Masters Degrees (Physiotherapy)
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Browsing Masters Degrees (Physiotherapy) by Author "Brandt, C."
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Item Open Access Concussion knowledge among South African rugby players(University of the Free State, 2016-07) Viljoen, Carel Thomas; Brandt, C.; Schoeman, M.Background: Concussion is one the most frequently reported injuries among rugby players. Potential dangerous long term side-effects such as neurological deficits and chronic traumatic encephalopathy (CTE), explain why concussion is currently an extensively debated topic in the media. The largest part of South Africa’s rugby playing population consists of amateur players. Anecdotal evidence suggest that only a very limited proportion of amateur clubs and schools offer medical assistance at matches or practices, generally due to a lack of funding. BokSmart currently leans towards educating coaches and referees to recognize concussion signs and symptoms and to remove concussed players from the field. However, in a country where field side medical assistance is scarce, the players themselves can play a pivotal role to report possible concussions to their coach or the referee. Currently, no rugby safety management programme is focussing on concussion education among South African rugby players. Further research on concussion knowledge among rugby players are warranted to generate benchmark data needed to inform development and motivate implementation of educational programmes among rugby players, as an addition to the current BokSmart programme. Aims: To evaluate the knowledge on concussion and attitudes/behaviours regarding concussion and return to play (RTP) among South African amateur high school and club rugby players. Methods: A descriptive, cross-sectional study design was used to achieve the aims. The participants (n = 294) were divided into two groups namely; junior amateur high school (JAHS) (n = 216) and senior amateur club (SAC) (n = 78) rugby players. All participants completed the modified Rosenbaum Concussion Knowledge and Attitudes Survey – Student Version (RoCKAS-ST) in order to evaluate their concussion knowledge and attitudes/behaviours regarding concussion and RTP. Descriptive statistics were used to summarise continuous data with means and standard deviations or medians and percentiles as appropriate. Frequencies and percentages were calculated for categorical data while significance was set at p < 0.05 for comparative analyses. Results: The Concussion Knowledge Index (CKI) mean correct answered questions in the JAHS group was 10.46 ± 2.36 (range 3 – 15) of a maximum score of 17 points. Participants of the JAHS on average identified 62.4% of the CKI questions correctly. The CKI mean correct answered questions in the SAC group was 10.17 ± 2.35 (range 4 – 14) of a maximum score of 17 points. Participants of the SAC group on average identified 60.2% of the CKI questions correctly. On average the JAHS participants identified 66.3% of concussion symptoms correctly, while the SAC participants only identified 62.7% correctly. The Concussion Attitudes Index (CAI) mean correct answered questions in the JAHS group was 56.49 ± 8.81 (range 36 – 75) of a maximum score of 90 points. Participants of the JAHS group had a mean safe response of 65.6% when answering the attitude/behaviour regarding concussion and RTP questions. The CAI mean for correct answered questions in the SAC group was 55.88 ± 11.42 (range 20 – 75) of a maximum score of 90 points. Participants of the SAC group had a mean safe response of 67% when answering the attitude/behaviour regarding concussion questions. No statistical significance were found between the mean concussion knowledge scores (p > 0.37) of the JAHS and SAC participants. A p-value of p > 0.98 was noted, also showing no statistical significance between the JAHS and SAC participants’ mean concussion attitude scores. Conclusion: It was concluded that both junior and senior South African amateur rugby players had insufficient knowledge on concussion. The participants’ lack of concussion knowledge were further emphasised during the poor concussion symptom identification. Both groups showed unsafe attitudes/behaviours towards concussion and RTP.Item Open Access The development of a physiotherapy intervention program for closed or open reduction and/or internal fixation of mandibular condyle fractures(University of the Free State, 2014-09-16) Van der Merwe, Anke; Barnes, R.; Brandt, C.English: Introduction: The need for physiotherapy intervention in the treatment of mandibular condyle fractures has been highlighted. No unifying criteria are currently available regarding a postsurgical functional exercise program for patients who sustained mandibular condyle fractures. Aim: The research study conducted aimed to perform a needs analysis amongst maxillo-facial surgeons and physiotherapists in South Africa, regarding the perceived need for a postoperative physiotherapy intervention program for patients who sustained mandibular condyle fractures. The study also aimed to develop a post-operative functional exercise program for patients who sustained mandibular condyle fractures. Methodology: The first part of the research comprised of a needs analysis questionnaire, sent out to qualified experts: one physiotherapist and one maxillo-facial surgeon from each of the training institutions in South Africa. The data obtained from the needs analysis questionnaire was used to compile an online questionnaire with statements regarding the type and dosage of a suitable physiotherapeutic treatment protocol. The Delphi method was used, and this questionnaire was sent out to a further 20 experts (national and international) in the fields of physiotherapy, maxillo-facial surgery and dental surgery. A convenience sampling method was used to select appropriately trained participants for the needs analysis and Delphi questionnaire. Results: A definite need for physiotherapy intervention for mandibular condyle fracture patients was proposed by the needs analysis participants (100%). A total of 85.7 % (needs analysis) and 100 % (Delphi questionnaire) of respondents indicated that all mandibular condyle fracture patients should receive in-hospital physiotherapy intervention. By utilising the Delphi method, a suitable physiotherapy intervention program for mandibular condyle fracture patients was developed. Inter-reviewer consensus was reached regarding what each exercise entails, as well as what in-hospital physiotherapy visits should be comprised of. Stability was reached regarding the commencement and dosage of the various jaw exercises. Conclusion: Experts in the field proposed that physiotherapists should provide post-operative rehabilitative therapy to patients who have sustained mandibular condyle fractures. The proposed post-surgical intervention program provided in this study can serve as a baseline for implementation in further research studies. The advantages of referring mandibular condyle fracture patients to physiotherapy were also presented.Item Open Access Lower limb muscle fatigue on grass and artificial turf playing surfaces among elite soccer players(University of the Free State, 2016-07) Greyling, J. A. T.; Brandt, C.; Coetzee, D.INTRODUCTION: Fatigue and hard playing surfaces have been indicated as risk factors for injury in soccer players. Recent literature, however, has found contradictory results on the prevalence of injuries on different playing surfaces, as well as regarding the interaction between fatigue and the type of playing surface. This raises the question as to the true mechanisms underlying the cause of injury on different playing surfaces. AIM: The aim was therefore to compare lower limb muscle fatigue on grass and artificial surfaces in elite soccer players. METHODS: Twenty two elite soccer players (mean age 24.8 years) were included in a cross-over study design. The players were randomly allocated to two conditions. It involved exposure to the same soccer-specific fatigue protocol on a grass and artificial surface respectively. A force plate was used for pre-test and post-fatigue measurements on force generation, force rates and jump height. The Pearson correlation coefficient was used to determine associations between baseline variables and interpreted by means of effect sizes and p-values. The Wilcoxon signed-ranks test was used to determine statistical significant changes from pre-test to post-test for each condition while the Chi-square test was used to compare the findings between the two conditions. RESULTS: Statistical significant correlations were found at baseline between propulsion and concentric forces (r=0.66, p<0.001); propulsion force and body mass (r=0.78, p<0.001); propulsion force and BMI (r=0.645, p<0.01); landing force and body mass (r=0.82, p<0.001); landing and eccentric forces (r=-0.75, p<0.001); jump height and concentric force (r=0.84, p<0.001); and body mass and concentric force (r=0.76, p<0.05). Propulsion and concentric forces increased statistical significance after fatigue on the grass surface (p=0.026 and 0.005 respectively). On the artificial surface there was a statistical significant increase in propulsion force and propulsion force rate post-fatigue (p=0.0001 and 0.0153 respectively). Comparison of the changes from baseline to fatigue between the two conditions yielded no significant differences (p>0.05). CONCLUSION: Limited significant differences were found comparing forces after fatigue on artificial and grass surfaces. The inconsistency in the behaviour of forces in response to fatigue indicate the possible variability in adaptation strategies to cope with a speculated fatigue state. Surface-specific training could therefore be recommended in order for muscle and sport/surface-specific adaptation to take place, thereby decreasing the risk for injuryItem Open Access Lumbo-pelvic core stability: profiles of female long-distance runners(University of the Free State, 2016-10) Pool, Lindie; Brandt, C.Running is a sport characterised by a 90% prevalence of predominantly lower-limb overuse injuries. Stress urinary incontinence (SUI) is also prevalent and its hindrance in terms of participation falls within the definition of running injuries. Neuromuscular mechanisms within the proximal kinetic chain have been correlated to these injuries and conditions, however contrasting views exist. Adaptations within the tonic and phasic characteristics of core musculature have been shown to elicit a series of kinetic adaptations within the movement system predisposing injury/recurrence of injury. The aim of this research was to discuss the changes in core muscle characteristics in relation to risk of injury after exposure to a functional activity. Changes were presented by means of profiling. A secondary objective was to identify numerous internal and external risk factors of running-injury. A descriptive, cohort analytical study design was used with a convenience sample of fifteen (15) eligible experienced female long-distance runners registered in Bloemfontein-based accredited running-clubs. The baseline- and post-exercise profiling test battery included electromyography (EMG) of the pelvic floor muscles (PFM) and M. Transversus Abdominus (TrA)(ICC 0.98), pressure biofeedback testing (PBU) (ICC 0.90) and functional endurance testing (ICC 0.97). Any 24+ km functional longrun served as functional task. External, internal and demographic factors were identified using a self-compiled questionnaire. The majority of the TrA EMG, PBU and Dominant-Side lateral muscle group profiles displayed an increase in post-exercise value. The profiles illustrated both failure (decrease in value) and or possible neuromuscular mechanisms (increase in value) attempting to augment stability. These mechanisms are suggestive of a loss of stability on a more central level. The cohort also displayed remarkably low-level integrated stability activity (PBU) both at baseline and post-exercise. There were no statistical significant difference between the baseline and post-exercise profiles for any of the PFM (p=0.7957), TrA (p=0.2769), PBU (p=0.1875), Anterior Muscle Group (p=0.1688), Posterior Muscle Group (p=0.1909), Lateral Dominant Muscle Group (p=0.5897) or Non-Dominant Lateral Muscle Group measurements (p=0.1848). Knee injury was identified as the most prevalent previous running injury (47%). Only 20% of the 67% of participants that included muscle conditioning in training programs included the PFM. Running training errors were the most significant external causative factors present within the cohort together with insufficient periodisation and recovery from longruns. The results of this research support the inclusion of core-stability components in running injury risk management and rehabilitation. The major limitations of this research were the small sample size and absence of a control group. This may be addressed by future research on valid functional core testing. Future research should also establish scientific indicators of fatigue and correlation between corecharacteristics and risk of injury.Item Open Access Parity and motor control in female recreational runners(University of the Free State, 2016-07) Bouwer, Rochelle T.; Brandt, C.; Schoeman, M.Female recreational runners are more prone to injuries than their male counterparts. Considering the associated risk for sustaining sport-related injuries with impaired core proprioception and the effect pregnancy has on females’ core structures, this study aimed to investigate the trunk motor control in parous and nulligravid female recreational runners. A descriptive cross sectional, case-control study was conducted and 29 female recreational runners were assessed. Eight parous participants were matched with eight participants from the nulligravid group. The matched nulligravid participants were significantly younger [95% CI: - 16 ; - 1] compared to the parous group and no significant difference [95% CI: - 45.9% ; 22.8%] was seen in comparison of sport-related injuries. When testing the muscle activation and endurance of the pelvic floor muscles, the nulligravid group performed better during the surface electromyography test, although no difference was found during the PERFECT test. No statistical significance was found between groups during the surface electromyography test for muscle activity of the Transverse Abdominis muscle [95% CI: - 201.3 ; 504.5], activation of local stabilisers using the pressure biofeedback unit test [95% CI: - 1 ; 1] as well as the Sahrmann test [95% CI: - 2.5 ; 2] to assess global mobility. The parous group tended to perform better during the sport specific plank test, to assess global core muscle function, but in contrast performed weaker in the active straight leg raise test used to assess global stability. During the single leg stand test as well as the unilateral squat (balance and control) no significant difference was found between groups. No significant difference was found between the parous and nulligravid group regarding injuries and only a few tests of trunk motor control showed statistical significant differences between the groups. Due to the small sample size of the matched groups and limited statistical differences that were found conclusive recommendations could not be made. Further research is warranted to investigate motor control in parous athletes.Item Open Access Return to sport after injury: The relationship between an athlete’s type of motivation and a recurrence of injury(University of the Free State, 2017-02) Human, Johan; Brandt, C.Introduction and goal Development of the decision-based return to sport model attempts to address a lack of objective criteria in the literature to determine an athlete’s readiness to return to sport (Creighton, Shrier, Shultz, Meeuwisse and Matheson. 2010). The model reveals motivational factors that may modify complex return to sport decisions, often the responsibility of physiotherapists. An athlete with extrinsic motivation to return to sport may persuade the physiotherapist and/or coach to return to sport too soon which may lead to the athlete being re-injured. The aim of this study was to establish coaches’ expectations from physiotherapists regarding motivational factors for athletes to return to sport, athletes’ type of motivation to return to sport, and a relation to recurrence of injury. Methodology A descriptive and cohort-analytical design were used to collect quantitative data from two populations. Six track and field coaches of elite athletes older than 18 years, participated in structured interviews. The data collected with the structured interviews included the coaches’ expectations and views with regards to physiotherapists’ role in return to sport decisions. Fifteen injured elite athletes, older than 18 years, returning to sport after injury were tested with an adapted revised sport motivation scale to determine their type of motivation to return to sport and follow-up phone calls were used to determine if their return to sport was successful. Results Coaches were of the opinion that their elite athletes often return to sport too soon due to pressure from persons, sponsors or institutions and indicated that a recommendation regarding the type of motivation of an athlete to RTS will be of value. The Kruskal-Wallis test and Wilcoxon two sample test indicated that type of motivation was not found to statistically influence injury recurrence. Summary Although higher scores for extrinsic types of motivation was not found to statistically influence injury recurrence for elite track and field athletes in Bloemfontein, the noted trend of higher scores in these types of motivation needs further investigation on larger populations from different ages and types of sport. Track and field coaches of these athletes were of the opinion that their athletes often return to sport too soon due to motivational factors and did mention that they would value input from physiotherapists regarding motivational factors prevalent in their athletes that may cause further harm. Physiotherapists who cleared an elite athlete for return to sport based on the decision-based return to sport model, could modify their decisions and referral to an appropriate healthcare professional could benefit the athlete with a successful return to sport.