M.Tech.

A dissertation submitted to the Faculty of Health Sciences, in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2005. / Objectives: To determine if serum cortisol levels are increased following Spinal Manipulation Therapy (SMT) to the low back region and to determine the effect of a short rest interval on the cortisol levels. Project Design: The research project was in the form of a randomised, clinical trial using human subjects. Setting: Patients presenting with low back pain to the Chiropractic Day Clinic at the Durban Institute of Technology and the Community Health and Indigent Programme Services clinic. Subjects: Adult, male patients, aged between 18 and 35 years of age, diagnosed with mechanical low back pain. Outcome measure: Daytime, serum cortisol levels. Results: A decrease in serum cortisol levels following SMT. Serum cortisol levels decreased significantly following a short rest interval. Conclusions: The results of this study support the previous finding that a neuroendocrine effect can be stimulated by SMT, albeit, a decrease in serum cortisol levels. A short-term rest period also influenced the serum cortisol levels. However, the mechanism of these effects is not established and requires further investigation as this was not within the scope of the present study. / M

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Master of Medicine in Orthopaedic Surgery Johannesburg, 2017 / Background: The anterolateral approach to the spine for the surgical management of the Tuberculosis of the spine has been described. The surgical technique has evolved since the gold standard published by Hodgson et al. in 1956. The use of a Titanium Mesh Cage and the anterior instrumentation to construct the anterior column after adequate debridement defined the evolution. The aim of the study is to review the results of the patients that underwent this procedure between January 2012 and December 2015. Methods: The study was a retrospective study where 60 patients treated with this technique from 2012 – 2015 were reviewed. Sixty-one percent (61%) of the tested patients were HIV positive and 70.4% of the patients were female in the age group of 31-45 years. The surgical procedure was standardised for all the patients irrespective of their HIV status. The clinical and radiological outcomes measured consisted of the patients’ disability using the Oswestry Disability Index (ODI), the Frankel Neurological grading to measure neurological deficits and the Cobb angle to measure Kyphosis. The diagnosis of Tuberculosis of the Spine was confirmed in all the patients. Results: At a mean follow up period of 21.25 months, the ODI improved from a mean of 95.42% ± 6.57% before surgery to a mean of 8.00% ± 12.15% at the last follow up. There were 58 patients who were unable to walk independently before the surgery (Frankel A or B) but at the last follow up, 52 of the patients had achieved independent ambulation (Frankel D or E). The mean kyphosis was 33.90 ± 12.44 degrees before surgery, and in the immediate post-operative period, the mean kyphosis was 23.69 ± 10.31 degrees, and a mean of 26.27 ± 10.91 degrees was measured at the last follow up. There was a 30.12% correction achieved in the immediate post-operative period and an overall correction of 22.51% at the last follow up reflecting a loss of 7.61% in the kyphosis correction in the period between the immediate post-operative period and the last follow up. Complications were documented in six patients including two deaths unrelated to the procedure. Discussion: The ODI score showed an improvement as the mean value decreased by 87.42%. This is statistically and clinically significant (p=0.001). According to the work of Solberg et al. (2013) in degenerative spine, the threshold for a success is a mean change of 20% in the ODI scoring after lumbar disc surgery. Using this value as a proxy, an improvement of 87.42% is an excellent outcome. Before surgery, fifty-eight patients (96.7%) were non-ambulatory using the Frankel Neurological score. At the last follow up, 53 patients (91.4%) achieved a Frankel score of D or E and independent ambulation. This outcome compares favourably with ones published in the literature. The overall post-operative kyphosis correction achieved was 26.27 degrees (which translated to 22.51% correction) at the last follow up. This reflects a kyphosis correction loss of 7.61% that was not associated with any neurological deterioration and is therefore of no clinical significance. There were six cases of complications including two deaths unrelated to the procedure but the general debilitation of military Tuberculosis and Nosocomial infection. Conclusion: The anterior column reconstruction using the Titanium Mesh Cage and Anterior Instrumentation is safe and effective for the surgical management of the Tuberculosis of the Spine. There were good clinical outcomes as measured by the ODI score and the Frankel Neurological Grading system, and even though there was a loss of Kyphosis correction at the last follow up, this was not associated with a negative neurological outcome. Despite its limitation as a retrospective study, this study demonstrates that the procedure is safe and effective when used as an adjunct to the medical treatment of the Tuberculosis of the Spine. / MT2017

MSc Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, 2009 / The cervical spine is subjected to wear and tear as well as trauma. This increases the occurrence of degeneration of intervertebral discs and facet joints. Degeneration will result in loss of disc height and the formation of osteophytes on adjacent vertebrae. Nerve roots can be irritated or compressed by this pathology and patients can possibly develop neurological signs and symptoms as well as pain. An anterior neck fusion is a surgical procedure that is frequently used to manage cervical pathologies such as degeneration, spinal stenosis, disc herniation, or trauma. Cervical pathologies can become severe and neural compression may develop. Compression of neural components can present with symptoms such as muscle weakness, numbness, tingling or radicular pain. The main aim of the surgery is to decompress the neural structures, permanently stabilize the vertebrae, to maintain a cervical lordosis and to hold an anatomical disc space. Chronic spinal disorders, including cervical and lumbar conditions, are considered the most expensive benign condition to manage. Previous research demonstrated poor functional outcomes especially in the lumbar area. Little evidence is available regarding the functional outcomes of patients after anterior neck fusion surgery. The aim of this study was to investigate the levels of pain and the quality of life experienced by patients who had an anterior neck fusion one year ago. Methods A cross – sectional survey was conducted. Neurosurgeons in the Johannesburg region were contacted telephonically to establish whether they performed anterior neck fusion surgery. Potential subjects were then identified and contacted to establish whether they suited the inclusion criteria for the study. Pain was assessed using the Visual Analogue Scale. The Neck Disability Index, Fear Avoidance Beliefs and Short Form-36 questionnaires were completed to determine the levels of dysfunction, anxiety and depression as well as health related quality of life in subjects who had an anterior neck fusion one year ago. The quality of life of these subjects was then compared to that of a healthy baseline group. Results and Discussion Forty-two (n = 42) subjects were telephonically identified from the neurosurgeons’ records. Thirty-five (n = 35) subjects met the inclusion criteria and participated in the study. Twenty-six subjects were female (n = 26) with an average age of 54 years and nine (n = 9) were male with an average age of 53 years. The demographic questionnaire demonstrated a high prevalence v for the use of pain- and anti-inflammatory medication (81.3%). According to the demographic questionnaire, the subjects received on average six physiotherapy treatments postoperatively. Most of the subjects (n = 22) demonstrated pain over the upper shoulder area as well as posterior regions of the neck on the body chart. At the time of assessment, the subjects indicated their level of pain using a VAS scale and had an average score of 35.48mm (SD ± 24.11) which indicated a low level of pain. Results obtained from the NDI questionnaire indicated that the subjects had moderate disability one year postoperatively. The mean score on the NDI for subjects was 31.10 (SD ± 11.96). Subjects did not demonstrate high scores on the FABQ and had a mean score of 54.09 (SD ± 0.99). There were no significant differences between the male and female groups for the FABQ. On the SF-36, the subjects had a moderate reduction in mental health components of QoL [MCS = 42.19 (SD ± 13.31)] as well as the physical health components of QoL [PCS = 46.78 (9.44)]. QoL of these subjects was compared to a baseline group. Results showed a statistically significant difference between the groups for all eight domains (p- values ranged between 0.0001 and 0.012). The mental health component score (MCS) was not significantly different between the groups but subjects with anterior neck fusion had a significantly lower score on the physical health component (PCS) than the baseline group (p = 0.001). Conclusion This paper concluded that subjects who had an anterior neck fusion 12 months ago still suffered from low levels of pain and moderate dysfunction. They reported low levels of QoL related to physical health one year postoperatively.

There is a dearth of published literature that documents the levels of functional ability post spinal cord injury (SCI) resulting in paraplegia, at discharge from in-patient rehabilitation facilities within Gauteng. In addition, the factors that influence functional ability are poorly defined in individuals with paraplegia, at their discharge from in-patient rehabilitation facilities in Gauteng. This necessitated further investigation since it is vital for the rehabilitation of individuals with SCI resulting in paraplegia. The aim of the study was to determine the functional ability and the factors that affect the functional ability in individuals with a SCI resulting in paraplegia, at discharge from rehabilitation facilities in Gauteng. The first objective of the study was to establish the level of functional ability in patients with SCI at discharge from in-patient rehabilitation. The second objective of the study was to describe the physical and demographic factors of the study population. The third objective of the study was to establish the demographic and physical factors that influence the level of functional ability in patients with SCI at discharge from in-patient rehabilitation. This was a cross-sectional, observational study design. Three instruments were used in this study: a self-designed questionnaire to establish the factors that influence the level of functional ability in patients with SCI at discharge from an in-patient rehabilitation unit; the American Spinal Injury Association (ASIA) classification scale of neurological impairment to describe the level and completeness of the lesion and the Spinal Cord Independence Measure III (SCIM III) to determine the level of functional ability. The main results of the study were as follows: The average SCIM score in this population was 64.6 (±27.6) with the lowest score being 20 and the highest score being 84. Participants with non traumatic SCI had 16.87% lower SCIM scores than those with traumatic SCI. After multivariate analysis the following factors were found to influence function: For every one year increase in the age of the participant, there was 0.18% decrease in the SCIM score. For every day increase in LOS, there was a corresponding increase of 0.06% in the SCIM score. With respect to the presence of a pressure sore from the acute hospital, those who had pressure sores had 9% lower SCIM scores than those who did not have pressure sores. Participants with spasticity had 8.3% lower SCIM scores relative to those that did not have spasticity. Relative to participants in government funding classification, workman’s compensation participants had 4.82% lower SCIM score followed by the medical aid participants with 8.07% lower SCIM and the private participants with 10.84% lower SCIM scores. For every unit increase in the ASIA motor score, there was an increase of 1.29% in the SCIM score. Conclusion: Majority of the participants in this study were discharged from rehabilitation without reaching functional independence. The following categories of patients with SCI may need to be monitored more for functional outcomes during rehabilitation and assisted in order to attain good functional ability: older age, a short rehabilitation length of stay, funded privately, a low ASIA motor score, having a pressure sore or spasticity, and higher level of SCI. Key words: Functional outcomes, paraplegia, rehabilitation, neurological level, spinal cord injury.

INTRODUCTION: While the impact of back pain on morbidity in older adults is well-understood, the influence of back pain on mortality is unclear. Back pain is the leading cause of disability worldwide, and disability is associated with elevated risk of mortality. Thus, we hypothesized that older women with persistent back pain would have a higher risk of mortality over 16-years of follow-up, compared to those with no back pain among participants in the Study of Osteoporotic Fractures (SOF), a large multisite cohort study. Furthermore, we hypothesized that limitations of Instrumental Activities of Daily Living (IADLs) would mediate a greater proportion of the mortality risk, compared to two objective measures of physical function, walking and chair stand speed. METHODS: The analytic sample included 8,321 SOF participants (mean age 71.5, SD=5.1) who answered back pain questions at baseline (1986–87) and visit 2 (1989–90). We created a four-category back pain variable by combining responses at two interviews (baseline and visit 2). Categories included: no back pain (24%), non-persistent back pain (23%), and infrequent (44%) or frequent (9%) persistent back pain. Participants were followed from visit 2 through visit 9 (2006–08). Death was confirmed with receipt of death certificates. Using Cox-proportional hazards, we calculated hazard ratios (HR) and 95% confidence intervals (CI) for all-cause and cause-specific mortality with the ‘no back pain’ participants as our reference group. We adjusted for age, sociodemographic characteristics, self-reported general health, smoking status, comorbid conditions (e.g., prevalent vertebral fractures, osteoarthritis, hip pain, diabetes, hypertension), previous stroke, history of breast cancer, hospitalizations and falls in the previous year. We evaluated self-reported IADL limitations, slow walking speed, and slow chair stand time as a priori mediators of back pain and subsequent mortality. RESULTS: A total of 4975 women (55.8%) died over the follow-up period. A higher proportion of women with frequent persistent back pain died (65.8%) compared to those with no back pain (53.5%) (adjusted HR = 1.24; 95% CI 1.11 to 1.39). We observed an increase in cardiovascular (adjusted HR = 1.34; 95% CI 1.12 to 1.62) and cancer (adjusted HR = 1.33; 95% CI 1.03 to 1.71) mortality. No increased risk was observed for other back pain groups. A larger proportion of the association was mediated by IADL limitations (47%), compared to poor performance on chair stand (27%) and walking speed (24%). CONCLUSION: Compared to older women with no back pain, those with frequent persistent back pain had an increased risk of mortality, which underscores the importance of developing safe interventions to address and prevent this condition. Therapies that address IADL limitations or improve physical function (e.g. walking speed, chair stand) may be ideal for preventing early death in individuals with back pain. / 2020-03-17T00:00:00Z

Digitized by Kansas Correctional Industries

No description available.

The aim of this study was to improve current counselling services at the Auckland Spinal Unit. This purpose was achieved by co-researching the topic with people who have extensive experience of living in the community with a spinal cord injury to reveal what they believe was helpful, or believe would have been helpful, in terms of the counselling, when they were newly injured. Listening to the stories of the research participants, through supervision of my own practice, doing a literature review and writing a journal became sources that provided rich knowledges to reflect on my current counselling practice. A qualitative study was conducted using aspects of action research, feminist research and post-structuralist methods. In November 2005, an information pack was mailed to the sixteen patients who had been discharged from the Auckland Spinal Unit between June 2002 and June 2004, who were under the age of sixty -five and lived in the Auckland area, inviting them to participate in this research. Seven people agreed and were available to participate. I interviewed these seven participants, using unstructured interviews. All the interviews were audio-taped and then transcribed verbatim. These verbatim transcripts were then sent back to the participants for any additions/deletions/alterations they chose to make. To initiate the reflecting process, I then went through all the interviews and identified common themes. I understand that if the research participants had been involved in this process, other themes might have emerged for them. The themes identified were loss and grief as a result of a spinal cord injury, sexuality, family (whanau) involvement and how counselling services should be positioned in a setting such as the Auckland Spinal Unit. These themes formed the iii foci of the chapters, with an additional chapter on weaving cultural threads into counselling. The main findings of the study centre on the very important role of counselling at the Auckland Spinal Unit. In particular, the study highlighted the importance of counselling as a place for conversations that make room for multiple positionings and multiple versions of events, a space that respects a patient's hopes, beliefs and dreams for his/her life (which often does not include wheelchairs, catheters and caregivers) but that also supports the patient to make meaning of living life with a spinal cord injury. The study also identified the importance of sexuality counselling. Not including sexuality as a topic in the rehabilitation services provided perpetuates dominant discourses that a person with a spinal cord injury does not want sexual intimacy or cannot be sexually intimate and cannot have children. Family (whanau) involvement in and family's becoming part of the rehabilitation team was very important to most participants. This study looks at how this involvement can be achieved and explores some of the structures currently in place at the Auckland Spinal Unit to facilitate this involvement. Participants in this study expressed a desire for counselling to be highly accessible to both themselves and their families (whanau). They would prefer the counsellors to get to know the patients in their own environment first (in their rooms), so that the patients are positioned to have agency to make choices about how they would like to use the available counselling services. The study concludes with my personal journey of working as a counsellor at the Auckland Spinal Unit and how this research has shaped and fine-tuned my practice.

Thesis (Ph. D.)--Ohio State University, 2006. / Title from first page of PDF file. Includes bibliographical references (p. 129-150).