<p>Psychological trauma can literally disrupt life&rsquo;s flow by damaging brain and bodily systems. When a flashback to a traumatic event is triggered in a person suffering from traumatic stress, or PTSD, key functions in the brain malfunction and are deactivated, potentially causing massive disassociation. In addition, trauma can cause chronic hyperarousal, resulting from the body&rsquo;s malfunctioning autonomic nervous system&rsquo;s defensive response of fight, flight, or freeze. To cope with these damaged bodily and brain systems and processes detrimental acts of hyperfocus and numbing are often employed by sufferers of trauma. However these obstructions can be cleared though movement practices: top-down and bottom-up regulation methods, innately embedded in certain movement and dance disciplines such as yoga and creative dance, have shown to aide in trauma recovery. This opens the possibility that a dance/movement instructor, using trauma-conscious curriculum and facilitation techniques, can use their highly structured movement practices to engage with top-down and bottom up regulation practices to not only instruct students suffering from trauma, but offer opportunities to engage in treatment. </p>

Thesis (MScPhysio)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Ankle sprains are reportedly the most common lower limb injury amongst active individuals. Aim: The aim of this study was to investigate whether treatment interventions employed by physiotherapists during the first week of functional rehabilitation of an ankle sprain, at primary care level, were aligned with evidence-based guidelines for acute ankle sprains. Design: A descriptive cross-sectional study was conducted. Participants: A total of 91 physiotherapists from the Western Cape Metropole (WCM) completed questionnaires. Method: Physiotherapists' treatment interventions were recorded based on a case study of a typical moderately sprained ankle. According to classification of the West Point Ankle Grading System, a moderate sprain is a partial macroscopic tear of the ligaments with moderate pain, swelling and tenderness with some loss of motion and mild to moderate instability of the joint. Anticipated return to sport is two to six weeks. Relative occurrence of selected interventions during the first week of rehabilitation was calculated. Chi-square tests were used to compare differences between physiotherapists' responses and the recommendations of the practice guidelines. Results: Physiotherapists' overall selections of treatment interventions were in alignment with the "Koninklijk Nederlands Genootschap voor Fysiotherapie" (KNGF) guidelines and correlated positively to the recommendations stipulated by KNGF therein. Physiotherapists indicated many interventions for which good evidence exists: compression, cryotherapy, early mobilisation, and neuromuscular exercises. It is of concern that 49% – 91% (n = 91) physiotherapists indicated some form of manual mobilisations for which there is a lack of evidence, and more than two-thirds indicated the application of an electrotherapy intervention, which is not recommended in the guidelines. Conclusion: Physiotherapists should reconsider interventions for which there is no evidence as this may reduce cost of care, without compromising patient outcomes. / AFRIKAANSE OPSOMMING: Verslae dui daarop dat verstuite enkels die mees algemene besering van die onderste ledemaat van aktiewe persone is. Doelwit: Die doel van hierdie ondersoek was om vas te stel of fisioterapeute in primere gesondheidsorg se keuse van rehabilitasie tegnieke gedurende die eerste week van funksionele rehabilitasie na 'n enkel besering, op koers is met bewysgebaseerde kliniese riglyne in die hantering van akute enkel beserings. Ontwerp: 'n Beskrywende deursnit ondersoek is geloods. Deelnemers: 'n Vooraf opgestelde vraelys is deur 91 fisioterapeute in die Weskaapse metropool voltooi. Metodiek: 'n Gevalle studie is aangebied van 'n tipiese matige verstuite enkel. Die respondent moes hulle tegnieke in die hantering van die geval aandui. Volgens die klassifikasie van die “West Point Grading System” word so 'n verstuiting gekenmerk deur makroskopiese gedeeltelike skeur van die enkel ligamente, matige pyn, swelsel en tasteerheid van die area. Dit gaan gepaard met 'n effense verlies van beweging en stabiliteit van die gewrig. Die prognose vir so 'n besering om na sport terug te keer is om en by twee tot ses weke. Die insidensie van aanwending van geselekteerde metodes van behandeling gedurende die eerste week en die verhouding met die vooraf geselekteerde behandelings riglyne opgestel deur die “Koninklijk Nederlands Genootschap voor Fysiotherapie” (KNGF) is bereken en ontleed. Die “Chi-square” toets is gebruik om die verskil te bereken tussen die respons van die Fisioterapeute en die aanbevelings van die kliniese riglyne. Resultate: Oorkoepelend is die keuses van behandelings tegnieke deur die fisioterapeute in lyn met die riglyne van die 'Koninklijk Nederlands Genootschap voor Fysiotherapie' (KNGF). Verskeie sinvolle behandelings is gekies waarvoor daar positiewe aanduidings was, byvoorbeeld: lokale kompressie, ys terapie, en oefeninge. Dit is egter kommerwekkend dat 49 – 91% (n=91) van die deelnemers 'n manuele tegniek ingesluit het waar daar tans gebrekkige aanduidings voor bestaan. Verder, het meer as twee derdes van die fisioterapeute aangedui dat hulle elektroterapie sou gebruik wat nie in riglyne aanbeveel word nie. Gevolgtrekking: Fisioterapeute moet die gebruik van tegnieke waarvoor daar nie duidelike bewyse in die literatuur bestaan nie, heroorweeg, want dit mag die koste van behandeling verminder, sonder om die positiewe resultate van herstel, negatief te beinvloed.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, Durban, 2006. / Core strengthening has become a major trend in the rehabilitation of patients suffering with lower back pain. Clinical trials have shown that core strengthening is beneficial for patients with low back pain. According to the literature, core strengthening consists of activating the trunk musculature in order to stabilize hypermobile symptomatic joints and thus lessen mechanical stress to the spine. Spinal manipulative therapy has also proved itself to be beneficial, particularly in the case of post-natal low back pain sufferers, as manipulation may correct hypomobility associated with spinal subluxations. Literature suggests that spinal manipulative correction of spinal subluxations in combination with core stability exercises, that stablise symptomatic hypermobile joints, may have more advantages than using these interventions singularly in the treatment of post-natal low back pain. However, the combination of a core stability muscle training program with spinal manipulative therapy has yet to be investigated. In order to choose the most appropriate therapy for managing this condition, it is essential for research to be carried out to identify the most effective treatment, which would allow for better overall management of low back pain during the post-natal period. Therefore this study was designed to establish the effectiveness of a combined protocol of spinal manipulation and core stability exercises in the treatment of post-natal mechanical low back pain and to establish whether this protocol should be utilized routinely in the management of this condition. / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, Durban, 2006. / Core strengthening has become a major trend in the rehabilitation of patients suffering with lower back pain. Clinical trials have shown that core strengthening is beneficial for patients with low back pain. According to the literature, core strengthening consists of activating the trunk musculature in order to stabilize hypermobile symptomatic joints and thus lessen mechanical stress to the spine. Spinal manipulative therapy has also proved itself to be beneficial, particularly in the case of post-natal low back pain sufferers, as manipulation may correct hypomobility associated with spinal subluxations. Literature suggests that spinal manipulative correction of spinal subluxations in combination with core stability exercises, that stablise symptomatic hypermobile joints, may have more advantages than using these interventions singularly in the treatment of post-natal low back pain. However, the combination of a core stability muscle training program with spinal manipulative therapy has yet to be investigated. In order to choose the most appropriate therapy for managing this condition, it is essential for research to be carried out to identify the most effective treatment, which would allow for better overall management of low back pain during the post-natal period. Therefore this study was designed to establish the effectiveness of a combined protocol of spinal manipulation and core stability exercises in the treatment of postnatal and mechanical low back pain and to establish whether this protocol should be utilized routinely in the management of this condition. / M

Dissertation submitted to the Faculty of Health at the Durban University of Technology in partial compliance with the requirements for the Master‟s Degree in Technology: Chiropractic, 2009. / The prevalence of neck pain in musculoskeletal practice is second only to that of low back pain (Vernon et al., 2007). There is a growing interest in neck pain research due to the escalating disability burden and compensation costs associated with neck pain (Côte et al., 2003). Manual therapies are commonly used in the treatment of neck pain (Côte et al., 2003). After an extensive literature review by Haldeman et al. (2008) they found that manual therapy techniques have some benefit but no one technique was clearly superior to the next. Therefore, the purpose of this study is to compare three commonly used manual therapy techniques in the treatment of chronic mechanical neck pain. OBJECTIVES The purpose of this study was to compare three different manual therapy techniques (SMT, MET and PNF) which are commonly used in the treatment of chronic MNP in terms of range of motion, pain and disability. METHOD Forty-five patients with chronic mechanical neck pain were obtained through non-probability convenience sampling and assigned into one of three treatment groups (15 per group) using a computer generated randomized table. The three different treatment groups were: Spinal Manipulative Therapy (SMT), Muscle Energy Technique (MET) and Proprioceptive Neuromuscular Facilitation (PNF). Each group received six treatments over a period of three weeks with a follow-up consultation. Measurements were taken at the first, third and sixth treatment and at the follow-up consultation. SPSS version 15.0 was used to analyse the data. A p value of <0.05 was considered as statistically significant. An intra-group analysis was done using repeated measures ANOVA testing to assess the time effect for each outcome separately. For inter-group analyses the time x group interaction effect was assessed using repeated measures ANOVA testing, and profile plots were used to assess the trend and direction of the effects. RESULTS Intra-group analysis of the results revealed that all three groups improved significantly between the first and the final consultation, for all measures. Inter-group analysis of the data did not show any difference between the three groups by the end of the final consultation. However, extension range of motion appeared to improve slightly faster in the PNF group iv but it was not significant when compared to the other two groups. Therefore, there was no statistical significance between the three groups. CONCLUSION It was concluded that all three treatment groups responded equally to the treatment, thus, suggesting that MET or PNF techniques can be used if SMT is contra-indicated. / M

Orientador: Dionei Ramos / Banca: Ercy Mara Cipulo Ramos / Mahara-Daian Garcia Lemes Proença / Resumo: O Tabagismo é considerado pela Organização Mundial de Saúde como a principal causa de morte evitável do mundo. Aproximadamente sete milhões de pessoas morrem todos os anos, como consequência de mais de 50 doenças tabaco-relacionadas. Muitos programas são realizados a fim de auxiliar o tabagista a lidar como processo de cessação. Tais programas se caracterizam por reuniões em grupo, compostas por terapia cognitiva comportamental, que tem como objetivo fazer com que o tabagista entenda os riscos em fumar e os benefícios de parar. Além disso, é recomendado o uso de medicamentos durante o processo, o que auxilia diretamente nos sintomas da síndrome de abstinência e na dependência química. No entanto, mesmo com tais programas, novas estratégias são estudadas a fim de que as taxas de sucesso de cessação e manutenção da abstinência sejam aumentadas. Diversos tipos de exercício físico foram considerados eficazes durante esse processo. O exercício aeróbico tem se mostrado uma estratégia eficaz, porém não há uma padronização relacionada a qual melhor intensidade, duração e frequência da prática do exercício, para que ocorra uma facilitação no período da cessação. Desta forma, o objetivo de ambos os estudos foi: reunir em uma revisão sistemática os efeitos do exercício aeróbico associado a terapia cognitiva comportamental no processo de cessação do tabagismo e avaliar a eficácia de um treino de exercício aeróbico periodizado individualizado em tabagistas saudáveis, com relação a cessaçã... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Smoking is considered by the World Health Organization as the leading cause of preventable death in the world. Approximately seven million people die each year as a consequence of more than 50 tobacco-related diseases. Many programs are conducted to help the smoker cope as a cessation process. Such programs are characterized by group meetings consisting of cognitive behavioral therapy that aims to make the smoker understand the risks of smoking and the benefits of quitting. In addition, it is recommended to use medications during the process, which directly aid in the symptoms of withdrawal syndrome and chemical dependence. However, even with such programs, new strategies are being studied in order for abstinence cessation and maintenance success rates to be increased. Several types of physical exercise were considered effective during this process. Aerobic exercise has been shown to be an effective strategy, but there is no standardization related to which intensity, duration and frequency of exercise practice, for facilitation to occur during the cessation period. Thus, the objective of both studies was to: gather in a systematic review the effects of aerobic exercise associated with cognitive behavioral therapy in the smoking cessation process and to evaluate the efficacy of an individualized periodic aerobic exercise training in healthy smokers, regarding smoking cessation, functional capacity and quality of life by means of a randomized clinical trial. Methods: For the s... (Complete abstract click electronic access below) / Mestre

Orientador: Diego Giuliano Destro Christofaro / Banca: Romulo Arújo Fernandes / Banca: Diego Augusto Santos Silva / Resumo: A prática de atividade física tem sido associada a melhor qualidade de vida, no entanto, barreiras relatadas para a prática têm sido muito frequentes em trabalhadores. Contudo, não está claro na literatura se os diferentes tipos de atividade física relacionam-se da mesma forma com a qualidade de vida, bem como quais são os fatores associados às barreiras para prática de atividade física em professores. Objetivo: Verificar a relação de diferentes tipos de atividade física com a qualidade de vida, bem como descrever as barreiras para prática de atividade física e fatores associados em professores da rede pública de ensino na cidade de Presidente Prudente-SP. Métodos: A amostra desse estudo foi composta por 249 professores da rede pública, selecionados em processo aleatorizado. A prática de atividade física foi avaliada por questionário em três diferentes domínios (trabalho, esporte/lazer e tempo livre) e no total. A qualidade de vida foi avaliada pelo questionário SF-36, que avalia oito diferentes domínios da qualidade de vida. Barreiras para prática de atividade física, condição socioeconômica e características de trabalho foram coletadas por questionários. Medidas de peso e estatura foram obtidas para cálculo do índice de massa corporal. As análises estatísticas foram realizadas de acordo com o delineamento de cada artigo constante na Seção de Resultados, com significância fixada em p<0.05 e o intervalo de confiança em 95%, sendo analisadas por meio do programa IBM SPSS Stati... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The practice of physical activity has been related to a better quality of life, however, barriers for practice has been most frequently reported among workers. It is not consensual in literature if different types of physical activity are related as same way with quality of life, as well as which are the associated factors to barriers for physical activity in teachers. Objective: This research Project aimed to analyze the relationship of different types of physical activity with quality of life, as well as describe the barriers for physical activity and its associated factors in public school teachers from the city of Presidente Prudente. Methods: The sample was composed by 249 public school teachers, selected in a randomized process. The practice of physical activity was assessed by questionnaire in three different domains (work, sports practice, and leisure time) and in total. The quality of life was assessed by SF-36 questionnaire, which provide scores for eight different domains from quality of life. Barriers for physical activity, socioeconomic status, and work characteristics were assessed by questionnaires. Measures of weight and height were collected to calculate body mass index. Statistical analysis were performed according to specific design of each article that is listed in the Results section, with statistical significance fixed at p<0.05 and confidence interval at 95%, analyzed by IBM SPSS Statistics software, version 15.0. / Mestre

Orientador: Luiz Carlos Marques Vanderlei / Banca: Francis Lopes Pacagnelli / Banca: Ana Clara Campagnolo Gonçalves Toledo / Resumo: Programas de reabilitação cardiovascular (PRC) podem promover controle de fatores de risco cardiovascular e redução da incidência de novas complicações coronarianos, porém a prática de exercício físico pode ser associada com o risco de surgimento de sinais e sintomas durante o seu desenvolvimento. A variabilidade da frequência cardíaca (VFC) vem sendo utilizada para realizar a monitorização e prognóstico de mortalidade, contudo será que índices de VFC podem ser utilizados para predizer sinais e sintomas em indivíduos que frequentam PRC? Se sim, quais os índices que melhor se correlacionam com a possibilidade de sinais e sintomas nesses programas? Será possível, estabelecer um ponto de corte desses índices que possa melhor prever as chances do aparecimento de sinais e sintomas nesses programas? Objetivo: Analisar a correlação entre os índices da VFC mensurados em repouso com a presença de sinais/sintomas em participantes de um PRC e determinar pontos de corte dos índices lineares da VFC, utilizando a curva ROC, para o surgimento de sinais e sintomas. Materiais e métodos: Foram analisados dados de 48 pacientes atendidos em um PRC. Foram realizadas avaliações em repouso da modulação autonômica e posteriormente, estes indivíduos foram acompanhados por um período de três meses durante as sessões do PRC para avaliação de sinais e sintomas. A relação entre o surgimento de sinais e sintomas dos pacientes e os valores das variáveis autonômicas foi analisada pela correlação de Pearson,... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Cardiovascular rehabilitation programs (CRP) may promote control of cardiovascular risk factors and reduce the incidence of new coronary events, but physical exercise may be associated with the risk of signs and symptoms arising during its development. Heart rate variability (HRV) has been used to perform mortality monitoring and prognosis, but can HRV rates be used to predict intercurrences in individuals who attend PRC? If so, which indexes best correlate with the possibility of intercurrences in these programs? Is it possible to establish a cutoff point for these indices that can better predict the chances of the occurrence of intercurrences in these programs? Objective: To analyze the correlation between the HRV indices measured at rest with the presence of signs/symptoms in participants of a PRC and to determine cutoff points of HRV linear indices, using the ROC curve, for the occurrence of intercurrences. Materials and methods: Data from 48 patients seen in a CRP were analyzed. Resting evaluations of autonomic modulation were performed and, later, these individuals were followed up for a period of three months during the PRC sessions to assess intercurrences. The relationship between the occurrence of patient intercurrences and the values of the autonomic variables was analyzed by Pearson's correlation, when normal data and when not, the Spearman correlation. The definition of cut-off points was obtained by the Receiver Operating Characteristic (ROC) curve, area under t... (Complete abstract click electronic access below) / Mestre

Orientador: Luiz Carlos Marques Vanderlei / Banca: Francis Lopes Pacagnelli / Banca: Roselene Modolo Regueiro Lorençoni / Resumo: Introdução: apesar dos benefícios da reabilitação cardiovascular (RCV) para as doenças cardiovasculares, a baixa aderência dos pacientes é uma preocupação. Ela pode estar relacionada a diversos fatores, dentre eles, à motivação e ao engajamento ao tratamento. Terapias alternativas podem melhorar motivação, engajamento e assim refletir em melhor aderência. Nesse contexto, a terapia baseada em realidade virtual (TRV) surge como uma opção para cardiopatas, contudo nesse grupo de pacientes é necessário um maior controle dos parâmetros hemodinâmicos, visto que se ultrapassados podem causar maior risco à saúde. Objetivo: investigar engajamento, motivação, barreiras e aderência frente a aplicação de TRV em cardiopatas ou pacientes com fatores de risco que participam regularmente da RCV e avaliar suas repercussões hemodinâmicas agudas. Métodos: foram recrutados participantes de um programa de RCV e alocados de forma randomizada para as intervenções RCV ou RCV+TRV. As intervenções foram realizadas por 12 semanas. Sendo o desfecho primário a avaliação o engajamento (escala de engajamento), motivação (Behavioral Regulation in Exercise Questionnaire 3), barreiras (escala de barreiras para reabilitação cardíaca) e aderência dos pacientes (frequência registrada no prontuário). O desfecho secundário foi a avaliação das repercussões hemodinâmicas agudas antes, durante e após uma sessão por meio da pressão arterial (PA), frequência cardíaca (FC), FC de reserva, frequência respiratória (f), sa... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: there is a concern regarding to the low adherence of patients in cardiovascular rehabilitation (CR), despite their benefits. It may be related to several factors, among them, motivation and engagement to treatment. Alternative therapies can improve motivation, engagement reflecting in better adherence and, in this context, virtual reality based therapy (VRBT) appears as an option for cardiac patients. However, in this population, a greater control of hemodynamic parameters is necessary, once if exceed they can cause a greater risk to health. Objective: to investigate engagement, motivation, barriers and adherence through the application of VRBT in patients with cardiovascular diseases or patients with risk factors who regularly participate in CR. In addition, to evaluate their acute hemodynamic repercussions. Methods: participants of CR program were randomized to CR or CR+ VRBT. The interventions were performed for 12 weeks. The primary endpoint was engagement (User Engagement Scale), motivation (Behavioral Regulation in Exercise Questionnaire 3), barriers (Cardiac Rehabilitation Barriers Scale), and patient's adherence (frequency recorded on the chart). The secondary endpoint was the acute hemodynamic repercussions before, during and after a session through blood pressure (BP), heart rate (HR), HR reserve, respiratory rate (rr), oxygen saturation and rate of perceived exertion (RPE). Statistical analysis: homogeneity of the data had been evaluated (Mauchley sph... (Complete abstract click electronic access below) / Mestre

Orientador: Luiz Carlos Marques Vanderlei / Banca: Deborah Cristina Gonçalves Luiz Fernani / Banca: Ana Laura Ricci Vitor / Resumo: A doença de Parkinson (DP) pode promover desordem no sistema nervoso autônomo, contudo estudos que verifiquem a relação entre o tempo de diagnóstico da doença e a modulação autonômica ainda não foram encontrados. Além disso, poucos estudos avaliaram a modulação autonômica na DP por meio da variabilidade da frequência cardíaca (VFC) utilizando métodos geométricos. Objetivos: 1) investigar a relação entre o tempo de diagnóstico e a modulação autonômica em indivíduos com a DP e comparar com indivíduos sem a doença. 2) investigar a modulação autonômica em indivíduos com DP, por meio de índices da VFC obtidos por métodos geométricos. Materiais e métodos: foram avaliados 50 voluntários com idade entre 55 a 83 anos, divididos em 2 grupos: o grupo Parkinson (GP; 26 voluntários) e o grupo controle (GC; 24 voluntários), pareados pelo sexo e idade. Para investigação do tempo de diagnóstico o GP foi subdividido em dois grupos conforme a mediana [mediana = 5,5 anos], sendo: GP1 (abaixo da mediana: menor tempo de diagnóstico; 13 voluntários) e GP2 (acima da mediana: maior tempo de diagnóstico; 13 voluntários). O protocolo experimental foi desenvolvido em duas etapas: na primeira foram coletados dados pessoais, peso, altura, composição corporal, frequência cardíaca, pressão arterial, avaliação pelo Mini-exame do Estado Mental e os voluntários com DP foram avaliados pela Escala de Estágios de Incapacidade de Hoehn e Yahr. Na segunda etapa foi realizada análise da modulação autonômica. Para e... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Parkinson's disease (PD) can promote disorder in the autonomic nervous system, but studies that verify the relationship between the time of diagnosis of the disease and the autonomic modulation have not yet been found. In addition, few studies have evaluated autonomic PD modulation through heart rate variability (HRV) using geometric methods. Objectives: 1) to investigate the relationship between the time of diagnosis and the autonomic modulation in individuals with PD and to compare with individuals without the disease. 2) to investigate the autonomic modulation in individuals with PD, through HRV indices obtained by geometric methods. Materials and Methods: Fifty volunteers aged 55 to 83 years were divided into two groups: the Parkinson group (GP, 26 volunteers) and the control group (CG, 24 volunteers), matched by sex and age. In order to investigate the time of diagnosis, GP was subdivided into two groups according to the median (median = 5.5 years): GP1 (below median: lower diagnostic time; 13 volunteers) and GP2 (above median: longer time 13 volunteers). The experimental protocol was developed in two stages: the first one was collected personal data, weight, height, body composition, heart rate, blood pressure, Mental State Mini-exam and the volunteers with PD were evaluated by the Disability Stages Scale of Hoehn and Yahr. In the second stage, the analysis of the autonomic modulation was performed ... (Complete abstract click electronic access below) / Mestre