A dissertation submitted to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg, in fulfilment of requirements for the degree of Masters of Science. Johannesburg 2012 / Background: The detrimental effects of prolonged mechanical ventilation (MV) on the respiratory muscles, especially the diaphragm, are well documented and it is crucial that MV should be discontinued as soon as possible to prevent added complications and additional risks to patients with critical illness. The spontaneous breathing stage of MV can be managed as a rehabilitation and conditioning phase for the respiratory muscles due to the fact that the respiratory muscles are more active during this stage of MV. Weaning strategies that provide insufficient respiratory work, too high a respiratory muscle load or insufficient respiratory muscle rest may lead to respiratory muscle fatigue and consequently failed weaning and extubation. The aim of this research project was to develop an individualised continuous positive airway pressure (CPAP) weaning programme and test its effects on the outcomes of extubation in the adult ventilated patient. Method: An experimental, prospective, non-randomised, sequential study of two groups of subjects was performed. Forty eight subjects [group one: n =24 (control) and group two: n = 24 (intervention)], who were mechanically ventilated for longer than 48 hours, in an open adult, general intensive care unit were recruited. Subjects in the control group were weaned according to the standard weaning programme of the test setting at the time; and those in the intervention group were weaned according to an individualised CPAP programme. This weaning programme was developed utilising three principles of muscle rehabilitation namely; daily stepwise progression, sufficient rest and recovery periods and adapted to the individual needs and progression of each subject. Objective measurements such as the rapid shallow breathing index (RSBI), RSBI rate and the maximum inspiratory pressure (MIP) were used to determine the subjects in group two’s readiness for a spontaneous breathing trial. The primary outcomes assessed were time spent in the different stages of MV, rate of failure to sustain spontaneous breathing in stage 3 of MV, successful extubation and mortality rate. Results and Discussion: The difference in rate of failure to sustain spontaneous breathing between the two groups was statistically significant (p = 0.01) with 10 events of failure in group one and three in group two. The rate of successful extubation from MV between groups one and two was 70.8% and 91.7% iv respectively (p=0.52). The mortality rate was 33.3% for group one and 8.3% for group two (p = 0.02). The difference in the total time spent on MV (days) did not differ significantly (group one = 8.6 (± 0.40) days; group two = 9.3 (±0.32) days; p = 0.75). The results yielded from this study suggest that the use of a multidisciplinary team model and an individualised CPAP programme aids successful extubation from MV as the success rate was much higher in the intervention group than in the control group without adding additional time on MV. Conclusion: Results from this study showed that the implementation of an individualised CPAP programme during the spontaneous breathing stage of MV may improve the outcomes of extubation in adult ventilated patients.

Thesis (Ed.M.)--Boston University

Yes / There is no single, universally accepted method of measuring isometric neck strength to inform exercise prescription and injury risk prediction. This study aimed to establish the inter- and intra-rater reliability of a commercially available fixed frame dynamometer in measuring peak isometric neck strength. A convenience sample of male (n = 16) and female (n = 20) university students performed maximal isometric contractions for flexion (Flex), extension (Ext), left- (LSF) and right-side flexion (RSF) in a quadruped position over three sessions. The intra-rater reliability results were good-to-excellent for both males (ICC = 0.83–0.90) and females (ICC = 0.86–0.94) and acceptable (CV < 15%) across all directions for both males and females. The inter-rater reliability results were excellent (ICC = 0.96–0.97) and acceptable (CV < 11.1%) across all directions. Findings demonstrated a significant effect for sex (p ≤ 0.05): males were stronger in all four directions, and a significant effect for direction (p ≤ 0.05): Ext tested stronger (193 N) than Flex (176 N), LSF (130 N) and RSF (125 N). The findings show that the VALD fixed frame dynamometer can reliably assess isometric neck strength and can provides reference values for healthy males and females.

Introduction: Before 2015 the hand classification in wheelchair rugby consisted of non-sport specific tests. The hand classification was not in accordance with the classification code introduced by the International Paralympic Committee in 2003. In 2015, the newly revised wheelchair rugby classification manual was released, containing the revised wheelchair rugby hand classification. Hand tests that were not functional sport-specific tests were removed from the bench test in wheelchair rugby classification. Lumbrical, interossei and thumb opposition manual muscle testing were added to the bench test in wheelchair rugby classification. On both national and international levels of classification, classifiers verbalised their uncertainty to their fellow panel members regarding their hand placement on the athlete’s hand and interpretation of the manual muscle testing of the hand that was observed and tested. This justified reliability testing of the new hand classification. Aim: The aim of this study was to determine the intra and inter-rater reliability of the manual muscle testing in the new hand classification of wheelchair rugby. Study design: This study followed a quantitative non-experimental, cross-sectional design. Method: The raters who took part in the study were active international wheelchair rugby classifiers from all over the world. The raters received an electronic questionnaire consisting of biographic information and three videos repeated two times. Each video showed an athlete’s hand being classified by a classifier. The raters had to give a manual muscle test grade for each subject (muscle) tested in each video by using tick boxes. The manual muscle test grades that could be given were: 0-1, 2, 3 and 4-5. The first three raters in each international wheelchair rugby classification level who completed the questionnaire were used for the data analysis. Data Analysis: The statistician used the two way model for the ICC in which each subject was rated by the same raters to determine the absolute agreement for each objective. The Medcalc program was used. To indicate the strength of agreement the ranges provided by Landis and Koch (1977) were used: 0.0 – 0.2 slight, 0.21 – 0.4 fair, 0.41 – 0.6 moderate, 0.61 – 0.8 substantial and 0.81 – 1.00 almost perfect. Conclusion: Raters one, two, five, seven, eight and nine’s intraclass correlation coefficient values fell between 0.81-1.00 which is descriptive of almost perfect levels of intra-rater reliability. Raters three, four and six’s intraclass correlation coefficient values fell between 0.61-0.80 which is descriptive of substantial levels of intra-rater reliability. However, none of the raters scored 100% when accuracy was determined. All three levels had intraclass correlation coefficient values which is descriptive of almost perfect levels of intra-rater reliability within each level. Level 2, 3 and 4 classifiers had intraclass correlation coefficient values between 0.81- 1.00 which is descriptive of almost perfect levels of inter-rater reliability when the manual muscle testing grades for the first and repeated videos were compared. Across all nine raters there was a high intraclass correlation coefficient value which was descriptive of almost perfect inter-rater reliability. The accuracy in each level and across all nine raters was low. Finger extensors, thumb abductor and thumb flexor showed intraclass correlation coefficient values between 0.41-0.6 which is descriptive of moderate levels of intrarater reliability. The only subjects (muscles) that were graded accurately when compared to a memorandum were subjects with a manual muscle test grade 0-1 and 4-5. Most of the accurate manual muscle test grades were for athlete two in the video footage. Athlete two was classified as having a 2.0 hand. / Dissertation (MOccThe)--University of Pretoria, 2017. / Occupational Therapy / MOccThe / Unrestricted

The goal of this study is to point out the influence of earlier experiences, and in particular the experiences in utero, on the identity formation of the adolescent. Although the identity problem is generally associated with the development during the adolescent years, the researcher strives to point out the relation between identity problems as they manifests in later years, and the intra-uterine experiences. The research view this problem from three different angles: i. A study that examines the identity problem as it occurs during adolescence, as well as the causes of the problem. This study points out the main characteristics of the identity problem, as well as the way it manifests during the adolescent years. ii. A study of psycho-neurobiological models offers an explanation of the influence of memory on behaviour. This study gives the neurological explanation of how and why the very first experiences that are encoded in memory, have a distinct and prevailing influence on the behaviour of the individual. The encoding of memory takes action as soon as there is sufficient neurological development - this occurs at some stage in the development of the fetus in utero. The behaviour is not controlled by the past experiences, but by the perceptions and associations that are formed during encoding of memory. iii. A description of regressive therapies that enable the researcher to retrieve the memory from the subconscious mind, and reframe the perceptions and associations that were formed through earlier experiences, in order to change the behaviour. Two types of therapies are discussed - hypnosis and kinesiology. A qualitative study is performed on three respondents. This study points out the significance of the intra-uterine experiences on the development of the identity problem as it manifests in later years. It also indicates the fact that, although the past experiences can never be changed, the perceptions and associations that were formed during the encoding of the memory of the experience can be changed through reframing. The reframing of the experiences and the reformation of perceptions and associations have a definite and positive effect on the behaviour of the individual. / Educational Studies / D.Ed. (Psychology of Education)

Die doel van hierdie ondersoek was om vas te stel of Opvoedkundige Kinesiologie deur die Opvoedkundige Sielkundige gebruik sou kan word as 'n psigoterapeutiese benadering ten einde emosionele welsyn te verhoog. Volgens Edu-K is die brein-liggaam sisteem onlosmaak:lik verbind en emosionele blokkerings is nie slegs in die denke en intellek van die mens gelee nie, maar ook op sellulere vlak vasgele. Navorsing aan die hand van die idiografiese benadering is gedoen. Vyf proe:tpersone, wat aangemeld is met emosionele probleme, het elkeen 'n reeks Edu-K balanserings ontvang volgens individuele behoeftes. Die doel daarvan was om te bepaal ofEdu-K balanserings sou lei tot verhoogde welsyn. Na die reeks balanserings is daar beduidende positiewe veranderinge waargeneem ten opsigte van emosionele probleme, sowel as verbeteringe in ak.ademiese prestasie. Daar is ook algemene prak.tiese riglyne gegee vir ouers, onderwysers en Opvoedkundige Sielkundiges. / The aim of this investigation was to ascertain whether Educational Kinesiology could be applied by the Educational Psychologist as a psychotherapeutic tool in order to enhance emotional wellbeing. According to Edu-K the mind-body system is inseperably one: emotional blocks are not only situated in the mind and intellect of a person, but are recorded on cellular level as well. Research was done by way of an idiographic approach. Five subjects with emotional problems received a series of balances according to their individual needs. The aim was to ascertain whether Edu-K balances could enhance emotional wellbeing. A significant positive improvement in emotional problems as well as in academic performance were noted. General guidelines for parents, teachers and Educational psychologists are also given. / Psychology of Education / M. Ed. (Voorligting)

The goal of this study is to point out the influence of earlier experiences, and in particular the experiences in utero, on the identity formation of the adolescent. Although the identity problem is generally associated with the development during the adolescent years, the researcher strives to point out the relation between identity problems as they manifests in later years, and the intra-uterine experiences. The research view this problem from three different angles: i. A study that examines the identity problem as it occurs during adolescence, as well as the causes of the problem. This study points out the main characteristics of the identity problem, as well as the way it manifests during the adolescent years. ii. A study of psycho-neurobiological models offers an explanation of the influence of memory on behaviour. This study gives the neurological explanation of how and why the very first experiences that are encoded in memory, have a distinct and prevailing influence on the behaviour of the individual. The encoding of memory takes action as soon as there is sufficient neurological development - this occurs at some stage in the development of the fetus in utero. The behaviour is not controlled by the past experiences, but by the perceptions and associations that are formed during encoding of memory. iii. A description of regressive therapies that enable the researcher to retrieve the memory from the subconscious mind, and reframe the perceptions and associations that were formed through earlier experiences, in order to change the behaviour. Two types of therapies are discussed - hypnosis and kinesiology. A qualitative study is performed on three respondents. This study points out the significance of the intra-uterine experiences on the development of the identity problem as it manifests in later years. It also indicates the fact that, although the past experiences can never be changed, the perceptions and associations that were formed during the encoding of the memory of the experience can be changed through reframing. The reframing of the experiences and the reformation of perceptions and associations have a definite and positive effect on the behaviour of the individual. / Educational Studies / D.Ed. (Psychology of Education)

Die doel van hierdie ondersoek was om vas te stel of Opvoedkundige Kinesiologie deur die Opvoedkundige Sielkundige gebruik sou kan word as 'n psigoterapeutiese benadering ten einde emosionele welsyn te verhoog. Volgens Edu-K is die brein-liggaam sisteem onlosmaak:lik verbind en emosionele blokkerings is nie slegs in die denke en intellek van die mens gelee nie, maar ook op sellulere vlak vasgele. Navorsing aan die hand van die idiografiese benadering is gedoen. Vyf proe:tpersone, wat aangemeld is met emosionele probleme, het elkeen 'n reeks Edu-K balanserings ontvang volgens individuele behoeftes. Die doel daarvan was om te bepaal ofEdu-K balanserings sou lei tot verhoogde welsyn. Na die reeks balanserings is daar beduidende positiewe veranderinge waargeneem ten opsigte van emosionele probleme, sowel as verbeteringe in ak.ademiese prestasie. Daar is ook algemene prak.tiese riglyne gegee vir ouers, onderwysers en Opvoedkundige Sielkundiges. / The aim of this investigation was to ascertain whether Educational Kinesiology could be applied by the Educational Psychologist as a psychotherapeutic tool in order to enhance emotional wellbeing. According to Edu-K the mind-body system is inseperably one: emotional blocks are not only situated in the mind and intellect of a person, but are recorded on cellular level as well. Research was done by way of an idiographic approach. Five subjects with emotional problems received a series of balances according to their individual needs. The aim was to ascertain whether Edu-K balances could enhance emotional wellbeing. A significant positive improvement in emotional problems as well as in academic performance were noted. General guidelines for parents, teachers and Educational psychologists are also given. / Psychology of Education / M. Ed. (Voorligting)