Browsing by Author "Ramklass, Serela Samita."

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A comparative study to determine the immediate effects of paraffin wax and moist heat therapies on pain, joint range of movement and grip ability in adults with rheumatoid arthritis afffecting the hands.
(2013) Ramsudh, Thirusha.; Ramklass, Serela Samita.; Joubert, Robin Wendy Elizabeth.
Physiotherapists use many treatment modalities in the management of rheumatoid arthritis of the hand. Two commonly used heating modalities are moist heat and paraffin wax therapy. The aim of this study was thus to compare the immediate effectiveness of moist heat therapy and paraffin wax therapy in the management of the rheumatoid hand. A quantitative, pretest – posttest design was used to compare the effects of paraffin wax and moist heat therapy on pain, joint range of movement and grip ability in adults with stage II rheumatoid arthritis, affecting the hands. One hundred and fifteen subjects at a district/regional provincial health care institution in the Ethekwini metro district were randomly allocated to two groups. Fifty six subjects in Group 1 were treated with paraffin wax therapy, using the drip-wrap method and active hand exercises and in Group 2, fifty nine subjects were treated with moist heat therapy and active hand exercises. Pre- and posttest measurements were taken in all subjects. Pain was measured using the numerical pain rating scale and intrinsic hand joint range of movement was measured using a metal short arm goniometer and the dorsal approach. Hand span and grip ability were also measured. Results revealed that both treatment modalities were effective in helping moderate pain, increase joint range of movement and improve grip ability in the adult rheumatoid hand. Paraffin wax improved joint range of movement significantly more than moist heat therapy in 25% of joints (p≤0.05). Right hand span was also significantly improved (p=0.013) by the application of wax. No statistically significant differences were found between the effects of paraffin wax and moist heat therapy on pain and grip ability however the findings of this study suggest clinical significance as both modalities improved pain perception and grip ability in the rheumatoid hand.
Effect of group exercise on anthropometry, nutritional status and health related quality of life of older persons living in aged care homes within the eThekwini Municipality.
(2014) Rugbeer, Nivash.; Ramklass, Serela Samita.; Van Heerden, H. J.
Introduction: Globally, the prevalence of chronic disease is on the increase with cardiovascular disease being the leading cause of death. Worldwide the proportion of older persons aged 60 years and older is also increasing. The elderly within institutionalised setting are often neglected, with the probability of poor nutrition being highly prevalent. Increasing in age and visceral fat coupled with a lack of structured exercise results in inflammatory and pro-inflammatory processes, contributing to the deterioration of physical and physiological functioning. In the context of the elderly living in aged care homes, health related quality of life is defined as their functional status and independence in engaging in activities of daily living. Little is known about the effect of group based exercise and its relation to anthropometry, nutritional status and health related quality of life among the elderly living in aged care homes within the eThekwini central business district (CBD). Aim: The aim of the study was to establish the effect of group exercises in relation to anthropometry, nutritional status and health related quality of life of older persons living in age care homes in the eThekwini central business district. Methodology: A quasi-experimental design was used to compare the effect of a 12 week group exercise programme on two groups of participants using pre-test and post-test procedures. A total of 100 participants selected from five aged care homes. Twenty participants from each of the five facilities were randomly selected through convenient sampling. From the 20 participants, ten participants were randomly assigned to Group A –experimental group and 10 in Group Bobserved group. Group A exercise three times a week and group B exercise two times a week for 12 weeks. Group based 12 weeks exercise intervention was implemented for both groups. Anthropometrical indices investigated included sum of skinfold, waist circumference, waist to hip ratio and BMI. MNA-SF, SF-36 questionnaires were used before and after the exercise intervention to determine nutritional status and health related quality of life respectively. Data was analysed using the Statistical Package for Social Science Version 18.0 (SPSS) for Windows software. A p-value of <0.05 was considered statistically significant. A paired t-test and independent t-test was used to analyse parametric data. Wilcoxon signed rank test and Mann Whitney U test was used to analyse normally distributed and non-parametric data. Results/Discussion: An inverse relation between 12 weeks of group exercise and sum of skinfold was noted comparing before (M: 141.05 mm, SD: ±37.43mm) and following (M: 153.66 mm, SD: ±46.59mm) group exercise (p<0.01). However this cannot be attributed to group exercise independently, but as a result of the inherent inverse relationship that exists between fat free mass and age. Group exercise when compared to baseline (M: 12.96, SD: ±1.48) and follow up (M: 13.02, SD: ±1.11) was effective in improving nutritional status (p<0.01). Group exercise improved components of HRQoL. Participation in vigorous activities had improved following the group exercise intervention (p<0.01). Exercise was effective in reducing a feeling of worn out (p=0.01), improving social functioning (p<0.01), improved feeling of peace (p<0.01), happiness (p<0.01), change in reported health (p<0.01), mental health (p=0.03) and vitality (p=0.01). There was a significant difference in social functioning (p<0.01), vitality (p<0.01) and mental health (p=0.03) comparing before and following training thrice a week. Group exercise twice a week may improve social functioning (p=0.02). There was a significant difference in mental component summary following 12 weeks of group exercise (p<0.01). There was a significant difference in physical component summary scale (p=0.03) and mental component summary (p=0.04) comparing before and following training twice a week. A significant difference was evident in the mental component summary scale comparing before and following training thrice a week (p<0.01). Conclusion: Group exercise significantly improved nutritional status and health related quality of life of the elderly living in aged care homes. Group exercise performed three times a week may improve social functioning, vitality and mental health whilst exercising two times per week may improve social functioning. This may assist the elderly in accomplishing activities of daily living safely, improving their functional ability and quality of life.
The effects of a structured group exercise program on functional fitness of older persons living in old age homes within the eThekwini Municipality, South Africa.
(2014) Chetty, Levin.; Ramklass, Serela Samita.; McKune, Andrew James.
Aim: The study aimed to determine the effects of a structured group exercise program on functional fitness of older persons living in five old age homes within the eThekwini Municipality of South Africa. Population: The study population comprised men and women aged 60 years and older, who reside in an old age home within the eThekwini Municipality. Design: A quasi-experimental design was used to compare the effect of a 12 week group exercise program on two groups of participants using pre-test post-test procedures. Methodology: Twenty participants each were selected from five old age homes. Participants were randomly allocated into either an experimental group or a comparison group at each site. The experimental group participated in the exercise intervention three times weekly for 12 weeks, while the comparison group received the same intervention twice weekly for 12 weeks. The prescribed intervention was guided by the recommendations outlined by the American College of Sports Medicine (ACSM) and American Heart Association (AHA) respectively. It comprised of warm-up, balance, endurance, resistance and cool-down components. Assessments of upper and lower body strength and flexibility, aerobic endurance, agility and balance were conducted before and after the intervention using the Senior Functional Fitness Test. Data was analysed using Microsoft Excel 2013 and Statistical Package for Social Sciences version 20.1. Results: Comparisons of baseline and post-intervention measures showed greater improvements in upper and lower body strength and flexibility, as well as aerobic endurance capacity (p < 0.05). But, no improvements were observed in participant’s agility and balance levels. With regards to training frequency, no significant difference in functional fitness measures was observed between both groups following the 12 week intervention program. Conclusion: Twelve weeks of multifaceted group exercise training, at least two times per week can be used as an effective strategy to promote functional fitness in the elderly population.
Effects of group exercise on salivary biomarkers of mucosal immunity and hypothalamic-pituitary adrenal axis activation in older persons living in aged care facilities.
(2015) Dudhrajh, Prathna Abhimun.; McKune, Andrew James.; Ramklass, Serela Samita.
Abstract available in PDF file.
A framework of critical thinking skills for teaching and learning physiotherapy.
(2000) Ramklass, Serela Samita.; Searle, Ruth Lesley.
The use of critical thinking is called for in the practise of physiotherapy and has been cited as a learning outcome in the design of the physiotherapy curriculum. Further, the South African Draft White Paper on Higher Education (July,1997) is committed to endow graduates with skills that build the foundation for lifelong learning and included in such skills is that of critical thinking. Although welcomed by the profession, the introduction of critical thinking within the programmes may be premature because of the lack of debate and subsequent understanding about the critical thinking skills necessary for the practise of physiotherapy. Hence critical thinking remains implicit within the context of physiotherapy. Physiotherapy educators are assessing the skill implicitly within the process of clinical reasoning and decision making, without articulating what critical thinking really is, in the context of physiotherapy clinical reasoning. Further one needs to identify the repertoire of component skills that one should possess, in order to be an accomplished critical thinker. Data obtained from interviews with level co-ordinators, and an examination of the course plans within one department at one institution, provided an insight into how critical thinking is understood within the profession. Further, it identified if, and how, critical thinking was currently incorporated into the physiotherapy curriculum. In an attempt to develop a deeper understanding and a guiding framework for critical thinking in Physiotherapy, a workshop was conducted amongst qualified physiotherapists. They were required to model the clinical reasoning and decision making processes that they employ in the clinical area, in the process of working through the clinical problem that was presented. The data that emerged was qualitatively analysed and categorised. This was for the purpose of generating meaning, and for the development of a framework of critical thinking skills, that may be used in conjunction with the process of clinical reasoning to enhance one's clinical judgement. Critical factors emerged from analysis of the data. These included the preponderance of the product over the process method for teaching and assessing, the implicit nature of teaching and assessing for critical thinking in physiotherapy, and the similarities and differences in perception and conception about the meaning of critical thinking and its associated skills. The findings of this study contribute to the understanding and development of critical thinking within the specific context of physiotherapy and inform the development of the physiotherapy curriculum towards the realisation of its intended goals.
Kinesio Taping® of the metacarpophalangeal joints and its effect on hand function in individuals with rheumatoid arthritis.
(2015) Roberts, Sarah Catherine.; Ramklass, Serela Samita.; Joubert, Robin Wendy Elizabeth.
Background Rheumatoid arthritis (RA) is a chronic systemic disease that affects the hands bilaterally, resulting in inflammation, pain, joint instability, diminished grip strength and difficulties with function. The metacarpal joint (MCP) is commonly affected in the hand. The effectiveness of Kinesio Taping® on taping of the MCP joints has not been established in assisting with the symptoms in the hand. Aim To determine the effectiveness of bilateral Kinesio Taping® of the MCP joints on pain, range of motion, grip strength and hand function in elderly individuals previously diagnosed with RA. Methods / Design A repeated measure experimental design was used for the study over a seven week period with the experimental group (n = 30) receiving bilateral space correction Kinesio Taping® of the MCP joints and the control group (n = 31) participating in joint protection (JP) workshops. The Kinesio Tape® was worn for 3 days per week with four applications during the data collection process. For the control group, 2 hour JP educational-behavioural workshops were run weekly for four weeks. Weekly assessments were completed for grip strength, ulnar deviation and pain (VAS), and two pre-intervention assessments and one post-intervention assessment was completed for the Michigan Hands Outcomes Questionnaire (MHQ). Results Kinesio Taping® of the MCP joints has shown a significant decrease in pain (P=0.00) and range of motion (P=0.00 bilaterally). Joint protection was found to have a significant difference in grip strength and in the work and ADL sections of the MHQ. No significant difference was found between groups after intervention in the majority of outcomes except for grip strength where a significant difference was found. The level of significance was set at 0.05. Discussion and Conclusion This study has shown that Kinesio Taping® of the MCP joints is an effective conservative intervention that can be used to improve pain and MCP ulnar deviation in individuals with RA over a 4 week period. This is completed through a space correction application of three days, with the tape being reapplied weekly. Kinesio Taping® can be therefore included into Occupational Therapy standard practice especially when the aim is to decrease levels of pain in the MCP joint but it may not be effective to ensure a long term effect on pain. Therefore, in order to ensure ongoing pain relief as well as to ensure maximum functioning in ADL, the taping should be used in conjunction with other therapy interventions as part of the total rehabilitation process. Further, Kinesio Taping® in conjunction with JP programmes would work effectively together to minimise pain and maximise participation in valued occupations, especially in the newly diagnosed client. Further research into the use of Kinesio Taping® in people with RA is recommended.
The physiotherapy undergraduate curriculum : a case for professional development.
(2006) Ramklass, Serela Samita.; Vithal, Renuka.; Kathard, Harsha Mothilall.
This study focuses on physiotherapy professional development and professional education and the multitude of theoretical, practical and political forces that shape and influence physiotherapy education. It does so by addressing the questions: how is an undergraduate physiotherapy curriculum within a historically disadvantaged university responding to post apartheid societal transformation in South Africa; and why is the curriculum responding in the way that it is within the current social, economic, political, cultural and historical context of South Africa. The study is theoretically and methodically located within critical, feminist and post-modern framings that disturb and disrupt the dominant medical model of health sciences practice. Employing narrative inquiry as the selected methodology, data was produced through multiple methods to obtain multiple perspectives and orientations. This multi-sectoral data production approach involving student physiotherapists, physiotherapy academics and practicing physiotherapists included in-depth focus group interviews, individual interviews, life-history biographies and open-ended questionnaires. The data is analysed firstly separately for each group of research participants - physiotherapy students, practitioners and academics, and then followed by a cross-sector analysis. The analysis illustrated current disciplinary trends and shortcomings of the physiotherapy undergraduate curriculum, whilst highlighting that which is considered valuable and progressive in physiotherapy and health care. The dominant themes that emerged included issues relating to physiotherapy theory and practice, and issues that influenced the construction of relationships in the curriculum. The main thesis presented is that for physiotherapy in the South African context, the notion of caring is identified as the link between transformation and professional development. The model proposed is: A Caring-Transformative Physiotherapy Practitioner Model for physiotherapy professional development advancing a view of what it could mean to be an agent of transformation in South Africa within the health care system. This model is located within multiple framings of caring that re-casts the physiotherapy professional previously located primarily within a medical model ideology, into a practitioner with a broadened view of practice and professional accountability within a critical-feminist framing.
The scope and spectrum of challenges presented to the general surgeon by patients affected with the human immunodeficiency virus (HIV) : a review.
(2012) Ebrahim, Sumayyah.; Singh, Bhugwan.; Ramklass, Serela Samita.
Background: Surgical disease related to HIV is scantily documented with a paucity of data detailing the manifestations of HIV in surgery especially in resource-poor, high prevalence settings such as in South Africa. This review provides an update on the topical issues surrounding HIV and surgery. Objectives: The objective of the study was to determine the incidence, pathogenesis, clinical presentation, aspects of diagnosis and management of: HIV- associated salivary gland disease in particular parotid gland enlargement; Kaposi’s sarcoma (KS) and lower limb lymphoedema; AIDS- related abdominal malignancies due to KS and lymphoma; Acalculous cholecystitis and HIV- cholangiopathy and HIV- associated vasculopathy. Methods: A collective review of the literature was performed and data sourced from a search of relevant electronic medical databases for literature from the period 2000 to the present date. Studies under each section were selected based on inclusion and exclusion criteria. Content analysis was used to analyse data. Results: The HIV pandemic has resulted in an increased frequency of benign lymphoepithelial cysts making it the commonest cause of parotidomegaly in most surgical practices. KS should be considered in the differential diagnosis of a patient with chronic lymphoedema. Lymphoedema may be present without cutaneous lesions, making clinical diagnosis of KS difficult. The gastrointestinal tract is the commonest site of extra- cutaneous KS. Surgical management of the lymphoma patient is restricted nowadays to determining the diagnosis and in some cases to evaluate disease stage. Highly active antiretroviral therapy (HAART) is an important part of the management of biliary tract conditions in addition to relevant surgical procedures. HIV- vasculopathy represents a distinct clinico- pathological entity characterized by a vasculitis with probable immune- mediated or direct HIV- related injury to the vessel wall. Conclusion: The rising incidence of HIV in South Africa and other developing countries has been associated with new and unusual disease manifestations requiring surgical management for diagnostic, palliative or curative intent. It is crucial that surgeons remain abreast of new developments related to the challenging spectrum of HIV and its protean manifestations.
The impact of the coronavirus pandemic on female leaders in the School of Clinical Medicine, University of KwaZulu-Natal.
(2023) Ndawonde , Mandisa.; Proches, Cecile Naomi Gerwel.; Ramklass, Serela Samita.
The coronavirus pandemic has altered the working experience interface in higher educational institutions, by redirecting how tasks are completed and how individuals interact with one another. This study aimed to determine the challenges faced by female leaders in the School of Clinical Medicine (SCM) at the University of KwaZulu Natal (UKZN) during the coronavirus pandemic. The study explored the impact of the coronavirus pandemic on female leaders in the SCM at UKZN and mechanisms implemented to facilitate growth and maintain function. This qualitative study used purposive sampling to identify nine female leaders from the School of Management Committee (MANCO) to participate voluntarily. Participants included the Academic Leader of Teaching and Learning and heads of various disciplines within the school. Nine female leaders in the SCM were interviewed individually using the Zoom platform to determine the challenges they experienced in their role as academic and/or clinical heads of departments during the coronavirus pandemic. The study was motivated by the absence of prior studies that reported challenges experienced by female leaders within the SCM. The data were analyzed using thematic analysis. The themes identified explained their challenges and impact on female leaders within the SCM. One of the reported challenges faced by the University of KwaZulu-Natal (UKZN) was the management of multiple programs. With various courses and programs running concurrently, it became difficult to allocate resources effectively. This led to issues such as inadequate staff for teaching and learning. The insufficient number of qualified staff members posed a significant challenge for UKZN. Due to resource constraints, there were not enough consultants available to meet the demands of all the programs. This resulted in larger class sizes and limited individual attention for students. Another challenge highlighted in the report was the contradictory staff policies between UKZN and the Department of Health (DOH). These conflicting policies created confusion among staff members regarding their roles, responsibilities, and reporting structures. It hindered effective collaboration between different departments within UKZN and with external healthcare institutions. The study highlighted the impact of the coronavirus pandemic on female leaders through challenges experienced. A discussion of the various changes that took place in teaching and learning is also included.