Doctoral Degrees (Exercise, Sport and Lifestyle Medicine)
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- ItemMuscle synergies during exercise and functional movement of unilateral transtibial amputees(Stellenbosch : Stellenbosch University, 2024-03) Arnold, Sarah Leigh; Venter, Ranel; Furlong, L.; Grobler, L.; Stellenbosch University. Faculty of Medical and Health Sciences. Dept. of Exercise, Sport and Lifestyle Medication.ENGLISH ABSTRACT: A biomechanically informed approach to rehabilitating individuals with a unilateral transtibial amputation (UTTA) holds promise for optimizing functional outcomes and enhancing overall quality of life. This thesis delves into the personal experiences of individuals with UTTA, scrutinizes healthcare professionals' (HCP) rehabilitation approaches, and considers various biomechanical factors. A unique aspect of this work involves muscle synergy analysis which refers to the understanding of co-ordinated activation of groups of muscles working together for specific movements. In individuals with UTTA, the loss of the lower limb influences neuromuscular co-ordination required for gait and functional activities. Differentiating muscle synergies between affected and unaffected sides offers insights to refine rehabilitation guidelines, improving exercise prescription for enhanced muscle recruitment and coordination, ultimately leading to better functional outcomes. METHODS This study consisted of two main parts. The first employed bespoke questionnaires to understand the challenges and perceptions of individuals and common rehabilitation exercises utilized by healthcare professionals. The second incorporated biomechanical evaluation of individuals with a UTTA during daily activities and common rehabilitation exercises. Questionnaires, distributed within South Africa via email to lower limb amputees, Prosthetists, Physiotherapists, Biokineticists and Occupational therapists. The biomechanical evaluation recruited 10 individuals with a UTTA within the Western Cape, South Africa for a once-off session. Participants performed a balance protocol, sit-to-stands stand-to-sits, walking at a self-paced and fixed speed (4km.hr-1), bridge, and squat. RESULTS Reported challenges by lower limb amputees (n = 28) included difficulties in activities like walking on uneven surfaces, on the beach, and climbing stairs, influenced by factors like fear of falling, altered proprioception, and mechanical limitations of the prosthetic limb. Healthcare professionals (n = 134) identified various exercises for UTTA rehabilitation, including balance, bridge, knee extension, hip abduction, and squats. Muscle recruitment for these exercises partially aligned with the biomechanical evaluation results. Biomechanical evaluation of ten individuals with UTTA (7 men and 3 women, 41 ± 12 years of age) revealed significant differences between different balance conditions of the modified Clinical test for Sensory Integration and balance when assessing the distances travelled in an anterior/posterior direction (p < 0.05). Differences were observed in the symmetry index of vertical ground reaction forces during the Sit-to-stand, Stand-to-sit, Squat and walking when comparing affected and unaffected sides. Similar observations were made when comparing muscle activation across the different tasks. The analysis demonstrated that, in general, two muscle synergies were required for most activities and exercises, except for walking, which needed only one muscle synergy to explain over 90% of the movement. CONCLUSION In conclusion, a biomechanically informed approach to the rehabilitation of unilateral transtibial amputees may optimize functional outcomes and improve the overall well-being of this population. Analysing muscle synergies, understanding the challenging activities, aligning rehabilitation practices, and emphasizing neuromuscular co-ordination, enables healthcare professionals to tailor individualised rehabilitation plans. This personalized approach can enhance muscle recruitment, improve functional performance, boost confidence, and facilitate better integration into daily activities, ultimately fostering a higher quality of life for individuals with limb loss.
- ItemHead smart: the implementation of a law variation in community rugby union and its effect on head injury rates(Stellenbosch : Stellenbosch University, 2024-03) Van Tonder, Riaan; Derman, Wayne; Brown, James; Hendricks, Sharief; Stellenbosch University. Faculty of Medical and Health Sciences. Dept. of Exercise, Sport and Lifestyle Medication.ENGLISH ABSTRACT: Background Concussion is a significant concern in contact and collision sports. Emerging evidence indicates potential negative long-term neurological and mental health outcomes associated with exposure to repetitive head impacts and concussion. Concussion is one of the commonest injuries in rugby union (‘rugby’) and most commonly occurs in the tackle. Thus, injury prevention strategies directed at the tackle require investigation. Objectives. The objective of this project was to investigate the implementation of a law variation trial in male amateur community rugby union and its effect on head injury rates, particularly concussion. The primary aim was to evaluate the effectiveness of lowering the maximum legal height of the tackle from shoulder- to armpit-level in reducing concussion incidence. Secondary aims were: 1) To characterise the tackle event and identify factors associated with illegal high tackles. 2) To investigate referee and player behaviour change as measures of successful implementation of the law variation. 3) To qualitatively explore stakeholder perceptions of the tackle law Methods.The study was conducted in Stellenbosch University's ‘Koshuisrugby’ League using a cross-sectional analytical design. Standardised epidemiological injury surveillance and return-to-play data were collected in years one and two of the study, and video footage of all matches in year 2. Covid-19 led to the cancellation of a planned third year of the study and thus no further injury or video surveillance occurred. Data were analysed to compare injury rates and severity between year 1 (2018; control year) and year 2 (2019; intervention year). Video footage was coded and analysed to characterise the tackle, identify factors associated with illegal high tackles, and investigate player and referee behaviour changes across one season. Individual, semi-structured stakeholder interviews were conducted to gain deeper understanding, through qualitative methods, of stakeholder perceptions of the effectiveness of the law variation and factors that influenced the law variation implementation. Results The incidence rate of concussion did not differ significantly between the control and intervention years (rate ratio: 0.69; 95% CI: 0.4 to 1.2; p=0.20). Overall, 108 matches were filmed and >14 000 tackles were coded and characterised. Factors associated with illegal high tackles were lower leagues, on tackles, arm tackles, upright tacklers, and ball carriers in low body positions. Promising positive player and referee behaviour changes were observed. Significantly fewer tacklers were upright in tackles in the last phase of the season and the sanctioning rate of illegal high tackles was significantly higher in the midphase of the season. Despite stakeholders valuing the law variation, many challenges remain to reduce concussion incidence. Ongoing educational campaigns are critical to address knowledge gaps and raise awareness. The prevailing culture in rugby, particularly in this cohort, pits performance against player welfare, mostly prioritising performance. This culture requires change. A multi-factorial, systems-based approach is needed to reduce concussion in rugby.
- ItemExploring stakeholders' perceptions on the status of women's rugby development in South Africa(Stellenbosch : Stellenbosch University, 2023-12) Solomons, Jocelyn; Kraak, Wilbur; Bekker, Sheree; Groom, Ryan; Stellenbosch University. Faculty of Medical and Health Sciences. Dept. of Exercise, Sport and Lifestyle Medication.ENGLISH ABSTRACT: Over the past 7 years, Women's Rugby has experienced remarkable global growth, marked by increased participation and a rise in tournaments. However, despite these advancements, the sport has received limited attention regarding women's participation, primarily due to historical and societal barriers. These barriers include the perception of rugby as a men’s-only sport, limited resources for female players, and societal discouragement. To comprehensively explore the challenges faced by South African Women's Rugby, this study collected qualitative data through online interviews, focus group discussions, and in-person observations, while considering stakeholders' (players, coaches, support staff (i.e., team doctor, physiotherapist, biokineticist, sport psychologist) and administrators (team managers and team/club administrators) perceptions and the impacts of historical and cultural factors. The findings uncovered significant challenges in overcoming gender-role expectations and gaining acceptance in a society that predominantly views rugby as masculine. To address these challenges, the study recommends that Women's Rugby coaches continually improve coaching practices by embracing experimentation, feedback, and reflection. Special considerations should be given to coaching Women's Rugby in South Africa, considering players' late entry and diverse sporting backgrounds. Integrating ethics and professionalism into coaching development frameworks is crucial. Moreover, the study emphasises the critical importance of the coach-athlete relationship, highlighting individual differences, and attachment styles. Effective communication, trust-building, and mutual support play key roles in creating an environment where players feel valued and motivated to excel. The coach-athlete relationship maximises performance and overall well-being. Both coaches and players must actively contribute to prioritising and nurturing this relationship, leading to effective coaching and improved player performance. In conclusion, this study sheds light on the challenges faced by participants in South African Women's Rugby and offers recommendations for improvement. Shifting gender-role expectations, dispelling stereotypes, and increasing media exposure are pivotal in promoting Women's Rugby as a popular and viable sport. Continuous improvement in coaching practices and the implementation of tailored coach development programs are crucial. Fostering effective communication, trust, and support within the coach-athlete relationship can contribute to the growth and success of Women's Rugby in South Africa. Implementing these recommendations will help South African Women's Rugby overcome historical, cultural, and economic barriers, creating a more inclusive and prosperous future for the sport. This will benefit players, coaches, administrators, and Women's Rugby as a whole.
- ItemHistorical narrative of high school athletics among oppressed communities in the Western Cape, 1956-1994(Stellenbosch : Stellenbosch University, 2023-03) Willis, Roderick Arthur; Cleophas, Francois; Kraak, Wilbur; Stellenbosch University. Faculty of Medical and Health Sciences. Dept. of Exercise, Sport and Lifestyle Medication.ENGLISH ABSTRACT: This dissertation creates a historical narrative of a multi-coded school sports organisation in the Western Cape, South Africa between 1956 and 1994, the Western Province Senior School Sports Union (WPSSSU). This organisation, established in 1956, was analysed historically and operationally up to its demise in 1994. The main narrative is preceded by a brief overview of a history of modern athletics in Great Britain. Modern athletics was formalised during the late 19th century at Oxford and Cambridge universities. After completing their studies, the graduates took their knowledge of athletics to schools in the Cape, a British colony at the time. A historical overview of athletics during the late 19th and early 20th centuries in Cape Town society therefore serves as historical contextualisation for the later establishment of WPSSSU in 1956. The study emanated in two published articles, the first concentrating on the period 1956 to 1972 and titled ‘A Historical Narrative of High School Athletics amongst “Coloured” Communities in Cape Town, South Africa, with Special Reference to the Western Province Senior Schools Sports Union, 1956–1972’. This article was published online on 10 March 2022 in the International Journal of the History of Sport. The second article focused on the period 1973 to 1994 and is titled ‘Reconstructing a Socio-Political Narrative of High School Athletics in the Oppressed Communities of the Greater Cape Peninsula, South Africa, 1973–1994’. This was published on 21 February 2022 in the South African Historical Journal. These articles are followed by a chapter that interrogates the main reasons that led to the demise of WPSSSU, namely the Double Standards Resolution, the policy of non-alignment, the formation of rival non-racial school sports organisations and the school sports unity debate. The study aimed to add to the corpus of literature on black sports history in South Africa, with a secondary aim to prove that school sports was a well-functioning discipline in oppressed communities during apartheid. The theoretical lens, reconstructionism, was employed to underpin the research methodology that relied on primary and secondary material, documents of mass communication, minutes, reports, oral and telephonic interviews as well as email communication. The study concluded by synthesising issues that were investigated in the main body of the dissertation and proposes that the current state of school sports in South Africa can be improved if the authorities consider the functioning and organisation of WPSSSU.
- ItemTransitioning out of the professional player pathway: A grounded theory on the process in South African Men’s tennis(Stellenbosch : Stellenbosch University, 2022-04) Skinstad, Deborah Anne; Stellenbosch University. Faculty of Medical and Health Sciences. Dept. of Sport Science.; Grobbelaar, Heinrich W.; Babchuck, Wayne A.ENGLISH ABSTRACT: To understand and describe the athlete and their environment(s), researchers, historically, have confined their description of retrospective events, such as sport participation, development, career transitions, etc., to the sport context. This approach has been limiting to researchers’ scope of interpretation (qualitative designs) and / or projection (quantitative designs) of past, present and future (athletic) selves along with transitioning and non-transitioning sporting careers. In other words, the person and athlete are portrayed as mutually exclusive. Considering this, the motivation for the current research project was to understand, reimagine and amplify the human experience of South African men’s tennis players, i.e., the people within their development pathways. To do this, a rigorous constructivist grounded theory (GT) methodology was employed both as the research process and as a strategy to generate theory. This GT study explored South African men’s tennis player transitions within and out of the professional player pathway in the Western Cape Province, South Africa. Four research questions guided the study: 1) what is happening in the development process of a promising competitive junior tennis player in the Western Cape, South Africa?; 2) what is happening [on and off the court] in the development of these players?; 3) what are the transitional processes throughout the junior career pathway and how are these transitions understood?; and 4) how do men’s tennis players [with a promising national junior ranking] transition out of the professional player pathway? To best answer these research questions, a range of tennis participants (n = 34) were selected using purposeful sampling (theoretical sampling) along with maximum variation sampling. Data collection entailed semi-structured interviews augmented with observational work. Theory generation adhered to the procedures for constructivist GT analysis (initial codes, focused codes, categories and categories underpinning theory). As a result, a GT model that explains South African men’s tennis player development and transition processes was developed. This model is underpinned by eight core categories: 1) pursuing a rich man’s sport; 2) transitioning steps; 3) playing inside the lines [small world]; 4) SA Coaching world; 5) life orbiting tennis; 6) college: driving the tennis vehicle; 7) manhood eclipsing childhood; and 8) being a pro at life, not tennis. The practical implications of this model are recognised firstly in its approach to tennis development, i.e., placing greater emphasis on the person and their individual life transitions and how these influence their tennis trajectories. Secondly, this model provides a unique context to the South African tennis player journey. A journey that Tennis South Africa’s (TSA) current long-term player development model (LTPD) generically and collectively attempts to accommodate in a long-term development plan. However, without context and individual experiences of junior to senior transitions, i.e., sport within life domains, the South African tennis player remains (figuratively) confined to a linear, reductionist and prescriptive approach to development and the complexity of their path is grossly misunderstood and misrepresented. A practical recommendation for TSA is to accommodate the doubles format as a mechanism for tennis development and utilize it as a viable professional tennis pathway.