physiotherapy - saphysio.co.za · paediatrics to neurological rehabilitation to sports in-juries....

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What is this crucial profession and what is its role within the web of healthcare

professions?

ANNUAL REVIEW2016/7

PHYSIOTHERAPY ANNUAL REVIEW

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AIMS AND OBJECTIVES of the South African Society of PhysiotherapyThe Society has the following fundamental, enduring and long-term aims and objectives, namely:• to promote on a national basis, the common interests of physiotherapists and the welfare of the profession, having regard at all times to the broader interests of the public whom the profession serves, and to endeavour to reconcile, where they may conflict, the interests of the profession and the public;• to safeguard and maintain the independence, objectivity and integrity of the profession;• to maintain and enhance the professional standards, prestige and standing of the profession and of its members both nationally and internationally, which standards shall be reviewed from time to time to take into account the objectives of the Society;• to uphold and encourage the practice of physiotherapy, and to promote and facilitate access to the profession;• to promote the training and continuing education of physiotherapists, research in the science of physiotherapy and in any related science or practice, research in technology as it relates to physiotherapy and the practical application of such technology;• to initiate, consider, promote, support, oppose or endeavour to modify legislation, whether existing or proposed, insofar as it relates to the profession;• to represent generally the views of the profession on a national basis;• to nominate, elect, appoint or delegate person(s) to represent the Society (or any portion of it) in any public, private or government forum where matters relating to Physiotherapy or the aims and objectives of the SASP are addressed;• to take up membership of or co-operate with any national or international organisation or body of a similar nature with similar objectives to the SASP. This would include organisations which extend their operations beyond the borders of SA.

(From the SASP constitution amended at the AGM in March 2016.)

NATIONAL EXECUTIVE COUNCIL President Dr Ina DienerDeputy President Prof Witness MudziFinance Co-ordinator Ms Neeta KhandooPublic Sector Representative Mr Ricky ZinnPrivate Sector Representative Ms Samantha DunbarProvincial Representative Ms Lonese JacobsSIG Representative Ms Isabeau NeethlingProfessional Development Rogier van Bever DonkerCommunications Ms Diana Coetzer

PROVINCESEastern Cape Ms Heather JenkinsNorthern Cape Mr Lourens de VilliersWestern Cape Ms Lonese JacobsFreestate Ms Candice ColynGauteng North Ms Tarryn SmithGauteng South Ms Heather TalbotKwazulu Natal Ms Carin HallLimpopo Mr Matthew RatcliffeMpumulanga Ms Alexa PohlNorth West Vacant

SPECIAL INTEREST GROUPSAcupuncture Ms Phyllis BergerAnimal Health Ms Ansi van der WaltAquatic Ms Mandy ThompsonCardio-pulmonary Rehabilitation Prof Brenda MorrowNeurological Rehabilitation Ms Lynn FearnheadOrthopedic Manipulative Ms Marica KokOccupational Health Ms Marisa CoetzeePaediatrics Ms Chantelle van der BergPain Management Ms Jacqui KoepSports Group Ms Ria Sandenbergh Women’s Health Ms Debbie Hill

PORTFOLIOSJournal Editor Prof Jose FrantzLecturers Forum Ms Natalie BenjaminQuality Improvement Prof Anthea Rhoda

MISSION STATEMENT of the South African Society of PhysiotherapyThe South African Society of Physiotherapy is a dynamic and professional organisation that works to meet the needs of its members while promoting and protecting the physiotherapy profession. It is committed to:• Being pro-active in the formulation and implementation of health care policy at all levels of government, in alignment with the National Health Plan, with the aim of achieving the goals of Accessibility, Affordability and Appropriateness;• Promoting transformation and equity in the profession;• Fostering national and international relationships with other health-care providers;• Promoting education and research;• Defending the integrity and unique nature of the profession.

THE VISION OF THE SASPThe SASP is committed to being a dynamic, professional and innovative organisation, effectively representing its members and playing a pro-active role in furthering and guarding the integrity and unique nature of the physiotherapy profession, while supporting the formulation and implementation of health care policy in South Africa for better health for all.

MISSION AND VISION

3FROM THE PRESIDENT’S DESK

Creating optimum function, curing illness or injury, maintaining health: time was when health was split into silos, separate cocoons that

barely communicated. Today, teamwork is essential. There are elements of multi-disciplinary practice everywhere, from coping with the most complex challenges, such as neurodegenerative disease, down through the spectrum to something as everyday as a knee injury.

Physiotherapists are linchpins in healthcare teams, working together to plan and manage treatment, and rehabilitate to function. Their role is to understand how bodies work, how they function, how each com-ponent system knits together to create a body in ac-tion. They work closely with both the patient and other healthcare professionals, weaving together the threads of skills sets and knowledge to facilitate optimum heal-ing and return to function. It’s hardly surprising that general practitioners refer more patients to physiother-apists than to any other healthcare profession.

Physiotherapy is a science-based profession, us-ing advanced techniques and modalities which are evidence-based. The profession’s ‘whole person’ ap-proach to health and wellbeing fits smoothly into the modern concept of healthcare as a partnership. Phys-iotherapists assess, diagnose, treat and prevent a wide range of health conditions and movement disorders, with the ultimate aim of improving quality of life. Physiotherapists are highly qualified health profes-sionals with a minimum of a four-year BSc or BPhys university degree under their belts, following a care-fully designed and curated curriculum. Many go on to further study in areas of specific focus, ranging from paediatrics to neurological rehabilitation to sports in-

juries. All are required to maintain an audited record of continuous professional development.

A well-established and recognised profession, physiotherapy dates back to the Royal Centre Insti-tute of Gymnastics, founded in 1813. The profession as practised today was formulated in 1894, when the Chartered Society of Physiotherapy was established in the United Kingdom, with formal training pro-grammes commencing in other countries within fol-lowing decades.

Physiotherapy in South Africa began to take shape in the late 19th century and early 20th century, with the South African Society of Physiotherapy being estab-lished in 1924. The first formal training of physiothera-pists in South Africa commenced in 1938. South Africa was a founder member of the World Confederation for Physical Therapy in 1951.

Physios who work in South Africa must be reg-istered at the HPCSA. The profession’s board at the HPCSA makes sure that they are qualified, competent and that their skills are updated frequently. The four-year university training, and the following Community Service year aligns physios with other regulated health professions.

Physiotherapists have first-line status, which means that practitioners are able to diagnose and must under-stand the healthcare and patient terrains well enough to meaningfully refer as well as treat.

With its long history, its thorough and continuing professional education, the professional title of Phys-iotherapist offers protection to patients when seeking healthcare, and assurance of science-based treatment and meaningful input for healthcare colleagues such as doctors, specialists and fellow allied health professionals.

Dr Ina Diener, President of the South African Society of Physiotherapy, speaks about the key role of the profession

Co-producing health

4 PROFESSION

In their four years at university earning their initial degrees, physiotherapists learn how the functioning body works, at the most detailed anatomical and

physiological level. They learn how to work with the moving parts: the joints, the nervous system, the cardio-vascular system, the myofascial tissues that cover organs and connect the muscles. They discover how to help the body function better at micro and macro levels.

Wherever, whoever, and whatever the conditionSo it doesn’t matter what state a patient is in when he or she first sees a physiotherapist, in hospital or as an outpatient. He may be unconscious in the Intensive Care Unit following a disastrous vehicle accident; she may be starting to move again after extensive abdominal surgery or a sport injury.

He may be a cyclist seeking help with painful knees or an older man battling arthritic pain. She may be a little girl with low muscle tone

following a premature birth, or a mother struggling with severe headaches.

At home, at work, during sport or play, all bodies are at risk of conditions, injuries or illness that cause pain and limit functioning.

Other medical professionals are tasked with fixing or taming the underlying causes; it’s the physiotherapist’s role to guide and assist the patient on the road back to function – the best function possible for each individual – and help them maintain function so that they achieve the best possible quality of life.

Thorough learningPhysiotherapy treatment is evidence-based; a large body of research has accumulated over a number of decades, and physiotherapy training at university is focused on passing on the wisdom gained, for the patients’ benefit. Their course requires hands-on prac-tical work, education and exercise prescription, and after graduating, physiotherapists join many other professions in community service, gaining invaluable experience.

It’s required by law that all physiotherapists (as must every medical professional) maintain the currency of their knowledge and skill by doing a certain audited amount of continuing professional education every year. Many do courses that are of special interest to them – a physiotherapist who focuses on treating children, for example, will do a tiered course over several years that adds those special insights and skills. An increasing number of physiotherapists invest extensive hours in doing Masters and PhD degrees, studying at night and on weekends to achieve their goals.

It’s crucial for a physiotherapist to be as knowledge-able as possible, because in South Africa and a number of other countries, they are first-line practitioners – that means they can be consulted directly, without a referral.

A physiotherapist can assess a patient who comes in off the street, and provide a diagnosis – so they must have an excellent and detailed foundation of knowl-edge about the body! Of course, they also have the knowledge and insight to know when to refer a patient to an appropriate professional such as a neurosurgeon, orthopaedic surgeon or gynaecologist. In best practice

What is physiotherapy?

A physiotherapist is the healthcare professional to turn to when you want to achieve the best working, playing, living body that is possible for you.

Physiotherapy is an Allied Health

Profession aimed at educating, teaching

and facilitating normal development,

movement and function after injury

and illness

5PROFESSION

throughout the world, physiotherapists work with in-terdisciplinary teams that include all necessary skills, from psychiatry to occupational and speech therapy. Wise medical professionals know that including physiotherapy means their own hard work in reha-bilitating patients will not be lost, that the patient will end up with better and more lasting function through physiotherapy.

Whatever worksThe research which underpins physiotherapy training shows the efficacy of a broad range of kinds of treatment. A physiotherapist may use their hands to mobilise joints and soft tissues; they may use a range of therapies that harness the intervention of electro-physical modalities; they may stimulate nerves with needles; or they may only explain a patient’s pain to him to reduce anxiety.

A thorough understanding of muscle

tissues and nerves in action means

that physiotherapists are experts

at prescribing exercise, from the

tiniest movements to recruit the deep

stabilising muscles of your spine,

through gentle repetitions tailor-

made for a specific problem, to more

strenuous exercises that build muscle

and strength.

Whatever carefully chosen mixed bag of therapies a physiotherapist selects to treat an individual patient, there’s the guarantee that these trained, qualified people are, indeed, medical professionals who use evidence-based modalities to best effect.

Few people choose to become a physiotherapist without a genuine and heartfelt desire to help and heal. This is fortunate, because physiotherapy calls for kindness and an understanding of human behaviour – it’s one of those rare medical professions that gets to spend time with each patient. A caring physiotherapist is often the recipient of confidences and a soother of tears – all part of the process of managing pain, healing the body, and restoring optimum function.

The focus in physiotherapy is on

the best function, the best movement

and the best level of physical wellbeing

for everyone

PROFESSION6

Ten years ago, it was a relatively rare thing to meet a physiotherapist with a

doctorate. Twenty years ago, it was almost unheard of.

In 2016 alone, all the eight physiotherapy training universities had about 58 PhD students enrolled with about 6 attaining their PhDs, in a year that was particularly hard on academic work.

This is a strong, clear sign of a solidifying focus on evidence-based treatment. It was about two decades ago that the physiotherapy pro-fession globally began to express a concern about the quality of evidence underlying practice. Frank questions were asked, and a few brave, pioneering physiotherapists set out to provide answers, each of them offering a piece in the jigsaw puzzle which started to build over time.

It was hard to see clearly back then, but if you take a moment to reflect on research activities in 2016 alone, you can see the colour and complexity of the picture that has come into being, from research firming up the critical

value of physiotherapy in intensive care, to extensive investigations of exercise as therapy; or confirming physiotherapy’s important role in management of anything from chronic pain to hypotonic infants to community-based rehabilitation.

In South Africa, we have pioneered research on developmental delay in children with HIV, management of pain in HIV patients, and the impact of HIV on functional outcomes. We have also cemented the body of knowledge on functional outcomes post stroke and have played a leading role in research focusing on injury prevention in sport, among others. The South African Journal of Physiotherapy (SAJP at www.sajp.co.za) is a very active open access publication, with constant submissions coming in from all over the country, as well as from other African countries.

Each paper published continues to refine our understanding of the impact and effectiveness of a wide range of techniques and treatments. Last year saw the SAJP publish a review which looked for evidence of the most efficacious treatment on shoulder pain, for example (Effect of corticosteroid injections versus physiotherapy on pain, shoulder range of motion and shoulder function in patients with subacromial impingement syndrome: A systematic review and meta-analysis), and a study which sought to provide evidence for physiotherapy intervention in children with developmental coordination disorder (Does a physiotherapy programme of gross motor training influence motor function and activities of daily living in children presenting with developmental coordination disorder?)

A stringent and ongoing quest for evidence is an indication of the vibrant nature of the profession, and its vital role in the multi-disciplinary landscape of modern medical care and medical science. Taking 2016 as a snapshot of the research scenario in physiotherapy reveals a profession which is constantly learning, questioning and growing – a healthy profession with a mature, research-based confidence in its role.

The academic and scientific base of the physiotherapy profession is very solid, says Professor Witness Mudzi

Evidence Based Practice in Physiotherapy –

An evolving profession

A stringent and ongoing quest

for evidence is an indication

of the vibrant nature of the

profession, and its vital role

in the multi-disciplinary

landscape of modern medical

care and medical science.

PROFESSION 7

Across the countryThe Provincial portfolio on the NEC

of the SASP represents the nine Provincial Group Committees.

Some of the provinces have towns farther away from each other, therefore some provinces have sub-branches. These committees represent the members and connect directly with the members. This allows the society to provide the support services uniquely required for that province. The Provinces embark on educating the communities they serve in, about the value of physiotherapy [info to medical practitioners and the public]; about good life habits and which universities offer Physiotherapy degrees [information to learners].

The field of physiotherapy, as in many medical professions, is constantly evolving. It is therefore important to keep our skills and knowledge as current as possible. The provinces and the branches continually assess the needs of the members and offer the opportunity to expand their knowledge. The expansion of knowledge is done through continued professional development courses, workshops and lectures.

The National Physiotherapy BackWeek is a highlighted date on the provinces’ calendars. Much preparation takes place; marketing opportunities are sought and loads of boxes are distributed throughout the country to the provincial offices. This is the week when the provincial offices are a buzz with activity. Liaising with members and their planned activities. This is when you see posters up in hospitals, physiotherapy information stands, and community outreach projects to get the public moving for good health.

Sporting events take place throughout the year in many provinces. Members get involved alongside student physiotherapists. Students and physiotherapists then come together for the common goal of taking care of aching bodies and tired muscles. Members of the public interact with physiotherapists and get to know more about the profession, often walking away understanding the human body better.

In private practiceThe Private Practitioners Physiotherapy Group

(PhysioFocus) forms the largest group of physiotherapy practitioners in the Society, and

in the country, mainly due to the limited number of physiotherapy posts in the public sector.

The SASP has recently embarked on a Physiotherapy Advocacy Project, a joint project between the Private and Public sectors, to market the relevance of physiotherapy in the medical arena, to support physiotherapy services in the public sector, and to prepare the profession for our essential role in National Health Insurance.

Strong efforts are made to improve the quality of service delivery by physiotherapists. A practice management accreditation programme has been rolled out. This project is supported by several medical funders. Members are educated with information, webinars and symposia to improve their practice management, to facilitate coding of treatments, and to improve communication with medical funders.

The public and other medical practitioners are informed about location of practices by a PhysioFinder directory, and listing of practices on the SASP and ASAIPA websites

The Private Practitioners group is very active with social responsibility projects, for example donating skipping ropes to disadvantaged primary schools to increase activity in children, and donating to ‘Stand with Stan’, a charity benefitting amputees who can not afford a prosthesis or a replacement prosthesis.

s At every stage of life, bodies may need physiotherapy to help them cope with their burdens.

Strong efforts are made to improve the quality of service delivery by physiotherapists.

8 SPECIAL INTEREST GROUPS

Getting to the point

n Phyllis Berger

Why do physiotherapists offer their patients treatment with needles?

Isn’t that acupuncture? Yes, it is a form of acupuncture. And it’s a great tool for pain management.

Physiotherapists practise Western Medicine Acupuncture, which adds value to treatment when used in conjunction with physiotherapy techniques.

Recognised by the WHO as a treatment modality, WMA is practised by medical doctors, physiotherapists and nurses in many countries in the world. This practice follows the guidelines as indicated by the World Health Organization (WHO) since 1997 and the International Acupuncture Association of Physical Therapists (IAAPT) since 1991.

WMA is a therapeutic modality that involves the insertion of fine needles into the skin and includes

the understanding of anatomy, physiology, pathology, diagnostics, neurophysiological mechanisms and the principles of evidence-based medicine in its uses. Physiotherapists therefore practise acupuncture as an integrated treatment modality or technique within their own scope of practice, incorporated into mainstream medicine for the management of pain and musculoskeletal conditions.

The conditions in which acupuncture contributes to physiotherapy treatments are: pain in many different areas, such as in joints, muscles, post-operative pain syndromes, phantom limb, facial (like trigeminal neuralgia, a nasty inflammation of one of the nerves affecting your face), headaches, viral nerve damage as in post herpetic neuralgia, and cancer among many others.

Acupuncture can also impact on stress and anxiety due to the release of endorphins, encephalin and serotonin and this may have profound impacts on pain management. WMA has the capacity to reduce inflammation in nociceptive and neurogenic conditions, and reduce aberrant nerve conduction and inflammation in neuropathic pain. This increases our ability to contribute to treatment in pain clinics, rheumatology departments, sports centres, stroke rehabilitation, and oncology, and may impact on pain management in physiotherapy departments especially in rural areas where often there is insufficient medication to fulfill their needs.

Acupuncture can also

impact on stress and

anxiety due to the release

of endorphins, encephalin

and serotonin and this may

have profound impacts on

pain management.

9FINANCE

I fell and fractured my right femur into three pieces, and my humerus.

They plated and screwed my femur – wonderful operation. Unfortunately in hospital I developed gastritis/diarrhoea which left me in bed for two weeks, without being able to move, and also the surgeon said there was to be no weight-bearing on my operated leg for at least three weeks, which again held me back.

I went into a rehab centre where I tried to convince them I wasn’t very mobile before I fell but they seemed to assume that after physio I would be walking a marathon. Then after four weeks there, on the 29th of February, two months after I fell, they discharged me to my daughter’s home and there I was just worse than hopeless. I couldn’t sit up in bed, I couldn’t do anything. I hated getting out of bed. I hated them lifting me onto a wheelchair. My daughter made me come in for supper every night.

I hated it, so the family decided we’d be better back in Port Elizabeth, so they arranged for us to come to Munro Kirk because we were in an Echo cottage. After about a week, Dr Visser came to see me and asked if they had arranged for physio and they hadn’t. He said he would and this delightful physio came in two hours to see me; and that was the Thursday before Easter, so of course you couldn’t do anything until after Easter and then I think, 10 days you had me standing and walking a little bit. And now I am as mobile as I was before I fell! Thanks to the physiotherapy.

PAT I E N T ’ S S T O R I E S

The positive effect of physiotherapy

Dorothy Golding speaking to her physiotherapist, Veronica Tinley

Money matters:

finance reportThe SASP works hard to use its finances to best effect, both for the benefit of its membership and for society at large. Neeta Khandoo, Finance Co-ordinator, reports on some ways in which funds are used to support access to education at undergraduate, post-graduate and continuing education levels.

The SASP finance department had a fruitful year, with funds spent wisely to achieve our goals. This is the second year running that members can register

online for their membership. The website launched on 1 January 2016 is operating well and is easily accessible by members.

We now have a full complement in the finance team which enabled the staff and members to continue our activities for 2016 in support of research, education and special projects.

n Research Committee and Education TrustThe Research Committee supports post-graduate research, mostly towards improving the evidence-base for physiotherapy. A total of R103,500 has been granted in 2016.

The Education Trust exists at an arm’s length from the SASP, and is funded by a portion of the growth of an SASP investment portfolio, as well as donations from the public. The Education Trust grants physiotherapy bursaries to second, third and fourth year students in need. The SASP granted bursaries of R150,000 and South Gauteng Provincial Group granted bursaries of R135 000 to the Education Trust.

The Education Trust received a personal donation from a member to the value of R10 000 for 2017, for which they are extremely grateful. For personal donations to the Research Committee and Education Trust, 18A forms are issued to donors. The Education Trust would ideally like to source a corporate sponsor. Individual, company, and CC donations of up to R 100 000 per annum to the Research Committee and Education Trust are tax exempt.

n PPK FundThe Promulgation of Professional Knowledge (PPK) Fund aims to assist members to attend courses, congresses and symposia, both nationally and internationally. Recipients are expected to share knowledge gained with other SASP members in the form of a course, a workshop, a poster or congress presentation, or an article in the PhysioSA magazine. The PPK Fund paid R28,000 worth of grants in 2016.

n Special Projects R100 000 was allocated for Special Projects in 2016. The Special Projects’ Fund aims to support groups for once-off projects which benefit the society and profession as a whole. There were four applications. A total of R 70,185.10 was granted to fund Sports Groups to attend the Life through Movement International Congress, to the Marketing Committee for the purchasing of stock photos for marketing purposes, to the Stellenbosch Disability network (SDN) for a walk through Stellenbosch in celebration of International Day of Disability and to the Vaal triangle for marketing materials.

Outlook for 2017In 2017 the SASP will continue to fund and support members through the Research Committee, Education Trust, PPK Fund and Special Projects. For WCPT 2017 the Finance Committee has allocated 35 grants of R 1000 each for members to towards their registration. In conclusion we look forward to having many more successful activities in the year ahead!

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n Mandy Thompson, Aquatic Physiotherapy Group (AQPG)

“A river cuts through rock, not because of its power, but because of its persistence.” James N Watkins

Aquatic physiotherapy moves physiotherapy management from a gravity-controlled en-vironment to a buoyancy-supported envi-

ronment, using the properties and benefits of water, combined with the knowledge and skill of the aquatic physiotherapist, to improve the outcome of the rehabili-tation process. The AQPG is a group of physiotherapists with a passion for both the water, and the treatment, management and rehabilitation of clients.

Exercising in water decreases pain, improves range of motion, decreases muscle spasm, relaxes muscles and increases flexibility by using the buoyancy, hydrostatic pressure and warmth of the water. The muscle strength and endurance of a client is increased by using the resistance water offers, improving stability, balance and co-ordination. The buoyancy and hydrostatic pressure of the water improves circulation and reduces swelling with free movement. Aquatic Physiotherapy has a ripple effect: one small change can have an enormous impact!

Water worksPatient Pat Farley of Nelson Mandela Bay

Pat Farley was a rather sporty person – until 2004, she explains.

A melanoma was found, and a bilateral inguinal lymph block was performed with radiation to follow over the right pelvis, which in turn caused severe lymphoedema (water retention) at that stage. (An inguinal lymph block prevents the cancer moving through the lymphatic system.)

This was followed by several operations from 2004 – 2007, and ongoing problems with lymphoedema.

Six or seven years ago I was introduced to physiotherapist Audrey Strydom, and from there on I could not go wrong.

I had many sessions of lymphatic drainage, until the measurements of the right leg were such that I was able to fit a compression stocking on the leg.

After the measurements had reduced by 10cms at the top of the thigh, graduating down to the ankle, we went on to try aqua aerobics… the best! … and I’ve never looked back.

The difference it has made physically mentally and socially is amazing! To be able to do exercise again makes one feel a different person, and very encouraging.

The regimen is lymph drainage roughly every three to four months, combined with a compression stocking on daily, combined with water aerobics, stationary cycling, and walking.

One can’t get any better than this.Over the years, from very little

drainage to about 80% drainage is pretty awesome!

I would recommend aqua aerobics to any person with lymphoedema. It can always be improved, as long as you are compliant with your physiotherapist. How grateful I am to the techniques and patience of my physiotherapist, Audrey Strydom. I hope this will help many other patients to know there is hope of being mobile again, with dedication and perseverance.

Never give up! Good luck to those patients out there with lymphoedema.

Come on in, the water’s lovely!


The buoyancy of water is helpful

in therapy

I would recommend

aqua aerobics to any person with

lymphoedema. It can always be improved,

as long as you are compliant

with your physiotherapist.

SPECIAL INTEREST GROUPS

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A little six year old girl with Down’s Syndrome started off terrified of the

water but soon came to enjoy it thoroughly. After a particularly stressful time at home she reverted significantly in terms of her function at school... she stopped talking and started wetting herself. This had been going on for about a week before the aquatic physiotherapist saw her in the water again. After just one session of play and lots of fun gross motor activities in the pool, she came out of her shell again, started talking and managed to stop wetting herself.

Why? Perhaps the freedom of movement, the warm nurturing environment, the support of buoyancy, or the suppression of her sympathetic nervous system had something to do with her being able to work through the stress her body was holding on to.

Another aquatic physiotherapist commented that her favourite thing was taking the classes: a group of people brought together by their shared but diverse challenges. A patient came in with agonising chronic back pain; she had had to give up her work which was also her favourite pastime...singing and playing piano. She progressed through individual sessions and into a class; from isolation into participation.

Yet another gave this account, of an

eight year old suffering from muscular dystrophy with severe elbow and knee contractures. “Independence is not high on his achievement list. He uses an electric wheelchair with two fingers and on a good day, he holds his own head up for 10 seconds. He can’t even scratch his nose when it has an itch. Add water and subtract gravity from the equation over a three month period and voila...independent floating and moving a whole length of the 10m pool independently. From being terrified to being free. From being stuck to being a dolphin...”

A spinal contusion, during an accident while playing rugby, left a promising young 16 year old facing life as a paraplegic, all his hopes of chasing a rugby ball ever again shattered. He started with aquatic physiotherapy, playing rugby in the water, diving and swimming after his ‘baby’ – as he called it. Six months later he started to walk on land with AFO support, and we gave him a brand new springbok rugby ball. Now he is singing: ‘Yes sir, that’s my baby...’. Aquatic physiotherapy in water was the ideal medium for him to be very active, relieving him of the frustration of immobility. And who said that one cannot play water-rugby?

“You can’t put a limit on anything. The more you dream the farther you get.” Michael Phelps


The support of buoyancy | Patient stories from the AQPG

No matter your age, working in

water is easier and more fun

Add water and subtract gravity from the equation over a three month period and voila... From being terrified to being free. From being stuck to being a dolphin...”


12


From pain to personal power

n Alison Lupton Smith, Cardiopulmonary rehabilitation group (CPRG)

Blood and breath – those are two of the most precious functions of the body, a beating heart and breathing lungs. And they’re at the heart of the CPRG’s focus on improving function and quality of life.

Cardiopulmonary physiotherapy addresses a wide spectrum of conditions. It is primarily related to

the management of both acute and chronic respiratory and cardiac conditions, post-surgery cases, trauma and critical illness. Cardiopulmonary physiotherapy also aims to address the effects of conditions such as diabetes, hypertension and HIV on the cardiorespiratory systems.

The aims of cardiorespiratory physiotherapy are to help enhance recovery after acute illness or surgery, assist in regaining optimal function, improve quality of life, educate people regarding their condition, and promote healthy lifestyles.

These aims can be achieved through a variety of methods, such as ‘hands on’ techniques, breathing re-education, rehabilitation through individualised exercise prescription and group classes, all of which can be performed in hospital, at home, at out-patient clinics and in the community.

Anyone with a respiratory or cardiac disease or who has undergone major surgery or suffered trauma, whether they are newborns or many years old, can benefit from cardiopulmonary physiotherapy.

What difference can physiotherapy make for these patients?Cardiopulmonary physiotherapy can help enhance recovery from acute conditions and surgery. In people who have suffered major trauma or been critically ill, through rehabilitation and exercise, physiotherapy helps maximise their function so that they can return to the life they enjoyed. In people with chronic conditions physiotherapy can help them better manage their condition so that they may continue to live life to the full.

Research in the field of pain has exploded in the last few years,

demonstrating that pain is a different experience to all people in pain, depending on their environment, previous experiences, mood and social context. Physiotherapists with a special interest in the management of pain use evidence-based assessment and management of people experiencing acute and chronic pain. The Pain Management Physiotherapy Group (PMPG) was established to promote evidence-based assessment and management of people experiencing acute and chronic pain, through education, collaboration and the support of research.

The aim of physiotherapists with an

interest in pain is to educate patients

and the public about the mechanisms of

pain, empowering patients to manage

their own pain so that they are able to

participate in meaningful life activities.

This is achieved through education, goal-

setting, therapy where applicable, graded

exercise therapy and the management of

other factors including sleep disturbances

and stress management.

Effective acute pain physiotherapy

treatment lessens chances for

development of chronic pain, and by

working collaboratively with patients

with chronic pain, physiotherapists can

help them to manage their pain, improve

their activities and ultimately their quality

of life.

Chest of treasure

n Ryall Jacobs, Pain Management Physiotherapy Group (PMPG)

The aim of physiotherapists

with an interest in pain is to educate

patients and the public about the mechanisms of

pain, empowering patients to

manage their own pain so that they are able to

participate in meaningful life

activities.


13IMPACT


Caring for the carerMrs EJ van Niekerk’s experience

In November 2014, my husband fell, breaking his hip. There was also a

haemorrhage in the brain. This has left him an invalid who cannot walk, and he has lost most of his ability to speak clearly.

This condition has made him vulnerable to recurrent bladder and lung infections. Dr D Stickells, a pulmonologist, recommended Veronica Tinley as a physiotherapist with very good skills and knowledge of patients in need of professional help, like my husband.

Mrs Tinley’s services have been engaged from February 2015 until the present, October 2016. She treats my husband twice a week to keep his lungs functioning effectively and helps him to exercise his limbs to prevent all the concomitant problems of his condition. Her handling of the patient is professional, friendly and firm. She encourages him to keep trying to perform the movements and activities, even if this is not easy for him.

I have found Mrs Tinley’s advice and support invaluable in this situation: she recommended the use of a sling and hoist to lift my husband in and out of bed. This has indeed been a great help to myself and the carers. She discusses the patient’s condition on a regular basis with me and also, when necessary, with the medical practitioner. Her suggestions and tips for the daily care for my husband have proved to be practical and beneficial.

Mrs Tinley has spoken to me about my health as a primary carer in these circumstances and has pointed out the importance of taking good care of myself. She is always willing to help me find the best solutions to problems and has a balanced approach to difficulties. She kindly shares her expertise and professional knowledge with me whenever I am in need of guidance in this situation. What a blessing this efficient and charming young lady has proven in our lives!

s Mr van Niekerk with Veronica Tinley at top right Mrs van Niekerk has learnt to take care of her own

health.

In people who have suffered major trauma or been critically ill, through rehabilitation and exercise, physiotherapy helps maximise their function so that they can return to the life they enjoyed.

14

What is rehabilitation? Is the act of restoring something to its original state, to optimise

functioning. Fundamentally, rehabilitation is behaviour change focused on a disorder. Physiotherapists with a special interest in neuro-rehabilitation focus on helping people of all ages with neurological disorders to function optimally within their own environments and societies. Neurological disorders impact on other systems (musculoskeletal, cardiovascular, respiratory, cognitive, urogenital and digestive) and our comprehensive training enables us to manage this diversity to guide, support and promote positive change.

The NRPG is also involved in the ‘MyStroke’ initiative. ‘MyStroke.co.za’ is a platform to facilitate the coordination of activities of healthcare practitioners, stroke survivor support groups and interested parties, to enable the significant advances made internationally to improve the outcomes of strokes to now be

implemented in South Africa.’ An important part of this ongoing initiative is development of guidelines for the acute management of thrombotic stroke using thrombolysis and also for the

There is no doubt that the role of physiotherapy in rehabilitation is changing. Significantly more emphasis is being placed on patient education and advocacy for an optimal recovery, with programmes such as ‘Drive your own rehab’. Fundamentally rehabilitation is behaviour change which depends on knowledge, skills, beliefs about consequences and capabilities as well as extrinsic factors like environmental context, resources and social influences. This is reflected in accurate assessment and management plans and mutually agreed goal setting using measurement to reinforce motivation and enthusiasm. Skilled physiotherapists are ideally placed to continue their role in this development.

Paediatric physiotherapy is a whole lot of fun – with a very serious purpose.

A paediatric physiotherapist has expert knowledge and understanding of child development, anatomy and physiology –

but must also be in tune with children and infants, to be able to work with them in playful ways.

Extensive and continuous training is undertaken to enhance their skills. Expertise is applied to paediatric cardiorespiratory, musculoskeletal and neurological disorders. A fun approach that is age appropriate, family centered, holistic and evidence based is used to enhance quality of life by helping to improve and where possible restore function.

Respiratory physiotherapy for children helps loosen and remove mucous from the lungs and improve lung function in a variety of respiratory conditions: pneumonia, lung collapse, cystic fibrosis, asthma, bronchiectasis and in ventilated patients. Respiratory physiotherapy may also be indicated in children due to

prolonged bed-rest or post-operatively. Techniques used may include manual therapy (percussions and vibrations), nebulisation, positioning, breathing exercises, use of various breathing devices, cardiovascular exercise and mobilisation. Various airway clearance techniques such as supported or assisted coughing, huffing and suctioning among others may also be performed.

Neurological and developmental conditions in children result in difficulty with movement and function and a delay in reaching developmental milestones. Some of the conditions that will benefit from physiotherapy include cerebral palsy, developmental delay, prematurity, spina bifida, various genetic conditions and syndromes. Any abnormalities in tone, HIV encephalopathy and traumatic brain and spinal cord injuries can also be managed by physiotherapy.

An in-depth assessment will determine a child’s specific movement and functional problems. A variety of techniques and specialised therapies, incorporating play, movement and exercise, helps enhance movement and function, prevent deformities and improve participation. Therapy is often based on the neurodevelopmental approach as well as the motor learning theory. Various assistive devices including wheelchairs and crutches can also be prescribed and fitted by the physiotherapists. Some physios are also trained in hippotherapy (using horses in treatment) as well as aquatherapy.

Physiotherapists are experts in treating problems that affect the bones, joints, muscles and connective tissues of the body. In children, these may include congenital orthopaedic conditions, club foot, fractures, scoliosis, torticollis, various forms of arthritis, nerve injuries, Bells Palsy, various forms of acquired and inherited neuromuscular diseases and complex regional pain syndrome. An assessment will determine areas of weakness and pain. Posture and gait analysis and correction is also performed. Exercise, mobilisation, stretching, myofascial release, and strengthening are all performed to correct alignment and posture, decrease pain and improve mobility.

Return to functionn Lynn Fearnhead, Neuro Rehabilitation Physiotherapy Group (NRPG)

Child’s playn Nicole Whitehead, Paediatric Special Interest Group (PSIG)

Neurological and developmental conditions in children result in difficulty

with movement and function and a delay in reaching developmental milestones.


15PAT I E N T ’ S S T O R I E S

“Thank you for giving me my life back”Lynn Fearnhead tells a patient’s story

Peter Davidson (72), had a stroke in May 2015. His right side was affected.

He was initially treated in an in-patient rehabilitation hospital for two months. Though he was able to get in and out of bed fairly early on in his rehabilitation and move in bed it was evident that he had motor weakness of the trunk on the right side. Likewise, though he was able to get from sitting to standing independently and stand with reasonable symmetry, his right leg lacked control and coordination for normal walking.

As far as arm function was concerned he was able to grasp, feel and had some use of his hand but had difficulty reaching his arm away from his body and needed assistance with dressing and washing and cutting up his food. He is a husband, family man and a serial entrepreneur who was used to driving himself to business meetings and valued his independence.

When I met him in August as an out-patient he had developed severe pain in the right shoulder girdle that impacted his sleep and dominated his life. Shoulder pain is not unusual following a stroke, particularly at his age. The shoulder joint is a shallow ball and socket joint that needs good muscle coordination and reasonable strength for its normal function. He was diagnosed with adhesive capsulitis or frozen shoulder.

Right from the start it was important for him to realise that he was the ‘boss’. I explained the progressive shoulder mobilisation programme would include a level of manual mobilisation that he was comfortable with, supplemented by his own mobilising exercises. Interspersed with the shoulder programme was his stroke rehabilitation programme focused on trunk control and improving his independent mobility. He did the selected activities, with my supervision, during our sessions; he would continue incorporating these into his daily routine at home. His wife was involved, and contributed to identifying specific difficulties he was having at home. We also discussed

managing risk factors for stroke.The pain decreased, he was able to

sleep better, then sleep on the right side, then use his right arm for all his activities of daily life. He could walk up and down stairs, and he practised it. He practised walking further and faster. He started driving.

His therapy sessions were once a week or every two weeks and there were breaks. Positive factors were his ability to understand and follow the mutually agreed programme, supported by his wife and reinforced by his decreasing pain and increasing function.

His arm swing on the right is not perfect, nor is his pattern of leg movement, but in October 2016 he was able to fly to Atlanta and Washington for a few days on his own for an important meeting.

Mr Davidson recently gave Lynn Fearnhead the present of a book in which he had inscribed “Thank you for giving me my life back”. In discussion with our editor, he said, “Oh no, that’s not just a nice thing to say – it’s the reality!”

There is no doubt that the role of physiotherapy in rehabilitation is changing. Significantly more emphasis is being placed on patient education and advocacy for an optimal recovery

IMPACT

16

For people lucky enough to never encounter accidents or painful conditions, one common reason for

consulting a physiotherapist is a sports injury of some kind. A physiotherapist belonging to the Sport Physio Group (SPG), a special interest group for physiotherapists interested in the prevention and treatment of sport injuries, will assess and treat injuries, not only with the aim of getting the patient back into the game, but also of improving performance where possible. A number of SPG members are an integral part of the medical and coaching teams for national representatives in a range of sports, both team and individual.

With around 600 members nationwide the SPG is involved in offering roadside treatment at major and

minor sporting events such as the Duzi Marathon, Comrades, Two Oceans, Argus and the 94.7 Momentum Cycle Challenge, either as individuals or as part of the SASP and SPG.

The SPG provides a platform for like-mind-ed physiotherapists to network; meaningful re-ferrals can be made across the country as well as overseas for travelling athletes and teams. It also provides a central database for organisers of events to locate sport physiotherapists to attend events. The SPG is affiliated with the International Federation of Sport Physical Therapists as well as the South Afri-can Sport Medicine Association with representation on both executive committees.

OMT includes therapeutic procedures such as passive joint movements (mobilisation and/

or manipulation), soft tissue mobilisation, nerve gliding and rehabilitative exercises, as well as other interventions and modalities. The main aims of OMT are to relieve pain, to optimise the patient’s functional ability and to prevent NMS dysfunction. It is largely characterised by both a ‘hands-on’ and a scientific and evidence-based clinical approach to assessment, treatment and rehabilitation of the individual or group of individuals.

The application of OMT is based on a compre-hensive assessment. This examination serves to define the presenting dysfunction(s) in the articular, muscu-lar, neural and other relevant systems; and how these relate to any disability or functional limitation, as de-scribed by the WHO’s (World Health Organisation) International Classification of Functioning, Disability and Health (ICF); thus addressing each case holistical-ly within a biopsychosocial framework.

In South Africa, physiotherapists are first-line practitioners registered with both the HPCSA (Health Practitioners Council of South Africa) as well as the SASP® (South African Society of Physiotherapy). The Orthopaedic Manipulative Physiotherapy Group (OMPTG) is a Special Interest Group (SIG) of the SASP and was established in 1974. The vision of the OMPTG is to promote excellence in manual and manipulative physiotherapy in South Africa, to ensure delivery of high quality standards of care and health promotion, optimising neuromusculoskeletal health for all.

In addition to ensuring high standards for the quality of service delivery to the public, the OMPTG offers significant support to its members in the form of on-going evidence-based education, resources, networking and research opportunities; it also represents members nationally, and internationally, at the International Federation of Orthopaedic Manipulative Physiotherapists.

On the moven Benita Olivier, Orthopaedic Manipulative Therapy Group

Orthopaedic Manipulative Therapy (OMT) is an arsenal of numerous physiotherapeutic techniques and interventions, used in the management of neuromusculoskeletal conditions across all levels of function for an individual or group of individuals.

Level playing fieldsSport Physio Group (SPG)

A good physio will understand

the important role exercise plays in your life, but will

advise you of the wisest course of

action to take. She will be dedicated

to helping you achieve your

goals, and share in the joy of your

success.


17


On the runDr Allison Glass speaks as a running patient

A physiotherapist is an essential part of the team that maketh a runner.

Over the last decade, since I started long distance running, I have come to appreciate the benefit of a knowledgeable physio with good hands. Regular running, especially when training for longer distances, will lead to injuries from time to time. These may be due to overuse or an imbalance.

I have learnt to listen to my body and to visit my physio as soon as something starts to niggle. It is important to find a physio who is good at figuring out the root cause of a problem. It’s easy enough to manage a niggle symptomatically, but identifying what led to the niggle in the first place is essential to resolving the problem. My physio has come to know me well over time. That, together with an excellent knowledge of anatomy and the mechanics of the body, has enabled her to successfully figure out what my weaknesses are and address them before they become major problems.

A good physio will not mince her words, but will tell you what is what. She will not be sympathetic when you moan about the pain she is inflicting (suck it up, if you want sympathy go to mommy for a cuddle).

She will understand the important role exercise plays in your life, but will advise you of the wisest course of action to take. She will be dedicated to helping you achieve your goals, and share in the joy of your success.

IMPACT

18

n Marisa Coetzee

A physiotherapist with a special interest in Occupational Health cares for the working individual who depends on their physical well being to provide for their family.

The problem of the injured worker is handled holistically, including empowerment with knowledge about how to look after their body

and prevent future re-injury where possible.When someone is injured at work, the employer

is allowed to dismiss the employee on grounds of incapacity. This could be disastrous for the person and their family; to prevent this, physiotherapy provides a service to both the employer and employee, acting as the rehabilitation specialist and treating the injured worker.

The physiotherapist assists in providing effective work-hardening within a reasonable time period, after which the employee can return to his work. The physiotherapist will liase with the employer to discuss the importance of rehabilitation as well as possible

adaptations that can be made in the work place to prevent future injuries. The goal is to work as a team with the employer to ensure the best possible outcome for both parties.

For physiotherapists working in occupational health, another goal is to address any fears or concerns that the injured worker may have regarding his injury. It is important to address the psychological aspects involved to identify any avoidance behaviours as well as chronic pain issues early on, in order to prevent possible complications and to return the client to full function as soon as possible. Physiotherapy also provides care to white-collar workers, who spend many hours in front of the computers as well as driving, in order to make their company a success. Jokes about the ‘rat race’ life are not so funny when you discover that the demands of your employment can cause much discomfort and pain.

In the event of a very serious injury, where the employee is unable to return to his previous form of work, the physiotherapist will assist in negotiating an accommodated or alternate duty for the employee. If an insurance company requires a Funcional Capacity Evaluation (FCE), the physiotherapist will perform an assessment using various research based standardised tests. The aim of the FCE is to provide appropriate and active recommendations with the goal of assisting the employee in returning to work force, either in his own occupation or in an alternate position.


Back to workMr Z lives in the Eastern Cape. Due to

the lack of job opportunities he has to work in the Western Cape, far away from his family.

One day during a strike, he still went to work as he really needs the money for his family, he was attacked by the other workers for going to work. He had left-sided paralysis as a result from a panga blow

to the right side of his skull.With hours of intense physiotherapy,

aiming at functional use of his left hand and leg to allow him to go back to work, he was able to walk (with the assistance of a foot orthotic) as well as use his hands to build cupboards.

This was not his previous job as he was not able to safely climb onto scaffolding and ladders again, but he was determined to work so he can support his family back home, and physiotherapy made it possible for this man to gain functional use of what was brutally taken away from him.

Working outSPECIAL INTEREST GROUPS

19

A man who escapes death en route on the second last day, jumping off just in time as a competitor in the

car class races through, crushing his bike (and not stopping to help). And hauls his crumpled steed through the South American bush, until he happens upon another bike, abandoned by a biker who was airlifted out. And settles down to cannibalise that bike, fix his own and go on to finish the Dakar Rally, making it from Asunción, Paraguay to Buenos Aires in Argentina in decent time – something he has dreamed of for many years.

But that is not the truly heroic part of Joey Evans’ story, says physiotherapist Sharné Bailey, who has worked with Evans since about two years after the bike accident which broke his T8 and T9 vertebrae, crushing his spinal cord and leaving him paralysed from just below the chest. The true heroism was the guts and grit and persistence that saw him working daily on the difficult job of rehabilitation with physiotherapists like Bailey and Melanie Harding, both dedicated and committed physiotherapists.

A talented neurosurgeon fused the two vertebrae to give him a 10% chance of walking again. Harding worked with Joey as an in-patient immediately after the accident and spinal fusion. A 10% chance was all a guy like Joey

needed. And once he was up on his feet, it was inevitable that he would want to get back on a bike. And that he’d start dreaming Dakar dreams again.

“About five years ago, we started talking about doing the Dakar,” says Bailey. “Biking was his life: he had that fire in him.”

Hard work, clever physiotherapy and the persistence to overcome obstacles (including riding into a cow at 120 kph two years ago, and sustaining more serious damage)… finally, Joey Evans was at the starting line of the Dakar Rally.

Harding says, “He told me that any competitor only has a 30% chance of finishing the Dakar, so he reckoned he had maybe a 10% chance – and that was enough for him, since the doctors had given him only a 10% chance of ever walking again ten years ago. I am so proud of him – it’s an amazing, amazing achievement.”

Bailey says, “I’m so privileged to have been part of his journey. He’s an inspiration; just to know that it is possible, if you are given a chance… and that’s what I try to do with all my patients, just give them a chance.”

I got a call on a Friday afternoon from a patient I had treated at

home, 17 years ago.In 2000, on a Saturday, he had had

a stroke that affected the middle brain. He’d been in intensive care for six weeks, four of them under sedation. His intubation had caused damage, and he was bleeding into the stomach. He had three bouts of pneumonia while in ICU, and when he was discharged, his wife was told: “There’s nothing further we can do, he is going to be a burden for you.”

But, the patient says, “She was stubborn and prepared to take me

home with a pec tube, not able to swallow or move, terribly depressed and disappointed in the medical world, to look after me till I died.” After some time adjusting, his wife asked Melvena Conradie, a physiotherapist, to see him at home.

“Apparently the first question I asked him was, ‘What can you move?’,” says Melvena.

His answer was, “Nothing.” To which the physiotherapists

replied, “No, that’s not true, you’re speaking, and I see a little finger moving. We’ll start there – I’ll have you walking in no time!”

“She is a total gem,” says the patient. “Such a good and strong person. She gave me such amazing inspiration.”

Within weeks, he was in a wheelchair, able to visit Melvena at

her rooms. Two months later he was walking.

Melvena says, “He went back to his business, working, driving and independent. He turned 70 last year, is now retired, and living at the coast. He looked after his wife when she was sick, till she died three years ago… the wife who took him home to die!” He recently did a 14 kilometre hike where some people had to be airlifted out, but not him, he finished on his own two legs.

He phoned to tell Melvena he often thinks of what physiotherapy accomplished for him, and the difference this profession makes to the lives of patients. “Physiotherapy is an amazing profession and a very important part of rehabilitation,” he says. “Never underestimate what physios are able to do!”

Long walk to functionWhy are we physios? Why do we what we do? Melvena Conradie’s heartwarming answer is this patient’s story


Physio: the Dakar connectionSuperhero: that’s the only title you could give a man who completes the 2017 Dakar Rally on a motorbike – ten years after a bike accident which left him a paraplegic...

IMPACT

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physiotherapy - saphysio.co.za · paediatrics to neurological rehabilitation to sports in-juries....

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