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Theses and dissertations (Health Sciences)

Permanent URI for this collectionhttp://ir-dev.dut.ac.za/handle/10321/12

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    The effect of cervical spine manipulation on elbow proprioception, electrical activity of the triceps and biceps muscles and balance
    (2018) McKay, Hannah Lenka; Matkovich, Grant
    Objectives The purpose of this study was to determine the effect of cervical spine manipulation (CSM) on joint position sense (JPS) of the elbow; electrical (muscular) activity of the biceps and triceps brachii muscles and balance. Background Balance is a complex process requiring constant communication between the visual, the vestibular and the somatosensory (nervous) systems. JPS and electrical activity of muscles play an important role in maintaining balance. Many of the tracts relaying information regarding JPS, electrical activity and balance pass through the cervical spine. It is thought that cervical spine fixations have a negative effect on the surrounding neurology and thus affect somatosensory integration. Therefore, correction of cervical spine fixations with CSM may improve and restore normal function, including, but not limited to, elbow JPS, electrical activity of the biceps and triceps brachii muscles and balance. Methods Institutional Research Ethics Committee (IREC) approval of the study was obtained (IREC reference number: REC 115/16). A quantitative, descriptive, pre-test post-test randomised control trial investigation design was utilised. A pilot study was performed to validate the experimental procedures. Potential participants were assessed through a telephonic interview, a case history and a physical examination, to screen them against the inclusion criteria. Eighty-one participants between the ages of 18-35 years were randomly allocated to either the control (n = 20) or the intervention group (n = 61). The intervention group was further stratified into three subgroups, namely upper cervical spine fixations only (C0-C3); lower cervical spine fixations only (C4-C7) and both upper and lower cervical spine fixations. Each participant completed two pre-tests for static balance (eyes open and closed) and dynamic balance (eyes open and closed) [Biosway Biopac balance system]; one pre-test for electrical activity of biceps and triceps brachii muscles at rest and then during an active movement; and one pre-test of the ipsilateral elbow for JPS [Biopac AcqKnowledge sEMG machine and goniometer]. All tests were performed on the dominant arm. The intervention group then received CSM to correct the fixated segments. The control group underwent a 20 second rest period instead of the CSM. The electrical activity of the biceps and triceps brachii muscles was recorded during the intervention period. The pre-tests were then repeated as post-tests immediately following the intervention. Analysis was by paired sample t-tests (pre and post outcomes for intra-analysis). Independent t-tests were conducted to determine mean differences between the control group and intervention group. An ANOVA test was conducted for mean differences from pre- and post-intervention readings between the control group and the three intervention subgroups. If the null-hypothesis was rejected, then post hoc tests were conducted to detect where the differences lay. A p- value < 0.05 was considered statistically significant. The effect size (Cohen’s d), was also used to determine the magnitude of the effect of interest. Results There was no statistically significant improvement in elbow JPS immediately following CSM. The combined intervention group showed a statistically significant increase in the electrical activity of biceps (p < 0.001) and triceps brachii (p = 0.004) muscles during the CSM. The group that received upper CSM only had the greatest increase during CSM in both muscles (p = 0.04 for biceps and p = 0.024 for triceps. This group also had a sustained increased electrical activity that was statistically significance for a 10% level of significance (p = 0.09), during the rest period. There was a statistically significant improvement in dynamic balance for the combined intervention group (p = 0.012). Of the subgroups, the lower CSM only group had the greatest improvement in dynamic balance (p = 0.035) followed by the upper CSM only group (p = 0.074, significant for a 10% level of significance). Comparison of the four groups indicated two trends in the outcomes. The first trend was that the upper CSM only group had the greatest effect size for elbow JPS improvement and increased electrical activity for the biceps and triceps brachii muscles during the intervention and rest period, as well as a statistically significant difference in dynamic balance at a 10% confidence interval (p = 0.074). The second trend was in the lower CSM only group, which had the greatest effect size in decreasing electrical activity during the active movement as well as the greatest statistically significant improvement in dynamic balance (p = 0.035). Conclusion This preliminary study indicates that there is no immediate improvement in elbow JPS following CSM as a once off intervention. CSM has an immediate effect on increasing electrical activity of the biceps and triceps brachii muscles during the CSM. CSM also improves dynamic balance. Upper CSM has the greatest effect on electrical activity during the CSM and rest period. Lower CSM has the greatest effect in improving dynamic balance.
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    The effect of interferential current treatment duration on chronic low back pain
    (2017) Carim, Ahmed Abdul; Varatharajullu, Desiree
    Background to the study: Chronic low back pain (CLBP) is a common musculoskeletal complaint, which results in increased absenteeism from work and other disabilities. Interferential current (IFC) is one of the treatment modalities used by manual and physical therapists to alleviate CLBP. Interferential current involves electrical stimulation of medium frequency using two currents that cross over each other. There have been numerous mechanisms proposed on how IFC works with regard to pain inhibition; however, these remain unconfirmed. Common theories include those based on the gate control theory of pain and integrated pain theories. Although the placement of the electrodes used in the IFC application has been well defined, the optimum treatment time for CLBP has not been well researched. Therefore, this study aimed to determine what protocol regarding the duration of IFC is most appropriate in the treatment of CLBP. Aim: The aim of this study was to investigate the effect of interferential current in the treatment of chronic low back pain using variable time intervals Methodology: This study was a randomised single-blinded clinical trial which consisted of 45 participants residing in the eThekwini municipality, divided into three groups of 15 each. The participants were randomly assigned using concealed allocation to one of three treatment groups of 15 each viz. 15, 20 or 30 minutes of interferential current (IFC). Low back pain level was determined using a numerical pain rating scale (NRS-101). Pain pressure thresholds (PPT) were measured with a pain pressure algometer. The effect of low back pain on participants’ activities of daily living was assessed using the Oswestry low back questionnaire (OLBQ).The participants received three treatments over a two week period with the fourth consultation being used for the final subjective and objective measurements a week later. Results: Repeated measures ANOVA testing was used to examine the intra-group effect of time and the inter-group effect of treatment on the outcomes of NRS-101 and algometer readings. Profile plots were used to assess the direction and trends of the effects. An intra-group analysis revealed that, objectively and subjectively, all groups responded positively to treatment over time, with no significant time-group interaction. Conclusion: This study concluded that neither group is more effective than the other with respect to participants’ pain perception and the OLBQ. However, groups one and three showed the largest individual improvement between consultation one and three, compared to group two which showed consistent improvement throughout for the NRS-101 readings. Based on the results collected from this study, the shortest time frame of 15 minutes of IFC application can be used in the treatment of CLBP.