A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Science in Occupational Therapy. Johannesburg, 2013 / Whilst patients are in hospital, their families are expected to understand and remember complex information from the medical team. Previous studies have shown that high levels of anxiety impair a person’s ability to interpret complex information and memory recall. It is unknown if family members experience anxiety whilst the patient is in rehabilitation. The study aimed to determine if family members experienced anxiety, and whether there was a significant correlation between anxiety and the length of time the client was admitted to the rehabilitation facility; length of time since the client’s injury; the FIM measurement of the patient; as well as the perception of received information by the treating team. A family representative participated by completing the Hospital Anxiety and Depression Scale (HADS) and an Information Checklist on three separate occasions during the patient’s stay in a rehabilitation hospital. Family members were found to be anxious throughout the period of rehabilitation, with a decreasing trend in the average scores of the HADS assessment. An increasing trend was noted in the satisfaction of information offered by the treating team. No significant correlation could be found between the family members’ anxiety and the motor or cognitive improvement in the patient – thus indicating that a strong possibility exists that the factors influencing the family members’ anxiety are wide spread and diverse.

Thesis advisor: Susan Shell / There are many urgent issues facing prisons in the United States today including overcrowding, inmate violence, sentencing concerns and cost. Some communities are using faith-based moral rehabilitation programs in prisons to address these issues and attempt to reform convicts in body and soul. These efforts, exemplified by Louisiana State Penitentiary’s moral rehabilitation program, have clear benefits for reducing in-prison violence and state costs, but they have also garnered ample criticism due to their use of religion in state facilities, the preferential treatment of some prisoners, unclear evidence of moral reformation and claims of abuse. This study looks at modern moral rehabilitation programs and compares them to the early 19th century American penitentiaries, which had similar goals of moral improvement. By examining the function, advantages and disadvantages of these modern moral programs and comparing them to the history of early American penitentiaries; the functions and flaws of the Pennsylvania and Auburn Systems; and Gustave de Beaumont and Alexis de Tocqueville’s analysis and criticism of the penitentiaries in their book On the Penitentiary System…; this study recommends the changes necessary to maintain the beneficial and laudable aspects of today’s moral rehabilitation programs while addressing the criticisms and questions over this form of punishment. The conclusion is the recommendation of a reformed, less religious moral program with six components: incarceration, a strong community citizenship for inmates, education and mentoring, labor, a limited component of religion with the possibility of radical moral transformation, and certain punishment through solitary confinement.

MSc, Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand / Introduction Rotator cuff tears can cause great impairment of the shoulder joint with debilitating pain and dysfunction. The surgical repair of rotator cuff tears result in an extensive rehabilitation being required. This process can be affected by various demographic, surgical and rehabilitative factors. There appear to be no studies relating these factors to the rehabilitation process. The aim of this study was to determine the prevalence of partial and full thickness tears seen in one physiotherapy practice over the period of four and a half years. It also was to identify and analyse the factors affecting the amount of physiotherapy following a rotator cuff repair. Methods This was a retrospective record review. It was also a cross sectional correlational study. Results The prevalence of partial and full thickness rotator cuff tears seen over a period of four and a half years in one physiotherapy practice is very similar. Partial thickness tears constituted 46% of the entire sample and full thickness made up 54% of the sample. Four out of eleven factors were found to be associated with the amount of physiotherapy received after a rotator cuff repair. These factors included the age of the patient, whether the patient was injured on duty, iv preoperative physiotherapy and additional procedures after surgery such as a revision of the repair or a manipulation of the shoulder. Conclusion There are only a few factors shown to be associated with the rehabilitation process after a rotator cuff repair. These factors would need to be correlated against outcome in future studies.

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 in Occupational Therapy Johannesburg, June 2017 / This study explores the implementation of two different synergistic wrist motion approaches in the treatment of flexor tendon injuries, the excursion-based approach and the force-based approach. A prospective, quantitative, comparative intervention research design was used to compare the two approaches and determine their effectiveness in a public hospital in South Africa. The five participants’ range of motion, independence in activities of daily living and satisfaction levels were measured throughout the 12 week treatment programme. The excursion-based group showed significant improvement in passive Strickland and Glogovac scores over the rehabilitation period. The excursion-based group also achieved better final place-and-hold and active Strickland and Glogovac scores than the force-based group which showed a decline in these scores over the 12 weeks. Both groups had a poor result for active movement at the final session due to the development of adhesions, but were found to have an improvement in their upper limb function measured on the Disabilities of the Hand, Shoulder and Arm questionnaire in all activities except for those related to work. These results were not statistically significant. The poor results may be attributed to the unique challenges experienced by patients with flexor tendon injuries, living in under-resourced South African communities. The small sample and the fact that the excursion-based group received isolated flexor digitorum profundus tendon repairs while the force-based group received combined flexor digitorum profundus and flexor digitorum superficialis repairs may also have had an impact on the results. The outcomes of this study indicate that despite yielding successful results in research studies performed in developed countries, it is unlikely that either of these approaches will be suitable in the rehabilitation of patients with flexor tendon repairs in a public hospital in South Africa. / MT2017

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Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

In the United States, more than 18 million people suffer from upper extremity injury. This population is in need of a device both to aid in the completion of activities of daily living (eating and grooming), as well as to provide daily muscular therapy. To assist persons suffering from disabling upper extremity neuromuscular diseases, this thesis concerned the redesign of a powered arm brace from a proof-of-concept design to a more functional, marketable product. The principles of Design for Manufacturability and Assembly (DFMA) were employed as part of the design methodology to create a product that could be scaled into production. Additionally, numerical analyses including Finite Element Analysis (FEA) were completed to prove the both the safety and structural integrity of the orthosis in computer simulations. The design was then successfully tested with marked improvement over the previous design, including a 58% reduction in weight, decreased manufacturing costs, and a significant improvement in functionality and comfort.

Within rehabilitation research recovery from a stroke has been defined by health professionals as the improvement in the physical ability and task-related skills of an individual. The negative psychological consequences of a stroke for both individuals and their families have been recognised for several years, but are poorly understood. Within this thesis an alternative approach has been used to explore psychological consequences following a stroke. The focus of study has been the change in identity of individuals and their spouses, rather than the ability of an individual to carry out tasks. Ten consecutive couples were included following one partner's admission to hospital following a stroke. Separate narrative life history interviews were carried out with the stroke respondent and their spouse in hospital, and at six months and at one year after hospital discharge. Data collection and analysis was based on an interpretative phenomenological approach. A second concurrent study was carried out including 38 stroke respondents who were admitted to hospital following a stroke. While in hospital they were asked to complete a questionnaire including indices of physical ability, task-orientated ability, mood and self-concept. The questionnaire was administered again at six months and one year following discharge. Multivariate statistical procedures were carried out to describe the associations between the variables assessed. All respondents reported that they had experienced a fundamental change in their lives. They continued to report this fundamental change up to the final interview at one year, apart from one couple, where the stroke partner had made a complete physical recovery. The issue which appeared to dominate the stroke respondent's first year post-stroke was a split between their body and their physical and social self They could not maintain their prior identity within the capabilities of their new body. The spouses reported that they became totally responsible for not only their own lives but also the life of their partner. The issues of body-self split and total responsibility appeared to be hidden from others,making the situation of the respondents more challenging. Younger spouses reported more difficulty than older spouses in integrating the stroke into their life situation. Issues facing the respondents also varied depending on their own life histories and life goals. Within the quantitative analysis the mood of the stroke respondents was not highly correlated with physical ability or task-oriented improvement. Perceived difference between past and present self-concept was correlated to anxiety and depression at all assessment times even when the other indictors were taken into account. Exploration of identity change appears to be a useful framework for exploring the psychological consequences of a stroke.

Although the management of Motor Neuron Disease (MND) remains devoid of a cure, persons affected by this devastating condition are nonetheless entitled to the best quality care that is available. A paucity of information exists documenting the perceptions of healthcare consumers regarding the management that is provided. In addition optimal healthcare comprises an intricate interaction of patient-centred care, patient-centred communication, and bioethical practice, and when these three dimensions are implemented according to acceptable standards, high-quality healthcare is perceived by the healthcare consumer. Given however the socio-political challenges that face healthcare systems, the management of MND needs to be considered against current trends in service delivery and the need for evidence-based medicine. An exploratory study was therefore conducted to investigate the perceptions of persons with MND and their family members regarding current medical and rehabilitative management. The sample comprised six persons with MND who presented with a communication impairment, as well as six family members. Participants’ perceptions were elicited through the use of a semi-structured interview schedule, and questions focused on healthcare professionals’ behaviours during healthcare encounters. In addition emphasis was placed on the potential of the communication impairment to influence management. A standardised dysarthria assessment was conducted to characterise the nature of the speech impairment in each person with MND. Qualitative responses obtained from the interviews were analysed in accordance with a matrix-based approach, while quantitative data from the dysarthria assessment were analysed using descriptive statistics. Despite individual variability, perceptions of both persons with MND and their family members revealed general dissatisfaction with regard to medical and rehabilitative management. The majority of persons with MND were not referred for intervention following diagnosis, and the recommended team approach for the management of MND was absent. In addition the bioethical practice of many healthcare professionals was deemed questionable, and the communication impairment was perceived to impose a significant burden on the healthcare encounter. Furthermore all participants perceived a lack of available support systems for persons with MND, and it was thus not uncommon for individuals to pursue complementary and alternative medicine. South Africa’s current healthcare climate also appeared to further limit healthcare for this clinical population. In an attempt to improve the management of MND, implications are provided in terms of health communication, intervention, bioethical practice, and support systems. A proposed new framework of ideal service delivery for healthcare consumers of MND management is also presented. Further implications are outlined with regard to the need for innovative models of service delivery in South Africa’s healthcare context, as well as the role of speech-language pathologists, other healthcare professionals, policy makers, and educators in the improvement of the medical and rehabilitative management of MND. Finally theoretical implications and implications for future research are also documented.