OBSTETRIC PHYSIOTHERAPISTS AND BREAST-FEEDING

A-M Bergh, R J Grimbeek, P M Kachelhof- 
fer*

ABSTRACT
This study determined the perceptions of obstetric physiother­
apists on the state of breast-feeding in South Africa and their 
contribution to breast-feeding education. A questionnaire to 
the 134 members of the Obstetric Association of the South 
African Society of Physiotherapy was completed by 36 prac­
tising respondents and 23 non-practitioners. The total re­
sponse rate was 44%. A significantly larger group of practising 
respondents who had completed theirtraining in the seventies 
returned the questionnaire. About 93% of respondents felt 
their basic training in breast-feeding had been inadequate. 
Almost 56% has received further training in breast-feeding 
during the previous five years. Regarding the impact of the 
South African national breast-feeding week campaign, 47% of 
respondents perceived a change in attitudes toward breast­
feeding and 22% a change in breast-feeding practices. It is 
concluded that the perceptions of other groups of health 
professionals, the educational needs of parents and effective 
educational strategies also need investigation.

OPSOMMING
Hierdle studie het die persepsies van verloskundige fisiotera- 
peute oor die stand van borsvoeding in Suid-Afrika en hul 
bydraetot borsvoedlngsvoorllgtlng ondersoek. 'n Vraelys aan 
al 134 lede van die Verloskundige Assosiasie van die Suid-Af- 
rlkaanse Vereniging vir Fisioterapie is deur 36 praktiserende 
respondents en 23 nie-praktiserendes voltooi. Die totale re- 
sponskoers was 44%. 'n Betekenisvol groter groep praktis­
erende respondente wat hul opleldlng in die sewentigerjare 
voltooi het, het die vraelys teruggestuur. Omtrent 93% van die 
respondente het gevoel hul basiese opleiding in borsvoeding 
was onvoldoende. Amper 56% het gedurende die vorige vyf 
Jaar verdere opleiding in borsvoeding ontvang. Ten opsigte 
van die uitwerking van die Suid-Afrikaanse nasionale bors­
voeding week veldtog het 47% van die respondente 'n veran- 
dering In houdlng teenoor borsvoeding waargeneem en 22% 
'n verandering in borsvoedingspraktyke. Die gevolgtrekking 
word gemaak dat die persepsies van ander professionele 
groepe, die opvoedkundige behoeftes van ouers en ef- 
fektiewe onderrigstrategiefl ook verdere ondersoek verdien.

Keywords: Breastfeeding; childbirth education.

INTRODUCTION
The incidence and duration of breast-feeding in industrialised 

countries1, and also am ongthe more affluent communities in South 
Africa, are on the increases This is possibly due to the influence of 
a complexity of factors, including an increased emphasis on promo­
tional and educational activities. In South Africa a breast-feeding 
campaign has been running since 1987. Obstetric physiotherapists 
have also taken part in some of these activities and are particularly 
active in the field of childbirth education.

Since the 1980’s there also appears to have been an increased 
interest in research related to breast-feeding. A number of South 
African reports on breast-feeding attitudes and practices of mothers 
have recently been published3*1 . as well as a few reports on support 
for breast-feeding mothers9,14 . Although a few studies have also

been reported in the literature on the knowledge, attitudes o r prac­
tices of health professionals in respect of breast-feeding, no reports 
on health professionals’ contribution to breast-feeding education in 
South Africa has been published up to date. Therefore, the aim of 
this study was to determine the perceptions o f obstetric physiother­
apists on the state of breast-feeding in South Africa, and to assess 
their contribution to breast-feeding education, specifically in the 
form of ante- and postnatal classes.

SUBJECTS, METHODS AND STATISTICAL 
ANALYSIS

An English questionnaire, with an Afrikaans translation on the 
reverse side, was mailed to all 134 members of the Obstetric Associ­
ation of the South African Society of Physiotherapy in March 1990. 
A reminder was posted three weeks after the closing date, which 
yielded another eight replies. The total response rate was 44% 
(N=59).

Table I: Demographic particulars of respondents

CURRENTLY
PRACTISING

Yes No
AS OBSTETRIC 
PHYSIOTHERAPIST 61% (N=36) 39% (N=23)

PLACE OF 
TRAINING

English
institution

Afrikaans
institution

54,2% <N=32) 45,8% (N=*27)

YEAR OF 
COMPLETION OF

A
<1960

B
1960-69

c *
1970-79

D
21980

BASIC TRAINING
16,9% 
(N=10)

22,0% 
(N=13)

40,7%
(N»24)

20,3%
(N=12)

FURTHER TRAINING
Yes No

IN BREAST-FEEDING
55,9% (N=33) 44,1% (N=26)

LANGUAGE IN WHICH 
QUESTIONNAIRE

English* Afrikaans
WAS COMPLETED

79,7% (N=47) 20,3% (N=12)

Differs from other category/ies in same group at p<0,05

Questions pertaining to demographic particulars of respondents 
(see Table I) and to their perceptions of the impact of the national 
breast-feeding week (see Tables III-V) were structured. A struc­
tured question was also posed about further training in breast-feed- 
ing during the past five years -  this could have been a training course 
in breast-feeding, a seminar, workshop or conference on breast-feed­
ing, or other courses and seminars where breast-feeding had been 
included as a topic. Open-ended questions were formulated to elicit 
data on the socio-economic status, language and culture of clients, 
as well as on the educational aids used by respondents who were in 
practice at that stage.

The log-linear model applied to contingency tables was used to 
establish associations between different variables. For the analysis of 
two by two contingency tables, Fisher’s exact test was applied. The 
Friedman non-parametric procedure for the two-way analysis of 
variance was used to identify important significant categories given 
by respondents in open-ended questions.

RESULTS
Respondents practising as obstetric physiotherapists (i.e. con­

ducting ante- or postnatal classes) at the time of the survey will be

Physiotherapy, February 1993 Vol 49 no 1 Pape 7

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referred to as practitioners and those not practising as non-practi­
tioners.

The demographic data obtained from the questionnaire are sum­
marised in Table I. O f particular interest is the year in which basic 
training had been completed and further training received in breast­
feeding. The total respondent size of Group C (i.e. respondents who 
had completed training between 1970 and 1979), as well as the size 
of the group of practising respondents in Group C, was significantly 
larger than those in Groups A, B and D. This was, however, not the 
case for non-practising respondents in Group C.

About 55,9% (N =33) of respondents had received further train­
ing in breast-feeding during the past five years and 44,1% none 
(N =26). Almost 75,8% (N =25) of practising respondents had re­
ceived further training, compared to only 24,2% (N =8) of non-prac- 
t i t i o n e r s . T h is d if f e r e n c e  b e tw e e n  p r a c t i t i o n e r s  a n d  
non-practitioners was highly significant (p =0,009) when Fisher’s 
exact test (one-tail) for a two by two contingency table was applied. 
There was, however, no difference between those receiving further 
training or no further training with regard to year or place o f training, 
or language used in the questionnaire.

Most respondents (93,1%, N =54) felt their basic training in 
breast-feeding had been inadequate. Slightly more practising re­
spondents (97,1 %, N =34) were dissatisfied with their basic training 
than non-practitioners (87%, N =20). There were no significant 
differences in perception of adequacy of training when results were 
compared to year or place of training, or language used in the 
questionnaire.

Other data for the practising respondents (N =36) showed that 
all of them lectured to private patients. Only 13,9% (N = 5 ) con­
ducted classes for state or hospital patients as well. The average 
number o f private patients educated by respondents during the 
previous year was 67,4 (ranging between 10 and 250) and for hospi­
tal/state patients 28,2 (ranging between three and 70).

In an open-ended question about the socio-economic status of

clients, all but one respondent considered the majority o f their clients 
to be “middle” or “upper class”. Other terms used were “average”, 
“good”, “privileged”, and “high”. All respondents, except for two, 
indicated that their clients were predominantly Afrikaans or English 
speaking whites. Only 21,1 % (N = 8) mentioned that they had clients 
of other ethnic groups as well.

All practising respondents also indicated that they discussed 
breast-feeding in a special lecture or talk. Thirteen said that breast­
feeding was the only topic o f that session.

Thirty four o f the 36 practising respondents mentioned at least 
one educational aid used in their breast-feeding classes. To identify 
the significantly more popular educational aids, a multiple compari­
son technique, based on Friedman rank sums, was applied at a 5% 
level of significance (Phase A). The item with the highest frequency,
i.e. visual aids, formed a category on its own and was significantly 
separated from the three items with the lowest frequency. Signifi­
cantly more popular educational aids at the 5% level o f significance 
were visual aids (72,22%), hand-outs (50%), audio-visual aids 
(41,67%), demonstrations and props (30,56%), and reading matter 
(25%). A second application o f the Friedman test at a 5% signific­
ance level (Phase B) to these five items showed reading m atter to be 
significantly separated from the other four. Table II gives a further 
breakdown of this procedure.

Table III: Perceived changes In attitudes as a result of the 
breast-feeding campaign (N=55)

Yes 
% <N>

Mo 
ft (N)

Uncertain 
% (N)

TOTAL 
% (N)

Practitioners 34,6 (19) 5,5 (3) 23,6 (13) 63,5 (35)
Non-practitioners 12,7 (7) 1,8 (1) 21,8 (12) 36,4 (20)
TOTAL 47,3 (26)* 7,3 (4) 45,4 (25)* 100,0+(55)

Significantly more than the "No" responses at p<0,05 
Difference in table due to rounding-off error

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Table II: Educational aids used by currently practising obstetric physiotherapists (N=36)

EDUCATIONAL AID

VISUAL AIDS
(diagrams, pic­
tures, photographs, 
posters, black 72%
board drawings, 
model of breast, 
breast atlas)
HAND-OUTS
(notes, support 50%
telephone numbers)

AUDIO-VISUAL AIDS 
(videos, slides, 42%
films)

DEMONSTRATIONS AND 
PROPS (doll, 31%
balloon, real mother 
breast-feeding)

READING MATTER
(books, booklets, 25% 
articles, pamphlets 
on loan or for sale)

BREAST-FEEDING 
DEVICES (pumps, 
nipple shields, 
breast pads)

SPECIAL LECTURER

AUDIO-TAPES

8%

3%

3%

PERCENTAGE OF PRACTISING RESPONDENTS 

B

N=3

N=1

N=1

N=
26

N=1 8

N=1 3

N=11

A Division by Friedman te s t between more and less popular educational aids a t a 5% level of significance 
B Division by Friedman te s t between more and less popular educational aids a t a 10% level of 

significance

Table IV: Perceived changes in practice as a result of the Table V: Perception that breast-feeding is being pushed too
breast-feeding campaign (N=55) much (N=53)

Yea No Uncertain TOTAL Yea No Uncertain TOTAL
% (N) % <N) % (N) % (N) t (N) % (N) % (N) % (N)

Practitioners 18,2 (10) 1,8 (1) 43,6 (24) 63,6 (35) Practitioners 7,6 (4) 54,7 (29) 0,0 (0) 62,3 (34)
Non-practitioners 3,6 (2) 0,0 (0) 32,7 (18) 36,4 (20) Non-pract i t i oners 0,0 (0) 34,0 (18) 3,8 (2) 37,8 (19)
TOTAL 21,8 (12) 1,8 (1) 76,4+(42)* 100,0 (55) TOTAL 7,6 (4) 88,7 (47)* 3,8 (2) 100,0+(53)

* Significantly more than the "No" responses at p<0,05 * Significantly more than the "Yes" and "Uncertain" responses
+ Difference in table due to rounding-off error at p<0,05

+ Difference in table due to rounding-off error

Physiotherapy, February 1993 Vol 49 no 1 Page 9

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Respondents were also questioned about their perceptions of the 
impact of the national breast-feeding week campaign. The log-linear 
model applied to contingency tables indicated that those who 
thought the campaign had influenced attitudes positively and those 
who were uncertain, were in proportion significantly more than those 
who thought the campaign had not made a difference. With regard 
to perceived changes in breast-feeding practices, a significantly 
higher proportion o f respondents were uncertain as opposed to the 
proportion who answereid that there had been no change.Although 
the difference was not significant, 54,3% o f practitioners tended to 
perceive changes in attitudes as a result of the breast-feeding cam­
paign, compared to 35% of non-practitioners. Only 28,6% o f prac­
titioners and 10% o f non-practitioners felt th a t changes in 
breast-feeding practices had occurred. The trend is more conspicu­
ous with regard to changes in attitudes than to changes in practices. 
Neither the year or place o f training, nor the language in which the 
questionnaire was completed, made a significant difference to the 
perceptions about the impact of the campaign. A more detailed 
analysis is given in Tables III and IV.

For both questions on the perceived changes in attitudes and 
practices as a result o f the national breast-feeding week a space was 
provided for comments. A few remarks by respondents on changes 
in attitudes were the following:
• Breast-feeding is now more acceptable.
• More positive support.
• Information is given to the general public. They are more aware 

of it.
• (Breast-feeding week) reinforces correct attitudes.
• Society, especially men, are now aware that breast-feeding is a 

natural way to feed a baby and are slowly accepting it.
• Wish it (i.e. breast-feeding week) could be more than once a year, 

especially in the platteland.
• Breast-feeding rooms (should be established) at department 

stores.
• Not as much as one should hope. Doctors and nurses need to be 

more encouraging and spend more time supporting patients.
• Population groups (i.e. number of people) exposed to it (i.e. 

breast-feeding week) is little in comparison to the number that 
could be exposed to breast-feeding by the GP or the gynaecolog­
ist.

• Breast-feeding in public is still largely unacceptable for whites. To 
a degree (there has been a change in attitudes). There is still a 
greater swing to the “easier” method of bottle-feeding.

• Difficult to motivate mother, who does not wish to feed, to attend 
(antenatal classes?/breast-feeding week activities?)
Changes in practices were perceived by individual respondents as 

follows:
• (Mothers) talk about problems more easily and seek help.
• Especially among nursing staff in hospitals
• Not much, but demand feeding (is now) better accepted by 

doctors and nurses.
Attitudes of respondents were also probed by a question on 

whether they though breast-feeding was being “pushed” too much 
(Table V). About 88,7% (N =47) answered “No”, 7,5% (N = 4 ) felt 
it was being “pushed” too much, and 3,8% (N =2) were uncertain. 
Applying the log-linear model, it was found that significantly more 
respondents answered “No” than “Yes” or “Uncertain”. Four prac­
titioners felt that breast-feeding was being “pushed” too much, 
compared to none of the non-practising respondents. This difference 
was not significant. There was also no significant difference with 
regard to year or place of training, or the language used in the 
questionnaire.

The following were a few of the comments of individual respond­
ents to the question o f whether breast-feeding was being “pushed” 
too much:
• Needs all the pushing it can get.
• Every bit helps.
• With more women needing to work, we need to “push” breast­

feeding.
• If things are repeated frequently enough people eventually take 

note.
• Medical profession needs to spend more time and effort prom ot­

ing breast-feeding.
• Unless breast-feeding in “public” (i.e. facilities for feeding) 

becomes the norm it will not succeed well.
• Mothers made to feel guilty if they cannot breast-feed.
• (a mother) should not be made to feel inadequate if she doesn’t 

want to feed.
• Mothers who want to feed will come for advice, but if they are 

against breast-feeding it will have little effect.

DISCUSSION
M ore practising (N = 3 6 ) than non-practising respondents 

(N =23) returned the questionnaire, which was expected, as people 
in practice tend to be more interested in subjects related to their 
activities than non-practitioners. No further conclusions can, how­
ever, be derived since no record is available of how many members 
o f the total population o f the Obstetric Association were practising 
at that stage. It is also not clear how many persons practising as 
obstetric physiotherapists are not members o f the Obstetric Associ­
ation.

None of the following variables made a significant difference to 
the findings: language in which the questionnaire was completed; 
language of training institution; the year in which basic training was 
completed. This may be due to the relative homogeneity o f a profes­
sional group and the feet that the group under study mainly serves a 
fairly homogenous portion of the population, namely whites from the 
middle and higher income groups who do not qualify for medical aid 
from the state.

Significantly more obstetric physiotherapists who had completed 
their training in the seventies responded and it could be assumed that 
more physiotherapists from the seventies belong to the Obstetric 
Association than from other periods. One explanation may be that 
professionals who completed their training during this period are 
now in the age group where professionals in general tend to belong 
to specialised professional associations. The group o f practising re­
spondents who had qualified in the seventies was also significantly 
larger than that o f respondents qualified in other periods. There has, 
however, not been a decline in the enrolment for physiotherapy 
courses in the eighties and one would have expected a larger number 
of respondents from the eighties. It may be that physiotherapists 
become interested in obstetric physiotherapy at a later stage, possibly 
after having had their own children, and that an increase in obstetric 
physiotherapists completing their training in the eighties could be 
expected during the nineties. Cross et al, in their study o f the conti­
nuing education preferences of dieticians, concluded that “pref­
erence for topics according to one’s age appears to be related to 
personal life; for example, the higher preference for nutrition in 
pregnancy and lactation by younger members”.(p. 185)20

Two variables made a significant difference in some o f the find­
ings, viz. currently practising as obstetric physiotherapist, and further 
training in breast-feeding during the previous five years. It is to be 
expected that practising respondents would be more interested in 
attending courses, conferences and seminars where topics related to 
childbirth are discussed. O f some concern is the fact that 24% of 
practitioners had received no further training in breast-feeding dur­
ing the previous five years. Approaches to breast-feeding manage­
ment have changed a lot during the past 10 years and in addition, 
97% o f practitioners indicated that their basic training in breast-feed­
ing had been inadequate. It is, therefore, unclear how much outdated 
information is still in circulation. An investigation into the practition­
ers’ sources of information and an assessment o f their knowledge on 
breast-feeding may provide more insight into the matter.

Most obstetric physiotherapists’ clients are white and it seems 
necessary to reflect on whether obstetric physiotherapists form an 
elitist group and whether it would be possible to broaden their base.

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Due to many factors, few members from underprivileged groups in 
this country have qualified as physiotherapists in the past. This limits 
the number o f professionals who can practice as obstetric physiother­
apists, which in turn may prevent them from rendering more com­
munity service to members o f other groups. It may also be necessary 
to investigate the role of cultural differences in the need for childbirth 
education.

Catering for clients from the higher income groups also poses 
special challenges. Families in westernised and industrialised cultures 
tend to be small, nuclear families. Most girls and women are, there­
fore, not frequently exposed to breast-feeding, are not equipped with 
the basic skills for coping with a new baby, and do not always have 
access to breast-feeding support in everyday life. Thus, clients of 
obstetric physiotherapists may require more in-depth and explana­
tory information as well as practical training. This makes it essential 
for obstetric physiotherapists to provide postpartum support, to 
keep up to date with the latest trends and to re-evaluate educational 
practices from time to time.

E d u catio n al aids p re fe rre d  by m ost practicing o b stetric 
physiotherapists are visuals, hand-outs, audio-visuals, demonstra­
tions and props, and reading matter. It was, however, not possible to 
assess the effectiveness o f these aids by means o f the questionnaire. 
Considering most obstetric physiotherapists’ clients’ lack of exposure 
to breast-feeding technique and management, effective use o f edu­
cational aids is essential. More “hands-on” experience, eg. with the 
aid of special dolls, may also be a possibility to investigate.

Visuals are the most used educational aid. From a practical 
viewpoint they are easy to use, readily available and easy to transport. 
Most may also be a relatively cost-effective investment. Although 
audio-visuals may be more effective in illustrating some aspects of 
breast-feeding technique, the few good videos and films may not be 
widely available, proper equipment for showing them could be a 
problem, or they may be too costly to acquire. Three possible reasons 
why only 25% o f practitioners mentioned reading matter are the 
following: not many clients like reading; some obstetric physiothera­
pists do not provide “library services” for clients; and clients obtain 
books and pamphlets from elsewhere.

Hand-outs were mentioned by half of the practitioners. These can 
be very helpful, especially if support telephone numbers are also 
provided so that new mothers can find help to overcome minor 
lactation difficulties and problems with self-confidence. Although 
only one respondent mentioned the use o f a special lecturer for the 
breast-feeding class, it is a practice that could be encouraged. Such 
a person should preferably have personal experience of breast-feed­
ing, a wide range of knowledge and some teaching skills.

The promotion of breast-feeding has been receiving much atten­
tion in South Africa during the past few years, for reastins which 
include an annual national breast-feeding week. This campaign is 
aimed at making the general public aware of the importance of 
breast-feeding. More practitioners than non-practitioners had ob­
served changes in breast-feeding attitudes and practices as a result 
of the campaign. This could be explained by the fact that practitioners 
are more frequently and more regularly in contact with breast-feed­
ing mothers and are in a position to personally observe minor and 
subtle changes.

Nearly half of all respondents felt that the campaign had con­
tributed to a change in attitudes and just more than one fifth of 
respondents perceived a change in practices. This difference may be 
due to the fact that changes in attitudes usually precede changes in 
behaviour, but may also indicate that people tend to observe changes 
in attitudes more intuitively than changes in practices, which are 
easier to measure quantitatively. For instance, one respondent who 
felt the attitudes had changed, commented on the question about 
changes in practices as follows: “Possibly. It is hard to establish this 
on face value. A  survey at clinics should be able to see the increase 
in breast-feeding, etc.”

The positive responses with regard to perceived changes in atti­
tudes and practices should also be evaluated against the large num­
ber of uncertain responses. For the question on attitudes, positive

and uncertain responses were nearly equal (47,3% and 45,4% re­
spectively). For the question on practices, 76,4% o f responses were 
uncertain, and only 21,8% positive. This phenomenon may indicate 
that professionals are hesitant to express an opinion not based on 
quantitative data. Empirical studies measuring the impact o f the 
breast-feeding campaign would, therefore, be necessary.

The nearly 89% o f respondents who felt that breast-feeding was 
not being pushed too much indicate a positive attitude and a com­
mitment among obstetric physiotherapists to breast-feeding promo­
tion. The four practising respondents who felt breast-feeding was 
being pushed too much may have bad negative experiences in their 
practices.

A  number of further research questions also emanated from this 
study. Studies similar to this one are needed for other groups such 
as midwives, community nurses, nutritionists, general medical prac­
titioners, obstetricians, and paediatricians. Furthermore, it is essen­
tial to consult the consumer of breast-feeding education as w ell For 
conducting more efficient breast-feeding education programmes, 
more systematic research on the following is needed: the educational 
needs of parents; the breast-feeding knowledge which is most benefi­
cial for parents; and the most effective educational strategies for 
creating positive attitudes and improving breast-feeding practices. 
Further investigation into the use o f the Friedman test as a statistical 
method for determining educational priorities also deserves con­
sideration.

Acknowledgements
We would like to thank the following persons and institutions: the 

Obstetric Association of the SA Society for Physiotherapy for their 
kind co-operation and their permission to publish the results; Margie 
Pretorius of the Obstetric Association for her support during the 
survey; the Sub-directorate: Nutrition, Department o f National 
Health and Population Development for logistical assistance; Denise 
Holton o f the Bureau for Computer Services, University of Pretoria, 
for the computer analyses.

The financial assistance of the Institute for Research Develop­
ment towards this research is hereby acknowledged. Opinions ex­
pressed in this publication and conclusions arrived at, are those of 
the authors and are not necessarily to be attributed to the Institute 
for Research Development.

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6. Ransome OJ, Chalmers B, Herman AAB et al. Infant feeding in an urban 
community. South African Medical Journal 1988;74:393-395.

7. Myburgh J, Price S. To breast-feed or not to breast-feed? That is the 
question. Curationis 1985;8:32-34.

8. Hoffman MN, Duncan NM, Disler PB. Breast-feeding in a socioecon­
omically disadvantaged area of Cape Town Part I. Analysis of breast-feed- 
ing patterns among clinic attenders. South African Medical Journal 
1984;66:64-65.

9. Hoffman MN, Duncan NM, Disler PB. Breast-feeding in a socio-econ- 
omically disadvantaged area of Cape Town Part II. Introduction of an 
educational and support programme. South African Medical Journal 
1984;66:66-67.

10. Ross SM, Van Middelkoop A, Khoza NC. Breast-feeding practices in a 
black community. South African Medical Journal 1983;63:23-25.

11. Steyn M, Swanepoel ASP, Roussouw U e ta l. ’n Ondersoek na die kennis, 
houdings en gebruike van ’n groep blanke moeders rakende borsvoeding 
en kindervoeding (Navorsingsbevinding KOMM N-163). Pretoria: 
Human Sciences Research Council, 1987.

continued on page 13...

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REPORT ON THE ANNUAL GENERAL MEETING OF THE INTERNATIONAL 
BOBATH INSTRUCTORS ASSOCIATION FOR ADULT HEMIPLEGIA (IBITAH) 

HELD IN OSAKA, JAPAN 17-21 SEPTEMBER 1992

The Executive Committee Meeting was held on Thursday 17 
September, followed by a “Welcome Party” at which the 43 delegates 
were introduced to the Japanese instructors and their colleagues. 
Delegates came from such diverse countries as Austria, Germany, 
Great Britain, Holland, Israel, Japan, Korea, South Africa, Spain, 
Switzerland and the USA.

The Annual General Meeting was held on the Friday and con­
cluded on the Sunday morning. Only minor changes were made to 
the Bye-Laws, Rules and Regulations as these had been finalised, 
after several years of work, at the previous AGM in 1991. Two new 
sub-committees were formed - an Education Committee and a Com­
mittee for Developing Countries. Their briefs are as follows:

Education Committee
• to co-ordinate future educational seminars with the host country
• to develop bibliographies and reference lists
• to co-ordinate literature reviews
• to encourage and develop research

Committee for Developing Countries
• to support basic or advanced courses in the treatment o f adult 

hemiplegia in countries who have no IBITAH-recognised instruc­
tors

• to facilitate training of instructors for these countries
In each case a preliminary committee was appointed and re­

quested to formulate detailed objectives and a suggested plan of 
action to be put to the next General Meeting.

My proposal for collaborative research was agreed upon in prin­
ciple and I shall be working with the Education Committee on its 
implementation.

Several proposals were put forward for courses designed for 
nurses and other supporting personnel. This is of particular interest 
for us in South Africa, where we are already considering specific 
courses on adult hemiplegia for physiotherapy assistants. It is hoped 
that the course structure and content will be finalised at the 1993 
Meeting.

At the General Meeting my certification asa Senior Instructor was 
approved. There are three grades of instructor - Instructor, Ad­
vanced Instructor and Senior Instructor, with only Senior Instructors 
being allowed to train and certify instructor candidates. This means 
that we shall now be able to train our own instructors

I was elected Chairman of IBITAH for the next three-year term 
o f office, and was also elected to the Committee for Developing

Countries. The next Executive Committee Meeting will be held in 
London in January 1993, and the Annual General Meeting in Venice 
in September o f the same year.

The educational seminar this year was in two parts - the first part 
consisted o f two 2-hour lecture sessions, each followed by discussions. 
Emeritus Professor Hirotaro Narabayashi, o f Juntendo University, 
spoke in detail on the physiological function o f the thalamus and basal 
ganglia and followed this up with an interesting series o f before-and- 
after videos on stereotaxis for tremor. Most o f the patients in the 
series had showed residual trem or after the akinesis o f Parkinson’s 
disease had been abolished by medication. Very good results had also 
been obtained by stereotaxic surgery in abolishing the choreiform 
movements seen as a side-effect o f medication with levadopa. O f 
particular interest to me was a small series of successful operations 
on severely athetoid cerebral palsied children. It was interesting to 
note that the criteria for selection in these cases were very similar to 
our own criteria for recommending children for selective posterior 
rhizotomy.

Professor Kisou Kubota, o f Kyoto University, talked on motor 
programming in the frontal lobe and environs. His session was of 
particular interest to therapists interested in the retraining o f func­
tional activities and the voluntary control o f movement. He enlarged 
upon this further when speaking o f cortical control o f hand function.

The second session occupied Saturday afternoon and part o f 
Sunday. Five small groups analysed a videotape recording o f upper 
limb function in an ambulant hemiplegic woman. Tasks set involved 
problem analysis and the development o f appropriate treatment 
strategies. Analysis showed that, due largely to trunk involvement, 
use of the normal arm was also very restricted. Problem solving 
involved both postulating strategies and demonstrating activities 
which might be used in treatment.

On the Friday night delegates were entertained at a magnificent 
banquet at the top of a skyscraper overlooking Osaka Castle and 
park. The banquet featured a sumptuous array o f Japanese cuisine, 
a display o f ice-sculptures, several traditional Japanese entertain­
ments and breathtaking views of the lights o f Osaka through floor- 
to-ceiling windows on both sides o f the room. Other events during 
the Meeting included a cruise on the Osaka river, traditional 
Japanese meals and a video on the work o f the Bobath Hospital in 
Osaka. On the two days following the Meeting very enjoyable tours 
were arranged to Nara and Kyoto, visiting many temples and shrines 
and getting to know a little o f the Japanese way o f life.

SH Irwin-Carruthers

12. Rossouw JPH, Jansen M. Memorandum to the Director General of the 
Department of National Health and Population Development. Breast­
feeding in South Africa 1987-1989. Pretoria: Human Sciences Research 
Council, 1990.

13. Naidoo N. A study of children under the age of six years attending a rural 
general practice. SA Family Practice 1991;12:129-137.

14. Ross SM, Loening WEK, Mbele BE. Breast-feeding support. South 
African M edicalJoumal 1987;72:357-358.

15 Thornton L. Support networks for breast-feeding mothers. Nursing RSA 
1987;2(9): 18-19.

16. Hofmeyr GJ, Nikodem VC, Wolman WLetal. Companionship to modify 
the clinical birth environment: effects on progress and perceptions of 
labour, and breast-feeding. British Journal o f Obstetrics and Gynaecology 
1991;9S(8):756-764.

17. Mkhasibe C, Wagstaff L. Breast-feeding practices of nurses at Baragwa- 
nath, Coronation and Johannesburg Hospitals. Curationis 1988;11(4):19- 
21.

18. Delport SA, Bergh AM, Hay IT. Breast-feeding practices in a private

maternity hospital. South African Medical Journal 1988;74:396-399.
19. Maasdorp J, Loening W. Are breast-feeding problems iatrogenic? South 

African Medical Journal 1989;76:397.
20. Cross N, van Horn L, Olson R etal. Assessment of continuing education 

preferences in Illinois. Journal o f the American Dietetic Association 
1984;84(2):181-186.

‘ Authors
A -M  B ergh: B A  (H o n s), B E d , S E D . D e p a rtm e n t o f C o m ­

parativ e d u catio n  a n d  E d u c a tio n a l M an ag em en t, U N IS A , 
P  O  Box 392, P re to ria  0001.

R  J  G rim b eek : M Sc. D e p a rtm e n t o f  Statistics, U niversity o f 
P re to ria .

P  M  K achelhoffer: B S c (E d ), D E d , D ip  T e rt E d . D e p a rtm e n t 
o f  D id a c tic a l P edagogics, U niversity o f  P re to ria .

Physiotherapy, February 1993 Vol 49 no 1 Page 13

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