Physiotherapy - Theses
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ItemFeasibility, safety and efficacy of dance for people with Parkinson's disease: a pilot study( 2013)The purpose of this thesis is to investigate the safety, feasibility and efficacy of dance for people with Parkinson’s disease (PD). Parkinson’s disease is a progressive neurological condition that is characterised by slow gait, reduced movement amplitude, tremor, rigidity, postural instability and diminished health-related quality of life (HRQOL). Physiotherapy and therapeutic exercise aimed at improving gait and balance are argued to be an important component in the management of PD and have been shown to improve gait function, mobility, balance and HRQOL in some individuals. Given the progressive and long term nature of the disease, it is important for people with PD to have access to a wide variety of exercise options so that they can remain active. Recent reports indicate that dance is emerging as an alternative to traditional exercise programs for people with PD, however there is little information regarding the safety and feasibility of dance interventions. A systematic review and critical appraisal was conducted with the aim of identifying studies that provide reports of safety, feasibility, intervention delivery and the efficacy of dance interventions for people with PD. The identified studies were of low to moderate methodological quality and design and the reporting of safety and feasibility outcomes was inconsistent. Whilst attrition was well reported, it was challenging to conclude the level of adherence and the occurrence of adverse events during dance classes due to limited reporting of these outcomes. The level of supervision provided, provision of instructor training and advice and the selection of music and movement choices was also not well reported. The results of a between-group synthesis of balance and mobility data showed a trend towards improvement in these outcomes following a dance intervention when compared to controls. These findings present limited evidence to support the efficacy of dance for people with PD. A group of nine Australians living with mild to moderate PD participated in a pilot case-series study to determine the safety, feasibility and efficacy of a six-week contemporary dance program. Safety and feasibility outcomes evaluated included the occurrence of adverse events, attrition, adherence and participant satisfaction. The effect of the dance program on gait function, functional mobility, balance, balance and gait self-efficacy and HRQOL was examined prior to the intervention, immediately post-intervention and at three months. The contemporary dance program was found to be a feasible and safe activity for people with PD in terms of attrition, adherence and adverse events. Attrition was low, with eight and seven participants completing follow-up assessments at post intervention and three-months respectively. Adherence was high with participants completing 78% of all available dance classes. Significant improvements in gait hypokinesia were observed immediately post-intervention compared to baseline measures and continued to improve three-months later. Significant improvements in functional mobility, relative to baseline were seen at post-intervention with a trend toward improvement noted at three-months. Despite improvements in gait function, there was little to no change observed for measures of balance, gait and balance self-efficacy and HRQOL. These results provide evidence to further support the safety and feasibility of dance for people with mild to moderate PD, and support the need for large randomized controlled trials to determine the efficacy and outcomes of dance therapy. Participant satisfaction is commonly regarded as an important component of quality health care and may influence the successful implementation of new interventions into clinical practice. Two focus groups were conducted after the pilot study with the purpose of gaining insight into the experiences and attitudes of the contemporary dance participants and to explore participant satisfaction within the context of feasibility. Thematic analysis revealed that participants were satisfied with the intervention and considered contemporary dance to be an acceptable form of exercise. The focus groups also revealed that the participants had a strong emotional reaction to the dance classes and identified several emotional, physical and cognitive benefits. This thesis has provided further knowledge to suggest that dance is a safe and feasible exercise alternative for some people with mild to moderate PD. Furthermore, this thesis has provided new evidence to support the efficacy of a short duration contemporary dance program to improve aspects of physical function and HRQOL. Although future work is needed, this research provides clinicians with evidence that supports the implementation of dance into clinical practice where it can benefit individuals living with Parkinson’s disease.
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ItemMobility characteristics in children with hereditary spastic paraplegia( 2013)The aim of this thesis was to investigate characteristic deviations in mobility and gait in children with hereditary spastic paraplegia (HSP). Hereditary spastic paraplegia is a neurodegenerative condition which is most commonly associated with limitations in functional mobility and gait dysfunction. Little quantitative information has been published describing the common mobility and gait deficits in children with HSP. The previous literature has not addressed the best measurement tools to quantify mobility nor has it provided objective evidence for changes in functional mobility over time in children with this condition. Although a small number of studies exist describing the kinematic gait deficits of children with HSP, results are limited to the sagittal plane of movement. A better understanding of the mobility and gait characteristics that are unique to this population would enable physiotherapists to provide a more holistic service to children and families with HSP. A greater depth of knowledge could help clinicians to develop more accurate hypotheses of the causative factors in gait and mobility disturbances, thereby facilitating the prioritisation of treatment techniques towards the most affected areas. A systematic literature review identified and critically evaluated outcome measures to quantify functional mobility in children with HSP. Evidence regarding the psychometric properties of functional mobility measures in this population was found to be limited. Three measurement tools were identified that clinicians may consider when assessing mobility in children with this condition. The outcome measures were the Gillette Functional Assessment Questionnaire, the Functional Mobility Scale and the Gross Motor Function Measures. The Functional Assessment Questionnaire and the Functional Mobility Scale were incorporated into three subsequent studies. A longitudinal study of retrospective data documented changes in functional mobility over time. Thirty children with HSP were assessed over an average of four years. Contrary to beliefs, analysis of functional mobility levels for the entire cohort demonstrated minimal changes over the period of assessment. Functional mobility over longer distances exhibited statistically significant improvements (p < .001). Functional mobility in the school environment was the only exception, with more children demonstrating a tendency towards deterioration over time. In general, the results indicate that not all children with HSP deteriorate in functional mobility over time. An analysis of retrospective kinematic gait data from 17 children with HSP confirmed that gait deviations existed in all three planes of movement when compared with the gait kinematics of unimpaired children. Overall, the deficits in the sagittal plane concurred with the previously published literature for children with HSP. The coronal plane revealed previously unreported kinematic gait deviations, including a reversal of the usual pattern of pelvic obliquity. These results confirm that kinematic deficits exist in all three planes of movement in children with HSP. Given the deviations at the proximal joints, further research is also warranted to describe the deficits at the trunk in children with this condition. A prospective study focussed on describing the kinematic deviations at the trunk, pelvis and hips in 11 children with HSP. Movements of the trunk and pelvis were found to be particularly compromised in the sagittal and coronal planes. These segments demonstrated larger amplitudes and subsequent increases in the ranges of movement. Although pelvic rotation showed little deviation when compared to unimpaired children, increased amplitudes of pelvic rotation were strongly associated with higher levels of functional mobility. These findings indicate that the trunk can be affected in some children with HSP. Further research is necessary to determine the cause of trunk and lower limb deficits in children with HSP. This thesis is the first to provide an in-depth analysis of mobility in children with HSP. Outcome measures were identified that can be utilised by physiotherapists when assessing children with this condition. The findings regarding mobility and gait characteristics in children with HSP are likely to assist physiotherapists and other health professionals to focus clinical assessments towards the most affected segments and planes. This information forms a foundation for future studies of mobility in HSP. In particular, the findings indicate the need for further investigations of longitudinal changes in mobility and the effectiveness of physiotherapy techniques in children with HSP. Ultimately, this new knowledge may help to improve the education of children and families with HSP, prioritise physiotherapy treatment plans and enable the best possible outcomes in children with this complex, neurological condition.