ETD Collection

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Subject: search.filters.subject.Spinal Cord Injuries

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Now showing 1 - 5 of 5
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    Factors influencing community reintegration of persons with spinal cord injury who received private inpatient rehabilitation in Gauteng
    (2018) Van der Veen, Dale Anne
    Persons with spinal cord injury (SCI) continue to face numerous contextual barriers to community reintegration, despite receiving rehabilitation. To ascertain the perceived factors influencing community reintegration of persons with SCI, who received private in-patient rehabilitation, a quantitative descriptive approach was used. Fifty-four persons participated in this study by completing a cross-sectional online self-administered survey, including; a sociodemographic profile, the Reintegrated into Normal Living Index (RNLI) and the Craig Hospital Inventory of Environmental Factors – Short Form (CHIEF–SF). Data was analysed using STATISTICA 13.2. Majority (63.5%) of participants were male, living with incomplete paraplegia (75%a) and 52% were employed. Eighty percent of participants experienced moderate to severe restrictions to participation, with low satisfaction in community reintegration. Help at work/school, business policies, help at home, attitudes at work/school and the natural environment were the greatest environmental barriers, while social support and access to private transport were the greatest facilitators to community reintegration.
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    The relationships between pain and sleep in spinal cord injury patients
    (2016) Pillay, Diana Subramony
    Spinal cord injury (SCI) is a devastating injury affecting many South Africans. The purpose of the study was to investigate the relationship between SCI pain and sleep issues during acute inpatient rehabilitation. Seventeen participants were recruited. There were 2 interviews in the study; the 1st interview was done on the day participants were recruited. The 2nd interview was conducted a day before participants were discharged. The time elapsed between the first and second interview was 7.9±2.4. The patients were discharged from the Auckland Rehabilitation hospital (Hope ward). In the 2nd interview the questionnaires for pain, sleep and mood measures were repeated, and two additional questions were asked and the answers recorded for analysis of content. The key findings were; majority of the participants were Black, male (82%). The main cause of traumatic SCI was motor vehicle accident (59%). The common sites of injury were in the legs and neck/shoulder areas in both assessment (admission and discharge). The verbal descriptors that were commonly chosen in both assessments were, “sharp, shooting and tight.” Below level neuropathic pain, followed by musculoskeletal pain were the common types of pain reported. Pain interference was reported greatest in sleep and on average pain intensity was moderate (4-6 on 11-point Numerical Rating Scale). Strong correlations and positive relationships between Pain Catastrophizing Scale and subscales, and with the Pittsburgh Insomnia Rating total scale and subscales were reported in this study. Environmental factors were reported to affect sleep. A high incidence of Restless Leg Syndrome was reported in this study (24%). Depression was commonly reported by participants in both assessments. No significant association was found for the measures of sleep, Restless Leg Syndrome, depression and quality of life and the injury characteristics that were assessed. Significant associations were found at the 95% confidence levels for pain scores and injury characteristics (completeness of injury, level of injury and pain sites). Further studies in this area of pain and sleep management is warranted. It is important that clinicians and researchers in this area find appropriate management for secondary issues which have a severe impact on the daily activities of SCI people, decreasing their quality of life. Key words: SCI pain, sleep disturbances, mood
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    Initial investigation into the factors related to employment of individuals living with a spinal cord injury in a specific South African population
    (2015-09-07) Michell, Lauren Anne
    Many factors have been shown to play a role in employment after a spinal cord injury. Globally the rates of employment post-injury have been disappointing with a rate of 36.8% 1. METHODS This mixed methods study was divided into two phases. During phase one qualitative data was gathered. This data was used to design a questionnaire which was emailed to members of the Quadpara Association of South Africa in phase two. Bivariate data analysis was performed and a logistic regression. RESULTS Eleven themes emerged from phase one. There was a high employment rate of 79.55% at the time of the study and 92.13% had worked for remuneration since injury. There was a statistically significant association between employment at the time of the study and six factors. CONCLUSION This study had a surprisingly high employment rate post-injury. Despite few results being statistically significant there were many that are of clinical importance.
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    Factors that influence functional ability in individuals with spinal cord injury.
    (2014-04-25) Hastings, Bronwyn Meloney
    There is a dearth of published literature that documents the levels of functional ability post spinal cord injury (SCI) resulting in paraplegia, at discharge from in-patient rehabilitation facilities within Gauteng. In addition, the factors that influence functional ability are poorly defined in individuals with paraplegia, at their discharge from in-patient rehabilitation facilities in Gauteng. This necessitated further investigation since it is vital for the rehabilitation of individuals with SCI resulting in paraplegia. The aim of the study was to determine the functional ability and the factors that affect the functional ability in individuals with a SCI resulting in paraplegia, at discharge from rehabilitation facilities in Gauteng. The first objective of the study was to establish the level of functional ability in patients with SCI at discharge from in-patient rehabilitation. The second objective of the study was to describe the physical and demographic factors of the study population. The third objective of the study was to establish the demographic and physical factors that influence the level of functional ability in patients with SCI at discharge from in-patient rehabilitation. This was a cross-sectional, observational study design. Three instruments were used in this study: a self-designed questionnaire to establish the factors that influence the level of functional ability in patients with SCI at discharge from an in-patient rehabilitation unit; the American Spinal Injury Association (ASIA) classification scale of neurological impairment to describe the level and completeness of the lesion and the Spinal Cord Independence Measure III (SCIM III) to determine the level of functional ability. The main results of the study were as follows: The average SCIM score in this population was 64.6 (±27.6) with the lowest score being 20 and the highest score being 84. Participants with non traumatic SCI had 16.87% lower SCIM scores than those with traumatic SCI. After multivariate analysis the following factors were found to influence function: For every one year increase in the age of the participant, there was 0.18% decrease in the SCIM score. For every day increase in LOS, there was a corresponding increase of 0.06% in the SCIM score. With respect to the presence of a pressure sore from the acute hospital, those who had pressure sores had 9% lower SCIM scores than those who did not have pressure sores. Participants with spasticity had 8.3% lower SCIM scores relative to those that did not have spasticity. Relative to participants in government funding classification, workman’s compensation participants had 4.82% lower SCIM score followed by the medical aid participants with 8.07% lower SCIM and the private participants with 10.84% lower SCIM scores. For every unit increase in the ASIA motor score, there was an increase of 1.29% in the SCIM score. Conclusion: Majority of the participants in this study were discharged from rehabilitation without reaching functional independence. The following categories of patients with SCI may need to be monitored more for functional outcomes during rehabilitation and assisted in order to attain good functional ability: older age, a short rehabilitation length of stay, funded privately, a low ASIA motor score, having a pressure sore or spasticity, and higher level of SCI. Key words: Functional outcomes, paraplegia, rehabilitation, neurological level, spinal cord injury.
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    An assessment of the clinical application and utility of the Babinski sign using objective kinematic and electromyographic methods
    (2013) Dafkin, Chloe Lynn
    The Babinski sign is a pathological response elicited by a stimulus to the lateral plantar border of thesole of the foot. The resulting reflex involves dorsiflexion (upward motion) of the toes, most notably the hallux, with accompanying flexion in the ankle, knee and hip. It is an important part of the clinical neurological examination and aids in the diagnosis of central nervous system dysfunction. There is however no wholly standardised method to elicit this reflex or interpret it, resulting in possible variation in its utility. The resulting aim of the studies constituting this dissertation were therefore to: 1) assess what techniques and pressures are used to elicit the reflex in a group of neurologists;2) to investigate the relationship between input variables of the reflex and the resultant output variables as measured with the use of electromyography and kinematics;3) compare objective variables, relating to toe, foot and leg movement, of the pathological reflex to the healthy response; 4) assess the inter-rater reliability of the reflex and 5) determine what aspects of the reflex are most closely related to the ratings of the students and neurologists. A specialized custom-built Babinski hammer was constructed to measure the duration of the stroke and pressures exerted on the foot of a single healthy subject by neurologists (n=12). The relationship between the recorded pressures and the movement of the toes (measured kinematically), muscle activity in the tibialis anterior and the pain felt by the subject (gauged using a visual analogue scale) were evaluated. Following this, the average pressure used by the neurologists was used to elicit the reflex in six patients with known positive Babinski responses and six healthy gender and age matched controls. These reflexes were compared with kinematic (measurement of toe, foot and leg movement) and electromyographic (muscle activity of the involved muscles) methods. These reflexes were recorded and the recorded footage was shown to 12 medical students and 12 neurologists who were asked to interpret if 3 the responses were pathological or non-pathological. Kinematic and electromyographic descriptions of each reflex made it possible to assess what aspects of the reflex are important for classification of a pathological response for both medical students and neurologists. A large amount of intra- and inter-rater variability was shown amongst the neurologists in how they elicited the reflex. The amount of pressure applied was shown to be significantly related to hallux movement (p<0.01) as well as to the degree of pain felt by the subject (p<0.01). Significant differences were found between the patients and controls for change in hallux angle (p<0.0001), movement latency (p<0.05)and the maximum electromyographic amplitude of tibialis anterior(p<0.01). The inter-rater reliability of the medical students and the neurologists showed substantial agreement between raters (kappa = 0.67 and 0.72 respectively). Both neurologists and students made use of the change in hallux angle, time taken to reach maximum ankle angle, movement latency and the maximum amplitude of gastrocnemius when rating the reflex. Neurologists alone observed time taken to reach maximum hallux angle and change in ankle angle as being important while medical students‘ alone looked at maximum amplitude of biceps femoris. In conclusion, I found a large variation between the techniques of neurologists when assessing the Babinski reflex. This variation is related to variation in aspects of the resultant reflex. The pathological response (the Babinski sign) has shorter movement latency and less activity in the tibialis anterior muscle than the flexor response seen in healthy individuals. Ratings of pre-recorded Babinski responses had substantial agreement when both neurologists and medical students assessed pathology. In order to assess them both groups made use of the speed of the reflex, the direction of hallux movement and concurrent withdrawal activity in the leg to differentiate between a pathological and a healthy response.