PhysioSA - South African Society of Physiotherapy

For every physio who cares

Vol.32 No.8 December 2018/January 2019

+ WHO campaign

+ Aquatic physio

+ Neuro rehab

Cheers for Congress & National Physiotherapy BackWeek!

Putting the profession in the limelight

PhysioSA3

HIP HIP HOORAY!

Do you know your Management and Head Office Team?

n President Professor Witness Mudzi

[email protected]

n Deputy President Mr Rogier van Bever Donker

[email protected]

n Professional Liaison ConsultantMagda Fourie

[email protected]

n National Operations ManagerVanessa Boshoff

[email protected]

n Finance CoordinatorTracy Crowther

[email protected]

n Membership enquiries Nozipho Hlatuka

[email protected]

n Marketing and Advertising enquiriesAmerico Pinheiro

[email protected]

n Private Sector enquiries Jan Janse van Rensburg

[email protected]

n PhysioFocus Liaison officer Wilma Erasmus

[email protected]

n Professional Development Information Officer Tamsen Edwards

[email protected]

n Head office telephone number: (011) 615 3170 email: [email protected]

Vol.32 No.8Dec 2018/ Jan 2019

www.saphysio.co.za DECEMBER 2018/JANUARY 2019 1

CONTENTS

PUBLISHERPhysiotherapy PublicationsTEL (011) 615 3170 FAX 086 559 8237WEBSITE www.saphysio.co.za

EDITORMandi SmallhorneTEL (011) 672-3555E-MAIL [email protected]

ADVERTISINGAmerico PinheiroTEL (011) 615-3170/80 FAX 086 559 8237E-MAIL [email protected]

SUBSCRIPTIONSNon- SASP® Members: R600 (local) andR990 (overseas) pa incl VAT (8 issues –included in SASP® membership fee)

DESIGN AND TYPESETTINGColleen MulrooneyE-MAIL [email protected]

CIRCULATION MANAGERFAX: 086 559 8237

DEADLINES: PhysioSA (was Hands On) is published 8 times a year in December/January, February, April, May, June, August, September and October. The advertising deadlines are listed below – late submissions should be cleared by telephone. We cannot guarantee the publication of any late material.

ISSUE DEADLINE Apri 2019 22 February 2019 May 2019 22 March 2019 June 2019 27 April 2019 August 2019 22 June 2019 September 2019 20 July 2019 October 2019 24 September 2019 Dec/Jan 2019/20 26 October 2019 February 2010 23 November 2019

CONTRIBUTIONSThe editor accepts contributions from any author.

SASP® HEAD OFFICETEL (011) 615-3170 FAX 086 559 8237Unit 4, Parade on Kloof Office Park,Bedfordview.©Physiotherapy Publications,PO Box 752378 Gardenview 2047E-MAIL [email protected]

Reproduction in whole or in part without written approval of the publisher is strictly prohibited. The views expressed herein do not necessarily reflect those of the SA Society of Physio therapy. The advertising of products does not indicate endorsement of those products.SUBMISSIONS Please send any text in a Word or Word-compatible format, to [email protected]. Articles should be no longer than 2000 words, ideally, and no shorter than 300. Please don’t send pictures as an integral part of a Word document; send them separately, ideally as a Jpeg file and pictures should be at least 1MB. Attachments should be smaller than 6.5MB per e-mail, zip them if needed or send separate e-mails.

EDITOR’S COMMENT

2 Sick and tiredSome thoughts about fatigue

MARKETING

16 Talking about physioA presentation for Career Day

18 Loads of energy and effortPhysios go the extra mile for National Physiotherapy BackWeek

29 Unleash the power of civil society

A vision for physiotherapy

SOCIAL RESPONSIBILITY

10 Ain’t no mountain high enough

They climbed Everest – in Joburg!

CONGRESS

24 Improving physiotherapy access, enhancing wellness

Snippets to give you an idea of the whirlwind of Congress

PRACTICE

36 Limits to practiceRestraint of trade

STUDENTS

4 All for one, one for allThe National Physiotherapy Student Group

8 Ring in the newHow Wits welcomes freshers

38 A little goes a long wayThe impact of health promotion

SIG

14 Is neuro rehab relevant in South Africa?

Yes, yes, yes!

34 Paediatric aquatic therapy applied to adults

Therapy in water has many applications

INTERNATIONAL

31 Get activeWe outline the WHO’s 2018-2030 global action plan on physical activity

SCIENCE FOCUS

9 What's new in scienceVaping – does it work to stop smoking?

For every physio who cares

MEMBER OF

2 DECEMBER 2018/JANUARY 2019 www.saphysio.co.za

Editor’s commentBy: Mandi Smallhorne

How many of your patients complain of a sort of constant depression, a combination of brain fog, exhaustion, lack of focus and lack of enjoyment

of life?Let me guess: if you’re in the urban areas, more than

half? How many of YOU feel that way as the year winds to an end?

Physiotherapists are better off than many urbanites, I guess, because they are at least aware of the benefits of exercise and their work keeps them active, even if some are that rare creature, a physiotherapist who doesn’t gym, run, or engage in some sort of physical activity. But in other ways, we’re all the same.

And my experience is that, rich and poor, we city dwellers are suffering from a malaise that is characterised by that common complaint, “Oh, I dunno, I’m just so tired!”

I believe that this comes from a toxic brew of factors, some familiar (lack of exercise, poor diet, time-stress, for example). But some are less likely to spring to mind. Identifying such factors, and working out a plan of action if possible, might be helpful to your patients.

The newsStarving children in Yemen; mass shootings in the USA; a never-ending chorus of woes about the environment and climate change; economic uncertainty; rising crime rates; massive pile-ups on our roads; it’s all bad news, and it’s hard not to be affected.

There’s a thread of research running through the 25 years or so since I last studied psychology, which indicates that indirect exposure to traumatic events – in the media and on social media – can trigger symptoms of post-

traumatic stress disorder (PTSD). And that includes sleep disturbances and mood changes.

Three years ago, Dr Pam Ramsden from the Faculty of Social Sciences, University of Bradford presented research on the impact of social media at the Annual Conference of the British Psychology Society being held in Liverpool.

Dr Ramsden explained: “The negative

effects of exposure to other people’s suffering have long been recognised in roles such as professional healthcare workers. Various studies have documented the negative psychological reactions following indirect exposure to traumatised people called vicarious traumatisation. Social media has enabled violent stories and graphic images to be watched by the public in unedited horrific detail.” In her research, she found that about one in four people responded to horrific news and imagery with symptoms of PTSD over a period of a month and more.

So it might be worthwhile suggesting that patients curate what they see and read more carefully. You can block messages from people who routinely send ghastly pictures of tortured animals or abused children, for example.

The air we breatheDid you see the report from Greenpeace at the end of October? An analysis of satellite data from 1 June to 31 August this year revealed that Mpumalanga – home to twelve coal-fired power plants – is the world’s largest NO2 hotspot across six continents. “Nitrogen Dioxide (NO2) is a dangerous pollutant in and of itself and also contributes to the formation of PM2.5 and ozone, two of the most dangerous forms of air pollution,” Greenpeace wrote. Coal and transport as the two principle sources of this pollution.

“The satellite data further reveals that the cities of Johannesburg and Pretoria are also highly affected by extreme NO2 pollution levels which blow across from Mpumalanga and into both cities due to close proximity and regular east winds,” the organisation said. For between a quarter and a third of the year, winds blow this dirty air into the eyes, noses and lungs of millions of urbanites. (NB: our other big cities have better air quality, but they’re still not ideal.)

There’s plenty of evidence for the risks to physical health of air pollution; but did you know that it’s also a factor in mental health?

“Long-term exposure to ambient air pollution was a risk factor of a wide range of potential mental health disorders,” concluded scientists who in April 2018 published the results of research they’d done across South Korea.

Sick and tiredSome thoughts about fatigue

indirect exposure to traumatic

events – in the media and on

social media – can trigger symptoms of

post-traumatic stress disorder

3 www.saphysio.co.za DECEMBER 2018/JANUARY 2019

Editor’s commentAnd a review published in the Journal of Urban Design

and Mental Health 2018;4:6 summarised: “Epidemiological evidence shows an emerging association between certain air pollutants and a range of mental health outcomes including depression, anxiety, psychosis, dementia, childhood cognitive development, and suicide.” The authors added that “the availability of green spaces, proximity to major roads and active transport initiatives, zoning of air polluting industries, and high-rise buildings are all features of urban environments identified as targets for improving the population mental health. We argue that on the basis of the evidence to date, it is reasonable to add “reducing exposure to air pollution” to the rationale for implementing these urban design features as an additional facet for addressing urban mental health.”

If you’re practising in Gauteng or Mpumalanga, this might be a factor in your patients’ malaise – especially for public sector physiotherapists whose patients come from a catchment area that abuts on old mine dumps crumbling due to lack of maintenance or being reclaimed. Last year, a Bench Marks Foundation study found that residents of communities like Riverlea‚ Diepkloof‚ Meadowlands and Doornkop, neighbours to what were some of the most intensive mining efforts, were hugely at risk of respiratory disease (many were on oxygen).

What can you do about this? Aside from some rather First World solutions like careful sealing of doors and windows and air-con, not much directly. But you can create awareness; make practical suggestions (a damp towel over a window can help a bit, for example); keep notes and provide activists who are fighting for cleaner air with data as ammo.

The light fantasticA few weeks ago, I began to feel extraordinarily tired after a few hours of work. At the same time, I was drowning in the worst possible moods – impatient, angry and miserable as sin. There were all sorts of possible reasons for this, so it took me quite a while to realise that one possible contributing factor is eminently fixable: blue light.

Thanks to both work pressures and high stress levels, I’d been spending even more time than usual in front of a screen (all screens emit blue light). I was spending hours on research; in between, I was communicating with friends via What’s App; and when I was ready to fall over at night, I’d got into the habit of pulling up a comforting episode of Heartbeat and watching it on my laptop. (It’s a 1990s British series set in 1960s Yorkshire in which nothing truly awful ever happens and village bobbies still need no other weapon than their truncheon and a stern “Now, now, what’s going on here?”)

I should know better. The light from the screens that are so integral to our lives have powerful effects on our brains (and especially children’s brains), as psychiatrist Victoria L Dunckley has noted in Psychology Today: “…many of the children I see suffer from sensory overload, lack of

restorative sleep, and a hyperaroused nervous system, regardless of diagnosis—what I call electronic screen syndrome. These children are impulsive, moody, and can’t pay attention…”

Just in case I’d temporarily forgotten, I’d had plenty of physical and other warnings – dry, red eyes, for example, as well as the fatigue and difficulty concentrating.

Too much screen time – and especially too much blue light – is particularly notorious for interfering with sleep by messing with melatonin and your circadian rhythm:

While light of any kind can suppress the secretion of melatonin, blue light at night does so more powerfully. Harvard researchers and their colleagues conducted an experiment comparing the effects of 6.5 hours of exposure to blue light to exposure to green light of comparable brightness. The blue light suppressed melatonin for about twice as long as the green light and shifted circadian rhythms by twice as much (3 hours vs. 1.5 hours).

In another study of blue light, researchers at the University of Toronto compared the melatonin levels of people exposed to bright indoor light who were wearing blue-light–blocking goggles to people exposed to regular dim light without wearing goggles. The fact that the levels of the hormone were about the same in the two groups strengthens the hypothesis that blue light is a potent suppressor of melatonin. It also suggests that shift workers and night owls could perhaps protect themselves if they wore eyewear that blocks blue light. Inexpensive sunglasses with orange-tinted lenses block blue light, but they also block other colors, so they’re not suitable for use indoors at night.

(Harvard Health Letter, updated August 2018)There’s a lot patients can do here:• Banish devices with screens from the bedroom.• Give yourself an evening cut-off time, say two to

three hours before bed, after which screens go off.• Set your screens to a slightly redder colour

temperature.• Take regular breaks – ideally, go for a five-ten

minute walk every hour or so.• Don’t gaze at the screen without breaks – look

up and focus on something distant, say six to ten metres away.

• Get outside into bright sunlight for a decent period of time during the day – this boosts your ability to sleep later.

Do what I’ve just done: go onto Amazon.com and search for “blue light blockers”. My amber-tinted clip-on lenses cost less than R500, delivery included. They’ll arrive in about ten days, and I intend to use them to block blue-spectrum light in twilight and night-time. I am hopeful that I’ll soon be sleeping better, in a better mood, and less inclined to grump at my husband and physio that “I’m just so tired!”

Take regular holidays – from the city, and from your screens. Go and breathe some real fresh air far from urban life, and have a wonderful holiday season!

DECEMBER 2018/JANUARY 2019 www.saphysio.co.za4

20g & 50g 100g Voltaren Emulgel. Each 100g contains 1,16g diclofenac diethylammonium corresponding to 1g diclofenac sodium. Reg. no.: U/3.1/77. Botswana: Reg. no.: B9305535. Namibia: Reg. no.:04/3.1/0344.

Indicated for use in adults and adolescents older than 12 years. Safety in pregnancy and lactation has not been established. Consult your pharmacist/healthcare professional if needed. Applicant: GlaxoSmithKline Consumer Healthcare SA (Pty) Ltd, Company Reg. No. 2014/173930/07.39 Hawkins Avenue, Epping Industria 1, 7460. Tel. No. +27 011 745 6000. CHZAF/CHVOLT/0018/17

*Nicolas Hall & Company, Benchmarking the World of OTC, DB6,2016. “Voltaren is the world best-selling non-prescription topical pain reliever”Reference: 1. Zacher J et al. 2008. Topical diclofenac and its role in pain and inflammation: an evidence based review. Current Medical Research & Opinion. Vol 24. No 4 (925-950).

Relievespain

Reducesinf lammation

Speeds healing1

1 2 3

Cutterguide: NO Printing Process: Offset GD: 561711 Size: 210 (W) mm x 297 (H) mm Pages: 1 Colors: C M Y K (4 Colors) Native File: Indesign CC Windows Generated in: Acrobat Distiller 10.0

2018-GSKCH-SA-653-D2-Signoff.indd 1 8/10/2018 12:37:58 PM

The South African Society of Physiotherapy recently founded a new student arm – the National Student Physiotherapy Group (NPSG). The NPSG is a group

of students from all physiotherapy universities around the country, all who also sit on their respective student councils for their universities. The student group is a completely voluntary group, falling under the Professional Development Portfolio of the National Executive Committee (NEC) of the SASP. The NPSG has 9 members, seven women and two men.

The NPSG is an amazing group of students inspired to improve the field of physiotherapy from the ground up, and who are working to bridge the gap between the SASP, on-the-ground community engagement and the physiotherapy student body of South Africa. The NPSG hopes to be a voice for the student body, and to increase awareness of physiotherapy throughout South Africa, as well as an awareness of student movements and their initiatives, while promoting a stronger student body with a unity and focus that joins all the universities into one. Creating awareness of the benefits of the SASP for the student body of South Africa is foundational, as well as showcasing what physiotherapy students can achieve in their communities.

The NPSG wants to strengthen the student body’s influence on educational matters, and to level the playing field for all students in South Africa, giving underprivileged students the opportunities to excel whatever their circumstances.

The NPSG objectives are: • To further the objectives and the philosophies set by

the previous members of the NPSG, as well as those of the SASP.

• To advise the SASP on all matters relating to interests and activities of both the group and the student body of South Africa.

• To increase awareness of the profession in areas served by the NPSG, and to further the interests and safeguard the welfare of the respective group members.

• To create awareness about the NPSG and its features and functions.

• To create awareness of the SASP among students,

and to promote student membership and participation in the SASP.

• To improve communication and collaboration between the respective universities, and to promote student body collaborations with the SASP.

• To promote and ensure the continuation and growth of the NPSG, and to increase the influence of the student body in appropriate physiotherapy related matters.

• To foster good relations with each local branch of the SASP, and with the academic staff, student bodies, national and international student organisations and the general public – our future partners in health.

• To compile rules, regulations and standing orders for procedures and administration of the functions and duties of the NPSG in collaboration with the SASP.

• To administer funds or assets so as to best help and assist students.

The NPSG is:Chairman: Matthew Binnington (Wits)I come from a little town in the Southern Drakensburg in Kwazulu-Natal called Underberg. I matriculated in 2015 from Maritzburg College and have just finished third year physiotherapy at the

University of the Witwatersrand. I am an avid hockey player and currently coach the second team at Saint Johns in Johannesburg. I also coach, umpire and have previously played at a provincial level.

I was recently elected to chair the NPSG, as well as to chair the Wits Physiotherapy student council for 2019. It’s a tremendous honour to be elected for these two roles, and I aspire to bring a sense of passion and drive to the profession, as best I can. I also want to bridge the gap between the student body of South Africa and the profession of physiotherapy. I feel the student body has vast amounts to offer to the profession, and I’m aiming to share that, to propel our amazing field of work to places we have yet to reach.

Initially I wasn’t interested in physiotherapy; I always thought I would go into medicine, but in the last year and a half I have found a passion for biomechanics and human movement, and want to eventually do a PhD in biomechanics, focusing on the use of robotics for motion analysis. I am extremely motivated about the future of physiotherapy in South Africa and feel there is extensive untapped potential that we have yet to explore. 2019 is going to be a very exciting year, and I feel the NPSG, with support of the SASP, will do big things for the student body of South Africa.

Contact details: Cell: 0715593883Email: [email protected]

Students

All for one, one for allNewly elected chair Matthew Binnington introduces the National Physiotherapy Student Group

Matthew Binnington

20g & 50g 100g Voltaren Emulgel. Each 100g contains 1,16g diclofenac diethylammonium corresponding to 1g diclofenac sodium. Reg. no.: U/3.1/77. Botswana: Reg. no.: B9305535. Namibia: Reg. no.:04/3.1/0344.

Indicated for use in adults and adolescents older than 12 years. Safety in pregnancy and lactation has not been established. Consult your pharmacist/healthcare professional if needed. Applicant: GlaxoSmithKline Consumer Healthcare SA (Pty) Ltd, Company Reg. No. 2014/173930/07.39 Hawkins Avenue, Epping Industria 1, 7460. Tel. No. +27 011 745 6000. CHZAF/CHVOLT/0018/17

*Nicolas Hall & Company, Benchmarking the World of OTC, DB6,2016. “Voltaren is the world best-selling non-prescription topical pain reliever”Reference: 1. Zacher J et al. 2008. Topical diclofenac and its role in pain and inflammation: an evidence based review. Current Medical Research & Opinion. Vol 24. No 4 (925-950).

Relievespain

Reducesinf lammation

Speeds healing1

1 2 3

Cutterguide: NO Printing Process: Offset GD: 561711 Size: 210 (W) mm x 297 (H) mm Pages: 1 Colors: C M Y K (4 Colors) Native File: Indesign CC Windows Generated in: Acrobat Distiller 10.0

2018-GSKCH-SA-653-D2-Signoff.indd 1 8/10/2018 12:37:58 PM

DECEMBER 2018/JANUARY 2019 www.saphysio.co.za

Students

6

Deputy-chairman: Grethe Gouws (UFS)Home for me is sunny Mpumalanga, where I attended HTS Middelburg. This is where the dream started. Thereafter the door opened for me to the dusty, flat Free State – I’m a proud Kovsie Physiotherapy student; only a Kovsie knows the feeling. One of

the main reasons I enjoy my studies is my year group – a group of fantastic people who are there when you need them. Whether it’s assisting transfers in the hospital, or catching tears, they inspire me to create an environment to support others and give them the opportunity to grow – exactly what is needed when working with people as a physio student. What a privilege to serve on the NPSG as Vice Chairperson. I am excited to be part of a dynamic group of people who strive to lay the foundation for others to build upon. My words to live by: Be courageous and kind.


Secretary and treasurer: Liesl Gerstner (SU)I am from a small town called Greyton in the Western Cape where I grew up on a farm. I inherited my love of nature and animals, as well as helping others, from my farmer dad and my mom who used to be a nurse.

I chose physiotherapy because I realised how closely movement/mobility is linked to independence and how closely independence is linked to a person’s self-worth – “menswaardigheid” in Afrikaans. I am hoping, with my degree, to help people achieve independence by assisting them in regaining their mobility; this way they can improve their self-worth and play an active and productive role in society. I am currently studying at Stellenbosch University. So far I have enjoyed my neuro-rotation and hearing all the patients’ stories the most. The absolutely best feeling I have experienced so far is seeing my patients get better and knowing I had some role, however small, in improving their quality of life and their ability to do activities they want. I am excited about my future as a physiotherapist in South Africa. I believe there is so much that we can do, least of all educating and empowering patients so they can make informed choices about their own health.


Project manager for comrades: Chrystal Marais (UCT)I am currently doing my physiotherapy degree at the University of Cape Town and have been elected Chair Person of our Physiotherapy Student Committee (PSC) for 2018 and 2019. The PSC is an amazing platform to further students’ learning

and exposure to different areas within physiotherapy, such as the Cape Argus and Two Oceans Marathon along with talks by experts in the field such as Professor Tim Noaks and Professor Dr. Bouwien Smits-Engelsman (Superwoman of Paediatric physio). I have a deep love for working with people plus a great interest in the human body, medicine, health and fitness and therefore physiotherapy was a natural fit. I was blessed to have matriculated from Hoerskool Rustenburg, North West, in 2015 – a wonderful school community laying foundations for success in all fields of academics, sport, culture and leadership, a foundation which has spurred me to take on leadership roles such as the PSC and the NPSG Executive and reach academic achievements such as the Golden Key Honours Society. In 2019 I want to continue to promote physiotherapy while making the most of my final year of studies by doing the best for my patients and my academics – all which is made possible by keeping the balance and enjoying many sunrises and sunsets on Lions Head and Signal Hill.


Project relations officer and Marketing: Jemma Houghton (UWC)I am a third-year BSc Physiotherapy student at the University of The Western Cape. My interest in physiotherapy stemmed from my passion for ballet, contemporary dance and general physical activity. I began dancing at the age

of 4 and continued until the age of 21, dancing both in South Africa and London. I am fascinated by how the body moves and did dance anatomy and movement studies whilst at school and performing in London.

But I wanted more. Wanting to work with the human body and movement while helping people and providing a service – I hit the jackpot with physiotherapy! Prior to studying, I completed my Yoga 200hr Teacher Training Course and have been teaching both vinyasa and bikram yoga since 2015 at various commercial and private studios in Cape Town. I am also currently completing my Pro Matwork

Grethe Gouws

Liesl Gerstner

Chrystal Marais

Jemma Houghton


StudentsPilates Teacher Training and will be instructing by the end of 2018. I wish to use my knowledge and experience of dance, yoga and Pilates and intertwine this with my BSc Physiotherapy degree to provide a niche service. I would like to do a master’s in Dance Science at Trinity Laban, London, but I am also passionate about amputation and prosthetics and wish to pursue a masters in this.


Research Liaison/Advocacy Liaison: Tabo Job Matlala (SMU)A 3rd year physiotherapy student at Sefako Makgatho Health Sciences University, I am from Limpopo, Polokwane. I hold a degree in Bachelor of Sciences (Biochemistry & Physiology), which I completed in the year 2014. The main reason why I chose to pursue a physiotherapy degree was

related to sports, particularly in the rural areas. Having some background there, I have experienced that it is quite a challenge for many young people who aspire to be in sports to emerge in the sporting world, because of the lack of ‘know how’ when it comes to the right sports for them to play and the required fitness levels (and access to fitness facilities) for them to partake in those sports, among other things. I aspire to expose them to the complete world of sports.

My other interests are in business and cooking; I have a registered fast-food restaurant on campus. I am also a former Student Representative Council member (2017/2018), because of my desire to be in spaces that allow me to bring about change. Being a part of the NPSG brings me closer to achieving all that I aspire to become in leadership.


Community Service Liaison: Kiara Birbal (UKZN)I originate from sunny-all-year-round Durban and I attend the prestigious University of KwaZulu-Natal. I’m a 21-year-old dynamic individual who believes that I can change the world. Physiotherapy is a new-found passion, which has brought great

happiness to me of late. I am passionate about paediatric and geriatric physiotherapy and love being challenged.

In 2019, I plan to help everyone as the Community Service Officer. Applications and placements are an extreme stress, and that isn’t needed nor necessary in the final year of our degree; my aim is to provide as much assistance as I can to make the entire process easier for the fourth years going into community service.


Special interests group Representative: Nesraé Williams (TUKS)My physiotherapy journey initially started off as a rather different yet definite chemistry journey. During my grade 10 schooling year, I joined an amazing three-year programme hosted by the University of Pretoria called ‘UP with Science’. Over three years we were introduced

to the wonderful world of science, this is ultimately where my love for chemistry grew. During this time, I served in leadership roles in my high school, Staats President C.R Swart, on the students representative council and eventually as head girl and as council member on the Pretoria Junior City Council. Concurrently, my love for sport, mainly rugby and cricket, grew week by week. As a true Pretorian most of my Saturday afternoons were spent at Loftus Versveld and December Boxing Days were at St. George’s Park, Port Elizabeth, enjoying the Boxing Day Test Matches. I eventually applied for chemistry and physiotherapy at various universities. Presently I’m a third year Physiotherapy student at the University of Pretoria (UP) and aspiring sports physiotherapist. Our training has been excellent with remarkable training facilities available such as Steve Biko Academic Hospital and Kalafong Hospital. I have recently taking a liking to Neurology as well as Spinal Rehabilitation. We will be trained in them during our fourth year and with the addition of UP’s new training facility: Sport, Exercise Medicine and Lifestyle Institute (SEMLI), I am truly excited to see where my physiotherapy journey leads.


Your suggestions are welcomeThe NPSG is a relatively new student group and still very young in their role in the student body of South Africa. If any individuals have any suggestions for the NPSG, or any queries in line with the objectives we have set out, please feel free to contact the group or appropriate member. We look forward to the progression of the NPSG in 2019 and hope that we can increase the influence and awareness of the group in South Africa.

Tabo Job Matlala

Nesraé Williams

Kiara Birbal


Students

On Friday 2 February 2018 the Wits

Physiotherapy Student Council (PSC) hosted

its annual meet-and-greet event, Phreshers. The purpose of the event is to welcome the first-year students and create a platform for the physiotherapy students from the various years of study to meet each other. 2018’s Phreshers was a great success, with an amazing turnout!

We started the afternoon with some friendly soccer games. Some students opted for frisbee, 30-Seconds, or Uno while others just relaxed in the hot sun, enjoying ice-cold drinks and boerewors rolls. The first-year students were then welcomed to the group after completing their orientation to the Wits Physiotherapy Department. They each received a welcoming gift, sponsored by the South Gauteng branch of the SASP, comprising a branded shop-ping bag and pen.

Everyone was then split up into teams for relay races with a physiotherapy twist. These included three-legged

races (using bandages to bind the team members’ legs together), and crutch, wheelbarrow, goniometer and tennis ball (a new spin on the traditional ‘egg and spoon’ race) races.

Great fun was had by all. Some of the lecturers even participated in the races! Hopefully the new relationships formed during the event will help the students along the challenging but incredibly rewarding pathway to becom-ing a physiotherapist.

A big thank you to South Gauteng branch for also spon-soring six-pack cooler boxes and peak caps for prizes and letting us make for the use of their gazebo for the day.

True confessions: PhysioSA has been told it was sent this report some months back. Did it go into a junk mail box? Did it fall foul of some weird software algorithm? Was it acci-dentally deleted? We’ll never know. But December and January seems like a good season to have a look at what senior students, with support from staff and qualified physios, do to welcome the new intake.

Ring in the newAs we look forward to a new intake of physiotherapy students, here’s a report from Nicole Price, South Gauteng Provincial Wits Physiotherapy student representative, of how last year’s freshers where welcomed at Wits Phreshers 2018*


Science

Vaping no boost to quit rates in smokers, study suggestsPeople who vape and smoke cigarettes are no more likely to drop the nicotine habit than those who just smoke, a new study suggests.

Researchers at The Ohio State University studied 617 tobacco users and found no differences in quit

rates for “dual users” of both traditional and electronic cigarettes.

This research adds important information to the conversation as public health and medical professionals grapple with the role vaping might play in reducing cigarette smoking, said study senior author Mary Ellen Wewers, a professor emeritus of health behavior and health promotion, and a member of Ohio State’s Center of Excellence in Tobacco Regulatory Science.

Participants in the study were part of a larger group of about 1,200 rural and urban Ohioans whose habits are being followed by researchers. The study appears in the journal Nicotine & Tobacco Research.

The researchers sat down with participants every six months for 18 months to ask them about tobacco use, interest in quitting and quit attempts they’d made. They also documented what type of tobacco products the participants used.

At the first check-in, six months into the study, the dual users were more likely to have stopped using tobacco, but that difference disappeared by the 1-year and 18-month interviews. By the end of the study, most dual users were back to smoking cigarettes exclusively.

“The initial difference we saw might be due to a higher interest in quitting among the dual users, but that higher quit rate vanished with time,” said lead author Laura Sweet, a graduate student in Ohio State’s College of Public Health.

“Tobacco is such a huge killer, and if these products help people quit, that could be really significant for public health. But in this study it looks like they don’t, and we need to know that as well,” Sweet said.

Though electronic products still deliver nicotine and much remains unknown about their long-term health effects, there’s general agreement that they are less harmful than cigarettes in adults.

“The hope would be that adult cigarette smokers are trying e-cigarettes because they want to stop cigarettes and are looking for alternatives to help them,” Wewers said, adding that she and others who work on tobacco prevention are concerned that younger people who vape will start there and transition to cigarettes down the road.

The researchers can’t be sure what factors contributed to their findings, but the results prompted Sweet to wonder if many adults who smoke and vape are doing so because vaping is more accepted in certain environments, rather than because vaping might help them drop nicotine altogether, she said.

Wewers, a member of the Cancer Control Research Program at Ohio State’s Comprehensive Cancer Center, said she wasn’t surprised to see a higher likelihood of quitting cigarettes at six months in the dual users, because that group expressed greater interest in quitting overall.

“It makes sense that during the first few months they may do better at quitting, but given that cigarette smoking is such a cyclical thing - people quit and resume all the time - it’s not surprising that they went back to smoking after a year,” she said.

Because this study didn’t assess light smokers or those who consider themselves “social” smokers, it’s hard to say what role vaping might play in quitting, Wewers said.

But for health care providers trying how best to help heavy smokers quit, this study could help inform those doctor-patient conversations, she said.

“Providers get questions about trying e-cigarettes all the time from people who want to quit. Our paper would suggest that it’s not a promising approach – the majority don’t quit, and most of them go back to combustible products exclusively,” Wewers said.

“This reinforces the recommendation that there are good, approved medications and nicotine-replacement products out there now and that those should be the first-line approach to helping smokers quit.”

ReferenceMary Ellen Wewers, Nicotine & Tobacco Research, http://dx.doi.org/10.1093/ntr/nty222

(EurekAlert, 20 November 2018)

We bring you science from fields that affect your patients


The Sunflower Fund’s Everest Challenge takes place on Johannesburg’s famous Westcliff

stairs. After a two-year lapse, the fund held its third challenge on 25 August 2018. The aim of the challenge is to simulate an ascent of Mount Everest (8850 m) by completing 170 laps of the Westcliff stairs. The competitors were required to complete the 170 laps in 17 hours between 7.00 and midnight.

The South Gauteng Provincial committee was approached by one of its members to provide a physiotherapy service for the competitors at the first challenge in 2014. In 2015, the committee decided to not only provide a physiotherapy station but take up the

challenge and enter a team.For the first two challenges,

competitors were required to complete 200 laps in 36 hours. Participants could compete individually or in teams. In the current year’s challenge, participants had to compete in teams consisting of six members. There was greater pressure to complete each lap in a limited amount of time. Each lap of the stairs needed to be completed in six minutes to finish the challenge before the cut-off time. The South Gauteng physiotherapy team (Rangers of Motion) consisted of a diverse group of physiotherapists of varying ages and fields of practice. The team comprised: Jane MacKinnon, Jeanne Mortimer, Megan Whelan, Louise Hichens, Shannon McAulay and Francis Rogan.

Why we do itRay Funnell, a leukaemia survivor and bone marrow recipient, developed the challenge and has been supported by his family and the staff of the Sunflower Fund to organise it. He was

Social responsibility

Ain’t no mountainhigh enoughFrancis Rogan reports on how Team “Rangers of Motion”

took on the 2018 Everest Challenge

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12

astounded by how few people were on the bone marrow registry and how small the likelihood was of finding a match.

The Sunflower Fund is a donor recruitment centre and registry. The fund fights blood diseases such as leukaemia through the recruitment of stem cell donors and maintaining a registry of potential donors committed to helping anyone in need of a life-saving stem cell transplant. The fund raises money for:

• the cost of education and awareness regarding stem cell transplants, and the process of becoming a stem cell donor,

• the cost of the HLA tissue-typing test needed in the recruitment of donors,

• assisting patients who are unable to afford the costs associated with having a stem cell transplant.

The fund is also actively involved in creating a platform for support structures to assist patients, families and communities.

The Westcliff stairs are a popular training destination in Johannesburg. On almost any day or at any time you will find people on the stairs – runners, hikers, fitness enthusiasts, walkers, and those who are just curious. I have often said, “It is where Jo’burg meets”. You can chat to people who have travelled from all over the city to come and train on the stairs and be inspired by their reasons for being there.

In the months leading up to the challenge, team members would train on the stairs whenever the opportunity arose. Closer to the time, the team had a few training sessions together on the stairs.

On the day, our team’s strategy was to get as many laps in without fatiguing and going over six minutes per lap. We started the first hour as a relay team, and then worked in pairs for hourly shifts with two hours off to recover.

Only six official teams took part in the event this year. We managed to finish in fourth place in a time of 13.5 hours. We were the first team with female runners to finish. The event organisers set up a seventh team which was called the Supporters’ Team to give the public an opportunity to experience the challenge and complete a few laps for charity.



Lessons learnt from the event:1. Training at the venue of the event helped the team

to gauge the pace required to complete the laps within the required time.

2. Never underestimate the generosity of family, friends and colleagues. They came to help us set up our base and the physiotherapy station, provided treats, ran a few laps with us and provided support on the side lines. They also rallied supporters in fundraising. Any journey is made lighter with support. This is true for sporting endeavours, life, and recovery from injury or illness.

3. There is a Kenyan proverb that says, “Little by little, a little becomes a lot”. This was true in both our fundraising and training. A week before the event we had only raised R900, but through spreading the word, we finally ended up raising just over R37 000.

4. “A journey of a thousand miles begins with the first step”- When I think back to our first few training sessions, we were happy just to finish the repetitions. Sometimes the hardest task was arriving at the stairs for training. But each time we went, we got a bit faster.

5. Remember to keep your eye on the goal. The challenge’s motto is “It always seems impossible until it is done”. There were times during the day where it felt like we would never get there, or had an eternity to go, but with each lap we got closer, until finishing was within reach.

6. Training as an individual was important, but training as a team was invaluable. It created a sense of unity and it gave the team members an opportunity to get to know each other better.

The Sunflower Fund representatives commented on how much our team and the volunteers at the physiotherapy station added to the success of the day. Events of this nature help to promote our profession and society. Even though this was a relatively small event it provided us with the opportunity to make valuable connections and lasting relationships.

For more information about the Sunflower Fund you can visit www.Sunflowerfund.org.za.


SIG

14

As the Neuro Rehab Physiotherapy Group (NRPG) of the SASP it is of significance to us that the incidence of neurological conditions and

injuries such as stroke and traumatic brain injuries is on the increase.

We will use the rising epidemic of stroke in South Africa to argue for management of a contextually relevant neurological condition with a high burden of care. It is imperative that therapists working in this field therefore receive capacity development opportunities, to ensure knowledgeable and skilled therapists practise in this field of neurological physiotherapy. Considering the impact we can make at all levels of healthcare, we wish to highlight the importance of the development and sharing of our unique skill set with patients, families, colleagues, higher education institutions as well as newly trained therapists.

Considering strokeStroke is a major global health concern in terms of mortality and chronic disability (Wissel et al. 2013). The World Health Organization (WHO) describes stroke as a “rapidly developing clinical sign of focal, or at times global disturbance of cerebral function, lasting more than 24 hours or leading to death with no apparent cause other than vascular origin” (WHO, 2002). Internationally

stroke causes approximately 5.5 million deaths annually and accounts for 44 million disability-adjusted life-years lost (Mukherjee & Patil 2011). Pillay-van Wyk et al. (2016) reported that stroke has become the primary cause of long-term disability in South Africa.

Stroke is on the rise in many low and middle-income countries, particularly sub-Saharan Africa (Feigin et al., 2014). The Heart and Stroke Foundation of South Africa

reports that approximately 240 people suffer a stroke every day, with 60 of these strokes being fatal. The higher incidence of stroke locally has been associated with an increase in non-communicable diseases (NCD) such as hypertension and diabetes, in conjunction with an increase in communicable diseases such as HIV (Defo, 2014; Wasserman, de Villiers & Bryer, 2009). HIV infection and its treatment has been reported to result in vascular damage adding to already higher rates of conventional vascular risk factors, such as hyper-cholesterolaemia (Benjamin et al., 2012). This combination of diagnoses has been associated with stroke in a younger population (Benjamin, Bryer, Emsley, Khoo et al., 2012). Young strokes are identified as occurring before the age of 45 (Griffiths & Sturm, 2011) or 49 (Smajlović, 2015) years. The rise in HIV-related stroke is of great concern due the psychosocial and resource implications for the individual, their families as well as the additional demands on an already strained healthcare system (Zimba et al., 2017).

The consequences of a stroke are complex and multi-faceted. The most common neurological deficits post-stroke are hemiparesis, hemisensory loss, visual impairments, dysphasia and balance dysfunction (Markus, 2012). Verma et al. (2012) reported that people with stroke have a four times higher risk of falling and a ten times higher risk of sustaining a hip fracture than the normal population. Other post-stroke deficits include altered coordination, proprioception loss, hemineglect and apraxia. All these deficits affect the individual’s functioning and lead to limitations in activities of daily living (ADL) such as self-care or walking (Young and Tolentino, 2009). It has been reported that 40% to 66% of PWS require assistance with at least one ADL and mobility post-incident (Verma, Arya, Sharma & Garg, 2012). People with stroke (PWS) also report being unable to participate in previously meaningful activities such as returning to work, social and recreational pursuits (Anderson & Whitfield, 2011). In South Africa, family dynamics become disrupted when, due to limited resources, a family member has to assume the role of primary caregiver to PWS (Pendleton and Schultz-Krohn,

The rise in HIV-related stroke is of great concern due

the psychosocial and resource implications

for the individual, their families as well

as the additional demands on an

already strained healthcare system

Is neuro rehabilitation relevant in the context of South Africa? Yes, is the firm answer from Barbara Meyhlan.

2013). Losing the ability to care for one’s personal needs often causes a loss of self-confidence in PWS due to dependency on carers (Pendleton and Schultz-Krohn, 2013). The inability to become a functional member of society and to return to gainful employment will place further strain on the sub-Saharan economy (Mochan et al., 2003).

Rehabilitation post stroke aims to improve quality of life (QoL) by enhancing physical and cognitive well-being (Langhorne, Bernhardt & Kwakkel, 2011). The critical goal of rehabilitation for PWS is to decrease the level of disability to enable return to previous levels of function within the home, community and work life (Bryer et al., 2010). For many who have significant disability due to their neurological deficits post-stroke, decreasing the burden of care for the family caregivers become the primary aim of rehabilitation (Bryer et al., 2010). It is well recognised that stroke rehabilitation is best managed using an interdisciplinary team and goal-orientated approach (Bryer et al., 2010). Physiotherapists are key role players in this diverse team along with occupational therapists, speech, language and hearing therapists, dieticians and social workers.

The plastic brainLongitudinal studies have shown that most spontaneous motor recovery occurs within the first ten weeks post-stroke (Kwakkel and Kollen, 2013). However, recovery may continue for many months to years based on the neurophysiological concept of “neural plasticity”.

Neuroplasticity is how we adapt to changing conditions, learn new facts, and develop new skills every day of our lives (Hallet 2005). In previous years, the brain was considered incapable of growth and change in adulthood, but this myth has been debunked with advances in our understanding of how the nervous system is organised. Advances in technology to document human brain function such as fMRI have further elucidated our understanding of the neurological adaptations humans are capable of. In fact, the brain is always changing, with the central nervous system (CNS) having the extraordinary ability to remodel itself, and therefore, also being capable of being moulded. This is achieved through the enhancement of existing connections (i.e. synapse strengthening) or the formation of new connections (i.e. unmasking and sprouting) within the neuronal networks spread across the CNS.

It is now well-documented that treatment-induced cortical reorganisation is possible in humans post stroke. Many argue that the CNS will recover spontaneously. Without appropriate therapeutic intervention or rehabilitation post stroke, the CNS will remodel but in a more haphazard manner, perhaps with self-learned poor compensations and resultant secondary complications such as contractures. All of which results in a poorer outcome or prognosis for functional independence in PWS.

There are many reasons why disability post stroke in

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SIG

16

South Africa remains high. Bryer et al. (2010) argues that it may be as a result of healthcare, resource and other psychosocial factors, such as:

• delays in acute management after stroke;• insufficient rehabilitation facilities, especially in the

public healthcare sector; • insufficient intensity of inpatient rehabilitation;• lack of outpatient or community-based

rehabilitation;• lack of end-stage rehabilitation such as vocational

rehabilitation;• lack of transport to attend rehabilitation,• reluctance of people to receive or complete

rehabilitation due to potential loss of social aid such as disability grant.

In our current under-resourced settings with limited inpatient rehabilitation available, many argue that the need to improve home-based care, outpatient and community-based rehabilitation is of great importance for the South African context (de Villiers et al., 2011; Bryer et al., 2010). The lack of socially and culturally relevant outcome measures and educational resource packages are areas that need further development and research. The success of community-based exercise and

support groups may be well documented in the stroke evidence base/literature, but it has not been widely implemented in the South African context.

This “stroke case study” above, which focused on the challenges and importance of stroke rehabilitation in SA, merely highlighted a few aspects. We acknowledge that there are many other factors that could influence the success of country-wide accessible and equitable stroke rehabilitation services, but one we strongly

support is the fundamental role and impact that well-trained neuro physiotherapists can contribute towards achieving such a goal.

One could provide equally strong motivation for other diagnoses that result in persistent long-term disability in need of the same dedicated focus, such as traumatic brain injuries, spinal cord injuries, HIV-related neurological sequelae and Parkinson’s disease, to name but a few. The NRPG wishes to pool our joint expertise and networks ensuring that ALL conditions relevant to our unique context and the members’ needs, receive the appropriate attention.

More educationWith this in mind, we as the new Committee of the National NRPG that is now functioning out of the Western Cape Province, have identified the need for continued education for our members and beyond.

Our mandate is to ensure that information and knowledge is spread to all levels of healthcare, both the public and private sectors, and that we reach all physiotherapists who work in the neuro rehab field. We envisage that our training and capacity building initiatives will continue to remain affordable and also reach more of the smaller and outer-lying areas of the country. We also strongly advocate that the public be informed of what physio can do and what role we play as partners in their recovery journey after a neurological injury or condition.

Our new national executive committee has been brainstorming on how some of these goals can be achieved. A few of our ideas:

• The sessions we intend presenting next year include:

- The Dizzy Patient, - Functional Neuroanatomy and - Exercise Prescription for Parkinson’s Disease.• Exciting developments: Some talks will be

presented as webinars, so we can extend our reach to as many physiotherapists as possible!We aim to provide information and keep NRPG physios up to

Without appropriate therapeutic

intervention or rehabilitation post

stroke, the CNS will remodel but in a more haphazard

manner, perhaps with self-learned poor

compensations and resultant secondary

complications

Laura Palmos was invited to present on physiotherapy at the Nobel Primary School Career Day for their

Grade 7 learners on Friday, 21 September. Nobel School is in Modderfontein, Gauteng, and its learners are currently drawn mainly from Thembisa. The school was started in 1898 to service the children of employees at the explosives factory, but teaching was temporarily disrupted by the Anglo Boer War; the school officially reopened in 1902, and was named after Nobel Industries, the dynamite manufacturing company, the majority of whose employees had been recruited from the Nobel factories in Ardeer, Scotland.

On their Career Day, the Grade 7 learners were colour-

Talking about physioLaura Palmos gave a presentation at Nobel School for Career Day

Marketing


SIG

date with current affairs and current research. To keep us current with research, we aim to connect with the academics from the various physiotherapy schools across the country.

• Online journal discussions will be started.• Information about specific and relevant health

calendar days, such as World Stroke Day on 29 October, will be shared, enabling us to educate our patients, their families and carers. We could also raise public (and referring doctors’) awareness of the importance of our role as rehabilitation physiotherapists in relation to these conditions.

• The SASP Neuro Rehab Physiotherapy Group on FB will be updated with links to useful resources.

• We will develop stronger relationships with the physios working in the public sector. This will be facilitated via exciting social responsibility projects.

• We are investigating ways to achieve a standardised APDL 2 level that is accessible and affordable for the members of the Neuro Rehab Physiotherapy Special Interest Group.

Overall, the NRPG wishes to create connections and networking opportunities amongst all physiotherapists practising in the Neuro Rehab field across the country!

We wish to partner with you in building a strong dynamic network of physiotherapists that advocates for better rehabilitation service delivery for all clients and

patients with neurological conditions in South Africa.We look forward to joining hands with you to re-build

our Neuro-Rehab Physiotherapy SIG.

Compiled by G Inglis-Jassiem with B.Meylahn and Talya Jehosafat(References available on request).

Meet your new executive committee for the National NRPG (Oct 2018):

Chairperson: Barbara Meylahn ([email protected]) Secretary: Talya Jehoshafat ([email protected]) Treasurer: Audrey Mallet Marketing: Lara Hundermark CPD Applications: Lauris De PentieriosMembers at large: Gakeemah Inglis-Jassiem and Lynn Fernhead

fully dressed to represent their current chosen careers.Laura gave the learners an overview of the profession,

what physical requirements it entails, and explained dress code and personal qualities desirable in a physiotherapist. She elaborated on the various different aspects of physiotherapy, and explained what kinds of patients and conditions would be treated under each, and also explained which universities in South Africa currently offer the physiotherapy degree. She gave an outline of the degree course, explained community service, and went into HPCSA registration requirements, and the benefits of SASP membership.

Laura elaborated on the specific entry requirements

for the physiotherapy degree course at the University of the Witwatersrand before closing, after which pamphlets about the Wits School of Therapeutic Sciences – donated by the Wits Physiotherapy Department – were distributed, as were fun SASP-branded promotional items, including pens, frisbees and bats and balls. The presentation was evidently enjoyed by the learners, and the school principal thanked Laura for exposing their learners to a profession that was not well understood in their community.

Many thanks to the SASP for providing the promotional items, and to the Wits Physiotherapy Department for providing the informative pamphlets. .


Marketing

18

Pholosong Hospital Physiotherapy Department Kirsty Mackay reports

Monday and TuesdayWe set up a stand at the medical and orthopaedic outpatients department (OPD). Here we gave a presentation to the patients waiting in the long queues on osteoarthritis and how physiotherapy can help them manage their condition. We had physiotherapists at the stand to answer questions and to hand out pamphlets for the patients to take home.

WednesdayThe nurses were invited to a presentation which focused on common injuries to the back and neck. This was explained on an anatomical level so that the nurses could understand the conditions. The common mechanisms of injury and how to prevent them were done through a kinetic handling demonstration. The physiotherapists emphasised how to lift heavy patients while protecting your back. Stretches and home advice to manage existing back pain were also given.

ThursdayAll the hospital staff were invited to attend a presentation which addressed the benefits of Pilates and how it differs from aerobic exercise. The staff were also educated on local stability and how Pilates can help to prevent back pain.

At Pholosong we currently run Pilates classes that are open to all the hospital staff, twice a week. The awareness around this service was emphasised and a special Pilates class was held on Thursday afternoon.

Friday. Pholosong has a well-established aerobics team. As a fun event promoting healthy lifestyle and exercise, an aerobics competition was held where medals and prizes were distributed. We also host aerobics classes twice a week for all staff to attend and to promote cardiovascular fitness.

Thank you to SASP for sponsoring us merchandise to use as prizes.

Loads of energy and effort!As always, physiotherapists went to great lengths to market the profession and help people during National Physiotherapy BackWeek in 2018

National Physiotherapy BackWeek

Pholosong physiotherapy department


MarketingCecilia Makiwane Physiotherapy Department and Holy Cross hospital, FlagstaffSidarshia Govender shares two reports

We are privileged to have National Physiotherapy BackWeek present annually on the National Health calendar. This year Cecilia Makiwane Physiotherapy department decided to go all out with the main theme of “Your physiotherapist has your back”.

We planned daily activities for the week of 3 September.

The activities ranged from morning promotions at the main entrance targeting staff and patients of Cecilia, to pop-up stands, to outreach at a local community centre for children.

Morning PromotionsEach morning from 7:30 - 8:15 two staff members

went to the main entrance of the hospital and promoted National Physiotherapy BackWeek. They asked people to take photos with A2 boards and post the photos on their Instagram and facebook with the hastag #GotYourBack #Physio #SASP

Pop-up stand The team organised to get some promotional goodies and a table cloth from SASP Eastern Cape to do a pop-up stand on 3 September. Two staff per hour oversaw the pop-up stand. They had various equipment present to do activities with anyone that passed the stand. Activities varied from:

• Pick up a box correctly • Pop quiz• One leg standing • Back exercises • Specific exercises to do at your desk The physiotherapists spoke to people about looking

after their busy bodies and provided education on exercises for back care and good ergonomics. This time was used to inform people about physiotherapy as a whole and what the role of physiotherapy is in different conditions.

Strengthening class During lunch on 4 September, we did a strength class with the main focus on posture, control and strengthening the core muscles.

Before the exercise class started everyone was told about National Physiotherapy BackWeek, and we took the time to briefly explain that physiotherapist can assist with more than just back care.

We then took a few minutes to demonstrate each exercise and relate it back to good back care principles

The exercise session consisted of:• Aerobic warm up programme

• Main workout• Steps• Bridging• Squats• Lunges • Plank/mountain climbers• Cool down (Stretch)

Mdanstane FM Athenkosi and Mirriam went to the local radio station, Mdanstane FM, where they promoted physiotherapy and spoke about its role. They spent some time on the promotion of National Physiotherapy BackWeek. They spoke about the causes of lower back pain and how people can prevent lower back pain.

National Physiotherapy BackWeek


Nontyambo Clinic Pop-up stand From 10:30 until 12:00 we had a pop-up stand in the waiting area of the Nontyambo Clinic. At this pop-up stand we gave information on what physiotherapy is and what conditions we treat. We gave information on back care and handed out pamphlets showing correct kinetic handling. We also spoke about conditions such as diabetes and having a chest infection and gave advice on what they could do for themselves. After giving this information to the people at our stand, we quizzed them and handed out sweets to those who could answer correctly. We also did demonstrations and made the people repeat the correct movements for good kinetic handling.

We would like to thank SASP for providing us with flyers, posters and promotional equipment. We would like to thank Sid Govender for her prompt responses and assistance.

Marketing National Physiotherapy BackWeek

Holy Cross Hospital

We had a lovely week here at Holy Cross hospital – I handed out flyers about exercise to all the wards’ nursing staff and a few out-patients, and gave them quick advice regarding regular exercise and the benefits thereof as well as kinetic handling. They loved the free gifts.

I handed out the toys to the kiddies in Paediatrics and to a few of the nursing staff who liked the frisbees and yoyos a lot.

It was lovely to educate people and promote our profession and I just realised once again that it only takes a few words of advice or a small gift to make someone’s day.

Let us all live to serve daily in our working environments.

Kuyasa – hope on the hill On Tuesday 4 September two of our therapists joined the team at Kuyasa. Kuyasa is a community centre that feeds about 300 children from the surrounding community three meals a day. We joined them during lunch time and assisted them with feeding the children. When everyone was settled we gathered them together and started our education.

We educated the children on carrying their school bags correctly, we also educated them on ergonomics in the classroom. We then conducted a quiz with the children on what they had just learnt; the best answers won prizes that were donated by SASP.

We left posters with the community centre to put up inside the building regarding ergonomics in the classroom and general back care tips.

Aerobics Class 5 September During lunch we did an exercise class for the staff and some of the patients. The idea was to show people how easy it is to do a 25-minute work-out during lunch that can raise your heart rate. Everyone was moving and dancing.

South Rand Hospital Throughout National Physiotherapy BackWeek, the physiotherapy department at South Rand Hospital (SRH) adopted the theme ‘exercise and mental health’ based on the WCPT 2018 Physiotherapy week theme.

MarketingNational Physiotherapy BackWeek


Day 1 & 2 To kick off National Physiotherapy BackWeek, the SRH Physiotherapy Department set up a promotional table on the busiest floor of SRH. Here, we hung up posters which were downloaded from SASP’s website, handed out pamphlets which were also downloaded from the SASP, and from the WCPT’s website, handed out SASP goodies, educated staff members and patients on the benefits of exercise for mental health and the role of physiotherapists, as well as advertised our exercise class that we were going to hold for the hospital staff later in the week.

Day 3The SRH Physiotherapist Department ran an exercise class for the staff of SRH. This class also included education on the benefits of exercise on mental health. A few of the staff were able to pull themselves away from their busy schedules to join in! After the class, while our spirits were still high, we put on our SASP capes, and headed to the Paediatric ward where SASP paddles and beach balls were handed out to the kiddies.

Day 4The SRH Physiotherapy Department visited a local old age home, where we gave education on the benefits of exercise and mental health, an exercise class and handed out SASP goodies. The residents enjoyed our visit so much that they requested for us to come back at least once a month! Next we visited a local children’s home, where

SASP Frisbees, beach balls and paddles were handed out to the children, and where we spent the next hour working up a sweat playing outside with the kiddies.

Day 5The SRH Physiotherapy Department celebrated Casual Day by dressing up as ‘Physiotherapy Super Heroes’ in our SASP capes. For the last event of the week, we provided education to the SRH rehabilitation in-patients on the benefits of exercise and mental health, and played some duster hockey for some exercise and fun!

Overall, National Physiotherapy BackWeek at South Rand Hospital was a huge success! We were able to get our message across to a large group of people, and enjoyed ourselves in the process. Thank you to SASP for all the donations and assistance that you provided for us. The week would not have been half the success it was if it wasn’t for your support.

Marketing National Physiotherapy BackWeek


For the childrenPaediatrics members got involved, writes Saman-tha Rosie (Paeds PR and Marketing)We had some feedback from our SASP members about the events that they hosted or participated in during National Physiotherapy BackWeek. Many physios used this week as an opportunity to promote our profession and educate communities.

The physiotherapy department at Red Cross War Memorial Children’s Hospital hosted an interactive day of back care education.

A talk was given to caregivers with children about how to look after their backs. There were other activities and games held in the corridors for children and adults alike. Physios from the department were also featured on RX radio SA, in an interview promoting physiotherapy and highlighting National Physiotherapy BackWeek!

Also in Cape Town, a private physio practice set up a stand in Bayside Mall and interacted with members of the public. “Our aim was creating awareness to the people within our community on how to care for their backs. We also handed out promotional goodies which the SASP provided and for which we would like to thank you,” Laurissa De Pentieiros says about the event.

Far left: South Rand Hospital shows its support.

Left and below: a private physiotherapy practice set up a stand at Bayside Mall and womanned it with great enthusiasm.

MarketingNational Physiotherapy BackWeek


Congress

24

PhysioSA editor, Mandi Smallhorne

Fascinating and challenging – that’s what the SASP Congress was like. Congress is always a showcase of the ever-expanding research being done in this

country, but this year, it was bold and brave and tackled issues that are big and even scary.

Dr Jeremy Lewis questioning the evidence for subacromial impingement, and questioning the value of surgery for that and rotator cuff tears; Lorraine Jacobs asking questions about the very nature of physiotherapy, the value of manual therapy, and how prepared physiotherapists are to deal with the psychosocial factors involved, the need for a ‘therapeutic alliance’; and Dr Ina Diener’s wonderful response that gathered so many strings together; these were just some of the many highlights.

And Dr Emma Stokes, of course. The unphotographable Emma Stokes, with her vibrant, animated face (I have

dozens of pics of her making faces or blurred by sudden movement). The President of the World Confederation for Physical Therapy (WCPT) inspired each time she spoke. She challenged physiotherapists to take up the challenge of being an active and living part of civil society, and provided some thoughts about how this could work and make a difference. (See page 29 for the SASP’s press release on this topic.)

And in between, of course, a stream of presentations. The people who put together the scientific programme did a fantastic job; it was always hard to choose what to attend.

And in between that, there was tea and lunch and a chance to meet people, to talk, to do the networking and creating community that is perhaps the most important part of Congress, both local and international.

We’ll have more info in upcoming issues!

What was the much-anticipated SASP Congress like? Some of the delegates give their impressions

This page, clockwise from the left: Joyce

Mothabeng, Samantha Dunbar and Moira

Wilson, Zola Dantile, Greg Lynch. The animated

Emma Stokes.


Congress

Samantha Jane LeeferinkI attended the congress on Sunday as a volunteer.

The scientific committee did a brilliant job. There were both local and international speakers who shared some of the latest findings in their fields as well as their experience with the audiences.

It was great to network with some familiar faces and to meet some new ones too.

I must congratulate the organising committee on setting up a world-class congress experience and for keeping everything running smoothly.

This year’s congress was a great success! Well done to everyone involved, no matter how big or small their contribution. It was so exciting to see what South Africa has done and is doing to move our profession forward. I look forward to the SASP Congress 2022.

Nosipho Zumana This congress was a great motivational initiative for clinicians, a wonderful platform for young and upcoming researchers like myself, who beyond all odds managed to partake in the congress. Contributing to the future of my profession is an exhilarating feeling.

I also learnt, from Emma Stokes, that I need to be the change that I want to see, especially in terms of delivering good quality services to the clients we cater for. Another change that comes to mind is that our profession needs to be strong and not fall behind what they call “rehabilitation professionals”, as Dr Ina Diener stated that physiotherapists are renowned for their manual therapy, so I suggest those of us in clinical practice, must do physiotherapy so well that there is no doubt in everyone’s mind that physiotherapists are the

Top left: Deputy president Rogier van Bever Donker tests his strength at the SASP stand; There was lots of networking during tea and lunch breaks

Middle: The Congress opened with some lively gumboot dancing; Professor Hellen Myezwa in conversation with Zola Dantile

Bottom: Everyone wanted to lunge; The Head Office and volunteer staff beavered away behind the scenes, their purple shirts evident everywhere


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go-to people to assist the population in decreasing the burden of disease in our country. The physiotherapists will EINA! DONNER! * (Afrikaans) this burden of disease....FYI...I AM THE FIRST FOLLOWER....Lol!

Finally I want to thank my mentors (Professor Benita Olivier and Professor Witness Mudzi) for their unconditional support.

*Editor: This, apparently, is how Dr Ina Diener is known in Stellenbosch: Eina Donner. Lag, mense!

Francis Rogan When I think back on the congress, it is hard to put into words all the little learnings. Sometimes perhaps there is less of one big wow factor, but rather a collection of

smaller things that come together. I started with the pre-congress course on shoulder rehab with Jeremy Lewis. This was a great kick-start to the congress, and a real plus at the outset for the power of physio. Perhaps the main stream message was that physiotherapy should not be considered second or third best care, but our outcomes compared to surgery for the management of many musculoskeletal conditions are as positive, and we can treat more people for the same cost, so we are as good and often more economical.

This was a great start to a physio congress. I think of Emma Stokes, President of WCPT, and her

purpose: “to show people the power of physiotherapy”. Wow what a statement!

This page, clockwise from the left: Dr Ina Diener, Dr Douglas Maleka, Professor Benita Olivier, Lorraine Jacobs, Professor Veronica Ntsiea Below left: The local invited speakers: Dr Ina Diener, Anita Erens, Professor Brenda Morrow, Dr Emma Stokes, Dr Jeremy Lewis, Dr Corlia Brandt. Below: Dr Emma Stokes


Congress

Congresses are not only about take-home messages but the networking opportunities- Emma’s advice was 2 up, 2 down and 2 across. So speak to 2 people who are senior to you, 2 peers and 2 people who are junior to you, that you could perhaps mentor. This is powerful, and if we drive this message home we could really be #bettertogether.

I gained by attending sessions outside of my field of interest such as medico legal and stroke rehabilitation. As a profession we have incredible people, working in different fields. Whichever part of physio you work in, know who you can cross refer to, or ask advice from, within the profession. We have a lot to offer, but perhaps we need to be more vocal and have more faith in ourselves. It seems a lot of work has been done by universities to establish prevalence of needs in different communities and the like. This is a great starting point, but going forward perhaps there’s a need to see the cost benefit ratio of physiotherapy in the management of

chronic conditions within a South African context – this is needed in both the public and private sector.

Franso-Mari Olivier(Presenter of a break-away session in sport)As I enter the exhibitors hall there’s a low buzz of excitement...almost like hardworking honey bees around a beehive in the early morning. It is the sound of many “happy-to-see-you’s” and “well-done-on-that-paper” and “good-to-be-here’s”.

It is going to be the first time I am presenting at a congress and the levels of excitement and anxiety keep shifting – at one point it’s the anxiety that outweighs the excitement, then they swap places and excitement takes the lead. What a privilege to be surrounded by fellow clinicians, academics and service providers to our industry.

Thank you for compiling a programme of substance and quality speakers...we truly are better together!

Volunteers in their distinctive purple T-shirts wandering the exhibits; membership admin Nozipho Hlatuka showed volunteers the ropes; Professor Brenda Morrow, who presented in a breakway session; Day one saw this group engaged in a paediatrics workshop; recent and current deputy presidents Dr Ina Diener and Rogier van Bever Donker with current president Professor Witness Mudzi; Lonese Jacobs from Western Cape with Ria Sandenbergh; Dr Jeremy Lewis delivers some startling news; Wilma Erasmus talks the nuts and bolts of private practice


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Left: Wilma Erasmus with Dr Emma Stokes and Samantha Dunbar; below, Professors Veronica Ntisea, Witness Mudzi, Joyce Mothabeng, Aimee Stewart, Hellen Myezwa and guests Below: The scientific committee did a fantastic job

Head office staff Carol Mankomba, Americo Pinheiro, Vanessa Boshoff, Elias Sitemere, Muneiwa Radzilani, Mandy Ndlovu, who kept the gears from grinding; Marlize Marais; Professor Benita Olivier, queenpin of all things Congress; delegates seen on the Congress floor; the National Executive Committee all together


Marketing

“Civil society has the power to initiate and shape change within our society. Professional bodies representing the healthcare community are part of civil society, a sleeping giant which could do a great deal to pioneer change and act as torchbearers, showing the way to the future,” said Professor Witness Mudzi, president of the South

African Society of Physiotherapy (SASP®).

He was speaking at the four-yearly SASP Congress, which took place in September 2018 in Tshwane,

in response to a stirring keynote address by World Confederation for Physical Therapy (WCPT) president Dr Emma K Stokes.

Stokes drew on the World Economic Forum’s “4 scenarios for the future of civil society” to paint a picture of a possible future, varying from authoritarian and conflict-ridden to a scenario where government and the private sector tackle societal challenges together.

Perhaps the most likely – and close at hand – of these is titled “Turbulence and Trust Deficits”, a scenario which “depicts a chaotic world where trust is a scarce commodity. Yet, thanks to the possibilities created by the rise of the networked society, there is a significant latent desire for social engagement by citizens, particularly at the local level.” (WEF on weforum.org)

In her speech, the WCPT president said in such a world, trust would be at a premium. “When this begins to happen, civil society is seen as trustworthy. We have an opportunity because we are trusted by the community

– so we must ensure we have that trust and keep that trust, so that when the time comes, we can have those conversations, we can speak truth to power.”

Organisations representing healthcare professionals have tended to become transactional in nature across the world, she says: their members pay membership fees in exchange for services (fee negotiation or discounts on professional liability insurance, for example). Their awareness of their own potential to leverage a better future is in abeyance; it needs to be woken to meet the challenges of the future.

“Civil society represents what is often referred to as the third sector,” Stokes said. “And it’s incredibly important. If there is a failure in government, or a failure in business, then civil society has a role, a responsibility, but also an opportunity to be a key player. What I am asking, of the WCPT, what I am asking of you in the SASP, is: are you ready for that? Are you keen to be a very solutions-orientated civil society organisation?”

Civil society at its best has multiple, shifting roles: watchdogs; advocates; service providers, champions; solidarity supporters; definers of standards; and several more. “Many of these roles potentially resonate with our mandate as representative of the physiotherapy profession,” said Professor Mudzi. “Part of our mission is to assist government with the social and developmental needs of the country. We call on all physiotherapists, and indeed all healthcare professionals, to give serious thought to their role as advocates for and providers of care to the citizens; to move beyond a strictly transactional basis for activity, and become proactive in speaking for quality healthcare for all. Don’t sit on the water’s edge and complain; dive right in and become part of the action!”

Unleash the power of civil society for a just and caring worldThis is the press release the SASP circulated after Congress

Outstanding practices continue to see value in achieving accreditation. This is the practice that received their PF accreditation. They celebrated their achievement at the AGM .


Congress

30

Congress wouldn't be Congress......without our wonderful exhibitors.

Thank you for adding info, fun and colour to the event!

Physio & Wellness Warehouse (Pearl exhibitor)

Human Tecar Therapy (Emerald exhibitor)

Datamax – Panacea (Pearl exhibitor)

www.physioww.co.za www.panacea.co.za

BSN Medical (Pearl exhibitor)

Nature’s Kiss (Pearl exhibitor)

Arjo (Emerald exhibitor)

www.bsnmedical.co.za www.natureskiss.co.za www.arjo.com

Debt Tec. (Emerald exhibitor)

eMD Technologies (Emerald exhibitor)

My Appointment (Emerald exhibitor)

www.debttec.co.za www.e-md.co.za www.myappointment.co.za

MEd-e-MASS (Emerald exhibitor)

Kyron Laboratories (Emerald exhibitor)

HiTech Therapy (Emerald exhibitor)

www.medemass.com www.kyronlabssa.co.za www.hitechtherapyonline.co.za

Ergotherapy Solution (Emerald exhibitor)

Adcock Ingram Critical Care (Emerald exhibitor)

Celltone (Diamond exhibitor)

www.ergotherapy.co.za www.adcock.co.za/OperatingAreas/CriticalCare www.celltone.co.za


International

An active world… that’s a world in which non-

communicable diseases are trending down, not up.

That’s why the World Health Organisation (WHO) has developed a new global action plan “to help countries scale up policy actions to promote physical activity”.

The plan has four objectives, each associated with several ‘actions’ aimed at moving countries forward step by step to reach those objectives.

The WHO says, “A key feature of this new plan is its call for a ‘’systems-based’’ approach where effective implementation will require bold leadership combined with cross-government and multisectoral partnerships at all levels to achieve a coordinated, whole-of-system response.

“Working in partnerships, WHO will support countries to implement a whole-of-community approach to increase levels of physical activity in people of all ages and abilities. Global, regional and national coordination and capacity will be strengthened to respond to needs for technical support, innovation and guidance.”

PhysioSA brings you a key explanatory extract, below, and the four objectives and their associated actions. You’ll find a role for yourself, your practice/hospital or your SIG in here somewhere… See blue highlights for some ideas. For more info, go to http://www.who.int/ncds/prevention/physical-activity/gappa.

This global action plan has been developed with full recognition that countries are at different starting points in their efforts to reduce levels of physical inactivity and sedentary behaviour. Furthermore, it recognizes

that the priorities and preferences for different types of physical activities, across different settings, and by different subpopulation groups, vary according to culture, context and resources. There is therefore no single policy solution. Rather, this action plan provides four strategic objectives achievable through 20 policy actions that are universally applicable to all Member States.

Prioritization, feasibility, and speed of implementation will vary according to context. Therefore, it is

recommended that each country assess their own current situation to identify existing areas of progress which can be strengthened, as well as the policy opportunities and practice gaps. All countries should implement “upstream” policy actions aimed at improving the social, cultural, economic and environmental factors that support physical activity combined with “downstream”, individually focused (educational and informational) approaches that should be implemented consistent with the principle of proportional universality. This systems-based approach should enable countries to identify a strategic combination of recommended policy solutions tailored to context for implementation over the short- (2–3 years), medium- (3–6 years) and longer-term (7–12 years).

Achieving full implementation

Get active

The World Health Organisation has launched The Global Action Plan on

Physical Activity 2018 - 2030. The plan fits physiotherapy like a glove

Effective implementation will require bold leadership combined with cross-government and multisectoral partnerships at all levels


International

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at national scale is a long-term agenda for most Member States. However, countries may commence policy initiatives at subnational and city level, as appropriate, to demonstrate effectiveness and build momentum towards national coverage. Successful impact of policy initiatives can, and should be, celebrated and promoted to raise political, stakeholder and community awareness and support. Mobilizing communities to engage in planning and implementation of solutions is critical to success. As such, this action plan provides policy actions consistent with a whole-of-society approach that aims to empower communities.

Objective OneCreate active societiesFour policy actions are proposed which aim to create positive social norms and attitudes and a paradigm shift in all of society by enhancing knowledge and

understanding of, and appreciation for, the multiple benefits of regular physical activity, according to ability and at all ages.

Action 1.1: Implement best practice communication campaigns, linked with community-based programmes, to heighten awareness, knowledge and understanding of, and appreciation for, the multiple health benefits of regular physical activity and less sedentary behaviour, according to ability, for individual, family and community well-being.

Action 1.2: Conduct national and community-based campaigns to enhance awareness and understanding of, and appreciation for, the social, economic, and environmental co-benefits of physical activity, and particularly more walking, cycling and other forms of mobility involving the use of wheels (including wheelchairs, scooters and skates) and thereby make a significant contribution to achievement of the 2030 Agenda for Sustainable Development (SDG2; SDG3; SDG4; SDG5; SDG8; SDG9; SDG10; SDG11; SDG13; SDG15; SDG16; SDG 17).

Action 1.3: Implement regular mass participation initiatives in public spaces, engaging entire communities, to provide free access to enjoyable and affordable, socially- and culturally-appropriate experiences of physical activity.

Action 1.4: Strengthen pre- and in-service training of professionals, within and outside the health sector, to increase knowledge and skills related to their roles and contributions in creating inclusive, equitable opportunities for an active society including, but not limited to, the sectors of: transport, urban planning, education, tourism and recreation, sports and fitness, as well as in grassroots community groups and civil society organizations.

Objective TwoCreate active environmentsFive policy actions address the need to create supportive spaces and places that promote and safeguard the rights of all people, of all ages and abilities, to have

equitable access to safe places and spaces in their cities and communities in which they can engage in regular physical activity.

Action 2.1: Strengthen the integration of urban and transport planning policies to prioritize the principles of compact, mixed-land use, at all levels of government as appropriate, to deliver highly connected neighbourhoods to enable and promote walking, cycling, other forms of mobility involving the use of wheels (including wheelchairs, scooters and skates) and the use of public transport, in urban, peri-urban and rural communities.

Action 2.2: Improve the level of service1 provided by walking and cycling network infrastructure, to enable and promote walking, cycling, other forms of mobility involving the use of wheels (including wheelchairs, scooters and skates) and the use of public transport, in urban, peri-urban and rural communities, with due regard for the principles of safe, universal and equitable access by people of all ages and abilities, and in alignment with other commitment.

Action 2.3: Accelerate implementation of policy actions to improve road safety and the personal safety of pedestrians, cyclists, people engaged in other forms of mobility involving the use of wheels (including wheelchairs, scooters and skates) and public transport passengers, with priority given to actions that reduce risk for the most vulnerable road users in accordance with the safe systems approach to road safety, and in alignment with other commitments.

Action 2.4: Strengthen access to good-quality public and green open spaces, green networks, recreational spaces (including river and coastal areas) and sports amenities by all people, of all ages and of diverse abilities in urban, peri-urban and rural communities, ensuring design is consistent with these principles of safe, universal, age-friendly and equitable access with a priority being to reduce inequalities and in alignment with other commitments.

Action 2.5: Strengthen the policy, regulatory and design guidelines and frameworks, at the national and subnational levels, as appropriate, to promote public amenities, schools, health care, sports and recreation facilities, workplaces and social housing that are designed to enable occupants and visitors with diverse abilities to be physically active in and around the buildings, and prioritize universal access by pedestrians, cyclists and public transport.


Objective ThreeCreate active peopleSix policy actions outline the multiple settings in which an increase in programmes and opportunities can help people of all ages and abilities to engage in regular physical activity as

individuals, families and communities.Action 3.1: Strengthen provision of good-quality

physical education and more positive experiences and opportunities for active recreation, sports and play for girls and boys, applying the principles of the whole-of-school approach in all pre-primary, primary, secondary and tertiary educational institutions, to establish and reinforce lifelong health and physical literacy, and promote the enjoyment of, and participation in, physical activity, according to capacity and ability.

Action 3.2: Implement and strengthen systems of patient assessment and counselling on increasing physical activity and reducing sedentary behaviour, by appropriately trained health, community and social care providers, as appropriate, in primary and secondary health care and social services, as part of universal health care, ensuring community and patient involvement and coordinated links with community resources, where appropriate.

Action 3.3: Enhance provision of, and opportunities for, more physical activity programmes and promotion in parks and other natural environments (such as beach, rivers and foreshores) as well as in private and public workplaces, community centres, recreation and sports facilities and faith-based centres, to support participation in physical activity, by all people of diverse abilities.

Action 3.4: Enhance the provision of, and opportunities for, appropriately tailored programmes and services aimed at increasing physical activity and reducing sedentary behaviour in older adults, according to ability, in key settings such as local and community venues, health, social and long-term care settings, assisted living facilities and family environments, to support healthy ageing.

Action 3.5: Strengthen the development and implementation of programmes and services, across various community settings, to engage with, and increase the opportunities for, physical activity in the least active groups, as identified by each country, such as girls, women, older adults, rural and indigenous communities, and vulnerable or marginalized populations, embracing positive contributions by all people.

Action 3.6: Implement whole-of-community initiatives, at the city, town or community levels, that stimulate engagement by all stakeholders and optimize a combination of policy approaches, across different settings, to promote increased participation in physical activity and reduced sedentary behaviour by people of all ages and diverse abilities, focusing on grassroots community engagement, co-development and ownership.

Objective FourCreate active systemsFive policy actions outline the investments needed to strengthen the systems necessary to implement effective and coordinated international, national

and subnational action to increase physical activity and reduce sedentary behaviour. These actions address governance, leadership, multisectoral partnerships, workforce capabilities, advocacy, information systems and financing mechanisms across all relevant sectors.

Action 4.1: Strengthen policy frameworks, leadership and governance systems, at the national and subnational levels, to support implementation of actions aimed at increasing physical activity and reducing sedentary behaviours, including multisectoral engagement and coordination mechanisms; policy coherence across sectors; guidelines, recommendations and actions plans on physical activity and sedentary behaviour for all ages; and progress monitoring and evaluation to strengthen accountability.

Action 4.2: Enhance data systems and capabilities at the national and, where appropriate, subnational levels, to support: regular population surveillance of physical activity and sedentary behaviour, across all ages and multiple domains; development and testing of new digital technologies to strengthen surveillance systems; development of monitoring systems of wider sociocultural and environmental determinants of physical inactivity; and regular multisectoral monitoring and reporting on policy implementation to ensure accountability and inform policy and practice.

Action 4.3: Strengthen the national and institutional research and evaluation capacity and stimulate the application of digital technologies and innovation to accelerate the development and implementation of effective policy solutions aimed at increasing physical activity and reducing sedentary behaviour.

Action 4.4: Escalate advocacy efforts to increase awareness and knowledge of, and engagement in, joint action at the global, regional and national levels, targeting key audiences, including but not limited to high-level leaders, policy-makers across multiple sectors, the media, the private sector, city and community leaders, and the wider community.

Action 4.5: Strengthen financing mechanisms to secure sustained implementation of national and subnational action and the development of the enabling systems that support the development and implementation of policies aimed at increasing physical activity and reducing sedentary behaviour.

International


SIG

34

Holding a child’s attention during therapy is challenging at the best of times.

According to the American College of Sports Medicine guidelines (ACSM 2001), children prefer shorter, recreational types of exercise, although capable of perform-ing longer duration exercise which may appeal later.

The medium of water has become a useful tool for physiotherapists, not only in the introduction of a new variety of functional activities. In addition, the physical and sensory properties of water can be used to advantage during therapy with children and adults. The physiological effects of immersion are used where appropriate, and need to be understood when they are used in patient selection and therapy.

Many children, able and disabled, enjoy water play. As the therapeutic use of water evolved and became more structured, techniques developed to overcome fear and widen the group of children who could benefit from therapeutic, fun water activities. Engineer-trained swimming coach James McMillan and his wife Kelsey introduced the Halliwick Concept in 1949. They became major contributors to swimming for the disabled and to

paediatric and adult aquatic physiotherapy as we know it today. The nautical principles of metacentre, that is the tendency to roll, was applied to disabled children in Halliwick, UK. He taught them how to recover from different positions during the course of group games with instructors. This led to learning to propel themselves in a modified swimming stroke. This opportunity for movement planning, trunk control, core stability and controlled stretching has a widespread benefit for both children and adults. In addition the aquatic medium provides a unique medium for fitness and improved health in those, old or young, who have difficulty in exercising on land. Gravity can be graded and reduced in water, to reduce load and unwanted reflex activity. This dispels the ‘land-based therapy only’ myth of just playing and wasting time in a pool! Land and aquatic therapy complement each other in many ways.

Physiotherapist Marion Campion has been an inspiration and produced a text book, Hydrotherapy in Pediatrics, in 1985 which she dedicated to James McMillan. Since then Campion and many other physiotherapists have contributed in no small way to

Paediatric Aquatic Physiotherapy applied to adultsGillian Adams, acting Chairperson of the SASP’s Aquatic Physiotherapy Group, wrote this for the WCPT Paediatric Newsletter in February 2015. This modified version shows how paediatric aquatic physio applies to many grown-up pathologies.


SIGthe practice of aquatic physiotherapy for a wide range of conditions and the ongoing development of the evidence base. This has provided a solid base for both one-on-one and group therapy.

Interestingly, the Halliwick Concept was not intended just for medical persons. The basic ten points address water enjoyment, trunk control, selective movement, safety and independence, all of which are of value to the teaching of disabled and mainstream swimming. Physiotherapists add other specific complementary techniques and occupational therapists may find the group activity, sensory and perceptual aspects useful in an aquatic setting.

Any functional gains in water are translated to functional gains on land. All of these principles apply to adult neurological, musculoskeletal and sports patients. There is now a wide evidence base for aquatic physiotherapy.

The physical properties of water allow the therapist to choose activities to achieve different aims:

The Metacentric principle describes the tendency to rotate when an object or body in water is asymmetrical. Head and trunk control is required to correct the rotation. Selective limb movement is facilitated in the process. An asymmetrical patient can achieve swimming in a straight line.

Buoyancy can be used to stretch muscles and to assist or resist movement. In the neurological patient, the reduced load in weight bearing reduces the effect of overactive reflexes which create a window of opportunity for the facilitation of more normal movement. Joint pain is reduced, reducing muscle inhibition and facilitating muscle strengthening.

Hydrostatic pressure damps down involuntary movement and assists the reduction of swelling in the lower limbs. The abdominal wall is supported, assisting breathing control, speech and coughing. Cardiac preload is affected and needs to be considered in children with cardiac abnormalities.

The increased work of breathing improves respiration in quadriplegics and in children with cerebral palsy.

Turbulence occurs when an object moves or is moved through water. This, with the ‘drag’ effect, can be used to assist or resist movement and allows for stretching.

Flow principles are used to increase resistance.Sensory factors: The therapy pool offers a variety of sensory and perceptual stimuli.

Skin friction during movement in water provides sensory input. The pool water inlet ‘jet’ provides useful sensory stimulation.Physiological factorsThe sympathetic nervous system is suppressed in water. Increased tone reduces, creating a window of opportunity to facilitate normal movement. The spine lengthens (2.5cm in adults). The heart rate is lower, making fitness activities safe for most patients.

Fitness is an important consideration. Every disabled child and adult has a right to be fit and healthy. Reduced activity makes these patients vulnerable. The rise in metabolic syndrome and the statistics on obesity in our population are a cause for increasing concern. We as physiotherapists are in a perfect position to address these needs.

Water is an additional tool, allowing a freedom of movement, at times difficult to achieve on land.

This contrast is demonstrated very well in the Halliwick DVD, ‘Another kind of Playground’. (https://halliwick.org.uk/)

Not all schools for the disabled have funding for therapy pools, but it is encouraging to see how many do have the facility or use other pools in the area.

I encourage all physiotherapists to share and enjoy the versatile aquatic modality.

Above: Gillian Adam's son after a knee replacement; Below: Tarryn Filday with patient Matt, aged 18, who has CP GMFCS Level V.


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Restraints of trade are often a hot topic across all professions, and are important for both employers

and employees to take note of. Below, see a quick reference guide of facts for your reference.

What is a restraint of trade?• It is an agreement between an employer and an

employee.• It is a provision in an employment contract that

restricts an employee from, for example, being employed by a competitor of the employer, or establishing a business in competition with the employer following termination of employment.

• It falls under Contract Law, not Labour law.1

• It is included as a clause in the contract to acknowledge that restraints are reasonable and may result in financial harm and loss if the employee breaches the provisions.

Why would you want a restraint of trade?• Restraints are meant to stop the employee “stealing”

intellectual property/clients.• A restraint enables an employer to protect the

proprietary information of its business. This includes

trade secrets, confidential information, trade connections, customers and clients, as well as the goodwill of the business.

• Restraint of trade does not mean that the employer can steal his or her livelihood.

What does a restraint of trade dictate? • A reasonable time period/duration for the restraint.• A reasonable geographical area.• Protectable Proprietary Interest. • Confidential Information.• No unreasonable restriction of a person’s freedom to

trade (against public policy).• Not contrary to public policy or interest/harm public

interest.

Disputing a restraint of trade• Restraints will only be invalid and unenforceable if

deemed unreasonable. • An employee alleging that a restraint is unreasonable

bears the onus of proving this in court. • The employee can only claim that it is not

enforceable if he is able to prove that the clause is, in fact, against public interest.

• The court would have to consider the circumstances at the time when it was asked to enforce the restriction.

• The court may find that the agreement is severable, and would be entitled to declare the agreement partially enforceable or unenforceable.

When disputed, what will the court take into account? • Is the area referred to in the restraint of trade clause

too big/wide? • Are the exclusions regarding scope of practice/

activities too wide/big?• Is the period of the restraint reasonable?• Each case is heard on its own merits and based on

previous cases.

What are protectable interests? Examples:• Relationships with customers, potential customers,

suppliers and others that make up the ‘trade connection’ or an important incorporeal asset =

Limits to practiceSamantha Dunbar fills us in on restraints of trade

What is the relationship between freedom of trade and a restraint of trade?In South Africa, every citizen has the right to choose their trade, occupation or profession freely. However, restraints are legal and very much enforceable against South African employees. This provides a conundrum, because there are laws governing trade and contractual agreements between parties, but the constitutional right of a party to an agreement can’t be overshadowed by national legislation. On the other hand, where the interest of the party sought to be restrained weighs more than the interest to be protected, the restraint is unreasonable and consequently unenforceable.


Practice

‘good will’. • Confidential material useful for carrying on the

business and which could be used by the competitor to gain competitive advantage = ‘trade secrets’.

• Not merely seeking to exclude competition!

What are trade connections? • Personal knowledge of and influence over the

customer. • Trade connections should be clearly defined to

include customers at the time of termination as well as prospective customers within the preceding months (quantify the time period).

Enforcement of a restraint of trade? • The employer has the responsibility to enforce the

restraint of trade, through an interdict. This should include information about a proven breach, it should establish risk of harm, potential or actual, trade connections and/or exploitation.

How does an employee challenge a restraint of trade? • Firstly, read your contract with the employer before

signing!• The onus is on the employee to prove enforcement

is contrary to public policy. This could include the following:

• No legitimate propriety interests. • Circumstances prevailing at the time of signature

and enforcement.• Senior/ordinary employee. • Public domain. • Personal skills.

There are a few controversial points where restraints of trade are not enforceable. • No-fault dismissals, such as retrenchments.• Unfair dismissals.• Where the employee was under coercion to sign.• Where the employee’s position has been made

redundant due to operational requirements.• If this is the case, the restraints need to be discussed

during retrenchment talks. A release/pay out for period and a Non-Disclosure agreement to be negotiated.

Speak to your lawyer and human resource department concerning setting up a valid restraint of trade.

Good luck!

References:

1. https://www.iol.co.za/business-report/economy/restraint-of-trade-a-guide-for-employers-2003761 Accessed 26/10/20172. https://www.iol.co.za/business-report/economy/restraint-of-trade-a-guide-for-employers-2003761 Accessed 26/10/20173. Laboursmart, Restraint of Trade Webinar. https://www.laboursmart.co.za Accessed 17/7/20184. https://www.samedical.org/images/attachments/guideline-on-restraint-of-trade-clauses-in-employment-contracts-jul012.pdf Accessed 19/7/20185. Magna Alloys and Research (SA) (Pty) Ltd v Ellis 6. Den Braven S.A. (Pty) Limited v Pillay and Another (2899/2008) [2008] ZAKZHC 22; 2008 (6) SA 229 (D); [2008] 3 All SA 518 (D) (27 March 2008)7 Johannes Van Veijeren t/a Van Veijeren & Partners v Kruger (12634/2015) [2016] ZAKZPHC 62 (24 June 2016)8. The Constitution of the Republic of South Africa, Chapter 2(Bill of Rights), section 22.9. Walter McNaughtan (Pty) Ltd v Schwartz and others [2003] 1 All SA 770 (C)

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What are trade secrets? Confidential information-factual questions. For information to be regarded as confidential information it must:• be capable of application in trade or industry,

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or a closed circle, and • be of economic value to the person seeking to

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Students

38

According to the World Health Organization, “Health promotion is the process of enabling people to increase control over, and to improve,

their health. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions.”

This year on the 13th of September, third-year physiotherapy students from the University of the Witwatersrand (Wits), Daniella Grupel and Jehan Ebrahim, were placed at Alexandra Community Health Centre (CHC) for their four-week public health clinical block. During this time, they were introduced to a support group for people with osteoarthritis, just one of a number of support groups offered at the CHC.

This group comprises women above the age of 50 years suffering from all forms of osteoarthritis, such as the hip, knee, shoulder and spine. These women meet every Thursday in the courtyard of the rehabilitation unit at Alexandra CHC to perform group exercises. During their

placement at the CHC, the Wits students treat patients with different conditions and they get to refer patients with osteoarthritis to the exercise group – and they would sit in and join the class too.

In their first contact sessions with the group of women, the students found that many of the women did not fully understand what osteoarthritis was and wanted more information on other conditions such as diabetes. The women’s main concern was pain management. Many of the women were told that in addition to exercise, hot-water bottles/bean-bags can aid in pain relief. However, they did not have the means to purchase such items. Upon further observation of the exercises performed during the session, the students noticed that the exercises were not targeting the specific requirements of individual patients; additionally they were not stretching prior to exercising, which can put them at risk for potential injuries.

Promoting healthIn consultation with the women, Daniella and Jehan thought it would be a great initiative to implement a health promotion plan to educate them on their conditions, teach them safe exercises and stretches which they can perform during their session and, most of all,

A little goes a long wayKganetso Sekome, lecturer in Public Health, Department of Physiotherapy, University of the Witwatersrand, writes about the impact of health promotion

A small intervention such as this will make a

huge impact in the lives of these women and uplift the

community as a whole.


Students

come up with a solution to aid these women in pain management. Daniella and Jehan were able to raise money to purchase hot-water bottles for the women. The fundraising was done through writing a letter and sending it to a number of companies such as Dis-Chem, Clicks, accounting firms and family businesses for donations.

The search for the most affordable hot-water bottle began, which the students found a challenge, but they succeeded. They received an outstanding response from the various businesses and managed to buy over 100 hot-water bottles and counting.

The hot-water bottles were gratefully received by the support group, and education on precautions and safe application was stressed by the students. Health education on osteoarthritis and diabetes mellitus was given by the students to improve understanding of these conditions and thus to facilitate self-care by the women. Pamphlets containing information on the topics were handed out to each woman. Lastly, demonstrations of correct exercises were done and an exercise booklet, including instructions and pictures of specific exercises for back, knees, hips and shoulder, was provided to the support group. This booklet will give them a variety of options and keep their exercise sessions fun and enjoyable.

As taught by Wits, there are three key tools that contribute to health promotion: Enablement, Mediation and Advocacy.

The students applied these principles in the following way:• Enablement Empowering the women through education on osteoarthritis and common health conditions that they

may be at risk of. Safe exercises to practise and the importance of stretching before exercising. Lastly, how to manage their pain effectively.• Mediation Acting as a middle man. The students were able to raise funds by contacting the relevant companies who had the funds to support the purchase of hot water bottles. • AdvocacyTo achieve advocacy the students contacted the local newspaper Alex Pioneer and arranged for a journalist to come through and interview the support group and students. By publishing this act of social responsibility, along with a description of the group, the students hoped to make people aware of these women, osteoarthritis and how physiotherapy can help, and encourage support from nearby communities.

The staff at Alexandra CHC were delighted, as the excess hot-water bottles were donated to the Rehab centre as a resource for future use. The students have continued with this initiative in hopes of receiving more donations to ensure the sustainability of the programme.

Wits teaches and encourages its students to make a difference in communities and emphasises the importance of fulfilling the range of roles available to a physiotherapist: curative, promotive, preventative, rehabilitative, consultative and research.

Through this intervention Daniella and Jehan learnt that a little goes a long way. Apart from the hot-water bottles, the group appreciated the exercises that were taught and were grateful for the exercise book and pamphlets that were made. A small intervention such as this will make a huge impact in the lives of these women and uplift the community as a whole.

Something as simple as having access to your own hot-water bottle can make a huge difference in pain levels.

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What’s Up

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Les Marais, Pretoria: Permanent position available for physiotherapist from 1 January 2019. Hospital as well as rooms work. Call 012 335 4351 or [email protected]

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Word from Head Office

Important Dates for 2019:• SASP General Meeting 15 March 2019, location: Cape Town• Movement For Good Health Day 10 May• SASP Annual General Meeting 13 September 2019, location: Johannesburg• SASP National Physiotherapy Backweek 02 – 08 September 2019

Changes to Head Office The SASP Head Office team would like to welcome Dolly Khumalo as our new Frontline Administrator. She will be responsible for our Head Office Reception, Bulk E-mails and will be assisting in co-ordinating the administration of the course requisition process.

You can contact her on:[email protected]

Please take note of the following changes in staff duties at Head Office, with immediate effect:• SASP Membership Administration: Nozipho Hlatuka [email protected]• SASP Courses Administration & Course

Budgets Carol Mankomba [email protected]

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The trauma of going through a cancer diagnoses and treatment is very upsetting, to say the least. When you thought that you have won the battle, and you then have to life with the consequences

of lymphodoema, it is very frustrating. Especially if there is something you could have done to reduce your risks of developing this lifelong condition.

So whether the doctor removed 1 or 20 lymph nodes, or even just did a sentinel node biopsy, please be advised that you are at risk for developing lymphodoema.Skin care: ensuring that your skin is healthy and well-nourished with a pH balanced cream. Also protecting your skin from any trauma e.g. cuts, ingrown hair, insect bites, sunburn, scratches. Trauma: No injections or infusion, as well as blood pressure cuff is ever again allowed on the at risk arm. This creates trauma to an already compromised lymphatic system and could lead to more severe lymphodoema.Weight control: Excess body weight slows down lymphatic flow. Exercise: Any movement that gets your muscles pumping will increases lymph flow and reduces the risk of fluids accumulating. It is better to do gentle regular exercise than occasional bursts of intense exercise. Increasing your body temprature: Sun, hot baths, spas, saunas, excessive exercise, sprains, bruises – all of these will increase the amount of lymphatic fluid that your body produces and might overload your compromised lymphatic system.Travelling: Pressure changes during a long car trip or flying, may reduce lymph flow. Supportive garments and simple movement will assist. Please know that even if you have no symptoms, but they removed only one lymph node, you should be flying with a compression garment. Diet: Maintaining a healthy diet will increase the peristalsis of your intestines and thus stimulate the cysterna chyle, the largest lymph node in your body. Making sure you drink enough water (6-8 glasses) and limiting your salt intake will aid in keeping your lymphatic system healthy. Exercise directly after surgery: Avoid lifting your arm above 90˚ for the first 2 weeks, then consult your physiotherapist with a special interest in lymphoedema management to gradually increase your range of movement of your shoulders. Axillary web syndrome: Look out for ‘cord like’ structures that is painful. It can be from your chest wall, under your arm and sometimes rights down to your wrist. Please consult your physio therapist if you are worried about this.

It is recommended to start treatment 10-14 days after surgery so that your physio therapist can start rerouting any excess fluid away from the affected area and start creating new pathways.Erika van der Mescht (B.PhysT)

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PhysioSA - South African Society of Physiotherapy

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