No description available.

Thesis (Ph. D.)--University of Wisconsin--Madison, 1969. / Typescript. Vita. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Thesis (M.Tech.: Chiropractic) - Dept. of Chiropractic, Durban Institute of Technology, 2004 1 v. (various pagings) / Chiropractors are treating spinal joint dysfunction in infants that present with conditions such as infantile colic. Authors conducting research into spinal joint dysfunction in infants have used static and motion palpation to identify these spinal lesions in the infants. The reliability of static and motion palpation used in infants for the assessment of spinal joint dysfunction has not yet been established. The lack of a reliable assessment tool for spinal joint dysfunction in infants reduces the inferential validity of the research studies assessing the efficacy of chiropractic treatment in infants. It is therefore necessary to establish the interexaminer reliability of static and motion palpation in infants. The purpose of this study was to determine the interexaminer reliability of static and motion palpation for the assessment of spinal joint dysfunction in healthy infants aged two to ten weeks

published_or_final_version / abstract / Orthopaedics and Traumatology / Doctoral / Doctor of Philosophy

No description available.

A dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 2001. / The purpose of this study was to investigate the effectiveness of spinal manipulation compared to passive oscillatory mobilization in order to evaluate the more effective treatment in the management of chronic mechanical thoracic spine pain. It was hypothesized that spinal manipulation and passive oscillatory mobilization would both be effective in the treatment of chronic mechanical thoracic spine pain. It was further postulated that spinal manipulation would be comparatively more effective than passive oscillatory mobilization in terms of objective and subjective clinical findings. This randomised controlled clinical trial consisted of a study population of 60, obtained by convenience sampling. Those patients diagnosed as suffering from chronic mechanical thoracic spine pain were randomly allocated to two groups of 30 each. One group received spinal manipulation and the other group passive oscillatory mobilization on the affected segments. Both groups of patients received 5 treatments over a two-week period. The subjective data was obtained by the use of the short-form McGill Pain Questionnaire and the Numerical Pain Rating Scale-101 Questionnaire. These were filled in by the patient before the first, third and fifth treatments. The objective data was acquired through the use of the algometer. Readings were taken before and after the first, third and fifth treatments. Intra-group analysis of the short-form McGill Pain Questionnaire was done using the Wilcoxon Signed Ranks Test. The paired t-test was used for the Numerical Pain Rating Scale -101 Questionnaire and the Algometer Readings (intra-group analysis). Inter-group analysis of the short-form McGill Pain Questionnaire was done using the Mann Whitney unpaired Utest. The unpaired t-test was used for the Numerical Pain Rating Scale-l 0 I Questionnaire and the Algometer Readings (inter-group analysis). a was set at a 0.05 level of significance. The results were illustrated by means of tables and / M

M.Tech.

Scoliosis is a three dimensional deformity in which the spine deviates from the normal sagittal and coronal position in upright posture and becomes fixed in an unbalanced posture. The aetiology is poorly understood, however the spinal deformity is a problematic developmental process, the outcome of which can be altered with appropriate intervention. There is some evidence in the literature that scoliosis is reversible. Asymmetric loading is the driving force for development and progression of curvatures. Progression of curvatures is related to growth potential, magnitude of the curve and bone age. Curves that are not managed result in signs and symptoms of pain, deformity, pulmonary dysfunction and psychological distress. For many cases that end up in surgery, spinal fusion fails to address the significant clinical symptoms of spinal deformity. The complications of surgery are high. There is controversy as to whether conservative management of wearing a brace and exercises are effective in stabilising the curve. Past studies have shown that exercises alone do not improve the curve. Studies have also shown that a brace only prevents progression of the curve and the efficiency of the brace is not clear. Guidelines for brace wearing have not been given in the literature. High correction bracing has however been shown to have favourable outcomes when patients are compliant. The aim of this study was therefore to determine the effect of compliance to the RSC brace and a specific exercise programme on idiopathic scoliosis curvature. Further objectives were to determine factors affecting compliance to the treatment protocol. The quality of life and psychological traits of compliant subjects and non compliant subjects during the study were established and compared. To achieve these objectives a pre test /post test study design was used with a post study comparison between subjects who complied with the management and those who did not comply. Fifty one subjects, girls aged 12-16 years were drawn from a private physiotherapy practice in Randburg, South Africa referred by different orthopaedic surgeons. Cobb angles were between 20-50 degrees and subjects had no prior treatment. Subjects were divided into two groups after the brace and exercise interventions were complete and when weaning out of the brace had begun. Subjects were allocated to the two groups according to their compliance. The compliant group was defined as those subjects who wore the brace 20 or more hours a day and exercised three or more times per week. The non-compliant group were those subjects who wore the brace less than 20 hours a day and exercised less than three times per week. The study was terminated the day the subjects started weaning out of the brace. The two study groups were compared with respect to the Cobb angle, kyphotic and lordotic angle, apical vertebral rotation, scoliometer measures, peak flow, quality of life and personality traits. The subjects in both groups were well matched at baseline. The compliant group, who wore the brace 21.5 hours per day and exercised four times a week, significantly improved in all measures compared to non compliant subjects, who wore the brace 12 hours per day, exercised 1.7 times a week and significantly deteriorated. The non compliant group followed the natural history of progression of IS curvatures. The major Cobb angles in the compliant group improved 10.19° (±5.5) and deteriorated 5.52°(±4.3) in the non compliant group. Compliant subjects had a significantly better quality of life than the non compliant subjects. Vitality, physical functioning, self esteem, bodily pain, school activity and general health perception, emotional function were significantly better in the compliant group compared to the non compliant group. The compliant group were significantly more emotionally mature, stable and realistic than the non compliant group. In conclusion good compliance to a conservative treatment programme of the RSC brace and a specific regime of exercises resulted in a significant improvement in curvatures, poor compliance resulted in progression/deterioration. A poorer quality of life in the non compliant group possibly was caused by personality traits of the group, being more emotionally immature and unstable. Possibly different personality traits have different psychosocial coping mechanisms and when put in a stressful situation, result in different levels of compliance. A personality trait questionnaire is recommended on subjects initially, to predict compliance and then to include psychological support if required. This conservative treatment programme can be offered to patients all over South Africa and Africa. The patients only have to visit the physiotherapist and brace technician once a month and in some cases every three months. Further studies are required on the long term effects of this conservative treatment programme. Scoliosis is a complex condition of the developing child, and their psychosocial coping mechanisms need further research to improve compliance.

The low back loading to which an individual is exposed has been linked to injury and the reporting of low back pain. Despite extensive research on the spine and workplace loading exposures, statistics indicate that efforts to date have not led to large reductions in the reporting of these injuries. One possible cause for the apparent ineffectiveness of interventions may be a poorly defined understanding of the mechanical exposures of the spine during work related activities. There are sophisticated models that can predict spine loads and are responsive to how an individual moves and uses their muscles, however the models are complex and require extensive data collection to be implemented. This fact has prevented these models from being employed in industrial settings and the simplified surrogate methods that are being employed may not be predicting load exposures well. Therefore, this work focused on examining surrogate methods that can produce estimates of spine loading equal to our most complex laboratory based models. In addition, our understanding of spine tolerance to combined motion and load has been based upon in-vitro work that has not accurately represented coupled physiologic compression and flexion or has not investigated potentially beneficial loading scenarios. The result has been a lack of clear data indicating when motion should be treated as the primary influence in injury development or when load is the likely injury causing exposure. As a result, research was conducted to determine the interplay between load and motion in cumulative injury development, as well as investigating the potential of static rest periods in mitigating the effects of cumulative compression. Study one examined the potential utility of artificial neural networks as a data reduction approach in obtaining estimates of time-varying loads and moments equal in magnitude to those of EMG-assisted and rigid link models. It was found that the neural network approach under predicted peak force and moment exposures, but produced strong predictions of average and cumulative exposures. Therefore this method may be a viable approach to document cumulative loads in industrial settings. Study two compared the load and moment estimates from a currently employed, posture match based ergonomic assessment tool (3DMatch) to those obtained with an EMG-assisted model and those predicted with a rigid link modeling approach. The results indicated that 3DMatch over predicted peak moments and cumulative compression. However, simple correction approaches were developed which can adjust the predictions to obtain more physiologic estimates. Study three employed flexion/extension motion with repetitive compression loading profiles in an in-vitro study, with both load and motion profiles being obtained from measures in study 1. It was found that at loads above 30% of a spine’s compressive tolerance, repetitive flexion/extension would not lead to intervertebral disc injury prior to an endplate or vertebral fracture occurring. However, as loads fall below 30% the likelihood of experiencing a herniation increases, while the overall likelihood of an injury occurring decreases. Comparison to relevant studies indicated that while repetitive flexion did not alter the site of injury it appeared to degrade the ability of the spine to tolerate compression. Finally, study four employed dynamic compression while the spine was maintained in a neutral posture to investigate the effects of ‘rest’, or periods of static low level loading, on altering the amount of load tolerated prior to injury. It was found that there was a non-linear relationship between load magnitude and compressive tolerance, with increasing load magnitude exposures leading to decreasing cumulative load tolerances. Periods of low level static loading did not alter the resistance of the spinal unit to cumulative compression or impact the number of cycles tolerated to failure. In summary, this work has examined methods that may allow for better predictions of spine loading in the workplace without the large data demands of sophisticated laboratory approaches. Where possible, suggestions for optimal implementation of these surrogates have been developed. Additionally, in-vitro work has indicated a load threshold of 30%, above which herniation is not likely to occur during dynamic repetitive loading. Furthermore, the insertion of static rest periods into dynamic loading scenarios did not improve the spine’s failure tolerance to loading, indicating that care should be exercised when determining optimal loading paradigms. In combination, the applied methods that have been developed and the information regarding injury development that has been obtained will help to refine our understanding of the exposures and tolerances that define mechanical injury in the spine.

The low back loading to which an individual is exposed has been linked to injury and the reporting of low back pain. Despite extensive research on the spine and workplace loading exposures, statistics indicate that efforts to date have not led to large reductions in the reporting of these injuries. One possible cause for the apparent ineffectiveness of interventions may be a poorly defined understanding of the mechanical exposures of the spine during work related activities. There are sophisticated models that can predict spine loads and are responsive to how an individual moves and uses their muscles, however the models are complex and require extensive data collection to be implemented. This fact has prevented these models from being employed in industrial settings and the simplified surrogate methods that are being employed may not be predicting load exposures well. Therefore, this work focused on examining surrogate methods that can produce estimates of spine loading equal to our most complex laboratory based models. In addition, our understanding of spine tolerance to combined motion and load has been based upon in-vitro work that has not accurately represented coupled physiologic compression and flexion or has not investigated potentially beneficial loading scenarios. The result has been a lack of clear data indicating when motion should be treated as the primary influence in injury development or when load is the likely injury causing exposure. As a result, research was conducted to determine the interplay between load and motion in cumulative injury development, as well as investigating the potential of static rest periods in mitigating the effects of cumulative compression. Study one examined the potential utility of artificial neural networks as a data reduction approach in obtaining estimates of time-varying loads and moments equal in magnitude to those of EMG-assisted and rigid link models. It was found that the neural network approach under predicted peak force and moment exposures, but produced strong predictions of average and cumulative exposures. Therefore this method may be a viable approach to document cumulative loads in industrial settings. Study two compared the load and moment estimates from a currently employed, posture match based ergonomic assessment tool (3DMatch) to those obtained with an EMG-assisted model and those predicted with a rigid link modeling approach. The results indicated that 3DMatch over predicted peak moments and cumulative compression. However, simple correction approaches were developed which can adjust the predictions to obtain more physiologic estimates. Study three employed flexion/extension motion with repetitive compression loading profiles in an in-vitro study, with both load and motion profiles being obtained from measures in study 1. It was found that at loads above 30% of a spine’s compressive tolerance, repetitive flexion/extension would not lead to intervertebral disc injury prior to an endplate or vertebral fracture occurring. However, as loads fall below 30% the likelihood of experiencing a herniation increases, while the overall likelihood of an injury occurring decreases. Comparison to relevant studies indicated that while repetitive flexion did not alter the site of injury it appeared to degrade the ability of the spine to tolerate compression. Finally, study four employed dynamic compression while the spine was maintained in a neutral posture to investigate the effects of ‘rest’, or periods of static low level loading, on altering the amount of load tolerated prior to injury. It was found that there was a non-linear relationship between load magnitude and compressive tolerance, with increasing load magnitude exposures leading to decreasing cumulative load tolerances. Periods of low level static loading did not alter the resistance of the spinal unit to cumulative compression or impact the number of cycles tolerated to failure. In summary, this work has examined methods that may allow for better predictions of spine loading in the workplace without the large data demands of sophisticated laboratory approaches. Where possible, suggestions for optimal implementation of these surrogates have been developed. Additionally, in-vitro work has indicated a load threshold of 30%, above which herniation is not likely to occur during dynamic repetitive loading. Furthermore, the insertion of static rest periods into dynamic loading scenarios did not improve the spine’s failure tolerance to loading, indicating that care should be exercised when determining optimal loading paradigms. In combination, the applied methods that have been developed and the information regarding injury development that has been obtained will help to refine our understanding of the exposures and tolerances that define mechanical injury in the spine.