Physiotherapy - Theses
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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 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.