Orientador: Antonio Sergio Ferraudo / Banca: Luiz Carlos Rêgo Oliveira / Banca: Daniel Côrtes Beretta / Banca: Tiago Luís Eilers Treichel / banca: Lindsay Unno Gimenes / Resumo: Os objetivos do presente estudo foram determinar as características de partos submetidos à intervenção manual e avaliar os efeitos dessa intervenção na taxa de remoção e no desempenho reprodutivo subsequente. Dados de 5.257 partos foram divididos em grupo Controle (n=1.433) e Intervenção (n=3.824). O critério para a intervenção manual nas fêmeas de ordem de parto 1 (OP1) foi determinado pela distocia, enquanto nas demais ordens de parto (OP), somente quando o intervalo entre o nascimento dos leitões foi maior que 10 minutos. Nas fêmeas de OP1, o percentual de partos submetidos à intervenção manual foi de 7,6%. Não houve diferença (P>0,05) na ocorrência de intervenções de acordo com as classes de tamanho de leitegada (<12, 12-15 e >15 leitões). A proporção de intervenção manual foi maior (P<0,05) no 2º trimestre e menor (P<0,05) no 4º trimestre. Não houve diferença (P>0,05) no 1º e 3º trimestres. A proporção de OP1 do grupo intervenção foi maior para partos com ao menos 1 natimorto (P<0,001), na taxa de natimortos (P<0,001) e na taxa de mumificados (P<0,05). Não houve diferença (P>0,05) para nascidos totais (NT) e nascidos vivos (NV). A taxa de remoção foi maior (P<0,001) para o grupo intervenção. A remoção não reprodutiva foi maior (P<0,05) para o grupo intervenção; enquanto a remoção reprodutiva, para o grupo controle (P<0,05). No desempenho reprodutivo subsequente, não houve diferença (P>0,05) entre os grupos para o intervalo desmame-estro (IDE), taxa de retorno ao estro (T... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The aim of this study were to determine the characteristics of farrowing submitted to manual intervention and evaluate the effects of this intervention on the removal rate and the subsequent reproductive performance. Data from 5,257 farrowing were divided into control group (n=1,433) and intervention group (n=3,824). The criterion for manual intervention in sows on the parity order 1 (PO1) was determined by dystocia while in the other parity orders, (PO) when the interval between the birth of the piglets was higher than 10 minutes. In sows of PO1, the percentage of farrowing submitted to manual intervention was 7.6%. There was no difference (P>0.05) in the event of interventions according to litter size classes (<12, 12-15 and >15 piglets). The proportion of manual intervention was higher (P<0.05) in 2nd quarter and lower (P<0.05) in 4th quarter. There was no difference (P>0.05) on the 1st and 3rd quarters. The proportion of PO1 in the intervention group was higher for farrowing to at least one stillborn (P<0.001), stillborns rate (P<0.001) and mummified rate (P<0.05). There was no difference (P>0.05) for total born (TB) and born alive (BA). The removal rate was higher (P<0.001) for the intervention group. The non-reproductive removal rate was higher (P<0.05) in the intervention group while reproductive removal rate, for the control group (P<0.05). In the subsequent reproductive performance, there was no difference (P>0.05) between groups for weaning to estrus interval (WEI),... (Complete abstract click electronic access below) / Doutor

Pregnancy diagnosis by transrectal ultrasonography (using a 5 MHZ linear probe) presented the maximum sensitivity and negative predictive values at day 26 and day 29 after estrus in heifers and cows, respectively. Palpation per rectum using the fetal membrane slip for pregnancy diagnosis did not increase embryo/fetus mortality when compared with a positive control group of non-palpated females. The use of a controlled randomized block design was a useful approach to study this problem. Blocking for category and number of embryos allowed us to remove these confounding factors. Factors that affected pregnancy loss during the first four months of pregnancy were: period of pregnancy, age of the animal, number of previous lactations and number of embryos. Pregnancy loss was higher during the embryonic than fetal periods. Spontaneous embryo/fetal mortality increased with the age of the animal and lactation number. The risk of spontaneous embryo/fetus mortality was higher in twin than in single pregnancies. Two types of embryo/fetus mortality were noted: Type I and Type II. Type I was characterized by presence of positive fetal membrane slip by palpation per rectum, signs of degeneration by transrectal ultrasonography and persistence of a functional corpus luteum. The uterus took approximately 3 weeks to be noted clean by transrectal ultrasonography and the animals showed estrus one month after the conceptus was diagnosed dead. Type II was characterized by absence of positive signs of pregnancy by palpation per rectum, absence of signs of degeneration by transrectal ultrasonography and absence of a functional corpus luteum. Pregnancy loss in nuclear transfer derived embryos was higher compared to in vivo derived embryos produced by artificial insemination. Pregnancy loss occurred mainly during the transition from the embryonic to the fetal period. Embryo/fetus mortality detected was Type I. Progesterone produced by the corpus luteum was noted at pregnancy levels for approximately two weeks after embryo/fetus death. Protein B, a hormonal placental marker, was maintained at pregnancy levels for approximately 3 weeks after embryo/fetus death. No differences in the levels of the two hormones were noted when comparing females with dead or live conceptuses.

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2010. / The aim of this study was to determine the inter-examiner reliability of motion palpation to detect joint dysfunction in hindfoot and midfoot joints of asymptomatic feet and feet with chronic ankle instability syndrome. The rationale for this study was that motion palpation is a commonly used assessment tool that is used by the chiropractic profession to detect the need for manipulation of the spine and extremities. Also until the reliability of motion palpation is known, other studies using motion palpation as an assessment tool to detect the need for manipulation in the hindfoot and midfoot are questionable. The study was conducted at Durban University of Technology (DUT). Patients that responded to the adverts were then screened via telephonic interview. The researcher performed a case history, physical examination and a foot and ankle regional examination on each patient. Three masters chiropractic students then independently assessed both the symptomatic and asymptomatic feet of each patient and recorded their results. The data was then statistically analysed using SPSS version 15. It was found that the inter-examiner reliability of motion palpation for detecting restrictions in feet with chronic ankle instability syndrome was fair and for detecting instability, there was moderate reliability. In the asymptomatic group the examiners showed to have poor reliability in detecting restrictions and moderate reliability in detecting instability. Inter-examiner reliability was better in the symptomatic group and in this group examiners had more agreement on detecting instability as opposed to restrictions. This study has showed that inter-examiner reliability ranged from poor to moderate in the symptomatic and asymptomatic group with the reliability ranging from poor to moderate. Therefore, one can conclude that motion palpation can be used as an assessment tool to detect joint dysfunction in hindfoot and midfoot joints. However, further studies are warranted to address other subjective and objective measurements such as tenderness and range of motion together with motion palpation.

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2011. / Background: Myofascial pain is a disorder, characterized by the presence of trigger points (MTrP). It is recognised by unique features which include a tender point in a taut band of muscle, a local twitch response (LTR), a characteristic referred pain pattern, and the reproduction of the patient’s usual pain upon examination. A debate exists as to the precise diagnostic criteria used in identifying trigger points. This has hampered the standardized assessment and treatment of Myofascial Pain Syndrome and has led to contradictory findings being reported by various authors due to the lack of a reliable diagnostic tool. Objectives: The first objective was to determine the inter-examiner reliability of palpation of MTrPs in the trapezius and gluteus medius muscles. The second objective was to determine whether training and standardization in palpation techniques would improve inter-examiner reliability of palpation of MTrPs. Methods: This study was designed as a quantitative pre and post intervention interexaminer reliability study. Three examiners (one qualified Chiropractor, one senior chiropractic intern from the CDC and the researcher) were used to examine sixty patients (thirty symptomatic and thirty asymptomatic) for MTrPs. This study was conducted in two phases. During the myofascial examination of patients examiners were required to determine whether a MTrP was present or absent, differentiate whether the MTrP was active or latent and determine the presence or absence of the five characteristics of MTrP (tender point in a taut band of muscle, a local twitch response (LTR), a pain characteristic referred pain pattern, the reproduction of the patient’s usual pain and a jump sign) however, in phase one the researchers were blinded to the characteristics being investigated. Subsequent to phase one, examiners had to attend two, one hour discussion sessions to reduce individual variation in the application of palpation techniques. Results: Inter-examiner reliability was assessed using Fleiss Kappa statistic, percentage agreement and confidence intervals. The results show that three examiners are able to attain acceptable agreement in the palpation of MTrPs, since the features (described above) were shown to improve considerably in phase two after the training session in which standardization of techniques was emphasized. Conclusion: This study provides preliminary evidence that MTrP palpation is reliable and therefore, useful diagnostic tool in the identification of MTrPs and the diagnosis of Myofascial Pain Syndrome.

Thesis (M.S.) -- University of Texas Southwestern Medical Center at Dallas, 2008. / Vita. Bibliography: p.64

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2011. / Introduction: Motion palpation is a commonly utilised clinical assessment tool of joint fixations. Most research surrounding motion palpation discusses inter and/or intra-examiner reliability as a pre-treatment tool. However, only two studies have assessed the reliability of motion palpation as a post-treatment diagnostic tool, and both these studies demonstrated that motion palpation has the ability to identify end-feel improvement in a restricted segment which had been manipulated. Therefore the use of motion palpation as a post-manipulation tool within the spine showed a relatively high level of responsiveness/efficacy of motion palpation. However little research has yet to be conducted on the use of motion palpation as a post-manipulation tool on the extremities and therefore this study aims to provide a clearer insight into the use of motion palpation as a post-treatment assessment tool in an extremity in terms of clinical responsiveness/validity of motion palpation. Furthermore the relationship between motion palpation and other clinical measures/short term outcomes, such as pain, functionality, range of motion and proprioception has yet to be seen i.e. when motion palpation indicates a reduction in a fixation due to manipulation does this correlate to a decrease in pain and increase in functionality, range of motion and proprioception. Therefore the primary aim of this study was to determine the clinical responsiveness of motion palpation as a post-manipulation diagnostic tool within the joints of the ankle in symptomatic participants with Chronic Ankle Instability (CAI). Method: Forty participants with CAI (Grade I and II) were recruited. One Group received manipulation (n=21), the other Group received no treatment (n=19). Motion palpation was performed, and subjective/objective measures were taken in both Groups pre- and posttreatment. Statistical analysis was performed using SPSS 15.0. Results: The findings of this study demonstrated that when using motion palpation as a posttreatment assessment tool a high level of responsiveness was observed (a highly significant association between being manipulated and End-Feel Improvement (EFI) occurred (p<0.001)); it was highly sensitive (0.90); and was highly specific (0.95). Overall no statistically significant association was observed in either group between, motion palpation results (with respect to EFI or no EFI noted) and any of the short term outcomes (the five subjective/objective clinical measures). Within the manipulation group; Visual Analogue Scale (VAS) (p=0.944), Functional Ankle Disability Index (FADI) (p=0.490), Pressure Algometer v (p=0.634), Berg Balance Scale (BBS) (p=0.512) and Weight Bearing Dorsiflexion (WBD) (p=0.966). In comparison, the control group; Visual Analogue Scale (VAS) (p=0.063), Functional Ankle Disability Index (FADI) (p=0.491), Pressure Algometer (p=0.828), Berg Balance Scale (BBS) (p=0.695) and Weight Bearing Dorsiflexion (WBD) (p=0.747). The most common fixations noted in this study, were mortise Long Axis Distraction (LAD), subtalar LAD and subtalar eversion. Conclusion: Therefore, motion palpation appears to be valid when used as a post-treatment tool in the foot and ankle; and overall, common fixations found in symptomatic participants with CAI in this study are similar to those found in previous studies.

Bakgrund: Det föds mellan 115 000 - 120 000 barn i Sverige varje år, där de flesta förlossningar är vaginala och slutar i någon form av bristning. Bristningarna delas in i fyra grader beroende på deras omfattning. Där grad ett och två innefattar vagina och perineum medan en grad tre och fyra ruptur innefattar sfinktermuskulaturen. Studier har visar att upp till 57% av de kvinnor som råkat ut för en sfinkterruptur lider av någon form av inkontinensproblematik tio år efter skadan. Samtidigt som vissa kvinnor först får problem några år efter att skadan inträffat. Uppföljning efter skada av dessa patienter sker antingen av specialistläkare, barnmorska eller av fysioterapeut. Syfte: Att göra en sammanställning av vilka sjukhus i norra Sverige som har en fysioterapeut inkopplad vid en obstetrik analsfinkterruptur som uppstått i samband med en vaginal förlossning. Metod: En enkät skapades online med fyra frågor om fysioterapeutisk uppföljning och kompetens gällande kvinnor som råkat ut för en sfinkterruptur. Enkäten skickades ut i två omgångar till nio sjukhus i norra Sverige tillsammans med ett informationsbrev. De sjukhusen/lasaretten som inte svarade på enkäten togs kontakt med på telefon för att ställa frågorna. Resultat: Elva procent av sjukhusen i norra Sverige erbjuder individuell information på vårdavdelning, tjugofem procent erbjuder hjälp vid behov, tjugotvå procent har kompetens inom vaginal palpation. Jämfört med en kartläggning gjord i södra Sverige där det låg mellan 80-90%. Konklusion: Den fysioterapeutiska uppföljningen och kompetensen kring dessa kvinnor skiljer sig i norra och södra Sverige.

Submitted by GIANCARLO COSTI null (costi.giancarlo@gmail.com) on 2016-08-26T04:26:53Z No. of bitstreams: 1 Tese versão final submissão UNESP.pdf: 1498136 bytes, checksum: dce342a5294f8ed176c92af24709db8c (MD5) / Approved for entry into archive by Ana Paula Grisoto (grisotoana@reitoria.unesp.br) on 2016-08-29T19:55:09Z (GMT) No. of bitstreams: 1 costi_g_dr_jabo.pdf: 1498136 bytes, checksum: dce342a5294f8ed176c92af24709db8c (MD5) / Made available in DSpace on 2016-08-29T19:55:09Z (GMT). No. of bitstreams: 1 costi_g_dr_jabo.pdf: 1498136 bytes, checksum: dce342a5294f8ed176c92af24709db8c (MD5) Previous issue date: 2016-07-27 / Os objetivos do presente estudo foram determinar as características de partos submetidos à intervenção manual e avaliar os efeitos dessa intervenção na taxa de remoção e no desempenho reprodutivo subsequente. Dados de 5.257 partos foram divididos em grupo Controle (n=1.433) e Intervenção (n=3.824). O critério para a intervenção manual nas fêmeas de ordem de parto 1 (OP1) foi determinado pela distocia, enquanto nas demais ordens de parto (OP), somente quando o intervalo entre o nascimento dos leitões foi maior que 10 minutos. Nas fêmeas de OP1, o percentual de partos submetidos à intervenção manual foi de 7,6%. Não houve diferença (P>0,05) na ocorrência de intervenções de acordo com as classes de tamanho de leitegada (<12, 12-15 e >15 leitões). A proporção de intervenção manual foi maior (P<0,05) no 2º trimestre e menor (P<0,05) no 4º trimestre. Não houve diferença (P>0,05) no 1º e 3º trimestres. A proporção de OP1 do grupo intervenção foi maior para partos com ao menos 1 natimorto (P<0,001), na taxa de natimortos (P<0,001) e na taxa de mumificados (P<0,05). Não houve diferença (P>0,05) para nascidos totais (NT) e nascidos vivos (NV). A taxa de remoção foi maior (P<0,001) para o grupo intervenção. A remoção não reprodutiva foi maior (P<0,05) para o grupo intervenção; enquanto a remoção reprodutiva, para o grupo controle (P<0,05). No desempenho reprodutivo subsequente, não houve diferença (P>0,05) entre os grupos para o intervalo desmame-estro (IDE), taxa de retorno ao estro (TRE), taxa de abortamento (TA), taxa de parto (TP), taxa de parto ajustada (TPA), NT, NV, natimortos (NM) e mumificados (MM). Nas fêmeas de ordem de parto maior que 1 (OP>1), a OP2 teve o menor percentual (P<0,001) de intervenção, enquanto a OP6-10, o maior (P<0,001). Não houve diferença (P>0,05) entre os grupos para as fêmeas OP3-5. Na classe de tamanho de leitegada, o grupo controle apresentou um maior percentual (P<0,05) de fêmeas na categoria <12 leitões, enquanto nas leitegadas >15 o grupo intervenção resultou em um maior percentual (P<0,05) de fêmeas. Não houve diferença (P>0,05) entre os grupos para a categoria 12-15 leitões. Quanto à classe período do ano, a proporção de fêmeas do grupo controle foi maior (P<0,001) no 1º trimestre e do grupo intervenção no 3º trimestre (P<0,001). Não houve diferença (P>0,05) no 2º e 4º trimestres. Nas fêmeas de OP>1, não houve diferença (P>0,05) entre os grupos no percentual de fêmeas com pelo menos 1 natimorto. As fêmeas com intervenção apresentaram maior média de OP (P<0,001), NT (P<0,05) e NV (P<0,05). Não foi observada diferença (P>0,05) para NM, MM, taxa de remoção, taxa de remoção reprodutiva e taxa de remoção não reprodutiva. Houve diferença (P<0,001) na OP média das fêmeas removidas. No desempenho reprodutivo subsequente das fêmeas de OP>1, não houve diferença (P>0,05) entre os grupos para as variáveis IDE, TRE, TA, TP, TPA, NT, NV e MM. Foi encontrada diferença apenas nos NM (P<0,05) e média de OP (P<0,001). / The aim of this study were to determine the characteristics of farrowing submitted to manual intervention and evaluate the effects of this intervention on the removal rate and the subsequent reproductive performance. Data from 5,257 farrowing were divided into control group (n=1,433) and intervention group (n=3,824). The criterion for manual intervention in sows on the parity order 1 (PO1) was determined by dystocia while in the other parity orders, (PO) when the interval between the birth of the piglets was higher than 10 minutes. In sows of PO1, the percentage of farrowing submitted to manual intervention was 7.6%. There was no difference (P>0.05) in the event of interventions according to litter size classes (<12, 12-15 and >15 piglets). The proportion of manual intervention was higher (P<0.05) in 2nd quarter and lower (P<0.05) in 4th quarter. There was no difference (P>0.05) on the 1st and 3rd quarters. The proportion of PO1 in the intervention group was higher for farrowing to at least one stillborn (P<0.001), stillborns rate (P<0.001) and mummified rate (P<0.05). There was no difference (P>0.05) for total born (TB) and born alive (BA). The removal rate was higher (P<0.001) for the intervention group. The non-reproductive removal rate was higher (P<0.05) in the intervention group while reproductive removal rate, for the control group (P<0.05). In the subsequent reproductive performance, there was no difference (P>0.05) between groups for weaning to estrus interval (WEI), return to estrus rate (RER), abortion rate (AR), farrowing rate (FR), adjusted farrowing rate (AFR), TB, BA, stillborns (SB) and mummified (MM). In PO sows greater than 1 (PO>1), PO2 had the lowest percentage (P<0.001) while the intervention PO6-10, the greatest (P<0.001). There was no difference (P>0.05) between groups for sows in the OP3-5. In litter size class, the control group had a higher percentage (P<0.05) of sows in the category <12 piglets while in litters >15 intervention group resulted in a higher percentage (P<0.05) of sows. There was no difference (P>0.05) between groups for the category 12-15 piglets. As the class, period of the year, the proportion of sows in the control group was higher (P<0.001) in the 1st quarter and the intervention group in 3rd quarter (P<0.001). There was no difference (P>0.05) on the 2nd and 4th quarters. In sows PO>1, there was no difference (P>0.05) between the groups in the percentage of sows with at least one stillborn. Sows with intervention had higher average of PO (P<0.001), TB (P<0.05) and BA (P<0.05). There was no difference (P>0.05) in SB, MM, removal rate, reproductive removal rate and non-reproductive removal rate. There were differences (P<0.001) in the PO average of removed females. In the subsequent reproductive performance of PO>1 sows, there was no difference (P>0.05) between groups for variables, WEI, RER, AR, FR, AFR, TB, BA and MM. A difference was found only in SB (P<0.05) and PO mean (P<0.001).

M.Tech. / It has been well documented in literature that at least 80% of the general population will suffer from lower back pain or dysfunction at one stage in their lives. Recent literature suggests Sacroiliac joint dysfunction to be a common cause of lower back pain. Clinical interest in the dysfunction and the consequences of this joint being a major cause of lower back pain is growing, as more biomechanical clinicians are finding Sacroiliac joint disorders to be a common occurrence in clinical practice (Pool-Goudzwaard, Vleeming, Stoekart, Snijders and Mens, 1998). Sacroiliac syndrome is characterised by loss of joint play or altered mobility in the Sacroiliac joint‟s range of motion, and is usually associated with altered structural relationships in the region of the Sacroiliac joint (Grieve, 2001). This loss of normal movement is often adjusted by Chiropractors to regain normal mobility, however the correct diagnosis of the loss of mobility is required to induce the correct treatment. Motion palpation has been scrutinised by many researchers who widely questioned its inter-tester reliability. As yet there has been no consensus as to a „gold standard‟ for motion palpation of the Sacroiliac joint. This study aims to reconfirm the inter-examiner reliability of two such motion palpation tests, i.e. Gillet‟s motion palpation and the Standing Flexion test. One hundred participants underwent a double blind experimental study where the results from eight different examiners were recorded to obtain the reliability of the tests. Four examiners tested the participants using Gillet‟s motion palpation and four examiners used the Standing Flexion test. The results were recorded as either right, left or no restriction. The results were then compared and correlated. There was no statistically significant reliability found in either of the two tests. The mean reliability for the Standing Flexion test was found to be 59.31% while the Gillet‟s Motion Palpation produced a mean reliability of 56.38%. These two values are considerably lower than the expected 80% indicating low reliability between the two tests.

M. Tech. / Although Chiropractors rely on palpation as a clinical tool, its reliability still remains to be proven (O‟Haire and Gibbons, 2000). Motion palpation is based on the assumption that Chiropractors‟ and other manual medicine practitioners‟ static palpation is performed correctly to identify bony anatomical landmarks (O‟Haire and Gibbons, 2000). The most common method taught to chiropractic students on the location of the seventh thoracic spinous process, is to place the patient‟s hand in the small of their back, forcing the inferior angle of the scapula to become more prominent. The horizontal line from the inferior angle of the scapula to the vertebral column is said to be on the seventh thoracic spinous process (T7). Therefore the scapula is a widely used anatomical landmark. One would therefore expect the literature to all be in agreement to the position of this line, but according to the literature consulted, it seems to vary. This study aimed to determine whether palpation of the inferior angle of the scapula was a reliable, accurate and/or a valid method of determining the location of the seventh thoracic spinous process. Sixty participants were marked by three examiners in the seated position, using the inferior angle of the scapula to locate the seventh thoracic spinous process. After being marked by all three examiners, measurements were then made on CT scan films as well as visual assessments by examiners to assess the location of the markers on the thoracic anatomy. The results demonstrated substantial inter-examiner reliability, and poor accuracy in locating the seventh thoracic spinous process. This is disappointing as the ability to palpate spinal levels is a basic skill and the cornerstone of Chiropractic assessment.