Thesis (M.Sc.(Physiotherapy)), Faculty of Health Sciences, University of the Witwatersrand, 2009 / Background: The impact of non-traumatic lower limb amputation on participant’s quality of life (QOL) is unknown. In an effort to provide better care for people with lower limb amputation, there is a need to first know the impact of this body changing operation on people’s quality of life. Aim of the study: To determine the impact of lower limb amputation on QOL in people in the Johannesburg metropolitan area during their reintegration to their society/community of origin. Objectives: 1. To establish the pre-operative and post-operative:  QOL of participants (including the feelings, experiences and impact of lower limb amputation during the time when they have returned home and to the community).  The functional status of participants.  Household economic and social status of these participants. 2. To establish factors influencing QOL. Methods: A longitudinal pre (amputation) test –post (amputation) test study utilized a combination of interviews to collect quantitative data and in-depth semistructured interviews to gather qualitative data. Consecutive sampling was used to draw participants (n=73) for the interviews at the study sites pre-operatively. The three study sites were Chris Hani Baragwanath Hospital, Charlotte Maxeke Johannesburg General Hospital and Helen Joseph Hospital. Participants were then followed up three months later for post-operative interviews and key informants were selected for in-depth interviews (n=12). Inclusion criteria: Participants were included if they were scheduled for first time unilateral (or bilateral amputation done at the same time) lower limb amputation. The participants were between the ages of 36-71 years. Exclusion criteria: Participants who had an amputation as a result of traumatic or congenital birth defects were excluded from the study. Participants with comorbidities that interfered with function pre-operatively were not included. Procedures: Ethics: Ethical clearance was obtained from the Committee for Research on Human Subjects at the University of the Witwatersrand and permission was obtained from the above hospitals. Participants gave consent before taking part in the study. Instrumentation: A demographic questionnaire, the EQ-5D, the Modified Household Economic and Social Status Index (HESSI), the Barthel Index (BI) and semi-structured in-depth interviews were used. Data collection: Participants were approached before the operation for their preoperative interviews using the above questionnaires and then followed up postoperatively using the same questionnaires and some were selected to participate in semi-structured in-depth interviews three months later. Pilot study: The demographics questionnaire and the modified HESSI were piloted to ensure validity and reliability. iii Data analysis: Data were analyzed using the SPSS Version 17.0 and STATA 10.0. The significance of the study was set at p=0.05. All continuous data are presented as means, medians, standard deviations and confidence intervals (CI 95%). Categorical data are presented as frequencies. Pre and post operative differences were analyzed using Wilcoxon Signed-rank test. A median regression analysis (both the univariate and multivariate regression) was done to establish factors influencing QOL. Pre and post operative differences in the EQ-5D items and the BI items were analyzed using Chi square/Fischer’s exact depending on the data. Data were pooled for presentation as statistical figures in tables. Both an intension to treat analysis and per protocol analysis were used. A grounded theory approach was used to analyze the concepts, categories and themes that emerged in the qualitative data. Results: Twenty-four participants (33%) had died by the time of follow up. At three months, n=9 (12%) had been lost to follow up and 40(55%) was successfully followed up. The preoperative median VAS was 60 (n=40). The postoperative median VAS was 70. The EQ-5D items on mobility and usual activities were reported as having deteriorated significantly postoperatively (p=0.04, p=0.001respectively) while pain/discomfort had improved (p=0.003). There was no improvement in QOL median VAS from the preoperative status to three months postoperatively The preoperative median total BI score was (n=40). The postoperative median total BI score was 19. There was a reduction in function (median BI) from the preoperative status to three months postoperatively (p<0.001). The ability to transfer was improved three months postoperatively (p=0.04). Participants were also found to have a decreased ability to negotiate stairs (p<0.001). Mobility was significantly reduced three months postoperatively (p=0.04). During the postoperative stage (n=40), 38% of the participants were married. Most (53%) of the participants had no form of income. The highest percentage of participants in all instances (35%) had secondary education (grade10-11), while 25% had less than grade 5. Only one participant was homeless, 18% lived in shacks, 55% lived in homes that were not shared with other families. People with LLA in the Johannesburg metropolitan area who had no problem with mobility preoperatively (EQ-5D mobility item), who were independent with mobility (BI mobility item) preoperatively, who were independent with transfer preoperatively (BI transfer item) had a higher postoperative quality of life (postoperative median EQ-5D- VAS) compared to people who were dependent or had problems with these functions preoperatively. Being females was a predictor of higher reported quality of life compared to being male. Emerging themes from the qualitative data were psychological, social and religious themes. Suicidal thoughts, dependence, poor acceptance, public perception about body image, phantom limb related falls and hoping to get a prosthesis were reported. Some reported poor social involvement due to mobility problems, employment concerns, while families and friends were found to be supportive. Participants had faith in God. Conclusion: Participants’ QOL and function were generally scored high both preoperatively and postoperatively but there was a significant improvement in QOL and a significant reduction in function after three months although participants were generally still functionally independent. Good mobility preoperatively is a predictor of good QOL postoperatively compared to people with a poor preoperative mobility status Generally, most participants had come to terms with the amputation and were managing well while some expressed that they were struggling with reintegration to their community of origin three months postoperatively with both functional and psychosocial challenges.

Background and purpose of research: The number of individuals playing rugby union is increasing every year particularly amongst adolescence at a school level. With the increase in participation an increase in injuries arises. The purpose of this study was to document the lower limb injuries previously sustained in the 2009 rugby season as well as the injuries sustained over a six week period in 2010 and to identify the risk factors associated with these injuries. Method: A prospective cohort design was used. Sixty-five participants from three high schools on the West Rand completed an injury questionnaire and participated in pre-season testing of lower limb muscle length, muscle strength and balance. Lower limb injuries were documented throughout the season. Descriptive statistics were used to describe the data and a univariate analysis was done to determine if there were any associations between various risk factors and sustaining an injury. Results: Six lower limb injuries were documented in 2010. Knee and ankle injuries accounted for 25 out of the 35 (71%) injuries sustained over the 2009 and 2010 rugby seasons. The risk factors for lower limb injuries included good flexibility of the hamstring muscle group and logistic regression also showed an association between a right lower limb injury and right sided muscle strength of the ankle dorsiflexors (p=0.04) and knee extensors (p=0.05). Conclusion: The risk factors associated with these lower limb injuries were good flexibility of the hamstring muscle group as well as right sided quadriceps and tibialis anterior muscle strength.

The extent to which sensory impairments in the foot, ankle and lower limb persist into the chronic phase of stroke is unclear. Furthermore, the extent to which these impairments influence walking, balance and falls is not well understood. This thesis investigated the prevalence, functional importance and measurement of lower limb somatosensory impairments in ambulatory people with chronic stroke. Methods This thesis comprised three studies: the first, a qualitative investigation, explored the views and experiences of people with chronic stroke (n=13). This led to the second study: a cross sectional observational study in which the prevalence, distribution and functional relevance of lower limb sensory impairments were investigated in chronic stroke participants (n=180) and healthy controls (n=46). The final study, informed by the findings from the first two studies, a “synthesis” review of current sensory measures and patient and carer involvement, developed and evaluated three novel, functionally oriented measures of lower limb somatosensory discrimination in chronic stroke (n=32) and healthy controls (n=32). Results People with stroke felt problems with foot, ankle and lower limb sensation affected their walking, balance and contributed to falls. Furthermore, sensory impairments in the lower limb are prevalent with up to 59% of chronic stroke survivors having a deficit of one or more somatosensory modality. Despite this, weak associations between traditional measures of tactile and proprioceptive sensation and walking, balance and falls were demonstrated. Novel, functionally oriented measures of tactile and proprioceptive discrimination were developed and evaluated. These measures were reliable and valid, showing greater sensitivity to predicting the presence of sensory impairments and had stronger associations with functional measures than traditional sensory tests. Conclusions This thesis has provided a comprehensive picture of lower limb somatosensory dysfunction in chronic stroke survivors. Sensory impairments persist into the chronic phase of stroke in the majority of stroke survivors. The extent to which such impairments influence functional ability warrants further investigation. The use of functionally oriented measures that assess higher-level somatosensation is encouraged.

With American football becoming increasingly popular in the United States, more efforts have been made on technology and advancements to reduce the number of injuries sustained by athletes. However, few studies have been conducted to evaluate how the field type, field condition, and shoe type interact with each other to induce injuries. To fill in the gap in the literature, this thesis used epidemiological methods to investigate the effect of field condition and shoe type on lower extremity injuries, specifically knee and ankle injuries, using real player data from the 2008, 2009, and 2010 football seasons from The University of Iowa. Results showed that over three seasons, 189 athletes experienced approximately 38,000 football exposures in 312 days. The athletes endured 250 injuries, in which 129 (51%) occurred in the lower extremity. Of all injuries, 34 (14%) involved the knee and 30 (12%) involved the ankle. Most of the lower extremity injuries, specifically knee injuries and ankle injuries, were of the joint (non-bone) and ligament type. Practices contributed to 73% of exposures, 11% for games, and 16% for other over the three sessions studied. 65% of all exposures occurred on an artificial surface, compared to 36% of all exposures that occurred on a natural surface. Most games were played on a natural surface (56%), while most practices occurred on an artificial surface (56%). For surface condition, 89% of all exposures were categorized as a normal condition compared to the 11% categorizes as a not normal condition. Most athletes used shoes with 9-12 cleats compared to shoes with 7, more than 12, or no cleats. In addition, most athletes used shoes with a high top at the shoe opening compared to a low top and shoes with short cleat lengths compared to long cleat lengths. The field condition variable (not normal vs. normal) was the only unadjusted GLM with significant results for all lower extremity injuries (Chi-square p-value=0.0307) and ankle injuries specifically (Chi-square p-value=0.0253). When the predictor variables were adjusted for team activity (i.e., games and practices) only the playing surface model was significant for all terms, including team activity (Chi-square p-value=0.0018), surface (Chi-square p-value=0.029), and the interaction term (Chi-square p-value=0.0189). This model was further analyzed for practice and games separately, and it was found that surface was significant in predicting lower extremity injuries in a game setting (Chi-square p-value=0.005). For all lower extremity injuries, the odds of having a lower extremity injury on an artificial surface in a game setting was 2.89 times more likely than on a natural surface. For the condition, top height, and number of cleat models, only the team activity term was found significant (Chi-square p-value=0.0143, <.0001, and 0.0038, respectively). When these models were further analyzed for practice and games separately, only field condition was found to be significant in a practice setting. For all lower extremity injuries, the odds of having a lower extremity injury in a not normal condition in a practice setting was 2.04 times more likely than in a normal condition. The cleat length model was not found to be significant when adjusting for team activity. The results of this analysis provide a foundation for future studies to understand why several extrinsic risk factors may be associated with lower extremity injuries.

<p>Subsequent to a difficult surgery or a sever injury to the lower part of the body, often partial </p><p>load bearing is needed to stimulate an optimal rehabilitation. Today, this is achieved by teaching </p><p>the patient the optimal load by iteration. This has been shown insufficient for many patients, due </p><p>to their difficulties of remembering the correct amount of load. Furthermore, patients who lack </p><p>proprioception are unable to feel the load. </p><p> </p><p>A portable measuring system would enhance the patient possibility of optimal loadings. This </p><p>thesis has two main objects. 1. A study of the state of the art on existing commercial system, </p><p>related patents and measuring techniques. 2. A new measuring technique, which is the part that </p><p>most of all determine the system performance, was developed. A new design, using off the shelf, </p><p>products is proposed. </p><p> </p><p>The design uses a finite number of thin sensors placed onto an insole. By placing the sensors at </p><p>the plantar pressure points most of the total load is captured by the insole setups. To compensate </p><p>for the measuring error fitting methods were evaluated. The result depends on the insole </p><p>calibration methods. The best result without individual calibration is: mean error for the group of </p><p>0.5% of the total patient load and a deviation of 24%. With individual calibration reduces the </p><p>deviation to about 12%.</p>

No description available.

No description available.

Although the 1837-38 Rebellions and the Union of the Canadas have received much attention from historians, the Special Council—a political body that bridged two constitutions—remains largely unexplored in comparison. This dissertation considers its time as the legislature of Lower Canada. More specifically, it examines its social, political and economic impact on the colony and its inhabitants. Based on the works of previous historians and on various primary sources, this dissertation first demonstrates that the Special Council proved to be very important to Lower Canada, but more specifically, to British merchants and Tories. After years of frustration for this group, the era of the Special Council represented what could be called a “catching up” period regarding their social, commercial and economic interests in the colony. This first section ends with an evaluation of the legacy of the Special Council, and posits the theory that the period was revolutionary as it produced several ordinances that changed the colony’s social, economic and political culture This first section will also set the stage for the most important matter considered in this dissertation as it emphasizes the Special Council’s authoritarianism. During this period, Lower Canadians lost all political rights and the decisions taken by the Special Council were made by non-elected councilors. The second section therefore considers the various ordinances the council passed, its obvious favoritism and authoritarianism, and the opinions of Lower Canadians towards them. The following questions are considered: did the British and French-Canadians react differently to the dissolution of their legislature and the suspension of their constitution? Considering the fact that many people, habitants and British alike, did not support the rebellion, did they view the council as a necessity in restoring peace and stability to the colony, and therefore accepted its authoritarianism, and even supported it? More importantly, did French-Canadians submit to the Special Council and all of the new laws and institutions it imposed in the years following the failed rebellions? Evidence suggests that French-Canadians were very vocal in their opposition to the Special Council.

Flaxseed (FS) is a rich source of lignans and n-3 polyunsaturated fatty acids (PUFA), compounds that may help preserve normal bone cell function during aging. Understanding the effect of FS alone or combined with lower doses of estrogen therapy on bone and other estrogen-responsive tissues (e.g. uterus) is of particular interest to postmenopausal women who combine dietary bioactives (e.g. FS) with pharmacological agents (e.g. estrogen monotherapy) to attenuate postmenopausal bone loss. The overall objective of my research was to determine the effects and mechanisms of FS, alone or combined with lower doses of estrogen therapy, on bone and uterus health by measuring a comprehensive set of outcomes in the ovariectomized rat model of postmenopausal osteoporosis. The results demonstrated that FS enhances the protective effect of low-dose estrogen therapy (LD) on vertebral bone mineral density (BMD), three-dimensional microarchitecture and strength in ovariectomized rats. Moreover, FS exerts a stronger effect on bone outcomes when combined with LD than when combined with ultra-low-dose estrogen therapy (ULD). These studies also showed that FS feeding results in higher lignans and n-3 PUFAs in vertebrae, tibias and femurs. Histological analyses at the lumbar vertebra (LV) showed that there were no differences in TRAP-5β, CTX, or OPG/RANKL ratio between the FS+LD and LD groups. FS+LD did however result in lower protein expression of osteocalcin, a marker of bone formation and overall bone turnover, and higher expression of OPG compared to the negative control (NEG), while LD did not. While these findings suggest that FS+LD results in greater attenuation of deterioration of bone tissue compared to LD due to a reduction in bone turnover, significant differences between FS+LD and LD were not observed. Elucidating these specific mechanisms of action require further investigation. In the uterus, FS+LD did not induce greater cell proliferation or differences in qualitative indices of uterine morphology compared to LD. These findings suggest that there may be no increase in the risk of endometrial hyperplasia and carcinoma with FS+LD compared to LD. These findings may lead to the development of strategies that combine food bioactives and current pharmacological agents to more effectively normalize bone turnover during aging.

Flaxseed (FS) is a rich source of lignans and n-3 polyunsaturated fatty acids (PUFA), compounds that may help preserve normal bone cell function during aging. Understanding the effect of FS alone or combined with lower doses of estrogen therapy on bone and other estrogen-responsive tissues (e.g. uterus) is of particular interest to postmenopausal women who combine dietary bioactives (e.g. FS) with pharmacological agents (e.g. estrogen monotherapy) to attenuate postmenopausal bone loss. The overall objective of my research was to determine the effects and mechanisms of FS, alone or combined with lower doses of estrogen therapy, on bone and uterus health by measuring a comprehensive set of outcomes in the ovariectomized rat model of postmenopausal osteoporosis. The results demonstrated that FS enhances the protective effect of low-dose estrogen therapy (LD) on vertebral bone mineral density (BMD), three-dimensional microarchitecture and strength in ovariectomized rats. Moreover, FS exerts a stronger effect on bone outcomes when combined with LD than when combined with ultra-low-dose estrogen therapy (ULD). These studies also showed that FS feeding results in higher lignans and n-3 PUFAs in vertebrae, tibias and femurs. Histological analyses at the lumbar vertebra (LV) showed that there were no differences in TRAP-5β, CTX, or OPG/RANKL ratio between the FS+LD and LD groups. FS+LD did however result in lower protein expression of osteocalcin, a marker of bone formation and overall bone turnover, and higher expression of OPG compared to the negative control (NEG), while LD did not. While these findings suggest that FS+LD results in greater attenuation of deterioration of bone tissue compared to LD due to a reduction in bone turnover, significant differences between FS+LD and LD were not observed. Elucidating these specific mechanisms of action require further investigation. In the uterus, FS+LD did not induce greater cell proliferation or differences in qualitative indices of uterine morphology compared to LD. These findings suggest that there may be no increase in the risk of endometrial hyperplasia and carcinoma with FS+LD compared to LD. These findings may lead to the development of strategies that combine food bioactives and current pharmacological agents to more effectively normalize bone turnover during aging.