SUNScholar - Browsing by Author "Unger, Marianne"

Browsing by Author "Unger, Marianne"

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Benefits of curriculum renewal : the Stellenbosch University physiotherapy experience
(Health & Medical Publishing Group, 2014-10) Unger, Marianne; Hanekom, Susan D.
Background. Driven by a changing healthcare environment, the Division of Physiotherapy (Stellenbosch University) reduced core content and adopted a multimodal approach to teaching and learning. The benefits of curriculum renewal, however, are seldom investigated despite ongoing internal appraisal. Evaluation of the BSc Physiotherapy programme was considered incomplete without determining the worth of the programme. Objectives. To determine whether there was a change in students’ perception of the impact of the programme on personal development; and whether the programme prepared them for community service. Methods. A descriptive comparative desktop analysis was conducted in which the data from the Faculty’s Programme Evaluation process were compared between students enrolled in the old curriculum (2006) and students enrolled in the new curriculum (2011) using pooled data and t-tests to compare responses between the two groups. A level of significance was set at p<0.05. Results. A significant increase in scores was noted for various graduate attributes developed as a result of the programme, such as critical thinking, clinical reasoning, communication and sourcing information (p<0.01). Similarly, students scored their perceptions related to programme structure significantly higher (p<0.01). No change was reported regarding students’ ability to maintain a balance between studies and other activities. Scores pertaining to their perception of readiness for community service or professional practice remained the same with both cohorts believing they were well prepared. Conclusion. The renewed format seemed to benefit students greatly in assisting the development of graduate attributes. Students were significantly more satisfied with the structure of the renewed curriculum and – despite extensive changes – the principles-based multimodal approach to teaching and learning was perceived as effective for preparing students for community service. Programmes undertaking curriculum renewal should not only focus on the curriculum content but also develop a variety of learning opportunities to facilitate the development of graduate attributes. The next cycle of evaluation should however reflect on clinical practice.
The efficacy of kinesiology taping for improving gross motor function in children with cerebral palsy : a systematic review
(AOSIS, 2018) Unger, Marianne; Carstens, Juan P.; Fernandes, Natasha; Pretorius, Rulanda; Pronk, Suzelle; Robinson, Ashleigh C.; Scheepers, Kara
Background: Kinesiology taping is an increasingly popular technique used as an adjunct to physiotherapy intervention for children with cerebral palsy (CP), but as yet we do not have a review of the available evidence as to its efficacy. Objectives: To critically appraise and establish best available evidence for the efficacy of truncal application of kinesiology taping combined with physiotherapy, versus physiotherapy alone, on gross motor function (GMF) in children with CP. Method: Seven databases were searched using the terms CP, kinesio taping and/or kinesiology tape and/or taping, physiotherapy and/or physical therapy and GMF. Only randomised controlled trials (RCTs) were included and appraised using the PEDro scale. Revman© Review Manager was used to combine effects for GMF in sitting, standing and activities of daily living. Results: Five level IIB RCTs that scored 3–6/8 on the PEDro scale were included. Meta-analysis showed that taping was effective for improving GMF in sitting and standing as measured by the Gross Motor Function Measure (B) (p < 0.001) and (D) (p < 0.001), respectively. Conclusion: There is moderate evidence to support kinesiology taping applied to the trunk as an effective intervention when used as an adjunct to physiotherapy to improve GMF in children with CP, especially those with GMF Classification Scale levels I and II, and particularly for improving sitting control. Clinical implications: Kinesiology taping is a useful adjunct to physiotherapy intervention in higher functioning children with CP. Current evidence however is weak and further research into methods of truncal application is recommended.
An electromyographic study of abdominal muscle activity in children with spastic cerebral palsy
(AOSIS Publishing, 2017) Adjenti, Saviour K.; Louw, Graham; Jelsma, Jennifer; Unger, Marianne
Background: Inadequate knowledge in the recruitment patterns of abdominal muscles in individuals with spastic-type cerebral palsy (STCP). Objectives: To determine whether there is any difference between the neuromuscular activity (activation pattern) of the abdominal muscles in children with STCP and those of their typically developing (TD) peers. Method: The NORAXAN® electromyography (EMG) was used to monitor the neuromuscular activity in abdominal muscles of individuals with STCP (n = 63), and the results were compared with the findings from age-matched TD individuals (n = 82). Results: EMG frequencies were recorded during rest and during active states and compared using repeated measures ANOVA. Spearman’s rank order correlation was used to explore relationships between age, body mass index and abdominal muscle activity. With the exception of the rectus abdominis (RA) muscle, the pattern of neuromuscular activity in children with STCP differs significantly from that of their TD peers. Three of the muscles – external oblique abdominis (EO), internal oblique abdominis (IO) and RA – in both groups showed significant changes (p < 0.001) in the frequency of EMG activity between the resting and active states. An elevated EMG activity at rest in the EO and IO was recorded in the STCP group, whereas the RA during resting and active stages showed similar results to TD individuals. Conclusion: The findings from this study suggest that the RA could be targeted during rehabilitation regimens; however, the force generated by this muscle may not be sufficient for the maintenance of trunk stability without optimal support from the EO and IO muscles.
The impact of an eight-week progressive resisted exercise program in adolescents with spastic cerebral palsy
(Stellenbosch : Stellenbosch University, 2004-04) Unger, Marianne; Faure, M.; Frieg, A.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Occupational Therapy.
ENGLISH ABSTRACT: Muscle weakness is a problem for many young people with spastic cerebral palsy (CP). Many studies have reported that selective strength-training programs can improve muscle strength. However, most of these studies are of single group design and do not adequately control for confounding variables. Objective: To determine the impact of a comprehensive strength training program targeting multiple muscle groups on adolescents with CP, using basic inexpensive free weights and resistance devices. Method: A randomised clinical trial evaluated the effects of an eight-week strength-training program on 31 independently ambulant adolescents with spastic CP, with or without walking aids, from Eros School (19 males, 12 females; mean age 16 years 1 month; range 13 - 18 years). The Kin-Com dynamometer, 3-D gait analysis, the Economy of Movement test and a questionnaire was used to evaluate selected muscle strength, the degree of crouch gait, free walking velocity and stride length, energy consumption during walking and perceptions of body image and functional competence. Twenty one subjects took part in the strength-training program and were compared with 10 control subjects. Results were analysed using repeated measures ANOVA and bootstrap analysis. Results: Compared with the control, significant improvement in the degree of crouch as measured by the sum of the ankle, knee and hip angles at midstance (p=0.05) and perceptions of body image (p=0.01) were noted for the experimental group. Significant trends were also noted for isometric knee extension muscle strength at 30° as well as for hip abduction at 10° and 20°. Walking efficiency, -velocity and stride length remained unchanged as well as perceptions of functional ability. Conclusion: A strength-training program targeting multiple muscle groups including upper and lower limbs as well as the trunk, can lead to changes in muscle strength and improve the degree of crouch gait with improved perception of body image. Successful participation in such a program at school may motivate children with CP to continue with home-based basic strength training. Strength training alone did not decrease oxygen consumption during walking and inclusion of aerobic exercise is recommended.
Motor skill intervention for pre-school children : a scoping review
(AOSIS, 2020) Van der Walt, Janke; Plastow, Nicola A.; Unger, Marianne
Background: There is a high prevalence of motor skill difficulties amongst pre-school children living in low socio-economic areas. Motor skill impairment can affect these children’s school readiness and academic progress, social skills, play and general independence. Objectives: This scoping review investigates the key elements of existing motor skill interventions for pre-school children. Method: We gathered information through structured database searches from Cinahl, Eric, PubMed, Cochrane, ProQuest, Psych Net, PEDro and Scopus, using a keyword string. The PRISMA-SCR design was used to identify 45 eligible studies. All included studies investigated a motor skill intervention with well-defined outcome measures for children aged 4–7 years with motor skill difficulties. Studies that exclusively focused on children with neurological conditions such as cerebral palsy, physical disabilities or medical/physical deteriorating conditions were excluded. Information was charted on MS Excel spreadsheets. Fundamental concepts were categorised into common key themes and were converted into a proposed framework. Results: Fifteen intervention approaches were identified. Treatment is mostly managed by occupational therapists and physiotherapists. Evidence supports individual and group treatment with a child-centred, playful approach in a school or therapeutic setting. Whilst session information varied, there is moderate evidence to suggest that a 15-week programme, with two weekly sessions, may be feasible. Conclusion: Children with motor skill difficulties need therapeutic intervention. This study identified the key elements of existing therapy intervention methods and converted it into a proposed framework for intervention planning. It is a first step towards addressing motor skill difficulties amongst pre-school children in low socio-economic areas.
Teaching my peers : perceptions of tutors in physiotherapy practical skills training
(Health & Medical Publishing Group, 2014-10) Unger, Marianne; Keiller, Lianne; Inglis-Jassiem, Gakeemah; Hanekom, Susan D.
Background. A near-peer tutorial system was introduced and implemented as part of a second-year module to assist physiotherapy students with the practising of manual techniques. Although not the primary drive for initiating this system, there are potential added benefits for the tutor reported in the literature. Objective. To determine the effect of near-peer teaching on the perceptions undergraduate physiotherapy students have of their own learning. Methods. A descriptive study utilising mixed methods was used. A pre-tutorial focus group discussion (FGD) format explored the expectations and perceptions of tutors’ own abilities and the proposed tutorial system. The researchers conducted a post-tutorial FGD to explore the experiences and perceptions of the tutors’ learning experiences. The responses were transcribed and analysed using deductive thematic analysis. A questionnaire was used to quantify which competencies or skills student tutors thought they had obtained through the facilitation of the tutorial sessions. The results were explored using a competency framework. Results. All ten tutors in the 2012 programme participated in the study. Students moved from unconscious incompetence to conscious incompetence, and seemed to have reached the phase of conscious competence by the end of the programme. Unconscious competence was not observed. More than half of the tutors agreed that the programme had a positive impact on their communication, ability to transfer skills and their own understanding of techniques and underlying theory, while two tutors felt that the programme did not improve their own theoretical basis of techniques. Conclusion. Participating and functioning as near-peer tutors had a positive influence on physiotherapy students’ perceptions of their own learning both in terms of own clinical technique competency, but also as teachers and facilitators of learning. It is hypothesised that these students will transition effectively between clinician and health advocator/teacher.
An ultrasonographic analysis of the activation patterns of abdominal muscles in children with spastic type cerebral palsy and in typically developing individuals : a comparative study
(BioMed Central, 2018-06-05) Adjenti, Saviour Kweku; Louw, Graham Jacob; Jelsma, Jennifer; Unger, Marianne
Background: Abdominal muscles have stiffer appearance in individuals with spastic type cerebral palsy (STCP) than in their typically developing (TD) peers. This apparent stiffness has been implicated in pelvic instability, mal-rotation, poor gait and locomotion. This study was aimed at investigating whether abdominal muscles activation patterns from rest to activity differ in the two groups. Method: From ultrasound images, abdominal muscles thickness during the resting and active stages was measured in 63 STCP and 82 TD children. The thickness at each stage and the change in thickness from rest to activity were compared between the two groups. Results: Rectus abdominis (RA) muscle was the thickest muscle at rest as well as in active stage in both groups. At rest, all muscles were significantly thicker in the STCP children (p < 0.001). From rest to active stages muscle thickness significantly increased (p < 0.001) in the TD group and significantly decreased (p < 0.001) in the STCP children, except for RA, which became thicker during activity in both groups. In active stages, no significant differences in the thickness in the four abdominal muscles were found between the STCP and the TD children. Conclusion: Apart from the RA muscle, the activation pattern of abdominal muscles in individuals with STCP differs from that of TD individuals. Further studies required for understanding the activation patterns of abdominal muscles prior to any physical fitness programmes aimed at improving the quality of life in individuals with STCP.
Whole-body vibration exercise improves functional parameters in patients with osteogenesis imperfect : a systematic review with a suitable approach
(African Traditional Herbal Medicine Supporters Initiative, 2017) Sa-Caputo, Danubia C.; Dionello, Carla da F.; Frederico, Eric Heleno F. F.; Paineiras- Domingos, Laisa L.; Sousa-Goncalves, Cintia Renata; Morel, Danielle S.; Moreira-Marconi, Eloa; Unger, Marianne; Bernardo-Filho, Mario
Background: Patients with osteogenesis imperfecta (OI) have abnormal bone modelling and resorption. The bone tissue adaptation and responsivity to dynamic and mechanical loading may be of therapeutic use under controlled circumstances. Improvements due to the wholebody vibration (WBV) exercises have been reported in strength, motion, gait, balance, posture and bone density in several osteopenic individuals, as in post-menopausal women or children with disabling conditions, as patients with OI. The aim of this investigation was to systematically analyse the current available literature to determine the effect of WBV exercises on functional parameters of OI patients. Materials and methods: Three reviewers independently accessed bibliographical databases. Searches were performed in the PubMed, Scopus, Science Direct and PEDro databases using keywords related to possible interventions (including WBV) used in the management of patients with osteogenesis imperfecta. Results: Three eligible studies were identified by searches in the analysed databases. Conclusion: It was concluded that WBV exercises could be an important option in the management of OI patients improving the mobility and functional parameters. However, further studies are necessary for establishing suitable protocols for these patients.
Whole-body vibration exercise is well tolerated in patients with duchenne muscular dystrophy : a systematic review
(African Traditional Herbal Medicine Supporters Initiative, 2017) Moreira-Marconi, Eloa; Sa-Caputo, Danubia C.; Dionello, Carla F.; Guedes-Aguiar, Eliane O.; Sousa-Goncalves, Cintia R.; Morel, Danielle S.; Paineiras-Domingos, Laisa L.; Souza, Patricia L.; Kutter, Cristiane R.; Costa-Cavalcanti, Rebeca G.; Costa, Glenda; Paiva, Patricia C.; Figueiredo, Claudia; Brandao-Sobrinho-Neto, Samuel; Stark, Christina; Unger, Marianne; Bernardo-Filho, Mario
Background: Duchenne muscular dystrophy (DMD) is caused by a defective gene located on the X-chromosome, responsible for the production of the dystrophin protein. Complications in the musculoskeletal system have been previously described in DMD patients. Whole body vibration exercise (WBVE) is a treatment that improves musculoskeletal function in movement disorders. The aim of this study was to review the effects of WBVE on functional mobility, bone and muscle in DMD patients. Materials and Methods: Four databases were searched. Three eligible studies were found; all three conclude the management of DMD patients with WBV was clinically well tolerated. The studies used a side-alternating WBV system, frequencies 7 - 24 Hz; and amplitudes 2 - 4 mm. Results: A work indicates that a temporary increase in creatine kinase in DMD during the first days of WBV was observed, but other authors did not find changes. No significant changes in bone mass, muscle strength or bone markers. Some patients reported subjective functional improvement during training. Interpretation: Conclusion: It is concluded that WBV seems to be a feasible and well tolerated exercise modality in DMD patients.

Browsing by Author "Unger, Marianne"

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