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A certain percentage of young offenders are re-incarcerated after their first offence and they land back in jail to serve a further sentence. This implies that they could not find their feet back in society once they have been released and it signifies failure on the part of the correctional authorities to rehabilitate the young offenders successfully. Recidivism is a complicated phenomenon which is not easy to deal with as the correctional institutions often have no control over the circumstances outside the prison walls affecting the young offender. The overall goal of this research was to establish the circumstances leading to the re-arrest of the young offender in the Kroonstad Youth Centre in order to adjust the rehabilitation programmes if necessary. The data was collected by means of a focus group consisting of young offenders who have been re-arrested after the first offence. The young offenders could not accurately identify the circumstances leading to their re-arrests, but they could give an indication of the family and community circumstances under which they must live. This ranged from unstable family life to community conditions not conducive to their adjustment. It was also found that the lack of support in the form of outside NGO's to assist them with their adjustment once they left prison was a serious shortcoming. It was recommended that intervention with the youth offenders should be focused on teaching skills that will help them to adjust in the community after their release. It was also recommended that families be trained on how to deal with the behaviour of the youths who has violated the law. / Thesis (M.A. (MW))--North-West University, Potchefstroom Campus, 2008.

Stroke is the principal cause of long-term disability. Hemiplegia affects up to 80% of people with stroke and a significant number will not recover use of the affected arm. People with profoundly-affected arm may experience pain, stiffness and difficulty with care activities. We cannot currently predict who is most at risk of these difficulties, and historically interventions have been designed without understanding the temporal evolution of impairment or disability. The International Classification of Functioning, Disability and Health (WHO, 2001) was used to develop a model of the consequences of the profoundly-affected arm on impairment, disability, and participation. A systematic review of thirty observational studies was undertaken and identified potential predictors of increased impairment in general populations of people with stroke. However, there was a paucity of evidence directed at people with profoundly-affected arm or regarding impact on passive care. The aim of this study was to test the feasibility of using an observational study design to develop a longitudinal profile of the profoundly-affected arm. Specific objectives of the feasibility study were to assess the processes of recruitment and follow-up, to review the sample characteristics, and to establish the acceptability and responsiveness of the predictor variables and outcome measures. Key tenets of the project were to involve people with cognitive and communication disability, and to use assessments that could be adopted by therapists working in a patient’s own home. Forty people with stroke and nine carers were recruited and followed up at three and six months post-stroke. Using enhanced communication techniques and personal consultees, it was possible to include people with severe cognitive and communication disability. The baseline demographic characteristics and the rate of loss to follow-up of participants reflect that expected in people more severely affected by stroke. Qualitative data suggest that participants affirmed the model of impairments and disabilities that had been developed. The predictor variables and outcome measures were considered acceptable to participants, and collected a range of data, generally performing in the manner expected. However, there were a number of exceptions. Cognitive and communication disability impacted on completion of the self-reported assessments, and may have affected performance on measures of mood and sensation/perception. In addition to this, measures of range of movement varied at each time point, in a manner not in accordance with expected change over time. The evidence from this thesis suggests the research design has potential to be used to develop a longitudinal profile of the profoundly-affected arm. Further work is required to improve carer recruitment, establish the best assessments for those with severest cognitive and communication disability, and review the method of measuring range of movement.

This thesis addresses some of the issues involved in the synthesis of swingthrough gait by functional electrical stimulation (FES). A general introduction is given to paraplegic gait, then the following areas are reviewed in detail: previous production of FES swing-through gait; biomechanical and energetics analyses of swing-through gait; general techniques for controlling FES gait; and the use of machine-learning techniques. Trained, non-impaired subjects wearing adjustable braces are used to model the movement patterns of FES swing-through gait. It is found that flexing the knees during the body-swing phase of swing-through gait reduces the energy cost of the gait. Hardware and software are developed to allow the production of FES swing-through gait in paraplegics with mid and low thoracic lesions of the spinal cord. The kinematic parameters of the resulting gait are assessed. It is found that the gait is faster than both knee-ankle-foot-orthosis (non FES) gait and reciprocal FES gait. This constitutes the first demonstration of FES free-knee swing-through gait in a spinal cord injured population. A symbolic inductive learning program, Empiric, is described. This program uses 'fuzzy' weighting to cope with uncertainty in the training data. This technique is found to offer improved classification performance (on artificially generated data) over both the orthodox (non-weighted) approach and an alternative weighting strategy. The fuzzy inductive learning technique is compared with a multi-layer perceptron type neural network for identifying the invariants (rules) that describe muscle activation during normal human gait. Both techniques are found to successfully model the muscular activation; the inductive learning technique has the advantage of producing explicit rules which are easily understood. The fuzzy inductive learning technique is applied to data obtained from the (previously mentioned) model of swing-through gait, in an attempt to mimic the control strategies used by the unimpaired subjects. It is found that the gait is best modelled with simple rule-sets, based on only one sensor. It is argued that this technique allows the automatic derivation of control strategies for FES gait: in particular, it allows the subjects' movement intentions to be determined. It is suggested that this 'intention detection' provides a more natural interface between a paraplegic subject and an FES control system than the techniques which are currently used.

Der freie an der Arteria radialis gestielte fasziokutane Unterarmlappen hat sich als Standardmethode für die Rekonstruktion nach Resektion ausgedehnter Tumoren im Kopf-Hals-Bereich etabliert. Hierzu trug nicht nur die überschaubare und komplikationsarme Operationstechnik bei, sondern auch die Möglichkeit der Wiederherstellung von durch den Tumor und dessen Resektion in Mitleidenschaft gezogenen Funktionen und somit die frühzeitige Rehabilitation und die Verbesserung der Lebensqualität der Patienten. In dieser Studie wurden Operationsfolgen und Komplikationen, funktionelle Einschränkungen und die postoperative Lebensqualität der Patienten für das an der Würzburger HNO-Universitätsklinik operierte Patientengut dargestellt. Neben dem Aktenstudium wurden hierfür Patientenfragebögen ausgewertet und die Patienten wurden nachuntersucht. Es konnten viele durch die operative Therapie und die adjuvante Strahlen- und Chemotherapie ausgelöste funktionelle Störungen festgestellt werden. Im Vordergrund standen dabei Schluckbeschwerden und Probleme mit dem Sprechen bzw. der Stimme. Eingeschränkte Beweglichkeit im Schulterbereich und Lymphödeme am Hals als typische Folgen der Neck Dissection kamen ebenfalls sehr häufig vor. Oft wurden auch Mucositis und Mundtrockenheit als Folgen der Strahlen- und Chemotherapie beobachtet. Auffällig war, dass die Häufigkeit der festgestellten Operationsfolgen davon abhängig war, ob sie vom untersuchenden Arzt oder vom Patienten selbst beobachtet wurden, was die Wichtigkeit von Fragebögen zur postoperativen Beurteilung der Operationsfolgen deutlich macht. Durch die Fragebögen konnte darüber hinaus die Lebensqualität der Patienten beurteilt werden. Die Auswertung ergab in den meisten Bereichen ein mittleres bis hohes Maß an Zufriedenheit mit den abgefragten Aspekten der Lebensqualität. Nur wenige Patienten gaben einzelne schlechte Bewertungen, vor allem die funktionellen Beschwerden wurden negativ bewertet. Trotzdem waren fast alle Patienten mit der Therapie zufrieden und würden sich wieder genauso entscheiden. Insgesamt konnte also gezeigt werden, dass trotz der häufig festgestellten funktionellen Einschränkungen ein hohes Maß an subjektiver Lebensqualität erreicht werden kann und eine Anpassung an die momentane Lebenssituation stattfindet. / Functional rehabilitation following microvascular flap reconstruction of head&neck tumor defects

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Science in Physiotherapy Johannesburg, 2015 / Introduction: In South Africa the prevalence of patients with stroke that need help with at least one activity of daily living is equal to that of high income countries. Care of persons with stroke is essential, as stroke can lead to neurological deficits which in turn lead to functional impairments. Functional recovery for a patient, who has suffered a stroke, begins with rehabilitation. It has been found that supervised rehabilitation in an institution or at home improves the patient’s quality of life and fitness. It may not be feasible however, for the physiotherapist to supervise all rehabilitation, especially in a home-environment. Therefore adherence to exercise programmes is important. Adherence to exercise programmes allows for a potential saving in treatment costs, may avoid morbidity and unwanted side effects. The mode of exercise prescription may affect adherence to a home exercise programme. There are studies that show that the use of verbal prescription with an added brochure (a written and pictorial home-exercise programme) improves adherence rates. However none of these studies have been conducted in patients with stroke. Aim: The aim of this study was to determine the effect of a written and pictorial home exercise prescription on adherence with a home-exercise programme in patients with stroke at the Chris Hani Baragwanath Academic Hospital (CHBAH). Method: A randomised controlled trial with a blind assessor. Ethical clearance was applied for at the University of the Witwatersrand and permission to conduct the study was also obtained from CHBAH physiotherapy department and the superintendent before the commencement of the research project. Written informed consent was obtained from the patient and the caregiver before being included into the study. Participant’s anonymity was kept. All participants’ and their caregivers’ demographic data was captured on the initial assessment. The control group received a verbal home-exercise programme only and the experimental group received a verbal home-exercise programme with written and pictorial instructions for the exercises. An exercise logbook was completed by the participant’s caregivers to monitor adherence for each group. The Modified Rivermead Mobility Index (MRMI) and Barthel Index (BI) were used to establish mobility and activities of daily living functional ability of the patients. The significance of the study was set at 0.05. Between group comparison for the categorical data was carried out using the Chi square test. The Wilcoxon sign rank test was used for the between group comparison for the continuous data, the non-parametric data from the functional outcome measures as well as the adherence rates. Lastly the Spearman’s rank correlation co-efficient was conducted to assess if there is a relationship between the level of adherence and functional outcome in patients with stroke. Results: The average age of the participants was 60.8 (SD: 15.5) years. The gender distribution of the study population was 52% male and 48% female. Majority (76%) of the caregivers were females. Majority of the study population was living with a stroke for one to three months. The average length of stay in hospital was 14.5 (SD: 8.3) days. Of the study population 64% received in-patient physiotherapy. There was no significant difference between the intervention and control group for functional change and adherence: MRMI (p = 0.4), BI (p = 0.65) and adherence (p = 0.53). In the intervention group there was a greater increase in the MRMI score compared to the control group. But for the BI score the increase was greater in the control group. The relationship between functional ability (MRMI and BI) and the level of adherence for both the control and intervention group was generally not statistically significant. However, there was a weak relationship (p = 0.05, r = 0.44) for the intervention group for adherence and BI scores. Conclusion: The adherence rates were similar for the two groups despite the intervention that was administered. Both groups benefitted from the exercise therapy despite the mode of exercise prescription. Therefore there is no need to change the clinical practice at CHBAH regarding mode of home exercise prescription. Instead focus needs to be placed on interventions that can improve adherence to home exercise programmes e.g. the implementation of a monitoring system such as an exercise logbook.

MSc Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, 2009 / Trauma is the leading cause of death in children. Burns represent the second most common cause of accidental death in children under the age of five. Burns are amongst the most traumatic injuries and may impose significant psychological, educational, social and future occupational impairments to the young child. Quality of life post discharge from a South African hospital is poorly researched. It is also not known whether poor socio-economic factors contribute to the high incidence of children with burn injuries who are admitted to the Paediatric Burns Unit. This crosssectional study aims to determine the socio-economic and clinical factors which predict quality of life in children with burn injuries in a burns unit in South Africa. The Paediatric Quality of Life Inventory (PedsQL) and the Household Economic and Social Status Index (HESSI) questionnaires were administered to children and their caregivers one week post discharge and three months post discharge from the Johnson and Johnson Paediatric Burns Unit, Chris Hani Baragwanath Hospital, Soweto. The findings of this study show that children three month post discharge from a burn injury have a minimally lower score in quality of life than the expected normal score. The improvement in the PedsQL overall scores suggests that the quality of life for children is good despite being burnt. The severity of the burn (partial thickness and full thickness) was found to be a significant clinical predictor of quality of life (p=0.00). The poor socioeconomic status was clearly evident in demographic data of the subjects. A marginally significant socio-economic predictor of quality of life was family problems reported by some of the mothers (p=0.07). To some extent this highlights the increased risk of burn injury where there are poor socio-economic circumstances.

A RESEARCH REPORT SUBMITTED TO THE FACULTY OF HEALTH SCIENCES, SCHOOL OF THERAPEUTIC SCIENCES, UNIVERSITY OF THE WITWATERSRAND, JOHANNESBURG, IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN OCCUPATIONAL THERAPY JOHANNESBURG, APRIL 2015 / Studies to determine which underlying motor deficits have the greatest impact on improvement in functioning within activities of daily living in stroke patients are nonexistent with regard to the South African context. Effective stroke rehabilitation is essential due to rapid discharge rates and therefore it is important to focus on the motor deficit that will contribute most significantly to function. Patients from the ages of 35 to 85, who had suffered a stroke and were admitted to a private, neurological, rehabilitation facility in Johannesburg gave consent to participate in three outcome measures determining adequacy of balance (Berg Balance Scale), upper limb movement (Frenchay Arm Test) and gait (Timed Up-and-go Test) as well as one outcome measure determining level of functioning within activities of daily living (Functional Independence Measure). Results from the pre- and post-tests indicated that all participants improved during the time of rehabilitation. The findings of the outcome measures for each of the three different motor components were correlated with functioning in ADLs for each patient. The results showed that balance had the strongest correlation with functioning in ADLs, followed by upper limb movement, and then gait. The use of the FIM as a functional measure appeared to have some limitations and is not standardised to be used within the South African context.

Background: Hip fractures are among the most common causes of disability and hospitalisation in the elderly. Currently there are no studies available in South Africa that determine the factors that influence the early post-operative functional outcome in elderly patients with a hip fracture.Aim: To establish the factors influencing the early post-operative functional outcome in elderly patients with a hip fracture. Methodology: A prospective pre-test post-test observational study design was used. Consecutive sampling was used to recruit participants (n=72). Assessments were conducted pre-operatively, at discharge and six weeks post discharge at two public health care hospitals in Johannesburg, South Africa. Pre-operatively the pre-fracture functional mobility of the participants was determined using the New Mobility Score (NMS), the presence of pre-existing co-morbidities was assessed using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) and the cognitive function was assessed using the Six-Item Cognitive Impairment Test (6CIT). At discharge and at six weeks post discharge the participants post-operative functional level was assessed using the Elderly Mobility Scale (EMS) and the Lower Extremity Functional Scale (LEFS). A multiple regression analysis was used to determine associations. The study was set at p = 0.05 level of significance and 95% confidence interval (CI). Results: Participants were generally independent with pre-fracture mobility at baseline and presented with approximately three pre-existing co-morbidities. The presence of cognitive impairments in the participants decreased during the duration of the study, while the post-operative functional level in this population improved. Pre-fracture functional level was strongly related to and also the strongest predictor of post-operative functional outcome. The presence of co-morbidities and impaired cognitive function were also indirectly related. Conclusion: Pre-fracture functional mobility was found to be the strongest determinant of post-operative functional outcome, followed by cognitive function and the presence of pre-existing co-morbidities. By ensuring that these factors are optimal prior to sustaining a hip fracture, elderly patients are more likely to have better outcomes. For those patients who do sustain a hip fracture, intensive rehabilitation is especially necessary for the patient who presents with poor pre-fracture mobility, impaired cognition and pre-existing medical co-morbidities.