There are several reasons to research the effects of axial twist exposures and the resulting loading on the spine. The lack of consensus from the limited work that has previously examined the role of axial twist moments and motions in the development of spine injuries or generation of low back pain is the primary reason. From recently published works, axial twist moments appear to represent an increased risk for injury development when it acts in concert with loading about other physiological axes (i.e. flexion, extension, and compression). However, there is a large body of epidemiologic data identifying axial twist moments and/or motion as risk factors for low back disorders and pain, demonstrating the need for this series of investigations. It is likely that these combined exposures increase risk through altering the spine’s load distribution (passive resistance) by modifying the mechanics, but this deduction and related causal mechanism need to be researched. The global objective of this research was focused on determining whether there is evidence to support altered load distribution in the spine, specifically between the intervertebral disc and facets, in response to applied axial twist moments (when added in combination with one and two axes of additional loading). Also included was whether these modes of loading can modify spine mechanics and contribute and/or alter the development of damage and pain. This objective was addressed through one in-vivo (Drake and Callaghan, 2008a– Chapter #2) and three in-vitro (Drake et al., 2008– Chapter #4; Drake and Callaghan, 2008b– Chapter #5; Drake and Callaghan, 2008c– Chapter #6) studies that: (1) Quantified the amount of passive twist motion in the lumbar spine when coupled with various flexion-extension postures; (2) Documented the effects of flexion-extension postures and loading history on the distance between the facet articular surfaces; (3) Evaluated the result of axial twist rotation rates on acute failure of the spine in a neutral flexion posture; and (4) Explored whether repetitive combined loading has the ability to cause enough deformation to the spine to generate pain. Through the combination of findings previously reported in the literature and the outcomes of Drake and Callaghan (2008a– Chapter #2) and Drake et al. (2008– Chapter #4), a postural mediated mechanism was hypothesized to be responsible for governing the load distribution between the facet joints and other structures of the spine (i.e. disc, ligaments). Increased flexed postures were found to decrease the rotational stiffness by resulting in larger twist angles for the same applied twist moment in-vivo relative to a neutral flexion posture (Drake and Callaghan, 2008a– Chapter #2). This suggested there might be an increased load on the disc due to a change in facet coupling in these combined postures. Similarly, increased angles were observed in flexed and twisted postures for in-vitro specimens relative to a neutral flexion posture. These observed differences were found to correspond with altered facet joint mechanics. Specifically that flexed twisted postures increased the inter-facet spacing relative to the initial state of facet articulation (Drake et al., 2008– Chapter #4). These finding supported the postulated postural mechanism. Therefore, in a neutral posture the facet joints likely resisted the majority of any applied twist moment based on the limited range of motion and higher axial rotational stiffness responses observed. It was suspected that the changes in mechanics would likely cause a change in the load distribution however the magnitude of change in load distribution remains to be quantified. Further support for this postulated postural mechanism comes from the mode of failure for specimens that were exposed to 10,000 cycles of 5° axial twist rotation while in a static flexed posture (Drake and Callaghan, 2008c– Chapter #6), and neutrally flexed specimens exposed to 1.5° of rotation for 10,000 cycles reported in the literature. Without flexion, the failure patterns were reported to occur in the endplates, facets, laminae and capsular ligaments, but not the disc. However, with flexion the repetitive axial twist rotational displacements caused damage primarily to the disc. If the load distribution was unchanged, the higher axial rotation angle should have caused the specimen to fail in less cycles of loading, and the failure pattern should not have changed. Modulators of this hypothesized mechanism include the velocity of the applied twist moment and the effects these have on the failure parameters and injury outcomes. The three physiologic loading rates investigated in this work were not shown to affect the ultimate axial twist rotational failure angle or moment in a neutral flexion/extension posture, but were shown to modify flexion-extension stiffness (Drake and Callaghan, 2008b– Chapter #5). All of the flexion-extension stiffness values post failure, from a one-time axial twist exposure, was less than those from a repetitive combined loading exposure that has been established to damage the intervertebral disc but not the facets. Therefore, it is likely that the facet joint provides the primary resistance to acute axial twist moments when the spine is in a neutral flexion posture, but there appears to be a redistribution of the applied load from the facets to the disc in repetitive exposures. The aforementioned studies determined there are changes in load distribution and load response caused by altered mechanics resulting from twist loading, but whether the exposures could possibly produce pain needed to be addressed. Previous research has determined that the disc has relatively low innervation in comparison to the richly innervated facet capsule and vertebra, with only the outer regions being innervated. Likewise, it is assumed that pain could be directly generated as the nucleus pulposus disrupted the innervated outer annular fibres in the process of herniation. Also, direct compression of the spinal cord or nerve roots has been shown to occur from the extruded nucleus and result in the generation of pain responses. Additionally, the nucleus pulposus has been shown to be a noxious stimulus that damages the function and structure of nerves on contact. The other source of nerve root compression commonly recognized is a decrease in intervertebral foramina space, which was previously believed to only be caused through losses in disc height. However, decreased intervertebral foramina space due to repetitive motions appears to be a viable pain generating pathway that may not directly correspond to simply a loss of specimen or disc height (Drake and Callaghan, 2008c– Chapter #6). This is new evidence for combined loading to generate pain through spinal deformation. The objective of many traditional treatments for nerve root compression focus on restoring lost disc height to remove the nerve root compression. Unfortunately, nerve root compression caused by repetitive loading may not be alleviated through this approach. This collection of studies was focused on determining whether altered load distribution in the spine, specifically between the intervertebral disc and facets, in response to applied axial twist loading (when added in combination with one and two axes of additional loading) was occurring, and examining how these modes of loading can contribute and/or alter the development of injury and pain. Therefore, findings generated from this thesis may have important implications for clinicians, researchers, and ergonomists.

There are several reasons to research the effects of axial twist exposures and the resulting loading on the spine. The lack of consensus from the limited work that has previously examined the role of axial twist moments and motions in the development of spine injuries or generation of low back pain is the primary reason. From recently published works, axial twist moments appear to represent an increased risk for injury development when it acts in concert with loading about other physiological axes (i.e. flexion, extension, and compression). However, there is a large body of epidemiologic data identifying axial twist moments and/or motion as risk factors for low back disorders and pain, demonstrating the need for this series of investigations. It is likely that these combined exposures increase risk through altering the spine’s load distribution (passive resistance) by modifying the mechanics, but this deduction and related causal mechanism need to be researched. The global objective of this research was focused on determining whether there is evidence to support altered load distribution in the spine, specifically between the intervertebral disc and facets, in response to applied axial twist moments (when added in combination with one and two axes of additional loading). Also included was whether these modes of loading can modify spine mechanics and contribute and/or alter the development of damage and pain. This objective was addressed through one in-vivo (Drake and Callaghan, 2008a– Chapter #2) and three in-vitro (Drake et al., 2008– Chapter #4; Drake and Callaghan, 2008b– Chapter #5; Drake and Callaghan, 2008c– Chapter #6) studies that: (1) Quantified the amount of passive twist motion in the lumbar spine when coupled with various flexion-extension postures; (2) Documented the effects of flexion-extension postures and loading history on the distance between the facet articular surfaces; (3) Evaluated the result of axial twist rotation rates on acute failure of the spine in a neutral flexion posture; and (4) Explored whether repetitive combined loading has the ability to cause enough deformation to the spine to generate pain. Through the combination of findings previously reported in the literature and the outcomes of Drake and Callaghan (2008a– Chapter #2) and Drake et al. (2008– Chapter #4), a postural mediated mechanism was hypothesized to be responsible for governing the load distribution between the facet joints and other structures of the spine (i.e. disc, ligaments). Increased flexed postures were found to decrease the rotational stiffness by resulting in larger twist angles for the same applied twist moment in-vivo relative to a neutral flexion posture (Drake and Callaghan, 2008a– Chapter #2). This suggested there might be an increased load on the disc due to a change in facet coupling in these combined postures. Similarly, increased angles were observed in flexed and twisted postures for in-vitro specimens relative to a neutral flexion posture. These observed differences were found to correspond with altered facet joint mechanics. Specifically that flexed twisted postures increased the inter-facet spacing relative to the initial state of facet articulation (Drake et al., 2008– Chapter #4). These finding supported the postulated postural mechanism. Therefore, in a neutral posture the facet joints likely resisted the majority of any applied twist moment based on the limited range of motion and higher axial rotational stiffness responses observed. It was suspected that the changes in mechanics would likely cause a change in the load distribution however the magnitude of change in load distribution remains to be quantified. Further support for this postulated postural mechanism comes from the mode of failure for specimens that were exposed to 10,000 cycles of 5° axial twist rotation while in a static flexed posture (Drake and Callaghan, 2008c– Chapter #6), and neutrally flexed specimens exposed to 1.5° of rotation for 10,000 cycles reported in the literature. Without flexion, the failure patterns were reported to occur in the endplates, facets, laminae and capsular ligaments, but not the disc. However, with flexion the repetitive axial twist rotational displacements caused damage primarily to the disc. If the load distribution was unchanged, the higher axial rotation angle should have caused the specimen to fail in less cycles of loading, and the failure pattern should not have changed. Modulators of this hypothesized mechanism include the velocity of the applied twist moment and the effects these have on the failure parameters and injury outcomes. The three physiologic loading rates investigated in this work were not shown to affect the ultimate axial twist rotational failure angle or moment in a neutral flexion/extension posture, but were shown to modify flexion-extension stiffness (Drake and Callaghan, 2008b– Chapter #5). All of the flexion-extension stiffness values post failure, from a one-time axial twist exposure, was less than those from a repetitive combined loading exposure that has been established to damage the intervertebral disc but not the facets. Therefore, it is likely that the facet joint provides the primary resistance to acute axial twist moments when the spine is in a neutral flexion posture, but there appears to be a redistribution of the applied load from the facets to the disc in repetitive exposures. The aforementioned studies determined there are changes in load distribution and load response caused by altered mechanics resulting from twist loading, but whether the exposures could possibly produce pain needed to be addressed. Previous research has determined that the disc has relatively low innervation in comparison to the richly innervated facet capsule and vertebra, with only the outer regions being innervated. Likewise, it is assumed that pain could be directly generated as the nucleus pulposus disrupted the innervated outer annular fibres in the process of herniation. Also, direct compression of the spinal cord or nerve roots has been shown to occur from the extruded nucleus and result in the generation of pain responses. Additionally, the nucleus pulposus has been shown to be a noxious stimulus that damages the function and structure of nerves on contact. The other source of nerve root compression commonly recognized is a decrease in intervertebral foramina space, which was previously believed to only be caused through losses in disc height. However, decreased intervertebral foramina space due to repetitive motions appears to be a viable pain generating pathway that may not directly correspond to simply a loss of specimen or disc height (Drake and Callaghan, 2008c– Chapter #6). This is new evidence for combined loading to generate pain through spinal deformation. The objective of many traditional treatments for nerve root compression focus on restoring lost disc height to remove the nerve root compression. Unfortunately, nerve root compression caused by repetitive loading may not be alleviated through this approach. This collection of studies was focused on determining whether altered load distribution in the spine, specifically between the intervertebral disc and facets, in response to applied axial twist loading (when added in combination with one and two axes of additional loading) was occurring, and examining how these modes of loading can contribute and/or alter the development of injury and pain. Therefore, findings generated from this thesis may have important implications for clinicians, researchers, and ergonomists.

This thesis concentrates on urban regeneration as a strategy of urban transformation in general and in the context of post-communist countries in particular. The spatial transformations in cities resulted by the urban renewal and regeneration processes are currently under discussion in Albania. The present research is based on three pillars: a review of the urban transformation, renewal and regeneration in the West and in post-socialist cities in particular / exploring the historical formation and transformation of the Tirana city centre / and finally the regeneration of the city centre through a series of international competitions as a completely new model introduced by the municipality. The thesis focuses particularly on the international competition organized to obtain the master plan for the regeneration of the Tirana city centre / it compares the main concepts, ideas and features of the three shortlisted entries: Those of Architecture Studio, Mecanoo Arkitekten and Boles and Wilson. The winning master plan is evaluated with regard to the objectives of the regeneration, its integration with the existing built environment and open spaces, as well as the process of implementation. Within this framework, the thesis aims to study and evaluate this process to direct the urban development through a master plan competition completed by a series of urban design and architectural competitions. The process of regeneration of the centre of Tirana illustrates that despite the increased capacity of the citizens in Albania in participating in the decision making of the government, the public participation in the planning process was a difficult task despite the efforts of the Municipality. Yet, the enthusiasm that the new vision of Tirana brings is considerable.

published_or_final_version / abstract / toc / Computer Science and Information Systems / Master / Master of Philosophy

Die Osteoporose ist eine systemische Skeletterkrankung, die durch eine niedrige Knochenmasse und eine Verschlechterung der Mikroarchitektur des Knochengewebes mit nachfolgend erhöhter Knochenbrüchigkeit charakterisiert ist. Hauptverantwortlich für den Verlust der Knochenmasse ist vor allem der Östrogenmangel, der die mit Abstand häufigste Form, die postmenopausale Osteoporose, verursacht. Jahrelang ist diese durch die Substitution von Östrogenen therapiert worden. Die Hormonersatztherapie, die unter vielen Substanzen nachweislich das höchste antiosteoporotische Potenzial besitzt, scheidet jedoch aufgrund diverser unerwünschter Nebenwirkungen als Therapieoption aus. Daher gilt es, Therapiealternativen zur Prävention und Behandlung der Osteoporose zu finden. Als potenzielle Therapiealternativen werden in dieser Arbeit ein Phytohormon namens Daidzein und ein endokriner Disruptor namens 4-MBC an der Lendenwirbelsäule ovariektomierter und konsekutiv an Osteoporose erkrankter Sprague-Dawley-Ratten über eine Therapiedauer von 35 (5 Wochen), respektive 70 Tagen (10 Wochen), untersucht. Als Kontrolle über die Wirksamkeit der getesteten Substanzen dienten eine sojafrei behandelte sowie eine mit Östrogenen behandelte Kohorte. Phytoöstrogene sind hauptsächlich Bestandteil von Sojabohnen, Klee, Alfalfasprossen und Leinsamen. Bevorzugt binden sie an Östrogenrezeptor β, wenn auch mit einer geringeren Affinität. Eines dieser Phytoöstrogene ist Daidzein, dessen osteoprotektive Wirkung zuvor bereits vielfach nachgewiesen wurde. 4-MBC als zweite Substanz ist ein sogenannter endokriner Disruptor, der in Europa zur Herstellung von Kosmetika zugelassen ist. Bevorzugt bindet 4-MBC an Östrogenrezeptor β und seine osteoprotektive Wirkung an ovariektomierten Ratten ist ebenfalls bereits nachgewiesen. In der vorliegenden Arbeit wurden 3 Monate alte ovariektomierte Sprague-Dawley-Ratten über einen Zeitraum von 8 Wochen mit einer sojafreien Nahrung gefüttert. In dieser Zeit entwickelt die Ratte eine schwere Osteoporose. Anschließend wurde bilateral eine Tibiaosteotomie, die osteosynthetisch versorgt wurde, durchgeführt. Die Ratten wurden in 4 Gruppen eingeteilt und die sojafreie Basisnahrung um die zu testenden Substanzen 4- MBC (200 mg), Daidzein (50mg) und Östradiol (0,4mg) pro Kilogramm Körpergewicht ergänzt. Nach 5, respektive 10 Wochen wurden 12 Ratten je Futtergruppe per Dekapitation getötet und jeweils an den Lendenwirbelkörpern wurden verschiedene Untersuchungen durchgeführt. So wurde der zweite Lendenwirbelkörper mikroradiographisch analysiert, der dritte Lendenwirbelkörper wurde verascht und der vierte Lendenwirbelkörper biomechanisch getestet. Auf den erhobenen Daten basierend konnte nachgewiesen werden, dass sowohl Daidzein als auch 4-MBC einen positiven Einfluss auf das Knochengewebe während der gesamten Therapiedauer besitzen. Östradiol verzeichnet wie erwartet den größten Effekt, gefolgt von 4-MBC und Daidzein. Bezogen auf die Therapiedauer zeigte sich, dass die größere Wirkungsentfaltung innerhalb der Kurzzeittherapie zu verzeichnen ist. Nach einer Langzeittherapie zeigt die sojafrei ernährte Kontrollgruppe ebenfalls verbesserte Knochenparameter, möglicherweise zurückzuführen auf Adaptationsmechanismen der Osteoporose. 4-MBC ist von seinem osteoprotektiven Wirkungspotenzial dem der Östrogene am ähnlichsten. Eine Therapie mit 4-MBC verbessert sowohl spongiöse, als auch kortikale Knochenparameter und könnte somit als potenzielle Therapiealternative der Osteoporose dienen. Allerdings sind die Wirkungsmechanismen des endokrinen Disruptors zum gegenwärtigen Zeitpunkt noch nicht verstanden und es bedarf diesbezüglich weiterer intensiver Forschung. Ein Aspekt, der einen Gebrauch von 4-MBC als antiosteoporotisches Medikament verhindern könnte, ist das noch nicht endgültig erforschte Nebenwirkungsspektrum. Auch hier sind weitere Untersuchungen erforderlich. Daidzein zeigt insgesamt im Vergleich zu Östradiol und 4-MBC den geringsten osteoprotektiven Effekt. Als potenzielle Therapiealternative ist es 4-MBC und Östradiol unterlegen. Möglicherweise können Patienten mit osteoporosebedingten Frakturen jedoch von einer Behandlung mit Daidzein profitieren. Komrakova et al. haben 2011 an Ratten, bei denen die Tibia osteotomiert und die anschließend osteosynthetisch versorgten wurde, nachgewiesen, dass nach einer 5 wöchigen Therapie mit Daidzein die größte Kallusdichte zu verzeichnen war, während bei 4-MBC und Östradiol eine Kallusdichte aufgewiesen wurde, die der sojafreien Kontrollgruppe ähnlich war. Ob sich Daidzein als Therapieoption zur Unterstützung der Frakturheilung eignet, ist zum aktuellen Zeitpunkt noch nicht geklärt und in weiteren Untersuchungen zu eruieren. Des Weiteren gilt es, auch für Daidzein den genauen Wirkungsmechanismus zu klären und sein Nebenwirkungsspektrum zu untersuchen.

The purposes of this study were to: 1) determine absolute intrarater reliability of using the cervical range of motion device (CROM) for measuring cervical movements in older adults, and 2) determine the intrarater reliability and concurrent validity of the Candrive protocol, which uses a universal goniometer to measure rotation. Forty older adults (75.7 + 4.7 years of age) were tested in two sessions, one week apart, by two raters. Intrarater reliability scores were good for the CROM protocol (coefficient of variation (CV) values were 5.5% and 6.2 % for cervical rotation). The Candrive protocol values were higher (CV = 7.9 and 9.4%). Concordance analyses suggested that the Candrive protocol was less than good in terms of its validity, particularly when order effects were taken into consideration. In conclusion, the CROM protocol demonstrated good reliability for either group or individual analyses, whereas the Candrive protocol was less reliable and its validity marginal.

Tyrimo problema: lėtinio nugaros juosmeninės dalies skausmo pasikartojimo tikimybė labai didelė, todėl svarbu ištirti ir įvertinti pratimų išliekamąjį poveikį gydant nugaros skausmą. Kol apatiniai stuburo segmentai yra nestabilūs, jokie pratimai, mažinantys nugaros juosmeninės dalies skausmą, nebus efektyvūs. Stuburą stabilizuojančių pratimų dozavimas, jų atlikimo trukmė ir išliekamasis poveikis vis dar kelia diskusijų ir reikalauja išsamesnių tyrimų. Tyrimo hipotezė: 12 savaičių 24 procedūrų stuburą stabilizuojančių pratimų programos išliekamasis poveikis yra nepakankamas, siekiant ilgalaikio gydomojo efekto 40–60 metų amžiaus moterims, kamuojamoms lėtinio nugaros juosmeninės dalies skausmo. Tyrimo tikslas: įvertinti 12 savaičių 24 procedūrų stuburą stabilizuojančių pratimų programos išliekamąjį poveikį 40–60 metų amžiaus moterims, kamuojamoms lėtinio nugaros juosmeninės dalies skausmo. Tyrimo uždaviniai: ištirti liemens lenkiamųjų ir tiesiamųjų raumenų izometrinę jėgą ir ištvermę prieš ir po stuburą stabilizuojančių pratimų programos bei praėjus 4 ir 8 savaitėms po jos; nustatyti tiriamųjų nugaros juosmeninės dalies skausmo lygį ir įvertinti funkcinę būklę prieš ir po stuburą stabilizuojančių pratimų programos bei praėjus 4 ir 8 savaitėms po jos; įvertinti liemens lenkiamųjų ir tiesiamųjų raumenų jėgos ir ištvermės pokyčio įtaką nugaros juosmeninės dalies skausmo intensyvumui bei funkcinei būklei. Tyrimo metodai: Biodex System 3 Pro izokinetinis dinamometras, pilvo ir... [toliau žr. visą tekstą] / The problem of the research: the probability that chronic low back pain will reoccur is very high. For this reason, it is important to examine and evaluate the lastingness of the effect of the exercises while treating back pain. To reduce low back pain spine stabilizing exercises are applied. Dosage of exercises, duration of their performance and lastingness of the effect are still generating discussions and require a more detailed research. The hypothesis of the research: lastingness of twelve-week, 24 procedures, spine stabilizing exercises programme is not sufficient for 40-60 year old women with chronic low back pain while seeking a long lasting healing effect. The aim of the research: to evaluate lastingness of twelve-week, 24 procedures, spine stabilizing exercises programme effect on 40-60 year old women with chronic low back pain. The objectives of the research: to examine isometric force and endurance of back bending and straightening muscles before and after spine stabilizing exercises programme as well as 4 and 8 weeks after it; to determine subjects’ level of low back pain and functional state before and after spine stabilizing exercises programme as well as 4 and 8 weeks after it; to determine the effect of change in strength and endurance of waist bending and straightening muscles on low back pain intensity and functional state. Methods applied in the research: Biodex System 3 Pro isokinetic dynamometer, tests on abdomen and back muscles endurance, Oswestry... [to full text]

Tyrimo objektas: lazerio terapijos poveikis. Tyrimo problema: Šiuo metu auga tyrimų poreikis, kurie mažintų individualią bei socialinę naštą esant stuburo kaklines dalies radikulopatijai, todėl mums yra būtina surasti efektyviausią kaklinės stuburo dalies radikulopatijos gydymo programą, techniką ar metodą (Gross et al., 2007). Daugumoje mokslinių straipsnių, kuriuose vertinamas fizikinių veiksnių poveikis kaklinės stuburo dalies radikulopatijos gydymui, teigiama, kad trūksta tyrimų su placebo efektu, kurie pateiktų dar tikslesnių rezultatų gydymo programų efektyvumui įvertinti (Leaver et al., 2010). Hipotezė: Esant kaklinės stuburo dalies radikulopatijai, pacientams, kuriems taikyta lazerio terapija, reabilitacija turėtų būti efektyvesnė, nei pacientams, kuriems taikytas placebo efektas. Tyrimo tikslas: Įvertinti lazerio terapijos poveikį skausmo intensyvumui ir kaklinės stuburo dalies judėjimo funkcijai esant kaklinės stuburo dalies radikulopatijai. Tyrimo uždaviniai: 1. Įvertinti lazerio terapijos, kineziterapijos bei masažo poveikį skausmo intensyvumui ir kaklinės stuburo dalies judėjimo funkcijai esant kaklinės stuburo dalies radikulopatijai. 2. Įvertinti placebo efekto, kineziterapijos bei masažo poveikį skausmo intensyvumui ir kaklinės stuburo dalies judėjimo funkcijai esant kaklinės stuburo dalies radikulopatijai. 3. Palyginti lazerio terapijos ir placebo efekto poveikį skausmo intensyvumui ir kaklinės stuburo dalies judėjimo funkcijai esant kaklinės stuburo dalies... [toliau žr. visą tekstą] / The object of the research: laser therapy effect. Problem of the research: Demand for research to reduce individual and social burden in upper cervical spine radiculopathy is currently growing, so it is necessary for us to identify the most effective cervical spine radiculopathy treatment program, technique or method (Gross et al., 2007). In many scientific articles that evaluate physical factors effects on upper cervical spine radiculopathy treatment it is stated a lack of studies using placebo effect that would provide even more accurate results to evaluate the effectiveness of treatment programs (Leaver et al., 2010). Hypothesis: In upper cervical spine radiculopathy rehabilitation of the patients undergoing laser therapy should be more effective than rehabilitation of the patients treated with placebo effect. Aim of the research: To evaluate laser therapy effect on pain intensity and upper cervical spine motor function in upper cervical spine radiculopathy. Tasks of the research: 1. To evaluate effect of laser therapy, physical therapy and massage on pain intensity and upper cervical spine motor function in upper cervical spine radiculopathy. 2. To evaluate effect of placebo, physical therapy and massage on pain intensity and upper cervical spine motor function in upper cervical spine radiculopathy. 3. To compare effects of laser therapy and placebo on pain intensity and upper cervical spine motor function in upper cervical spine radiculopathy. Research organization and... [to full text]

Referrals to the Halifax Infirmary Neurosurgery Department are submitted with regards to spinal conditions with different degrees of complications. Although there exists a Spinal Condition Consultation Protocol to standardize spinal referrals, the information provided from referring physicians is frequently inadequate to accurately triage the patient's condition, partly due to missing diagnostic therapies. The Neurosurgery Department receives a high volume of referrals each year, which imposes a significant administrative workload on the staff. We propose to develop a protocol-driven decision support system to: 1) Provide primary care physicians with timely access to condition specific consultation treatment protocols; and 2) Automate the referral assessment process to eliminate processing delays and administration burden. To this aim, we transformed the Consultation Protocol into a semantic knowledgebase. The decision support services are integrated within a standardized electronic referral system. We believe this system can significantly improve the referral process at the Neurosurgery Division.

The purposes of this study were to: 1) determine absolute intrarater reliability of using the cervical range of motion device (CROM) for measuring cervical movements in older adults, and 2) determine the intrarater reliability and concurrent validity of the Candrive protocol, which uses a universal goniometer to measure rotation. Forty older adults (75.7 + 4.7 years of age) were tested in two sessions, one week apart, by two raters. Intrarater reliability scores were good for the CROM protocol (coefficient of variation (CV) values were 5.5% and 6.2 % for cervical rotation). The Candrive protocol values were higher (CV = 7.9 and 9.4%). Concordance analyses suggested that the Candrive protocol was less than good in terms of its validity, particularly when order effects were taken into consideration. In conclusion, the CROM protocol demonstrated good reliability for either group or individual analyses, whereas the Candrive protocol was less reliable and its validity marginal.