Physiotherapy - Theses
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ItemThe reliability and validity of the squeeze test for athletic groin pain in Australian Rules Football players(University of Melbourne, 2009)
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ItemHistology of the fascial-periosteal interface in lower limb chronic deep posterior compartment syndrome(University of Melbourne, 2007)
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ItemThe functional mobility scale for children with cerebral palsy: reliability and validity( 2008-02)The purpose of this thesis was to investigate the psychometric properties and clinical utility of the Functional Mobility Scale (FMS) for children with cerebral palsy (CP). The FMS quantifies mobility according to the need for assistive devices in different environmental settings. Initially a systematic review was conducted on the psychometric properties and clinical utility of existing evaluative outcome measures that assessed activity limitation in children with CP. Good to excellent reliability was found for all tools. In contrast, the validity and responsiveness of many tools required further investigation. The FMS was the only tool to quantify activity with different assistive devices for a range of environmental settings. A key objective of this thesis was to investigate the reliability, construct, concurrent and discriminative validity, as well as the responsiveness to change of the FMS. (For complete abstract open document)
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ItemSevere crouch gait in the sagittal gait patterns of spastic diplegic cerebral palsy: the impact of single event multilevel surgery( 2005)The purpose of this thesis was to study the outcome of Single Event Multilevel Surgery (SEMLS) on the gait pattern known as crouch gait in children with spastic diplegic cerebral palsy. The term “crouch gait” in the literature has been defined by many authors to mean a flexed knee coupled with many different combinations of posture at the ankle. Consequently it was necessary to provide a robust definition of crouch gait before the outcome study could proceed. Crouch gait was defined in the context of a classification of sagittal gait patterns in spastic diplegia. In the cross-sectional study on the classification of sagittal gait patterns, 187 children with spastic diplegia were categorised according to visual recognition of their gait pattern and sagittal plane kinematic data. Six gait patterns in spastic diplegia were identified, one of which was crouch gait. A pattern of increasing age, severity and biomechanical incompetency in maintaining an extended posture was seen across the gait patterns and crouch gait appeared to be the “end” gait pattern. A longitudinal study documented how the identified gait patterns evolved over time. Thirty-four children were followed for more than one year and the results indicated that the stability of the gait pattern was variable. The reliability of the classification was found to be acceptable. (For complete abstract open document)
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ItemPrevention of falls in the subacute hospital setting( 2004)Falls are a relatively frequent occurrence amongst older people. Rates of falls amongst patients in subacute care are substantially higher than amongst people living in the community. Falls have been reported to cause physical and psychological injury, increase the likelihood of being discharged to nursing home, and are associated with longer lengths of stay in hospital. Thus, minimisation of falls in the subacute hospital setting is of high public health importance. (For complete abstract open document)
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ItemThe Melbourne pusher scale: a reliability and validity study( 2003)The pushing phenomenon in stroke patients has been more extensively researched in recent years. Previous studies have concentrated on examining the incidence, causes and functional outcome for these patients, however, the validity for this research has been questioned due to the lack of use of a psychometrically sound assessment scale for pushing. The first aim of the current study was to develop a clear, concise, ordinal pushing scale, the Melbourne Pusher Scale, that would measure the severity of pushing in acute stroke patients. The second aim was to determine the reliability and validity of the Melbourne Pusher Scale in measuring the pushing phenomenon. The study involved 30 acute stroke patients for the inter-rater reliability and validity studies, 20 acute stroke patients for the intra-rater reliability, and 15 control subjects for the validity study. The Melbourne Pusher Scale was found to have strong inter-rater reliability (Kappa statistic= 0.91) as well as strong intra-rater reliability (Kappa statistic= 0.92). The investigation of concurrent validity of the scale found the Melbourne Pusher Scale to have some validity. Further research using video analysis in a larger sample may aid in the validation of this scale. Not only is the Melbourne Pusher Scale the first such scale to have psychometric analysis documented, it is the first reliable scale that measures the severity of pushing. The Melbourne Pusher Scale may aid in future research into the cause and management of the pushing phenomenon, more accurate clinical decision-making and the effective use of relevant health care resources for these acute stroke patients.
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ItemThe effect of the 'Mother and baby' exercise program on new mothers psychological well-being and depressive symptoms( 2007)The benefits of physiotherapy exercise and allied health education programs on new mothers psychological well-being have never been studied, despite extensive awareness worldwide on cost-effective and non-medicated strategies to prevent women from developing Post-natal Depression (PND). The findings of previous studies investigating general physical activity and depression have often been limited by general populations, not including women in the post-natal period, small sample sizes and/or the lack of an adequate control group. In order to determine whether an allied health intervention including specialised women's health physiotherapy exercise combined with mother crafting education, the first randomised controlled trial was completed. The aim of this study was to determine the effect of an eight week physiotherapy based exercise program with allied health education named the “Mother & Baby" program on the psychological well-being of new mothers. The experimental group (n=62) attended the "'Mother & Baby" program once a week for eight weeks and the control group (n=73) received the same educational material as the experimental group via mail. The primary outcome measures of psychological well-being, depressive symptoms and measure of physical activity levels were collected at baseline, eight weeks later (post program) and then twelve weeks later. Results indicated a significant effect on well-being scores and depressive symptoms of the exercise group when compared with the control group over the three time periods (p< 0.001). Women who had been identified as "'at risk" of post-natal depression had reduced their depressive symptoms by 50% by the end of the intervention. More specifically, there was a significant effect on well-being scores and depressive symptoms at eight weeks (p < 0.001) and this effect on both well-being scores and depressive symptoms were maintained four weeks later after completion of the program. A correlation analysis revealed The Affect Balance Scale of well-being and the Edinburgh Post-natal Depression Scale were well-correlated (p<0.01) indicating a high well-being score reflected low symptoms of post-natal depression. Analyses also revealed that the intervention did not significantly increase participants’ physical activity levels. However, membership of the “Mother & Baby” program was a strong predictor of well-being scores and depression symptoms. The significant results of this trial demonstrate the effectiveness of the "Mother & Baby" Program which involves specialised women's health physiotherapy exercise and allied health education, on new mothers' psychological well-being and risk of depression. The results of this study reinforce that a multi-factorial intervention, involving both physiotherapy exercise and allied health education are required to influence well-being and post-natal depression symptoms.
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ItemPeople with Parkinson's disease should avoid performing dual-tasks while walking: myth or reality?( 2009)Traditionally, people with Parkinson’s disease (PD) are advised to avoid performing dual-tasks while walking. Rehabilitation programs also emphasise the need to train walking under single-task conditions to improve gait and reduce risk for falls. There are findings that people with PD can walk faster and with longer strides while performing a secondary motor or cognitive task, when cued by a metronome or visual floor stripes. There are also findings that people with PD can walk faster and with longer strides while performing a secondary motor task simply by prioritising their attention to take big steps. Using attention is a convenient strategy favoured by people with PD to manage their gait difficulties. This thesis examined the immediate and training effects of two attention-priority strategies on dual-cognitive task walking in people with mild to moderate PD. Two groups of participants received 30 minutes of training to prioritise attention to take big steps while performing serial three subtractions (gait-priority strategy) or to divide their attention between taking big steps and the cognitive task (equal-priority strategy). Control groups received no training. Measures of gait hypo-bradykinesia (stride length and gait velocity), stride variability (Coefficient of variation [CV] of stride length and CV of stride time) and cognitive task performance (accurate enumeration rate) were assessed at baseline, during training, immediately after training and 30 minutes after training. Both attention-priority strategies improved stride length and gait velocity during training. The improvement was retained for at least 30 minutes after training. Both strategies have no effect on CVs of stride length, stride time and accurate enumeration rate. Many daily routines require our ability to overcome single-, dual- and multi-task demands while walking. Rehabilitation strategies should encompass real life demands in order to minimise functional impairments, activity limitations and participation restrictions, as recommended by the World Health Organisation. Putting together the findings of this thesis and the evidence provided by previous studies, it is concluded that traditional recommendations need qualification. Avoiding dual-tasks during walking or gait retraining in people with mild to moderate PD may not be necessary. Gait-priority and equal-priority strategies can be used as compensatory strategies to improve gait during dual-tasks. The two strategies can also be used in training programs for walking rehabilitation.
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ItemImpact of adverse events on motor development in early infancy( 2009)The central nervous system (CNS) develops in a temporally and spatially organised manner. Any adverse events happening during the critical periods of early brain formation may lead to arrest in the process or injury to specific developed structures. Infants born at less than 30 weeks of gestation and those with intra-partum asphyxia are at risk of motor delay. The cause of this delay may be related to injuries in the brain such as the motor cortex, basal ganglia and cerebellum, all of which are essential in controlling movements. According to the dynamical systems theory of motor development, other than the CNS, body systems within the infant such as the musculoskeletal system, and external to the infant such as environmental enrichment and supportive child-rearing practice also have a decisive role in motor development in infants. Paediatric physiotherapists have been involved in the management of these infants since birth. A number of well-established assessment tools are used to assess these infants’ motor functions. Most of these tools typically do not describe the movement patterns of infants but emphasise the achievement of age-specific motor milestones. The Alberta Infant Motor Scale (AIMS) is one of the few tools that acknowledge the importance of movement quality. The overall aim of the present research was to examine the impact of adverse events in early infancy, including birth prior to 30 weeks of gestation and intra-partum asphyxia, on motor development of infants during the first two years of (corrected) age. One hundred and twenty infants were recruited, including 58 preterm infants, 10 infants with post-asphyxia neonatal encephalopathy (NE) and 52 term born infants as the control group. All the infants were assessed using the AIMS at 4, 8, 12 and 18 months of (corrected) age. The preterm group scored significantly lower on various sub-scores of the AIMS at all age levels than the control group. Uneven progression in the sit subscale from 4 to 8 months corrected age (CA) was found in the preterm infants, possibly due to a dominant extensor strength, inadequate tonus and postural control in the trunk. At 12 and 18 months CA, limited variations in movements were evident in some preterm infants in the crawling, sitting and standing positions. The ten infants with post-asphyxia NE showed scattered motor development, related mostly to the severity of their NE. The moderate NE group had the most varied motor outcomes ranging from normal to suspected mild cerebral palsy. The AIMS was shown to be a valid assessment tool in the preterm population although limitations in its use were found at 4 months CA and when the infants walked or were close to independent ambulation. The present results show that motor performance of typically and non-typically developing infants should be investigated longitudinally as variations are the characteristic of early development. The dynamical systems theory provides a more satisfactory explanation of the motoric differences in infants in this study. All these findings have great implications for the clinical management of these at risk infants.