La cervicalgia es un problema de salud ocupacional en los odontólogos y está presente desde las prácticas del pregrado. Se realizó un estudio cuasi experimental para evaluar el efecto de un programa de gimnasia laboral en todos los estudiantes de cuarto año de un escuela de odontología de Lima para reducir la prevalencia de cervicalgia. El programa duró seis semanas, consistía en dos charlas para que realicen ejercicios de estiramiento de 5 minutos 3 veces por día y un recordatorio diario por mensaje de texto. 31 estudiantes fueron evaluados al inicio y final de la intervención, 13/31 manifestaron no haber realizado los ejercicios. Se encontró que la prevalencia de cervicalgia en las últimos 4 semanas se redujo de 90,3% a 71,0% (p=0,034) y la intensidad del dolor se redujo de 5,4 a 3,6 (p=0,009). El programa demostró reducir la cervicalgia, futuras intervenciones deben buscar alternativas para incrementar la adherencia.

M.Tech. / Purpose: Posterior mechanical neck pain is considered a debilitating musculoskeletal problem and is one of the most common reasons for visiting an emergency sector (Murphy, 2000). This study aims to compare the effects of Chiropractic manipulative therapy directed at the thoracic spine to that directed at the cervical spine for the treatment of chronic neck pain with regards to pain, disability and cervical range of motion. Method: This study was a comparative study and consisted of two groups of fifteen. The participants were between the ages of eighteen and forty-five, with a half male to female ratio. The potential participants were examined and accepted according to the inclusion and exclusion criteria. The method of treatment administered to each participant was determined by group allocation. Group 1 received chiropractic spinal manipulative therapy to restriction(s) of the upper thoracic region only. Group 2 received chiropractic spinal manipulative therapy to restriction(s) of the cervical spine only. Objective and subjective findings were based on the above treatment protocols. Procedure: Treatment consisted of six treatment consultations with an additional follow up consultation over a three week period, with two consultations being performed per week interval. Objective and subjective readings were taken at the beginning of the first, fourth and seventh consultations. Subjective readings were taken from the Vernon-Mior Neck Pain and Disability Index as well as from the Numerical Pain Rating Scale (NPRS). Objective readings were taken from measurements taken from the Cervical Range of Motion device (CROM). Analysis of collected data was performed by a statistician. The Chiropractic manipulative techniques used were based on restrictions identified during motion palpation and were applied at the first six consultations, with the seventh consultation consisting of data gathering only. Results: Clinically significant improvements in both Group 1 and Group 2 were seen over the course of the study with regards to cervical spine range of motion, pain and disability. However group 1 showed greater statistically significant improvements in their mean cervical range of motion whereas group 2 showed a greater statistically significant improvement in their subjective readings of pain and disability.

M.Tech. (Chiropractic) / Introduction: Neck pain is a common condition which affects up to 70 percent of people at some point in their lives, and at any given time about 10 to 20 percent of the population reports neck problems. Although spinal manipulation on its own is effective in the treatment of chronic neck pain, chiropractors continue to search adjunctive modalities to improve the positive outcomes of their treatment. Therefore, it is important to look for the best possible treatment protocol as well as research alternatives, should contraindications for present protocols, such as spinal manipulation, arise. One such alternative could be Kinesio® taping. The purpose of this study was to determine the efficacy of utilising Kinesio® taping, spinal manipulation or the two therapies combined, for the treatment of chronic neck pain. It will also provide further evidence on the efficacy of spinal manipulation and Kinesio® taping in isolation. Method: This study was a comparative study consisting of three groups of ten participants. The method of treatment was determined by random group allocation. Group 1 received spinal manipulation to restriction(s) of the cervical spine only. Group 2 received Kinesio® taping to the longissimus cervicis muscles only. Group 3 received a combination of spinal manipulation and Kinesio® taping as previously described. Subjective measurements consisted of the Vernon-Mior Neck Pain and Disability Index and the Numerical Pain Rating Scale (NPRS) and objective measurements was assessed in degrees by making use of the Cervical-range-of-motion (CROM) instrument. Procedure: There were seven consultations in total. There were six treatment consultations over three weeks. The seventh consultation consisted of data collection only. Subjective and objective measurements were taken prior to treatment on the first and fourth consultation, and on the seventh consultation where no treatment took place. Subjective readings were taken from the Vernon-Mior Neck Pain and Disability Index and the NPRS. Objective readings were assessed in degrees by making use of the Cervical-range-of-motion (CROM) instrument. Results: It was evident from the data that all three groups responded well to their respective treatment protocols. With regards to the subjective measurements Group 1, 2 and 3 demonstrated statistically significant improvement in both neck pain severity and functional disability. As Group 1 had the highest clinical improvement with regards to the NPRS, it indicates that the Group 1 treatment protocol was more effective in decreasing the pain intensity throughout the treatment period. All three groups responded similarly with regards to the Vernon-Mior Neck Pain and Disability Index, although Group 1 responded the best clinically. With regards to the objective measurements Group 1, 2 and 3 demonstrated statistically significant improvement in all ranges of motion of the cervical spine. However, it was found that Group 3 clinically responded best to treatments in all the ranges of motion except for right lateral flexion in which Group 2 responded best to treatment. Conclusion: The study showed that the treatment protocols for Group 1, 2 and 3 were effective in treating chronic neck pain. The evidence suggests that the Group 1 treatment protocol, which received spinal manipulation, is more effective than Kinesio® taping alone and the two therapies combined in decreasing pain intensity and functional disability in the treatment of chronic neck pain. The evidence further suggests that the Group 3 treatment protocol, which received spinal manipulation in combination with Kinesio® taping, is more effective than spinal manipulation and Kinesio® taping alone in increasing all cervical spine ranges of motion in the treatment of chronic neck pain.

M.Tech. / The aim of this study was to compare the effectiveness of cervical adjustment therapy, dry needling of the levator scapulae muscle and a combination of the two in the treatment of chronic mechanical neck pain. Forty-five patients were recruited via posters and advertisements from in and around the University of Johannesburg. The participants had to present with bilateral neck pain, decreased range of motion and an active levator scapulae muscles trigger point, which was diagnosed using range of motion and trigger point examination. The participants were randomly allocated into three groups of fifteen participants each. Prior to treatment a full case history, physical examination and cervical regional examination were performed to ensure that the patients were eligible to partake in the clinical trial. Group 1 was the adjusting group; group 2 was the combination group while group 3 was the needling group. Participants were treated five times over a period of three weeks. The objective measurements used in this clinical trial involved a cervical range of motion instrument (C.R.O.M., Performance Attainment Associates) and an algometer (Wagner Instruments). Subjective measurements were achieved using the Neck Pain and Disability Index (Appendix G) and the Numerical Pain Rating Scale (Appendix H). Each measurement was taken prior to treatment on the first and third visits and after treatment on the fifth visit with three measurements per participant overall. The statistical analysis was conducted using the Kruskal-Wallis, Friedman and Wilcoxon tests to compare data. The results indicated that the three groups responded favourably to their respective treatments. Overall, this study has indicated that dry needling of the Levator scapulae muscle provides no statistically significant contribution to the conservative treatment of mechanical neck pain caused by levator scapulae trigger points.

M.Tech. (Chiropractic) / Purpose: The aim of this comparative study was to compare the effects of spinal adjustment with static passive stretch to the cervical spine, and spinal adjustment with proprioceptive neuromuscular facilitation to the cervical spine in the treatment of chronic posterior neck pain with regards to pain, disability and cervical spine range of motion. These effects were based on a questionnaire consisting of a Numerical Pain Rating Scale, a Vernon-Mior Neck Pain and Disability Index Questionnaire, and on cervical spine ROM readings taken using an analogous cervical spine ROM inclinometer. The questionnaire was completed and the ROM readings taken prior to treatment at the first, fourth and seventh consultation. Method: Thirty participants who met the inclusion criteria were randomly diversified in number and gender between two groups of equal size (15 participants each). Group one received spinal adjustment/s to restricted cervical spine joints followed by static passive stretching. The second group received spinal adjustment/s to restricted cervical spine joints followed by proprioceptive neuromuscular facilitation. Participants were treated six times out of a total of seven sessions, over a maximum three week period. Procedure: Subjective data was collected at the beginning of the first and fourth consultations, as well as on the seventh consultation by means of a Numerical Pain Rating Scale (NPRS) and a Vernon-Mior Neck Pain and Disability Questionnaire in order to assess pain and disability levels. Objective data was collected at the beginning of the first and fourth session, as well as on the seventh consultation by means of a cervical spine range of motion inclinometer in order to assess cervical spine range of motion. Analysis of collected data was performed by a statistician. Results: Clinically significant improvements in group 1 and group 2 were noted over the duration of the study with reference to pain, disability, and cervical spine range of motion. Statistically significant changes were noted in group 1 and group 2 with reference to pain, disability, and cervical spine range of motion over time except for cervical spine extension range of motion.

Magister Scientiae - MSc / Neck pain is a common health problem affecting the general population and it can be associated with significant activity limitation, It contributes to a number of lost work days and high costs in its management. The purpose of this study was to identify the trends in the physiotherapy management of patients suffering from episodes of neck pain at the physiotherapy department of the Muhimbiki Orthopaedic Institute (MOI), Dar es Salaam, Tanzania. / South Africa

Magister Scientiae Dentium - MSc(Dent) / Purpose: To assess the value of postoperative CT scans in the management of severe cervicofacial infections or deep neck abscesses. Patients and Methods: Thirteen patients underwent post-operative contrast enhanced CT scans after initial incision and drainage followed by a tracheostomy. As per surgical protocol, the CT scans were taken with radiopaque surgical drains in situ from the brain down to the mediastinum and chest/lungs. Data were collected on the presence of abscesses, their location, the location of surgical drains and presence of other pathology. Results: The most common initially affected space was the submandibular space (69%), followed by the submental space (62%). Almost half of the cases studied had two spaces affected and slightly less than a third had three spaces affected. Slightly more than half (54%) of the patients were in good health generally. More than a third (38.5%) of the patients were HIV positive, and thus immuno-compromised. The mean time lapse between the CT and surgery was 2.61 days (SD = 1.56). In the majority (69.23%) of post-operative scans a residual pus collection was found. In just over a quarter (30.8 %) of the patients no residual pus collection was detected on the postoperative CT scan, while in seven patients (53.8%) affected fascial spaces were missed by the surgeon. These spaces included the submasseteric, anteriormediastinum and parotid spaces. Almost half (44.15%) of the patients required a repeatincision and drainage. Conclusion: This study demonstrates clinical value of post-operative CT scans in severe cervicofacial infections. This study also advances the argument for acquisition of preoperative CECT scans for all patients with severe cervicofacial infection.

The goal of this thesis was to evaluate the cost-effectiveness of implantable Doppler technology (IDT) used to monitor free tissue transfer (FTT) procedures in the treatment of cancer of the upper aerodigestive tract (UADT). First, a systematic review of the literature on the effectiveness of traditional and IDT monitoring techniques was performed. Second, a utility survey using a time trade-off technique was created and administered. The results from this survey were used to establish utility values for health states common in patients undergoing FTT procedures. Third, a cost study using the microcosting data available through the Ottawa Hospital was performed. Finally, a decision analytic model was created and an economic evaluation from the payer perspective was completed. A probabilistic sensitivity analysis (PSA) and a value of information analysis (VOI) were performed. The thesis found that the currently available evidence supports IDT as a cost-effective intervention. Further research should be directed towards determining the effectiveness of both traditional and IDT monitoring.

Receptor Tyrosine Kinase (RTK) inhibitors, such as erlotinib/tarceva, have been introduced in the past decade as a promising therapeutic option in Head and Neck Squamous Cell Carcinoma (HNSCC), however, they lack significant efficacy as single agents. As a result, RTK inhibitors require a combination based therapeutic approach with other treatment modalities. To uncover such a combination of agents, we performed a high throughput Prestwick library screen that included 1200 compounds approved by the FDA on HNSCC cell lines and found that monensin, a coccidial antibiotic, synergistically enhanced the cytotoxicity of erlotinib. RT-PCR revealed that monensin induced the expression of Activation of Transcription Factor (ATF) 3 and its downstream target C/EBP homologous protein (CHOP) which are key regulators of apoptosis. Furthermore, RNA-Seq analysis suggests that monensin augments erlotinib cytotoxicity by disturbing lipid and sterol biosynthesis. Therefore, identifying the mechanism of action exerted by monensin may open alternative avenues of cancer treatment.

M. Tech. / Purpose: Many studies have shown the effect of treatment of the cervical spine on parts distant to the spine itself, which are linked anatomically, biomechanically or neurologically, e.g. the temporomandibular joint (Curl, 1994). Curl (1994) reports a neurological link between the cervical spine and the temporomandibular joint, and Reggars (1994) reports a biomechanical link between the temporomandibular joint and cervical spine. These links may affect the cervical spine when adjusting the temporomandibular joint. For these reasons, further study is necessary to establish the possibility of temporomandibular joint involvement in the formation of neck pain, and the possibility of chiropractic manipulative therapy delivered to the temporomandibular joint as a successful alternative treatment for neck pain. The purpose of the study was to determine the effectiveness of chiropractic adjustment of the temporomandibular joint, compared to cervical spine adjustment of the upper cervical spine as a treatment form for neck pain, with regards to pain, disability and cervical spine range of motion. Method: This study consisted of two groups of 15 participants between the ages of eighteen to thirty-five, similar in age and gender ratios. The potential participants were examined and accepted according to the inclusion and exclusion criteria. The method of treatment administered to each participant was determined by group allocation. Group 1 received chiropractic adjustment techniques delivered to the temporomandibular joint and group 2 received cervical spine adjustment techniques delivered to restrictions of the upper cervical spine.