Bakgrund: Hjärnskakning är en vanlig skada inom ishockey. Efter skada ses även påverkan på cervikala strukturer och nackutredning föreslås som en del i undersökningen efter hjärnskakning.  Neck Flexor Endurance Test är ett test som använts för att mäta nackflexorernas uthållighet. Syftet med den här studien var att fastställa normalvärde för junior-senior ishockeyspelares uthållighet i stabiliserande cervikal muskulatur.  Design:Deskriptiv pilotstudie Metod: Totalt 40 friska ishockeyspelare (33 herrjuniorer och 7 damspelare) testades i ryggliggande. Testpersonen höll huvudet statiskt i given position och testledaren observerade att testen utfördes rätt och klockade tiden med tidtagarur. Inga andra hjälpmedel användes. Varje deltagare hade två försök och tiden mellan försök ett och två var två minuter Resultat: Medelvärde för hela gruppens båda försök var 55,5 sekunder. Medelvärde för försök ett var för hela gruppen 62,3 sekunder +22,8, försök två 48,5 sekunder +18,1. Skillnaden mellan försök ett och försök två var statistiskt säkerställd (p<0,05). Konklusion: 40 friska ishockeyspelare har i den här studien uthållighet i nackens flexorer på i medelvärde 62,3 sekunder i ett försök. Spridningen var för stor för att man ska kunna ge råd om generell baseline. Skillnaden mellan gruppens försök ett och försök två tyder på att längre tid än två minuter behövs för full återhämtning av testade muskler.

Neck pain is the second most common musculoskeletal disorder after low back pain adding to the global burden of disease. A focus on evaluating outcomes for musculoskeletal conditions is imperative to evaluate the effect of interventions and to track the progression of disease. As evidence based practice and associated use of patient-based outcomes are taken up across different countries, it becomes imperative for cross-cultural translation studies. Given the uptake of technology in workplaces, it is also important to understand the prevalence of neck pain in this context. This thesis has focused on two objectives: 1. Translating a newly developed patient-report outcome measure of neck-related disability and testing its psychometric properties. 2. Estimating the prevalence of neck pain in computer-using workers. The first manuscript focusses on cross cultural translation and validation of ND10 (Neck difficulty10) that was designed to measure neck-related disability. A new English outcome measure for neck disability (ND10) was cross culturally translated and validated in computer users in India using forward and backward translation, and cognitive interviewing to determine a final version. The ND10-H demonstrated high reliability (ICC= 0.93) and convergent construct validity with the NDI and DASH (r= 0.78 and 0.86) The second manuscript reported the prevalence of neck pain in computer users in India. Sampling was performed in two different companies: A Spiritual Media Publication Organization (SMPO) and an Information Technology (IT) company. The companies were selected based on computer use and their willingness to participate. The survey was administered to all employees (n=150 & n=54) at these two companies. The overall prevalence of neck pain was 64%. In the IT company, 78% of employees reported neck pain; and in the SMPO the prevalence was 40%. There were no significant differences in prevalence based on gender or age. All of the IT company computer users worked more than seven hours at their computers, while 38% of the SMPO workers did so. Chronic pain was present in 48%of the total sample. The ND10-H can be used to assess neck-related disability in Hindi-speaking individuals. It should be accompanied by a valid pain measure when assessing patient outcomes. The prevalence of neck pain is high in computer-using workers in India. / Thesis / Master of Science Rehabilitation Science (MSc) / 1. Translating a newly developed patient-report outcome measure of neck-related disability and testing its psychometric properties. 2. Estimating the prevalence of neck pain in computer-using workers. The first manuscript focusses on cross cultural translation and validation of ND10 (Neck difficulty10) that was designed to measure neck-related disability. A new English outcome measure for neck disability (ND10) was cross culturally translated and validated in computer users in India using forward and backward translation, and cognitive interviewing to determine a final version. The ND10-H demonstrated high reliability (ICC= 0.93) and convergent construct validity with the NDI and DASH (r= 0.78 and 0.86)

Introduction: Frailty represents a complex geriatric syndrome associated with elevated rates of postoperative complications as shown for several malignant entities, including head and neck cancer. A specific screening instrument to assess frailty in head and neck patients does not exist. Both the FRAIL Scale and the G8 questionnaire are well-established and easy to use as screening tools. The present study’s aim was to assess the potential of frailty screening to predict postoperative complications in head and neck patients prior to surgery. Patients and methods: We recorded demographic data, pre-existing medical conditions and clinical characteristics in a prospective cohort of 104 head and neck cancer patients undergoing major head and neck surgery and assessed frailty prospectively on the day of admission utilizing the G8 questionnaire and the FRAIL Scale. We analyzed the link between occurrence of postoperative complications up to the twenty-first postoperative day and age, frailty and other covariates using χ 2 tests and receiver operating characteristic (ROC) curves. Results: There was no significant correlation between patients’ pre-existing medical conditions and postoperative complications. Whereas chronological age alone did not predict the occurrence of postoperative complications, frailty posed the highest risk for complications. Frailty according to either the G8 questionnaire or the FRAIL Scale predicted occurrence of complications with an area under the curve (AUC) of 0.64 (p = 0.018) and 0.62 (p = 0.039) and severe complications with an AUC of 0.72 (p = 0.014) and 0.69 (p=0.031), respectively. Neither frailty score correlated with age or with each other. Conclusion: Prospective screening using the FRAIL Scale or the G8 questionnaire reliably detected frailty in our sample group. Frailty is linked to increased risk of postoperative complications. The correct prediction of severe postoperative complications as shown identifies vulnerable cases and triggers awareness of potential complications. Anticipating risk allows for a more comprehensive view of the patient and triggers decision making towards risk adjustment, and therefore a selective view of alternative treatment modalities.

Thesis (M.Tech.: Chiropractic) -Dept. of Chiropractic, Durban Institute of Technology, 2005. xii, 51 leaves : ill. (some col.) ; 30 cm / According to the recent literature the application of non-steroidal anti-inflammatory drugs (NSAIDS) is the mainstay and first line of conventional treatment for many types of pain, including that of spinal origin (DiPalma and DiGregorio 1994; Dabbs and Lauretti 1995; Koes et al. 1997). NSAID therapy has inherent side effects (Goodman and Simon 1994), however, given the risks involved, they are still of value as an adjunct to spinal manipulation (Crawford 1988), which has been shown to have less side effects and be more effective than conventional NSAIDS (Dabbs and Lauretti 1995; Giles and Müller 1999). A homeopathic alternative to NSAIDS is Traumeel S, it fulfils all the criteria for a locally acting therapeutic medication, with promotion of the natural healing process, and minimum side effects (Zell et al. 1989). A study by Hepburn (2000) compared the relative efficacy of Traumeel S against NSAIDS in the treatment of cervical facet syndrome. Hepburn concluded that there was statistically no difference between the two therapies. It could therefore be inferred that Traumeel S may be a valid alternative to NSAID therapy in the treatment of cervical facet syndrome. This study tested this hypothesis by comparing the effectiveness of spinal manipulation with the concurrent administration of oral Traumeel S against spinal manipulation alone in order to assess the potential benefit of combining Traumeel S with manipulation.

Thesis (M.Tech.: Chiropractic)- Dept. of Chiropractic, Durban Institute of Technology, 2006. 130 leaves. / The purpose of this investigation was to evaluate the efficacy of the adjustment of the first rib as an adjunct to the manipulative treatment of mechanical neck pain, according to subjective and objective clinical findings. The results of this study would indicate to Chiropractors which specific types of adjustments, used for the treatment of mechanical neck pain, would potentially increase the cervical range of motion and / or decrease pain experienced by the patient and thus lead to a more effective treatment protocol. The outcome of the study will help clinicians select the more appropriate treatment for patients based on the subjective and objective outcomes.

A dissertation presented to the Faculty of Health Sciences at the Durban University of Technology in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, 2009 / Introduction: The aetiology of Temporomandibular Joint Dysfunction (TMJD) is not fully understood and the treatment of TMJD is controversial. Most treatment plans are based on postulated aetiology. Treatment plans currently range from pharmacological to surgical and occasionally physical therapy is also used for any myofascial component. Myofacial Trigger Points (MFTP’s) in the head and neck region have similar pain referral patterns as TMJD and there is overlap in aetiology and epidemiology. If correlation can be proved to exist between the severities of TMJD and MFTP’s then the treatment of MFTP’s can potentially decrease the severity of TMJD and then the more radical treatments can be avoided. Objectives: To determine whether TMJD was present and establish severity. To locate any MFTP’s in the Sternocleidomastiod (SCM), Temporalis, Masseter, Posterior Cervical (PC), Lateral and Medial Pterygoid muscles and determine their severity. Methods: A random sample of 25 participants were evaluated. A p value <0.05 was considered as statistically significant. Quantitative variables were summarized using median, inter-quartile range and range due to skewness of distribution, while categorical variables were described using frequency distributions and bar charts. Spearman’s nonparametric correlation analysis, and curve estimation were used to determine the existence of a relationship between TMJ severity and MFTP severity. A scatterplot was used to graphically assess the relationship. Conclusion: The results suggested that the participants were actually chronic neck pain suffers that developed TMJD over the long term as a result of chronic neck pain changing the kinematic biomechanics or as a result of a completely different and independent event as suggested by Foreman and Croft (1995).

Dissertation submitted to the Faculty of Health at the Durban University of Technology in partial compliance with the requirements for the Master‟s Degree in Technology: Chiropractic, 2009. / The prevalence of neck pain in musculoskeletal practice is second only to that of low back pain (Vernon et al., 2007). There is a growing interest in neck pain research due to the escalating disability burden and compensation costs associated with neck pain (Côte et al., 2003). Manual therapies are commonly used in the treatment of neck pain (Côte et al., 2003). After an extensive literature review by Haldeman et al. (2008) they found that manual therapy techniques have some benefit but no one technique was clearly superior to the next. Therefore, the purpose of this study is to compare three commonly used manual therapy techniques in the treatment of chronic mechanical neck pain. OBJECTIVES The purpose of this study was to compare three different manual therapy techniques (SMT, MET and PNF) which are commonly used in the treatment of chronic MNP in terms of range of motion, pain and disability. METHOD Forty-five patients with chronic mechanical neck pain were obtained through non-probability convenience sampling and assigned into one of three treatment groups (15 per group) using a computer generated randomized table. The three different treatment groups were: Spinal Manipulative Therapy (SMT), Muscle Energy Technique (MET) and Proprioceptive Neuromuscular Facilitation (PNF). Each group received six treatments over a period of three weeks with a follow-up consultation. Measurements were taken at the first, third and sixth treatment and at the follow-up consultation. SPSS version 15.0 was used to analyse the data. A p value of <0.05 was considered as statistically significant. An intra-group analysis was done using repeated measures ANOVA testing to assess the time effect for each outcome separately. For inter-group analyses the time x group interaction effect was assessed using repeated measures ANOVA testing, and profile plots were used to assess the trend and direction of the effects. RESULTS Intra-group analysis of the results revealed that all three groups improved significantly between the first and the final consultation, for all measures. Inter-group analysis of the data did not show any difference between the three groups by the end of the final consultation. However, extension range of motion appeared to improve slightly faster in the PNF group iv but it was not significant when compared to the other two groups. Therefore, there was no statistical significance between the three groups. CONCLUSION It was concluded that all three treatment groups responded equally to the treatment, thus, suggesting that MET or PNF techniques can be used if SMT is contra-indicated.

BACKGROUND:The aim of the study is to assess the effectiveness of intensity-modulated radiotherapy (IMRT) or image-guided radiotherapy (IGRT) for the prevention of retropharyngeal nodal recurrences in locally advanced head and neck cancer.METHODS:A retrospective review of 76 patients with head and neck cancer undergoing concurrent chemoradiation or postoperative radiotherapy with IMRT or IGRT who were at risk for retropharyngeal nodal recurrences because of anatomic site (hypopharynx, nasopharynx, oropharynx) and/or the presence of nodal metastases was undertaken.The prevalence of retropharyngeal nodal recurrences was assessed on follow-up positron emission tomography (PET)-CT scans.RESULTS:At a median follow-up of 22months (4-53months), no patient developed retropharyngeal nodal recurrences.CONCLUSION:Prophylactic irradiation of retropharyngeal lymph nodes with IMRT or IGRT provides effective regional control for individuals at risk for recurrence in these nodes.

Bei dieser Arbeit handelt es sich um eine retrospektive Studie bezüglich Inzidenz und Therapie von Mundhöhlen- und Oropharynxkarzinomen, welche in dem Zeitraum von 1993 bis 2009 in der HNO-Klinik der Universität Leipzig als „High Volume Center“ behandelt wurden, mit besonderem Augenmerk auf die Stadien III-IV nach UICC/AJCC. In unserer Studie konnten wir eine Zunahme der an der Universität in Leipzig registrierten Patienten mit Mundhöhlen- und Oropharynxkarzinomen über die Jahre 1993 bis 2009 verzeichnen. Männer waren mehr als fünfmal so häufig betroffen wie Frauen. Diese Verteilung hielt sich über den Beobachtungszeitraum konstant. Bei den weiblichen Patientinnen wurden im Durchschnitt niedrigere Tumorstadien bei Erstdiagnose festgestellt. Frauen hatten insgesamt eine höhere 5-Jahresüberlebensrate. Die Stadienverteilung nach UICC/AJCC bei Erstdiagnose eines Mundhöhlen- und Oropharynxkarzinoms blieb über die Jahre hinweg annähernd gleich. Es wurden meist hohe Stadien festgestellt (62,7% Stadium IV). Das mittlere Erkrankungsalter von Mundhöhlen- und Oropharynxkarzinomen sank über den Beobachtungszeitraum. Das Alter bei Rezidivmanifestation blieb allerdings über die Jahre gleich und lag unter dem durchschnittlichen Alter bei Erstdiagnosestellung. In diesem Zeitraum wird in der Literatur eine zunehmende Infektionsrate mit HPV beschrieben, welche gemäß der Literaturdaten mit einem jüngeren Erkrankungsalter einhergeht. Über die Jahre fanden wir in dem von uns untersuchten Patientenkollektiv der Universitätsklinik Leipzig eine stetige Verbesserung der mittleren Überlebensraten. In zeitlicher Assoziation zu dieser Entwicklung fand eine Änderung der Therapiemodalitäten insbesondere mit Einführung der systemischen Chemotherapie ab ca. 2004 in Richtung einer zunehmenden multimodalen Therapie statt. Es konnte ein Vorteil im Gesamtüberleben nach einer kombiniert-operativen Therapie mit adjuvanter Radiochemotherapie gegenüber allen anderen Therapieformen gezeigt werden. Insbesondere im Stadium IV nach UICC/AJCC zeigte sich ebenfalls ein Vorteil der kombinierten Radiochemotherapie gegenüber einer alleinigen Radiotherapie.

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