Background: Many patients with Down syndrome (PWDS) have poor cardiometabolic risk profiles, aerobic capacities and weak hypotonic muscles, primarily because of physical inactivity and poor diet.Objectives: This study discusses the benefits of exercise therapy on body composition, aerobic capacity, muscle strength, proprioception and cardiometabolic profiles of PWDS.Methods: A literature review using the Crossref metadatabase, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), focusing on the period 2007-2018, was undertaken. Each record was judged adopting the modified Downs and Black Appraisal Scale. The literature investigation identified 15 701 records. Records were excluded if they were published before 2007, pertained to the impact of exercise on intellectual disabilities beyond Down syndrome or the impact of medical, pharmaceutical, nutrition and psychological interventions among PWDS and were published in languages besides English. Nineteen articles were synthesised into this commentary.Results: PWDS have a heightened cardiometabolic risk profile and high oxidative stress associated with elevated insulin resistance, poor insulin sensitivity, atherosclerosis and hypertension. PWDS have low aerobic capacity (VO2max), peak heart rates, muscle strength, agility and balance. Regular physical activity is beneficial to improve their VO2max and muscle strength. Moreover, regular physical activity reduces lipid peroxidation and arterial cell wall damage, the pathogenesis of atheroma is limited.Conclusion: Exercise therapy compliance seems to have a positive impact on the cardiometabolic risk profile, muscle strength and aerobic work capacity of PWDS. Nonetheless, additional vigorous experimental investigations are necessary to better understand the effect of exercise therapy on the aerobic, strength, proprioception and cardiometabolic risk profile of PWDS.

Background: There are approximately 1 billion people living with chronic lower limb disability, many of whom are wheelchair users.Objectives: Review cardiometabolic and neuromuscular risk profiles of wheelchair users, benefits of regular exercise and the causes of neuromuscular upper limb and hip injuries that hinder regular adherence.Method: Literature published between 2013 and 2017 was adopted according to the standard practices for systematic reviews (PRISMA) through Crossref Metadata and Google Scholar searches. Individual paper quality was evaluated using a modified Downs and Black Appraisal Scale.Results: The literature search identified 16 600 papers which were excluded if they were non-English, non-peer-reviewed or published before 2013. Finally, 25 papers were accepted, indicating that sedentary wheelchair users have poor cardiometabolic risk profiles (PCMRP) because of a lack of physical activity, limiting their quality of life, characterised by low self-esteem, social isolation and depression. Their predominant mode of physical activity is through upper limb exercises, which not only improves their cardiometabolic risk profiles but also precipitates neuromuscular upper limb overuse injuries. The primary cause of upper limb injuries was attributed to poor wheelchair propulsion related to incorrect chair setup and poor cardiorespiratory fitness.Conclusion: Wheelchair users have a high body mass index, body fat percentage and serum lipid, cholesterol and blood glucose concentrations. Empirical investigations illustrate exercise improves their PCMRP and cardiorespiratory fitness levels. Although literature encourages regular exercise, none discusses the need to individualise chair setup in order to eliminate wheelchair pathomechanics and upper limb neuromuscular injuries. Wheelchair users must be encouraged to consult a biokineticist or physiotherapist to review their wheelchair setup so as to eliminate possible incorrect manual wheelchair propulsion biomechanics and consequent overuse injuries.

Interprofessional knowledge and perceptions of selected South African healthcare practitioners towards each other

Background: Habitual school backpack carriage causes neuro-musculoskeletal vertebral, shoulder and hand pain; deviated posture compromised cardiopulmonary function and proprioception.Objective: Present a novel literature summary of the influence of backpack carriage associated with deviated cervical posture and compromised pulmonary function.Method: An electronic literature appraisal adopting the Preferred Reporting Items for Systematic Reviews, using Google Scholar, Science Direct, EMBASE, AMED, OVID, PubMed and Sabinet search engines, was instituted during 2009–2019. Key search words: schoolbag, backpack, carriage, cervical posture and children. The quality of the studies was assessed using the Downs and Black Appraisal Scale.Results: 583 records were initially identified which was reduced to 14 experimental and observational studies. A total of 1061 participants were included across the 14 studies, with an average age of 11.5 ± 1.3 years, body mass of 37.8 ± 6.6 kilograms (kg), height of 1.41 ± 0.05 meters (m), backpack mass of 5.2 ± 0.9 kg and percentage backpack mass to child’s body mass of 13.75%. The studies mean rating according to the Downs and Black Appraisal Scale was 76.3%. The average craniovertebral angle (CVA) was 53.9° ± 14.6° whilst standing without carrying a backpack was reduced to 50.4° ± 16.4° when loaded (p 0.05). Backpack loads carried varied from 5% – 30% of the participant’s body mass that produced a mean CVA decline of 3.5°.Conclusion: Backpack carriage alters cervical posture, resulting in smaller CVA and compromised pulmonary function. There is no consensus of the precise backpack mass that initiates postural changes. Girls’ posture begin changes when carrying lighter backpacks as compared to boys of the same age strata.

This chapter describes the South African profession of Biokinetics, which operates within the pathogenic and fortogenic health paradigms. Biokinetics is an exercise therapy profession that exclusively prescribes individulaised exercise and physical activity for rehabilitation and promotion of health and quality of life. Biokinetics differs from physiotherapy primarily due its management of injuries, illnesses and disabilities within the final-phase of rehabilitation. A brief history of the profession and its scope of profession and its alignment within the South African National Health statutory and professional bodies will be presented. The two pedagogic models adopted for the teaching and training of Biokinetics will also be discussed. Interprofessional collaborative partnerships within the medical-rehabilitation fraternity, sport, health and fitness industries and educational employment opportunities will be reviewed. Finally, the idea of internationalisation of the profession of Biokinetics to similar exercise therapy professions such as Clinical Exercise Physiology and Athletic Training will be presented.

Work-related injuries date back to antiquity. Attempts to resolve these work-related challenges have, inter alia, led to the establishment of the professions of Ergonomics, Occupational Therapy, Physiotherapy, Occupational Hygiene, and Biokinetics. The objective of this article is to illustrate the value of Ergonomic principles as an adjunct to the profession of Biokinetics. Insofar as Ergonomics addresses the physical and environmental risks which predispose and precipitate injuries, the profession of Ergonomics is primarily concerned with the practice of eradicating work-related challenges that impede human–machine interfacing, and which adversely influence work productivity and employee health. While Occupational Therapy and Biokinetics, by rehabilitating work-related injuries, assist in improving working conditions, little is known about the exact interface between the professions of Ergonomics and Biokinetics. The Google Scholar database was consulted in order to determine the relationship between Ergonomics and Biokinetics. The key words used were ergonomics and biokinetics and lead to the identification of 545 records, none of which pertained to the aforementioned subject. A subsequent search was conducted using the key words work-related musculoskeletal injuries and biokinetics. This search identified 925 records, the number of which were reduced to 42 (4.76%) after the exclusion of patents (n = 24), citations (n = 3), and nonbiokinetic work-related injury research (n = 856). Given that many work-related injuries are managed through the use of biokinetic rehabilitation, knowledge of the physical ergonomic risk factors at play will afford biokineticists an enhanced understanding of the etiology of work-related injuries, thereby helping to improve the vigor of the rehabilitation.