Browsing by Department "Department of Health and Rehabilitation Sciences"

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    Open Access
    A case study exploring the application of the Occupation-based Community Development Framework: co-constructing humanising praxis
    (2019) Krenzer, Meghan Lee Mackenzie; Galvaan, Roshan
    The Occupation-based Community Development (ObCD) framework draws on critical occupational science concepts in working with marginalized communities to bring about transformative change (Galvaan & Peters, 2017a). However, little research has been conducted on this to date, specifically within community development practice (CDP) and in the Global South. This study asked the question: “How does the application of an occupational perspective and participatory action methods influence the processes within ObCD?” A qualitative research design employing an instrumental single case study was conducted. The case was bounded within the University of Cape Town’s final year Occupational Therapy student service-learning placements during the period of 2014 to 2016, in South Africa. Participants were purposively selected and included occupational therapy clinical educators and recent occupational therapy graduates who had applied the ObCD framework during their CDP placements. Data was generated through a focus group; individual semi-structured interviews and analysis of graduates’ written reports. A thematic analysis revealed the case to be that of co-constructing humanising praxis, describing the evolving thinking and doing of practice. Three themes, namely: 1) Processes of dialogue and doing; 2) Situating occupational perspectives in socio-political and historicised contexts; and 3) Negotiating positionalities, offer detailed descriptions of the elements to consider in engaging and developing this form of praxis. The discussion illustrates how praxis resonates with the values of critical and social occupational therapy in working towards promoting occupational justice. Thereby, proposing that occupational justice implies engaging in humanising praxis, through a co-constructed journey with stakeholders. The suggestion made is that praxis guided by the ObCD Framework promotes occupational justice. Shifts in terminology and concepts, that could depict the values in ObCD more explicitly are suggested. Finally, praxis as a potential avenue for decolonising domains of occupational therapy practice is identified. Recommendations relating to occupational therapy curricula, services and research are offered.
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    A case study of emerging practice in speech-language therapy in a community practice context
    (2019) Abrahams, Kristen; Kathard, Harsha; Pillay, Mershen; Harty, Michal
    Background: The profession of speech-language therapy (SLT) continues to struggle with challenges around equity and service delivery. The dominant medical model, characterised by one-on-one, individualised health care, is struggling to serve the large population in need of services. As such, there is a need to reconceptualise SLT practices toward a social justice focus. The study used clinical education as the entry point of exploration into how emerging professional practices (EPPs) may be developed. Aims/Objectives: The study aimed to describe and analyse a case study of an emerging professional practice in SLT as part of a university-school partnership in a peri-urban settlement in South Africa. The objectives were: 1. To describe and analyse the practice methods of the EPP, 2. To describe and analyse the educational and knowledge bases which support the EPP, and 3. To describe and analyse the underlying epistemology, ontology and methodology underpinnings shaping the EPP. Method: A qualitative case study methodology, guided by critical theory and decoloniality, was used. Final year SLT students were the primary participants for the study. Data were collected in the form of document analyses, participant observations, interviews, photovoice, and experiential drawings from a number of stakeholders (including SLT students, a school principal, a project coordinator, a library assistant and a clinical educator) from January to December 2017. The data were analysed using reflexive interpretation (Alvesson & Sköldberg, 2009) as a guiding frame. Findings: The three-level analysis process was used to generate the thesis offering. The first level of analysis was the construction of the overall case narrative - documenting the practice methods of the EPP through the experiences of the SLT students. The second level of analysis used thematic analysis approach to identify key themes emerging from the case narrative. Four key themes were explored in the form of narratives, collages and paintings. The third level of analysis used decoloniality (i.e. coloniality of power, knowledge and being) and the Relationship of Labouring Affinities (RoLA) as critical lenses to deepen my understanding of the case. Through using both RoLA and decoloniality, dialogue emerged as a critical form of engagement toward developing EPPs. The study specifically puts forward the concept of critical dialoguing as a necessary process for conscientisation and change. Conclusion: The findings of the study illuminated how SLT students navigated through their experiences of disruption of their traditional practice. The findings weave together participant narratives, drawings and collages to engage the reader in the EPP. The findings showed how critical engagement with political, historical, social and linguistic influences underlying their work in communication, facilitated new learning and insight into SLT practice. The thesis offering discusses the role of critical dialoguing in opening up space for critical discussions about the profession. In conclusion, supported disruption provided students with a platform to interrogate current SLT practices, re-examine the viability of practices to serve populations, and reflect on how the SLT profession can adapt and change with the changing needs of the population.
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    A case study of how a centre-based preschool programme for children who are blind/visually impaired supports early multilingual communication development
    (2023) Kamedien, Layla; Kathard, H
    Communication development is an essential part of a child's development – socially, academically, and vocationally. For children with visual impairment/blindness (VI/B), the literature indicates that opportunities supporting early communication development can benefit a child with VI/B. Speech-language therapists' (SLTs) core focus on communication is instrumental in supporting children to develop their communication. However, little is known about the practices which support the communication development of children with VI/B. The study therefore aimed to explore and describe how the centre-based preschool programme at the League of the Friends of the Blind (LOFOB) in Cape Town supported early multilingual communication development. A qualitative case study design was used to explore and describe the programme's knowledge, values, principles, skills, and practices. Semi-structured interviews were conducted with key stakeholders, along with classroom observations and document reviews of key government policies, principles and standards. Thematic analysis was used to analyse and interpret findings. During this process a key informant with VI was used to assist with the interpretation of the data. The findings are presented as a narrative and accompanying individual vignettes. The narrative explores the activities and opportunities available for multilingual communication support. While the individual vignettes describe the knowledge, values, principles and skills that inform the practices of the programme. Key themes that emerged from thematic analysis of the data include an inclusive approach to encourage multilingual engagements and support, a structured programme that focussed on capabilities, and a committed team offering support. The study argued that there is an opportunity for the SLT profession to rethink how communication is typically supported and shifting from a focus on pathology to communication supports that explore capabilities and inclusion.
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    A case study on the experiences of persons with disabilities of the disability grant processes occurring at SASSA Springbok in the Northern Cape
    (2021) Bock, Stacey Louisa; Sonday, Amshuda; Buchanan, Helen
    Introduction: Persons with disabilities (PWDs) living in rural areas are known to have a higher risk of living in poverty as they have the lowest levels of employment. To assist persons with disabilities to overcome these challenges, the South African government has developed interventions such as social assistance programmes which aim to prevent poverty and assure the basic minimum standard of living. Over the past five years minimal research has been published which focused on the disability grant in the South African context. More specifically, no research has been conducted in the Northern Cape, home to a high proportion of persons with disabilities. Of the research conducted in other parts of South Africa, no studies have sought to understand the experiences of persons with disabilities while engaging in the disability grant process. The research question for this study was, “How are PWDs experiencing the disability grant processes occurring at the SASSA Springbok branch in the NC?” This study therefore aimed to describe the experiences of disabled persons with the disability grant processes as they occurred at the South African Social Security Agency (SASSA) in Springbok, Northern Cape. Method: A single instrumental case study research design was utilised. Five participants were purposively sampled. Data were collected through document review of pertinent SASSA documents, non-participant observation, and semi-structured interviews. Data were analysed inductively, taking a thematic approach. Findings: The theme that emerged was Respecting differences is part of humanity. The main findings reveal that engaging with persons with disabilities as humans and not disregarding their humanity because of their disability are imperative to how they experience the disability grant process. Two categories, For us, human dignity matters, and the Impact of context on occupational rights, encapsulate two specific areas that relate to the theme. Conclusion: The experience of the disability grant process in this case study was influenced by stakeholder engagement with participants, mandatory protocols implemented due to the novel coronavirus, and the administrative aspects of the process. Recommendations for an improved overall experience of the disability grant process include streamlining the disability grant application process, the implementation of consistent Batho Pele principles by all stakeholders, suitably accommodating the disability grant application process for all types of disabilities, as well as maintaining the logistical structures put in place (albeit unintentionally) from the year 2020.
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    A critical evaluation of the effectiveness of interventions for improving the well-being of caregivers of children with cerebral palsy: a systematic review protocol
    (BioMed Central, 2016-07-13) Dambi, Jermaine M; Jelsma, Jennifer; Mlambo, Tecla; Chiwaridzo, Matthew; Tadyanemhandu, Cathrine; Chikwanha, Mildred T; Corten, Lieselotte
    Background: Over the years, family-centered care has evolved as the “gold standard” model for the provision of healthcare services. With the advent of family-centered approach to care comes the inherent need to provide support services to caregivers in addition to meeting the functional needs of children with physical disabilities such as cerebral palsy (CP). Provision of care for a child with CP is invariably associated with poor health outcomes in caregivers. As such, there has been a surge in the development and implementation of interventions for improving the health and well-being of these caregivers. However, there is a paucity of the collective, empirical evidence of the efficacy of these interventions. Therefore, the broad objective of this review is to systematically review the literature on the effectiveness of interventions designed to improve caregivers’ well-being. Methods/design: This is a systematic review for the evaluation of the effectiveness of interventions designed to improve caregivers’ well-being. Two independent, blinded, reviewers will search articles on PubMed, Scopus, Web of Science, CINAHL, Psych Info, and Africa-Wide Information using a predefined criterion. Thereafter, three independent reviewers will screen the retrieved articles. The methodological quality of studies meeting the selection criterion will be evaluated using the Briggs Institute checklists. Afterwards, two independent researchers will then apply a preset data-extraction form to collect data. We will perform a narrative data analysis of the final sample of studies included for the review. Discussion: The proposed systematic review will provide the empirical evidence of the efficacy of interventions for improving the well-being of caregivers of children with physical disabilities. This is important given the great need for evidenced-based care and the greater need to improve the health and well-being of caregivers. Systematic review registration: PROSPERO CRD42016033975.
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    A pilot study to investigate the use of the ICF in documenting levels of function and disability in people living with HIV
    (2006) Jelsma, J; Brauer, N; Hahn, C; Snoek, A; Sykes, I
    Objective: The study was a pilot study aimed at investigating the use of the International Classification of Functioning, Disability and Health (ICF) checklist developed by the World Health Organisation in determining the function of individuals living with HIV in a township near Cape Town. Methods: Twelve participants attending the HIV clinic were examined using the ICF checklist. Findings: Areas of the ICF in which problems were noted included emotional functioning and energy and drive. Four participants complained of increased sensitivity to sound. Several respondents (three) reported difficulties in relationships with community members, with less having problems in family and intimate relationships. Conclusion: The ICF was found to be time consuming and many codes were not relevant. Some of the concepts were not well understood by the participants. However, despite limitations, the use of the ICF in a resource poor setting formed a useful framework within which to examine the functional problems of HIV infected individuals. In the absence of any equivalent unifying framework within which to classify health and health related states, the use of the ICF merits further investigation.
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    A qualitative study into the advocacy and activism of carers of adolescents with Down Syndrome in Oshana, Namibia
    (2019) Kambowe, Hannah; Duncan, Madeleine; Mckenzie, Judith
    Background: Down Syndrome (DS) is a chromosomal defect known to cause intellectual disability. Adolescents with DS may need to live with their families beyond the transition period into adulthood because they require lifelong care due to the disabling consequences of the genetic condition. Evidence is lacking about the actions that carers in remote rural communities are taking to enhance the rights of their adolescents with DS as enshrined in the United Nations Convention on the Rights of Persons with Disabilities (CRPD). Aim: To describe the advocacy and activism actions of carers that promote the disability rights of adolescents with DS. Objectives: To describe carers’ understanding of 'activism’ in relation to the needs of adolescents with DS; to explore what actions carers are engaging with in order to promote participation and equal opportunities for social inclusion of adolescents with DS; to describe barriers encountered and strategies used and to describe carers’ advocacy priority list for social inclusion of adolescents with DS. Methodology: A descriptive qualitative approach was used where three carers told their stories of activism and advocacy actions through a semi-structured in-depth interview method. Their stories were audio-recorded, transcribed into textual form and an inductive data analysis followed a framework approach guided by the research aims. Findings: One overriding theme Puuyelele (bringing adolescents with DS into the open) emerged with four categories: namely, “Speaking for and acting on behalf of adolescents with DS”, “Enabling a continuous enlightening process”, “Ensuring ongoing care and services” and “Raising public awareness on human rights of adolescents with DS”. Discussion: Three concepts about DS advocacy and activism for adolescents with DS formed the discussion; first, it is a strategic process requiring togetherness, courage and perseverance; second, it proceeds from vigilant care-giving and service provision and, lastly, it requires rising of human rights awareness. Conclusion: A strategic and contextualised DS advocacy and activism process such as Puuyelele requires human rights awareness and emerges from vigilant care that enhances community participation and social inclusion of adolescents with DS. The process creates a possible and realistic conceptual framework for further strengthening of disability-inclusive development initiatives in Namibia.
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    A questionnaire for assessing breastfeeding intentions and practices in Nigeria: validity, reliability and translation
    (BioMed Central, 2017-06-07) Emmanuel, Andy; Clow, Sheila E
    Background: Validating a questionnaire/instrument (whether developed or adapted) before proceeding to the field for data collection is important. This article presents the modification of an Irish questionnaire for a Nigerian setting. The validation process and reliability testing of this questionnaire (which was used in assessing previous breastfeeding practices and breastfeeding intentions of pregnant women in English and Hausa languages) were also presented. Method: Five experts in the field of breastfeeding and infant feeding voluntarily and independently evaluated the instrument. The experts evaluated the various items of the questionnaire based on relevance, clarity, simplicity and ambiguity on a Likert scale of 4. The analysis was performed to determine the content validity index (CVI).Two language experts performed the translation and back-translation. Ten pregnant women completed questionnaires which were evaluated for internal consistency. Two other pregnant women completed the questionnaire twice at an interval of two weeks to test the reliability. SPSS version 21 was used to calculate the coefficient of reliability. Results: The content validity index was high (0.94 for relevance, clarity and ambiguity and 0.96 for simplicity). The analysis suggested that four of the seventy one items should be removed. Cronbach’s Alpha was 0.81, while the reliability coefficient was 0.76. The emerged validated questionnaire was translated from English to Hausa, then, back-translated into English and compared for accuracy. Conclusion: The final instrument is reliable and valid for data collection on breastfeeding in Nigeria among English and Hausa speakers. Therefore, the instrument is recommended for use in assessing breastfeeding intention and practices in Nigeria.
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    A randomised control trial for the restoration of functional ability in patients post total knee arthroplasty: Eccentric versus concentric cycling ergometry
    (2018) Silal, Sandhya Prakash; Albertus, Yumna; Tam, Nicholas; Posthumus, Michael
    Introduction: While the total knee arthroplasty procedure improves joint-specific outcomes, including pain and range of movement, functional deficits post-surgery has been noted. Movement abnormalities and quadriceps weakness of the operated limb, as well as a decrease in strength on the non-operated have been widely reported. Recovery of strength and function to normal levels is also rare, thereby predisposing patients to future disability with increasing age. The purpose of this study was to determine the effects of an eight-week eccentric cycling ergometry exercise intervention versus a concentric cycling ergometry exercise intervention in total knee arthroplasty recipients three to nine months post-surgery. This study aimed to a) investigate the change in joint kinetics, kinematics and muscle activity during the phases of gait, between the eccentric and concentric groups over time and b) To determine if an eccentric cycling exercise intervention produces greater improvements in knee function when compared to concentric cycling exercise. Methods: Eighteen participants, three to nine months post total knee arthroplasty were recruited and randomly assigned to either an eccentric or concentric cycling exercise intervention group. Participants performed three exercise sessions weekly over a progressive eight-week period on the Grucox Isokinetic Ergometer. Walking gait analyses and functional outcomes, as measured by the six-minute walk test and validated knee scores (Knee Injury and Osteoarthritis Outcome Score, SF-36 Health Survey and Tegner Activity Scale) were recorded pre- and post-intervention. Results: The concentric group knee flexion range of movement increased significantly during the swing phase of gait (p=0.021) post-intervention together with a significant increase in the peak knee flexion angle during swing (p=0.038). The concentric group showed significant differences between pre and post-rehabilitation in knee flexion range of movement during the swing phase of gait (p=0.030). Significant correlations between knee joint stiffness and the quadriceps:hamstring co-activation ratio were observed in the concentric intervention group pre-intervention: during the pre-activation phase of gait between knee joint stiffness and vastus medialis / biceps femoris (r=-0.68; p=0.042) and during load acceptance phase of gait between knee joint stiffness and vastus lateralis / biceps femoris (r=0.07; p=0.036). The eccentric group recorded neuromuscular changes post-intervention with a significant decrease in the muscle activity of the biceps femoris during load acceptance phase of gait (p=0.021). The eccentric group had significantly better functional outcomes in the overall score of Knee injury and Osteoarthritis Outcome post-intervention (p=0.008) with a significant increase in function seen in the Sports and Recreation subgroup (p=0.008) and a significant increase in the level of activity as measure by the Tegner Activity Scale post-intervention (p=0.028), despite not showing any significant changes in the knee joint kinetics and kinematics. The concentric group only reported a significant increase in the overall score of the of the SF-36 Health Survey (p=0.011) with significant increases in three of the subgroups post-intervention: Bodily pains had improved (p=0.042), the role limitations due to physical heath had improved (p=0.028) and the role limitations due to emotional health had also improved (p=0.009). The concentric group also showed significant improvement in the emotional health over the intervention in comparison to the eccentric intervention group (p=0.020). Both intervention groups reported a similar significant increase in the distance covered during the six-minute walk test post-intervention (p=0.038). Conclusion: The results of this exploratory study did not find the eccentric cycling rehabilitation intervention exclusively more effective than the concentric cycling intervention in the restoration of functional ability in patients post-TKA. The eccentric intervention did however result in neuromuscular adaptations consistent with a move towards a more typical asymptomatic gait pattern and participants reported greater functional improvements on validated knee functional assessments and levels of activity scores. The concentric intervention yielded kinematic changes and participants reported improvements in their emotional and physical health post-intervention. Eccentric training and its role in early stage post-operative rehabilitation is limited. Based on the findings from this exploratory study, the benefit of eccentric training as an adjunct to rehabilitation and its role in contributing to greater improvements in the restoration of functional ability post-TKA needs to be further explored.
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    A review of childhood vestibular disorders
    (2010) Rogers, Christine
    Diagnosis of disorders of balance is challenging, as there are broad differentials and patients may present to a variety of healthcare practitioners, ranging from an audiologist to a psychiatrist. In addition, investigations, both at the bedside and laboratory, are often non-contributory, expensive and unpleasant. The adult dizzy patient is regarded with dread by many in the healthcare community: the patient is difficult to diagnose and challenging to treat, and the situation is frequently complicated by the presence of anxiety, panic and depression. When symptoms arise in childhood they cause alarm in the parents and the treating healthcare professional. Diagnosis and management of balance disorders in childhood, is even more demanding when patients are frequently unable to communicate the nature of the complaint. Furthermore, the aetiology and presentation of vestibular disturbance is markedly different between adults and children. Symptoms of vestibular disorders in children may easily be mistaken for behavioural or other medical problems, leading to under-diagnosis and inappropriate investigations and treatment. Detrimental effects of childhood vestibular disorders may include delayed gross motor development, learning and spatial problems, and time off school. This review summarises the most common causes of childhood vestibular disorders and suggests the need for a multidisciplinary approach to assessment.
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    A study of the collaborative process of volunteers in a literacy intervention programme in support of vulnerable children in South Africa
    (2019) Zoetmulder, Amy; Kathard, Harsha; Pillay, Mershen
    The development of early literacy skills is critical for all children in South Africa. Children receive language and literacy development support in the home, school, and community environments. Vulnerable children, such as orphans, may receive this support from volunteers in their home environments. Additional language development support systems in the form of programmes run by volunteers are important. This study describes and analyses the process of collaboration between six volunteers who are involved in languageliteracy programmes by examining how volunteers negotiate collaboration in promoting literacy development. This qualitative research study used a participatory action cycle design to investigate collaboration. A range of research methods such as focus groups, interviews, reflections and observations were used. Findings from this study provided insight into the identity of volunteers. They were people who had strong values in respect of literacy, a positive experience of volunteering, a sense of civic responsibility and an empathetic personality. The collaborative process was established through the presence of a strong common cause, vulnerability and trust among volunteers, a structured and well-led action cycle process, the development of self-reflection, and a passion to be change agents. Volunteers were able to problem solve and act to make changes to the intervention programme which included actions at a programme and volunteer level. The speechlanguage therapist (SLT’s) role was critical in a literacy-related intervention as a support for volunteers. The expertise of SLTs, namely knowledge in language and literacy development, was valued in streamlining the process of taking appropriate actions to enrich the literacy programme.
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    A systematic review protocol on the effectiveness of therapeutic exercises utilised by physiotherapists to improve function in patients with burns
    (BioMed Central, 2017-10-23) Mudawarima, Tapfuma; Chiwaridzo, Matthew; Jelsma, Jennifer; Grimmer, Karen; Muchemwa, Faith C
    Background: Therapeutic exercises play a crucial role in the management of burn injuries. The broad objective of this review is to systematically evaluate the effectiveness, safety and applicability to low-income countries of therapeutic exercises utilised by physiotherapists to improve function in patients with burns. Population = adults and children/adolescents with burns of any aspect of their bodies. Interventions = any aerobic and/or strength exercises delivered as part of a rehabilitation programme by anyone (e.g. physiotherapists, occupational therapists, nurses, doctors, community workers and patients themselves). Comparators = any comparator. Outcomes = any measure of outcome (e.g. quality of life, pain, muscle strength, range of movement, fear or quality of movement). Settings = any setting in any country. Methods/design: A systematic review will be conducted by two blinded independent reviewers who will search articles on PubMed, CiNAHL, Cochrane library, Medline, Pedro, OTseeker, EMBASE, PsychINFO and EBSCOhost using predefined criteria. Studies of human participants of any age suffering from burns will be eligible, and there will be no restrictions on total body surface area. Only randomised controlled trials will be considered for this review, and the methodological quality of studies meeting the selection criteria will be evaluated using the Cochrane Collaboration tool for assessing risk of bias. The PRISMA reporting standards will be used to write the review. A narrative analysis of the findings will be done, but if pooling is possible, meta-analysis will be considered. Discussion: Burns may have a long-lasting impact on both psychological and physical functioning and thus it is important to identify and evaluate the effects of current and past aerobic and strength exercises on patients with burns. By identifying the characteristics of effective exercise programmes, guidelines can be suggested for developing intervention programmes aimed at improving the function of patients with burns. The safety and precautions of exercise regimes and the optimal frequency, duration, time and intensity will also be examined to inform further intervention. Systematic review registration. PROSPERO CDR42016048370.
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    Accuracy of prediction of edurance running performance : relationship to training history, muscle pain and relative perception of effort
    (2014) Nunes, Dawn; Burgess, Theresa; Lambert, Mike
    Background: Endurance running performance is a complex interaction between training factors, exercise-induced muscle damage, and fatigue. The accuracy of prediction of running performance allows for the consideration of the effects of teleoanticipatory factors such as pacing and prior experience on performance. However, previous studies have not adequately considered the role of predicting performance outcomes before competition, and the potential influence of self-regulated pacing and prior experience on running performance. Aim: The aim of this descriptive analytical correlational study was to determine potential factors associated with the accuracy of prediction of running performance during a marathon race. Specific objectives: (a) To determine whether there were differences in training history, pacing, muscle pain and the relative perception of effort (RPE) in three identified groups that accurately predicted race time, performed faster than the predicted time, or performed slower than the predicted time; and (b) to determine if demographic characteristics, training and competition history, self-identified pacing strategy, muscle pain and the relative perception of effort (RPE) were associated with the accuracy of predicting performance during the marathon. Methods: Sixty-three healthy male and female runners were recruited through a short message service (SMS), word of mouth and at the 2013 Mandela Day marathon registration. Participants were included if they were over the age of 20 years, and were taking part in the marathon race. Participants were required to complete the marathon within the seven-hour cut-off time. Participants who had any lower limb musculoskeletal injury, medical condition or surgical intervention that prevented training for seven consecutive days in the three-month period prior to the race were excluded from the study. Participants who reported any flu-like symptoms during the two weeks preceding the race were also excluded from the study. In addition, participants with any missing race RPE or pain scores were excluded. Participants were allocated to one of three groups depending on their accuracy in predicting their final race time. A margin of two percentage points was considered as a meaningful difference in time. If the participants’ actual race time was accurate within two percentage points of their predicted race time, it was considered accurate, and those participants formed the accurate group (n = 16). Participants on either side of the two percentage points formed the fast (n = 21) and slow (n = 26) groups respectively. All participants completed an informed consent form and a medical and training questionnaire at a familiarisation session before to the race. Participants were also familiarised with the tests and procedures for collecting data during the race. During the marathon, muscle pain and relative perception of effort (RPE) were recorded at 0 km, 10 km, 21.1 km, 30 km, and 42.2 km. A short compliance questionnaire was completed when participants finished the marathon. Official race times were obtained from the Championchip® website. Muscle pain was recorded for seven days after the marathon. Participants were also asked to report when they resumed running training after the race. Results Participants in the slow group were significantly younger (p < 0.05), had faster 10 km PB times (p < 0.01), and trained at a faster pace (p < 0.01) compared to participants in the accurate and fast groups. Participants in the slow group had faster actual (p < 0.05) and predicted (p < 0.01) marathon times (p < 0.01) compared to participants in the accurate and fast groups. There was a significant positive relationship between actual and predicted marathon times (r = 0.71, p < 0.01). There were no significant differences between groups in muscle pain and RPE during the race; however there were significant main effects of time for pain (p < 0.01) and RPE (p < 0.01) during the race. Muscle pain and RPE were significantly increased at 21 km, 30 km, and 42.2 km, compared to pre-race values. There were no significant differences in post-race pain between groups, but there was a significant main effect of time (p < 0.01) as muscle pain was significantly elevated for three days after the race. This study was also unable to identify any significant demographic, training and competition history, or race factors associated with the accuracy of prediction of marathon performance. Conclusion: Linear increases in muscle pain and RPE were observed during the race in all groups. This study was unable to identify specific factors associated with the accuracy of prediction of running performance during a marathon race. However, it is possible that the slow marathon times and the low relative exercise intensity in all groups may have limited the effects of muscle pain and RPE on self-regulated pacing and performance. Future studies should have more stringent inclusion criteria to ensure runners are competing at moderate to high relative exercise intensities. In addition, future studies should carefully consider route profiles to ensure that the race profile does not potentially confound the accuracy of prediction of performance by limiting actual marathon times.
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    Adaptation of the abuse assessment screening tool for midwives in northern Nigeria
    (2019) Musa-Maliki, Ayishetu Uduoye; Duma, Sinegugu
    The term „intimate partner violence‟ (IPV) is employed in this study to denote the physical, sexual, economic, and psychological or other harm directed against a pregnant woman by her partner or spouse. It affects both pregnant women and their unborn children, as both may suffer serious health consequences. The purpose of this study is to investigate midwives‟ current screening practice for IPV among pregnant women in a northern Nigerian hospital and to adapt the Abuse Assessment Screen (AAS) tool to aid midwives‟ screening practice. Qualitative data were collected from midwives in the antenatal clinic of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, in four phases using a panel longitudinal design as a guide. In the first phase non-participant observation and individual face-to-face semistructured interviews were conducted with ten participants using an interview guide. In phase two non-participant observation of the same participants took place as pregnant women were screened with the original AAS tool for two months, then a focus group discussion was conducted in phase three. Thematic data analysis was carried out in all phases using Yin‟s five stages of analytical cycle and also guided by the conceptual framework of Wile‟s human technology model. In phase four the original AAS tool was modified based on the findings of phases two and three. Five themes emerged in phase one and four in phase three after triangulation of data from phase two. It was found that routine screening for IPV is not practiced by midwives in the research setting as a result of various factors, some internal and others external to them. The midwives also faced several challenges that discourage screening of pregnant women for IPV. Their suggested solutions to these challenges were also incorporated into a modified version of the original AAS tool after analysing the data. Thereafter the modified tool was given to the same participants to use and to confirm its suitability for IPV screening in phase four, and a theme emerged. With adequate education and training the internal factors hindering midwives‟ screening practice can be eliminated, while the external factors will need the intervention of hospital authorities to eliminate or mitigate their effects on screening.
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    Amputation rate following tibia fractures with associated popliteal artery injuries
    (2017) Roussot, Mark; Maqungo, Sithombo; Roche, Stephen
    Objectives: 1. Determine the amputation rate; and 2. identify risk factors in patients with tibia fractures and associated popliteal artery injuries. Intervention: Amputation or limb salvage. Design: Retrospective case-control study. Setting: Level 1 trauma center. Patients: Thirty popliteal artery injuries with ipsilateral tibial fractures. Outcome measures: Primary and delayed amputation rates were determined. Risk factors tested for significance (Fischer's Exact) included: mechanism of injury, signs of threatened viability, compartment syndrome, fracture pattern, surgical sequence, and time delay from injury or presentation to revascularization. Results: The study group consisted of 22 males and 8 females, with a mean age of 31 years. Motor vehicle accidents and gunshot wounds constituted the mechanism in 17 and 11 patients respectively. Twenty-one were polytrauma victims. Intra/extra16 articular metaphyseal fractures (OTA 41 A-C) were recorded in 19 and diaphyseal (OTA 42 A-C) in 7 patients. Primary amputation was performed in 7 and delayed in 10 patients (overall rate 57%). No individual risk factors were predictive of amputation; however, the "miserable triad" of a proximal tibia fracture (OTA 41) with signs of threatened viability, and delay to revascularization ≥ 6 hours from injury or ≥ 2 hours from presentation was predictive of amputation (p = 0,036 and p = 0,018 respectively). Conclusions: We should aim to intervene within 6 hours following injury or 2 hours following presentation to reduce the risk of amputation. This provides a target for trauma teams even with uncertain time of injury. Level of Evidence: III.
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    An exploration of services and member profiles at Senior Service Centres in the Western Cape, South Africa
    (2018) Harris, Fahmida; Amosun, Seyi Ladele; Kalula, Sebastiana
    Introduction The number of South Africans aged 60 years and older is increasing. The National Development Plan (NDP) aims to raise average life expectancy to 70 years by 2030. In response to similar global trends, the World Health Organization (WHO) developed the global Active Ageing Policy Framework (AAPF) to inform the actions taken by countries to address the needs of older persons, acknowledging the different contexts and cultures. The WHO recommended that the framework should have been evaluated to test its applicability and use in member countries by the first half of the twenty-first century. In South Africa, Senior Service Centres for Older persons were set up in communities to provide services to enhance the achievement of the goals of the AAPF. Unfortunately, little information is available on how the framework has been applied to inform services offered in African countries, including South Africa. This study explored services provided by Service Centres for Older Persons in the Western Cape using the WHO framework on Active Ageing as a guide to the services. The study was conducted in two phases. Aims In the first phase, the study explored the characteristics of Service Centres – the organisational structures, the types of services offered, the profile of the managers, and their perception of the needs of the members of the centres. In the second phase, the study explored the profile of the members of these centres by determining their socio-demographic profile, health and psychosocial characteristics. Methodology In phase 1, forty-one service centres were selected by stratified random sampling to proportionally represent the five districts and the Cape Metropole in the province. Only 35 service centres consented to take part in the study. In phase 2, a sample of convenience was recruited from 3 051 registered members at the 35 service centres. Only 625 members consented to participate. A cross sectional, descriptive research design was utilised to collect data on the characteristics of the service centres from the managers, using a modified self-developed questionnaire. To explore the profile of members of the service centres, a self-developed questionnaire and two standardised questionnaires namely, World Health Organization Quality of Life-BREF (WHOQOL-BREF) and World Health Organization Disability Assessment Schedule II (WHODAS II), were administered. Data analysis Descriptive statistics were used to analyse the responses to the closed-ended questions in phases 1 and 2 of the study, and data presented as frequencies. Similarly, responses to the open-ended questions were summarised and themes were identified. In phase 1, quantitative and qualitative responses were analysed according to the WHO Active Ageing Framework. In phase 2, the data generated were analysed according to the WHO International Classification of Functioning, Disability and Health Framework (ICF) model. Results Services offered to members at the centres in the six categories of determinants of the AAPF included the following: • Health and social care systems – Limited screening programs were provided as part of health promotion and disease prevention services. • Behavioural – Physical activity/exercise programmes were most common, but no programs addressed healthy eating habits, tobacco and alcohol abuse, or adherence to medication use. • Personal factors – Services were provided to enhance members’ cognitive skills. • Physical environment – No services were offered on falls prevention. • Social environment – Different types of social support programmes were offered, including meeting education and literacy needs of members through the provision of Adult Basic Education Training (ABET). • Economic – Some centres offered members opportunities for formal work and volunteering, while some provided income generation activities. Most of the managers had high school education but expressed the need for training to manage these centres. The managers perceived the needs of the members would relate to health care, social support, inactivity, isolation and safety among others. The summary of the profile of the 625 members of the centres are presented in the domains of the ICF model: • Personal factors – The members were predominantly widowed women with a mean age of 74.1 ±7.51 years (range 60–100 years). Most members displayed good lifestyle habits and engaged in various leisure and physical activities. Members were also satisfied with themselves, their health, bodily appearance and quality of life and reported a variety of aspirations for their future with and without possible future-orientated behaviours. • Health conditions – Hypertension, arthritis and diabetes were the most common health problems reported by members for which they took medication. Falls were not common among members although the majority feared falling. • Body structure and function – Most members expressed good cognitive function, could concentrate and follow conversations, and reported no hearing, visual or bladder problems. Members also reported good postural balance. • Activities and participation – Members were satisfied with their abilities to do daily activities, participate in the community, and learn new tasks. • Environmental factors – Most members resided with their children or family for various reasons, including needing care for themselves or to provide care to their children and/or extended families. Discussion and conclusion Using the WHO AAPF as a guide, it was found that services provided by Service Centres for Older Persons in the Western Cape, although varied, were deficient at most service centres. The managers responsible for providing these programmes were women with limited skills who needed more education and training to be able to manage the centres appropriately. The members of service centres, despite presenting with health challenges and multi-morbidities, indicated aspirations for the future. In view of the goals of the National Development Plan (NDP) to increase life expectancy of older persons to 70 years by 2030, a more comprehensive exploration of the profile of older persons will assist the managers of the Service Centres to respond more appropriately to the diversity of needs and interests of members.
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    An exploration of the facilitators and barriers experienced by Rehabilitation Care Workers in the provision of Speech-Language Therapy related services
    (2018) Higgs, Salma; Harty, Michal; Norman, Vivienne
    Background: South Africa experiences a severe shortage of speech-language therapists (SLTs) which results in individuals requiring Speech-Language Therapy (SLT) services having to travel long distances or being placed on long waiting lists to access services. Rehabilitation Care Workers can assist with bringing this service closer to the communities they serve. It is important to explore the experiences of these individuals to ensure that they are adequately supported and skilled. The University of Cape Town (UCT) has been training Rehabilitation Care Workers (RCWs) since 2012, however to there is currently no empirical data documenting the facilitators and barriers experienced by RCWs in their work. Aim: To explore RCWs (in the Mitchells Plain/Klipfontein sub-structure) perceptions of the facilitators and barriers in providing SLT related activities in their work context. Methods: A descriptive exploratory study was conducted. Eighteen RCWs were approached and 13 participated in 2 focus groups. Data was transcribed and analysed using thematic analysis. An inductive approach was used to develop meaningful themes and sub-themes. Results: The plot of “vital role players” best synthesized the 3 main themes namely scope of practice, RCW position and value as an intrinsic motivator and challenges. : The scope of practice theme included 4 sub-themes namely, RCW activities; awareness of broad scope; understanding family needs; including family as stakeholders in patient management. RCW position and value as an intrinsic motivator - included 4 sub-themes namely, integral members of the team; agents for change; community servants; go between formal structures and the community. Finally the theme challenges –included 4 sub-themes namely, training gaps; safety; lack of resources; feeling undervalued. The facilitators and barriers identified by the RCW’s aligned with perceptions of other mid-level health care workers as reported in the literature. Implications: RCWs work within a family centred care approach and see themselves as community servants who bring vital rehabilitation services into homes by transferring their skills to families and communities through education, support and advocacy. Despite their value and passion, RCWs feel undervalued by those around them, including management structures and the Department of Health (DOH). Conclusion: RCWs can bring much needed rehabilitation services into the homes of communities in Cape Town. For this reason, it is imperative to consider the facilitators and barriers experienced by these individuals in order to harness their natural skills and strengthen the current RCW service and solidify their roles within the Multidisciplinary Team (MDT).
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    An exploration of the occurrence of speech sound disorders in children with autism spectrum disorder aged 4;0 ? 7;11 years
    (2023) Kapoutsis, Stefania; Harty, Michal
    Language development in children with autism spectrum disorder (ASD) is an area of study that has received a lot of attention, however there is limited research available on speech development in this population. There is especially limited research that has investigated speech sound disorders (SSDs) in children with ASD in South Africa. This study aimed to describe the type of SSDs children with Autism Spectrum Disorders (ASD) aged 4;0 – 7;11 years present with. The study employed a descriptive, exploratory research design. Twentyfive children aged 4;0 – 7;11 years with a diagnosis of ASD, attending English-medium schools in the Southern Suburbs of Cape Town, South Africa, participated in the study. The findings were described based on the classifications of SSDs (using Dodd's (2005) differential diagnostic framework), intelligibility ratings, production of phonemes and phonotactic structures, the occurrence of phonological processes, oro-motor ability, and prosody. Phonological delays were the most commonly occurring SSDs, this was followed by articulation disorders, phonological disorders and inconsistent phonological disorders. No participants in the sample were diagnosed with childhood apraxia of speech (CAS). The findings suggested that children with ASD appear to acquire vowels, consonants and phonotactic structures at the same trajectory as typically developing children. Variations in the acquisition of fricatives, affricates and liquids were observed. Substitution, syllable and atypical phonological processes were observed across the sample. A higher prevalence of delayed and atypical phonological processes were observed in the sample of children with ASD, compared to the norms available for typically developing children. The results of this study have indicated that while children with ASD acquire phonemes at the same rate as their typically developing peers, children with ASD may be more likely to present with SSDs. These findings highlight the need for SLTs to ensure that accurate speech assessments are carried out among this population, rather than focusing solely on language. This study is a starting point for further research to be carried out on speech development and SSDs in children with ASD.
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    An investigation into the risk factors of musculoskeletal diseases and the association between chronic diseases of lifestyle in an under-resourced area of the Cape Town Metropole
    (2019) Britz, Carmen; Hendricks, Candice; Jelsma, Jennifer
    Background: A recent shift in the global burden of disease from communicable to noncommunicable has shown that a third of the global burden of disease is attributable to noncommunicable disease, with the heaviest burden affecting poor communities in urban areas. Musculoskeletal disease (MSD) is the most common cause of severe chronic or persistent pain, functional limitations, and physical disability, affecting 20-50% of adults. Globally, disability due to musculoskeletal disease is estimated to have increased by 45% from 1990 to 2010 accounting for 6.8% of total years lived with disability. Research has highlighted a possible co-existence of musculoskeletal disease and chronic noncommunicable diseases of lifestyle, however, there is inadequate South African evidence regarding these inter-relationships and possible risk factors. This highlights a gap in research as management may not be appropriately targeted toward risk factors and thus may not reduce the high prevalence rates of musculoskeletal disease. Aim: The main aims of this study were firstly to determine the prevalence and patterns of acute and chronic musculoskeletal disease. The secondary aim was to explore the relationship between these factors by examining the patterns of onset of musculoskeletal disease, chronic diseases of lifestyle, and risk factors across gender and six age categories (from 18 years to 70 years and older) in patients seeking medical services at a community health centre in Cape Town, South Africa. It was hypothesised that if some conditions were found to have an earlier onset, these conditions might lay the foundation for the development of other chronic diseases of lifestyle and musculoskeletal disease. Methodology: A descriptive, cross-sectional, analytical study design was used at primary health care level at a community health centre in Cape Town, South Africa. All males and females aged 18 years and older, except those who were pregnant or unable to answer the English, Afrikaans, or isiXhosa versions of the selected questionnaires, were eligible to participate. The outcome measures were the Community Orientated Program for Control of Rheumatic Diseases (COPCORD) screening tool for musculoskeletal disease, the Brief Pain Inventory (BPI), the European Quality of Life-5 Dimensions (EQ-5D) health-related quality of life measure, the International Physical Activity Questionnaire (IPAQ), and anthropometric measures of weight, height, and waist and hip circumference. Data were collected via interview and anthropometric measurement. Responses were captured by online questionnaires on mobile devices using the mobile data collection application Magpi by DataDyne Group, LLC. Data were exported to Microsoft Office Excel spreadsheets for descriptive and inferential statistical analysis. Ethical permission was obtained from the University of Cape Town. Results: This study recruited 1115 participants, with a mean age of 48.7 ± 16.8 years. A prevalence rate of 33.6% (95% Confidence Intervals; CI: 30.1-36.5%) for acute MSD and 43.3% (CI: 40.4-46.3%) for chronic MSD was found. The number of participants reporting an overall prevalence of any MSD was 505 (45.7%; CI: 42.8-48.7%). The highest prevalence of MSD was found in females aged 40-59 years. The most common anatomical sites of chronic MSD were the knees (35.6%; CI: 31.5-39.9%), low back/pelvis (33.8%; CI: 29.8- 38.0%), shoulders (26.8%; CI: 23.1-30.9%), and hands/fingers (21.9%; CI: 18.5-25.7%). Of those with MSD, exercise was reported as the best management strategy for musculoskeletal pain (35.6% of 191 respondents; CI: 29.1-42.6%). Hypertension was found to be the most prevalent chronic disease of lifestyle (47.8%; CI: 44.8-50.7%), followed by type 2 diabetes mellitus (21.4%; CI: 19.1-23.9%), and hypercholesterolaemia (20.2%; CI: 17.9-22.6%). All chronic diseases, except chronic obstructive airway disease (COAD), increased with age, while COAD and both acute and chronic MSD peaked around the 50-59 age category and then decreased with age. Most females reported to be highly physically active (46.0%) while males reported mostly low physical activity levels (47.8%). Around the 50-59 year old age group the proportion of participants with a ‘high’ physical activity level decreased while that of participants with a ‘low’ physical activity level increased at the same age group. A higher proportion of those without MSD reported ‘high’ levels of physical activity (41% compared to 32%). In the 30-39 and 40-49 age groups, low levels of physical activity were associated with chronic MSD (70.6% compared to 37.5% of those. with high levels; Chi-Square=13.833; df=2; p=0.001). Body mass index (BMI) category was found to be associated with MSD (p< 0.001) with 73% of those with MSD being overweight or obese and 27% being extremely obese. There were significant differences in BMI between those with and without hypertension (p< 0.001), hypercholesterolaemia (p <0.001), and type 2 diabetes mellitus (p< 0.001). A trend of increasing obesity, high waisthip ratio and low levels of physical activity with age was observed. In smokers, being 30 years of age or older was associated with an increased risk of MSD (42% compared to 21.1%). Gender emerged as a risk factor in the 40-49 and 50-59 age categories with 76.2% of females in these categories reporting chronic MSD compared to 45.1% of the males. However, no risk factor seemed to track the plot of MSD. Age emerged as having the highest association with chronic MSD (Chi-Square=136.6; p< 0.001). Conclusions: Bivariate associations of musculoskeletal disease and chronic diseases of lifestyle were detected because they all become more prevalent with age. The comorbidity of musculoskeletal disease and chronic disease of lifestyle appeared to almost entirely be due to the aging process, rather than the mutual influence that musculoskeletal disease and chronic diseases of lifestyle may have. Low levels of physical activity were only associated with musculoskeletal disease among those in the 30-49 age categories. As previous evidence has shown that increased levels of physical activity can reduce pain in chronic or persistent musculoskeletal disease, a window of opportunity is suggested where increasing physical activity levels in the 30-49 age group may result in a decrease in the prevalence of musculoskeletal disease in the older age group. The only factor that emerged as being predictive in the group with the highest prevalence of musculoskeletal disease, the 40-59 age categories, was gender. Although gender is clearly not modifiable, this finding should inform the development of culturally appropriate intervention strategies. Implications: Although it was not possible to detect any evidence supporting causation, the co-existence of chronic musculoskeletal disease, chronic diseases of lifestyle, and risk factors highlights the need for holistic care to address the multiple problems experienced by adults, specifically as age progresses. The impact of chronic musculoskeletal disease is large, both in terms of prevalence and impact on health-related quality of life. The management of chronic musculoskeletal disease should thus focus on the most effective and affordable intervention strategies and healthcare systems and coherent policies for dealing with this condition should be developed. This management should not only be based on a pharmacological model but on biopsychosocial integration emphasising self management.
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    Antibody engineering to evaluate binding, internalisation, and intracellular routing of tumour-targeting fusion proteins
    (2023) Karaan, Maryam; Barth, Stefan
    Breast cancer is a major global health crisis, particularly affecting women, and triple-negative breast cancer (TNBC) is an aggressive subtype with limited treatment options. TNBC is challenging to treat due to the lack of specific therapeutic markers such as estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). Current treatments primarily involve chemotherapy, radiotherapy, and surgery, as targeted therapies are limited. TNBC also exhibits significant heterogeneity among patients, emphasizing the need for precise diagnostic and therapeutic approaches. Immunotherapy, the manipulation of the immune system to target diseases, holds promise for precision medicine. Antibody-drug conjugates (ADCs) use antibodies to deliver drugs selectively. This study focused on a novel recombinant fusion protein format for ADCs using a single chain variable fragment (scFv) specific to chondroitin sulphate proteoglycan 4 (CSPG4), a tumour-associated antigen often overexpressed in TNBC. The scFv antibody derivative was genetically fused to a SNAP-tag, enabling stable and site-specific conjugation of the scFv to diagnostic and therapeutic substrates. To enhance antigen binding, internalisation, and therapeutic efficacy, a bivalent scFv fusion protein was created in tandem with the standard monovalent fusion protein. In vitro experiments using fluorophores and the cytotoxin, monomethyl auristatin F (AURIF), demonstrated that the bivalent fusion protein exhibited improved binding, faster uptake, and efficient release of the conjugate within target cells. Colocalization analysis revealed that the fusion proteins were routed to the lysosomal degradation pathway which is essential for the functionality of ADCs. The cell viability assays revealed that the enhanced binding and uptake of the bivalent fusion protein resulted in a more potent cytotoxic effect on antigen-positive TNBC cells. This study successfully compared mono- and bivalent αCSPG4-SNAP fusion proteins, revealing the superiority of the bivalent format in antigen binding and targeted drug delivery. It also, for the first time, explored the intracellular routing of scFv SNAP-tag fusion proteins upon uptake. The findings may influence the design of future scFv-based immunotherapeutics, possibly resulting in the incorporation of multiple scFv domains for increased efficacy. Furthermore, the diagnostic potential of these fusion proteins, aiding in prognosis prediction and patient responsiveness to targeted therapies have been highlighted. The versatility of SNAP-tag technology makes it relatively easy to transform immunodiagnostic fusion proteins into immunotherapeutic tools, potentially advancing TNBC management. In summary, this study contributes to the development of precision medicine tools for TNBC, addressing its complex nature and limited treatment options. The bivalent fusion protein format shows promise for improved TNBC therapy, offering a new avenue for research and potential clinical applications.