The purpose of this study was to examine the coping styles, beliefs, and symptoms of head-injured adults during long term recovery. Twenty-eight head-injured and thirty-two control subjects suffering from non-neurological illnesses or injuries participated. Subjects completed the Ways of Coping Questionnaire and two questionnaires developed for this study: the "Why Me?" Questionnaire assessed subjects' causal attributions and beliefs about responsibility and the Head-Injury Symptom List provided self-report of the severity of symptoms of head-injury. The coping and belief profiles of the two groups were compared. Head-injured subjects were more likely to place responsibility for their injury on others and to undertake personal efforts to effect their recovery. Various relations between injury attributions and coping styles were obtained. Among both head-injured and control subjects those who endorsed beliefs of retribution were more likely to cope by wishing they could change their situation. Responses to the Head-Injury Symptom List identified tiredness as the most pervasive symptom. Greater symptomatology was related both to a coping style characterized by lack of ability or willingness to engage in social activity or to seek social support and to beliefs that the injury had occurred to serve a meaningful purpose. Consistent with these quantitative results, interviews with head-injured subjects revealed themes of both loss and enhancement. A majority compared their recovery favorably with that of other individuals. In support of cognitive coping theory, this research demonstrates the feasibility of studying the coping capacities of head-injured individuals and shows that they have distinctive coping styles and beliefs which are related to each other. This knowledge should aid those trying to support the recovery of head-injured individuals by adding to the framework upon which interventions are based.

Bakgrund: Svensk idrott med cirka tre miljoner medlemmar spelar en viktig roll i främjandet av god hälsa men medför även en risk för skador. Det kräver både preventiva och rehabiliterande åtgärder. En kartläggning av de vanligaste idrottsskadorna kan bidra till att identifiera kunskapsluckor samt underlätta implementering av förebyggande åtgärder inom fysioterapi. Syfte: Studiens syfte var att kartlägga och analysera skadepanoramat efter år 2000 inom de fem mest utövade idrotterna i Sverige, samt identifiera eventuella skillnader baserat på kön, ålder och idrott. Metod: En allmän litteraturöversikt genomfördes med fokus på epidemiologiska- och kohortstudier. 163 studier identifierades via sökningar i databaserna Pubmed (n = 78), Cinahl (n = 30) och SportDiscus (n = 55). Efter granskning av titel och abstrakt, återstod 17 studier för kvalitetsgranskning med Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Resultat: 15 studier (fotboll = 7, friidrott = 3, gymnastik = 2, innebandy = 4) inkluderades i litteraturöversikten med ett totalt deltagarantal på 3 635 628 aktiva, varav 69.7% män. Inga svenska studier om golf kunde identifieras. En hög frekvens skador i nedre extremitet noterades i alla idrotter, framförallt i fotboll och friidrott, medan skador i underarm/hand framträdde i gymnastik. Dessutom framkom en hög frekvens rygg- och huvudskador inom innebandy och gymnastik. Konklusion: Skademönstret varierar inte markant mellan könen men män uppvisar en högre skaderisk än kvinnor. Endast fotboll noterade ett varierande mönster mellan ungdomar och vuxna där ungdomar hade en lägre skadeincidens och fler frakturer. Generellt finns det ett behov av uppdaterad, könsrepresentativ forskning inom idrotterna. / Background: Swedish sports play a crucial role in promoting good health but also carry a risk of injuries. This requires both preventive and rehabilitative measures. A mapping of sports injuries can help identify knowledge gaps and facilitate the implementation of preventive measures within physiotherapy. Aim: The aim was to map and analyze the injury landscape after the year 2000 within the five most practiced sports in Sweden, and to identify any differences based on gender, age, and sport. Method: A literature review was conducted, focusing on epidemiological-, and cohort studies. 163 studies were identified through the databases Pubmed (n = 78), Cinahl (n = 30), and SportDiscus (n = 55). After reviewing title and abstract, 17 remained for quality review with the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results: 15 studies (football = 7, athletics = 3, gymnastics = 2, floorball = 4) were included with a total of 3,635,628 participants, of which 69.7% were men. No studies on golf were identified. A high frequency of lower extremity injuries was noted in all sports, especially in football and athletics, while forearm/hand injuries were prominent in gymnastics. In addition, back and head injuries were noted within floorball and gymnastics. Conclusion: The injury pattern does not vary significantly between the sexes, but men show a higher risk of injury than women. Only football noted a varying pattern between youth and adults, where youth had a lower injury incidence and more fractures. There is a need for updated, gender-representative research within sports.

Thesis (MScPhysio)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Introduction: Groin injuries are among the top six injuries in contact sports and may lead to career ending chronic pain. Research on the role of knee kinematics in developing chronic groin pain in sport is scarce. Objective: The purpose of this study was to determine if there are differences in knee kinematics during a single-leg drop-landing in sports participants with chronic groin pain compared to asymptomatic controls. Methodology: A descriptive study was conducted. Twenty active sports’ participants were recruited from soccer and rugby clubs situated around the Cape Peninsula area, Western Cape, South Africa. The three-dimensional (3D) knee kinematics of ten cases with chronic groin pain and ten asymptomatic controls was analysed. Knee kinematics was analysed in the FNB-3D Vicon Laboratory at Stellenbosch University, using an eight camera Vicon system. A positive adductor squeeze test was used as a diagnostic test to include cases with chronic groin pain. Each participant performed six single-leg drop landings. The main outcome measure was 3D knee kinematics at initial foot contact and at the lowest vertical position of the drop landing. The following sub-groups were analysed: seven unilateral groin pain cases compared to their seven matched controls; three bilateral groin pain cases where their most painful leg and least painful leg were compared to their matched controls, respectively. Descriptive statistical techniques were used for all outcome measures; means and standard deviations (SD) were calculated, followed by a Student’s t-test to determine significant differences between the cases and controls. For all outcomes with p-values equal to or below 0.05, the effect size was calculated using the Cohen’s D. Results: The findings of this study indicated a significant difference (p=0.0001) between cases with unilateral groin pain having less knee internal rotation compared to the controls at the lowest vertical position of the drop landing in the transverse plane. Significantly less internal rotation (p<0.0001), was also noted in the cases with bilateral groin pain (in the most painful leg and the less painful leg), although this was noted at foot contact. Cases with bilateral groin pain also had significantly (p<0.001) more knee varus (adduction) during the landing phase. Conclusion: Differences in knee kinematics between sports participants with chronic groin pain and asymptomatic controls were found. These findings imply that the knee joint should be included during assessment and rehabilitation of individuals suffering with chronic groin pain. Due to the cross-sectional study design of the current study, it cannot be stated for certain whether the knee kinematics noted in the groin pain group are causative or as a result of groin pain. Future prospective studies are thus recommended; these studies should focus on the effect of contralateral knee kinematics on the hip adductors and may include exploration of the muscular components during a single-leg drop landing. / AFRIKAANSE OPSOMMING: Inleiding: Lies beserings is een van die top ses beserings in kontak sport en kan lei tot chroniese lies pyn en selfs die be-eindigging van ‘n sportloopbaan. Navorsing oor die rol van knie kinematika in die ontwikkeling van chroniese liesbeserings in sport is skaars. Doelwit: Die doel van hierdie studie was om te bepaal of daar verskille in die knie kinematika is tydens 'n enkel been val landing in sport deelnemers met chroniese lies pyn in vergelyking met gesonde kontroles. Metode: 'n Beskrywende studie was uitgevoer. Twintig aktiewe sport deelnemers is gewerf van rugby en sokker sportklubs geleë rondom die Kaapse Skiereiland, Wes-Kaap, Suid-Afrika. Die 3D knie kinematika van tien gevalle met chroniese lies pyn en tien asimptomatiese bypassende kontroles is ontleed. Knie kinematika was ontleed in die FNB-3D Vicon Laboratorium by die Universiteit van Stellenbosch, met behulp van 'n agt-kamera Vicon stelsel. 'n Positiewe Adduktor druk toets was gebruik as 'n diagnostiese toets om gevalle met chroniese lies pyn in te sluit. Om die knie kinematika te analiseer, het elke deelnemer ses enkel been val landings uitgevoer . Die belangrikste uitkomsmeting was 3D knie kinematika by die aanvanklike voet kontak en by die laagste vertikale posisie van die enkel-been val landing. Die volgende sub-groepe was ontleed: sewe unilaterale lies pyn gevalle in vergelyking met hul sewe bypassende kontroles; drie bilaterale lies pyn gevalle waar hul mees pynlike been, sowel as minder pynlike been onderskeidelik vergelyk was met hul bypassende kontroles. Beskrywende statistiese tegnieke was gebruik vir alle uitkoms maatreëls; gemiddeldes en standaardafwykings (SA) was bereken, gevolg deur 'n Studente’s t-toets om beduidende verskille tussen die gevalle en kontroles te bepaal. Vir al die uitkomste met p-waardes gelyk of onder 0.05, is die effekgrootte bereken deur die Cohen’s D. Resultate: Die bevindings van hierdie studie dui op 'n beduidende verskil (p=0,0001) tussen gevalle met unilaterale lies pyn met minder interne knie rotasie in vergelyking met die kontroles by die laagste vertikale posisie van die val landing in die dwars vlak. Aansienlik minder interne rotasie (p<0,0001), is ook opgemerk in gevalle met bilaterale lies pyn (in die mees pynlike been en die minder pynlik been), alhoewel tydens voet kontak. Gevalle met bilaterale lies pyn het ook betekenisvol (p <0.001) meer knie varus (adduksie) tydens die landingsfase gehad. Gevolgtrekking: Verskille bestaan in die knie kinematika tussen sport deelnemers met chroniese liesbesering pyn en gesonde kontroles. Hierdie bevindinge impliseer dat die knie behoort ingesluit te word tydens die assessering en rehabilitasie van individue met chroniese lies pyn. As gevolg van die deursnee-studie ontwerp van hierdie studie, kan dit nie bevestig word of die knie kinematika die oorsaak van die chroniese pyn is nie. Toekomstige voornemende studies word dus aanbeveel, hierdie studies moet fokus op die effek van die kinematika van die kontralaterale knie op die heup adduktore en kan moontlik die ondersoek van die spier kinetika tydens hierdie aktiwiteit insluit.

The aim of the study was to explore the reasons why health workers reported their occupationally acquired needle stick injury. The secondary reasons for this study was to be able to identify the factors that contributed to the choice to report as well as the feelings health workers experienced during and after the injury.

This diploma thesis engages in the issue of protection of children's health. It focuses on the prevention occurrence of accidents among children. The aim of this thesis is to refer to the importance of this topic and to realize the project, in which primary school pupils have an opportunity to reduce the rate of accidents actively. The theoretical part presents epidemiological data about childhood's accidents, warns of the specifics of psychomotor development of primary school children. In addition to inform about the methods of intervention and prevention levels and it gives an overview of organizations which engage in the protection of health. The practical part presents the results of a survey that addressed the teachers in point of view on idea of leadership in teaching by older primary school pupils. Then constitute the specific prevention project in which fifth grade pupils prepares a lesson on the subject of injury prevention for the second grade pupils. Conclusion the practical part includes modifying the original project and recommendations for teachers, based on the experience gained in implementing the project.

Traumatic brain injury (TBI) is the signature injury of modern military conflicts due to widespread use of improvised explosive devices (IEDs) and modern body armor. However, the exact biophysical mechanisms of blast-induced traumatic brain injury (bTBI) and its pathological effects on the blood-brain barrier (BBB) – a structure essential for maintaining brain homeostasis – remain poorly understood. The specific aims of this thesis are to: 1) determine a threshold for primary blast-induced BBB dysfunction in vitro; 2) determine the effect of repeated blast on BBB integrity in vitro; 3) improve BBB recovery in vitro as a potential therapeutic strategy for mitigating effects of blast; and 4) quantify the time course and pore-size of BBB opening in vivo. In this work we utilized a shock tube driven by compressed gas to generate operationally relevant, ideal pressure profiles consistent with IEDs. By multiple measures, the barrier function of an in vitro BBB model was disrupted after exposure to a range of blast-loading conditions. Trans-endothelial electrical resistance (TEER) decreased acutely in a dose-dependent manner that was most strongly correlated with impulse, as opposed to peak overpressure or duration. Significantly increased hydraulic conductivity and solute permeability post-injury further confirmed acute alterations in barrier function. Compromised ZO-1 immunostaining identified a structural basis for BBB breakdown. These results are the first to demonstrate acute disruption of an in vitro BBB model after primary blast exposure; defined tolerance criteria may be important for development of novel helmet designs to help mitigate effects of blast on the BBB. After determining that exposure to a single primary blast caused BBB disruption, we hypothesized that exposure to two consecutive blast injuries would result in exacerbated damage to the BBB in vitro. However, contrary to our hypothesis, repeated mild or moderate primary blast delivered within 24 or 72 hours did not significantly exacerbate reductions in TEER across a brain endothelial monolayer compared to sister cultures receiving a single exposure. Single blast exposure significantly reduced immunostaining of ZO-1 and claudin-5 tight junction proteins, but subsequent exposure did not cause additional damage to tight junctions. The second injury delayed recovery of TEER and hydraulic conductivity in BBB cultures. Extending the inter-injury interval to 72 hours, the effects of repeated injury on the BBB were independent given sufficient recovery time between consecutive exposures. Investigation of repeated blast on the BBB will help identify a temporal window of vulnerability to repeated exposure. Restoration of the BBB after blast injury has emerged as a promising therapeutic target. We hypothesized that treatment with dexamethasone (DEX) after primary blast would potentiate recovery of an in vitro BBB model. DEX treatment resulted in complete recovery of TEER and hydraulic conductivity 1 day after injury, compared with 3 days for vehicle-treated injured cultures. Administration of RU486 (mifepristone) inhibited effects of DEX, confirming that barrier restoration was mediated by glucocorticoid receptor signaling. Potentiated recovery with DEX treatment was accompanied by stronger ZO-1 tight junction immunostaining and expression, suggesting that increased ZO-1 expression was a structural correlate to BBB recovery. This is the first study to provide a mechanistic basis for potentiated functional recovery of an in vitro BBB model due to glucocorticoid treatment after blast injury. Using an in vivo bTBI model, systemic administration of sodium fluorescein (NaFl; 376 Da), Evans blue (EB; 69 kDa when bound to serum albumin) and dextrans (3 – 500 kDa) was used to estimate the pore-size of BBB opening and time required for recovery. Exposure to blast resulted in significant acute extravasation of NaFl, 3 kDa dextran, and EB. However, there was no significant acute extravasation of 70 kDa or 500 kDa dextrans, and minimal to no extravasation of NaFl, dextrans, or EB 1 day after exposure. This work is the first to quantify the time course and size of BBB opening after bTBI, suggesting that the BBB recovered 1 day post-injury. This study supports our hypothesis that transient opening of the BBB may permit serum-components to infiltrate the brain parenchyma and contribute to pathological secondary cascades. This research has shown that BBB damage, demonstrated in vitro and in vivo, is a major mechanism contributing to vascular and neuronal pathology of bTBI at exposure levels above a critical threshold. Compared with published studies on blast-induced damage to the BBB, we have developed primary blast injury tolerance criteria by precisely controlling the biomechanical initiators of injury and measuring resulting alterations to the structure and function of an in vitro BBB model by methods not possible in vivo. We have also developed a potential glucocorticoid treatment to rapidly restore the BBB after injury, which may lead to more promising therapeutic strategies to treat TBI-related pathologies. This work will also guide the development of novel armor designs to protect service members and civilians in order to more effectively address the burden to society of bTBI.

Graduation date: 2004

Context: Concussion is a major sports medicine concern that is currently under scrutinisation worldwide. Well-publicised cases of careers ending due to multiple concussions, and the potential for permanent, disabling neurocognitive deficits have raised concerns and encouraged further research to take place. Objectives: This study aimed to investigate subjects exposed to mild head injuries with the aim of determining if neuro logical sequelae are detectable. The objectives of this study were to evaluate changes in neuropsychological performance over a period of playing rugby for one full season, which extended over nine months. This study investigated the relationship between concussion history and neuropsychological performance relating to the possible cumulative effects of concussion. Neuropsychological functioning in recently concussed athletes was compared with that of non-injured (control) athletes to detect whether neurological sequelae were present. Investigation into the relationship between post-concussion symptoms and neuropsychological performance was evaluated. The position of play was analysed to see if there were any measurable differences m neuropsychological performance present between forward and backline players. Design, Setting, and Participants: 35 club rugby players and 35 non-contact sports athletes were assessed over a period of 9 months. Both groups underwent pre-season baseline testing and post-season testing. A comprehensive battery of reliable and valid neuropsychological tests was used to assess these subjects, with particular focus on the following 5 areas of cognition: planning, visuo spatial and constructional ability; attention and concentration; memory; verbal fluency and speed of information processing. Results: The data showed that significant differences occurred in rugby players participating regularly in the sport over one full season in terms of changes in neuropsychological test performance in a range of cognitive domains, including planning, visual spatial and constructional ability, attention and concentration, memory and verbal fluency. Numerous significant relationships were found between certain Post Concussion Symptom Scale (PCSS) scores and poor neuropsychological performance, which were considered indicative of subtle effects of sub-concussive injuries and mild head injury (MHI). Surprisingly, following the assessment of concussed players during the season, the data did not show any reliable significant declines in cognitive performance compared to their baseline testing. However, mean scores of the concussed group did show a trend of decreased neuropsychological performance in almost every cognitive domain following the concussive injury. The data did not show any significant relationship between a history of three or more previous concussions and neuropsychological performance. Furthermore, no significant differences in neuropsychological performance between backline and forward players were evident. Conclusion: This research demonstrates that concussion can present serious consequences for athletes and warrants the attention it has received. This present study gives a clear description of the potential negative consequences of playing rugby, which are evident by looking at the change in scores between pre- and post-season testing and poorer performance in most neuropsychological measures following a concussive injury. Although this study dealt mainly with 'normal' players, the results shown here are a cause for concern. What has become evident is that the player need not be exposed to severe concussion in order to experience some form of cognitive impairments. Even if these impairments are minimal, they are however still present and have the potential of accumulating, which could lead to disastrous permanent deficits. / Thesis (M.A.)-University of KwaZulu-Natal, Pietermaritzburg, 2008

There has been much debate about whether shallow water diving , in the absence of neurological insult , can lead to cognitive deficits. The aim of this study was to investigate possible neuropsychological effects on two groups of divers , without any known history of decompression illness, who represent opposite ends of the spectrum of diving practice (rescue divers and sport divers) , and to compare them with a non-diving control group. 17 rescue divers , 17 non-diving controls and 15 sport divers were recruited. The groups were matched for age, but not for education. The two diving groups were comparable in terms of diving history. Results of neuropsychological testing indicated that the rescue diving group was not significantly different from the control group, suggesting that rescue diving under controlled conditions is comparatively safe. The sport diver group performed significantly worse than controls on a test of verbal reasoning (Comprehension, SAWAIS-R) and on a measure of word fluency (Controlled Oral Word Initiation Test), suggesting the possibility that risky diving practices may lead to decrements in frontal lobe functioning. Another possibility is that global decrements occur, but that the tests of frontal lobe functioning were more sensitive to mild deficits in functioning. This contention is tentative, and further research into frontal lobe functioning of divers should be conducted. Sport divers are recommended to follow safe diving practices and use dive profiles that avoid bubbling in order to prevent cognitive damage. VI / Thesis (M.A.)-University of Natal, Pietermaritzburg, 2002.

The aim of the study was to explore the reasons why health workers reported their occupationally acquired needle stick injury. The secondary reasons for this study was to be able to identify the factors that contributed to the choice to report as well as the feelings health workers experienced during and after the injury.