Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic Faculty: Health Sciences, Durban University of Technology, 2009 / Aim To determine the profile of traumatic cervical spine fractures with respect to the epidemiology, clinical presentation, types of fractures, conservative and surgical intervention, short-term post-intervention (i.e. post-conservative and post-surgical) complications and short-term post-surgical rehabilitation of patients presenting at the Spinal Unit of King George V Hospital over a 12-week period. Methods Patients who presented to the King George V Hospital Spinal Unit from surrounding hospitals with traumatic cervical spine fractures were evaluated by the medical staff. Data concerning the epidemiology, clinical presentation, types of fractures, conservative and surgical intervention, short-term post-intervention (i.e. post-conservative and postsurgical) complications and short-term post-surgical rehabilitation data were recorded by the researcher. A p-value of <0.05 was considered as statistically significant. Appropriate statistical tests were applied to the hypothesis-testing objectives. These involved the Pearson’s Chi Square Tests for categorical variables or Fisher’s Exact Tests as appropriate where sample sizes were small. Paired t-tests were done to compare preand- post-surgical Frankel grading and Norton Pressure Sore Assessment scores. Results The number of patients who presented to the Spinal Unit over a 12-week period was 20, of this number 17 were males, three were females and all were black. Eleven patients were treated surgically while nine patients were treated conservatively. The most frequent aetiology of cervical spine fractures was motor vehicle accidents (n = 10) followed by falls (n = 9). The most common co-existing medical conditions were smoking (n = 7), HIV (n = 5), alcohol abuse (n = 3) and obesity (n = 3). The most frequent locations of cervical spine fractures were C2 (n = 6), C1 (n = 4) and the posterior column of C6 (n = 3), while dislocations occurred primarily at the C5-C6 levels (n = 5) of the lower cervical spine. Odontoid fractures (n = 6), Jefferson’s fractures (n = 4) and unilateral facet dislocations (n = 6) were the most common fractures and dislocations v observed. Head injuries (n = 4) and lower limb fractures (n = 3) were the most common extra-spinal fractures. All subjects who sustained head injuries also had associated C1 or C2 fractures. Neurological complications most frequently involved the upper limb where loss of motor function (n = 8) and weakness (n = 4) were observed. The majority of the patients (n = 8) reported a Frankel Grading of E. There were no significant associations between types of fracture and gender with the exception of fracture/dislocation observed in two females. There was a statistically significant difference in the NPSA score (p = 0.004). Conservative care utilized included soft collar (n = 6), cones calipers (n = 6), physiotherapy (n = 4), Minerva jacket (n = 4) and SOMI (sterno-occipital mandibular immobilization) brace (n = 1) while surgical intervention included anterior decompression (n = 8), anterior fusion (n = 8), allograft strut (n = 8), discectomy (n = 8), anterior cervical plating (n = 8), anterior screw fixation (n = 2), a transoral approach (n = 1) and a corpectomy (n = 1). The short-term post-conservative care complications observed in this study were an occipital pressure sore (n = 1), severe discomfort (n = 1) as well as severe neck pain (n = 1), while the short-term post-surgical complications were severe neck pain (n = 2), oral thrush (n = 1), pneumonia (n = 1), odynophagia (n = 1) and hoarseness (n = 1). Of the 11 patients who underwent cervical spine surgery, ten were sent for physiotherapy and one for occupational therapy. No significant associations were seen between the type of cervical spine fracture and the age of the subject. There was a significant association between fracture/dislocation and the female gender (p = 0.016). There was significant negative association between odontoid fracture and: anterior decompression, anterior fusion, allograft strut, discectomy and anterior cervical plating (p = 0.006). Conclusion The results of this study reflect the presentation and management of cervical spine fractures at a referral spinal unit of a public hospital in KwaZulu Natal. The impact of HIV and other co-existing medical conditions were not determined due to the small sample size in this study. Further epidemiological studies are required to be conducted in the Spinal Units of all South African public hospitals in order to confirm or refute the observation of this study.

The purpose of this study was to determine the vastus medialis oblique muscular electromyographical (EMG) activity during two therapeutic exercises: the modified straight leg raise and the traditional straight leg raise. Two subject groups of 10 subjects each, one with anterior knee pain (PHY) and the other group with no history of patellofemoral pathology (NORM), performed the traditional straight leg raise (SLR) and a modified straight leg raise with external hip rotation (MOD). Each subject performed an isometric maximum voluntary contraction and three trials of each of the two therapeutic exercises. The EMG variables analyzed were the percent of the maximum voluntary contraction for each muscle, vastus medialis oblique, vastus lateralis, and rectus femoris: the percent of the maximum voluntary contraction of the ratio between the vastus medialis oblique and the vastus lateralis; the percent of the maximum voluntary contraction for the integrated EMG for each muscle; and the percent of the maximum voluntary contraction for the root mean square for each muscle. The statistical analysis was conducted with two-way analysis of variance procedures. The statistical analysis revealed no significant differences; however, the data appeared to illustrate a trend toward more electromyographical activity in the vastus medialis oblique in the PHY subject group during the MOD therapeutic exercise. This suggests that the MOD therapeutic exercise may be able to isolate the vastus medialis oblique muscle in persons with anterior knee pain and allow them to regain strength and normal function earlier than with the use of the SLR therapeutic exercise. / School of Physical Education

Augmented Soft Tissue Mobilization (ASTM) is a new noninvasive technique utilized to treat chronic musculoskeletal injuries. The purpose of this study was to trace the morphological events in collagenase injured rat Achilles tendons during ASTM treatment and to observe passive occurrence of post treatment remodeling in tendons. Twelve groups of rats were divided into the following categories, A) control, B) sham surgery, C) ASTM only, D) ASTM/sham , E) tendinitis, F) ASTM/tendinitis 1 week, G) ASTM/tendinits 2 weeks H) ASTM/tendinits 3 weeks I) ASTM/tendinits 4 weeks, J) Post ASTM 5 weeks, K) Post ASTM 10 weeks, L) Post ASTM 15 weeks. One week after the last designated treatment, the Achilles tendons were harvested and then prepared for light microscopy, electron microscopy, and bifringence polarizing microscopy. An increase in fibroblast activation and proliferation was noted with the tendinitis, ASTM/tendinitis, and post groups. Ossification occurred in the core of the Achilles tendon in all of the ASTM groups. The presence of inflammatory cells was observed in the tendons and longitudinal remodeling of the collagen fibers did not occur. / Department of Biology

The primary purpose of this study was to determine the ratio of activation between the VMO and VL while performing three selected knee exercises (drop squat, modified lateral squat, Muncie Method). Additionally, the data was analyzed to determine if a correlation existed between the muscle's activation rate per set and whether or not the rates are affected by Q-angle or gender. Twenty Ball State University subjects (10 male, 10 female) who were asymptomatic to Patellofemoral Syndrome (PFS), provided electroymyographic (EMG) data while performing the three selected exercises. A one-way ANOVA found no statistical significance (p=0.500) on any of the tested variables except the Drop Squat VL Root Mean Square (RMS). Significant correlations were found between: VL RMS to set number during drop squat, and VMO and VL RMS to set number during Muncie Method performance. Based on the results of this study, each of these exercises could be used to selectively strengthen the VMO in treatment of PFS. / School of Physical Education

The purpose of this study was to examine the utility of the Dean-Woodcock Sensory Motor Battery (DWSMB) as a diagnostic tool for identifying individuals with and without closed-head injury, comparing the predictive power of a two- and three-factor representation (DWSMB; Dean & Woodcock, 2003). The current study's major research questions focused on the predictive utility of the structure of the DWSMB. The simplified two-factor model (Total Sensory and Total Motor), based on the DWSMB manual (Dean & Woodcock), was compared to a three-factor theoretical model (Basic Sensory, Higher Sensory and Motor Functions) (R.S.Dean, personal communication, March 29, 2006) for this study. Logistic Regression was used to analyze the data. Results from this study demonstrate that when using the two-factor solution, the overall correct prediction of group membership was 73.8 % (59.4% for CHI and 85.2% for normals). The Total Motor Impairment variable was the only meaningful predictor. The results from the three-factor solution show an 84.2 % overall correct prediction rate (71.4 % for CHI and 95.1 % for normals). The significant contributors for identifying CHI when using the three-factor model included Basic Sensory and Motor Functions. Everything favors the three-factor model as being more precise. All indicators of prediction accuracy and goodness of fit favored the three-factor model. Based on these results, the DWSMB was determined to be a good screening instrument for identifying children in school contexts who should be referred for a neuropsychological examination to confirm pre-existing CHI that interfere with school functioning. / Department of Educational Psychology

The present study attempts to further define the neuropsychological characteristics associated with mild, moderate, and severe closed head injuries (CHI). The Dean-Woodcock Neuropsychological Assessment System (D-WNAS), a new neuropsychological battery, was administered to 119 CHI patients. The scores of the cognitive portion of the D-WNAS were then analyzed via cluster analysis in an attempt to further delineate neuropsychological impairment into more specific classifications occurring within types of brain trauma.Results suggested that the cognitive portion of the D-WNAS was effective in separating 4 subtypes within CHI, which are best interpreted as "profiles" or characteristics associated with "levels" of impairment. These levels of impairment were characterized by distinctly different subtest profiles, and were labeled as mild/high functioning, mild, moderate, and severe. The highest performing group, mild/high functioning, showed no neuropsychological deficits. The most severely impaired group was characterized by many deficits in short-term memory, visual stimuli, new learning, processing speed, visual-spatial abilities, abstract reasoning, attention/concentration, and remote memory tasks. A multivariate analysis showed that educational level was significant in differentiating between the subtypes and suggested that, depending on the severity of injury, educational level might also protect individuals from obtaining a poorer prognosis.From this investigation, the cognitive portion of the D-WNAS appears to offer valuable utility in identifying CHI patients and in further classifying their varied neuropsychological characteristics. Implications for diagnosing and differentiating between different levels or profiles of CHI was discussed. / Department of Educational Psychology

The objective of this study was to investigate the intra-rater (within day & between days) and inter-rater reliability of foot/ankle water volumetry in healthysubjects.Study design: Repeated measures design with 2 raters.Background: Physiotherapists more often aim to reduce swelling in the acute phase of soft tissue injury. Reduction in swelling will hasten the healing process. Therefore swelling forms an important outcome measure that is worth studying during the healing process to determine the efficacy of the intervention. Though there are different methods available to measure extremity swelling, water displacement method is widely used in physiotherapy studies. Although water volumetry has been used to assess the reduction in swelling over time, there is paucity of reliability studies that have assessed the between-days reliability.Methods: Thirty normal subjects with asymptomatic ankles were measured by 2 raters. Three repeated foot volume measurements were performed by each of the rater using water volumetry during a single test session. The same procedure was repeated approximately at the same time on the 3rd day and 5th day following the 1st measurement day by the same raters on the same subjects. The raters were blinded to each other's measurements. The order for rater's volumetric measurement on each subject on each day was determined by a random chart produced by SPSS. The reliability was measured in terms of systematic bias (Paired t test & Bland & Altman's plot), absolute reliability (Limits of Agreement [LOA] & Standard Error of Measurement [SEM]) and relative reliability (Intraclass Correlation Coefficient [ICC]).Results: There was no systematic bias between any of the trials within day/between days or between raters. The intra-rater reliability within day as calculated by ICC; LOA and SEM were 0.99, ±10ml and ±3.5ml respectively and for between days reliability the values were 0.99 (ICC), ±20ml (LOA) and ±7ml (SEM) and for interrater reliability the values were 0.99 (ICC), ±13ml (LOA) and ±5ml (SEM). The results demonstrated that water volumetry method was highly reliable within day and between days for both the raters; and highly reliable between raters.Conclusion: Water volumetry is a highly reliable method for measuring foot/ankle volume repeatedly on different days. The random error range in milliliters (ml) as estimated by the absolute reliability indices provides the practical use of this method in a clinical/research setting.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 5 uppsatser.