Physiotherapy - Theses
Permanent URI for this collection
Search Results
1 - 7 of 7
-
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)
-
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)
-
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)
-
ItemAn investigation of the clinical assessment of joint position sense( 2000-11)The assessment of proprioception in contemporary clinical practice usually involves having the patients with eyes closed attempt to identify passively held test positions using verbal descriptions or limb matching responses. It is equally common for the examiner to estimate the accuracy of these responses without the aid of a measuring instrument. Since these uninstrumented assessments are unlikely to allow adequate identification or quantification of a patient’s proprioceptive deficits, the aim of this study was to develop and validate an improved method for the clinical assessment of joint position sense. The two main types of assessment investigated were: (1) replication of joint positions using limb matching responses, during which the test and response positions were measured using computer-aided or manual digitisation of videotape images, and (2) joint position sense assessments where rating scales were used to define either the test or response positions. (For complete abstract open document)
-
ItemThe three dimensional angular kinematics of the lumbo-pelvic-hip complex during running( 2002)From an anatomical and biomechanical perspective, the lumbar spine, pelvis and hip may be considered as an integrated complex that is highly likely to operate in a coordinate manner during a functional task such as running. Furthermore, given that runners are at risk of numerous overuse injuries and that dynamic biomechanical parameters may be capable of explaining a proportion of this risk, certain angular rotations of the lumbo-pelvic-hip complex during running may potentially relate to injury. The overall research objectives of this thesis were twofold. First, to develop and evaluate a method with which to measure the three dimensional angular kinematics of the lumbo-pelvic-hip complex during running. Second, to implement the developed method to assess the independent effects of gender, speed and injury. Whilst the overall level of repeatability associated with the measurement of the three dimensional angular kinematics of the lumbo-pelvic-hip complex during was found to be satisfactory, several angular rotations were susceptible to errors that needed to be considered when interpreting the results of subsequent investigations. Use of a high powered treadmill with a small intra-stride belt speed fluctuation allowed a suitable representation of the typical three dimensional angular kinematics of the lumbo-pelvic-hip complex during running to be obtained. Significant differences between males and females existed for certain anthropometric and spatio-temporal parameters. Whilst the basic patterns of the angular rotations of the lumbo-pelvic-hip complex during running were found to be similar for males and females, differences occurred for the amplitudes of some of the angular rotations. Females displayed greater amplitudes of lumbar spine lateral bend and axial rotation, pelvis anterior-posterior title, obliquity and axial rotation, and, hip adduction- abduction compared to males. An offset was also apparent between the male and female group mean waveform for pelvis anterior-posterior tilt. Typical patterns were evident in the waveforms of the angular rotations of the lumbo-pelvic-hip complex during running. With increasing running speed from 2 m/s to 5 m/s, the amplitudes of most of the angular rotations increased with no appreciable change to the patterns of the waveforms. When comparing a group of runners who had sustained an injury in the previous twelve months attributable to running to an injury-free (control) group, none of the measured anthropometric or spatio-temporal parameters were significantly different between groups. In addition, no significant differences were found for any of the lumbar spine or pelvis angular parameters. Injured females displayed an increased amplitude of hip adduction-abduction whilst injured males displayed increased peak hip flexion. The findings of this thesis suggest that the three dimensional angular rotations of the lumbo-pelvic-hip complex display intricate but characteristic patterns during running. The angular rotations are influenced by factors such as gender and speed. However, the current findings did not demonstrate a clear association between anthropometric and dynamic biomechanical parameters of the lumbo-pelvic-hip complex and running injuries. This may be because no association truly exists. It may also be due to methodical issues such as reduced statistical power and the heterogeneity of the injured group. Further research is therefore required exploring the integrated biomechanical function of the lumbo-pelvic-hip complex during running with a particular focus on potential relationships with specific injury categories.
-
ItemClassification of low back pain( 2002)Low back pain is a common and costly problem in the community. A variety of treatment approaches have failed to make an impact on the size of this problem. A false assumption of low back pain sufferers as a homogeneous population is proposed as contributing to the failure of treatment. The research in this thesis intended to investigate the proposition that homogeneous categories of low back pain can he developed to enable improved effectiveness of specific treatment. Part 1 of the thesis developed a methodological model for the development and validation of a LBP classification system. Part 2 applied this model to the development and validation of a classification system based on internal disc disruption and selected psychosocial factors. The application of the model was via four research studies. In the first sections of Part 1, the low back pain literature pertaining to classification was reviewed. No classification system for low back pain was found to be accepted or validated, and a variety of methodological approaches to development and validation were observed. However, strong evidence exists for the unsuitability of uni-dimensional classification systems for low back pain. In addition, because of the complexity of low back pain, and a lack of information regarding causal relationships, the development of a natural classification may be an unrealistic goal. In order to clarify appropriate methodology for the development and validation of low back pain classification systems, a review of the biological, non-Hodgkin's lymphoma and headache classification literature was performed. A consistent use of methodological approaches was described, and through comparison with the low back pain literature, a new methodological model for the classification of low back pain presented. Additional methodological issues regarding determination of causation were discussed and applied, in combination with the methodological model, in reviewing the literature on internal disc disruption and psychosocial factors. This final review provided a background for the research studies in Part 2. The first study in Part 2 developed and evaluated the reliability and validity of a questionnaire for the measurement of subjective complaints. 'The questionnaire was shown to have acceptable reliability and validity in a self administered format and was therefore used in the subsequent studies. The second study investigated the role of inflammation in internal disc disruption by measuring the presence of inflammatory markers in surgically excised discs assessed as being disrupted. These discs were then compared to age matched discs from fresh cadavers with no history of significant low back pain. The demonstration of inflammatory markers in the discs assessed as having internal disc disruption provided support for the inclusion of inflammatory related criteria in the proposed classification system. The development of the classification system based on internal disc disruption and psychosocial factors was described in the chapter of the third research study. The classification system was then tested for discriminant validity, and cross-validated using cluster analysis, with both analyses providing support for preliminary validity. The final study in Part 2 evaluated the predictive validity of the classification system in a sample of participants undergoing a functional restoration program. The classification categories predicted outcome of the program, with the presence of internal disc disruption being shown to be the strongest predictor of poor outcome. This thesis provides a broad review of the research literature relevant to the classification of low back pain. The methodological model arising from that review was applied in an example of the development and validation of a classification system. Further research is required on validation of the classification system proposed in this thesis. However, to impact upon the extent of the low back pain problem, extensive further research on additional classification categories and specific treatment is required.
-
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.