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A Dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of Master of Science (Physiotherapy). Johannesburg 2017 / Aim: The aim of this study was to evaluate the applicability of an existing behavioural observation tool and assess whether it could be used to quantify and define physiotherapeutic actions (PA) as implemented during treatment sessions of children between the ages of one and 16 years with a diagnosis of Cerebral Palsy (CP). If the tool was found to be unsuitable a more appropriate measure would need to be developed. Method: This study consisted of three phases and was exploratory in nature with one phase leading to the next. Phase 1: A panel of experts evaluated the Original Observation Protocol (OOP) by implementing it on treatment videos of children from different Gross Motor Function Classification System (GMFCS) levels, thereby testing its usefulness in a different context to its original intended purpose. Phase 2: The OOP’s content validity was evaluated with the help of the same panel of experts. The recommended adaptations were based on the feedback collected during a series of modified Nominal Group Technique (NGT) sessions. Phase 3: The Adapted Observation Protocol (AOP) was piloted on five treatment videos, each with different GMFCS levels, by a sample group of six experienced physiotherapists (PT’s). Inter-rater and intra-rater reliability were determined to start unpacking some of the psychometric properties of the AOP. Results: Phase 1: The mutual exclusivity of the OOP was found to be unsatisfactory and hence unsuitable for use with older children within the South African context where adaptation was deemed necessary. Phase 2: Content validity for an adapted version was established by achieving 80% agreement between the experts for the inclusion and adaptation of items from the OOP. The AOP consisting out of three sections was developed as the end result of this phase. Phase 3: Some of the preliminary results of the psychometric properties of the AOP looked promising. In Section 3 a high to very high positive correlation were found when looking at both inter- and intra-rater reliability for relative duration of the therapeutic activities across all videos. The ICC values ranged from α= 0.68 to α=0.94 for the inter-rater reliability and α=0.65 to α=0.99 for the intra-rater reliability with a confidence level of 95%. In contrast, the incidence of therapeutic activities scored in Section 3 had slightly lower correlation, ICC ranging from α=0.43 to 0.76. In Sections 1 and 2 a negligible to moderately positive level of correlation was predominantly observed. This might be ascribed to a lack of training amongst other reasons. Conclusion: Further research is needed to develop the psychometric properties of the AOP. However, it does have the potential to be a tool that defines and quantifies therapeutic input in children with CP and an invaluable free resource that can be implemented across a variety of practice settings within South Africa. / MT2017

Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / There are few reports in the veterinary literature concerning the use of physiotherapy in the postoperative recovery and quality of life of dogs with thoracolumbar intervertebral disc disease (IVDD). Therefore, this retrospective study aim was: to demonstrate the physiotherapeutic modalities used in the treatment of dogs with thoracolumbar IVDD experiencing different neurological dysfunction degrees and underwent surgical decompression; to report elements that determined the protocols changes (article 1); to compare the functional recovery and quality of life (QOL) of paraplegic dogs without deep pain perception that underwent a home physiotherapy protocol to those that received care in a specialized center (article 2). In the first article, 30 dogs with deep pain perception were included in the first physiotherapy session, presenting a range of clinical signs from ambulatory paraparesis to paraplegia. An initial protocol composed of different physiotherapeutic modalities was applied in all dogs, regardless of the degree of neurological dysfunction. The therapeutic exercises included in the initial protocol were selected according to the clinical evolution and acceptance of each patient, highlighting the inclusion and exclusion criteria of each modality. Eighty percent (80%) of the dogs manifested improvement in their neurological dysfunction degree before starting physical therapy and 93% were able to walk again (ambulatory paraparesis) at the end of physiotherapy. The number of sessions and recovery time were higher in patients with higher neurological dysfunction degrees. In the second article, 28 dogs underwent a home protocol (GA) while other 38 patients were cared in a specialized center (GB). Forty three percent (43%) of the GA animals recovered the ability to walk in an average of 40 postoperative (PO) days and 42% in an average of 36 days in GB. In 53% of the cases (35/66) the dogs remained paraplegic without deep pain perception at the end of physiotherapeutic protocols. There was no difference in rates and time of functional recovery between the groups. The evaluation of the animals survival time, euthanasia and the QOL score demonstrated that dogs that underwent a physiotherapeutic treatment in a specialized center probably were benefited by the close monitoring and orientation to owners until 90 days of PO. / Na literatura veterinária, há poucos relatos sobre o emprego da fisioterapia na recuperação pós-operatória e qualidade de vida de cães com doença do disco intervertebral (DDIV) toracolombar. Diante disso, o objetivo deste estudo retrospectivo foi: demonstrar as modalidades fisioterapêuticas empregadas no tratamento de cães com DDIV toracolombar em diferentes graus de disfunção neurológica e submetidos à descompressão cirúrgica; relatar os fatores que determinaram as alterações de protocolos (artigo 1); comparar a recuperação funcional e a qualidade de vida (QV) de cães paraplégicos sem percepção à dor profunda submetidos a um protocolo de fisioterapia domiciliar ou em um centro especializado (artigo 2). No primeiro artigo, foram incluídos 30 cães que apresentavam desde paraparesia ambulatória à paraplegia com dor profunda na primeira sessão de fisioterapia. Um protocolo inicial composto por diferentes modalidades fisioterapêuticas foi aplicado em todos os cães, independente do grau de disfunção neurológica. Os exercícios terapêuticos incluídos no protocolo inicial foram selecionados de acordo com a evolução clínica e a adaptação de cada paciente, destacando os critérios de inclusão e exclusão de cada modalidade. Oitenta por cento (80%) dos cães alteraram o grau de disfunção neurológica antes de iniciar a fisioterapia e 93% retornaram a habilidade de caminhar (paraparesia ambulatória) ao final da fisioterapia. O número de sessões e o tempo de recuperação foi maior quanto pior o grau de lesão do paciente. No segundo artigo, 28 cães foram submetidos ao um protocolo domiciliar (GA) e 38 em um centro especializado (GB). Recuperaram a habilidade de caminhar 43% em uma média de 40 dias de pós-operatório (PO) no GA e 42% em uma média de 36 dias no GB. Em 53% dos casos (35/66) os cães permaneceram paraplégicos sem percepção a dor profunda ao final do período de 90 dias de PO. Não houve diferença nas taxas e tempo de recuperação funcional entre os grupos. A avaliação do tempo de sobrevida dos animais, realização de eutanásia e nota atribuída a QV demonstraram que os cães que realizaram tratamento fisioterapêutico em centro especializado provavelmente foram beneficiados pelo estreito acompanhamento e orientação aos tutores até 90 dias de PO.

Introdução. A tuberculose pulmonar é uma doença para a qual no decorrer do tempo muitos tratamentos foram usados na tentativa de conseguir o seu controle. O advento dos quimioterápicos, em meados de 1940, que associados à melhoria de condições de vida fez com que ocorresse um decréscimo acentuado do número de óbitos, principalmente em países desenvolvidos. Entretanto, ainda hoje existem problemas em relação ao controle da doença. Algumas questões surgem em relação à prevenção, tratamento e controle. Um dos aspectos questionados neste trabalho é a necessidade do repouso, que por muito tempo foi utilizado e que continua sendo apesar de existirem vários estudos sobre os efeitos deletérios do repouso prolongado. Objetivo. Este trabalho visa verificar alterações relacionadas com o repouso prolongado em paciente com tuberculose pulmonar internados em um hospital de longa permanência e outro de curta permanência na cidade de São Paulo. Métodos. Foi realizado um estudo transversal descritivo, por meio de um questionário de avaliação fisioterapêutica especificamente elaborado para o estudo, compreendendo avaliações através de palpações, mensurações usando aparelhos específicos e entrevistas com perguntas abertas e fechadas. Resultados. Foi observado que 40 por cento dos indivíduos enContravam-se desnutridos, 40 por cento apresentavam déficit de marcha, 49 por cento apresentavam-se taquicárdicos, 60 por cento apresentavam-se com expansibilidade diminuída e 56 por cento apresentavam algum grau de dor. Conclusões. Na variação dos sistemas observou-se que no sistema gastrointestinal houve a maior variação positiva (+0.21). No sistema cardiovascular houve a maior variação negativa (-0.16), observou-se ainda que 52 por cento dos indivíduos analisados apresentaram algum grau de imobilismo, sugerindo que o repouso adotado como prática terapêutica pode ser prejudicial nesta população. / Introduction. A long time many treatment had been used to obtain the control the lung tuberculosis. The advent of chemeotherapy, around 1940 years, that associate to the improvement of life conditions results in a accented reduction of death, especialy in developed countries. However, nowadays there are problems to about to control this disease. Some questions arise to about the prevention, treatment and control. One of the aspects questioned in this research is the necessity of the rest, that for a long time was and continues used although to have some research to about the deleterious effects of the longest rest. Objective. This research to aims to verify alterations related with the longest rest in patient with lung tuberculosis admitted to the long permanence hospital and another one in short permanence hospital in São Paulo city. Methodos. A descriptive transversal research was executed, through phisiotherapist evaluation questionnaire specifically elaborated for this research, with evaluation through palpation, mensuration, using especific equipments and interviews with open and close questions. Results. 40 per cent of the patients were with malnutricion, 40 per cent were with walk problems, 49 per cent were with high cardiac frequency, 60 per cent were with low expansibility of chest and 56 per cent were with some degree of pain. Conclusions. Gastrointestinal system had the biggest positiva variation (+0.21). Cardiovascular system had the biggest negativa variation (-0.16), 52 per cent of patients had some degree of immobilism, suggesting that the adopted rest as therapeutical practical could be harmful in this population.

Introdução. A tuberculose pulmonar é uma doença para a qual no decorrer do tempo muitos tratamentos foram usados na tentativa de conseguir o seu controle. O advento dos quimioterápicos, em meados de 1940, que associados à melhoria de condições de vida fez com que ocorresse um decréscimo acentuado do número de óbitos, principalmente em países desenvolvidos. Entretanto, ainda hoje existem problemas em relação ao controle da doença. Algumas questões surgem em relação à prevenção, tratamento e controle. Um dos aspectos questionados neste trabalho é a necessidade do repouso, que por muito tempo foi utilizado e que continua sendo apesar de existirem vários estudos sobre os efeitos deletérios do repouso prolongado. Objetivo. Este trabalho visa verificar alterações relacionadas com o repouso prolongado em paciente com tuberculose pulmonar internados em um hospital de longa permanência e outro de curta permanência na cidade de São Paulo. Métodos. Foi realizado um estudo transversal descritivo, por meio de um questionário de avaliação fisioterapêutica especificamente elaborado para o estudo, compreendendo avaliações através de palpações, mensurações usando aparelhos específicos e entrevistas com perguntas abertas e fechadas. Resultados. Foi observado que 40 por cento dos indivíduos enContravam-se desnutridos, 40 por cento apresentavam déficit de marcha, 49 por cento apresentavam-se taquicárdicos, 60 por cento apresentavam-se com expansibilidade diminuída e 56 por cento apresentavam algum grau de dor. Conclusões. Na variação dos sistemas observou-se que no sistema gastrointestinal houve a maior variação positiva (+0.21). No sistema cardiovascular houve a maior variação negativa (-0.16), observou-se ainda que 52 por cento dos indivíduos analisados apresentaram algum grau de imobilismo, sugerindo que o repouso adotado como prática terapêutica pode ser prejudicial nesta população. / Introduction. A long time many treatment had been used to obtain the control the lung tuberculosis. The advent of chemeotherapy, around 1940 years, that associate to the improvement of life conditions results in a accented reduction of death, especialy in developed countries. However, nowadays there are problems to about to control this disease. Some questions arise to about the prevention, treatment and control. One of the aspects questioned in this research is the necessity of the rest, that for a long time was and continues used although to have some research to about the deleterious effects of the longest rest. Objective. This research to aims to verify alterations related with the longest rest in patient with lung tuberculosis admitted to the long permanence hospital and another one in short permanence hospital in São Paulo city. Methodos. A descriptive transversal research was executed, through phisiotherapist evaluation questionnaire specifically elaborated for this research, with evaluation through palpation, mensuration, using especific equipments and interviews with open and close questions. Results. 40 per cent of the patients were with malnutricion, 40 per cent were with walk problems, 49 per cent were with high cardiac frequency, 60 per cent were with low expansibility of chest and 56 per cent were with some degree of pain. Conclusions. Gastrointestinal system had the biggest positiva variation (+0.21). Cardiovascular system had the biggest negativa variation (-0.16), 52 per cent of patients had some degree of immobilism, suggesting that the adopted rest as therapeutical practical could be harmful in this population.

Orientador: Helder Anibal Hermini / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia Mecanica / Made available in DSpace on 2018-08-07T21:32:07Z (GMT). No. of bitstreams: 1 Gregorio_Dagoberto_M.pdf: 10229197 bytes, checksum: ae87f07eb1d4902ea8a47a0ad3b57b32 (MD5) Previous issue date: 2006 / Resumo: Este trabalho apresenta a utilização das tecnologias da automação no processo, de desenvolvimento, para uma solução na prevenção de úlceras de pressão em pessoas; inertes, obesas, mantendo sua integridade física durante o período de reabilitação hospitalar. Dentre as tecnologias da automação foram utilizados os sistemas integrados de CAD / CAE para: o modelamento ergonométrico, o modelamento tridimensional, a montagem tridimensional virtual, as simulações de funcionabilidade com ferramentas digitais para a análise cinemática dos sistemas mecânicos e a análise estrutural dos componentes, criando-se assim o protótipo virtual do estudo; também foi desenvolvido e testado um sistema supervisório para a programação e controle da movimentação do equipamento com comunicação, via rede informatizada, ao controlador lógico programável de um protótipo funcional sensorizado, promovendo os movimentos de prevenção e garantindo a condição de segurança ao paciente durante o processo de reabilitação hospitalar. Os resultados obtidos podem ser aplicados, em estudos futuros, na utilização da automação de equipamentos hospitalares mecatfônicos para a reabilitação humana / Abstract: This work presents the use of the technologies of the automation in the process, of "';' development, for a solution in the prevention of pressure ulcers in people; inert, obese, maintaining his/her physical integrity during the period of hospital rehabilitation. Among the technologies of the automation the integrated systems of CAD were used / CAE for: the modeling ergonometric, the three-dimensional modeling, the virtual three-dimensional assembly, the operation simulations with digital tools for the cinematic analysis of the mechanical systems and the structural analysis of the components, growing up like this the virtual prototype of the study; it was also developed and tested a system supervisoring for the programming and control of the movement of the equipment with communication, through computerized net, to the programmable logical controller of a prototype functional sensoring, promoting the prevention movements and guaranteeing safety's condition to the patient during the process of hospital rehabilitation. The obtained results can be applied, in future studies, in the use of the automation of hospital mecatronics equipment for the human rehabilitation / Mestrado / Mecanica dos Sólidos e Projeto Mecanico / Mestre em Engenharia Mecânica

Ospecifik ländryggssmärta är den vanligaste typen av ländryggssmärta och saknar identifierbar patoanatomisk orsak, därför har det blivit en utmaning att utveckla effektiva behandlingar. Det saknas nationella riktlinjer i Sverige för fysioterapeutisk behandling av ospecifik ländryggssmärta. Det är oklart vilka typer av åtgärder som idag används av svenska fysioterapeuter.  Syftet med studien var att kartlägga vilka fysioterapeutiska åtgärder för ospecifik ländryggssmärta som används av fysioterapeuter i Sverige samt undersöka om det föreligger eventuella skillnader i val av åtgärd mellan offentligt och privat anställda fysioterapeuter och mellan kvinnliga och manliga fysioterapeuter.  Studien var en kvantitativ tvärsnittsstudie av deskriptiv och komparativ design. Urvalet var ett bekvämlighetsurval bestående av yrkesverksamma fysioterapeuter i Sverige. Data samlades in via en enkät som besvarades av 105 fysioterapeuter.  De mest frekvent använda åtgärderna var information och råd kring fysisk aktivitet, sedan följde information om ergonomi, information om smärtmekanismer, muskelstärkande träning samt träning av rörlighet. Privat anställda fysioterapeuter använde laserterapi (p=0.020), massage (p=0.006), samt yoga (p=0.013) oftare i genomsnitt jämfört med offentligt anställda. McKenzie träningsprogram (p=0.010) var mer frekvent använt av offentligt anställda i genomsnitt. Kvinnliga fysioterapeuter använde aerob träning (p=0.012), akupunktur (p=<0.001), information om ergonomi (p=0.023), träning av balans (p=0.013), träning av bålstabilitet med motorisk kontroll (p=0.012), träning av rörlighet (p=0.016) samt TENS (p=<0.001) oftare än manliga.      Studien visade att det i övrigt fanns mycket likhet mellan grupper men att typen av anställning samt kön kan påverka till en viss utsträckning val av åtgärder. / Nonspecific low back pain is the most common type of low back pain and lacks an identifiable pathoanatomical cause, which makes it difficult to develop effective treatments. There are no national guidelines in Sweden for this condition and it is unclear what methods are currently used by Swedish physiotherapists. The purpose of the study was to map physiotherapeutic measures for nonspecific low back pain used by physiotherapists in Sweden and to investigate whether there are differences between public and private physiotherapists and between female and male physiotherapists. The study was a quantitative cross-sectional study of descriptive and comparative design. The sample was a convenience sample and the data were collected via a questionnaire that was answered by 105 physiotherapists.  The most frequently used methods were information and advice on physical activity, followed by information about ergonomy, information on pain mechanisms, muscle-strengthening training and training of mobility. Laser therapy (p=0.020), massage (p=0.006) and yoga (p=0.013) were more often used by public physiotherapists while McKenzie training programme (p=0.010) was more often used by public physiotherapists. Female physiotherapists used aerobic training (p=0.012), acupuncture (p=<0.001), information about ergonomy (p=0.023), training of balance (p=0.013), training of core stability with motorical control (p=0.012), träning of mobility (p=0.016) and TENS (p=<0.001) more often than male physiotherapists.  The study showed that there were strong similarities between groups but that the type of employment and gender can affect to a certain degree the choice of measures.

The diploma thesis named "The system of providing of medical and physiotherapeutic care for adult physically disabled people in the Czech Republic: The connection among medical and physiotherapeutic care, integration and the quality of life" maps a particular kinds of medical and physiotherapeutic services provided (it includes for instance ambulatory physiotheraphy and bath medication) and offered by the system to the people with physical impairment. The data were obtained from qualitative interviews made with patients and also with specialists who works on in the field of medical-physiotherapeutic and social care. The autobiographical method was also used during 4 the research. Each kind of the care provided are valuated by patients - recipients of the care and and by specialists - persons who provide services. We esspecially focused on the number, availability, frequence and quality. We followed namely the possibility of getting and need of each kind of a medical-physiotherapeutic service: it's sequence and it's involvement to the possibility of the integration and the quality of life of the people with a physical impairment. Using the method of the tree of problems the data were organized and evaluated. There were identificated problematic parts of working of the whole system and outlined some...

Author: Pavla Suchanová Title: Lymphedema in patients after the breast cancer treatment from the view of physiotherapy: literature review Objective: The aim of the literature review was to find out which are the most used and in practice the most effective physiotherapeutic approaches which affect secondary lymphedema of the arm related to breast cancer. The purpose was also to gather the current available knowledge of this issue. Methods: The presented literature review is of the analytical-descriptive nature. It was divided into two parts. The first part is called the theoretical background and deals with the anatomy, pathophysiology, and physiotherapy of arm lymphedema after breast cancer. The second part is focused on the data collection according to the given criteria, analysis, and interpretation of the results of the research. The sources were searched for in the electronic databases of Cochrane trials, Pub Med and PEDro in the period from 2010 to 2021. Of the total number of 7379 studies, 11 randomized controlled trials, meeting the evaluation criteria, were further analyzed. Searches were performed using various keywords and synonyms connected with the research questions: breast cancer lymphedema, postmastectomy lymphedema, breast cancer lymphedema and exercise. Results: Of the searched...

Background: Stress-Related Exhaustion (SE) has increased in the last 10 years. Examination is key for good care, but research on body examinations for SE is lacking. Clinically, autonomic stress response with affected respiratory patterns can be observed in SE.  Global Body Examination (GBE) can be used to evaluate autonomic stress responses. GBE has a respiratory domain (rGBE) that has been tested for validity, but not for its intra-rater reliability. Moreover, its’ association with SE symptom severity is unknown. Aim: To examine intra-rater reliability of rGBE in SE, and concurrent validity between rGBE and symptom severity in SE, measured with the self-reported outcome measure Shirom-Melamed Burnout Questionnaire (SMBQ). Method: Test-retest and cross-sectional design was used in the study, with a sample of convenience. Intra-rater reliability was analyzed with ICC, standard error of measurement (SEM) and agreement through a Bland-Altman plot. Spearman’s rho was used to analyze correlation between SMBQ and rGBE. Result: Sample size was 25. Intra-rater reliability was very high (ICC: 0.94, 95% CI: 0.86-0.97, p<0.01). Bland-Altman plot revealed no systematic errors. Mean of rGBE: 7.51 (SD2.14) with SEM: 0.56. Correlation between rGBE and SMBQ was low, Spearman’s rho=0.48,95% CI: 0.09-0.74, p=0,02, with 22% shared variance. Conclusion: rGBE shows good intra-rater reliability and seems suitable for examining SE symptoms. However, its use in diagnostic and to determinate symptom severity in SE remains uncertain due to the wide CI. Beyond SE, rGBE might be useful for other disorders affecting the autonomic balance, as well as diseases that affect respiration. / Bakgrund: Utmattningssyndrom har ökat i samhället de senaste 10 åren. Undersökning är viktig för god rehabilitering men forskning gällande kroppsundersökningar saknas på utmattningssyndrom. Kliniskt har bland annat påverkat respirationsmönster observerats, som ett kroppsligt uttryck på autonom uppvarvning. Global Body Examination (GBE) är en undersökningsmetod som kartlägger autonom uppvarvning. GBE har en respirationsdomän (rGBE) som har testats för validitet, men inte för intrabedömarreliabilitet. Om ett samband föreligger mellan rGBE och besvärsgrad vid utmattningssyndrom är också okänt. Syfte: Att undersöka intrabedömarreliabilitet hos rGBE, samt den samtidiga validiteten mellan rGBE och självskattad besvärsgrad enligt Shirom-Melamed Burnout Questionnaire (SMBQ) hos individer med utmattningssyndrom. Metod: Test-retestdesign och tvärsnittsdesign användes i studien. Bekvämlighetsurval utfördes. Intrabedömarreliabilitet analyserades med ICC, standardmätfel och överenstämmelse via en Bland-Altman analys. Korrelationen mellan rGBE och SMBQ analyserades med Spearman’s rho. Resultat: Deltagarantalet blev 25. Intrabedömarreliabiliteten var mycket hög; ICC=0.94, 95% konfidensintervall 0.86-0.97, p<0.01. Bland-Altman analys visade inga systematiska mätfel. Medelvärde av rGBE blev 7.51 (SD 2.14) med standardmätfel på 0.56. Sambandet mellan rGBE och SMBQ var lågt; Spearmans's rho=0.48, 95% konfidensintervall 0.09-0.74, p=0.02. Samvariationen blev 22%. Slutsats: rGBE visar god intrabedömarreliabilitet och kan vara en lämplig undersökningsmetod för att observera utmattningssymtom. Inga säkra slutsatser kan dras gällande rGBEs användbarhet vid diagnostik eller besvärsgradering av utmattningssyndrom då konfidensintervallet blev brett. Utöver utmattningssyndrom kan rGBE troligen vara användbar vid besvär som påverkar den autonoma balansen, såväl som besvär som påverkar respirationen.