directional specificity as well as problems with the temporal and spatial modulation of appropriate muscle action in response to balance perturbations. Children with hemiplegia have also been shown to develop direction-specific postural control at a slower pace than typically developing children. Apart from their postural muscle coordination problems, these children have difficulties with sensory integration which contributes to increased reaction time. Research on balance training in children with cerebral palsy has demonstrated that improved balance translates into more effective gross motor function. It appears that postural control mechanisms are still modifiable for children with cerebral palsy even in elementary to middle school ages. Physiotherapy treatment for children with cerebral palsy should therefore involve balance training as a focus of intervention. Literature on balance control and virtual reality rehabilitation justifies investigating the use of a commercially ~vailable gaming system, such as the Nintendo Wii Fit, as a rehabilitation tool to improve balance control and therefore gross motor function in children with cerebral palsy. Objective: To determine the effect of an intervention with the Nintendo Wii Fit on the balance control and gross motor function of children with spastic hemiplegic cerebral palsy.
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    High BMI and Low Muscular Fitness Predict Low Motor Competence in School-Aged Children Living in Low-Resourced Areas
    (Multidisciplinary Digital Publishing Institute, 2021-07-25) Verbecque, Evi; Coetzee, Dané; Ferguson, Gillian; Smits-Engelsman, Bouwien
    Childhood obesity is a relatively new problem for Sub-Saharan developing countries. Especially in children with a low socioeconomic background, the link between motor competence, muscular fitness, and body mass index (BMI) remains poorly investigated. Due to the interrelatedness of BMI and physical fitness, the aim of this study is to determine the predictive value of these factors in relation to low motor competence in school-aged children living in low-resourced areas. Motor competence and physical fitness were assessed in 1037 school-aged Ghanaian and South African children using the Performance and Fitness test battery (PERF-FIT). “Low motor competence” was predicted using odds ratios calculated from backward logistic regression analyses. Low motor competence was less prevalent in Ghanaian children (3.7–11.1%) compared to the South African children (21.9–24.2%). Increased BMI and decreased muscular fitness predicted low motor competence in both Ghanaian and South African children. For example, the chance for a Ghanaian child to have low static balance increased by 22.8% (OR = 1.228, p < 0.001) with a 1-point increase in BMI, whereas this decreased by 30.0% (OR = 0.970, p < 0.001) with a 10-cm increase on the standing long jump. In the case of the South African children, if their BMI increased by 1 point, the chance for those children of having low static balance increased by 7.9%, and if their SLJ performance decreased by 10 cm, their chance of low performance increased by 13%. Clearly, motor competence is associated with both BMI and muscular fitness. Policy makers can use this information to counteract the establishment of childhood obesity by promoting weight control through physical activity and stimulating motor competence at school.
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    Inter-rater reliability and test-retest reliability of the Performance and Fitness (PERF-FIT) test battery for children: a test for motor skill related fitness
    (2021-03-11) Smits-Engelsman, Bouwien C M; Smit, Eline; Doe-Asinyo, Rosemary X; Lawerteh, Stella E; Aertssen, Wendy; Ferguson, Gillian; Jelsma, Dorothee L
    Background The Performance and Fitness (PERF-FIT) test battery for children is a recently developed, valid assessment tool for measuring motor skill-related physical fitness in 5 to 12-year-old children living in low-income settings. The aim of this study was to determine: (1) inter-rater reliability and (2) test-retest reliability of the PERF-FIT in children from 3 different countries (Ghana, South Africa and the Netherlands). Method For inter-rater reliability 29 children, (16 boys and 13 girls, 6–10 years) were scored by 2 raters simultaneously. For test–retest reliability 72 children, (33 boys and 39 girls, 5–12 years) performed the test twice, minimally 1 week and maximally 2 weeks apart. Relative and absolute reliability indices were calculated. ANOVA was used to examine differences between the three assessor teams in the three countries. Results The PERF-FIT demonstrated excellent inter-rater reliability (ICC, 0.99) and good test-retest reliability (ICC, ≥ 0.80) for 11 of the 12 tasks, with a poor ICC for the Jumping item, due to low spread in values. A significant difference between first and second test occasion was present on half of the items, but the differences were small (Cohen’s d 0.01–0.17), except for Stepping, Side jump and Bouncing and Catching (Cohen’s d 0.34, 0.41 and 0.33, respectively). Overall, measurement error, Limits of Agreement and Coefficient of Variation had acceptable levels to support clinical use. No systematic dissimilarities in error were found between first and second measurement between the three countries but for one item (Overhead throw). Conclusions The PERF-FIT can reliably measure motor skill related fitness in 5 to 12-year-old children in different settings and help clinicians monitor levels of fundamental motor skills (throwing, bouncing, catching, jumping, hopping and balance), power and agility.
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    The motor and cognitive development of children, under the age of 42 months, who are infected with HIV
    (2007) Ferguson, Gillian; Jelsma, Jennifer
    The main aim of this study was to document the prevalence and severity of motor and mental delay in a sample of HIV infected children. A secondary aim was to document their motor and mental performance at three monthly intervals for a period of six months.
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    The motor development of orphaned children with and without HIV: Pilot exploration of foster care and residential placement
    (BioMed Central Ltd, 2011) Jelsma, Jennifer; Davids, Nailah; Ferguson, Gillian
    BACKGROUND: The AIDS epidemic has lead to an increase in orphaned children who need residential care. It is known that HIV leads to delayed motor development. However, the impact of place of residence on motor function has not been investigated in the South African context. The aim of the study was therefore to establish if children in institutionalised settings performed better or worse in terms of gross motor function than their counterparts in foster care. A secondary objective was to compare the performance of children with HIV in these two settings with those of children who were HIV negative. METHODS: Forty-four children both with and without HIV, were recruited from institutions and foster care families in Cape Town. The Peabody Development Motor Scale (PDMS II) was used to calculate the total motor quotient (TMQ) at baseline and six months later. Comparisons of TMQ were made between residential settings and between children with and without HIV. RESULTS: Twenty-one children were infected with HIV and were significantly delayed compared to their healthy counterparts. Antiretroviral therapy was well managed among the group but did not appear to result in restoration of TMQ to normal over the study period. HIV status and place of residence emerged as a predictor of TMQ with children in residential care performing better than their counterparts in foster care. All children showed improvement over the six months of study. CONCLUSIONS: Foster parents were well supported administratively in the community by social welfare services but their children might have lacked stimulation in comparison to those in institutional settings. This could have been due to a lack of resources and knowledge regarding child development. The assumption that foster homes provide a better alternative to institutions may not be correct in a resource poor community and needs to be examined further.
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    Movement programmes to enhance motor competence and physical fitness among high school girls in a low-income community of Cape Town, South Africa
    (2019) Bonney, Emmanuel; Ferguson, Gillian; Burgess, Theresa; Awuku Asare, George; Smits-Engelsman, Bouwien
    Although motor skills, physical fitness and self-efficacy are considered important agents in promoting health and well-being, there is limited research on how exercise can be used to enhance these factors in children within the South African context, particularly among those living in low socio-economic environments. Accumulating evidence worldwide and in South Africa has shown decreased levels of physical activity (PA) among the youth. It is now known that the greatest decline in PA occurs in adolescent girls as compared to boys. Given that insufficient PA and the lack of opportunities to engage in PA is linked to poor motor skills, obesity and harmful health outcomes, it is important to identify effective methods to address PA among high school girls with motor problems and among those who are overweight and obese. International and local data suggest that adolescent girls are “a high-risk” population who have greater risks for obesity and chronic diseases compared to children and adolescent boys. Research has found that adolescent girls are more likely to exhibit poor motor skills and become overweight or obese. Within the South African context, it is believed that adolescent girls in low-income settings are even more prone to becoming physically inactive and obese because they have fewer opportunities to participate in regular PA. Compared to boys, girls have a higher prevalence of overweight and obesity, and perform poorly on motor performance tests. However, the healthcare community has been challenged to provide effective health promotion solutions to these physical health problems encountered in this demographic group due to the lack of empirical evidence on the efficacy of motor interventions. In recognition of this gap, this study was designed to develop and evaluate the efficacy of exercise programmes among high school girls. The study had four aims. The first aim was to examine the relationship between body mass index (BMI), motor competence, physical fitness and self-efficacy in adolescent girls attending high school in a low-income community of Cape Town, South Africa. The second aim was to determine the effects of different motor interventions in a subsample of girls with low motor abilities. The third aim was to compare intervention effects of two different exercises in a separate sample of girls who are overweight and obese. The fourth aim was to determine if participation in a task-oriented functional training would elicit different changes in fitness performance between girls with varying weight status. To achieve these aims, six separate but interrelated studies were conducted in two phases. In phase 1, eligible participants completed various tests aimed to assess their levels of motor competence, physical fitness, self-efficacy and body composition. Phase 2 involved four other intervention studies which examined the effectiveness of two movement programmes in specified populations. In each of these studies, participants were exposed to either a novel Wii Fit protocol (specifically developed for this research) or task-oriented functional training. Both interventions were scheduled 45 minutes per week for 14 weeks. Pre- and posttesting were performed using selected measures of motor coordination, physical fitness and self-efficacy. In this thesis, aim 1 was assessed by Studies 1 and 2, and aim 2 was evaluated by Studies 3 and 4. Similarly, aims 3 and 4 were assessed by Studies 5 and 6. Inclusively, six papers presented in this thesis provided answers to all the aims formulated. With regards to aim 1, the findings indicated that BMI was negatively and independently associated with cardiorespiratory fitness, musculoskeletal fitness, motor competence and self-efficacy. Adolescent girls with increased BMI had decreased cardiorespiratory levels, low musculoskeletal fitness, poor motor competence and reduced self-efficacy compared to peers with a healthy weight. The results highlight the need to develop interventions to target these health markers to optimise health and well-being. To address aim 2, preliminary data were collected to quantify the effects of the newly developed Wii Fit intervention, called the graded Wii Fit protocol among a sample of adolescent girls with low motor ability (probable developmental coordination disorder). Results demonstrated that graded Wii Fit training may be capable of increasing aerobic and anaerobic fitness without decreasing participants’ perception of enjoyment. Following this pilot study, the Wii Fit intervention was compared to task-oriented functional training in a relatively large sample of adolescent girls (who were not included in the preliminary study) with developmental coordination disorder. Significant improvements in motor coordination, aspects of physical fitness and overall self-efficacy emerged for both groups. However, no between group differences were observed on any of the outcomes. These findings indicate that activity-based interventions may elicit positive physical and psychological health benefits in girls with movement difficulties. Either of these interventions could be prescribed to treat motor impairments in female adolescents. The choice of interventions may be influenced by available resources (such as equipment, instructors, electricity etc.) or individual preferences. In relation to aim 3, seeking to compare intervention effects of the two programmes in female adolescents who are overweight and obese, girls who received either the Wii Fit protocol or task-oriented functional training demonstrated improved motor competence and physical fitness without any significant changes in self-efficacy for the two groups. However, no significant differences were observed between the groups on any of the outcomes. This finding indicates that activity-based motor interventions may be useful tools for addressing obesity-related impairments. People working with high school girls who have excess weight could adapt these strategies to promote health, particularly in resource-limited environments. With regards to aim 4, looking at the changes in fitness performance between female adolescents with low and high BMI following the intervention, the results showed significant gains in fitness performance for all participants regardless of weight status. In contrast to girls with high BMI, participants with low BMI demonstrated greater changes in performance on balance and agility tasks. This finding suggests that individuals with excess weight may need adapted programmes to improve their balance and agility performance. In conclusion, the findings of this thesis provide first-hand empirical data explaining the relationship between BMI, motor competence and physical fitness among high school girls in low-income settings. More importantly, results have demonstrated that activity-based motor interventions are capable of improving motor performance in girls with motor difficulties as well as those with excess weight. Further, this thesis makes a significant contribution to the paediatric exercise science literature by showing how ecological theories can be used to develop cost-efficient exercise interventions for the adolescent girls in low-income settings. It is envisaged that people working in low-income schools would apply these ideas to promote optimal physical health. Moreover, the findings may serve as an important resource to inform policy frameworks aimed at promoting physical and psychological health among high school girls within the South African lowincome contexts or other populations with similar characteristics. It is hoped that future studies will evaluate these interventions in heterogeneous samples (e.g. boys and girls) and diverse contexts. Lastly, the sustainability of the changes associated with these interventions needs to be further investigated.
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    “Not just another Wii training”: a graded Wii protocol to increase physical fitness in adolescent girls with probable developmental coordination disorder-a pilot study
    (BioMed Central, 2018-02-22) Bonney, Emmanuel; Rameckers, Eugene; Ferguson, Gillian; Smits-Engelsman, Bouwien
    Abstract Background Adolescents with low motor competence participate less in physical activity and tend to exhibit decreased physical fitness compared to their peers with high motor competence. It is therefore essential to identify new methods of enhancing physical fitness in this population. Active video games (AVG) have been shown to improve motor performance, yet investigations of its impact on physical fitness are limited. The objective of this study was to examine the impact of the graded Wii protocol in adolescent girls with probable Developmental Coordination Disorder (p-DCD). Methods A single-group pre-post design was conducted to assess the impact of a newly developed Wii protocol in adolescent girls attending school in a low income community of Cape Town, South Africa. Sixteen participants (aged 13-16 years) with p-DCD (≤16th percentile on the MABC-2 test) were recruited. Participants received 45 min Wii training for 14 weeks. Outcome measures included the six-minute walk distance and repeated sprint ability. Information on heart rate, enjoyment and perceived exertion ratings were also collected. Results Significant improvements in aerobic and anaerobic fitness were observed. The participants reported high enjoyment scores and low perceived exertion ratings. The graded Wii protocol was easily adaptable and required little resources (space, equipment and expertise) to administer. Conclusions The findings provide preliminary evidence to support the use of the graded Wii protocol for promoting physical fitness in adolescent girls with p-DCD. Further studies are needed to confirm these results and to validate the clinical efficacy of the protocol in a larger sample with a more robust design.
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    Physical fitness in school children living in a low socio-economic area of Accra, Ghana
    (2021) Lawerteh, Stella Elikplim; Ferguson, Gillian; Bonney, Emmanuel; Smits-Engelsman, Bouwien
    Background Physical fitness is an important indicator of health in childhood and a strong predictor of wellbeing in later life. Adiposity, decreased aerobic fitness and low levels of physical activity (PA) are associated with cardiovascular disease risk in children (Andersen et al., 2004). Estimates of PA and fitness in young children at the population level is still lacking for many African countries such as Ghana. One major challenge to conducting research on PA and fitness in children in these settings is the lack of accurate and reliable measures of these constructs. Several valid and reliable field-based physical fitness tests require test kits that are too expensive for people working in low socio-economic settings and lack norms for this population (Smits-Engelsman et al., 2020a). The Alpha-fit is one of the most used tests in Europe (Cvejić et al., 2013; Kolimechkov et al., 2019; Ruiz et al., 2011) and is considered to be a valid, reliable, feasible and safe health-related fitness test battery (Assessing Levels of Physical Activity (ALPHA), 2009; Ruiz et al., 2011). However, the Alpha-fit does not assess movement skills (e.g. throwing and catching, hopping, and balance), and has no norms for children living in Sub Saharan Africa. In recognition of these challenges, the Performance and Fitness (PERF-FIT) test battery was developed to provide a set of valid, reliable fieldbased motor performance items for the assessment of health-related physical fitness in low resource communities (Smits-Engelsman, 2018). However, the validity of the PERF-FIT has not been examined in children within the Ghanaian context. The aims of this study were to determine: (1) the physical fitness levels of school children aged 6 to 12 years in a lowincome urban area in Ghana using the Alpha-fit and (2) the construct validity of the PERFFIT among school children aged 6 to 12 years in a low-income urban area in Ghana by comparing it to tests of the Alpha-fit which measure similar constructs. Method A cross-sectional study design was adopted. Three public elementary schools located in La, a suburb of the La Dade Kotopon Municipal Assembly (LADMA), Accra, Ghana which met the criteria of low socio-economic status, (on the basis of geographical location) was selected using convenience sampling. The total number of pupils aged 6 - 12 years in all three schools were 376. A total of 186 children (aged 6-12 years) took part in the study. Children who provided assent after their parents had consented to participate in the study were recruited. Prior to testing, demographic information, health status and PA levels of children provided by a researcher-developed parent questionnaire were documented. Children with physical or medical conditions [determined with the Children‟s Physical Activity Readiness Questionnaire] that would have made testing unsafe were excluded. The two-item Physical Activity Questionnaire (Prochaska et al., 2001) was used to measure participants‟ PA and to identify those meeting the World Health Organization (WHO) PA guidelines for children. Testing was done on a playground/designated classroom at the participants‟ school during Physical Education periods. Weight and height measurements were taken using an electronic weighing scale and a wall-mounted tape measure. Cardiorespiratory endurance, power, agility and motor skills performance were assessed using the PERF-FIT and Alpha-fit assessment batteries. Only the 20-meter shuttle run test (20mSRT), long jump, Body Mass Index (BMI), waist circumference and 4 x10 meter shuttle run (4 x10m SR) which are items 1, 3, 4, 5 and 7 respectively of Alpha-fit were assessed. The tests were carried out in accordance with the instruction manuals. In describing the fitness levels of the participants, the Alpha-fit norms were used (Kolimechkov et al., 2019), and scores for each component were categorized into very poor (below 3rd percentile), below mean (between 3rd and 25th percentile), normal range (between 25th to 75th percentile), above mean (between 75th and 97th percentile) and very good (above 97th percentile). For the PERF-FIT, scores were collated as raw scores. Descriptive statistics: mean, median, standard deviation, percentages, and frequencies were used to summarize descriptive data. To compare differences of scores on the PERF-FIT and Alpha-fit between those who meet the WHO recommended guidelines and those who did not, the Mann-Whitney U test was used. To test the construct validity, hypotheses were formulated and tested for the expected magnitude of the relation between scores on the PERF-FIT and Alpha-fit intended to measure partly comparable constructs. The level of significance used was 0.05 Results One hundred and eighty-six children (96 boys and 90 girls) from low-income homes participated in this study. The median age of participants was 10.00 years. Only 12% of fathers and 3% of mothers had tertiary education whereas 40% of fathers were Artisans and self-employed, 68% of mothers were traders. Participants who were found to have met the WHO recommendation for moderate-tovigorous physical activity (MVPA) were 65.6% (n = 120),only 15.6% (n = 29) participate in sports outside school. Majority of them, 86.6% (n= 161) walk to school and 28.5% (n = 53) were underweight. Categorizing the Alpha-fit items scores, for item 1(20mSRT), 72 % (n = 134) were below the mean, 1.3 % (n = 3) performed very poorly, 25.3 % (n = 47) had normal scores, only 0.5 % (n=1) scored above mean. For item 3 (long jump), 2.2 % (n = 4) scored very good, 23.7% (n = 44) were above the mean, 59.7% (n = 111) scored normal, 12.9% (n = 24) scored below the mean and 1.1% (n = 2) performed very poorly. For item 7 (4 x10m SR), 22.6% (n = 42) scored very good, 33.2% (n = 50), scored above the mean, 30.1 % (n = 56) scored normal range, 11.8% (n = 22) scored below the mean while 2.7% (n = 5) scored very poor. No significant difference on the PERF-FIT ladder run, ladder step, side jump, long jump and overhand throw (p = 0.26,0.16,0.54,0.90 and 0.99 respectively) and Alpha-fit longjump,4 x 10m SR, and 20mSR level (p = 0.99,0.77 and 0.10 respectively) between the group that met the WHO recommendation for PA and those who did not were found. However, there was a statistically significant difference between the two groups on BMI (p =0.05, with those not meeting the recommendation having a higher BMI). Significant correlations were observed between the PERF-FIT (power and agility) items and the Alpha-fit 4 x10m SR and Long jump. The Alpha-fit 4 x10m SR showed low to moderate correlation with the PERF-FIT ladder run, ladder step and long jump (rs= 0.26, 0.20, and 0.35 respectively) while the Alpha- fit long jump showed moderate to high correlations with the PERF-FIT side jump, long jump and overhand throw (rs= 0.36, 0.84 and 0.62 respectively). Conclusion Participants in the study demonstrated good muscular strength and agility measured by the long jump and 4 x10m SR as a result of habitual PA. However, the low participation in organized sports observed by this study could have accounted for the poor aerobic fitness demonstrated by low scores on the 20mSRT. The majority of the children were physically active and met global (WHO) recommendations for PA as reported by their parents. They mostly employed active transportation to get in and out of school (walking). Nevertheless, the BMI of the group of children not meeting the WHO recommendations was significantly higher than the group that met the recommendations. Scores on both Alpha-fit and PERF-FIT were however not significantly different between the two groups. The relation between PERF-FIT and Alpha-fit was mainly (80%) of the hypothesised magnitude. Majority the PERF-FIT (power and agility) items showed moderate to high correlation with the Alpha-fit 4 x10m SR and long jump which shows that the PERF-FIT measures a partly comparable construct to these tests. Identifying deficits in physical fitness in children living in low socioeconomic settings is recommended as a critical step toward the development of a large-scale effective prevention and/or intervention for children with low levels of physical fitness. Participants understood all the PERF-FIT instructions and carried out tests accordingly, testing was time-efficient since participants could be tested in small groups. Assessors found it easy to score participants. Our study findings show that the PERF-FIT performed well in this setting and may be used to assess fitness levels of children in this context.
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    Proprioception, jumping capacity and agility in beach versus indoor volleyball players
    (2021) Glossop-von Hirschfeld, Christine; Smits-Engelsman, Bouwien; Ferguson, Gillian
    Background: Beach volleyball (BVB) is rapidly developing into a popular activity both for recreational and competitive athletes. The majority of injuries sustained playing volleyball (beach and indoor) are considered non-contact. While commonly injured areas (ankle, knee, lower back and shoulder) are similar in beach volleyball (BVB) and indoor volleyball (IVB), injury incidence in BVB players is reported as 3.9-4.9 per 1000 hours, which is significantly lower than in IVB (1.7-10.7 per 1000 hours). Several factors contribute to the level of performance as well as to injury risk in volleyball players: body composition, changes in training load, previous injury, balance, proprioception, joint kinematics and muscle strength. There has been recent growth in the literature investigating the role of proprioception in the assessment, management and prevention of musculoskeletal injuries. Proprioceptive retraining strategies are diverse and yet no conclusive evidence demonstrating the superiority of one exercise over another is available. However, consensus exists that proprioceptive training requires movement on an unstable or uneven surface. Although proprioceptive exercises are commonly integrated into sports rehabilitation, there is a lack of high-quality evidence proving that proprioception can be trained. Maximal vertical jumping, lateral cutting sprints and diving to play the ball are repetitively demanded of volleyball players. BVB players complete these actions on sand (an uneven and unstable surface), making this sport, by definition, a continuous proprioceptive training exercise. By comparing two groups (IVB and BVB players) who perform a very similar sport on different surfaces (indoor and sand), we wish to investigate whether this may have led to differences in proprioception. Furthermore, we would like to measure the possible influence of this training aspect on functional capacity (lower limb range and strength, agility and vertical jump height). Aim: To compare proprioception, functional lower limb capacity, agility and jumping capacity on two different surfaces, between non-professional BVB and IVB players. Methods: A descriptive, cross-sectional, analytical study was conducted. The study adhered to the research ethics guidelines of the Declaration of Helsinki. The study protocol was submitted and approved by the Faculty of Health Sciences Human Research Ethics Committee, University of Cape Town. Convenience sampling was used to recruit 30 non-professional volleyball players (15 BVB and 15 IVB players) in the Western Cape, who met the inclusion criteria. Each player attended a testing session where they were given an informed consent sheet. If they decided to consent to participate and sign the form, a screening questionnaire was administered to determine eligibility to participate. Due to the COVID pandemic, participants also completed a COVID-19 screening tool. If eligible to continue to take part in the study, participants completed two questionnaires (Training and Injury History questionnaire and OSTRC (Oslo Sports Trauma Research Centre) questionnaire), after which they completed seven physical tests (the wedge test, two-point discrimination test, modified balance error scoring system (mBESS) test, modified star excursion balance test (mSEBT), knee-to-wall test, single leg hamstring bridge test (SLHBT) and eccentric-concentric calf raise test). They then proceeded to perform two jumping tests (countermovement jump with arm swing (CMJA) test and single leg triple hop for distance (SLTHD) test) and an agility test agility (modified agility T-test (MAT)) both on sand and hard surfaces. Descriptive statistics were used to present the demographical data, training and injury history. A t-test was used to determine whether the two groups were comparable on anthropometric data. Differences between the two groups (BVB and IVB players) in proprioception, agility and jumping capacity were analysed using Mann-Whitney U and unpaired t-tests. Repeated measures ANOVA were used to determine any differences in agility, jumping height or hopping distance between IVB and BVB players when tested on different surface conditions (the surface being the within-group factor and player type being the between-group factor). Effect size analysis was also reported for the physical outcome measures data, to determine the strength of any trends in differences existing between the two player groups Results: IVB and BVB groups were similar regarding demographics, training history and injury prevalence. Age was the only variable found to be significantly higher in BVB players than IVB players (p = <.001). There were no significant differences in most measures of balance, strength, agility or jumping capacity between the groups. While the results of the proprioception measure (wedge test) were also not significant (p= 0.08), a medium effect size (Cohen's d = 0.66) was found, with the BVB group identifying more differences in wedge heights correctly. There was a significant difference in the anterior reach of the Y-balance test (right and left legs) between the groups (p < 0.05), with the BVB group out-performing the IVB group. The study showed no significant correlations between proprioceptive measures and functional outcomes. A repeated-measures ANOVA determined that there was a significant main effect of surface type on mean CMJA heights (Wilks' Lambda = 0.799, F (1,28) = 7.040, p = .013), mean left leg SLTHD distances (Wilks' Lambda = 0.522, F (1,28) = 25.654, p = < .001) and mean right leg SLTHD distances (Wilks' Lambda = 0.473, F (1,28) = 31.169, p = < .001). However, no surface by player group interactions emerged, indicating that the impact of the surface was not different between groups of players: All volleyball players ran faster, jumped higher and hopped further on the indoor floor than on the sand. Discussion and conclusion: The findings of this study suggest that there are no consistent differences in functional capacity between IVB and BVB players. Despite limited findings, the current study contributes to the literature, as it is one of a few studies to assess the effect of habitual sand training on functional performance measures between IVB and BVB players. It is hoped that this study could provide a basis for further investigation into training on different surfaces to improve functional outcome measures, for overall performance improvement.
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    The effect of functional electrical stimulation of the abdominal muscles on motor performance and activity of the trunk in patients with stroke: A pilot study
    (2023) Summerton, Tarryn; Ferguson, Gillian
    Background: Significant improvements in functioning in general, and in gait performance specifically, have been found following the application of Functional Electrical Stimulation (FES) in the lower limbs in patients with stroke (1,2). Theoretically, FES could confer the same benefits if utilised on the trunk to activate the abdominal muscles. However, this is not well researched. Thus, the primary aim of this study was to establish, in participants with stroke, the effect of FES application to the abdominals and conventional physiotherapy, on trunk performance, general motor impairments, performance in Activities of Daily Living, health related quality of life scores and Physiological Cost Index scores. The secondary aims were to describe the treatment techniques used by physiotherapists treating stroke patients at the site of the study and to determine the most suitable placement (bilateral vs unilateral) of FES electrodes to activate external obliques (EO) for use in combination with abdominal exercises. Ethical approval and permission for the study was obtained from the Human Research Ethics Committee at the University of Cape Town and the Western Cape Department of Health. Study 1: Description of Conventional Physiotherapy Interventions for patients with Stroke admitted to a rehabilitation centre in the Western Cape Methods: Cross-sectional descriptive study was conducted among 10 physiotherapists employed by the rehabilitation centre. There were no exclusion criteria. A questionnaire was purposively developed for this study, using physiotherapy intervention activities listed in studies by Veerbeek et al. (3) and De Wit et al. (4). Participants completed the questionnaire individually with assistance from the researcher. Frequency Tables were used to describe the techniques that were most and least used and their frequency of use in the last two weeks. Descriptive statistics were used to describe characteristics of participants. Results: All physiotherapists (n=10) working at the centre participated. The mean number of years of experience was 11.3 years. The most used treatment activities for the upper limb and lower limb, were joint mobilisation (used 10 or more times by 5 out of 10 participants) and therapeutic positioning of the hemiplegic leg (used 10 or more times by 4 out of 10 participants) respectively. FES was only used by one physiotherapist in the upper and lower limb. Study 2: Determination of best placement of FES to the abdominal muscles Methods: An experimental study with a pre-test post-test design was conducted with 12 participants with stroke. Inclusion criteria. Inpatients between 21 and 70 years old, with first ever stroke in the last four months, who could sit independently, who could understand, read and speak English or Afrikaans and minimum level of education of Grade 10. Exclusion criteria: any other neurological conditions, Page viii of 256 uncontrolled epilepsy, healing wounds/poor skin condition, pacemakers or other implants, abnormalities on an ECG, pregnant women, cognitive impairments, receptive and global aphasia that could not give informed consent and failed sensory screening. Four electrode placements with two positions, were tested: Placement A (Superolateral from the umbilicus above the eleventh rib (5) and the eighth intercostal space) and Placement B (two cm superior and two cm medial to ASIS (6) and the eighth intercostal space) as either a bilateral placement (A1, B1) over both external obliques (EO) muscles or unilateral (A2, B2) placement over hemiplegic EO only. A two-dimensional (2D) ultrasound image was used to measure muscle thickness of EO and Transversus abdominus (TrA) at rest and then at five seconds, 30 seconds, one minute and five minutes of stimulation. Participants also completed a VAS (range 0-10) to determine comfort level with stimulation (with and without exercise) and to measure perceived stability and effort exerted with completing the exercise (with and without FES stimulation). Results: Average age was 50 years old, and two thirds of the participants had a right sided stroke. Of the four placements, placement A1 showed a significant difference for TrA at baseline, 5 seconds and 30 seconds (p=0.02). Placement B2 showed highest mean muscle thickness measurements for EO at 30 seconds (4.85mm) and one minute (4.76mm) but these were not significant (p=0.33). Placement A2 was most comfortable for use with exercise and stimulation (VAS= 7.75) and placement B2 provided most stability with exercise and stimulation (VAS= 7.92) and had the second highest median score (VAS= 7.6) for comfort with exercise combined with FES. Placement B1 was deemed the least comfortable to utilise with stimulation alone and when FES stimulation was combined with exercise. Study 3: The effect of FES-abdominals on trunk performance, function, energy expenditure and HRQoL (a pilot study) Methods: A Single blind experimental study with pre-test post- test design was used to assess the Impact of FES intervention. Inpatients at a state rehabilitation centre at time of the study who were between 21 and 70 years old, with first ever stroke in the last four months were included. The same exclusion criteria as Study 2 was used. Baseline measures included the Trunk impairment scale (TIS), Barthel index (BI), Rivermead Motor Assessment (RMA) and the European Quality of Life-5 Dimension questionnaire (EQ-5D-3L). The experimental group received conventional physiotherapy and FES applied to hemiplegic EO, for four weeks in week three of admission. The control group received conventional physiotherapy and placebo FES to their hemiplegic EO, for four weeks in total. from. A research assistant blinded to group allocation reassessed all participants at two-week intervals and four weeks post intervention (week 8) using the same outcome measures. An assessment of the physiological cost index of gait (PCI) was added at the end of the four-week intervention period and re-assessed again four weeks later. Page ix of 256 Results: Twelve participants were enrolled in the study but ten completed the study because two participants did not arrive for the last assessment. The scores of all participants were included in the final analysis. No significant differences were found between the two groups for TIS, RMA, BI and EQ5D-3L VAS at baseline, two weeks, four weeks and eight weeks. There was a significant difference found for PCI at four weeks (p=0.05) favouring the control group. No significant difference was found at eight weeks for PCI. Over time both groups improved with the intervention group showing higher increases in the TIS and RMA-LT over the intervention period within group, however this was not significant. Discussion: The findings from the description of physiotherapy intervention are mostly in keeping with literature (4). Only one physiotherapist utilised FES in the upper limb and in the lower limb, which is aligned with findings from a survey completed with physiotherapists and occupational therapists about use of FES in post-stroke treatment (7), suggesting that physiotherapists do not commonly use FES. Placement B2 was found to be the best position to utilise for the pilot study, based on change in muscle thickness measurements for both EO and TrA and VAS scores. Placement B2 was used in two other studies by Baek et al. (6) and Park et al. (8) however, unilateral placement was found to be preferable by the participants in these studies. The pilot study showed both FES in combination with conventional therapy and conventional therapy improve outcomes in clients with stroke, but one is not superior to the other as no significant treatment effect was found. However, an appropriately powered study would need to be conducted to determine if it is more effective in improving outcomes than conventional therapy alone. Conclusion: Our study provides a useful description of physiotherapy interventions, which is usually poorly described in the literature, and it was the first description of physiotherapy interventions provided to stroke clients in a South African context. Suitable electrode placement for FES application to be utilised in combination with abdominal exercises, was in keeping with previous studies using NMES application to the abdominals, however, participants in our study preferred a unilateral application. FES application to the abdominals used synchronously with physiotherapy intervention may be a promising intervention to improve trunk performance, motor impairments and ADL performance however the result of our small study suggests that this intervention is not better than conventional physiotherapy.