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The problem with which this investigation is concerned is that of determining the effect of neurological impairment on the Rorschach performance of children.

Background: Neurodegenerative diseases, like multiple sclerosis, dementia and motor neurone disease, represent one of the major public health threats of our time. There is a clear persistent need for novel, affordable, and patient-acceptable biomarkers of these diseases, to assist with diagnosis, prognosis and impact of interventions. And these biomarkers need to be sensitive, specific and precise. The retina is an attractive site for exploring this potential, as it is easily accessible to non-invasive imaging. Remarkable technology revolutions in retinal imaging are enabling us to see the retina in microscopic level detail, and measure neuronal and vascular integrity. Aims and objectives: I therefore propose that retinal imaging could provide reliable and accurate markers of these neurological diseases. In this project, I aimed to explore the clinical utility of retinal imaging derived measures of retinal neuronal and vessel size and morphology, and determine their candidacy for being reliable biomarkers in these diseases. I also aimed to detail the methods of retinal imaging acquisition, and processing, and the principles underlying all these stages, in relation to understanding of retinal structure and function. This provides an essential foundation to the application of retinal imaging analysis, highlighting both the strengths and potential weaknesses of retinal biomarkers and how they are interpreted. Methods: After performing detailed systematic reviews and meta-analyses of the existing work on retinal biomarkers of neurodegenerative disease, I carried out a prospective, controlled, cross-sectional study of retinal image analysis, in patients with MS, dementia, and ALS. This involved developing new software for vessel analysis, to add value and maximise the data available from patient imaging episodes. Results: From the systematic reviews, I identified key unanswered questions relating to the detailed analysis and utility of neuroretinal markers, and diseases with no studies yet performed of retinal biomarkers, such as non-AD dementias. I recruited and imaged 961 participants over a two-year period, and found clear patterns of significance in the phenotyping of MS, dementia and ALS. Detailed analysis has provided new insights into how the retina may yield important disease information for the individual patient, and also generate new hypotheses with relation to the disease pathophysiology itself. Conclusions: Overall, the results show that retinal imaging derived biomarkers have an important and specific role in the phenotyping of neurodegenerative diseases, and support the hypothesis that the eye is an important window to neurological brain disease.

Although the integrated relationship that exists between the lumbar spine and hip joints is frequently acknowledged in scientific journals and by medical professionals, specific functional and injury relationships, are speculative and have not been substantiated. Lumbar spine and hip dysfunctions are suspected to be associated with inhibition of the surrounding extensor musculature, particularly the gluteal muscles, and facilitation of the flexor musculature. This phenomenon has been observed in other joints following effusion and is often termed ‘arthrogenic inhibition’. Its apparent occurrence about the hip has never been validated. The primary objective of this thesis was to investigate whether arthrogenic inhibition occurred about the hip. If inhibition was found to exist, its relationship with volume vs pressure was investigated to determine if either of these factors were a more appropriate predictor of inhibition. Finally, compensatory motor patterns in response to apparent inhibition were of interest. Participants were allocated to the following groups: 1) Control 2) Intervention I (magnetic resonance arthrogram) or 3) Intervention II (therapeutic arthrogram). Electromyography was collected on the rectus abdominis, erector spinae, gluteus maximus and semimenbranosis bilaterally during hip rehabilitation exercises prior to and following the intervention. Intra-capsular pressure was measured during the intervention. The findings provided support for the presence of extensor-inhibition in the hip following infusion of intra-articular fluid with intra-capsular pressure being the most appropriate predictor of the magnitude of inhibition. Hip extensor inhibition appeared to be compensated for by lumbar spine extensors during the selected tasks. Arthrogenic inhibition should be considered in the clinical evaluation and management of patients with hip joint effusions and/or elevated intra-capsular pressure.

No description available.