The Internet and cyberspace are still relatively new occurrences in our lives, yet they already exert powerful influences over us. Research in South Africa is still limited and this is an attempt to begin correcting our lack of knowledge in the field. The study was conducted entirely in cyberspace. E-mail was used to gather information from six participants, who where recruited from the Quadriplegic Association of South Africa website. It is a qualitative examination of the unique experiences of spinal cord injured people, who are regularly interacting in cyber-communities with other injured people and people without injuries. The study attempts to describe the role that computer-mediated communication and cyber-communities play in the spinal cord injured person's self-concept. The information was collected in unstructured, asynchronous interviews, which were e-mailed on a regular basis. The participants included one woman and five men, with a mix of quadriplegic and paraplegic injuries. The questions revolved around two central themes: 1) the participant's experiences of other people offline and 2) their experiences of people online. These experiences were identified and grouped into 14 different categories. The categories were then integrated with the literature on cyberspace and self-concept theory. Although the participant group was small, their experiences were richly illustrated and often confirmed previous results by other cyberspace researchers. Essential to this study was the embodied isolation that participants experienced offline, which evoked a number of negative emotions and consequently affected the self-concept and self-esteem. Online the participants were often able to experience a release from isolation and felt empowered by the expansion in their social support Networks and the practical information they gained. In some cases self-esteem improved. In general, more skills and concepts were integrated, increasing the complexity of the self-concept. Applications of this study's results include greater rehabilitative speed and increased continued support for the spinal cord injured. The online spinal cord injured person can moderate her/his reintroduction to uninjured social circles. In certain situations, adapting to the new injured self-concept may become easier. / Dissertation (MA (Psychology))--University of Pretoria, 2006. / Psychology / unrestricted

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<p> Clinical diagnosis, classification of injury and the reliable and detailed description of a patient's neurological status are key factors in determining intervention, rehabilitation programs and predicting recovery. The American Spinal Injury Association (ASIA) impairment scale (AIS) is a standardized method for spinal cord injury (SCI) classification and neurologic status examination. Studies have revealed the AIS classification to be a general assessment tool that fails to explain the varying degrees and patterns of neurological damage, especially in individuals with incomplete injuries. In addition, intragroup variability can be attributed to inaccuracies in examinations and improper assessment tools that have limited research findings. Transcranial Magnetic Stimulation (TMS) has been used as a non-invasive method of evaluating the integrity of the motor nervous system. The primary purpose of this study was to evaluate TMS as an assessment tool to describe motor impairment of SCI individuals. A second purpose of this study was to assess AIS accuracy and sensitivity to muscle activation by using surface electromyographic (sEMG) techniques during clinical examinations. Six incomplete SCI participants were clinically assessed to obtain their individual motor scores from key muscles following AIS assessment criteria. TMS was then used to stimulate the motor cortex to elicit motor evoked potentials (MEPs) in 4 key muscles. MEPs correlated with motor scores, where significantly higher and lower MEPs corresponded to the highest and lowest motor scores, respectively. Of the 48 muscles analyzed, 18 received a motor score of zero; however MEPs were obtained in 7 of these 18 muscles. In general, MEPs paralleled motor function as assessed by the AIS. Results suggest that TMS may provide information on the relationship between corticospinal integrity and the quality of motor function. In addition, TMS demonstrated adequate validity and sensitivity to SCI individual differences. MEPs provided additional information regarding the existence of spared neuronal pathways not identified by standard clinical evaluations. The therapeutic potential of these motor pathways has yet to be explored. EMG activity was significantly correlated to motor scores and MEPs however; EMG analysis revealed some inaccuracies in muscle examinations and supported MEP data. Results suggest that the implementation of electrophysiological assessment tools may be more sensitive to detect motor damage, adaptive movement patterns and overall muscle activation that may be misinterpreted during clinical examinations.</p> / Thesis / Master of Science (MSc)

Spinal cord injury (SCI) is an acquired physical disability through traumatic injuries such as car accidents and shooting incidents, and non-traumatic injury such as a tumour on the spinal cord, amongst others. Unlike other parts of the body, the spinal cord does not have the ability to repair itself if it is damaged. Consequently, a person who has acquired an SCI will have a physical disability and will be either a paraplegic – paralysis of the lower part of the body, including the legs, or a quadriplegic, which is paralysis of all four limbs. Acquiring a spinal cord injury (SCI) has devastating long-term negative outcomes for the injured person as well as his/her cohabiting partner on a physical, psychological, psychosocial and socio-economical level. Exposure to such prolonged adversity and resulting negative outcomes calls for resilience, namely the ability to positively adapt despite the adversity being exposed to. Not all individuals have the natural ability to “bounce back”, and consequently resilience promotion is imperative. In South Africa, the focus of service delivery in rehabilitation centres is mainly centred on the injured person and consequently the well-being of the spinal cord injured person’s partner (SCIPP) is neglected. Little information is available on resilience-promoting programmes for SCIPPs; thus the main aim of this study was to design and develop a group resilience-promoting programme (GRPP) for SCIPPs. The researcher mainly followed a qualitative research approach and included a small quantitative component. In the context of applied research, an intervention research model comprising six phases was employed. Phase 1, Problem analysis and project planning, was reported on in section A. Manuscript 1 reports on phase 2 (information gathering and synthesis), and consists of a qualitative research synthesis, and mainly aimed at organizing and synthesizing previous research on resilience-promoting processes in order to inform the design and development of a group resilience-promoting programme (GRPP) for SCIPPs. After a systematic review and quality appraisal a total of 74 papers were selected to be quality appraised after abstracts and titles were assessed for relevance. Twenty-one studies were included and synthesized where after an outline for the content of a GRPP for SCIPPs was formulated. Conclusions and recommendations highlight that the formulated GRPP for SCIPPs needs to be further developed into an intervention that could be implemented with SCIPPs. As such, the researcher therefore proceeded with the study (see manuscript 2), aiming in developing small-group programme content and activities (using knowledge gathered from pre-existing interventions; resilience literature; consultations with experts; people living with spinal cord injury (SCI) and personal experience) to promote resilience in SCIPPs. By means of purposive sampling six advisory panel members from a diverse background were interviewed before and after the pilot study with two SCIPPs and one observer to contribute towards the further development of the GRPP for SCIPPs. A six-session GRPP for SCIPPs was formulated, including the following: (1) Information on SCI and resilience; (2) Help SCIPPs understand that their reactions to/emotions regarding these huge changes are normal; (3) Caretaking and support; (4) My dual role; (5) Own caretaking by SCIPPs; and (6) Termination and way forward. The newly developed GRPP for SCIPPs however had to be formally evaluated. Recommendations were made by professionals in the field that the GRPP for SCIPPs should first be subjected to peer review prior to implementing it with the target population. Therefore in manuscript 3 (reporting on phase 5 – evaluation ) the evaluation purpose was to subject the GRPP for SCIPPs to peer review by means of an empirical study with professional role-players (social workers and psychologists) in the field of spinal cord injury, prior to exhibiting it to the target population. The six group sessions were presented to professional role-players (n=12) working within the field of SCI during two 2-day workshops, whereby they were requested to evaluate the content and procedural elements of the GRPP for SCIPPs mainly by means of qualitative research, with a small numerical (quantitative) component. Thematic content analysis and basic descriptive statistics were employed. Overall positive feedback regarding the newly developed intervention was received, with suggested adjustments that needed to be made to the GRPP for SCIPPs prior to formal evaluation with the target group. The GRPP for SCIPPs will further be subjected to expert review in other provinces in South Africa, as the current participants were all from Gauteng. Furthermore, postgraduate students will be recruited to test the programme with the target-population in South Africa for possible further improvement and suggestions, as well as possible expansion to adjust this intervention to meet the needs of male SCIPPs; SCIPs themselves; children of a parent/s living with SCI; and also for post-injury cohabiting relationships, as this intervention might be a starting point for above-mentioned research-opportunities.

Spinal cord injury (SCI) is an acquired physical disability through traumatic injuries such as car accidents and shooting incidents, and non-traumatic injury such as a tumour on the spinal cord, amongst others. Unlike other parts of the body, the spinal cord does not have the ability to repair itself if it is damaged. Consequently, a person who has acquired an SCI will have a physical disability and will be either a paraplegic – paralysis of the lower part of the body, including the legs, or a quadriplegic, which is paralysis of all four limbs. Acquiring a spinal cord injury (SCI) has devastating long-term negative outcomes for the injured person as well as his/her cohabiting partner on a physical, psychological, psychosocial and socio-economical level. Exposure to such prolonged adversity and resulting negative outcomes calls for resilience, namely the ability to positively adapt despite the adversity being exposed to. Not all individuals have the natural ability to “bounce back”, and consequently resilience promotion is imperative. In South Africa, the focus of service delivery in rehabilitation centres is mainly centred on the injured person and consequently the well-being of the spinal cord injured person’s partner (SCIPP) is neglected. Little information is available on resilience-promoting programmes for SCIPPs; thus the main aim of this study was to design and develop a group resilience-promoting programme (GRPP) for SCIPPs. The researcher mainly followed a qualitative research approach and included a small quantitative component. In the context of applied research, an intervention research model comprising six phases was employed. Phase 1, Problem analysis and project planning, was reported on in section A. Manuscript 1 reports on phase 2 (information gathering and synthesis), and consists of a qualitative research synthesis, and mainly aimed at organizing and synthesizing previous research on resilience-promoting processes in order to inform the design and development of a group resilience-promoting programme (GRPP) for SCIPPs. After a systematic review and quality appraisal a total of 74 papers were selected to be quality appraised after abstracts and titles were assessed for relevance. Twenty-one studies were included and synthesized where after an outline for the content of a GRPP for SCIPPs was formulated. Conclusions and recommendations highlight that the formulated GRPP for SCIPPs needs to be further developed into an intervention that could be implemented with SCIPPs. As such, the researcher therefore proceeded with the study (see manuscript 2), aiming in developing small-group programme content and activities (using knowledge gathered from pre-existing interventions; resilience literature; consultations with experts; people living with spinal cord injury (SCI) and personal experience) to promote resilience in SCIPPs. By means of purposive sampling six advisory panel members from a diverse background were interviewed before and after the pilot study with two SCIPPs and one observer to contribute towards the further development of the GRPP for SCIPPs. A six-session GRPP for SCIPPs was formulated, including the following: (1) Information on SCI and resilience; (2) Help SCIPPs understand that their reactions to/emotions regarding these huge changes are normal; (3) Caretaking and support; (4) My dual role; (5) Own caretaking by SCIPPs; and (6) Termination and way forward. The newly developed GRPP for SCIPPs however had to be formally evaluated. Recommendations were made by professionals in the field that the GRPP for SCIPPs should first be subjected to peer review prior to implementing it with the target population. Therefore in manuscript 3 (reporting on phase 5 – evaluation ) the evaluation purpose was to subject the GRPP for SCIPPs to peer review by means of an empirical study with professional role-players (social workers and psychologists) in the field of spinal cord injury, prior to exhibiting it to the target population. The six group sessions were presented to professional role-players (n=12) working within the field of SCI during two 2-day workshops, whereby they were requested to evaluate the content and procedural elements of the GRPP for SCIPPs mainly by means of qualitative research, with a small numerical (quantitative) component. Thematic content analysis and basic descriptive statistics were employed. Overall positive feedback regarding the newly developed intervention was received, with suggested adjustments that needed to be made to the GRPP for SCIPPs prior to formal evaluation with the target group. The GRPP for SCIPPs will further be subjected to expert review in other provinces in South Africa, as the current participants were all from Gauteng. Furthermore, postgraduate students will be recruited to test the programme with the target-population in South Africa for possible further improvement and suggestions, as well as possible expansion to adjust this intervention to meet the needs of male SCIPPs; SCIPs themselves; children of a parent/s living with SCI; and also for post-injury cohabiting relationships, as this intervention might be a starting point for above-mentioned research-opportunities.

La prise en charge rapide et systématique des patients en traumatologie par des protocoles tels que l’Advanced Trauma Life SupportTM maximise la survie. À l’intérieur de ces protocoles, l’examen le plus souvent proposé pour l’évaluation neurologique est l’International Standards For Neurological Classification of Spinal Cord Injury (ISNCSCI). Cet outil d’évaluation des patients avec une lésion médullaire traumatique (LMT) est le plus reconnu mondialement, mais n’est pas adapté à la prise en charge initiale en traumatologie de par son exhaustivité. L’objectif principal de ce mémoire était de combler le besoin pour un outil d’évaluation neurologique adapté au patient avec une LMT en contexte aigu.La première partie de ce travail consista au développement et à la validation d’une version simplifiée de l’ISNCSCI qui a été nommée le Montreal Acute Classification of Spinal Cord Injury (MAC-SCI). Sa validation par rapport à l’ISNCSCI révéla une capacité à déterminer correctement le grade de sévérité ainsi que l’étage lésionnel de la LMT dans 100% des cas. La seconde partie de ce travail évalua la capacité du MAC-SCI à détecter les variations neurologiques périopératoires et montra qu’aucune détérioration neurologique n’était ratée. Finalement, la troisième partie de ce travail évalua l’implémentation clinique du MAC-SCI et montra des taux de complétion 2,4 fois supérieurs à ceux de l’ISNCSCI. Nous souhaitons que le MAC-SCI soit incorporé dans les protocoles de traumatologie à grande échelle dans le but d’uniformiser l’évaluation neurologique des patients en situation de traumatologie et ultimement d’améliorer les soins prodigués aux patients blessés médullaires. / Rapid and systematic management of trauma patients using protocols such as the Advanced Trauma Life SupportTM maximizes survival. Within these protocols, the tool the most often suggested for neurological assessment is the International Standards For Neurological Classification of Spinal Cord Injury (ISNCSCI). This assessment tool for patients with traumatic spinal cord injury (TSCI) is the most recognized worldwide, but is not suitable for initial trauma care due to its comprehensiveness. The main objective of this thesis was to fulfill the need for a neurological assessment tool adapted to the patient with TSCI in an acute context. The first part of this study consisted in the development and validation of a simplified version of the ISNCSCI which was named the Montreal Acute Classification of Spinal Cord Injury (MAC-SCI). Its validation against the ISNCSCI revealed an ability to correctly determine the grade of severity as well as the neurological level of injury of the TSCI in 100% of cases. The second part of this study assessed the ability of the MAC-SCI to detect perioperative neurological variations and showed that no neurological deterioration was missed. Finally, the third part of this study evaluated the clinical implementation of the MAC-SCI and showed completion rates 2.4 times higher than the ISNCSCI. We would like the MAC-SCI to be incorporated into large-scale trauma protocols in order to standardize the neurological assessment of trauma patients and ultimately improve the care provided to patients with spinal cord injuries.