Thesis (MEng) -- Stellenbosch University, 2014. / ENGLISH ABSTRACT: The Dorsiflexometer is a device designed and built for the assessment of a patient’s balance capabilities. The birth of the Dorsiflexometer is due to a serious need for physiological balance assessment equipment, capable of conducting dynamic tests in the clinical setting. This is accomplished by recording and analysing the patient’s response to sagittal plane perturbations. The Dorsiflexometer is operated from a computer software interface program. It uses the measurements from a single force plate to calculate four balance metrics’ characterising a patient’s ability to maintain balance. These balance metrics include the sway index, equilibrium score, postural stability index and radius parameter. A single and a double inverted pendulum model of the human body is derived to calculate a patient’s centre of mass movement in the sagittal plane with the measured force plate data and body parameters. Three experiments, involving 48 subjects, were conducted. The experimental tests proved the competency of the machine, the accuracy of both inverted pendulum models and the balance response of seafarers aboard an Antarctic research and supply vessel during rough sea conditions. The tests concluded that the inverted pendulum models can be used to calculate the body centre of mass displacement. The double inverted pendulum model results are more accurate compared with the single inverted pendulum model. During rough sea conditions, the body movement and postural response of seafarers are increased in order to keep themselves upright. The body is furthermore exposed to a fluctuating ground reaction force which may lead to the progression of osteoarthritis and musculoskeletal injuries. The Dorsiflexometer proved to be capable of conducting repeatable assessments and yielding accurate results which can be used to distinguish between balance capabilities. / AFRIKKANSE OPSOMMING: Die Dorsiflexometer is ’n apparaat wat die balansvermoë van pasiënte analiseer. Die masjien is ontwerp en vervaardig weens die groot behoefte aan fisiologiese balans assesserings toerusting wat dinamiese toetse in die mediese sektor kan bepaal. Dit word bereik deur pasiënte se liggaamsreaksie in die sagittale vlak te meet en te assesseer. Die Dorsiflexometer is beheerbaar vanaf ’n rekenaar sagteware koppelvlak program. Die masjien maak gebruik van ’n enkele kragplaat om pasiënte se balans statistieke te meet. Hierdie balans statistieke wat die pasiënte se balans vermoë beskryf en karakteriseer behels die sogenaamde: swaai indeks, balans telling, posturale stabiliteit indeks en die radius parameter. ’n Enkel en dubbel inverse slinger model van die liggaam is afgelei. Hierdie modelle maak gebruik van ’n pasiënt se kragplaat metings en sy liggaamlike parameters om die swaartepunt tydens beweging te bereken. Drie eksperimente, waarin 48 persone betrokke was, is gedoen. Die eksperimente is gedoen om die apparaat se bevoegdheid te bewys, die akkuraatheid van altwee inverse slinger modelle te toets en verder die balans van seevaarders op die Antarktiese navorsings en toevoer skip tydens rowwe see toestande te analiseer. Die toetse het bewys dat die inverse modelle gebruik kan word om die liggaam se swaartepunt te bereken. Die dubbel inverse slinger model resultate is wel akkurater as die enkel slinger model. Daar is bevind dat seevaarders van meer liggaamsbeweging en posturale reaksies gebruik moet maak om orent te bly tydens rowwe seetoestande. Verder word hul liggame blootgestel aan ’n wisselende grond reaksie krag wat kan lei tot die ontwikkeling van osteoarthritis en muskuloskeletale beserings. Die Dorsiflexometer is bewys as ’n aparaat wat wat akurate resultate lewer vir herhaalbare assesserings. Dit kan gebruik word om te onderskei tussen verskillende balans vermoëns.

Thesis (PhD (Industrial Engineering))--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Back pain is a common concern amongst a growing population of people across the world today, where in most cases the pain can become unbearable resulting in major lifestyle adjustments. Seventy to eighty percent of the population of the Western world experiences low-back pain at one time or another. Pain can be produced as a worn disc becomes thin, narrowing the space between the vertebrae. Pieces of the damaged disc may also break off and cause irritation to the nerves signalling back pain. Depending on the severity of a patient’s condition, and after conservative treatment options have been exhausted, a disc replacement surgery (arthroplasty) procedure may be prescribed to restore spacing between vertebrae and relieve the pinched nerve, while still maintaining normal biomechanical movement. Typical complications that are however still observed in some cases of disc implants include: anterior migration of the disc, subsidence (sinking of disc) and lateral subluxation (partial dislocation of a joint). Issues such as function, correct placement and orientation, as well as secure fixation of such a disc implant to the adjacent vertebrae are highly important in order to replicate natural biomechanical behaviour and minimise the occurrence of the complications mentioned. As various imaging and manufacturing technologies have developed, the option for individual, patientspecific implants is becoming more of a practical reality than it has been in the past. The combination of CT images and Rapid Manufacturing for example is already being used successfully in producing custom implants for maxilla/facial and cranial reconstructive surgeries. There exists a need to formalise a process chain for the design and manufacture of custom-made intervertebral disc implants and to address the issues involved during each step. Therefore this study has investigated the steps involved for such a process chain and the sensible flow of information as well as the use of state-of-the-art manufacturing technologies. Strong emphasis was placed on automation of some of the processes as well as the user-friendliness of software where engineers and surgeons often need to work together during this multi-disciplinary environment. One of the main benefits for customization was also investigated, namely a reduction in the risk and potential for implant subsidence. Stiffness values from pressure tests on vertebrae were compared between customized implants and implants with flat endplate designs. Results indicated a statistically significant improvement of customized, endplate matching implants as opposed to flat implant endplates. Therefore it may be concluded that the use of customized intervertebral disc implants with patient specific endplate geometry may decrease the risk and potential for the occurrence of subsidence. / AFRIKAANSE OPSOMMING: Rugpyn is ‘n algemene bekommernis vir ‘n groeiende populasie van mense in die wêreld vandag, waar in meeste gevalle die pyn ondraagbaar kan raak en groot leefstyl aanpassings vereis. Sewentig tot tagtig persent van die populasie in die Westerse wêreld ondervind lae rugpyn op een of ander stadium. Die pyn kan veroorsaak word deur ‘n intervertebrale skyf wat verweer en dunner word, en veroorsaak dat die spasie tussen die vertebrae vernou. Stukkies van die beskadigde skyf mag ook afbreek en irritasie aan die senuwees veroorsaak wat verdere pyn kan veroorsaak. Afhangende van die ernstigheid van ‘n pasiënt se geval, en nadat opsies vir konservatiewe behandeling uitgeput is, kan ‘n skyf vervangings-prosedure (artroskopie) voorgeskryf word om die spasie tussen die vertebrae te herstel en sodoende die geknypte senuwee te verlos. Die skyf vervanging herstel spasiëring tussen vertebrae terwyl die normale biomeganiese beweging ook behoue bly, in teenstelling met ‘n fusieprosedure wat die betrokke vertebrae aanmekaar vasheg en normale beweging belemmer. Tipiese komplikasies wat egter steeds na ‘n skyf vervanging in sommige gevalle waargeneem word sluit in: anterior migrasie van die inplantaat, insinking, sowel as laterale sublukasie (gedeeltelike dislokasie van ‘n gewrig). Faktore soos funksie, korrekte posisionering en orientasie, sowel as vashegting van so ‘n skyf inplantaat tot die aanliggende vertebrale bene is besonder belangrik om natuurlike biomeganiese beweging te herstel en sodoende bogenoemde komplikasies te verminder. Soos wat verskeie beeldings- en vervaardigingstegnologië verbeter het oor die laaste dekade, het die moontlikheid vir individuele, pasiënt-spesifieke inplantate al hoe meer ‘n praktiese realiteit begin word. Die kombinasie van Gerekenariseerde Tomografie (GT), tesame met Snel Vervaardiging word byvoorbeeld reeds suksesvol aangewend tydens die ontwerp en vervaardiging van pasiënt-spesifieke inplantate vir maksilla- en kraniale rekonstruktiewe chirurgie. Daar bestaan egter ‘n behoefte om ‘n formele prosesketting vir die ontwerp en vervaardiging van pasiënt-spesifieke intervertebrale skyf inplantate te ontwikkel en om belangrike faktore tydens elke stap noukeurig te beskryf. Hierdie studie het na die verskillende stappe in die prosesketting gekyk om ‘n sinvolle vloei van informasie en benutting van hoë gehalte vervaardigingstegnologië saam te snoer. Sterk klem was gelê op outomatisering van prosesse asook gebruikersvriendelikheid van sagteware waar ingenieurs en medici dikwels saam moet werk tydens hierdie kruisdissiplinêre omgewing. Een van die hoof verwagte voordele met die gebruik van pasklaar skyf inplantate, naamlik die vermindering van moontlike insinking van die inplantaat in die been, is ook ondersoek. Die ondersoek het druktoetse behels en die vergelyking van ooreenstemmende styfheid tussen inplantate wat die kontoer van die bene volg teenoor gewone plat eindplate. Die resultate was statisties beduidend in die guns van die pasklaar inplantate wat die beenkontoere gevolg het, en bewys dus dat die risiko vir insinking verminder is.

All trunk muscles are important contributors to spine stability. However, the deepest abdominal muscle, transversus abdominis (TrA), with its characteristically horizontal fibre orientation seems to serve a unique function in trunk motor control. The main mechanical role of TrA is believed to be to contribute to vertebral alignment during imposed moments on the trunk, executed mainly via either regulating the pressure level within the abdominal cavity and/or transmit forces to the spine via the thoracolumbar fascia. However, the complete function of TrA and what factors affect its activation are still not fully understood. The purpose of the present thesis was to investigate the role of TrA in trunk motor control, specifically in relation to the presence or absence of postural demand on the trunk. The timing and magnitude of TrA activation were investigated, in relation to other trunk muscles, with intramuscular fine-wire electrodes in different loading situations and body positions with varying postural demand. In a side-lying position, with no postural demand of keeping the trunk upright, the activation of TrA was delayed relative the superficial abdominal muscles compared to previous experiments performed in a standing position. The timing and magnitude of activation of TrA did not depend upon the direction of perturbation. In the standing position, different static arm positions revealed that the activation of TrA co-varied with variations in the degree of postural demand on the trunk and also the imposed moments, regardless of moment direction. Finally, a study on rapid arm flexion movements confirmed that TrA is part of the pre-programmed anticipatory response in advance of known perturbations. The activation magnitude of TrA was the same regardless if the arm movement induced flexion or extension  moments on the trunk. In conclusion, the activation of TrA is associated with the upright postural demand on the trunk and with balancing imposed moments acting on the spine, regardless their direction. The findings are in support of the beliefs that TrA act as a general, direction non specific, stabilizer of the lumbar spine.

The Behavioral Medicine Questionnare (BMQ) is a 44- item instrument administered via a computer CRT display or pencil and paper. The BMQ was designed to help primary care physicians treating spinal disorders to screen for emotional factors which warrant further psychological evaluation. The test is composed of three scales: Anxiety, Depression, and Somatization. Concurrent validity for each scale was determined through comparisons with subject (n = 133) scores on clinician judgement ratings, pain drawings, and the MMPI. The psychometric properties of the test were supported through statistical analysis. Significant correlations were found between the BMQ, MMPI, and clinician ratings, with the latter showing relationships of lesser strength. The only significant correlation to subject generated pain drawings was to the BMQ depression scale. Analysis indicated the need for seperate norms for males and females. Further research is needed to facilitate measurement and interpretation of the BMQ.

Postoperative spinal patients were randomly assigned to one of three treatment conditions and were taught five adaptive movements by occupational therapists. The Control group received routine hospital occupational therapy; the Placebo group participated in an imagery relaxation task unrelated to the mental practice task of the Imagery group, which was shown line drawings of the adaptive movements under study, provided movement instructions, and asked to mentally practice each movement in a familiar, daily living situation. Thirty-five patients returned for follow-up, and a measure of outcome was obtained through the use of a quantified movement assessment instrument. Subjective ratings for anxiety, rumination, and imagery were made by the occupational therapists. An occupational motoric-symbolic rating scale was developed to assess the symbolic portion of the patient's job experience. Statistical procedures including chi square, analysis of variance, and Pearson correlation were performed. Results were in the predicted direction although statistical significance was not achieved. Possible explanations for the obtained results were discussed.

EFFECTS OF THORACIC SPINAL MANIPULATIVE THERAPY ON THORACIC SPINE AND SHOULDER KINEMATICS, THORACIC SPINE FLEXION/EXTENSION EXCURSION, AND PRESSURE PAIN SENSITIVITY IN PATIENTS WITH SUBACROMIAL PAIN SYNDROME By Joseph R. Kardouni, Ph.D., PT A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy, at Virginia Commonwealth University. Virginia Commonwealth University, 2013. Major Director: Lori A. Michener, PhD, PT, ATC, Professor, Department of Physical Therapy In patients with shoulder pain, the use of manual therapy directed at the spine and shoulder have been reported to provide superior outcomes to exercise based interventions or usual care without the use of manual therapy. Clinical trials have also reported improved pain and disability after thoracic spinal manipulative therapy (SMT) as a stand-alone treatment for shoulder pain. Although clinical efficacy is reported for the use of thoracic SMT for the treatment of shoulder pain, the mechanisms underlying the clinical benefits are not well understood. This limits the directed use of SMT. The benefits could be due to changes in spine or shoulder motion or neurophysiologic mechanisms of pain modulation. Elucidating the mechanism of manual therapy will aid the directed use of thoracic SMT for treating patients with shoulder pain. The research described in chapters 3 and 4 was performed to assess the effects of thoracic SMT in patients with subacromial pain syndrome with regard to biomechanical changes at the thoracic spine and shoulder and effects on central and peripheral pain sensitivity. Subjects with shoulder impingement pain symptoms were randomly assigned to receive 1 visit of thoracic SMT or sham SMT, applied to the lower, middle, and upper (cervicothoracic junction) thoracic spine. A 3-dimensional electromagnetic tracking system was used to measure thoracic and scapular kinematics during active arm elevation, and thoracic excursion at end-range of flexion and extension pre- post-treatment. Pressure pain threshold (PPT) was measured at the painful shoulder (deltoid) and unaffected regions (contralateral deltoid and bilateral lower trapezius areas) immediately pre- and post-treatment. PPT measures at the painful shoulder were used to assess peripheral and/or central pain sensitivity, and PPT at unaffected regions measured central pain sensitivity. Patient-rated outcomes measures of pain (Numeric Pain Rating Scale-NPRS), function (Pennsylvania Shoulder Score-Penn), and global rating of change (GROC) were used to assess changes in clinical symptoms following treatment. No significant differences were found between treatment groups for the thoracic kinematics or excursion, shoulder kinematics, PPT measures, or patient-rated outcomes. No differences were noted pre- to post-treatment in either group for thoracic kinematics or excursion or PPT measures. In both groups, there was a decrease in mean scapular external rotation over time during ascending arm elevation, but the change was less than measurement error. Outcome measures of NPRS, Penn and GROC indicated clinical improvements in both groups following treatment, but there were no differences between the thoracic SMT or sham SMT groups. There were no meaningful correlations between thoracic and scapular kinematics or thoracic excursion with the outcome measures of NPRS, Penn, or GROC. There was a significant positive correlation (r=0.52 , p=0.009) between change in PPT at the lower trapezius on the unaffected side and baseline Penn scores. Biomechanically, thoracic spine extension and excursion did not change following thoracic SMT, and the SMT group had no greater changes in shoulder kinematics or patient-rated pain and function than the sham SMT group. Additionally, thoracic SMT did not improve peripheral or central pain sensitivity as measured by PPT. Furthermore, improvements in patient-rated outcomes were not found to be related to changes in thoracic spine mobility, or shoulder kinematics with SMT. The single correlation between change in PPT and baseline Penn may indicate a neurophyciologic effect of SMT in patients with higher baseline function scores, but the since no other significant relationships between PPT and outcome were seen, the implications of this finding are limited. Overall, alterations in thoracic spine mobility and pressure pain sensitivity do not appear to be responsible for improved outcomes in patients with subacromial pain syndrome. Future studies should explore the effects of SMT using other measures of thoracic spine motion and experimental pain modalities, as well as greater dosing of SMT over a longer follow-up.

Low back and neck pain are frequent reasons for adults to seek healthcare. Three types of practitioners are commonly used in the United States: physicians, chiropractors and physical therapists. In this study, Andersen's "Behavioral Model of Health Services Utilization" is used to examine care seeking and provider selection. Estimates of back and neck pain prevalence in the United States are presented as well as care seeking rates and care consumption estimates for patients who used the three providers of interest. Multivariate regression analyses are presented that model the variables that most influence care seeking and provider selection.Cases with the conditions of low back pain and neck pain were drawn from the Medical Expenditure Panel Survey Panel 6 participants. Episodes of care and non-care were defined and the provider used during an episode was identified.Determinants of care seeking for low back pain included MSA status, insurance coverage, perceived health status, number of comorbidities and number of episodes. Determinants of care seeking for neck pain included insurance coverage and number of episodes. When condition was included in the analysis, it was a determinant of care seeking. All of these variables are enabling factors or need factors in Andersen's model.In the analysis of provider selection for low back pain, variables that determined the provider from whom care was sought included patient age, gender, race, ethnicity, marital status, MSA status, insurance coverage, perceived health status, if the condition was disabling and number of episodes. In the analysis of provider selection for neck pain, variables that determined the provider from whom care was sought included patient ethnicity, marital status, and if the condition was disabling.Andersen's Behavioral Model adequately predicts care seeking in LBP and NP with enabling and need factors playing a predominant role. In terms of equity of access this finding indicates a problem of access to care for persons who were uninsured. In the case of provider selection, all the constructs from the model were found to have a role in prediction indicating that access may be inequitable in the case of some providers.

Title Evaluating the Effect of Spa Treatment for Ideopatic Scoliosis Objectives The main objective of this work is to evaluate effect of spa treatment for children with ideopatic scoliosis at age of 12-15 years. My objective was to find out the efficiency of spa treatment. I also would like to find out a long-term effect while comparing girls and boys. A long-effect means, that the spa effect will last at least until the next spa visit. The next objective was to find out how many children are affected by ideopatic scoliosis, or how many children suffer from bad body posture. I was also seeking, if there is sufficient number of spa centers for treating these kinds of diseases in Czech Republic. Methods This work has a scientific character. It is a retrospective study focused on evaluation of the effect of spa treatment for children with ideopatic scoliosis. For evaluating the rate of improvement, informations from semi-standartized tests was used. These tests are used in the spa centre in Lázně Bělohrad, Czech Republic. I extracted a selected category of patients, compared these data, and visualised them in a graphs. There are 5 physioterapists working in this centre, and all of them are using the same methods for patient monitoring. However, all data had to be standardised before working with them,...

Evidenční list Souhlasím se zapůjčením své diplomové práce ke studijním účelům. Uživatel svým podpisem stvrzuje, že tuto diplomovou práci použil ke studiu a prohlašuje, že ji uvede mezi použitými prameny. Jméno a příjmení: Fakulta / katedra: Datum vypůjčení: Podpis: ______________________________________________________________________ ABSTRAKT Název: Zhodnocení vlivu sportovního lezení na pohybový aparát se zaměřením na bederní páteř Cíle práce: Cílem práce je zhodnotit vliv sportovního lezení na pohybový aparát člověka s užším zaměřením na oblast bederní páteře pomocí předem stanovených testů a vyšetření orientujících se na bederní část axiálního systému u skupiny lezců a nelezců. Dílčím cílem je teoretické zpracování problematiky sportovního lezení, bederní páteře a shrnutí vlivu sportovního lezení na pohybový aparát. Metoda řešení: Nejprve byla provedena rešerše literatury týkající se problematiky sportovního lezení a bederní páteře. Poté byla na skupině dvaceti lezců a kontrolní skupině dvaceti nelezců provedena komparativní studie, během které bylo provedeno funkční vyšetření bederní páteře pomocí PBU ("pressure biofeedback unit") dle konceptu Spinální segmentální stabilizace a vyšetření pohybových stereotypů a zkrácených svalů dle Jandy. Výsledky byly statisticky zhodnoceny pomocí programu Microsoft...

Title: Physical activity of patients after surgical treatment of the lumbar spine. Aim: Main aim of my diploma thesis is to present an up to date review on the topic of postoperative physiotherapy in short-term and long-term phase after lumbar surgery and to find out how recommendations about postoperative physiotherapy are created. Methods: A systematic review on the topic. Results: The review answers the questions about physiotherapy after lumbar surgery in short-term and long-term phase and shows current trends and unique approaches in this study area. Keywords: Lumbar spine, intervertebral disc, discectomy, physiotherapy, physical activity.