Anterior cervical discectomy and fusion (ACDF) is one of the most common cervical spine surgery procedures performed worldwide. ACDF utilizes autologous bone graft (autograft) from the iliac crest to induce fusion between neighboring vertebrae following the procedure. The iliac crest is widely considered the gold-standard autograft for ACDF procedures due to its osteoinductive, osteoconductive, and osteointegrative properties. However, harvesting from a second surgical site, as seen with iliac crest autograft, is commonly associated with short- and long-term complications. To mitigate iliac crest harvest site complications, a novel autograft location must be identified. The adjacent cervical vertebral body has been identified as a potential alternative donor site to the iliac crest. Previous studies have shown that this novel autograft site does not biomechanically compromise the vertebral body harvest site and has demonstrated clinically successful fusion rates comparable to those of the iliac crest. Despite prior successful fusion, a direct morphological and mechanical comparison between autograft from the adjacent cervical vertebra and iliac crest has not been thoroughly investigated. The primary goal of this thesis was to morphologically and mechanically compare the cervical spine and iliac crest. It was hypothesized that the cervical spine and iliac crest would not significantly vary in their morphological properties; however, due to daily physiological loading at each graft location, it was hypothesized that the two graft locations would differ mechanically. A clinical model utilizing iliac crest and cervical vertebral bone from human donors was characterized at the meso- and microscale to quantify morphological properties and collagen organization using micro-computed tomography (microCT) and second-harmonic generation (SHG) imaging modalities, respectively. A pre-clinical large animal model was used to characterize the mechanical and material properties of lumbar spine tissue, under similar physiological loading as the cervical spine, relative to the iliac crest through uniaxial compression testing. No significant difference was identified in the morphological and collagen organization properties in tissue from a human clinical cohort; however, directionality and anatomical location significantly impacted the mechanical and material properties in a bovine comparative anatomy model. Here, trabecular bone from the lumbar vertebra was found to be transversely isotropic whereas iliac crest trabecular bone was nearly isotropic; thus, directionality and anatomical location should be considered and quantified when selecting autograft tissue for future ACDF surgeries. Further characterization of the mechanical properties of cervical vertebral tissue and determination of correlations between directionality, anatomical location, and morphology through microCT and compression testing should be completed before adopting the cervical vertebra as the gold standard autograft for ACDF procedures. / Master of Science / Anterior cervical discectomy and fusion (ACDF) is a common upper spine surgery that helps to stabilize the spine by fusing two or more vertebrae together. To achieve this fusion, surgeons often use bone grafts taken from the patient's own hip, specifically the iliac crest. While this method is effective, it can lead to complications at the hip bone harvest site. To avoid these complications, researchers are exploring the possibility of using bone from a nearby vertebra in the upper spine as an alternative graft source. Early studies suggest that using bone from the upper spine does not weaken the spine and achieves similar success rates in fusion as the hip bone. However, a detailed comparison between both graft sites has not been thoroughly investigated until now. The main goal of this thesis was to compare the bone from the upper spine and the hip in terms of structure and strength. It was expected that the two types of bone would be similar in structure but different in strength due to difference forces they experience in the body. The research involved examining human bone samples from both the upper spine and hip using advanced imaging techniques to analyze their structure and collagen organization. Additionally, a large animal comparative model was used to test the strength and material properties of bone from the lower spine and hip, which experience similar forces as the human upper spine and hip. The findings showed no significant difference in the structure and collagen organization of the human bone samples. However, in the animal model, the strength and material properties of the bone significantly varied depending on the direction and location. Bone from the lower spine was found to be significantly stronger in one direction in comparison to two other directions in the lower spine and all three directions in the hip. These results suggest that when choosing bone for fusion in ACDF surgeries, it is important to consider the direction and location of the graft. Further research is needed to fully understand the mechanical properties of upper spine bone and to confirm its suitability as a standard graft for ACDF procedures.

Yes / Lumbar radiographs remain a common imaging examination despite strategies to reduce their use. Many authors have demonstrated benefits in changing from traditional supine and recumbent lateral projections to a prone and/or erect orientation. Despite evidence of clinical and radiation dose optimisation, widespread adoption of these strategies has stalled. This article describes the single-centre implementation and evaluation of erect PA and lateral projections. This was an observational study pre- and post-implementation of an erect imaging protocol. Patient BMI, image field size, source image and source object distances and DAP were collected together with assessment of radiographic spinal alignment and disc space demonstration. Effective dose was calculated with organ specific doses. 76 (53.5%) patients were imaged in the supine AP and recumbent lateral position, 66 (46.5%) had erect PA and lateral radiographs. Despite the larger BMI of the erect cohort and similar field sizes, effective dose was lower in the PA position by an average of 20% (p

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2011. / Introduction: Radiographic parameters of the cervical spine are utilized by chiropractors and spinal surgeons for making diagnoses and determining management protocols. However several researchers have reported discrepancies in these parameters which need to be investigated across ethnic groups and gender. Aim: To evaluate the normal selected cervical spine radiographic parameters i.e. the cervical lordosis (CL), sagittal canal diameter (SCD), interpedicular distance (IPD), and the cervical gravity line (CGL) in apparently healthy young to middle-aged males across four ethnic groups in Durban, KwaZulu Natal. Participants: Eighty healthy male participants between 18 and 45 years of age of White, Black, Indian and Coloured ethnicity. Methodology: A case history, physical examination and an orthopedic assessment of the cervical spine was conducted for each participant. Study-specific data such as age, ethnicity, weight and height were recorded. A lateral and an A-P radiograph of the cervical spine was taken of each participant. Selected radiographic parameters viz. SCD, IPD, CL, CGL were assessed and recorded. SPSS version 15.0 (SPSS Inc., Chicago, Illinois, USA) was used for data analysis. Results: The mean (± SD) values of the CL, SCD and IPD are shown in the table below for the respective ethnic groups Parameter Ethnic Group Black (Mean (± SD)) White(Mean (± SD)) Indian(Mean (± SD)) Coloured (Mean (± SD)) CL° (C1-C7 method) 42.6° (± 9.6°) 46.2° (± 11.0°) 46.5° (± 11.3°) 47.7° (± 9.1°) CL° (C2-C7 method) 15.1° (± 6.4°) 17.4° (± 9.3°) 13.1° (± 10.2°) 18.1° (± 10.4°) SCD (mm) C2 22.1mm (± 1.6) 24.1mm (± 1.4) 22.8mm (± 1.7) 22.9mm (± 1.5) C3 19.5mm (± 1.6) 20.6mm (± 1.4) 19.7mm (± 1.6) 20.0mm (± 1.5) C4 18.6mm (± 1.9) 19.9mm (± 1.3) 19.1mm (± 1.6) 19.5mm (± 1.3) C5 18.9mm (± 1.8) 20.0mm (± 1.5) 19.3mm (± 1.7) 19.8mm (± 1.6) C6 18.8mm (± 1.7) 20.4mm (± 1.5) 19.5mm (± 1.6) 20.0mm (± 1.8) iv C7 18.5mm (± 1.7) 20.3mm (± 1.5) 19.4mm (± 1.6) 19.7mm (± 1.9) IPD (mm) C3 28.2mm (± 1.2) 28.9mm (± 1.8) 27.8mm (± 1.1) 29.1mm (± 1.4) C4 28.6mm (± 1.4) 29.6mm (± 1.8) 28.5mm (± 1.4) 29.5mm (± 1.6) C5 29.4mm (± 1.2) 30.0mm (± 1.7) 28.8mm (± 1.2) 30.1mm (± 1.5) C6 29.3mm (± 1.6) 30.7mm (± 1.6) 30.0mm (± 1.6) 30.1mm (± 1.5) C7 29.3mm (± 1.2) 30.1mm (± 1.5) 29.6mm (± 1.6) 30.3mm (± 1.9) There was anterior placement of the CGL in 60% of the Black ethnic group, 45% of the White ethnic group, 55.6% of the Indian ethnic group and 52.6% of the Coloured ethnic group. No significant differences in mean CL was observed across the four ethnic groups for both methods utilized (p > 0.05). The significant differences in SCD lay between the White and Black ethnic groups at C2, C6 and C7 (p = 0.002, 0.030 and 0.017, respectively, ANOVA). The C3 and C5 IPD varied significantly between the Coloured and Indian ethnic group (p = 0.048 and 0.027, respectively, ANOVA). The CGL was not influenced by the CL in all the ethnic groups. Conclusion: Significant differences were observed between ethnic groups for the SCD and IPD. These will assist South African health care practitioners with patient management within these ethnic groups when diagnosing spinal stenosis and tumors. A larger South African based population should be evaluated to confirm the trends observed utilizing digitized diagnostic imaging modalities including radiographs, CT and MRI scans as errors may occur during manual assessment of conventional radiographs.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2012. / Aim: To evaluate the normal selected cervical spine radiographic parameters i.e. the cervical lordosis (CL), sagittal canal diameter (SCD), interpedicular distance (IPD) and cervical gravity line (CGL) in asymptomatic young to middle-aged females across four ethnic groups (Black, White, Indian and Coloured) in Durban, KwaZulu Natal, South Africa. Participants: Eighty apparently healthy females between the ages of 18 and 45 years from the Black, Indian, Coloured and White ethnic groups in Durban, KwaZulu Natal. Methodology: Written informed consent was obtained from each participant. A case history, physical examination and an orthopaedic assessment of the cervical spine was conducted for each participant. Study specific data such as ethnicity, age, height and weight was recorded. A lateral and an A-P radiograph of the cervical spine were taken for each participant. The selected radiographic parameters viz. cervical lordosis (CL), sagittal canal diameter (SCD), interpedicular distance (IPD) and cervical gravity line (CGL) were evaluated according to methods described previously. SPSS version 15.0 (SPSS Inc., Chicago, Illinois, USA) was used for data analysis. Coefficients of variation were calculated within ethnic groups to assess intra-group variation. Inter-group variation was assessed using ANOVA testing with Bonferroni-adjusted post-hoc tests in the case of a significant ANOVA test. Pearson’s chi square test was used to assess the association between ethnic groups and position of the CGL. T-tests were used to compare mean CL between those with anterior and normally placed CGL within each ethnic group. Results: The mean ± SD of the CL in South African females by ethnic group using the C1-C7 and C2- C7 methods CERVICAL LORDOSIS (mean ± SD) (°) ETHNICITY C1-C7 C2-C7 Black 42.1° (±13.4) 16.3° (±8.3) White 37.4° (±10.3) 9.9° (±4.8) Indian 33.7° (±9.7) 6.9° (±4.8) Coloured 42.5°(±10.9) 12.1° (±9.5) The mean ± SD of the SCD in South African females by ethnic group SAGITTAL CANAL DIAMETER (mean ±SD)(mm) ETHNICITY Black White Indian Coloured SCDC2 SCDC3 SCDC4 SCDC5 SCDC6 SCDC7 20.2 (±1.7) 17.4 (±1.4) 17.2 (±1.4) 17.0 (±1.4) 17.6 (±1.3) 17.5 (±1.4) 20.8 (± 2.2) 17.9 (±1.6) 17.6 (±1.6) 17.4 (±1.6) 17.6 (±1.4) 21.0 (±2.0) 18.2 (±1.7) 17.5 (±1.5) 17.4 (±1.7) 17.6 (±1.6) 17.1 (±1.5) 20.3 (±1.6) 17.5 (±1.8) 17.4 (±1.5) 17.7 (±1.2) 17.6 (±1.3) 16.9 (±1.2) 16.9 (±1.4) The mean ± SD of the IPD in South African females by ethnic group INTERPEDICULAR DISTANCE (mean ±SD)(mm) ETHNICITY IPDC3 IPDC4 IPDC5 IPDC6 IPDC7 Black 27.0 (±2.8) 27.6 (±3.2) 28.2 (±4.0) 28.9 (±4.2) 27.5 (±3.5) White 28.4 (±2.6) 28.8 (±2.2) 29.5 (±2.3) 29.3 (±2.5) 28.2 (±2.9) Indian 27.2 (±1.8) 27.5 (±1.8) 27.9 (±1.6) 27.9 (±1.6) 27.5 (±2.0) Coloured 27.9 (±2.3) 27.8 (±2.3) 28.3 (±2.2) 28.4 (±1.8) 28.2 (±1.7) The placement of the CGL in South African females in each ethnic group CERVICAL GRAVITY LINE ETHNICITY PLACEMENT OF CGL Black 70% anterior placement White 70% anterior placement Indian 60% anterior placement Coloured 60% anterior placement The C1-C7 measurements and the C2-C7 CL measurements were significantly different amongst the ethnic groups. For the C2-C7 method, Blacks differed significantly from both Whites (p = 0.037) and Indians (p = 0.001; Bonferroni adjusted post-hoc test); with the values for the Blacks being higher than both Whites and Indians. There was no correlation between CL and BMI amongst any of the selected ethnic groups. There were no significant differences in the mean SCD and IPD amongst the ethnic groups (p > 0.05; ANOVA test). There was no significant association between any ethnic group and the position of the CGL (p = 0.830; Pearson’s chi square test). In Black females, those with a normally positioned CGL had significantly higher C2-C7 CL measurements (p = 0.008; T- tests). There was no correlation between the CL and anterior placing of the CGL in any of the ethnic groups. Conclusion: No individual differences were observed in the CL amongst the ethnic groups when using the C1-C7 method. However, significant differences were observed when the C2-C7 method was used. There were no significant differences observed in the mean SCD and IPD amongst the ethnic groups. In Black females, those with a normally positioned CGL had significantly higher C2-C7 CL measurements. The trends observed in this research study and the differences in the findings to those of previous studies lay the platform for a larger population-based study across South Africa to establish normative reference values for each radiographic parameter specific for gender and ethnicity.

Procurou-se avaliar a sensibilidade e a reprodutibilidade da escala funcional de Basso, Beattie e Bresnahan (escala BBB) para a avaliação da capacidade locomotora dos ratos após lesão medular. A escala BBB é uma medida preditiva baseada em critérios observacionais específicos da movimentação do animal durante a marcha e que atribui uma pontuação seqüencial e acumulativa correspondente aos critérios pré-estabelecidos satisfeitos. Submeteram-se 30 ratos Wistar à laminectomia e à contusão medular leve, moderada e grave produzida pelo equipamento computadorizado de impacto por queda de peso desenvolvido pela Universidade de Nova Iorque (NYU Weight-Drop Impactor). No 28º dia após a contusão medular, cada rato foi colocado numa caixa transparente (80x80x30cm), com o fundo e a parede posterior forrados com material antiderrapante escuro e estimulado a se movimentar. A movimentação de cada rato foi registrada, simultaneamente, por 3 câmeras digitais e, após a edição, cópias idênticas dos filmes foram encaminhadas à seis pesquisadores independentes, sem a informação sobre a gravidade da lesão correspondente de cada rato, para a determinação da capacidade locomotora segundo a escala funcional de Basso, Beattie e Bresnaham. Verificou-se a sensibilidade do método para detectar diferenças entre os resultados das patas do lado esquerdo e direito, entre os ratos submetidos a lesões leves, moderadas e graves e entre os avaliadores através de comparações dos resultados funcionais e a reprodutibilidade através de testes de correlação. A escala BBB apresenta: a) nas lesões leves sensibilidade satisfatória e elevada reprodutibilidade; b) nas lesões moderadas a sensibilidade é insatisfatória e a reprodutibilidade satisfatória, porém moderada; c) sensibilidade insatisfatória e redução da reprodutibilidade. / An assessment of the sensitivity and reproducibility of the Basso, Beattie and Bresnahan functional scale (BBB scale) was carried out, to evaluate the locomotion capacity following spinal cord injury. The BBB scale is a predictive procedure based on specific observational criteria of the locomotion of the animal under way, which attributes a sequential and cumulative score corresponding to satisfied pre-established criteria. 30 Wistar rats underwent laminectomy and light, moderate and severe spinal cord injury generated by the computerized equipment of impact through weight-drop developed by the University of New York (NYU Weight-Drop Impactor). At day 28 following the spinal cord injury, each rat was placed into a transparent box (80x80x30cm), with the bottom and the posterior wall lined with dark anti-slip material, and stimulated to move. The locomotion of each rat was recorded, simultaneously, by 3 digital cameras and, after editing, identical copies of the films were sent to six independent researchers, with no information regarding the severity of the injure in each rat, for determining the locomotory capabilities according to the Basso, Beattie and Bresnahan scale. The sensitivity of the method was verified for detecting differences between the results obtained from the left and right-side paws, among the rats subjected to light, moderate and severe injuries and among the evaluators through comparisons of the functional results and the reproducibility through correlation tests.

Bibliography: leaves 160-171. / xii, 171 leaves, [9] leaves of plates : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Evaluates the effect of an anterior surgical approach and antero-lateral inter-body fusion of the cervical spine on spinal cord blood flow and electrical function using a sheep model. / Thesis (M.D.)--University of Adelaide, Dept. of Orthopaedic Surgery & Trauma, 1993?

Made available in DSpace on 2014-06-11T19:34:58Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-02Bitstream added on 2014-06-13T20:45:40Z : No. of bitstreams: 1 santos_rs_dr_guara.pdf: 2269496 bytes, checksum: 15510607497762c601558887cb80984f (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A mobilização póstero-anterior consiste numa técnica de terapia manual que tem a finalidade de detectar alterações no padrão normal e na amplitude dos movimentos das articulações intervertebrais em pacientes com lombalgia. Mecanicamente, define-se como uma sobrecarga de inclinação de três pontos e, embora, o procedimento de aplicação desta técnica tenha sido descrito, caracteriza-se por um método subjetivo de análise clínica. No sentido de buscar um melhor esclarecimento acerca dos aspectos mecânicos envolvidos na mobilização póstero-anterior, foi desenvolvido um dispositivo eletromecânico, para análise in vivo da rigidez segmentar póstero-anterior da coluna lombar. Tal aparato compõe-se essencialmente de um suporte de sustentação com dois graus de liberdade (x, y) integrado a um motoredutor de corrente contínua acoplado a um pino guia e fixo a uma maca especialmente adaptada. Permite o controle preciso da intensidade, direção e velocidade da força aplicada, além da mensuração da amplitude do deslocamento intervertebral. Os resultados demonstraram que o instrumento desenvolvido apresenta a possibilidade de uma análise quantitativa acurada, em termos de rigidez segmentar na coluna lombar, indicando um grau de confiabilidade significativo para os dados obtidos em testes de repetibilidade (ICC > 0,80). Foi demonstrado haver diferença estatisticamente significativa (p<0,05) entre os valores médios dos graus de rigidez dos níveis vertebrais analisados (LI, LII, LIII, LIV e LV) em 10 sujeitos avaliados. Deste modo, é importante que seja questionado o conceito da comparação do grau de rigidez entre os diferentes níveis vertebrais, num mesmo sujeito, para critério de diagnóstico. / The posteroanterior motion test consists of a manual therapy technique to assess the range of motion and stiffness parameters of intervertebral joints in subjects with low back pain. Mechanically, it is defined as a three point bending loading. Although, has been described the technique procedure of the posteroanterior motion test, it is characterized by a subjective method of clinical analysis. In the quest to better understand concerning the mechanical aspects of posteroanterior motion test was developed a mechanical device for assessment the response of the lumbar spine to a posteroanterior pressure in vivo. Essentially, such apparatus is composed of a sustentation support with two degrees of freedom (x, y) fixed to a couch especially adapted and integrated to a continuous current motor and a guidance pin. It allows variables such as force, frequency of oscillation and displacement to be precisely controlled. The results demonstrated high reliability (ICC > 0,80) of the measures obtained in test and re-test. So, the instrument developed presents the prospect of an accuracy quantitative analysis of intervertebral posteroanterior stiffness in lumbar spine. There was statistically significant difference (p<0,05) amongst the means of stiffness coefficients of the vertebral levels analyzed (LI, LII, LIII, LIV and LV) in 10 subjects evaluated. Therefore, its is important to be questioned the concept of the comparison of stiffness in different vertebral levels in a same subject for diagnosis criterion.

Orientador: Tamotsu Hirata / Banca: José Elias Tomazini / Banca: José Geraldo Trani Brandão / Banca: Rubens Corrêa Araújo / Banca: Mauro Gonçalves / Resumo: A mobilização póstero-anterior consiste numa técnica de terapia manual que tem a finalidade de detectar alterações no padrão normal e na amplitude dos movimentos das articulações intervertebrais em pacientes com lombalgia. Mecanicamente, define-se como uma sobrecarga de inclinação de três pontos e, embora, o procedimento de aplicação desta técnica tenha sido descrito, caracteriza-se por um método subjetivo de análise clínica. No sentido de buscar um melhor esclarecimento acerca dos aspectos mecânicos envolvidos na mobilização póstero-anterior, foi desenvolvido um dispositivo eletromecânico, para análise in vivo da rigidez segmentar póstero-anterior da coluna lombar. Tal aparato compõe-se essencialmente de um suporte de sustentação com dois graus de liberdade (x, y) integrado a um motoredutor de corrente contínua acoplado a um pino guia e fixo a uma maca especialmente adaptada. Permite o controle preciso da intensidade, direção e velocidade da força aplicada, além da mensuração da amplitude do deslocamento intervertebral. Os resultados demonstraram que o instrumento desenvolvido apresenta a possibilidade de uma análise quantitativa acurada, em termos de rigidez segmentar na coluna lombar, indicando um grau de confiabilidade significativo para os dados obtidos em testes de repetibilidade (ICC > 0,80). Foi demonstrado haver diferença estatisticamente significativa (p<0,05) entre os valores médios dos graus de rigidez dos níveis vertebrais analisados (LI, LII, LIII, LIV e LV) em 10 sujeitos avaliados. Deste modo, é importante que seja questionado o conceito da comparação do grau de rigidez entre os diferentes níveis vertebrais, num mesmo sujeito, para critério de diagnóstico. / Abstract: The posteroanterior motion test consists of a manual therapy technique to assess the range of motion and stiffness parameters of intervertebral joints in subjects with low back pain. Mechanically, it is defined as a three point bending loading. Although, has been described the technique procedure of the posteroanterior motion test, it is characterized by a subjective method of clinical analysis. In the quest to better understand concerning the mechanical aspects of posteroanterior motion test was developed a mechanical device for assessment the response of the lumbar spine to a posteroanterior pressure in vivo. Essentially, such apparatus is composed of a sustentation support with two degrees of freedom (x, y) fixed to a couch especially adapted and integrated to a continuous current motor and a guidance pin. It allows variables such as force, frequency of oscillation and displacement to be precisely controlled. The results demonstrated high reliability (ICC > 0,80) of the measures obtained in test and re-test. So, the instrument developed presents the prospect of an accuracy quantitative analysis of intervertebral posteroanterior stiffness in lumbar spine. There was statistically significant difference (p<0,05) amongst the means of stiffness coefficients of the vertebral levels analyzed (LI, LII, LIII, LIV and LV) in 10 subjects evaluated. Therefore, its is important to be questioned the concept of the comparison of stiffness in different vertebral levels in a same subject for diagnosis criterion. / Doutor

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2018. / Background: The World Spine Care (WSC) is a non-governmental organization that provides evidence-based spinal care to underserved communities around the world. The WSC opened a clinic in the Mahalapye District Hospital (MDH) in 2011 (Haldeman et al., 2015:2304). The WSC aims for long term presence in Botswana. They will require ‘buy in’ from the local community including the health care professionals of the region. Little is known about how WSC has been received by other health care professionals in the settings where they are present. Hence, this study aimed to determine the knowledge, attitudes and perceptions of health care professionals working at the MDH about the WSC. Method: A qualitative exploratory descriptive study was conducted using semi-structured interviews. Twenty health care professionals were interviewed at the Mahalapye District Hospital to ascertain their levels of knowledge, attitudes and perceptions. The interviews were semi- structured and conducted in English and later transcribed verbatim. The transcripts were then analyzed using the thematic analysis described by Graneheim and Lundman (2003:105). Thereafter codes, categories and themes were formed. Results: A variety of health care professionals from different departments were interviewed. Three overarching themes emerged from the data: knowledge of WSC and the management of spinal related disorders at the MDH, the perceived role of WSC, challenges to integration and possible solutions. The HCPs had varying levels of knowledge of the WSC depending on the amount of interaction they had with WSC. Some HCPs who had greater inter-professional interaction with WSC displayed more positive attitudes towards WSC. Many of the HCPs had a positive perception of the WSC though they were not confident in their knowledge of the WSC scope of practice which has limited referral by HCPs WSC. This is mainly due to an unclear referral pathway within the hospital and limited knowledge of WSC’s scope of practice. Increased awareness and an improved system of referral was a strong recommendation made. Many mentioned an unclear referral pathway for their patients. Those who had interacted with WSC generally had pleasant personal interactions with the WSC. Several of the HCPs had themselves been patients of the WSC. Most HCPs felt that WSC was beneficial to patients and made suggestions for WSC to expand to other centres across Botswana. Conclusion: Overall there was a positive perception of WSC however more effort to increase knowledge of what WSC offers and how it can be integrated into the hospital is necessary. Future studies should assess the perceptions of patients as well as knowledge and attitudes of HCPs towards WSC at other sites. / M

Procurou-se avaliar a sensibilidade e a reprodutibilidade da escala funcional de Basso, Beattie e Bresnahan (escala BBB) para a avaliação da capacidade locomotora dos ratos após lesão medular. A escala BBB é uma medida preditiva baseada em critérios observacionais específicos da movimentação do animal durante a marcha e que atribui uma pontuação seqüencial e acumulativa correspondente aos critérios pré-estabelecidos satisfeitos. Submeteram-se 30 ratos Wistar à laminectomia e à contusão medular leve, moderada e grave produzida pelo equipamento computadorizado de impacto por queda de peso desenvolvido pela Universidade de Nova Iorque (NYU Weight-Drop Impactor). No 28º dia após a contusão medular, cada rato foi colocado numa caixa transparente (80x80x30cm), com o fundo e a parede posterior forrados com material antiderrapante escuro e estimulado a se movimentar. A movimentação de cada rato foi registrada, simultaneamente, por 3 câmeras digitais e, após a edição, cópias idênticas dos filmes foram encaminhadas à seis pesquisadores independentes, sem a informação sobre a gravidade da lesão correspondente de cada rato, para a determinação da capacidade locomotora segundo a escala funcional de Basso, Beattie e Bresnaham. Verificou-se a sensibilidade do método para detectar diferenças entre os resultados das patas do lado esquerdo e direito, entre os ratos submetidos a lesões leves, moderadas e graves e entre os avaliadores através de comparações dos resultados funcionais e a reprodutibilidade através de testes de correlação. A escala BBB apresenta: a) nas lesões leves sensibilidade satisfatória e elevada reprodutibilidade; b) nas lesões moderadas a sensibilidade é insatisfatória e a reprodutibilidade satisfatória, porém moderada; c) sensibilidade insatisfatória e redução da reprodutibilidade. / An assessment of the sensitivity and reproducibility of the Basso, Beattie and Bresnahan functional scale (BBB scale) was carried out, to evaluate the locomotion capacity following spinal cord injury. The BBB scale is a predictive procedure based on specific observational criteria of the locomotion of the animal under way, which attributes a sequential and cumulative score corresponding to satisfied pre-established criteria. 30 Wistar rats underwent laminectomy and light, moderate and severe spinal cord injury generated by the computerized equipment of impact through weight-drop developed by the University of New York (NYU Weight-Drop Impactor). At day 28 following the spinal cord injury, each rat was placed into a transparent box (80x80x30cm), with the bottom and the posterior wall lined with dark anti-slip material, and stimulated to move. The locomotion of each rat was recorded, simultaneously, by 3 digital cameras and, after editing, identical copies of the films were sent to six independent researchers, with no information regarding the severity of the injure in each rat, for determining the locomotory capabilities according to the Basso, Beattie and Bresnahan scale. The sensitivity of the method was verified for detecting differences between the results obtained from the left and right-side paws, among the rats subjected to light, moderate and severe injuries and among the evaluators through comparisons of the functional results and the reproducibility through correlation tests.