Includes bibliographical references. / Background: Stroke is a leading cause of death and disability in both developed and developing countries. Stroke results in a loss of movement on one side of the body and patients have trouble moving the trunk in relation to the pull of gravity, regardless of which muscle action is required. Re-educating the function of the trunk muscles is essential in successful rehabilitation of patients with stroke. Functional Electrical Stimulation (FES) of the abdominal muscles is an intervention which may result in increasing the activation of these muscles and improving proximal stability and function. However the effects of FES, although proved useful in other muscles groups, have not been tested when applied to the abdominal muscle in patients who have had a stroke. Aims: The aim of this study was to evaluate the effect of FES of the abdominals on th e functional recovery in patients with stroke, when used as part of physiotherapy treatment. Secondary aims are to document the content of physiotherapy received during rehabilitation and compare it to that of published literature.

Introduction: The prevalence of health risk behaviours is growing amongst South African employees. Health risk behaviours have been identified as a major contributor to reduced health related quality of life (HRQoL) and the increase prevalence of non-communicable diseases. Worksite wellness programmes promise to promote behaviour changes amongst employees and to improve their HRQoL. Aims: The aim of this study was to evaluate the short-term efficacy of an employee wellness programme on HRQoL, health behaviour change, levels of self efficacy, pain intensity, body mass index (BMI) and absenteeism amongst clothing and textile manufacturing employees. Methods: The study was a randomised control trial consisting of 80 participants from three clothing manufacturing companies in South Africa. The experimental group was subjected to a wellness programme based on the principles of cognitive behaviour therapy (CBT) as well as weekly supervised exercise classes over six weeks. The control group received a once-off health promotion talk and various educational pamphlets, with no further intervention. Measurements were recorded at baseline and at six weeks post-intervention. Outcome measures used included the EQ-5D, Brief Pain Inventory-SF, Stanford Exercise Behaviours Scale, Stanford Self-Efficacy Scale, Stanford Self-Rated Health Scale, BMI and absenteeism. Data Analysis: All the data were analysed with the Statistica-8 software program. Although t-tests are the most commonly used statistical method for evaluating the differences in the means between two groups (e.g. control and experimental), it assumes that the variable is normally distributed. Thus, because the ordinal data were not normally distributed, non-parametric tests were used to evaluate the differences in the medians between the two groups and to determine the level of significance. The Sign test was used in place of the paired t-test to determine the within group changes. The Mann- Whitney U test was used in place of the independent t-test to determine the difference between the two groups. Results: The experimental group consisted of 39 subjects. At six weeks post intervention the experimental group demonstrated improvement in almost every parameter. In contrast, apart from an overall decrease in time off work, there was no change noted in the behaviour of the control group. Seventy percent of the experimental group had improved HRQoL VAS scores post intervention, indicating improved perceived HRQoL. In comparison, only 58% of the control group had improved HRQoL VAS scores post intervention. v Conclusion: An employee wellness programme based on the principles of CBT combined with weekly aerobic exercise class was beneficial in improving the HRQoL and changing health-related behaviours of clothing/textile manufacturing employees.

Gait difficulties experienced by individuals following a stroke may be related to the commonly observed reduced hip extension in the stance phase of gait. The aim of this initial exploratory study was to evaluate the effects of a home-based strengthening programme on hip muscle strength and gait performance in individuals following stroke. Six chronic stroke patients (> 9 months duration) participated in this pretest-posttest group design which was composed of two six week phases, A and B, where B immediately followed A. No training or advice was given to the six subjects during phase A. During Phase B, the same six subjects participated in a "hip extension focused" home exercise programme aimed at improving hip extensor muscle strength and the range of anterior hip structures. The exercise programme consisted of functional strengthening, task related activities and stretching. At the end of this sixweek period, the subjects were re-tested in order to evaluate the effects of the exercise programme. The outcome measures included isometric muscle strength, walking speed and range of the anterior structures of the hip. The walking section of the Motor Assessment Scale for Stroke and the Nottingham Extended Activities of Daily Living were also employed. In addition, clinical gait analysis was used to gather measures of gait velocity, step length and hip joint excursion. Statistically significant increases were found in the study group (n = 6) for the identified parameter of hip extensor strength after the intervention (p = 0.05), although this change could not necessarily be attributed to intervention effects alone. Hip extension strength was significantly correlated with (1) step length (r = 0.82; p = 0.04) and (2) joint excursion (r = 0.8; p = 0.05) after the intervention. These correlations, although tentative and not conclusive, suggest that hip extensor strength may influence gait performance and therefore warrants further investigation. While the results obtained from this exploratory study appear to suggest that the hip extensors play an important role in providing stability for the lower limb during gait, a randomised controlled study with a larger cohort of patients would be necessary to make any definitive conclusions.

Includes abstract. / Includes bibliographical references. / Chronic musculoskeletal conditions of the spine and periphery are a burden both internationally and in South Africa. There is a socio-economic burden as a consequence of the severity, duration and recurrence of chronic cervical musculoskeletal conditions among information technology and sedentary office workers. However, the precise mechanisms behind chronic cervical disorders remain unclear. It is theorised that the pathophysiological mechanisms in chronic cervical musculoskeletal conditions share a similar theoretical framework to chronic pain itself. The biopsychosocial model of chronic pain accepts the dynamic nature of pain. This model accepts the dual biological and psychosocial components that enhance the experience and maintenance of chronic pain, through central sensitisation. There appears to be a neurophysiological, biomechanical and psychological link between the cervical area and the temporomandibular area. Although numerous studies have implied that individuals with temporomandibular disorders have concurrent cervical dysfunction, there is currently no evidence that individuals with cervical dysfunction exhibit altered muscle activity in the masseter and cervical erector spinae muscles or report teeth clenching habits. Consequently, identification of factors that may contribute to chronic cervical musculoskeletal conditions, stemming from the temporomandibular area, may potentially be lost. The aim of the present study was to explore the activity levels of the cervicomandibular muscles in females with chronic cervical musculoskeletal conditions, who showed no symptoms of temporomandibular disorders. This study had a descriptive cross-sectional correlational design with single-blinding. The telephonic screening process was followed by the signing of informed consent forms. Validated questionnaires were used for categorisation and comparison of the socio-demographic and biopsychosocial profiles of the pain group (n = 20) and the no pain group (n = 22). The screening, informed consent and questionnaires were completed by an assistant. The first of five questionnaires, the adapted Research Diagnostic Criteria History questionnaire, was used as an instrument for exclusion of temporomandibular disorders and the recording of a daytime parafunctional teeth clenching habit. The remaining four questionnaires, listed as the Neck Disability Index, the Computer Usage Questionnaire, the Brief Pain Inventory, and the EuroQol-5D were used for determining levels of cervical disability for categorisation and comparison between groups, as well as for determining levels of pain-related disability, occupational and sporting activity, and health related quality of life.

Background: Pain is the one of the most prevalent symptoms in people living with Human Immunodeficiency Virus/Acquired Immune Disease Syndrome (HIV/AIDS) and is largely undermanaged. In urban amaXhosa women living with HIV/AIDS (LWHA), the 'Positive Living' (PL) programme has been identified as an effective non-pharmacological intervention for managing pain and may be affected by an empathetic therapeutic relationship. As a high prevalence of pain is likely to exist in rural amaXhosa women LWHA in South Africa, research is warranted on these two interventions amongst this population. Aim: To determine the effect of the combined PL programme and therapeutic relationship intervention (PL intervention), in comparison to a therapeutic relationship intervention (TR intervention) alone on pain severity, pain interference, symptoms of depression, health-related quality of life (HRQoL), self-efficacy and physical function in rural amaXhosa women LWHA. Method: A single-blind randomised trial was conducted using a sample of convenience. Interviewer administered questionnaires and functional tests at Baseline and at Weeks 4, 8, 12 and 24 were collected for the PL and TR intervention groups. Regression analysis determined the change of the primary outcomes, pain severity and interference, and secondary outcomes over the 24 weeks of the study. Results: Forty-nine amaXhosa women LWHA participated in the study. The PL programme and the data collection points were poorly attended by both groups. The pain severity and pain interference scores improved significantly in the PL (n = 26) and TR (n = 23) intervention groups over the 24 weeks of the study, with no significant differences between intervention groups. Symptoms of depression, HRQoL, self-efficacy and six of eight physical function tests were also significantly improved in the PL and TR intervention groups and, with the exception of self-efficacy, no significant differences existed between intervention groups. Conclusion: The therapeutic relationship appears to be sufficient to manage pain in rural amaXhosa women LWHA and should therefore be recognised as a necessary intervention to provide effective and adequate pain management.

Includes bibliographical references (leaves 105-115). / The functional integrity of the vestibular system in children is not often tested. Due to the close relationship between the cochlea and the peripheral vestibular system, the function of the vestibular system may be impaired in children with sensorineural hearing loss.The aims of this study were to determine the prevalence of impairments of motor performance, vestibular function and dynamic visual acuity, and the nature and extent of interaction between these in children between the ages of four and fourteen years with congenital and early acquired sensorineural hearing loss. Motor performance was evaluated by means of the Movement Assessment Battery for Children-2, dynamic visual acuity was determined by means of the Dynamic Visual Acuity Test, and vestibular function with the Southern California Postrotary Nystagmus Test.

Background and justification: African children are reported as having a higher prevalence of generalised joint hypermobility (GJH) than their Caucasian counterparts. It is believed that abnormal joint biomechanics as a result of the joint laxity contribute to the damage of joints. The ability to perceive movement or position sense at joints (proprioception) is necessary for good postural control and motor performance. Sensory receptors carry information from the joints to the central nervous system for interpretation and appropriate motor response. Damage to these receptors or joint pain may have a negative effect on proprioception and motor control. A number of children with GJH also present with poor motor coordination and some may even have Developmental Coordination Disorder (DCD). Children with DCD and GJH also have similar functional difficulties. Both groups of children display difficulty in motor activities at school and home and are referred to as clumsy. There is evidence that poor motor coordination seen in children with DCD may be as a result of their inability to adequately control their flexible joints during movement. The role proprioception, balance and muscle strength plays in the relationship between GJH and DCD is still not clear. Aims and objectives: The main aim of this study was to determine whether proprioception, standing balance and strength in the lower limbs was different between children with GJH and children with normal joint mobility (NM). The specific objectives were to firstly identify the prevalence of GJH in a sample of Nigerian children and determine whether age and gender are related with the prevalence of GJH. Secondly, to determine whether having DCD or not was associated with differences in performance on these measures in children with and without GJH.

Bibliography: leaves 196-200. / The purpose of this study was to explore the impact of physical movement disability amongst adult homeless persons in the Wynberg Haven Night Shelter and secondly to make recommendations with regard to their needs that have been identified by the study. A cross sectional exploratory descriptive study was done using both qualitative and quantitive methods of data collection elucidating triangulation to validate data.

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.

Includes abstract. / Includes bibliographical references. / Competitive swimmers have a high incidence of shoulder pain. Secondary shoulder impingement is thought to be primarily responsible for shoulder pain in competitive swimmers. The effective management of shoulder impingement has been widely investigated; however there is minimal consensus on the optimal method of treatment and rehabilitation of shoulder impingement. In addition, current research does not adequately consider the role of scapulothoracic rehabilitation in the management of shoulder impingement. Aim: To determine the effects of a scapulothoracic rehabilitation programme on shoulder pain in competitive swimmers.