published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

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Maximizing recovery of function after brain injury is the goal for many neuroscientists and rehabilitation medicine professional alike. To further elucidate the neural mechanisms underlying compensatory changes in brain injury and to determine the possibility of enhancing these changes, three experiments are described. Experiment 1 looks at the effects of structured (skilled reaching) versus functional (enriched environment) training with and without FGF-2, a pharmacological intervention, as treatment paradigms for rehabilitation-induced recovery of function in cortical lesion adult rats. Experiment 2 examines the treatment effects of tactile stimulation to enhance motor abilities in postnatal day 4 rat pups sustaining cortical damage. Finally, experiment 3 explores changes in the cortical motor representation after cortical damage. Results indicate a marked improvement on behavioral testing combing FGF-2 and functional training. Tactile stimulation significantly enhances recovery of motor functions. Post-lesion cortical mapping reveals changes in the motor representation utilizing the adjacent posterior parietal cortex. / xv, 127 leaves : ill. ; 28 cm.

The outcome of acute stroke in 210 White adult patients admitted to Addington Hospital, Durban in 1983 and 1984 was investigated by means of retrospective case-note review. In addition, the level of functional independence of 35 people who, at the time of this study, were survivors of an initial acute stroke was assessed through household survey. The study was considered relevant and worthwhile for several reasons: 1. Stroke is an important contributor to morbidity and mortality in Whites in South Africa, however, l i t t l e information is available in respect of the outcome of sufferers of stroke who were admitted to the study hospital. 2. Knowledge of the needs of survivors of acute stroke is necessary if appropriate health care is to be provided. 3. Few community studies have been done in South Africa in which the status of stroke survivors has been established. The principle aims of the study were therefore: 1. To establish the survival of patients with acute stroke who were admitted to the study hospital. 2. To determine in survivors of an initial stroke their residual functional loss and hence to identify the supportive health care needs of this group. The most important findings of the study were as follows: 1. Of the 286 stroke admissions identified through the hospital's medical record retrieval system, stroke diagnosis according to the study definition could be confirmed in only 210 (73.4%) cases due to misplaced files or miscoded diagnoses. The need for improvement in the method of recording, storing and retrieving of patient information is indicated by these findings. The overall hospital fatality rate for stroke was 54%. Mortality was highest in the first week after admission (71%). The number of males and females, in respect of whom a final diagnosis of stroke was attributed, was almost equal. A significant difference (p < .000 2) in respect of age was noted between the sexes. The mean age of onset of stroke was 62.9 and 70.0 years for males and females respectively. The major diagnostic categories (haemorrhagic or occlusive) of stroke could only be ascertained in respect of 30% of cases. This was due to incomplete recording of clinical findings, and possibly, due to the absence of resident brain-scanning facilities at the time. Analysis of the results of the household interviews indicated that:-( I ) Of the 35 patients interviewed 13 (37%) were found to be fully independent in self-care and were mobile outside of the home. (ii) The patients' potential for improvement in an appreciable number of cases had been under-estimated by the hospital staff. Patient adjustment following hospital discharge appeared adversely affected by.-(i) Inadequate preparation for discharge, especially where patients were returning to their own homes. (ii) Inadequate explanation given to patients and their families of the meaning and implications of stroke. (iii)The non-involvement of the family during the period of hospitalization. (iv) The absence of appropriate follow-up after discharge. Stroke onset was a traumatic experience in all cases. Amongst the most important reasons given for reduced life-satisfaction post stroke were confinement to the home, reduced independence and unresolved loss (eg death of spouse, forced retirement). 8. In some cases it was f e l t that social isolation, general ill-health and old age were more significant problems in the lives of patients than the stroke itself. The advent of stroke merely exaggerated these problems. 9. The advantage of administering a standardized functional assessment at intervals during the rehabilitation of the patients became increasingly clear as the study progressed. It is proposed that functional assessment be considered as important as clinical assessment in the management of stroke patients. 10. Recommendations have been submitted concerning rehabilitation and the provision of supportive services for stroke patients. As the role of the nurse in short and long-term care is central to successful stroke outcome, emphasis has been placed on her role in the team. The main conclusions formulated in the study were:-1. Mortality from stroke is high but in survivors an appreciable proportion maintained functional independence. 2. Preparation of patients and their families is important to adjustment following discharge from hospital. 3. Supportive services are important to the maintenance of the stroke patient in the home environment. 4. A team approach, consisting of a wide range of health professionals is appropriate to the management of stroke. 5. Functional assessment is an important component of the clinical examination and should be done prior to discharge and subsequently at regular intervals to assess the patient's competence to exist in the current domestic environment. / Thesis (MMed.)-University of Natal, Durban, 1986.

Introduction: Balance dysfunction, particularly in standing, is a devastating sequel to stroke since the ability to balance is one of the most critical motor control factors in daily life. Physiotherapists use a variety of balance and stability techniques as a part of treatment programmes to improve functional independence in patients following a stroke. However more scientific evidence for the effectiveness of these techniques or programs is required. Purpose: The purpose of this study was to quantify the effect of a balance and stability training program on stability, balance and functional independence in stroke patients. Method: The aims of this study were achieved using a randomised controlled trial. A questionnaire allowed the collection of demographic data from fifty participants who had suffered the first stroke, regardless of gender or race. The Postural Assessment Scale for Stroke patients (PASS), Berg Balance Scale (BBS), Barthel Index (BI) and questionnaire were administered to all fifty participants on the first and last weeks of a twelve week physiotherapy program. For ten weeks twenty five randomly assigned participants in each of the control and experimental groups underwent either normal physiotherapy or stability and balance intervention exercise program respectively. Data Analysis: The raw data was normalized by calculating percent changes for each item for each participant and the pooled data subjected to Wilcoxon signed ranks testing, paired samples signed tests and Pearson’s correlations. Results: PASS, BBS and BI scores increased significantly from pre-test to post-tests in both groups, with greater changes noted in the experimental group, showing improvements in stability, balance and function. In addition a strong and significant correlation between stability scores and balance scores suggested that stability is important to improve balance. Similarly a strong and significant correlation between stability and balance scores with function scores confirms the value of stability and balance in improving function. It was further noted that in addition to a certain degree of spontaneous recovery, traditional physiotherapy programs also result in improvement in stability, balance and function but not to the same extent as with the program of treatment which emphasizes stability and balance exercises. Conclusion: A significant improvement in the stability, balance and function in stroke patients was achieved with the balance and stability intervention program. Conventional physiotherapy methods also improved stability, balance and function, but to a lesser extent than the balance and stability training. / Thesis (M.Physio.)-University of KwaZulu-Natal, Westville, 2012.

The purpose of this research study was to examine the nature and scope of nutrition counseling and/or education available to cardiac patients and the role of the Registered Dietitian (RD) in Cardiac Rehab Phase II Programs. One hundred and fifty programs were surveyed in regards to their program and the programs elements in regards to nutrition topics. To our knowledge, this is the first study to systematically examine the nature and scope of nutrition counseling and/or education and the role of the Registered Dietitian in Cardiac Rehab Phase II Programs.The results indicated that almost 75% of the programs surveyed offered nutrition counseling and/or education, regardless of the region examined. Also the majority of the programs were identified to have a Registered Dietitian on staff, but less than half reported a Registered Dietitian employment as full-time. There were also significant differences in regards to nutrition education topics among the regions. The results also uncovered a discrepancy between the perceived importance of having a Registered Dietitian on staff and their role as the primary provider of nutrition counseling and/or education. / Department of Family and Consumer Sciences

The purpose of this study was to determine if the perceived level of ability (self-efficacy) differed from actual performance ability for individuals with cerebral vascular accidents (CVA's). Patients were assessed for perception and actual ability level on Activities of Daily Living (ADL's) and Balance skills at admission and at discharge from an inpatient CVA rehabilitation program. Thirty patients with unilateral brain lesions (15 right and 15 left) constituted the study group. ANOVA and repeated measures were used in this quasi-experimental, quantitative study to examine data. All three research hypotheses were tested at an alpha level of .05 for significance. The first and third research hypotheses were supported: CVA patients' self-efficacy scores on ADL's and Balance Skills were significantly different from actual performance scores at time of admission to a CVA rehabilitation program; and the self-efficacy scores were significantly closer to actual performance scores for ADL skills at discharge. The improved accuracy in perception of Balance Skills was not supported by comparison of scores between admission and discharge measurements. The second hypothesis that right hemisphere CVA lesion patients self-efficacy and actual performance scores would be significantly different compared to the scores of patients with left hemisphere CVA lesions was not supported. A ttest for paired samples was also performed on the ADL scores data to investigate three-way significance for the third hypothesis. The patients studied successfully completed the prescribed therapeutic activities in a CVA rehabilitation program and were able to predict with significantly improved accuracy, performance ability on ADL skills at discharge. / School of Nursing

Physical activity (PA) is related to prevention and rehabilitation (rehab) of oncology patients, however little is known about PA habits of patients with cancer. Purpose. The purpose of this study was to assess and characterize PA habits, fatigue, and mood states of cancer survivors from before participation in an exercise rehab program to the final week of a 16 session exercise rehab program. Methods. Eleven subjects (9 women, 2 men, with an average age 60.9±1 0.1 years) wore an Actigraph GT1M accelerometer and New Lifestyle series pedometer a week before beginning an exercise rehab program (baseline), the first week (week 1) and the final week of exercise rehab (week 8). Intensity counts/minute and steps were measured by the GT1M and steps were calculated by the pedometer. Results. Ten subjects were classified under the sedentary step index, walking <5,500 steps/day and further grouped under the subcategory for chronic diseased individuals proposed by Tudor-Locke and Myers of 3,500-5,500 steps/day. One subject was recorded by the accelerometer to meet the Surgeon General, American College of Sports Medicine/Center for Disease Control and Prevention, the American Cancer Society, and 10,000 step/day PA guidelines throughout the study. The accelerometer underestimated rehab activity of 4 subjects who exercised on the Nu-step during rehab. PA habits of steps and intensity varied at baseline, week 1, and week 8 and on rehab and non-rehab days. There were no patterns seen determined by diagnosis, treatment, or staging of cancer. Five subjects increased their 6 minute walk distance, 6 subjects decreased in total mood disturbance, and 4 subjects lowered their perception of fatigue. Conclusion. The intervention, exercise, with 11 cancer survivors maintained PA habits, functional ability, fatigue, and mood states over time and on rehab and non-rehab days. / School of Physical Education, Sport, and Exercise Science

The purpose of this study was to examine the effects of teaching-coaching interventions on knowledge scores and anxiety scores on a group of individuals In a phase II cardiac rehabilitation program as compared with Individuals not receiving teaching-coaching. Ten individuals received the traditional cardiac rehabilitation program given by the participating hospital. The second group of ten individuals received the traditional cardiac rehabilitation program plus additional teaching-coaching by a registered nurse.Sister Callista Roy's (1984) adaptation model was used as the conceptual framework for this study. Roy's adaptation model was appropriate because the teaching-coaching function of the nurse that was utilized in this study, has been found to help individuals adapt to changes and to decrease anxiety. Roy's model used guidance and direction with the individual's cognator and regulator to promote physiological functioning, improve self-concept, develop role function, and interdependence to bring about adaptation to the myocardial infarction.Hypothesis one and two tested different effects of the teaching-coaching function on two groups of cardiac rehabilitation patients on knowledge scores and anxiety scores by analysis of variance. Hypothesis three determined the relationship between knowledge and anxiety in the two groups by Pearson's product moment correlation.A twenty question multiple choice test focusing on content from the cardiac rehabilitation program, designed by the researcher, determined knowledge gain by the participants. Anxiety was determined by the state section of the State-Trait Anxiety Inventory (Form Y) by Spielberger. The teaching-coaching was accomplished in two thirty minute sessions that focused on content in the cardiac rehabilitation program with each participant by the researcher.The knowledge test and anxiety questionnaire were coded by number to give anonymity. Confidentiality was maintained. The participant was free to discontinue the study at any time without jeopardy.Findings of this study found no significant Increase In knowledge or reduction in anxiety between groups. However, the experimental group that received registered nurse teaching-coaching had a mean score Increase of 3.1 in knowledge scores and mean score reduction of 4.4 In anxiety. Correlation of post knowledge scores and post anxiety scores indicated as knowledge increased anxiety decreased in the participants as related to registered nurse teaching-coaching interventions.Conclusions Indicated that further research is needed to demonstrate the effectiveness of nurse teaching-coaching on knowledge and anxiety. The teaching-coaching function of the nurse warrants strong consideration for further study and use in nursing practice in assisting individuals in recovering from illness and being restored to optimum quality of life. / School of Nursing