Short Report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfillment of the requirements for the degree of Master of Science in Occupational Therapy Johannesburg 2017 / This research project described the outcomes for upper limb motor function (ULMF) and personal management (PM) for patients attending occupational therapy at Chris Hani Baragwanath Academic Hospital post-stroke. A quantitative, descriptive correlation design was used. A purposive sample of adult patients who met the inclusion criteria was selected. The researcher completed initial assessments of ULMF using the Fugl–Meyer assessment and the South African Data for Functional Measurements: Beta Scale to assess independence in PM. Research participants received rehabilitation as usual. The same measurements were administered on discharge and during out-patient follow up appointments at one, two and three months. Data was analysed using descriptive statistics. Results indicated that recovery of ULMF was influenced by the site of lesion. Gender and age did not influence recovery of ULMF. Severe motor disability, which resulted in poor recovery of UL and LL, yielded poor independence in PM. / MT2017

The present study used phenomenology to inquire about the quality of life experiences of six adults who had undergone an amputation. This study also explored how the adults perceive their lives. All participants resided in Western Canada and had undergone an upper limb amputation several years prior to the study. Each participant was interviewed twice. Some of the interview questions were from Roberts and Cairns’ (1999) adaptation of Keith and Schalock’s (1994) QOL model. Interviews were conducted, transcribed, and thematically analyzed. Results indicated that some participants experienced a change whereas others reported stability in quality of life. The data analysis revealed specific categories, clusters, and themes of participants’ quality of life experiences. Quality of life categories related to empowerment, satisfaction and well-being, and the social realm. Participants described their lives as being significantly changed as a result of an amputation. The data analysis also revealed specific categories, clusters, and themes of participants’ perceptions of their lives. Psychological attributes and health care were two categories. The present study offers implications for several groups of people. / Graduate

The intent of this study was to describe the effects of long term paraplegia and wheelchair use on upper limb function. Bilateral upper extremity isokinetic and grip strength, pain, and active range of motion were compared in 52 men with paraplegia (mean age 44 years: mean duration of spinal cord injury (SCI) 17 years) and 52 age and activity-level matched able-bodied men. The impact of upper limb pain on activities of daily living (ADL) performance was examined in the paraplegic sample. Strength was not significantly different between the two samples except for bilateral shoulder flexion (able-bodied stronger) and bilateral elbow extension (paraplegia stronger). Strength changed similarly with age in the two groups. The effect of duration of SCI on strength, excluding age, was significant for grip strength only. Duration of paraplegia and activity-level were better predictors of strength than age in 9 of 14 muscle groups, whereas in the able-bodied, age was the best strength predictor. Limited bilateral shoulder internal rotation and non-dominant external rotation were associated with paraplegia. Upper limb pain in the past week was associated with paraplegia (shoulder p<.001; elbow p<.00l; wrist/hand p<.00l). Reported pain prevalences for the paraplegic sample were: shoulder 39%, elbow 31%, wrist/hand 40%. The paraplegic subjects' pain intensity ratings revealed them to be experiencing mild to moderate levels of upper limb pain. Shoulder pain was associated with duration of injury, exclusive of age (p<.05). Measurement of the impact of upper limb pain On 18 activities of daily living (ADL) tasks revealed pain to be experienced by the majority of subjects with paraplegia (mobility tasks 60%; self-care tasks 5 8 % ; general activities tasks 60%). However, only 23-35% had made changes in their routines, and 6-16% had sought assistance with ADL due to upper limb pain. ++ / When age was excluded, it appeared that duration of SCI was more associated with pain during ADL, but this was significant only for pain during self-care tasks. The tasks most reported to cause upper limb pain were work/school, sleep, wheelchair transfers, outdoor wheeling, and driving. These results suggest that preventative and management steps are required to ensure continued independence and quality of life in this group over time. The effect of duration of SCI suggests that limitations in upper limb function may be seen in this population at relatively young ages.

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Objective As part of this work, two preliminary studies were conducted that identified three possible swings used at the elite level of volleyball and the resulting ball velocities created using these swings. Therefore, the purpose of this work was to explore the kinematic aspects of the different spike attack arm swings (straight ahead (SA), cross body (CB) and outside (OS)) where each different swing was broken down into its constituent parts. Methods Six elite-level varsity players participated in this study. A motion tracking system was used to collect motion data which was used to calculate the kinematics of the upper arm during each of the swing types. A number of minimums and maximums were then calculated including maximum hand speed. To compare means between swings one-way ANOVA’s were used. Results Few differences were found between the swing types. The only difference seen between the SA CB swings was a more pronounced wrist flexion during the CB swing. It is possible that this helped propel the ball across the body during the CB. The OS swings differed from the CB and SA swings in that the OS was less horizontally adducted and there was a more pronounced external rotation during CB than during OS. These differences are likely to be responsible for the ball being hit away from the midline of the body during the OS swing. Typically, the hand speed results agreed with those of the study done previously concerning resulting ball speeds when these swings were employed. Conclusions Between the SA, CB and OS swing types, only the OS was consistantly different throughout the three studies. It is recommended that future studies attempt to examine the whole body during these types of swings. Also, it appears that elite-level players may be quite different kinematically, and each one should be treated as a separate case in a training situation. The findings of these studies may help coaches, trainers and athletes develop better training, injury prevention and rehabilitation programs in the sport. / Thesis (Master, Kinesiology & Health Studies) -- Queen's University, 2008-07-16 12:10:06.42

In stroke rehabilitation, the assessments of the severity of stroke that are based on objective and robust measurements are the key to improve the efficacy of the rehabilitation efforts. It is essential, therefore, to complement the existing tools, where the assessments are partly relied on therapists’ subjective judgements, with a tool that can quantify important indicators of stroke recovery. One such indicator is the level of spasticity. The reliability of the current methods of measuring the severity of spasticity can be significantly improved by incorporating a feasible way to measure muscle forces and activations during stroke assessment. However, most of the present methods of estimating muscle forces require input parameters that are difficult to obtain in a clinical setting. A musculoskeletal arm model has been developed to bridge the gap between the domains of muscle forces estimation and stroke rehabilitation assessment. The project is divided into three stages. In the first stage, a biomechanical arm model that computes the joint torques with kinematic data from sensors is developed. The model has three features that eliminate the need for parameters that are difficult to obtain thus making it a feasible tool in clinical settings. The first is the use of a hybrid method that combines the data from sensors and a shoulder rhythm model to compute the orientation of the shoulder complex. The second is a method to compute the elbow joint angles without the need to compute the ambiguous carrying angle. The third is a method of estimating the inertial properties using published data, scaled by parameters that can be easily measured. The musculoskeletal properties of the human arm are added to the model in the second stage. The muscle model consists of 22 muscles that span from the thorax via the shoulder and the upper arm to the forearm. The muscle path is defined using Obstacle Set method where the anatomical structures are modelled using regular-shaped rigid bodies. Dynamics of the muscle is computed based on the Hill’s type muscle model that consists of an active contractile element, a passive parallel element and a series element. Due the difficulties in defining the moment arms, an optimization routine is designed to compute the optimal moment arms for each muscle for a subject. The muscle-sharing problem is solved using optimization which minimises the square of sum of muscle stresses. The muscle activation predicted by the model is compared to EMG signal for validation. In the final stage of this project, the model is used in the application of spasticity assessment. The tonic stretch reflex threshold (TSRT) which is an indicator for the severity of spasticity is computed using the model. Fifteen patient subjects participated in the experiments where they were assessed by two qualified therapists using Modified Ashworth Scale (MAS), and their motions and EMG signals were captured at the same time. Using the arm model, the TSRT of each patient was measured and ranked. The estimated muscle activation profiles have a high correlation (0.707) to the EMG signal profiles. The null hypothesis that the rankings of the severity using the model and the MAS assessment have no correlation has been tested, and was rejected convincingly (p ≈ 0.0003). These findings suggest that the model has the potential to complement the existing practices by providing an alternative evaluation method.

no abstract provided / Thesis / Master of Science (MSc)

There are several ways in which a disability can occur. Strokes are a leading cause, affecting older people in particular, with an estimated annual incidence rate of 180, 125, 200, and 280 per 100,000 citizens in the USA, Europe, England, and Scotland, respectively. Muscle strengthening through resistance training has been reported to have a positive effect on the recovery of normal physiological functions after the occurrence of a neurological or traumatic injury. A number of studies have shown that resistance training results in improved mobility, a reduction in pain, and improved stability. Several rehabilitation devices have been developed and introduced for use in the healthcare sector, but a new generation of intelligent therapy-assisted machines is needed if there is to be a significant impact on the numbers of patients that can be treated under current staffing level. In this project, the design and performance of multi-degree-of-freedom smart balland-socket dampers and their application to fully-controllable rehabilitation training systems were investigated. A key feature of these dampers is the use of magnetorheological (MR) fluids which can exhibit dramatic changes in their rheological properties, such as yield stress, when subjected to external magnetic fields. These fast and reversible fluid rheological changes would permit the smart damper to provide the required impedance at orthotic arm joints, which are aimed for upper-limb rehabilitations and in accord with the exercise specifications prescribed by the physiotherapist. An exemplar upper-limb orthotic arm incorporating smart ball-and-socket dampers at its joints was assessed using SolidWorks software and the results confirmed the response of the dampers to variable excitation inputs under an input simulating a wheelchair driving motion. This study also enabled the estimation of the orthotic arm reach envelope, task performance and limitations in which important device design factors such as the angle of rotation of the smart dampers were taken into account. Although, three smart dampers with variable torque resistance capability are required at the shoulder, elbow and wrist joints of upper-limb rehabilitation orthoses, this project was focused on the development of a smart ball-and-socket damper aimed for the shoulder joint only. The target was to produce a compact smart electromagnetic damper that is capable to deliver the required torque resistance with the least power consumption. The efficient excitation of MR fluids requires a magnetic circuit, which consists of a source of magnetic flux and a path to deliver it to the fluid. Electromagnetic finite element analysis using Ansys software were carried out to achieve the optimum design of the damper’s electromagnetic circuit. The effects of the relative permeability of the damper’s materials on the generation of the magnetic field and its delivery to the MR fluid were examined. Other factors such as the coil shape, size, orientation and location in addition to the utilisation of non-magnetic materials in the electromagnetic circuit design were also investigated with the aim to optimise the performance of the smart damper. Furthermore, 3-D electromagnetic analyses were conducted, which confirmed the validity of the 2-D magnetic trials. Accordingly, the size of the MR fluid ball-and-socket damper was estimated with a ball diameter of 100 mm, which was found to produce a braking torque of about 50 N.m when the MR fluid is energised by about 1 Tesla. The performance of the ball-and-socket damper was estimated using theoretical, and numerical approaches. The theoretical model combines the viscous-friction and the controllable field-dependent characteristics of the MR fluid in which a Bingham plastic model was used to simulate the shear stress of the fluid under various input conditions. The numerical approach involved a special procedure to simulate the device performance using computational fluid dynamics techniques, which were performed using Ansys CFX code. Three commercial MR fluids were assessed and it was found that the simulated device torque compared well with the theoretical values. The mechanical design of the optimised ball-and-socket damper was accomplished using SolidWorks software when several important design and manufacturing factors were taken into account. These factors included the assembly of the ball and socket parts, the sealing of the MR fluid inside its designated gap, winding of the coil inside the socket part, maintaining a uniform MR fluid gap, and insertion of the nonmagnetic rings at their predesigned locations. Finally, a dedicated experimental rig was constructed which facilitated the assessment of the smart damper under both static and dynamic testing conditions. It was found that agreement between model predictions and experimental observations was excellent. Furthermore, this device performance was found to meet torque requirements expected in most upper-limb rehabilitation regimes.