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Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2008. / lntroduction: Swimming is one of the most popular participation sports 1 as people are drawn to swimming for leisure, cardiovascular workouts, or competition 2 . As a result, the sport of swirnrninq has improved 9reatly over the past 20 years 3 . Olbjectoves: The aim of this study was to determine a profile of musculoskeletal injuries in competitive swimmers in the greater Durban area of KwaZulu-Natal, South Africa; as well as to determine whether any relationships exist between swimming injuries sustained in this study and the risk factors identified in other studies, and to compare the results with international data. Therefore; for the purpose of this study, the following information was gathered in order to build up an injury profile: o Demographics of competitive swimmers in South Africa, o The participants swimming history, o The presence of any past or current injuries and o Factors associated with current and previous injuries were also investigated. This study was a prospective, cross-sectional, questionnaire based study, investigating the profile of musculoskeletal injuries in 101 competitive swimmers in the greater Durban area. The data was collected by means of a self-administrated questionnaire, which was completed by the participants, under the supervision of the researcher, parents or coach. / M

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 Occupational Therapy. Johannesburg, 2013 / Whilst patients are in hospital, their families are expected to understand and remember complex information from the medical team. Previous studies have shown that high levels of anxiety impair a person’s ability to interpret complex information and memory recall. It is unknown if family members experience anxiety whilst the patient is in rehabilitation. The study aimed to determine if family members experienced anxiety, and whether there was a significant correlation between anxiety and the length of time the client was admitted to the rehabilitation facility; length of time since the client’s injury; the FIM measurement of the patient; as well as the perception of received information by the treating team. A family representative participated by completing the Hospital Anxiety and Depression Scale (HADS) and an Information Checklist on three separate occasions during the patient’s stay in a rehabilitation hospital. Family members were found to be anxious throughout the period of rehabilitation, with a decreasing trend in the average scores of the HADS assessment. An increasing trend was noted in the satisfaction of information offered by the treating team. No significant correlation could be found between the family members’ anxiety and the motor or cognitive improvement in the patient – thus indicating that a strong possibility exists that the factors influencing the family members’ anxiety are wide spread and diverse.

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 Dentistry in the branch of Maxillofacial and Oral Surgery. Johannesburg, 2015 / Aim: The aim of this prospective study was to compare epidemiologic characteristics of maxillofacial fractures between Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and Polokwane–Mankweng Hospital Complex (PMHC). Objective: To compare the patterns; aetiologies and incidences of maxillofacial fractures in patients of all ages between the two units. Materials and Methods: We present a prospective study of 194 patients with 226 maxillofacial fractures reported and treated between CMJH and PMHC from December 2013 to August 2014. These patients were clinically and radiographically assessed by registrars and a consultant in both units. Variables recorded included Patient’s age; file number; sex; socioeconomic status; population group; aetiology; time of injury; identity ( whether known or unknown ) of assailant; the site of the fracture and associated injuries. Results: Of the 194 total patients from both units, 159(82.0%) patients were males and 35(18.0%) patients were females, giving overall male to female ratio of 4.54:1. The minimum age was (2) two years and the maximum age was 61 years. In both males and females, the majority (75%) of patients were in the age group of 20-39 years with a peak frequency in the 3rd decade. The overall mean age was 30.6 (10.02). Assaults were by far the leading cause of maxillofacial fractures from our study accounting for 60.3% fractures of the total study population, followed by road traffic accidents accounting for 17.5%. Road traffic accidents accounted for 22.7% maxillofacial fractures in PMHC, a rate higher than CMJAH (14.8%) and overall rate (17.5%). Sport injuries accounted for more (6.1%) maxillofacial fractures in PMHC than CMJH (0.8%). In total, 127(65.8%) patients sustained maxillofacial fractures during the night and 66(34.2%) patients during the day. The mandible was the most frequently fractured facial bone (73.0%), followed by the zygoma. The angle of the mandible was the most common fractured site (35.0%). Conclusion: Interpersonal violence is by far the leading cause of maxillofacial fractures in South Africa. Prevailing factors like socioeconomic status of patient; industrialisation and geographic location have somewhat influenced the characteristics of maxillofacial fractures in the two units.

Thesis (M.Sc.(Emergency Medicine))--University of the Witwatersrand, Faculty of Health Sciences, 2014. / Aim. The aim of the study was to analyse the prevalence and type of injuries over two years of a Johannesburg High School rugby festival by assessing the injuries (number, anatomical sites, types and severity), to compare the injuries between the two years and to compare the injuries between the three days of the festival. Methods. The study design was a retrospective, descriptive and observational study. The study population was the participating rugby players at the two rugby festivals in 2010 and 2011. Medical records of rugby related injuries in schoolboy participants were used for capturing injury data. Results. A total of 626 players participated (322 and 304 in 2010 and 2011 respectively) of which there were a total of 100 injury data sets analysed. The injury rate per player in year one was 16.8%, and 15.2% in year two. There was no statistical difference (P = 0.6526) in the injury numbers between the two years. The injury profiles between the respective days between the two years were not statistically different. Most injuries were to the head/face, with the majority being concussion related. The next commonest injuries were to the neck area. Most injured players had not had previous similar injuries. Tackles were the commonest mechanism of injuries. Twenty four percent of injuries were deemed severe enough to stop the players from continuing play. Few required referral for investigations or specialist physician care and most were managed with simple first aid at the primary care level. Conclusion. The nature and mechanisms were in keeping with numerous local and international studies of schoolboy rugby players, but with a lower injury frequency. Providing medical services at rugby events such as these festivals is a requirement and adequate standardised record keeping is recommended to increase knowledge and monitor trends as the dynamic nature of the game of schoolboy rugby continues to develop and change.

There is a dearth of published literature that documents the levels of functional ability post spinal cord injury (SCI) resulting in paraplegia, at discharge from in-patient rehabilitation facilities within Gauteng. In addition, the factors that influence functional ability are poorly defined in individuals with paraplegia, at their discharge from in-patient rehabilitation facilities in Gauteng. This necessitated further investigation since it is vital for the rehabilitation of individuals with SCI resulting in paraplegia. The aim of the study was to determine the functional ability and the factors that affect the functional ability in individuals with a SCI resulting in paraplegia, at discharge from rehabilitation facilities in Gauteng. The first objective of the study was to establish the level of functional ability in patients with SCI at discharge from in-patient rehabilitation. The second objective of the study was to describe the physical and demographic factors of the study population. The third objective of the study was to establish the demographic and physical factors that influence the level of functional ability in patients with SCI at discharge from in-patient rehabilitation. This was a cross-sectional, observational study design. Three instruments were used in this study: a self-designed questionnaire to establish the factors that influence the level of functional ability in patients with SCI at discharge from an in-patient rehabilitation unit; the American Spinal Injury Association (ASIA) classification scale of neurological impairment to describe the level and completeness of the lesion and the Spinal Cord Independence Measure III (SCIM III) to determine the level of functional ability. The main results of the study were as follows: The average SCIM score in this population was 64.6 (±27.6) with the lowest score being 20 and the highest score being 84. Participants with non traumatic SCI had 16.87% lower SCIM scores than those with traumatic SCI. After multivariate analysis the following factors were found to influence function: For every one year increase in the age of the participant, there was 0.18% decrease in the SCIM score. For every day increase in LOS, there was a corresponding increase of 0.06% in the SCIM score. With respect to the presence of a pressure sore from the acute hospital, those who had pressure sores had 9% lower SCIM scores than those who did not have pressure sores. Participants with spasticity had 8.3% lower SCIM scores relative to those that did not have spasticity. Relative to participants in government funding classification, workman’s compensation participants had 4.82% lower SCIM score followed by the medical aid participants with 8.07% lower SCIM and the private participants with 10.84% lower SCIM scores. For every unit increase in the ASIA motor score, there was an increase of 1.29% in the SCIM score. Conclusion: Majority of the participants in this study were discharged from rehabilitation without reaching functional independence. The following categories of patients with SCI may need to be monitored more for functional outcomes during rehabilitation and assisted in order to attain good functional ability: older age, a short rehabilitation length of stay, funded privately, a low ASIA motor score, having a pressure sore or spasticity, and higher level of SCI. Key words: Functional outcomes, paraplegia, rehabilitation, neurological level, spinal cord injury.

Motor vehicle collisions are one of the leading circumstances of death worldwide and are contributory to the second most common circumstance of death in South Africa, “transport-related deaths”. A total of 3248 transport-related deaths were recorded in Gauteng alone in 2009 and for that reason motor vehicle collisions pose a substantial threat to the South African population. This study was undertaken to determine if specific patterns of injuries in victims of fatal motor vehicle collisions existed. For the purposes of this study, “patterns of injury” can be defined as similar injuries of similar severities repeatedly and predictably occurring in similar body regions. The study consisted of all individuals involved in fatal collisions who fit the inclusion criteria during the period between 13 May 2011 and 1 June 2012. The external, visceral, and skeletal injuries sustained by the individuals involved in fatal motor vehicle collisions were observed via x-ray and photographic procedures performed by the investigator, as well as documentation from the Forensic Medical Practitioner/scribe notes. The South African Police Force attending officer’s affidavit and the Johannesburg Metropolitan Police Force Accident Reports were used to determine the make and model of the vehicle, the occupant’s position, type of collision and object with which the vehicle collided. The study’s results indicated that distinct patterns of injuries existed for those individuals involved in fatal motor vehicle collisions. The most frequently observed patterns of injuries included either severe head injuries in isolation, severe thoracic and/or abdominal injuries in isolation, or a combination of the two. Distinct patterns of injuries were noted for individuals occupying different types of vehicles but not for individuals occupying different positions within a single vehicle which is contrary to other international findings.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Master Science in Medicine in Emergency Medicine, Johannesburg, 2013 / Objectives: To describe the current analgesic practices for hand injuries used at a private hospital emergency department in Johannesburg, Gauteng and to explore any differences in analgesic practice between different doctor groups with different backgrounds, working in the ED. Design: Retrospective descriptive review. Setting: Private hospital emergency department in Johannesburg. Patients: A study sample of 423 patients who presented to the emergency department with hand injuries during 2010. Methods: The emergency department register was used to identify patients who presented with hand injuries. The clinical notes and where appropriate, nursing notes of the identified patients were reviewed. Main Results: Hand injuries were found to represent 9.3% of patients presenting to the emergency department. The most commonly used form of analgesia for hand injuries was found to be nerve blocks, which constituted 30% of the analgesic use. Digital blocks were the most frequently used block accounting for 69% of all nerve blocks done. Parenteral analgesia was the second most common form of analgesia implemented with the intramuscular route being most favoured. Specialised techniques such as nerve blocks are possibly underutilised by doctors with less surgical and emergency department experience. Conclusions: Analgesic practices between different doctor groups are varied. Standardising pain management for hand injuries should lead to improved utilisation of techniques such as nerve blocks. Guidelines should be available and include nerve block techniques. Training should be provided to doctors who are unfamiliar with the use of additional modalities such as nerve blocks.