A dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg in fulfillment of the requirements for the degree of Master of Science in Occupational Therapy Johannesburg, June 2017 / This study explores the implementation of two different synergistic wrist motion approaches in the treatment of flexor tendon injuries, the excursion-based approach and the force-based approach. A prospective, quantitative, comparative intervention research design was used to compare the two approaches and determine their effectiveness in a public hospital in South Africa. The five participants’ range of motion, independence in activities of daily living and satisfaction levels were measured throughout the 12 week treatment programme. The excursion-based group showed significant improvement in passive Strickland and Glogovac scores over the rehabilitation period. The excursion-based group also achieved better final place-and-hold and active Strickland and Glogovac scores than the force-based group which showed a decline in these scores over the 12 weeks. Both groups had a poor result for active movement at the final session due to the development of adhesions, but were found to have an improvement in their upper limb function measured on the Disabilities of the Hand, Shoulder and Arm questionnaire in all activities except for those related to work. These results were not statistically significant. The poor results may be attributed to the unique challenges experienced by patients with flexor tendon injuries, living in under-resourced South African communities. The small sample and the fact that the excursion-based group received isolated flexor digitorum profundus tendon repairs while the force-based group received combined flexor digitorum profundus and flexor digitorum superficialis repairs may also have had an impact on the results. The outcomes of this study indicate that despite yielding successful results in research studies performed in developed countries, it is unlikely that either of these approaches will be suitable in the rehabilitation of patients with flexor tendon repairs in a public hospital in South Africa. / MT2017

Thesis (M. Med. Sc.)--University of Hong Kong, 2007.

No description available.

Thesis (M.Sc.)--York University, 2007. Graduate Programme in Kinesiology & Health Science. / Typescript. Includes bibliographical references (leaves 72-83). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&res_dat=xri:pqdiss&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&rft_dat=xri:pqdiss:MR38803

Thesis (M.S.)--West Virginia University, 2001. / Title from document title page. Document formatted into pages; contains vii, 56 p. : ill. (some col.). Includes abstract. Includes bibliographical references (p. 48-50).

No description available.

Thesis (M.S.)--Rutgers University, 2009. / "Graduate Program in Biomedical Engineering." Includes bibliographical references (p. 52-54).

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Serotonin (5-HT) and noradrenalin (NA) increase persistent inward currents mediated by sodium and calcium channels on the dendrites of motoneurons. The ability of 5-HT and NA to modulate these channels depends on the distributions of 5-HT and NA synapses. Recent studies of the distribution of 5-HT and NA synapses on motoneurons innervating the neck muscle splenius reported that these synapses are rare on the somata and have a strong bias to dendrites with small diameters. It is unknown whether this distribution pattern represents a general principle of organization (1) for all motoneuron groups or (2) for all types of modulators. To address the first question, we have examined the distribution of 5-HT and NA synapses on flexor motoneurons, which unlike extensor motoneurons, are not able to generate self-sustained discharges known to involve the activation of persistent inward currents. To answer the second question, we have mapped the distribution dopamine (DA) synapses. The dendrites of motoneurons that innervate the neck flexor rectus capitis anterior (RCA) were stained. Synapses containing 5-HT, NA and DA were identified using immunohistochemical techniques. Observations based on five RCA motoneurons indicate that the average densities of 5-HT and NA contacts are 2.3 and 1.4 times less dense than the average densities of 5-HT and NA contacts on splenius motoneurons, respectively. Moreover, pairs of 5-HT contacts and pairs of NA contacts were found to be 3.0 and 1.8 times closer together on splenius compared to RCA motoneurons, respectively. These observations may reflect the inability of flexor motoneurons to generate self sustained discharges. Similar to splenius motoneurons, 5-HT and NA synapses were found to preferentially innervate dendrites with diameters less than 2 µm. Thus, 5-HT and NA synapses facilitate channels in regions where excitatory or inhibitory signals undergo the largest attenuations. DA synapses on the dendritic tree were sparse (0.2 and 0.1 contacts per 1000 µm2), suggesting that the actions of DA synapses are confined to local regions on the dendritic tree. These results highlight that motoneurons do not all share the same intrinsic properties, and the distribution of modulatory synapses have a crucial role in determining these properties. / Thesis (Master, Neuroscience Studies) -- Queen's University, 2011-09-28 15:17:54.335

The management of flexor tendon injuries in the hand is complex and requires skill not only on the part of the surgeon but also the rehabilitation therapists and compliance on the part of the patient. Anecdotally it is clear that therapists (occupational therapists and physiotherapists) gain their skills and knowledge as practitioners through hands-on experience, since very little specialized training is available in the field of hand therapy. Therapists should equip themselves with the knowledge of the surgical management of the patient, since post-operative rehabilitation depends on it. Ideally the hand surgeons should advise the therapists or dictate the post-operative management based on the surgical technique performed. The actual practices, attitudes and experiences of South African therapists in the management of flexor tendons are not known. The purpose of this study was to determine the practices, attitudes and experiences of the public sector physiotherapists and occupational therapists in the postoperative rehabilitation of patients post repair of flexor tendons surgery in the hand. The first part of the study consisted of a cross sectional survey which explored the postoperative rehabilitation practices, attitudes, and experiences regarding flexor tendon rehabilitation. The second part which was a focus group discussion sought in depth information on the attitudes and experiences of the therapists. Sixty three therapists from different public hospital settings in two districts of KwaZulu-Natal completed a validated questionnaire. The therapists were accessed from randomly selected hospitals located in two conveniently selected health districts in KwaZulu- Natal. The findings suggest that the use of the Kleinert-type and immobilisation protocols is widely used. Overall there was no significant differences in the choice of rehabilitation protocol, but this differed by hospital setting. Therapists in the tertiary hospital preferred the Duran protocol (53.6%, p = 0.003). Regional hospitals utilized the immobilization protocol (74.1%, p=0.045) and district hospitals treated presenting postoperative symptoms mostly (20% p=0.75).There was no statistical (p=0.196) difference on the decision to initiate therapy amongst different hospital settings. Frequency of therapy visits varied, but was not statistically different (p=0.16) amongst different hospital settings. More respondents (29.2%) reported typically initiating active ROM exercises on the fourth post-operative week. There was a significant difference (p=0.002) in the initiation of active range of movement amongst different hospital settings. Approximately 37% of the respondents discontinue protective splinting at five weeks. There was a significant difference (p=0.004) by hospital setting regarding when the protective splinting should be discontinued. Initiation of resistance exercises varied between four and six weeks. Nearly half (49%) of the therapists reported that they are sometimes apprehensive about how to progress patients through rehabilitation. The focus group revealed that there is poor communication between therapists and surgeons, lack of protocol guidance, lack of knowledge of the flexor tendon protocols of the newly qualified therapists and doctors. During the focus group discussion therapist’s attitudes and experiences were revealed through the eight themes that emerged namely challenges experienced during flexor tendon (FT) rehabilitation, the patient's socio-economic background, patient’s home environment, compliance with flexor tendon rehabilitation protocol, multidisciplinary team approach, clinical experience, university undergraduate curriculum on flexor tendon rehabilitation, outcomes of flexor tendon postoperative rehabilitation. Conclusion. The rehabilitation protocols that are commonly used include the Kleinert -type and the immobilisation protocols. Duran type protocol was used less frequently, only when it was the best option for that particular patient according to the surgeon or the surgical management of that patient. The focus group discussion revealed that rural hospital therapists modify the protocols, due to lack of resources and the poor compliance of the patients. rehabilitation practices, flexor tendon experiences, hospital settings / Thesis (M.Physio.)-University of KwaZulu-Natal, Westville, 2013.