Saudi Cultural Missions Theses & Dissertations
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Item Restricted Advances in the assessment and rehabilitation of ambulatory chronic stroke survivors.(King's College London, 2024-11-13) Ajaj, Kawthar; Pavlou, Marousa; Harridge, Stephen; Sorinola, IsaacWalking at a functional level is a requirement for walking safely in the community. Walking at a functional level requires good balance control and the ability to perform functional tasks while walking in challenging situations such as walking across a busy road. This thesis attempts to answer a number of questions regarding assessment of walking at a functional level in older people at risk of falls and in stroke survivors. The first part of the work involves a systematic review. The aim of the systematic review is to identify the available clinical OM used in clinical physiotherapy to assess walking at a functional level for stroke rehabilitation and to evaluate their psychometric properties. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The Consensus-based Standards for the selection of health status Measurement Instruments (COSMIN) tool was used to assess the risk of bias in the quality of the methodological design and statistical methods in reliability, validity, and responsiveness in the included studies. Fifty-four studies were included in the review, six OM were identified for dynamic balance, twenty-one OM for functional gait, and three studies including five tests each for motor and cognitive tests to assess dual task while walking. The most tested psychometric properties were reliability and construct validity. Studies on responsiveness were limited. The aim of the first experimental study (Chapter 5) is to identify the associations between walking at a functional level and subjective visual verticality (SVV), cognitive function, psychosocial aspects, and physical activity (PA) levels. Twenty chronic stroke survivors capable of independently walking at least 6 metres and twenty healthy controls were recruited in this study. Assessment of functional-level walking included the Mini-Balance Evaluation Test (Mini-BESTest), and the Functional Gait Assessment (FGA). The Rod and Disc test was used to assess the SVV, the Cambridge Neuropsychological Test Automated Battery (CANTAB) tests for the cognitive functions, a set of questionnaires were used to assess psychosocial aspects and the AX3 monitor to determine the PA levels. The difference was significant between the groups in the Mini-BESTest and the FGA (p<0.001), lower (i.e., worse) Mini-BESTest and FGA scores were observed for ambulatory chronic stroke survivors. Balance confidence emerged as a key factor associated with both the Mini-BESTest and the FGA in ambulatory chronic stroke survivors. The Spearman’s rank-order correlations between the balance confidence scale and the Mini-Best, and the FGA were (rs = 0.72 and 0.75) respectively in ambulatory chronic stroke survivors. The results suggest that there is a need for rehabilitation for walking at a functional level for ambulatory stroke survivors and balance confidence should be considered in their assessment and treatment. Difficulties in balance control and limited walking functions are also common in older adults and increase their risk of falls. Both populations (older adults at risk of falls and stroke survivors) need balance training rehabilitation based on a multifactorial approach, which current rehabilitation programmes do not incorporate. Current rehabilitation programmes are limited to simple physical exercises. In addition, previous studies have shown that adherence rates to exercise rehabilitation programmes are low. Using telerehabilitation can enhance adherence rates and adds enjoyment to the exercise rehabilitation programmes. The aim of the next experimental work presented in this thesis was to assess the feasibility and acceptability of a novel telerehabilitation system in older adults at risk of falls and ambulatory chronic stroke survivors: the HOLOBalance system. This is a platform that uses a hologram to deliver the exercise instructions for balance training and uses wearable sensors to detect simultaneous body movements. The training addresses all components relevant to balance using multisensory rehabilitation exercises, exergames, and cognitive training. In addition to assessment of feasibility and acceptability, trends of improvement in balance and functional gait were also investigated. This was undertaken in both older adults at risk of falls and stroke survivors. For older adults at risk of falls (n=54) the participants were randomised to HOLOBalance intervention home-based (HOLOBalance), clinic based (HOLOBox) or control groups. In a second study, the HOLOBalance system (clinic based HOLOBox) was assessed for feasibility and acceptability in stroke survivors (n=8). The main finding from both feasibility studies was that the HOLOBalance system was feasible and acceptable for older adults at risk of falls and ambulatory stroke survivors, as assessed by drop-out, adherence rates, exit interviews, and usability scales. The preliminary data showed that there were trends of improvement in balance and functional gait measures in the intervention groups (HOLOBalance and HOLOBox) in the older adults, and in the stroke survivors who had received the clinic based HOLOBox intervention.41 0Item Restricted A Survey Assessing the Perceptions and Interpretations of Saudi Therapists on the Use of Virtual Reality Therapy for Patients with Spinal Cord Injury(Cardiff University, 0024-06-13) Alqarni, Rawabi; Williams, AlisonTitle: A Survey Assessing the Perceptions and Interpretations of Saudi Therapists on the Use of Virtual Reality Therapy for Patients with Spinal Cord Injury. Background: Virtual Reality (VR) has emerged as a promising tool for enhancing rehabilitation, particularly for individuals with spinal cord injuries (SCI) and neurological conditions. This study offered a comprehensive examination of VR-based interventions, encompassing the user experience (UX), game mechanics (GM), in-game assistance (IGA), and VR-induced symptoms and effects (VRISE). Methods: A descriptive survey with a self-developed questionnaire investigating the 31 Saudi therapist's perspectives that were based on patient feedback who were recruited via WhatsApp then filled up the questionnaire that contained 22 questions (both closed& opened-ended), providing a well-rounded assessment of the VR rehabilitation experience. Statistical outcomes, therapist involvement, and specific context were considered to identify areas for improvement and opportunities for further research. Results: The study highlighted the significance of enjoyment in fostering patient engagement and the need for customized VR setups aligned with patient preferences. Graphics and sound quality, while important, are not the sole determinants of engagement, emphasizing the importance of a holistic VR experience. GM and IGA show promise but require customization. Addressing VRISE through technological advancements is essential. Conclusion: This research underscored the continuous evolution of VR technology and design to better serve individuals with SCI and neurological conditions, emphasizing the importance of tailored approaches and ongoing advancements in VR-based rehabilitation.8 0Item Restricted Epidemiology of Cerebral Palsy in the Kingdom of Saudi Arabia(The University of Sydney, 2024-05-31) Mushta, Sami Mukhdari E; Khandaker, Gulam; McIntyre, Sarah; Rashid, Harunor; Badawi, NadiaBackground: Cerebral palsy (CP) is the primary cause of childhood physical disability and lacks comprehensive epidemiological data in Saudi Arabia and similar regions. This PhD thesis explores the epidemiological profile, clinical manifestations, and challenges of CP in Saudi Arabia, aiming for a better understanding and potential intervention strategies. Methods: This thesis utilised multiple research methods: - Narrative literature review to define the burden of CP in Arabic-speaking and Middle Eastern countries. - Systematic reviews, meta-analyses, and a hospital-based surveillance of children with CP in Saudi Arabia from 2020 to 2022 to assess epidemiology and nutritional status. - An online survey to examine the impact of COVID-19 on primary caregivers of children with CP in Saudi Arabia. - Designing and establishing a CP register in Saudi Arabia through multi-organisational collaboration. Results: Literature reviews indicate scant data on CP epidemiology in the Middle East, including a CP prevalence of 1.8/1000 live births in the region. Spastic CP is predominant (59.8%), with significant consanguinity-related risk (37.7%). In Saudi Arabia and similar regions, 71.5% of children with CP suffer from malnutrition. Surveillance of 442 children indicated a majority are over four years old, with birth asphyxia being a major cause (32.4%). Many children lacked rehabilitation services and were not current on immunizations. COVID-19's impact was notable but mostly non-hospitalised; however, telehealth was deemed inadequate by most families. Conclusions: CP epidemiology in Saudi Arabia is poorly defined despite being a high-income country. Significant gaps in population-based surveillance and research persist, underscoring the need for comprehensive studies to understand CP's aetiologies and improve prevention, diagnosis, and treatment. Establishing a Saudi CP register is crucial for advancing research and healthcare strategies.28 0Item Restricted A Novel Shape Memory Polymer Actuator(Saudi Digital Library, 2023-11-20) Hejazi, Rahaf; Keller, Alex; Qi, QiukaiBladder dysfunction, arising from an underactive bladder results in restricted mobility and the emergence of diseases such as kidney failure, with minimal long-term bladder treatments available. The developing field of Biorobotics presents solutions to problems of this nature by employing biomimetic principles and drawing from nature. In response to the propensity of the bladder to exhibit geometrical changes in the the long term, it is increasingly important to develop artificial tissues which closely mimic the mechanical and biological stimuli of natural muscle tissue. In this work, methods were employed to enable the design of shape memory composites that mimic the properties of the detrusor wall, amongst those properties were actuation. The shape fixity and shape recovery rates of silicone paraffin composites were analysed by heating them in a hot water bath measuring their change in elongation. The test results displayed a positive correlation between shape fixity and paraffin content. The results had also demonstrated that the specimens recovered almost entirely. Further, actuation was measured by clamping the specimens and measuring their contraction. Joule heating was employed as a method to thermally activate the shape memory behaviour of the silicone paraffin wax composites. Varying voltage as different responses were observed and image processing was used to extract the data. Ultimately the aim of the thesis is to provide a potential solution and prototype for a long term morphologically changing artificial detrusor. The findings in this study show promise in producing an artificial robotic detrusor that mimics the changing bladder shape while maintaining its fixity. Subsequently, the novel material composite which was investigated in this study may be used in wider shape memory polymer applications.37 0Item Restricted Telerehabilitation in occupational therapy practice in Saudi Arabia(Saudi Digital Library, 2023-06-18) Aljabri, Naif Q; Cusick , AnneBackground: In line with Saudi Vision 2030, ways to make rehabilitation accessible and available need to consider telerehabilitation as a potential, but to date, no information is available about Saudi occupational therapy (OT) and this model of care. Aim: to develop an evidence base to support the introduction and implementation of telerehabilitation in OT practice in Saudi Arabia. To do this, existing research about telerehabilitation in Saudi Arabia is identified, characteristics of the OT profession in Saudi Arabia are presented, and OTs' knowledge, perspectives, and attitudes about the current and future use of telerehabilitation are explored. Methods: The study series used a non-clinical case study of OT development in Saudi Arabia, a structured review of the literature regarding telerehabilitation in the Middle East and North Africa (MENA) region, a cross-sectional survey of OTs in Saudi Arabia regarding telerehabilitation based on the Technology Acceptance Model (TAM), and interviews that explored Saudi OTs experiences and perspectives of telerehabilitation in their practice which included the use of this model of care during the Covid-19 pandemic lockdown. Results: OT is a rapidly growing but emerging profession in Saudi Arabia. There is evidence that telerehabilitation is used across MENA, with most activities in physiotherapy but non-Saudi examples in OT. The TAM survey revealed positive attitudes and readiness to use telerehabilitation among OTs, with 48.6% of the variability in the intention to use telerehabilitation affected by gender, education level, type of care, attitude towards telerehabilitation, perceived usefulness, technical infrastructure, and sharing of information. The Saudi OTs have had positive experiences using telerehabilitation during the pandemic and identify ways to use and sustain OT telerehabilitation in the future. Conclusion: Telerehabilitation is promising in OT practice in Saudi Arabia.49 0Item Restricted Development of a core outcome set for lower limb orthopaedic suregical interventions in ambulant children and young people with cerebral palsy(2023-05-09) Almoajil, Hajar; Dawes, Helen; Toye, Francine; Theologis, Tim; Hopewell, Sally; Saboskbar, AfsieFirst and foremost, I offer my sincerest gratitude to my primary supervisor, Mr. Tim Theologis, for his guidance and support, valuable advice and feedback, for being straight-forward, for not giving up and patiently helping me to stay on the track and unwavering support, in many an hour of self-doubt. I would like to thank him for seeing the potential and believing in me, encouraging me to pursue this body of work. Thank you! I am grateful to my co-supervisors, Professor Helen Dawes, Professor Sally Hopewell and Dr Francine Toye, for offering their expertise, insight, and for their patience, guidance. Thanks must go to Professor Crispin Jenkinson, for his support and contribution and guidance on setting up the project. I am extremely grateful to all advice from members of our Patient and public Involvement group, and the steering committee, ensured that this work focussed on what mattered most to children undergoing lower limb orthopaedic surgery. This project, which I am, always have and always will be passionate about, would not have been possible without the participation of children and young adults with CP, their families and healthcare professionals across the UK and colleagues internationally, who have participated with excitement, wisdom and honesty. I hope that the influences of this research are far-reaching. I am indebted to the Imam Abdulrahman bin Faisal University for funding me to undertake a DPhil program. This decision has made an incredibly positive impact on my life, and I hope, produced work that will benefit children with CP internationally. To my colleagues, Foteini Mavrommati, Stella Koukides, Jerneja Uhan, Norah Almulhem and Wafa Almusallam for their guidance and inspiring me every single time we met through the years in completing this research. I reserve my most heartfelt thanks for my family. My parents and family, for their constant love and support and for believing in me enthusiastically. Most of all, I would like to thank my husband, Abdullah, who has been my biggest supporter, and whose bravery, integrity and resilience are a constant source of inspiration.27 0