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.

This exploratory study was designed to gather information about the needs and concerns of significant others of patients with recent spinal cord injuries. The respondents were asked about the impact of the patients' injuries on their own lives and about their feelings in relation to the treatment they and their patients were receiving from health care personnel. The study was conducted with a convenience sample of seven respondents, five women and two men, designated as significant others by seven patients with recent spinal cord injuries. Using a semi-structured interview guide each significant other was interviewed in depth from one to three times over a period of three to six weeks following their patient's injury. The interview guide covered eight selected themes relating to the significant other's': - need to feel that he or she is getting adequate information - need to feel that he or she is being helpful to the patient - need to feel able to cope with home and family responsibilities - need to have someone from whom he or she can obtain emotional support - need to express feelings, both positive and negative - need to feel that his or her patient is getting good care - past experiences and methods of coping with crisis situations - needs and concerns that may arise because of the likely major effects the patient's injury will have on the significant other's life in the future. All respondents reported needing initial access to physicians who would give a true report of their patients' medical conditions and progresses. Thereafter five respondents reported receiving adequate information from their patients or the nurses. The six respondents who were given a negative prognosis for their patients' recovery of function expressed less apparent emotional conflict than the one who was told there was some possibility of recovery. After the first interview three respondents stressed the need for practical information about how to help with their patients' physical care, although during the first interview all respondents expressed fear that any physical assistance they attempted might harm their patients. All respondents felt their greatest value to their patients was as a source of emotional support. Two respondents reported being able to defer all home and family responsibilities; the other five stated their home and family responsibilities were not directly increased by their patients' injuries. However these five reported stress caused by the necessity of coping with the patients' needs as well as home and family responsibilities. All seven significant others reported using some sources of external support, the most common being family members and close friends. All respondents voiced positive feelings about their patients and the health care they were receiving. Only three respondents expressed strong negative feelings which were directed at the cause of their patients' injuries or what they perceived as incorrect or inappropriate information given to them by health care personnel. All respondents stressed their need to know their patients were receiving good care. All significant others reported their patients' injuries were the severest crises they or their patients had ever undergone, but all also stated they believed they would be able to cope with the crisis. The respondents reported their patients' gravest concerns for the future related to finances, work and sexual functioning. The respondents themselves voiced less concern about finances and sexual functioning. Other concerns for the future expressed by the respondents related to housing, transportation, family activities, social relationships and coping with the inevitable "ups and downs" of the patients. There were some differences in concerns expressed by male and female respondents. The findings of the study demonstrated the presence of selected needs and concerns in a small convenience sample of significant others of spinal cord injured patients. Further research would be necessary to determine whether the findings are representative and whether there is a relationship between expressed needs and concerns and the sex of patients and/or significant others. The study offers suggestions to practicing nurses who wish to improve their care of spinal cord injured patients and their significant others. / Applied Science, Faculty of / Nursing, School of / Graduate

Thesis (Ph.D.)--University of Florida, 2004. / Typescript. Title from title page of source document. Document formatted into pages; contains 244 pages. Includes Vita. Includes bibliographical references.

Thesis (Ph.D.)--University of Florida, 2005. / Typescript. Title from title page of source document. Document formatted into pages; contains 198 pages. Includes Vita. Includes bibliographical references.

No description available.

Thesis (Ed. D.)--Columbia University. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 182-192).

Thesis (Ed. D.)--Columbia University. / Includes bibliographical references (leaves 182-192).

Thesis (Ph. D.)--Virginia Commonwealth University, 2006. / Prepared for: School of Nursing. Bibliography: leaves 165-183. Also available online via the Internet.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2010.

Dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree Master of Science. 2013 / The Babinski sign is a pathological response elicited by a stimulus to the lateral plantar border of thesole of the foot. The resulting reflex involves dorsiflexion (upward motion) of the toes, most notably the hallux, with accompanying flexion in the ankle, knee and hip. It is an important part of the clinical neurological examination and aids in the diagnosis of central nervous system dysfunction. There is however no wholly standardised method to elicit this reflex or interpret it, resulting in possible variation in its utility. The resulting aim of the studies constituting this dissertation were therefore to: 1) assess what techniques and pressures are used to elicit the reflex in a group of neurologists;2) to investigate the relationship between input variables of the reflex and the resultant output variables as measured with the use of electromyography and kinematics;3) compare objective variables, relating to toe, foot and leg movement, of the pathological reflex to the healthy response; 4) assess the inter-rater reliability of the reflex and 5) determine what aspects of the reflex are most closely related to the ratings of the students and neurologists. A specialized custom-built Babinski hammer was constructed to measure the duration of the stroke and pressures exerted on the foot of a single healthy subject by neurologists (n=12). The relationship between the recorded pressures and the movement of the toes (measured kinematically), muscle activity in the tibialis anterior and the pain felt by the subject (gauged using a visual analogue scale) were evaluated. Following this, the average pressure used by the neurologists was used to elicit the reflex in six patients with known positive Babinski responses and six healthy gender and age matched controls. These reflexes were compared with kinematic (measurement of toe, foot and leg movement) and electromyographic (muscle activity of the involved muscles) methods. These reflexes were recorded and the recorded footage was shown to 12 medical students and 12 neurologists who were asked to interpret if 3 the responses were pathological or non-pathological. Kinematic and electromyographic descriptions of each reflex made it possible to assess what aspects of the reflex are important for classification of a pathological response for both medical students and neurologists. A large amount of intra- and inter-rater variability was shown amongst the neurologists in how they elicited the reflex. The amount of pressure applied was shown to be significantly related to hallux movement (p<0.01) as well as to the degree of pain felt by the subject (p<0.01). Significant differences were found between the patients and controls for change in hallux angle (p<0.0001), movement latency (p<0.05)and the maximum electromyographic amplitude of tibialis anterior(p<0.01). The inter-rater reliability of the medical students and the neurologists showed substantial agreement between raters (kappa = 0.67 and 0.72 respectively). Both neurologists and students made use of the change in hallux angle, time taken to reach maximum ankle angle, movement latency and the maximum amplitude of gastrocnemius when rating the reflex. Neurologists alone observed time taken to reach maximum hallux angle and change in ankle angle as being important while medical students‘ alone looked at maximum amplitude of biceps femoris. In conclusion, I found a large variation between the techniques of neurologists when assessing the Babinski reflex. This variation is related to variation in aspects of the resultant reflex. The pathological response (the Babinski sign) has shorter movement latency and less activity in the tibialis anterior muscle than the flexor response seen in healthy individuals. Ratings of pre-recorded Babinski responses had substantial agreement when both neurologists and medical students assessed pathology. In order to assess them both groups made use of the speed of the reflex, the direction of hallux movement and concurrent withdrawal activity in the leg to differentiate between a pathological and a healthy response.