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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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.