Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 1999. / To investigate the efficacy of adjusting the ankle in the treatment of subacute and chronic grade I and II ankle inversion sprains. The researcher hypothesised that adjusting a symptomatic ankle, in terms of the above, would result in a more significant improvement than that of a placebo treatment / M

A growing body of evidence has now accumulated supporting the involvement of oxygen-derived free radicals in the development of myocardial ischemia/reperfusion (I/R) injury. We have, therefore, undertaken the present study to examine (1) I/R-related alterations in myocardial antioxidant capacity in pentobarbital anesthetized open-chest rabbits subjected to left circumflex coronary artery ligation followed by reperfusion; (2) the protective effects of pretreatrnent with allopurinol or the 21-aminosteroid U74006F; (3) alternative mechanisms to xanthine oxidase inhibition for allopurinol protection against I/R injury; and (4) the effect of allopurinol treatment on the antioxidant capacity of erythrocytes in pigs used in a heart-lung transplantation study. In the rabbit myocardium, a marked impairment in myocardial antioxidant capacity developed in association with the onset of irreversible injury, as reflected in the enhancement in glutathione (GSH) depletion and formation of thiobarbituric acid-reactive substances (TBARS) following in vitro incubation of tissue homogenate with tert-butylhydroperoxide (TBHP). During the course of post-ischemic reperfusion, the protracted time-course of alterations in antioxidant capacity dissociated them from the early burst of radical formation known to occur at the onset of post-ischemic reperfusion of the myocardium. When the time-dependent changes in functional indices of antioxidant status (TBHP-induced GSH depletion and formation of TBARS) were analysed in relation to activities of antioxidant enzymes, evidence suggestive of functionally relevant impairments in Cu,Zn-superoxide dismutase (Cu,Zn-SOD) and glutathione reductase (GRD) activities was found. These results and our demonstration of significant decreases in the activity of GSH-dependent antioxidant enzymes under acidotic conditions suggest that a transient impairment in the functioning of antioxidant enzymes may be involved in triggering irreversible myocardial I/R injury. Repetitive brief episodes of I/R produced a progressive decrease in myocardial ATP levels, which was not associated with any detectable changes in myocardial antioxidant capacity. Ischemic preconditioning produced by brief episodes of I/R did not affect the severity of subsequently induced I/R injury. These results suggest that brief episodes of myocardial ischemia do not produce oxidative tissue damage and the ischemia-induced depletion in myocardial ATP level is at least partially dissociable from the I/R-related impairment in tissue antioxidant capacity. Isolated Langendorff-perfused rabbit hearts subjected to I/R did not show any changes in antioxidant capacity. However, when intact hearts were subjected to ischemia in vivo and a subsequent reperfusion in vitro, an impairment in myocardial antioxidant capacity became apparent. These results suggest that blood elements, possibly activated neutrophils, may be a crucial factor involved in the development of I/R-induced oxidant injury. Chronic allopurinol pretreatment (1 mg/ml in drinking water or approximately 75 mg/kg/day) for 7 days prior to ischemia provided significant protection against I/R-induced alterations in myocardial antioxidant capacity, but not the decrease in tissue ATP levels. This chronic allopurinol regimen was found to enhance myocardial GRD activity in nonischemic tissue. In addition, both allopurinol and oxypurinol inhibited the transition metal ion-catalysed ascorbate oxidation and lipid peroxidation in vitro, likely as a consequence of their metal chelating properties. Similarly, myoglobin-TBHP-catalysed oxidation of uric acid and lipid peroxidation were also suppressed by allopurinol. All these suggest that allopurinol may favorably alter myocardial antioxidant capacity directly by virtue of its transition metal chelating properties and its antioxidant actions in myoglobin-mediated oxidative processes. The acute administration of 21-aminosteroid U74006F (3 mg/kg, i.v) under conditions comparable to those known to protect against trauma-induced damage in the central nervous system failed to reduce manifestations of oxidative injury in rabbit hearts subjected to ischemia and reperfusion. Although reactive oxy-radicals have been implicated in both types of tissue damage, the observed difference in susceptibility to protection by this steroidal antioxidant suggests that the molecular mechanisms involved are not identical. In the heart-lung transplantation study, erythrocytes from allopurinol-treated pigs (given repeatedly at an oral dose of 50 mg/kg) showed a time/dose-dependent increase in antioxidant capacity as reflected in the decrease in malondialdehyde production following in vitro oxidative challenge. The extent of red cell protection in both donor and recipient animals correlated significantly with the functional viability of the transplanted lung tissue, as assessed by tissue water content. These results suggest that the measurement of erythrocyte antioxidant capacity may provide an useful assessment of generalized alterations in tissue antioxidant status produced by pharmacological interventions. / Medicine, Faculty of / Anesthesiology, Pharmacology and Therapeutics, Department of / Graduate

Considerable interest has been expressed regarding the issue of recovery of language following head injury in childhood. The two questions most frequently addressed are: 1) Do children recover linguistic abilities faster and better than adults after suffering a head Injury? 2) Is the linguistic disorder, if evident, mainly syntactic or lexical in nature? We have examined 8 children from 6;10-17; 0 who suffered traumatic head injury and who are in varying stages of recovery. Each child has been matched with a normal child of the same age. Despite reports of complete recovery from childhood aphasia, our results indicate persistent word finding problems, with otherwise normal language abilities. There was no correlation between severity of deficit and age at injury or length of coma. / Medicine, Faculty of / Audiology and Speech Sciences, School of / Graduate

Social Skills Training for Head Injured Adults Research has demonstrated numerous personality and behavioral disturbances resulting from head injury (Lezak,1978). It is these changes rather than the physical disabilities that create the stress, in the long term for the relatives of the head injured (MeKinley,1981). Therefore, social skills training is a important part of intervention with this population. This study evaluates a social skills training program "Stacking the Deck" (Braunling-McMorrow et al 1986) which has been modified to include structured learning assignments. This is a single case evaluation (A - Baseline, B - Treatment) with replication. The subjects are four males with severe head injuries, ages 19,22,34,and 36. Social skills were described as requiring an action or reaction within six skill areas: compliments, social interaction, politeness, criticism, social confrontation, and questions/answers. Measures include the baseline developed in the "Stacking the Deck" program, Staff Questionnaire on Social Behavior (Spence,1979) and the Social Skills Assessment Chart (Spence,1980). Results indicate that this is an effective program for social skills training with the adult head injured population. / Arts, Faculty of / Social Work, School of / Graduate

Research shows that up to 80% of recreational skiers have lower limb alignments which can impede their ability to turn their skis properly (Subotnick,1982). The most difficult of these alignment problems to control within a ski-boot is the varus alignment of the subtalar joint (Macintyre and Matheson, 1988). The use of custom molded footbeds made specifically for use inside of ski boots has been suggested as one method of compensating for a varus aligned foot. This study compared the effectiveness of one brand of custom molded ski boot footbed with that of a noncustom insole in controlling the motions of the lower limb associated with subtalar varus. Specifically these motions were those of the rearfoot and the navicular tubercle, along with the alignment of the tibial tuberosity with respect to the mid-line of the ski boot. In addition, subjects were given the opportunity to assess their subjective feelings of edge control, pain, and fatigue while skiing with both the custom molded footbeds and non-custom insoles. The subject group for this study consisted of 13 advanced level adult skiers who demonstrated more than three degrees of subtalar varus when non-weight bearing. Each subject received a pair of custom molded ski boot footbeds at the beginning of the study. Ski boots that had been cut away at the rear and the medial side were used in the laboratory in order to observe the motions of the navicular tubercle and the rearfoot as the subject transferred their weight in a simulated skiing motion. The right and left navicular tubercle, tibial tubercle, and the insertion of the Achilles at the calcaneus of each subject were located by palpation and marked. After sufficient practice of the weight transfer motion, two trials of each landmark were photographed using 35mm slide film. The subjects were first photographed while using the non-custom insoles and again using the custom molded footbeds. The slides were digitized and comparisons were made between the two types of insoles for both the start and end locations of the landmarks as well as for the ranges of motion through which the landmarks traveled. Statistical analyses of the group results indicated that there was significantly less (p=0.000) navicular motion during the shift from the start to the end positions with the use of the custom molded footbeds as compared to the non-custom insoles. The rearfoot angle was significantly less at both the start (p=0.000) and end (p=0.000) positions with the use of the custom footbeds as compared to the noncustom insoles. There was no statistical difference between the amount of rearfoot motion allowed by either type of insole. The tibial tubercle was positioned significantly (p=0.000) closer to the mid-line of the ski boot when using the custom footbeds than with the use of the non-custom insoles. These results indicate that the custom footbeds domaintain the subtalar joint in a more neutral position than do non-custom insoles. During the skiing section of the study the subjects rated the custom footbeds as providing better edge control (p=0.000) and resulting in less fatigue (p=0.000) than noncustom insoles. There was no statistical significance when comparing the ratings given by the group for the level of pain experienced with the use of either type of insole. There was a statistically significant improvement (p=0.000) in race times for the group when using the custom footbeds as compared to the non-custom insoles. The results of this study indicate that custom molded ski boot footbeds are able to control subtalar motion more effectively than a non-custom insole. It appears that this control of subtalar motion enhances the skiing experience by increasing edge control and reducing the amount of fatigue experienced. / Education, Faculty of / Curriculum and Pedagogy (EDCP), Department of / Graduate

The purpose of this study was to determine the effects of varying periods of immobilization on ligamentous healing and strength in a rat experimental model. Sixty-one mature male Wistar rats were used. The left knee medial collateral ligament was surgically exposed, divided, and repaired. The rats were randomly placed into one of four groups: Group A, no immobilization, Group B, 2 weeks' immobilization, Group C, 6 weeks' immobilization, and Group D, 10 weeks' immobilization of the operated limb. The right knee served as a control. The ligaments were studied histologically and biomechanically at 2 weeks, 6 weeks, 10 weeks and 20 weeks post-operatively. Histologic samples were objectively evaluated with the light microscope using a Maturity Index Score and Scale that were devised based on the numbers and orientation of the fibroblasts and the amount and orientation of the collagen fibres. Ligament-bone preparations were studied using an Instron material testing machine to determine the biomechanical properties of the ligament until failure. Utilizing the Maturity Index Score and Scale, it was shown that Group A, with no immobilization, matured more rapidly than the other groups, and achieved full maturity at 20 weeks post-operatively. The other groups all showed a retarded rate of healing while immobilized. The electron microscopic study supported this data by demonstrating the level of metabolic activity of the fibroblasts which decreased with increasing maturity and by demonstrating that the size, amount and orientation of the collagen fibers increased with mobilization. The biomechanical testing showed that at 2 weeks post-operative, Group A had achieved a strength which was 46% of controls while Group B was only 29% of controls (p = 0.055). At 6 weeks Group A was 65% of controls, Group B was 56% of controls and Group C was 39% of controls (p = 0.0004). At 20 weeks Group A was 83% of controls, Group B was 71% of controls, Group C was 66% of controls and Group D was 48% of controls (p = 0.0005). Group A was 71% stronger than Group D at this time, indicating that the healing medial collateral ligament attained a greater strength and histologically matured more rapidly if mobilization is begun immediately. / Science, Faculty of / Botany, Department of / Zoology, Department of / Graduate

A study was undertaken to examine the major eye injury problems in industry, to determine the hazards that caused them, and to develop methods for improving industrial eye protection programs so as to reduce the incidence of eye injuries. The study was conducted in Alberta through the Occupational Health and Safety Division of Alberta Labour and the Alberta Workers' Compensation Board. A review of literature was performed to determine the status of eye protection programs, current epidemiological investigations and modes of protection, and to search for historical, legislative and cost benefit information. The project consisted of seven studies which were designed and carried out independently but, together, would provide a wide perspective concerning eye protection in industry. These studies were: a) A Review of W.C.B. Statistical Master File Data - which was concerned with a cumulative review of every eye injury claim received by the Workers' Compensation Board over the years 1974, 1975 and 1976. This included a review of Permanent disability claims, claims for lost work time and claims where only medical aid was required. b) A Review of Selected W.C.B. Personal Medical Files - which was concerned with the detailed review of eye injury claims from fifteen high eye injury risk industry classes. Each medical file was examined individually, paying particular attention to prevention-oriented information. c) A Survey of Occupational Health and Safety Officers - where thirty-one occupational health and safety officers (inspection personnel) were given an in-depth interview to obtain their perceptions and informed opinions on the nature of eye injury hazards, compliance factors, and the status of eye protection programs in industry. d) A Survey of Occupational Health and Safety Personnel - where questionnaires were sent to over six hundred persons in Alberta, identified as being involved in the provision of occupational health and safety services in industry. This included physicians, nurses, safety personnel, and persons in government. Questions were similar to those in Section c. e) A Review of the Minutes of Selected Joint Work Site Committees in Alberta - where the minutes of selected meetings concerning health and safety on the work site between management, the worker, and government, were analyzed to determine the extent of the unsolicited concern for eye injury prevention in companies which were known to have incurred a large number of eye injuries. f) A Review of Anecdotal Data - where several interviews were held with union and management representatives to determine the concern and need for eye injury prevention, and the development of eye protection programs at a policy level in industry. The comments and concerns of many other persons were also considered. g) A Review of Selected Site Visits to Industries in Alberta -where the researcher made six plant visits to better understand the conditions which lead to eye injuries and the problems in implementing preventive programs. It was found that industries involved in the manufacture or use of metal products, chemicals or construction materials were at high risk. More specifically, however, it was determined that certain occupational groups such as machinists, plumbers and pipefitters, welders, and mechanics were also at high eye injury risk. It was concluded that occupational classification and eye injury hazards should be treated as a basis to eye injury prevention. Injuries were found generally to occur most frequently among the young and inexperienced workers, while grinding and welding operations were found to be the most prevalent source of injury. Injuries occurred most often at certain times of the day, and there was some question of the effects of boredom and fatigue. It was found that there is a lack of knowledge and education concerning standards of eye protection and in the proper selection of the protector for the hazard. The physical strength of the protector was minor, however, in comparison to the need for better protector design and fitting of the device to the face of the worker. It was concluded that companies must be encouraged to develop eye protection policies as a basis to the provision of eye protection programs. A plan was recommended for the improvement of eye protection programs in industry. This included the presentation of a comprehensive eye protection program formulated through a review of literature on the subject, and the elucidation of a system of occupational vision care involving the interaction of all groups concerned with eye injury prevention in industry. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第21700号 / 社医博第91号 / 新制||社医||10(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 今中 雄一, 教授 佐藤 俊哉, 教授 小池 薫 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

Electrical stimulation has long been used in the treatment of a variety of ailments. Its current uses range from muscle re-education and orthotic substitute to scoliosis management and edema control. I chose to study the effect of electrode polarity in high voltage electrogalvanic stimulation in the treatment of edema for several reasons. I had access to subjects because I was the only physical therapist at the Stockton Orthopedic Medical Group. High voltage electrogalvanic stimulation is a commonly used modality in treating edema (Brown, 1981). High voltage generators have a polarity switch, and the direction manual which accompanies the Electro-Med generator used by the Stockton Orthopedic Medical Group states that the negative pole should be used for edema reduction. (Instruction manual for high voltage Electrogalvanic Stimulator, 1977). However, the effect of electrode polarity on edema reduction has not been demonstrated, nor documented in the literature.

Thesis (MSc (Radiography))--Cape Peninsula University of Technology, 2019 / Introduction: Traumatic brain injury (TBI) is frequently associated with mortality and morbidity in low-income countries. Computed Tomography Brain (CTB) imaging aid in the management of patients by accurately exploring primary and secondary brain injuries following trauma. However, there is controversy among researchers on the benefits of follow-up CTB imaging (FCTBI) amongst patients presenting with TBI showing a normal baseline scan. As such, in an attempt to address the contention, the primary focus of this research study was to explore the role of FCTBI with regards to the clinical status of such patients. The secondary focus was to determine the timing of performing FCTBI post TBI. Method: A retrospective cross sectional quantitative design was conducted for this research study. A total sampling strategy was employed on medical records of 85 patients treated at the research site in Zimbabwe. Data were collected over a two year period. Adult patients between the ages of 18 and 75, with TBI and who had a normal first CTBI1 (primary scan done upon hospital admission) were included in this research study. The evolution of different types of brain pathology diagnosed on FCTBI in affected patients were recorded on data collection sheets. An analysis then followed to establish whether the sample patients had developed any neurological complications. Results: The study showed that in 85 patients with TBI, 36% recorded abnormal radiological findings on FCTBI with subdural haematoma (19%) being the most common intracranial lesion followed by intracerebral haemorrhage (8%), subarachnoid haemorrhage (6%) and lastly, pneumocephalus and epidural haematoma (1% respectively). The most frequent causal mechanism of trauma was road traffic accidents (RTAs) at 58%. Males with TBI comprised a higher proportion (53%) than did females (47%). The performance of CTBI1 at 8 hours post trauma occurrence, within a recommended hospital observation period of 20 hours post trauma occurrence, may provide sufficient time for lesions to evolve and thus determine the appropriate patient management. The young adult age group of 26-35 years was found to be more susceptible to TBI. Conclusion: FCTBI was found to be of value in timely detection of evolving intracranial lesions which enabled appropriate management of patients. The current study recommends that patients who exhibit a declining Glasgow Coma Scale (GCS) score and deteriorating neurological status undergo a FCTBI.