Background: The Summer Paralympics have grown from participation of a mere 16 athletes at the 1948 Stoke-Mandeville Games, to a large multi-code event of 4176 athletes competing in 20 different sporting codes at the 2012 London Summer Paralympic Games. Unlike able-bodied athletes, Paralympic athletes represent a heterogenous group of people with a varied degree of physical-, mental- and physiological impairment. Despite the growth in the Paralympic sport, limited research exists describing injury and illness in Paralympic athletes. For athletes with impairment to perform optimally and not to jeopardise their health, studies should identify and eventually address risk factors for both injury and illness. Aim: The main aim of this study was to determine the incidence and nature of illnesses and injuries in a cohort of athletes with spinal cord injury (SCI) during the 3-day pre-competition and 11-day competition period at the 2012 London Summer Paralympic Games. This knowledge could provide an initial framework for future research regarding injury- and illness prevention strategies in athletes with SCI. Methods: This study was a component of the large prospective cohort study which was conducted over the 14-day period of the London 2012 Summer Paralympic Games, coordinated by the Medical Committee of the International Paralympic Committee (IPC). The data were collected at the London 2012 Summer Paralympic Games during the 3-day pre-competition and 11-day competition periods. Three data sources were used. Firstly, the IPC provided a comprehensive athlete database that contains accreditation number, country code, sports code (20 sports), gender and age. The second data source was the medical encounters of staff that provided care to their own teams. At the London 2012 Summer Paralympic Games, a novel system (WEB-IIS) was used to collect data via desktop computer interface, tablet or smart phone. The third data source was from an electronic medical data capture system (EMDCS) (ATOS, France) where the medical staff of the Local Organizing Committee of the London Summer Paralympic Games (LOCOG) were requested to enter all medical encounters, at both the Paralympic Village polyclinic and at the sports venues wherever the athlete reported for care. A standardized form was used for this purpose. After comparing all the data, a total of 3009 athletes, of which 709 were athletes with SCI formed part of this study. The Incidence Rate (IR) for illnesses and injuries in athletes with SCI was calculated as the number of illnesses and injuries per 1000 athlete days and was compared to a group of all other Paralympic athletes with injury and illness (who had other impairments). Results: There were significantly more upper limb injuries in athletes with SCI (p=0.0001), with an IR of 6.4 injuries / 1000 athlete days (95% CI 4.6 - 8.9). The IR for all the other athletes were 4.4 injuries / 1000 athlete days (95% CI 3.4 - 5.8). For lower limb injuries, the IR for athletes with SCI was significantly lower (p=0.0001) at 1.4 injuries / 1000 athlete days (95% CI 0.8 -2.5) compared to an average IR of 4.2 injuries / 1000 athlete days (95% CI 3.3-5.4) for all other athletes participating at the 2012 London Paralympic Games. Athletes with SCI had a significantly higher IR for illness than the group of all other athletes (p=0.0004). The IR for illness in athletes with SCI was 15.4 illnesses / 1000 athlete days (95% CI 11.8-20.1), whereas the average for all other athletes were 11.0 illnesses / 1000 athlete days (95% CI 8.7-14.1). The IR for skin- and genito-urinary illness were significantly greater in athletes with SCI (p=0.0001), with an IR of 3.9 illnesses / 1000 athlete days (95% CI 2.5-6.2) for skin illness and 2.3 /1000 athlete days (95% CI 1.8-4.6) for genito-urinary illness. The IR in skin illness for all other athletes were 1.8 illnesses / 1000 athlete days (95% CI 1.1-2.7) and genito-urinary illness, were 0.5 illnesses / 1000 athlete days (95% CI 0.3-0.8). Summary: The results of this study present an insight into injuries and illnesses in athletes with SCI. Athletes with SCI injury have a greater incidence rate of upper limb injuries and a lower incidence of lower limb injuries, than other Paralympic athletes. Total-, skin- and genito-urinary illnesses were also significantly greater in athletes with SCI compared to other Paralympic athletes. For clinicians caring for athletes with SCI, the results indicate that more attention should be given to the prevention of upper limb injuries and specifically skin- and genito-urinary illnesses.

The rising rate of insulin resistance and type 2 diabetes in humans over the past two decades have been linked to increasing rates of obesity, aging and urbanisation. A similar pattern is occurring in domestic animals, specifically cats and dogs. Skeletal muscle is a vital organ in the regulation of blood glucose. Its composition in terms of muscle fibre type, metabolism and contractility can differ substantially between species, but is poorly studied in the domestic dog, in particular the various breeds. It was hypothesised that insulin resistance and type 2 diabetes may be associated with muscle fibre type, in particular, muscle with a low type I fibre content being a predisposing factor. Therefore, the aims of this study were to investigate the skeletal muscle fibre composition and metabolic profile in the Triceps brachii (TB) and Vastus lateralis (VL) of 16 breeds of domestic dogs (Canis lupus familiaris). A secondary aim was to correlate the skeletal muscle composition with breeds reported as having a high incidence of diabetes. Skeletal muscle samples were collected post mortem from the TB and VL of 38 dogs from different breeds, age and sex, and analysed for fibre type composition, fibre size, oxidative and glycolytic metabolic capacity (citrate synthase (CS), 3-hydroxyacetyl co A dehydrogenase (3-HAD), creatine kinase (CK) and lactate dehydrogenase (LDH) enzyme activities). There was no significant difference between the TB and VL in any of the measurements. Type IIA was the predominant fibre type for both muscle groups (TB: 43%; VL: 44%) followed by type I (TB: 33%; VL: 38%) and type IIX (TB: 24%; VL: 18%). The cross sectional area (CSA) of the fibres were all smaller compared to humans and other wild animals. Surprisingly, there was no difference in the CSA between the fibres types and muscle groups: Type I: TB: 1740 µm2 ; VL: 1712 µm2 , Type IIA: TB: 1690 µm2 ; VL: 1720 µm2 , Type IIX TB: 1726 µm2 ; VL: 1791 µm2 ). Metabolically, the muscle of the dog displayed a high oxidative capacity with high activities (all activities in µmol/min/g protein) for CS (TB: 61; VL: 49) and 3-HAD (TB: 53; VL: 46). Lower CK (TB: 6115; VL: 6279) and higher LDH (TB: 1550; VL: 1478) activities than humans indicated a lower and higher flux through the high energy phosphate and glycolytic pathway, respectively. These results indicate that the dog has a predominance of type IIA fibres along with a higher oxidative capacity. There appears to be no pattern in fibre type profile that could be associated with a predisposition of a specific breed to insulin resistance and diabetes, although many of the breeds with a known risk did not form part of the study sample. This is the first study to characterise the skeletal muscle composition of a large population of dogs (16 breeds), but the association of breed to diabetes was not found. Future studies should include younger and more animals, as well as a diabetic population of dogs.

The aim of the study was to document the epidemiology of injuries sustained by South African high school soccer players. Subjects for the study were selected from all the high schools (n = 10) in Tembisa (Gauteng, South Africa). A cohort of 227 high school soccer players, representing all the players in the Tembisa schools, was followed over one playing season. All practice and match hours were recorded and specific injury report forms were completed by all the coaches. All injured players were then referred to the principal investigator (JR) for detailed examination to document injuries. Factors such as pre-season training, warm-up, stretching, playing surface, environmental factors, and the use of protective equipment were also recorded. In this study, 63% of all the players sustained an injury during the season (seasonal incidence). The overall incidence of injuries was 9.04/1000 hours of play. The incidence in matches was 274 times higher than in practice. More than half (57%) of the injuries were classified as moderate. The highest incidence of injury per player position was in goalkeepers (13.7/1000 hours play). The lower extremity accounted for most injuries (88.8%), principally the ankle (42.4%) and the knee (27.1%). The most common type of injury was a ligamentous sprain (68%), followed by musculotendinous strains (15.8%). There were only two joint dislocations, and no fractures. All the participants in this study played on gravel pitches and on no occasion was a first-aid kit available. The majority of players were not aware of appropriate stretching, warm-up, and strapping techniques to prevent injuries. None of the players engaged in any form of pre-season training. In two of the schools (20%) the soccer coaches had formal training with coaching certification. Although the injury rate in high school soccer players in this study is only slightly higher than that reported · by others, it is clear that scientifically based measures of injury prevention (pre-season training, warm-up, stretching, and strapping) need to be implemented in these schools. In addition, proper sports and first-aid facilities should be provided, and coaches should receive formal continuous training.

Background: Rugby union ('rugby') has a high injury risk. These Injuries range from having minor consequences to catastrophic injuries with major life changing consequences. In South Africa, previous research indicated that the risk of catastrophic injury was high and that the immediate management was sub-optimal, worsening the injury outcome. In response, the South African Rugby Union launched the BokSmart nationwide injury prevention programme in 2008. Through education - mainly of coaches and referees - this programme aims to improve the prevention and management of catastrophic injuries. Moreover, the programme began administering a standardised questionnaire for all catastrophically injured players to assess the prevention and management of these injuries. Objectives: To assess whether factors in the immediate pre- and post-injury management of catastrophic injuries in rugby were associated with their outcome. In addition, as part of the BokSmart programme in Rugby in South Africa, there were modules developed as part of the education material delivered to referees and coaches in their workshops that deal specifically with safety in the playing environment, and the correct management of catastrophic injuries. We assessed whether these protocols within the modules were implemented. Design: A prospective, cohort study conducted on all catastrophic injuries in rugby collected through a standardised questionnaire by BokSmart between 2008 - 2014. Methods: Secondary analyses were performed on the information collected on all rugby-related catastrophic injuries in BokSmart's serious injury database. Injury outcomes were split into 'permanent' (permanently disabling and fatal) and 'non-permanent' (full recovery/ "near miss"). Immediate post injury management factors as well as protective equipment and ethnicity were analysed for their association with injury outcome using a Fisher's exact test. Results: There were 87 catastrophic injuries recorded between 2008 and 2014. Acute spinal cord injuries (ASCI) made up most of the catastrophic injuries (n=69) with traumatic brain injuries (TBI) the second most common (n = 11 injuries). There were 7 cardiac events. Black African players were associated with a 2.4 times higher proportion of permanent outcome that the injured White players (p=0.001). There was no association between any protective equipment or injury management (including optimal immobilization, time and method of transport taken to hospital) and ASCI outcome (non-permanent vs. permanent) Conclusions: Neither immediate post-injury management, nor the wearing of protective equipment was associated with catastrophic injury outcome in these South African rugby-related injuries. This might indicate that the initial injury is more important in determining the outcome than the post-injury management and associated secondary metabolic cascade, as proposed by some experts in this area. Moreover, that ethnicity was associated with ASCI outcome in this study is indicative of the wider problems in South Africa; not only specific to rugby. It is recommended that BokSmart continue to focus their programme in low socioeconomic areas that play rugby in South Africa.

The first aim of this study was therefore to review the available literature on the epidem iology of injuries in professional rugby. The second aim was to collect data on medical profiles, previous injuries, use of protective gear, medication and nutritional supplements in South African professional rugby players. Thirdly, the incidence, nature and circumstances surrounding injuries in a cohort of professional South African rugby players were documented. The data collected was compared with available literature.

Includes bibliographical references (leaves 73-77). / Exercise-associated muscle cramping (EAMC) is a common condition of spontaneous, painful skeletal muscle spasms that occur in exercising muscles during exercise or in the immediate post-exercise period. There is a high prevalence in endurance athletes, including ultra-distance triathletes. The exact cause for this condition has not been defined but various hypotheses have been proposed. Over the last decade the ""fatigue hypothesis"" has received most of the support in the scientific literature. Evidence from animal experiments, clinical studies on endurance athletes and situational information, suggest that neuromuscular fatigue may precede the increased neuromuscular excitability leading to EAMC. The objective of this research study was to identify factors associated with EAMC in endurance triathletes in an attempt to further elucidate the aetiology. Triathletes competing in the 2006 South African lronman triathlon were recruited as subjects in a prospective cohort study. A total of 44 triathletes made up the cramping group and 166 the non-cramping group. A detailed questionnaire, including information on training, personal best performances and a cramping history was completed by both groups of triathletes. Full clinical data was also collected from both groups. This included pre-and post race body weights, and pre- and post-race serum electrolyte concentrations. The main findings of the study were that the two independent risk factors for EAMC in these triathletes were a faster overall race time (and cycling time), and a past history of cramping (in the last 10 races). Results showed that EAMC was correlated with faster overall and cycle section times. The athletes who had experienced cramps in this event not only achieved taster race times but also predicted faster times, despite similarly matched preparation and performance histories as those who did not cramp. A higher intensity of racing would thus be required by these athletes, predisposing them to premature fatigue. The results thus agree with the ""fatigue hypothesis"" as an aetiological mechanism for EAMC. This study also showed no correlation between EAMC and changes in hydration status or changes in serum electrolyte concentration. This study thus adds to the evidence against disturbances in hydration and electrolyte balance as causes for cramping in exercise and further focuses attention on neuromuscular fatigue as a possible primary factor.

No description available.

Thesis (M.Sc.(Med.) in Biokinetics)--University of the Witwatersrand, Faculty of Health Sciences, 2014.

No description available.

Use of accelerometers to assess physical activity (PA) is widespread in public health research, but their utility is often limited by the accuracy of data processing techniques. We hypothesized that more sophisticated approaches to data processing could distinguish between activity types based on accelerometer data, providing a more accurate picture of PA. Using data from MTI Actigraphs worn by 6 subjects during four activities (walking, walking uphill, vacuuming, working at a computer) quadratic discriminant analysis (QDA) was performed, and a hidden Markov model (HMM) was "trained" to recognize the activities. The ability of the new analytic techniques to accurately classify PA was assessed. The mean (SE) percentage of time points for which the QDA correctly identified activity mode was 70.9(1.2)%. Computer work was correctly recognized most frequently (mean (SE) percent correct = 100(0.01)%) followed by vacuuming (67.5(1.5)%), uphill walking (58.2(3.5)%), and walking (53.6(3.3)%). The mean (SE) percentage of time points for which the HMM correctly identified activity mode was 80.8(0.9)%. Vacuuming was correctly recognized most frequently (mean (SE) percent correct = 98.8(0.05)%) followed by computer work (97.3(0.7)%), walking (62.6(2.3)%), and uphill walking (62.5(2.3)%). In contrast to a traditional method of data processing that misidentified the intensity level of 100% of the time spent vacuuming and walking uphill, the QDA and HMM approaches correctly estimated the intensity of activity 99% of the time. In a second study, we applied and HMM to data collected on five subjects doing a variety of activities. The HMM was able to correctly classify sitting most frequently (mean(se) percentage of time points correctly identified was 99.2%(0.8%)) followed by walking on declined treadmill (94.2%(4.6%)), jogging (91.6%(5.6%)), walking on level treadmill at 1.25 m·s-1 (90.8%(6.3%)), walking on level treadmill at 1.70 m·s-1 (81.8%(18.2%)), walking on an inclined treadmill (73.1%(16.6%)), vacuuming (58.6%(14.3%)), walking up stairs (50.3%(17.0%)), walking down stairs (43.3%(17.8%)), and a box loading task (27.8%(9.5%)). The novel approach of estimating activity mode, rather than activity level, may allow for more accurate field-based estimates of physical activity using accelerometer data, which would allow for more accurate public health information regarding the relationship between exercise and a variety of chronic diseases.