Thesis (MScPhysio (Physiotherapy))--University of Stellenbosch, 2009. / The ability to walk has been rated by stroke patients as one of the most important goals of their rehabilitation. Knee control is a key element in normal gait. Currently, treatment options aimed at improving poor knee control in stroke patients are often costly, need specialised equipment and have poor patient compliance. The purpose of the current study was to assess whether medial patellar taping could improve knee control in stroke patients. Gait speed, dynamic standing balance, knee alignment and whether the subjects experienced any subjective stabilising effect on the knee after taping were tested. Twenty subjects diagnosed with hemiplegia after a stroke served as their own controls in a repeated measures experimental study. Results indicated that dynamic standing balance as tested by the Step Test (p=0.063) and the Timed-up-and-go test (p=0.099) (Wilcoxon test) showed marginal improvement after taping. This improvement in dynamic standing balance may indicate that neuro-motor control and/or eccentric knee control had improved. There was no change in walking speed and knee alignment as tested by change in the Q-angle (Wilcoxon test). However, a decrease in the Q-angle correlated with an improvement in dynamic standing balance as tested by the Step Test (p=0.029) (Spearman‟s test). Participants with decreased Q-angles after taping possibly had better knee alignment and were more willing to accept weight on their affected leg indicating a change in quadriceps activation. No change in walking speed (p=0.351) (Wilcoxon test) before and after taping may indicate that there was no change in the magnitude of contraction and/or concentric activity in the quadriceps muscle. Thirty percent of the participants reported a subjective change in knee stability after taping. Subjective change did not, however, significantly correlate with either of the balance tests, walking speed or Q-angle measurements. The possibility that medial patellar taping may be useful in treating poor knee control in stroke patients during dynamic balance activities should be investigated further.

While the cognitive disturbances that frequently follow severe TBI are relatively well understood, the ways in which these affect the psychosocial functioning of people with TBI are yet to be determined and have thus received little attention in treatment research. Growing evidence indicates that that a significant proportion of individuals with TBI demonstrate deficits in the perception of affective information from the face, voice, bodily movement and posture. As accurate evaluation of emotion in others is critical for the successful negotiation of social interactions, effective treatments are necessary. Until recently, however, there have been no rehabilitation efforts in this area with TBI groups. The present research aims to redress this absence. The literature on emotion perception deficits in TBI is examined, and a theoretical rationale for intervention is presented. Several lines of research are reviewed which suggest that rehabilitation targeting such deficits is tenable. These include research on emotion perception remediation with other cognitively impaired populations, findings from cognitive neuroscience suggesting the potential for neuronal restoration after brain damage, and the successful applications of remediation techniques, in particular errorless learning and self-instruction, for treating other cognitive deficits in a range of neurological disorders and TBI. Discussion of this research is followed by a description of two randomised controlled trials aimed at improving emotion perception in individuals with TBI. The findings are discussed with reference to useful theoretical models of rehabilitation, learning and emotion perception. Suggestions for future directions of research are outlined together with relevant design issues.

While the cognitive disturbances that frequently follow severe TBI are relatively well understood, the ways in which these affect the psychosocial functioning of people with TBI are yet to be determined and have thus received little attention in treatment research. Growing evidence indicates that that a significant proportion of individuals with TBI demonstrate deficits in the perception of affective information from the face, voice, bodily movement and posture. As accurate evaluation of emotion in others is critical for the successful negotiation of social interactions, effective treatments are necessary. Until recently, however, there have been no rehabilitation efforts in this area with TBI groups. The present research aims to redress this absence. The literature on emotion perception deficits in TBI is examined, and a theoretical rationale for intervention is presented. Several lines of research are reviewed which suggest that rehabilitation targeting such deficits is tenable. These include research on emotion perception remediation with other cognitively impaired populations, findings from cognitive neuroscience suggesting the potential for neuronal restoration after brain damage, and the successful applications of remediation techniques, in particular errorless learning and self-instruction, for treating other cognitive deficits in a range of neurological disorders and TBI. Discussion of this research is followed by a description of two randomised controlled trials aimed at improving emotion perception in individuals with TBI. The findings are discussed with reference to useful theoretical models of rehabilitation, learning and emotion perception. Suggestions for future directions of research are outlined together with relevant design issues.

Pharmacological interventions to treat Human Immunodeficiency Virus (HIV) with antiretrovirals (ARVs), have dramatically improved the survival rates of HIV positive children maturing into adulthood. However, HIV-associated neurocognitive decline still persists in the era of ARVs. Within the framework of brain plasticity, a number of researchers have begun to assess the feasibility of cognitive rehabilitation therapy as a complement to ARVs to reverse neurocognitive decline as a result of HIV (e.g., Becker et al., 2012). Only one study has been conducted in South Africa, by Zondo & Mulder (2014), assessing the efficacy of cognitive rehabilitation in a paediatric sample. The current research builds on the above mentioned study by implementing an experimental approach to examine the effect of cognitive rehabilitation in a sample of both HIV positive and HIV negative children. Five HIV positive and six HIV negative children were assigned to either an experimental or control group. The experimental group underwent two months of cognitive rehabilitation therapy remediating sustained attention, whereas the control group took part in placebo activities. Sustained attention measures were taken before and after the intervention training sessions, using a sustained attention subtest from the Test of Everyday Attention for Children (TEA-CH). A Mann Whitney U Test revealed that the experimental group (Mdn=38.50) did not differ significantly from the control group (Mdn = 37.00) after the cognitive rehabilitation intervention, U=12.00, z= -.55, p= .66, r= -.17. But a Wilcoxon Signed Rank Test found that there was a significant improvement from pretest scores (Mdn=31.00) to posttest scores (Mdn=38.00) following the rehabilitation for HIV positive participants in the sample, T=15.00, z = -2.02, p= .04, r= -.90. This raises the possibility that cognitive rehabilitation could be used as a low cost intervention in underdeveloped contexts

The development of emergency department medical interventions and the implementation of fast-transport trauma systems has decreased the rate of death resulting from traumatic brain injury (TBI). Without corresponding methods for long-term treatment and recovery, the prevalence of people disabled by TBI has increased, creating a growing public health problem. Investigations generated by physicians, rehabilitation programs, and social scientists, which attempt to associate standard measures of injury severity with outcome, leave unexplained variance in long-term functional status for persons with TBI. The purpose of this investigation was to use persons with brain injury and their family members, to guide an analysis of the factors that foster successful recovery from brain injury. Three studies were conducted. In Study #1, the method for observation generated by Kurt Goldstein (1934) was adopted to conduct 20 case studies of persons who sustained brain injury. The Schema of the EsEx Couple (Maynard. 1992) was used to orient the investigation. The EsEx Couple Schema proposes that events in human life must be understood by considering the whole system of Person (Essence) in the Environment (Exchange), and the transactions that flow in a recursive loop from Person to Environment and back. Kurt Goldstein's Laws of Organismic Life (1934), a model consistent with that of the EsEx Couple, was used to evaluate the data. Strong patterns associated family and social networks, autonomy, and perceived self-determination with higher levels of recovery, and were used to generate a Model for Recovery. In Study #2. the Motivational Analysis of Self-Systems Processes (Connell & Wellborn, 1991) was combined with results from Study #1 to generate a Development Model, and to build a survey which was administered to 248 persons with brain injury. Results (1) confirmed the model, indicating factors that contribute to recovery were hypothesized measures of Social Context, Perception, and Engagement; and (2) established a valid instrument, generated by persons with brain injury and their families, for measuring functional status. In Study #3. results of the survey research were used to return to the case studies to consider where individual lives differ from expected patterns, and why. Deviations from expected patterns were explored to identify how individual differences operate to affect outcome. Recommendations for clinical practice include (1) directing interventions toward family as well as patient, as a method of enhancing the Social Context for the patient, and (2) using careful evaluation of each patient's idiosyncrasies to consider individual interventions.

Thesis (MSc)--Stellenbosch University, 2015 / Stellenbosch : Stellenbosch University / ENGLISH ABSTRACT : Substance abuse is a major problem globally with immeasurable consequences to the health of users. Rehabilitation is one of the strategies that can help to fight against substance abuse. It is divided into two forms: in-patient and out-patient rehabilitation. In this study, we consider a compartmental model of substance users in rehabilitation, where a periodic function is included to illustrate seasonal oscillations of drug users entering rehabilitation. In this thesis, we derive two basic reproduction numbers R0 and [R0], where R0 is the model with periodicity and [R0] the model without periodicity. We show that the model has a drug-free equilibrium when the basic reproduction number R0 is less than one and drug persistent equilibrium when R0 is greater than one. We fit the model to data and obtained sneak preview of the future of these forms of rehabilitation. Our results indicate that when R0 is less than one, the in- and out-patient populations decrease quickly and when R0 is greater than one drugs persists and after a long period of time, individuals in rehabilitation approaches w-periodic solution. Sensitivity analysis is performed and the results show that control measures should focus on the effective contact rate between susceptibles and drug users so as to control the epidemic. These results have significant implications on the management and planning of rehabilitation programs in South Africa. / AFRIKAANSE OPSOMMING : Dwelm misbruik is wêreldwyd ‘n ernstige problem met onmeetbare gevolge vir die gesondheid van gebruikers. Rehabilitasie is een van die strategieë wat dwelm misbruik kan help beveg. Dit word in twee vorms verdeel: binnepasiënt- en buitepasiëntrehabilitasie. In hierdie studie ondersoek ons ‘n kompartementele model van dwelmgebruikers in rehabilitasie, waar ‘n periodieke funksie ingesluit word om seisoenale skommelings aan te toon met betrekking tot dwelmgebruikers wat rehabilitasie aanpak. In hierdie tesis lei ons twee basiese reproduksienommers af, R0 en [R0], waar R0 die model met periodisiteit en [R0] die model sonder periodisiteit is. Ons toon aan dat die model ‘n dwelmvrye ekwilibrium het wanneer die basiese reproduksienommer R0 minder as een is en ‘n dwelm-voortsettingsekwilibrium het wanneer R0 meer as een is. Ons pas die model op die data toe en verkry ‘n vooruitskouende blik op die toekoms van hierdie vorms van rehabilitasie. Ons resultate dui aan dat wanneer R0 minder as een is, die binne- en buitepasiënt-bevolkings vinnig verminder en wanneer R0 meer as een is, die gebruik van dwelms voortduur en dat nà ‘n lang tydperk individue in rehabilitasie nader aan w-periodieke oplossing beweeg. Sensitiwiteitsontleding word uitgevoer en die resultate toon aan dat daar ‘n bewustheid moet bestaan dat die graad van effektiewe kontak tussen vatbare individue en dwelmgebruikers beperk moet word ten einde die epidemie onder beheer te bring. Hierdie resultate het betekenisvolle implikasies vir die bestuur en beplanning van rehabilitasieprogramme in Suid-Afrika. / rs201601

The single subject alternating treatment design experiment reported here compared the effectiveness of pencil-and-paper versus computerized communication treatment for neurologically impaired adults. Five stroke patients receiving outpatient speech/language treatment (ages 51-72) served as subjects. One subject completed the experiment as designed and clearly supported the hypothesis that a higher number of correct responses would be produced using the computer generated exercises than the pencil-and-paper version. Two subjects were unable to demonstrate improvement using the experimental treatment program and the other two subjects were unable to master keyboarding skills necessary to use the computer effectively. However, four out of five subjects preferred using the computer even though it did not result in improved performance. Details of specific subjects' performance, and benefits and cautions regarding computer use are discussed. Results suggest that adequate receptive language skills favor effective computer use while impulsivity and visual spatial deficits may be expected to interfere. Careful matching of treatment task to the individual is important; if the task is too easy or too difficult potential benefit of computer use may be masked. The study also supports the finding that computer use is a highly motivating treatment technique for some patients and may be of benefit even if improved task performance does not result. Suggestions for further research include comparison of computerized versus non-computerized treatment for a greater variety of tasks, careful task analysis of currently available software, examination of techniques for training the mechanics of computer use, examination of specific subject characteristics which correlate with successful use of the computer, and determination of which aspect of computer use, specific feedback or improved motivation, is responsible for improved performance. / Graduation date: 1992

[Truncated abstract] Knee osteoarthritis (OA) patients have high levels of pain, functional and strength deficits of the quadriceps, decreased proprioceptive acuity, and increased co-contraction and knee joint loading in gait, compared to age matched controls. The increased knee joint loading in this population occurs most commonly in the medial tibio-femoral compartment, due to increased external adduction moments, and with increasing disease severity there is a concomitant increase in the knee adduction moments. A key finding within the knee OA literature is that dynamic loading in gait, due to increased external adduction moments, strongly predicts pain and radiographic disease progression. Current research has shown that exercise interventions reduce pain and time to complete functional activities; however, the effect of these interventions on knee joint loading and muscular activation in gait is still unclear. In addition, the need for specific knee joint strengthening to cause these alterations has not been investigated and it remains unknown if improvements occur due to specific muscle strengthening or due to some general effect of exercise. Therefore, the primary aim of this research study was to examine the effects of general (upper body) and specific (lower body) resistance training interventions on self-perceived outcomes, neuromuscular function and kinematic, kinetic and muscle activation during gait of OA patients compared with asymptomatic controls. ... The examination of gait data following exercise (Study 4) showed trends for changes in the muscle co-contraction ratios. Specifically, the medial/lateral co-contraction ratio (MLCCR) displayed a trend in early stance where the upper body exercise group increased their lateral muscle activity and the lower body group reduced their lateral muscle activity, and the medial/lateral hamstring co-contraction ratio (HAMCCR) displayed this same trend during loading. The trend toward reduced lateral muscle activation, following lower body resistance training, suggests that specific muscle strengthening may have the ability to alter the load distribution. The kinematic and kinetic variables of gait were unchanged by the exercise interventions, highlighting the sensitivity of muscle activation pattern changes due to muscle strengthening. This thesis provides new insights into the co-contraction strategies utilised by knee OA patients. The directed co-contraction strategy employed by knee OA patients and its relationship to the external adduction moment in gait suggest an attempt to redistribute the loading within the knee joint, most likely in response to pain. Further, we have separated the effects of exercise and found differences in self-perceived outcomes based on exercise specificity. This first examination into muscle co-contraction following resistance training of knee OA patients has highlighted the possibility of alterations to the co-contraction patterns following lower body exercise. However, the implications of altering this muscle activation strategy and the consequent effect on distribution of load within the knee joint requires further consideration.

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