Introduktion: Att kvinnor drabbas av en bristning efter en vaginal förlossning är vanligt förekommande och drabbar cirka 80% av alla förstföderskor. Bristningarna innebär i vissa fall direkta skador på muskler, nerver och stödfunktioner vilket kan leda till urinläckage, avföringsläckage, tarmtömningssvårigheter, framfall av vaginal-väggarna och sexuell dysfunktion. Uppföljningen av denna patientgrupp varierar i landet, allt mellan utebliven uppföljning och noggrann uppföljning av profession med specialistkunskap. Syfte: Syftet var att ta reda på fysioterapeutens interventioner och roll vid vård av kvinnor som drabbats av en obstetrisk analsfinkterruptur i samband med vaginal förlossning vid landets sju regionsjukhus. Metod: För att besvara syftet genomfördes en kvantitativ enkätstudie. En egenkonstruerad eenkät användes och utformades med inspiration från nationella riktlinjer och en tidigare enkät. De som svarade på enkäten var fysioterapeuter som arbetar med förlossningsskador vid sex av landets sju regionsjukhus. Resultat: Fysioterapeuter var involverade vid eftervård och rehabilitering av kvinnor vid olika grader av skada efter vaginal förlossning. Fysioterapeutiska riktlinjer, interventioner och rutiner för uppföljning skilde sig mellan regionsjukhusen. Konklusion: Alla regionsjukhus i Sverige förutom ett har fysioterapeuter inkopplade vid vård av kvinnor som drabbats av en obstetrisk analsfinkterruptur i samband med vaginal förlossning. De fysioterapeutiska riktlinjerna skiljer sig något mellan regionsjukhusen då fysioterapeuterna bygger sina riktlinjer på olika direktiv och fakta. Baserat på denna studie finns behov av mer forskning som undersöker fysioterapeutens interventioner och roll vid vård av kvinnor med obstetrisk analsfinkterruptur i samband med vaginal förlossning.

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2010. / The aim of this study was to determine the inter-examiner reliability of motion palpation to detect joint dysfunction in hindfoot and midfoot joints of asymptomatic feet and feet with chronic ankle instability syndrome. The rationale for this study was that motion palpation is a commonly used assessment tool that is used by the chiropractic profession to detect the need for manipulation of the spine and extremities. Also until the reliability of motion palpation is known, other studies using motion palpation as an assessment tool to detect the need for manipulation in the hindfoot and midfoot are questionable. The study was conducted at Durban University of Technology (DUT). Patients that responded to the adverts were then screened via telephonic interview. The researcher performed a case history, physical examination and a foot and ankle regional examination on each patient. Three masters chiropractic students then independently assessed both the symptomatic and asymptomatic feet of each patient and recorded their results. The data was then statistically analysed using SPSS version 15. It was found that the inter-examiner reliability of motion palpation for detecting restrictions in feet with chronic ankle instability syndrome was fair and for detecting instability, there was moderate reliability. In the asymptomatic group the examiners showed to have poor reliability in detecting restrictions and moderate reliability in detecting instability. Inter-examiner reliability was better in the symptomatic group and in this group examiners had more agreement on detecting instability as opposed to restrictions. This study has showed that inter-examiner reliability ranged from poor to moderate in the symptomatic and asymptomatic group with the reliability ranging from poor to moderate. Therefore, one can conclude that motion palpation can be used as an assessment tool to detect joint dysfunction in hindfoot and midfoot joints. However, further studies are warranted to address other subjective and objective measurements such as tenderness and range of motion together with motion palpation.

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2011. / Background: Myofascial pain is a disorder, characterized by the presence of trigger points (MTrP). It is recognised by unique features which include a tender point in a taut band of muscle, a local twitch response (LTR), a characteristic referred pain pattern, and the reproduction of the patient’s usual pain upon examination. A debate exists as to the precise diagnostic criteria used in identifying trigger points. This has hampered the standardized assessment and treatment of Myofascial Pain Syndrome and has led to contradictory findings being reported by various authors due to the lack of a reliable diagnostic tool. Objectives: The first objective was to determine the inter-examiner reliability of palpation of MTrPs in the trapezius and gluteus medius muscles. The second objective was to determine whether training and standardization in palpation techniques would improve inter-examiner reliability of palpation of MTrPs. Methods: This study was designed as a quantitative pre and post intervention interexaminer reliability study. Three examiners (one qualified Chiropractor, one senior chiropractic intern from the CDC and the researcher) were used to examine sixty patients (thirty symptomatic and thirty asymptomatic) for MTrPs. This study was conducted in two phases. During the myofascial examination of patients examiners were required to determine whether a MTrP was present or absent, differentiate whether the MTrP was active or latent and determine the presence or absence of the five characteristics of MTrP (tender point in a taut band of muscle, a local twitch response (LTR), a pain characteristic referred pain pattern, the reproduction of the patient’s usual pain and a jump sign) however, in phase one the researchers were blinded to the characteristics being investigated. Subsequent to phase one, examiners had to attend two, one hour discussion sessions to reduce individual variation in the application of palpation techniques. Results: Inter-examiner reliability was assessed using Fleiss Kappa statistic, percentage agreement and confidence intervals. The results show that three examiners are able to attain acceptable agreement in the palpation of MTrPs, since the features (described above) were shown to improve considerably in phase two after the training session in which standardization of techniques was emphasized. Conclusion: This study provides preliminary evidence that MTrP palpation is reliable and therefore, useful diagnostic tool in the identification of MTrPs and the diagnosis of Myofascial Pain Syndrome.

This thesis deals with the development of novel haptic array system that can render distributed pressure pattern. The haptic devices are force feedback interfaces, which are widely seen from consumer products to tele-surgical systems, such as vibration feedback in game console, mobile phones, virtual reality applications, and daVinci robots in minimally invasive surgery. Telemedicine and computer-enabled medical training system are modern medical infrastructures where the former provides health care services to people especially in rural and remote places while the latter is meant for training the next generation of doctors and medical students. In telemedicine, a patient at a remote location consults the physician at a distant place through the telecommunication media whereas in computer enabled medical training system, physician and medical students interact with the virtual patient. The experience of physical presence of the remote patient in telemedicine and immersive interaction with virtual patient on the computer-enabled training system can be attained through haptic devices. In this work we focus on palpation simulation in telemedicine and medical training systems. Palpation is a primary diagnostic method which involves multi-finger, multi-contact interaction between the patient and physician. During palpation, a distributed pressure pattern rather than point load is perceived by the physician. The commercially available haptic devices are single and five point devices, which lack the face validity in rendering distributed pressure pattern; there are only a few works reported in literatures that deal with palpation simulation. There is a strong need of a haptic device which provide distributed force pattern with multipoint feedback which can be applied for palpation simulation in telemedicine and medical training purposes. The haptic device should be a multipoint device to simulate palpation process, an array device to render distributed force pattern, light weight to move from one place to another and finally it has to cover hand portion of physician. We are proposing a novel under-actuated haptic array device, called taut cable haptic array system (TCHAS), which in general is a m x n system, consist of m+n actuators to obtain m.nhaptels, that are multiple end effectors. A prototype of 3 x 3 TCHAS is developed during this work and detailed study on its characterisation is explored. The performance of device is validated with elaborate user study and it establishes that the device has promising capability in rendering distributed spatio-temporal pressure pattern.

Submitted as the dissertation component in partial fulfilment of the requirements for the degree of a Masters in Technology in Chiropractic in the department of Chiropractic and Somatology, Durban University of Technology, Durban, South Africa, 2017. / Background: Hip pain is a common problem. Motion palpation is a manual technique applied by the hands in various degrees of joint motion that specifically evaluates range of motion in relation to specific anatomical landmarks, joint play and end feel. Motion palpation remains one of the most used diagnostic techniques and yet it remains unclear whether or not it is a reliable, sensitive and specific tool; especially in the hip joint. Objectives: This study assessed intra- and inter-examiner reliability and clinical responsiveness of motion palpation when it is used as a diagnostic tool in patients with non-specific unilateral anterior hip pain and unilateral asymptomatic hip joints. Methods: Ten participants, between the ages of 18 and 60, were included in this study (three ballet dancers, three golfers and four participants from the general population). The participants were assessed randomly by three blinded examiners. All of the participants then received one adjustment delivered by the researcher (half on the symptomatic side and half on the asymptomatic). The participants were then re-assessed. Data was recorded on a data collection sheet and analysed using SPSS version 23. Intra-examiner reliability and clinical responsiveness were analysed using McNemar’s test and the Chi-Square Test of Independence. Inter-examiner reliability was analysed using Fleiss’ Kappa. Results: Intra-examiner reliability showed to be markedly better on the left-hand side for all three examiners. Kappa scores for inter-examiner reliability varied from none to perfect. The average pairwise agreement scores ranged from 33.3% to 100% at the first assessment, and from 46.6% to 100% in the second assessment. A mean and standard deviation were calculated for the pairwise agreements which represented the sensitivity and specificity respectively. Both showed improvement between the first and second assessments which is positive for inter-examiner reliability. Clinical responsiveness was shown to be absent for examiners A and B but was present for examiner C on the left. Conclusion: This study found that, contrary to the expectations of many clinicians, motion palpation has limited to poor levels of intra-examiner reliability, inter-examiner reliability and clinical responsiveness. This is however limited by the small sample size and methodological limitations in this study. Therefore, the role of palpation as a diagnostic tool used in the diagnosis hip dysfunction may be limited. / M

Dissertation submitted in partial fulfilment of the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2010. / Motion palpation is an examination technique commonly used by chiropractors to identify a manipulable subluxation prior to manipulation. In order for its continued use, it must be validated. Many studies conducted on motion palpation’s inter-examiner reliability in the spine have shown it to be below average, however only a few studies have addressed its use in the extremity joints. No inter-examiner reliability studies on motion palpation were found for the elbow, let alone the symptomatic elbow with regards to chronic lateral epicondylalgia, a common disorder of the elbow effectively treated by the use of manipulation. Objectives The objectives of this study were to determine the inter-examiner reliability of motion palpation of the elbow for the asymptomatic elbow and the symptomatic elbow with regards to chronic lateral epicondylalgia. It also aimed to compare these results to determine any difference in reliability, the number of manipulable subluxations and the presence of manipulable subluxations in particular directions, between the two groups. Method Twenty participants (n=40 elbows) between the ages of 18 to 65, with one asymptomatic and one symptomatic elbow (chronic lateral epicondylalgia) were examined by three final year masters chiropractic students for the presence of manipulable subluxations in end play, using only motion palpation. The examiners were pre-trained, randomised and blinded. Each examiner individually motion palpated both elbows on each participant, in nine directions of motion palpation, incorporating the humeroulnar and proximal radioulnar joints. They were also required to identify which elbow was symptomatic. Fleiss’ kappa and percentage agreement (perfect percentage agreement and mean percentage agreement) were used to measure reliability. Paired non parametric Wilcoxon signed ranks compared the difference between both groups and McNemar’s chi square tests assessed the percentage of correctly identified symptomatic elbows for each examiner. A p value <0.05 was considered statistically significant. iv Results The asymptomatic elbows showed a poor range of kappa results, from 0.0683 to -0.1321, with a mean kappa of -0.0664. Perfect percentage agreement was 50% to 85% and mean percentage agreement was 83.30% to 94.99%. The symptomatic elbows’ kappa values ranged between -0.2691 to 0.4034 with a mean kappa of -0.0028. The humeroulnar medial to lateral direction of motion palpation had a moderate kappa value of 0.4034. Perfect percentage agreement ranged from 10% to 85% and mean percentage agreement from 69.94% to 94.99%. There was an insignificant difference in kappa values between the two groups (p=0.260), although there was a trend towards the asymptomatic kappa values being lower than the symptomatic values. The difference between symptomatic and asymptomatic elbows was significant in proximal radioulnar posterior to anterior glide in pronation (p=0.013), as well as proximal radioulnar rotation of the radial head on the ulna (p=0.008). Overall, more manipulable subluxations were found in the symptomatic elbows than in the asymptomatic elbows. The examiners correctly identified the symptomatic elbow in 65% to 90% of participants (p=1.000). Conclusions and Recommendations In conclusion, the inter-examiner reliability of motion palpation in the asymptomatic elbow was poor, and in the symptomatic elbow (chronic lateral epicondylalgia), poor to moderate. There was an insignificant difference in reliability between the two groups, although more manipulable subluxations were found in the symptomatic elbows overall. These were mainly in proximal radioulnar posterior to anterior glide in pronation, as well as proximal radioulnar rotation of the radial head on the ulna, two directions of motion that form part of Mills’ manipulation. This study also found that examiners were able to identify the symptomatic elbows with the use of motion palpation. It is recommended that future research continue from this study in assessing the identification and presence of manipulable subluxations in all the extremity joints. However the methodological problems with the statistical analysis need to be addressed.

Thesis (MScEng (Mechanical and Mechatronic Engineering))--University of Stellenbosch, 2007. / An abnormal sized mass in the neck is a common clinical finding and it can be the result of inflammation caused by bacterial or viral infection or it can be due to more serious diseases and malignant tumours. The most popular method of examining the neck is by manual palpation. Other methods include ultrasound, CT scan, MRI and PET. These methods though are expensive to perform and require specialists to interpret the results. The aim of this thesis was to design and develop a neck palpation device for telemedicine applications. The device uses an array of Force Sensing Resistors (FSRs) attached to an inflatable bladder. The bladder is mounted to the inside of a neck brace and it is inflated with an air pump controlled by a computer. As the bladder inflates the sensors press against the patient’s neck and the necessary data can be collected. A technique known as image registration is used to improve the resolution of the images sensed with the FSRs. The device provides a reproducible record of the examination for both the surgeon and the patient’s medical record, and provides the patient information as if the doctor examined the patient with his own hands without physically being there. A prototype of the device was built and used to perform numerous tests. The tests were conducted using different objects which are inserted into a silicone neck to simulate different lymph nodes. The device was used to test for shape, smallest size, different sizes, repeatability and hardness. The results showed that the device works well for spherical objects of different sizes but gives unsatisfactory results when the objects have sharp edges and complex forms. The image registration algorithm enhanced the images to a good representation of the object. Different sizes could be distinguished as well as hardness to some extend.

Este estudo avaliou a contratilidade dos músculos do assoalho pélvico (MAP) de mulheres com dor pélvica crônica (DPC) comparadas com mulheres sem dor pélvica. Para essa avaliação foi realizada a palpação vaginal e a perineometria. Na palpação vaginal a função muscular foi classificada usando a escala de Oxford modificada de 0 a 5. Também foi avaliada a capacidade de contração, coordenação e a resistência dos MAP. A capacidade de contração foi registrado como sim ou não; a coordenação foi avaliada pela capacidade de contração dos músculos do assoalho pélvico, sem a utilização da musculatura acessória e a resistência foi o tempo em que a paciente manteve a contração dos MAP. A avaliação da pressão de contração dos MAP foi realizada através do perineômetro, que consiste em um aparelho que registra a pressão vaginal gerada pela contração dos MAP em medidas de cmH2O. Foram analisadas 78 mulheres, com e sem DPC. A análise comparativa entre os grupos mostrou que existe diferença estatisticamente significativa em relação ao seguintes itens: força muscular demonstrada pela Escala Modificada Oxford (p = 0,018), resistência muscular (p <. 0001), a função intestinal (p = 0,012), infecção do trato urinário (p = 0,006), cirurgia abdominal (p <0,0001), parto vaginal (p = 0,041), a cesariana (p = 0,002), dispareunia (p <0,001) , índice de massa corporal (p = 0,0127) e pressão de contração demonstrada pela perineometria (p = 0,0001). Não houve diferença significativa na capacidade de contração (p = 0,152), coordenação muscular (p = 0,999), incontinência urinária de esforço (p = 0,804), história obstétrica (p = 0,692), a presença de partos (p = 0,414), aborto ( p = 0,804) e idade (p = 0,2992). Houve uma forte correlação entre a escala de Oxford e perineometria, com um valor de p 0,0001. Este estudo concluiu que as mulheres com DPC têm alteração na contratilidade do MAP em relação às mulheres sem DPC, demonstrado pela escala de Oxford modificada e perineometria. / This study evaluated the contractility of the muscles of the pelvic floor of women with chronic pelvic pain compared with women without pelvic pain. The evaluation of the pelvic floor muscles was performed by vaginal palpation and perineometry. In vaginal palpation the muscle function was classified using the modified Oxford scale of 0 to 5. It was also evaluated the ability contraction, coordination and strength of the pelvic floor muscles. Contraction capacity was recorded as yes or no; coordination was evaluated by the contraction capacity of the pelvic floor muscles without the use of accessory muscles and the resistance was recorded with the time that the patient could sustain the contraction of the pelvic floor muscles. The evaluation of floor muscles contraction pressure was conducted through the perineometer, consisting of an apparatus which records vaginal pressure generated by the contraction of MAP in cm H2O measures. We analyzed 78 women, with and without CPP. The comparative analysis between the groups showed that there is a statistically significant difference in relation to the following: Scale Modified Oxford (p = 0.018), the muscle strength (p <.0001), intestinal function (p = 0.012), urinary tract infection (p = 0.006), abdominal surgery (p <0.0001), vaginal birth (p = 0.041), cesarean section (p = 0.002), dyspareunia (p <0.001), BMI (p = 0.0127) and perineometry (p = 0.0001). There was no significant difference in the contraction capacity (p = 0.152), muscle coordination (p = 0.999), urinary incontinence (p = 0.804), obstetric history (p = 0.692), presence of births (p = 0.414), abortion (p = 0.804) and age (p = 0.2992). There was a strong correlation between the scale of Oxford and perineometry, with a p value of 0.0001. This study found that women with CPP have change in contractility of MAP in relation to controls, demonstrated by the modified Oxford scale and perineometry.

Made available in DSpace on 2014-06-11T19:22:13Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-02-26Bitstream added on 2014-06-13T19:27:11Z : No. of bitstreams: 1 sartori_dvb_me_botfm.pdf: 798212 bytes, checksum: 1e163ee316520ce8224fddb60879f42b (MD5) / O objetivo deste trabalho foi estudar a função e a reprodutibilidade da avaliação subjetiva do assoalho pélvico, utilizando a palpação vaginal digital, em mulheres continentes de diferentes faixas etárias. Foram estudadas prospectivamente 150 mulheres multíparas, saudáveis, sem disfunções urinárias, distribuídas em quatro grupos, G1 (n=37) mulheres na faixa etária de 30 a 40 anos, G2 (n=39) na faixa de 41 a 50 anos, G3 (n=39) na faixa de 51 a 60 anos e G4 (n=35) acima de 60 anos. Os dados demográficos, como idade, número de partos, índice de massa corpórea (IMC), atividade física e sexual, foram obtidos por questionário. A avaliação subjetiva dos músculos do assoalho pélvico (MAP) foi feita por palpação digital da vagina nas porções anterior e posterior por três examinadores. Foi utilizada a classificação descrita por Amaro e col, 2003, foi garantido sigilo entre os examinadores. A média de idade foi de 35, 45, 54 e 66 anos em G1, G2, G3 e G4 respectivamente. 69,3% das mulheres tinham atividade sexual e 40,7% atividade física regular. O IMC foi classificado como normal no G1 e pré-obeso no G2, G3 e G4, sendo significativamente menor no G1 em relação ao G4 (p<0,05). O número de partos vaginais foi menor no G2 em relação ao G4 (p<0,05), e de cesáreas foi menor no G4 em relação aos grupos G2 e G3. Não houve diferença estatística significativa entre os graus de contração muscular e entre a porção anterior e posterior do AP (p>0,05). A concordância plena da palpação digital na porção anterior foi de 44,7% e na posterior 55,3%, não houve diferença estatística significativa. Houve concordância entre os diferentes examinadores do método subjetivo de palpação digital do AP na porção anterior e posterior do AP independente da faixa etária garantindo a reprodutibilidade do método. / The aim of this study is to assess the function and the reproductibility of subjective evaluation of pelvic floor muscle (PMF) using the digital vaginal palpation in continent women from different age ranges. 150 healthy multipararous women were studied with no urinary dysfunction, distributed in four different groups: G1 (n=31) from 30 to 40 years; G2 (n=39) from 41 to 50 years; G3 (n= 39) from 51 to 60 years; and G4 (n=35) over 60 years. The demographic data, such as age, number of deliveries, body mass index ( BMI ), physical and sexual activity, were all obtained using a questionnaire. The subjective assessments of the pelvic floor muscles (PFM ) were performed by three different examiners using transvaginal digital palpation (TDP) in the anterior and posterior areas. It was used tha classification as described by Amaro et al, 2003, the secret amongst the examiners was granted. The ages were in average 35, 45, 54 and 66 years old in G1, G2, G3 and G4 respectively. 69,3% of the women had sexual activity and 40,7% had regular physical activities. The BMI was classified was significantly lower in G1 in comparasion to G4 (p<0,05). The number of natural deliveries was lower in G2 in comparasion to G4 ( p<0,05), and the number of caesarian was lower in G4 in comparasion to groups G2 and G3. There was no statistical difference between the subjective evaluation of PMF, neither the anterior and posterior area Threre was 44,7% agreement among the different examiners using TDP in the anterior and of 55,3%in the posterior, there was no statistical difference. There was an agreement among the different examiners in the subjective evaluation of PMF using TDP in the anterior and posterior area independent of the age range, demonstrating the reproducibility of this method.

L'échographie constitue aujourd'hui un des piliers de l'imagerie médicale. Appliquée en clinique depuis plus de quarante ans, elle repose sur les ultrasons, ondes mécaniques de compression à hautes fréquences, pour réaliser des images principalement morphologiques des organes. Développée plus récemment, l'élastographie permet de sonder directement les propriétés viscoélastiques des tissus et pourrait ainsi renseigner sur l'état pathologique des tissus comme le fait la palpation du médecin. L'élastographie transitoire, basée sur l'étude de la propagation des ondes de cisaillement naturelles ou artifi- cielles, permet une mesure quantitative de ces propriétés viscoélastiques. Combinant la pression de radiation ultrasonore, véritable palpation à distance, et l'échographie ultrarapide, le Supersonic Shear Imaging peut gé- nérer et suivre des ondes de cisaillement in vivo en quelques millisecondes. On peut alors, par inversion de l'équation d'onde, former des cartes d'élasticité du milieu. Nous proposons ici une nouvelle méthode de reconstruction des cartes d'élasticité, plus robuste, qui est ensuite appliquée, in vivo et en clinique, à l'imagerie des lésions du sein, à l'étude de la fibrose du foie ainsi qu'à celle des maladies neuromusculaires. Une méthode de mesure de la dispersion de l'onde de cisaillement générée est aussi proposée et testée in vivo. Elle permet de retrouver, en une seule acquisition, les propriétés viscoélastiques complètes des tissus et a été appliquée au foie et au muscle de plusieurs volontaires sains. Finalement, nous nous intéressons à l'échographie ultrarapide de la contraction du muscle, déclenchée par électrostimulation. Cette méthode, locale et transitoire, permet de retrouver les paramètres clés de la réponse musculaire et offre ainsi, couplée avec l'électromyographie, des perspectives cliniques très intéressantes pour l'étude de la physiologie du muscle ou les maladies neuromusculaires.