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Item Shining a light on recovery : investigating the effectiveness of bright light therapy in mitigating fatigue after mild traumatic brain injury : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, New Zealand(Massey University, 2023) Connolly, Kathryn MarieFatigue is a common and debilitating symptom experienced by individuals following a mild traumatic brain injury (mTBI). Despite its prevalence, post-mTBI fatigue remains a challenging, and at times misunderstood condition, with a scarcity of scientifically evidenced treatment approaches. The complexity of fatigue's underlying causes in this population calls for further research. Recognising its significant impact on individuals' quality of life emphasises the need to identify effective interventions and enhance symptom management. This study aims to investigate the potential effectiveness of daily bright light exposure as a non-invasive intervention to alleviate fatigue in the post-mTBI population. While existing research has shown positive outcomes for bright light therapy in managing fatigue in broader traumatic brain injury populations, the current study focuses on individuals with injuries at the mild end of the spectrum, offering valuable insights into the efficacy of this treatment in a more targeted context. The primary objective of the research was to investigate whether daily bright light exposure effectively reduced fatigue symptoms in individuals with mTBI. Additionally, the study aimed to explore the impact of light exposure on secondary outcomes, including daytime sleepiness, sleep quality, depression, anxiety, stress, and circadian rest-activity cycles. To address recruitment challenges, a randomised multiple baseline controlled trial design was adopted. The results revealed that all nine participants consistently experienced significant fatigue throughout the study. Fatigue levels appeared to decrease during the bright light therapy sessions suggesting a potential positive impact of bright light exposure on fatigue, although this reduction was not statistically significant across the group. Due to limitations in data, the ability to confidently demonstrate efficacy was low and this prompted a shift in focus towards assessing the feasibility of conducting research of this nature. Moving forward, future studies can benefit from an understanding of the complexities involved in implementing intensive intervention protocols. The current study demonstrates a need for close collaboration with participants to monitor adherence and potential side effects, alongside coordination with colleagues in the mTBI field to ensure access to a sufficient participant pool for achieving statistically significant results. Overall, this research provides some limited evidence of positive effects from bright light therapy for select individuals and contributes to the expanding body of evidence investigating light as a potential intervention for alleviating fatigue symptoms post-mTBI. More importantly, by shedding light on the hurdles in implementing such interventions among individuals with mTBI, it contributes to the development of targeted and potentially effective interventions for improving the quality of life for individuals affected by this condition. It is hoped that this study contributes to the broader literature aimed at facilitating better outcomes for individuals with mTBI and related fatigue symptoms.Item Social interactions in New Zealand common bottlenose dolphins (Tursiops truncatus) : association dynamics, skin diseases and aggressive injuries, and variations in vocal signals : a thesis presented in partial fulfilment of the requirement for the degree of Doctor of Philosophy in Conservation Biology at Massey University, Auckland Campus, New Zealand(Massey University, 2022) Patin̋o-Pérez, JessicaSocial behaviour is described as a series of interactions between two or more members of the same or different species that usually benefits all the individuals involved. Individuals form strong bonds because of these interactions, which might be cooperative, hostile, mutualistic, or altruistic. Depending on the nature of the relationships and participants, social behaviour can lead to the establishment of distinct social systems. Although it is evident that social behaviour does not have to be selfless, the question of why and how social behaviours occur in animals is still being debated. According to Krause and Ruxton (2002), sociality emerges when the advantages of long-term social contacts outweigh the drawbacks of such close relationships with conspecifics. Among the advantages of living in a group are increased opportunity for food and mating, as well as protection from predators. This sociality, on the other hand, might have negative implications, such as increased rivalry for mates and resources or increased disease transmission risks. I investigated multiple aspects of the social lives of common bottlenose dolphins Tursiops truncatus (hereafter bottlenose dolphins) in New Zealand. Historically, the north-eastern North Island bottlenose dolphin population has been intensively studied at the Bay of Islands since it was the only place where dolphins are constantly sighted. A rapid decline in this population and high calf mortality raised concern about the viability of this population. The key objective of my research was to understand how different social aspects influence the population of bottlenose dolphins at Great Barrier Island (GBI), New Zealand, an area that was recently describe as a ‘social hub’ for the species. Although, throughout my thesis I talk about the population of dolphins present in GBI, it is important to keep in mind that this is one part of the entire North Island population. In the first part of my thesis, I describe the social structure of bottlenose dolphins in GBI using historical data from the Bay of Islands (BOI) and GBI, in addition to my own data. I analysed their social structure by examining: (1) preferred/avoided companions, (2) strength and distribution of associations, (3) temporal and spatial patterning of associations, and (4) residence times. The analysis of BOI-GBI showed two distinct social communities, each of which is made up primarily of members photographed only in their respective areas. Only a few individuals were identified in both areas. For GBI, two datasets were analysed: 2011-2013 and 20015-2019. During both time periods, the population exhibited low levels of association, characteristic of fission-fusion societies like bottlenose dolphins, but the populations also showed some structure, with dolphins forming long-lasting bonds with some individual and avoiding others. Moreover, during 2015-2019, two social communities were identified in the population, exhibiting different ranging patterns and pattern of association within communities. The temporal analysis showed that during 2011-2013, the population exhibited a combination of stable associations among individuals and other individuals that associate, disassociate, and may reassociate again over extended periods of time. During 2015-2019, dolphins associate for short periods of times before breaking up, happening at two different times. Analysis of residency times during 2011-2013, showed that the models including emigration + reimmigration were the best to describe the population, while during 2015-2019, were the models including emigration/mortality. Bottlenose dolphins associate in groups that frequently change in size and composition, characteristic of fission-fusion societies. Skin lesions and tooth rakes can be used to assess natural and anthropogenic pressures within a population, which is useful information for better understanding population dynamics. In addition, tooth rake marks are a measure of the level of social contacts within a population and are usually the outcome of inter- and intra-specific interactions. Gregariousness is a major component in disease transmission and increases the likelihood of aggressive confrontations. When it comes to diseases, animals with a high incidence of interactions with others will increase the chances to spread diseases, putting their populations at risk. In this thesis, I described for the first time the prevalence of skin lesions and tooth rakes for the north-eastern population of bottlenose dolphins. In addition, I described the skin lesions found in, and determined the location of, the skin lesions and tooth rakes on dolphins’ bodies. I also proposed a protocol to assess skin lesions and what are the implications for future studies. Finally, I tested if there was an association between skin lesions and tooth rakes, and the strength of the dolphins in their social network. I wanted to know if presence or absence of tooth rakes was defined by the strength in their social network and if dolphins with a higher coverage score of tooth rakes will have a higher strength in their social network. In addition, I examined if tooth rake scores were different based on the presence and absence of skin lesions. From the literature, I found 19 skin lesions with distinct and non-overlapping definitions. These lesions were the foundation of the protocol that I used to assess lesion presence in my population. Eight skin lesions were present in bottlenose dolphins at Great Barrier Island, with different prevalence in the population and varying distribution across different parts of the dolphin body. Pale lesions had the highest prevalence at 84.4% and were found across four body parts, but mainly in the dorsal fin. Similarly, black lesions, white-fringe spots, nodules, and dark-fringe spot were found in four body parts but their prevalence in the population were lower (33.1%, 17.5%, 11.7%, and 15.6%, respectively). Finally, spotted lesions (10.4%), white fin fringe (5.84%), and tattoo-like disease (4.54%) had the lowest prevalence and were found in three, two, and one body region(s), respectively. Tooth rakes also had a high prevalence in the population (94%), and they were found mostly on the dorsal fin (100%, n = 150), followed by mid-flank (90.2%, n = 139), and anterior section (88.3%, n = 136). The mean coverage score did not change significantly over time (images were compared up to 20 months apart). From the 150 dolphins included in the tooth rake analysis, individuals sighted four or more times were included in the analysis of tooth rakes and strength of associations, giving a sample size of 50 dolphins. I found that the strength of the individual (i.e., it is the individual’s gregariousness) in the social network does not affect the tooth rakes an individual has and having tooth rakes is not dependent on strength. In addition, coverage score (a value obtained dividing the presence of skin lesions in 12 body parts by their visibility) did not change with the presence of skin lesions. In this chapter, I emphasised the need to determine the overall health of cetaceans in the North Island, as well as the need for more precise and systematic evaluations of the skin lesions of this population and other cetaceans in the region. Cetaceans are highly vocals animal that depend on sound to communicate, navigate, and find food. Most dolphins can produce three different types of sound, from which whistles have been the most studied due to this type of vocalisation being within the human hearing range and more easily visualised in spectrograms for analysis. Whistles are narrowband, frequency modulated sounds with strong harmonic structure and are used in social interactions. Geographic variation in whistle characteristics has been reported in many populations of bottlenose dolphins around the world and the causes of this variation are diverse. For the first time in New Zealand, I have compared the variation in whistle characteristics of two isolated populations of bottlenose dolphins, GBI and Fiordland, using seven time-frequency variables. In addition, I compared the parameters between these isolated populations using Random Forests analysis (RF) and assessed the influence of location, group size, and presence of immatures on these characteristics. Finally, I compared the whistle characteristics of bottlenose dolphin populations from around the world with New Zealand populations using a hierarchical cluster analysis. Whistle characteristics of both populations were similar to other populations around the world, surprisingly, my populations were similar to other populations from the northern rather than the southern hemisphere regions. A comparison of whistle parameters between GBI and Fiordland, showed that the Fiordland population had longer whistles and more inflection points than whistles from the GBI population. Whistles from these two populations were distinct enough to be correctly allocated to one population based on acoustic measures alone with a 90% of accuracy. The most important variables for classification were whistle type contour, duration, and end frequency. I obtained two principal components from the NIPALS PCA. The first principal component (PC1) explained 55.6% and the second component (PC2) explained 44.4% of the variance. Linear Mixed Models on PC1 and PC2 were used to assess whether whistles acoustic parameters were influenced by location, group size, and presence of immatures. I found that PC1 was not different between areas or with the presence of immatures. However, minimum frequency and duration differed between the two populations (location). Overall, my research has produced significant new knowledge on the social structure, prevalence of skin lesions and tooth rakes, and geographic variation in vocalisations of bottlenose dolphins. My research provides better understanding of the high degree of social and acoustic plasticity of bottlenose dolphins by applying state-of-the-art approaches such as social network and random forests analyses to multiple temporally and spatially diverse datasets. In addition, I developed a useful tool for non-invasive categorisation of infectious skin diseases that can be used by researchers and conservation practitioners worldwide to assess the health of individuals and populations.Item Broken shoulders in dairy heifers in New Zealand : investigating the relationship between live weight and bone morphology in the bovine forelimb : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Animal Science at Massey University, Palmerston North, New Zealand(Massey University, 2021) Gibson, MichaelaSpontaneous humeral fractures in first lactation dairy heifers are a significant economic and welfare issue in the New Zealand dairy industry. With approximately 4% of dairy farms being affected and, within farm, up to 25% of replacement heifers lost, the cost to the dairy industry is estimated to be over $10 million. Preliminary observations from Dittmer et al. (2016), showed the presence of growth arrest lines in bones from affected heifers, indicating a period of malnutrition in the heifer’s life. However, with little known about how heifer’s bones grow within the New Zealand pastoral system, it is difficult to identify developmental time periods that have the greatest impact on long bone growth and, therefore, greatest potential to affect the risk of fracture. Therefore, the aim of this thesis was to investigate the relationship between live weight and bone morphology in the bovine forelimb to identify potential risk periods for spontaneous humeral fractures in first-lactation dairy heifers. In this thesis, the metacarpus and humerus were opportunistically collected from cattle from a variety of experiments carried out at Massey University and from samples submitted from farms throughout New Zealand. Measures of bone morphology in the metacarpus were highly correlated with the same measure in the humerus (R²=0.89-0.98). Measures of the humerus and metacarpus were also highly correlated with live weight at all ages. However, the relationship between bone and live weight changed over time demonstrating differences in bone maturity. Distal regions of the forelimb such as the metacarpus matured by one year of age as indicated by a different relationship between live weight and pQCT measures of the humerus at 24 months compared with 8-12 months of age. However, proximal regions of the forelimb such as the humerus continued to grow after a year of age. Differences in proximal and distal bone growth were reflected in the pattern of stature growth. A cohort of dairy heifers (Holstein Friesian, Jersey, and Holstein-Friesian cross Jersey) were measured for live weight, height, wither-rump length, girth, and distal and proximal forelimb length (stature) from birth to 15 months of age. As live weight increased, the contribution of the distal limb to increases in height decreased, which is consistent with knowledge that physeal closure in cattle occurs earlier in distal limb bones, such as the metacarpus, than in proximal limb bones, such as the humerus. Finally, bones collected from heifers affected and unaffected by spontaneous humeral fractures were compared and the effect of copper status on bone measures was examined. The mid diaphysis of the humerus of the affected group had reduced cortical bone mineral density (p<0.05) and a trend for reduced cortical content and total bone content which contributed to a reduced stress-strain index. A trend for reduced bone length in affected humeri provides additional support for the hypothesis of inhibited humeral growth. Heifers with low liver copper concentration had reduced humeral length and reduced cortical bone mineral density (p<0.05). Growth and fracture data presented in this thesis support the hypothesis that the most likely developmental period in which inadequate bone growth occurs in heifers subsequently affected by humeral fracture is in the months leading up to the event, which coincides with the animal’s second winter.Item Investigation of genotype and phenotype interactions using computational statistics : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Statistics at Massey University, New Zealand(Massey University, 2021) Angelin-Bonnet, OliviaDeciphering the precise mechanisms by which variations at the DNA level impact measurable characteristics of organisms, coined phenotypes, through the actions of complex molecular networks is a critical topic in modern biology. Such knowledge has implications spanning numerous fields, from plant or animal breeding to medicine. To this end, statistical methods must be leveraged to extract information from molecular measurements of different cellular scales, allowing us to reconstruct the regulatory networks mediating the impact of genotype variations on a phenotype of interest. In this thesis, I investigate the use of causal inference methods, to infer relationships amongst a set of biological entities from observational data. More specifically, I tackled the reconstruction of multi-omics molecular networks linking genotype to phenotype. In the first part, I developed a simulator that generates benchmark gene expression data, i.e. RNA and protein levels, from synthetic gene regulatory networks. The originality of my work is that it includes transcriptional and post-transcriptional regulation amongst genes. I used the developed simulation tool to evaluate and compare the performance of state-of-the-art causal inference methods in reconstructing causal relationships between the genes. The evaluation focused on the ability of the methods to reconstruct relationships mediated by post-transcriptional regulations from observational transcriptomics data. I also evaluated the methods performance to detect different types of causal relationships between genes via a catalogue of causal queries, and highlighted the shortcomings associated with using transcriptomics data alone in reconstructing gene regulatory networks. In the second part, I developed an analysis framework to shed light on the biological mechanisms underlying tetraploid potato tuber bruising. I first integrated a GWAS analysis with a differential expression analysis on transcriptomics data, to uncover genomic regions in which variations affect the response of tubers to mechanical bruising. I then used a multi-omics integration tool to jointly analyse genomics, transcriptomics, metabolomics and phenotypic data and to identify molecular features across the omics datasets involved in tuber bruising, including some not identified with traditional differential expression analyses. Finally, I made use of causal inference tools to reconstruct a multi-omics causal network linking these features to decipher the molecular relationships involved in tuber bruising. I used causal queries to extract information from the reconstructed causal networks and interpret the uncovered relationships.Item Injury incidence and physiological requirements of a domestic amateur women's rugby union team in New Zealand : a thesis submitted to Massey University in fulfilment of the degree of Doctor of Philosophy at Massey University, Palmerston North, New Zealand(Massey University, 2021) King, DouglasWomen’s rugby union has undergone a period of transition to become, reportedly, the fastest growing form of the game worldwide. Although the game is played nationally and internationally, it was not until 1991 that the first Rugby World Cup for women (RWC(W)) was held. Despite increased popularity and growth, the published studies investigating the epidemiological aspects of match and training in women’s rugby union is limited. Of the published studies to date, none have reported on aspects related to women’s rugby union participants in New Zealand. Therefore, the overall aim of this thesis was to explore and document the epidemiology of injuries in an amateur women’s rugby union team in New Zealand. As fatigue has been indicated as a possible injury risk factor, the physiological demands of match participation in amateur women’s rugby union were also assessed. Specific aims of the thesis were (1) The identification of the physiological and heart-rate demands of match participation for amateur women rugby union players; (2) The identification of the most common site, type, severity, and frequency of injuries that occur to women in rugby union training and match related activities (Systematic Review); (3) The identification of the most common site, type, severity, and frequency of injuries that occur to women in rugby union training and match related activities in New Zealand. The methodological approaches utilised in this thesis included an epidemiological analysis (Chapter 3), and a prospective observational cohort analysis (Chapters 2, 4 and 5). In measuring the movement demands of amateur domestic women’s rugby union (Chapter 2), player movements were monitored using microtechnology GPS devices. Players’ heart rates were also continuously monitored during match participation using a portable monitor. A mean total distance per match of 3,546.6 ±1,329.2 m was recorded over 28 matches. This resulted in a mean distance of 38.3 ±13.7 m.min-1 which was less than women’s football (79.3 to 118.0 m.min-1: mean 101.0 ±11.9 m.min-1), hockey (79.0 to 115.0 m.min-1: mean: 98.5 ±15.6 m.min-1) and women’s elite rugby union (54.8 to 68.0 m.min-1; mean: 61.4 ±9.3 m.min-1). Although Forwards recorded a lower total distance (3,409.7 ±1,201.9 m vs. 3,692.3 ±1,440.5 m) and m.min-1 (36.7 ±12.4 m.min-1 vs. 40.0 ±14.9 m.min-1) than Backs, they had a similar player-load (PL) (3.8 ±1.3 au.min-1 vs. 3.9 ±1.4 au.min-1), PL 2-dimensional (2.9 ±1.0 au.min-1 vs. 2.9 ±1.1 au.min-1), PL Forward (1.8 ±0.7 au.min-1 vs. 1.7 ±0.7 au.min-1), PL side (1.9 ±0.7 au.min-1 vs. 1.9 ±0.7 au.min-1) and PL vertical (2.9 ±1.0 au.min-1 vs. 3.0 ±1.2 au.min-1) when compared to Backs. Forwards recorded a higher maximum heart rate than Backs (191 b.min-1 vs. 188 b.min-1), indicating a higher cardiovascular stress and physiological strain for Forwards compared with Backs. The results of this study suggested that the physical and physiological profile of the playing group, at the amateur domestic level of women’s rugby union, were quite similar and may be suggestive of generalised, rather than specialised, training regimes that fail to prepare players for the position specific demands needed at higher levels of competition. The systematic review (Chapter 3) of literature reporting on women’s rugby union incorporated both rugby-15 and rugby-7s match and training related published studies. Only 10 articles identified through systematic searches of PubMed, SPORTDiscus, Web of Science Core Collection, Scopus, CINAHL(EBSCO) and ScienceDirect databases using keywords were included in the review. The incidence of injuries in rugby-15s varied from 3.6 (95% CI: 2.5-5.3) per 1,000 match-hr (including training and games) to 37.5 (95% CI: 26.5-48.5) per 1,000 match-hr, with a pooled incidence of 19.6 (95% CI: 17.7-21.7) per 1,000 match-hr. For rugby-7s, the injury incidence varied from 46.3 (95% CI: 38.7-55.4) per 1,000 match-hr to 95.4 (95% CI: 79.9-113.9) per 1,000 match-hr with a pooled incidence of 62.5 (95% CI: 54.7-70.4) per 1,000 player-hr. The tackle was the most commonly reported injury cause, with the ball carrier recording more injuries than the tackler at the collegiate, and RWC(W) levels of participation. Concussions and sprains/strains were the most commonly reported injuries at the collegiate level of participation. The incidence of injury in women’s rugby-15s and rugby-7s was lower than in men’s professional rugby-15s and rugby-7s competitions, but similar to male youth rugby-15s players. Differences in reporting methodologies limited comparisons of results between studies. Of note, the systematic review failed to identify any New Zealand based studies in women’s rugby union. A key finding of the systematic review was that there were no women’s rugby union training-specific studies identified. By conducting a prospective cohort observational study on the training sessions of an amateur women’s rugby union team, over two-years (Chapter 4), it was identified that the total injury incidence was 11.4 (95% CI: 8.3 to 15.6) per 1,000 training hrs. There were 12 injuries that resulted in a time-loss injury incidence of 3.6 (95% CI: 2.0 to 6.3) per 1,000 training-hrs. The tackle was the most common cause for total (3.0 [95% CI: 1.6 to 5.6] per 1,000 training-hrs.) injuries, but collisions (1.5 [95% CI: 0.6 to 3.6] per 1,000 training-hrs.) with the ground or another person were the most common cause for time-loss injuries. The training injuries occurred most often to the lower limb and during the latter part of training sessions. These injuries were mostly minor in nature, resulting in minimal time-loss away from training. The time-loss injury incidence (3.6 [95% CI: 2.0 to 6.3] per 1,000 training-hrs.) for the amateur women’s rugby 15s team players was higher than that reported for National (1.2 [95% CI: 0.4 to 3.1] per 1,000 training-hrs.) and RWC(W) (0.2 [95% CI: 0.0 to 2.2] to 3.0 [95% CI: 1.8 to 5.0] per 1,000 training-hrs.) competitions. The incidence of match injuries (Chapter 5) was conducted utilising a prospective cohort observational study on an amateur women’s rugby union, over two consecutive seasons. A total of 138 injuries were recorded resulting in an injury incidence of 247.0 (95% CI: 209.1 to 291.9) per 1,000 match-hrs. A total of 57 injuries resulted in a time-loss injury incidence of 102.0 (95% CI: 78.7 to 132.3) per 1,000 match-hrs. Although Forwards (261.8 [95% CI: 209.7 to 326.9] per 1,000 match-hrs.) recorded a higher total injury incidence than Backs (230.2 [95% CI: 178.7 to 296.4] per 1,000 match-hrs.), Backs recorded higher time-loss injury incidence (107.4 [95% CI: 74.2 to 155.6] per 1,000 match-hrs.) than Forwards (97.3 [95% CI: 67.6 to 140.1] per 1,000 match hrs). The lower limb sustained the highest injury incidence, with the knee having the greatest proportion of these injuries for both total (48.3 [95% CI: 33.1 to 70.5] per 1,000 match-hrs.) and time-loss (21.5 [95% CI: 12.2 to 37.8] per 1,000 match-hrs.) injuries. Sprains and strains recorded the highest incidence of all the injuries recorded and the lower limb body region recorded the most days lost and had the highest mean days lost per injury. The incidence of concussion (16.1 [95% CI: 8.4 to 31.0] per 1,000 match-hrs.) over the study was higher than previous studies reporting on women’s rugby union at the RWC(W) (3.5 [95% CI: 1.7 to 7.0] per 1,000 match hrs) and collegiate rugby union (1.6 [95% CI: 1.1 to 2.3] per 1,000 player match-hrs.) levels of participation. The tackle was recorded as being the most common injury cause and this was expected. Upon further analysis, it was identified that the action of being the ball carrier, rather than the tackler, during a tackle situation was associated with a notably higher injury incidence than any other match event. Future research is warranted to identify risk factors involved in the tackle unique to women participants. This PhD thesis has contributed knowledge regarding the incidence of injuries in amateur women rugby union players in New Zealand which has not been undertaken before. In addition, this PhD thesis has contributed further knowledge regarding the physiological demands of amateur women’s rugby union match participation (see Chapter 6).Item Proof-of-concept of a 16-week foot muscle specific intervention programme on non-contact anterior cruciate ligament and lateral ankle sprain injury risk : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Sport & Exercise Science at Massey University, Manawatu, Palmerston North, New Zealand(Massey University, 2020) van der Merwe, CarlaDuring high-intensity sports where abrupt decelerations and unanticipated changes of direction are prevalent, impaired foot function is thought to play a role in increasing the risk for non-contact anterior cruciate ligament rupture (ACLR) and lateral ankle sprain (LAS) injury. The risk for sustaining an ACLR is linked to increased rearfoot eversion and excessive, dynamic subtalar joint pronation coupled with internal rotation of the shank, leading to a larger knee valgus angle, and increasing anterior cruciate ligament (ACL) strain under high loads. Impaired forefoot stability is linked to larger moment arm lengths around the ankle joint, increasing the risk for lateral ankle sprain (LAS) under high loads. Previous research has shown that dynamic foot function can influence ankle, knee, and hip movement. Increasing forefoot and medial longitudinal arch stiffness modulates the distal-to-proximal transfer of rotational movement in straight-line walking and running as well as low intensity change of direction tasks. Foot stiffness is created by both passive and active structure in the foot. Passive structures include the foot bones and -ligaments and work in conjunction with the plantar fascia to create stiffness and stability. The intrinsic and extrinsic muscles acting on the foot act in synergy to create stiffness actively. However, current prophylactic programmes do not aim to explicitly train the foot muscles. The aim of this project was thus to provide proof of concept for a foot muscle specific training intervention on dynamic foot function, as well as risk factors associated with ACLR and LAS injury. Establishing proof of concept provides valuable information for future large-scale randomised control studies investigating the integration of a foot muscle specific intervention in to ACLR and LAS injury prevention programmes. The overview of the functional anatomy of the foot in Chapter 2 described the bones that form the joints of the foot as well as the muscles that move the bones of the foot. The interaction of the segments of the foot is described as well as the way in which the foot is modelled. The chapter also provided the contextual evidence for exercise selection. Chapter 4 reviewed the literature and highlighted the relationship between dynamic, excessive subtalar joint pronation and rearfoot eversion to internal tibial rotation, the increase in the knee valgus angle and ACL strain. A link between instability of the forefoot and a larger hallux extension range of motion increasing risk for LAS is discussed. The review also discussed the effect of intrinsic and extrinsic foot muscles on movement of the foot segments and general foot function. A hypothesis was formed that a foot muscle specific intervention has the potential to influence dynamic foot function and risk factors associated with ACLR and LAS, supplementing current prophylactic programmes. Current literature does not definitively describe the coupling relationship between the segments of the lower limb nor the coupling between the segments of the foot during high-intensity unanticipated change of direction tasks. It is thus unknown whether training the foot muscles in an attempt to modulate the transfer of rotational forces from distal-to-proximal segments to decrease injury risk, is justified. A modified vector coding technique was adapted to describe and quantify the coordination patterns between the lower limb and foot segments, respectively. In Chapter 5 the literature regarding the modifications to the vector coding technique and its development from the continues relative phase method of describing movement relationship between objects was presented. The coupling relationship between the tri-planar calcaneus and transverse plane rotation of the shank during unanticipated change of direction tasks was described in Chapter 6. A distal-to-proximal coupling relationship between frontal- and transverse plane movement of the calcaneus and transverse plane rotation of the shank was established. The distal-proximal coupling between the calcaneus and shank suggested that shank rotation may be modulated by manipulating the frontal and transverse plane movement of the calcaneus. It thus seems worthwhile to investigate whether training the muscles that act on the foot would manipulate shank rotations and, in this way, decrease the strain on the ACL, reducing ACLR risk. In Chapter 7 the coupling relationship between the foot segments was described as it influences LAS risk. The forefoot was the only point of contact during unanticipated change of direction tasks. Throughout stance, an anti-phase coupling relationship in the form of metatarsal flexion coupled with calcaneus eversion, and metatarsal extension was coupled with calcaneus inversion. These coupling relationships indicated the importance of forefoot function in calcaneus control and potentially LAS risk. In the loading phase, metatarsal inversion was coupled with calcaneus inversion, potentially increasing LAS risk if metatarsal inversion was not limited. At maximum calcaneus inversion- and adduction velocities, both of which are associated with increased risk for LAS, hallux and metatarsal flexion accelerated. The increased forefoot flexion acceleration indicating the importance of the forefoot stiffness in creating forefoot stability, potentially influencing whole foot stiffness and lateral ankle stability during change of direction tasks. As the forefoot provides stiffness the foot is likely to be more stable and the rearfoot segments are free to move and align with the shank, potentially decreasing LAS risk. It seems thus important to investigate whether training the foot muscles will influence LAS risk. The 16-week progressive foot muscle specific intervention program was detailed in Chapter 8. Exercise components, selection and progression was described. The outcomes of the proof-of-concept study revealed that training the muscles acting on the foot show potential to resist the deformation of the medial longitudinal arch (MLA). Resistance to MLA deformation potentially played a role in the observed decrease of the maximum knee valgus angle, and ACLR risk factor, of the training group (TG). LAS injury risk factors, maximum ankle inversion angle and maximum ankle eversion moment arm length were also smaller for the group undergoing the intervention training. The decrease in the maximums of these LAS risk factors was potentially influenced by the increasing stiffness of the metatarsal anterior transverse arch (MetATA), which is likely to increase foot and ankle stability. Guidelines for future randomised controlled trials included variables to consider ensuring the groups are well matched before the intervention. A proposal regarding the methodology and implementation of an injury prevention programme as well as sample size recommendations were outlined. To ensure the groups are well matched before the intervention it would be prudent to match athletes for stance times, peak ground reaction forces (GRF) in addition to sport and body mass index (BMI). During data collection, the approach speed and thus the timing of the unanticipated change of direction task proved difficult to monitor and control, which potentially influenced the kinetic and kinematic outcomes of the pilot study. The TG also had low compliance to training which could have influenced the result of the intervention. Sample size calculations revealed that a sample size of 30 (falling within the recommended size for biomechanical studies) are needed to find significant differences in foot arch and foot segment angle variables. However, a larger number of athletes are needed per group to establish changes to ACLR and LAS risk variables. Functional anatomy and the coupling relationship between the segments of the lower limb and foot segments justified investigating the effect of foot muscle-specific intervention on ACLR and LAS risk factors. The pilot study revealed that training the muscles acting on the foot seem to influence foot function, but the effect on risk factors associated with ACLR and LAS is unclear. Following the guidelines as described in future randomised control trial is necessary to establish the effectiveness of integrating foot muscle-specific exercises into current ACLR and LAS prophylactic programmes.Item Treatments for mild traumatic brain injury : fish oil supplementation and information provision in New Zealand health care services : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Wellington, New Zealand(Massey University, 2020) Cresswell, BryleeMild Traumatic Brain Injury (mTBI) has the highest incidence of all brain injuries and can lead to symptoms in the physical, cognitive and mood domains. Most symptoms abate within weeks to months, however some individuals experience ongoing symptoms leading to longer-term disruption of social and occupational functioning. Current mTBI management recommendations include providing early injury related education, and addressing symptoms in a multidisciplinary fashion as they arise. As with any injury, it is important to ensure treatments are effective in order to reduce the costs to both the health system and the individual. The studies presented in this thesis aimed to assess the effectiveness of fish oil – a novel treatment for mTBI symptoms, and the current practice for providing information to mTBI patients. Study One was a randomised placebo controlled trial of fish oil as an adjunct treatment for mTBI symptoms. This study was cancelled due to recruitment difficulties, nevertheless the literature review delineates the pre-clinical evidence of its potential to treat both cognitive and mood symptoms via various pathways. In addition, the outlined procedures and the researcher’s reflections highlight the unforeseen difficulties that will need to be addressed should a similar trial be conducted in future. Study Two surveyed New Zealand health practitioners on their current practice of information provision for mTBI patients. It aimed to assess whether practices have changed in the 16 years since similar research was published, and since the introduction of information sheets by the Accident Compensation Corporation (ACC). It also assessed the quality and accessibility of the information provided. The frequency of information provision after mTBI has improved since 2004, though the issues with variability and formatting of presented information remain similar. The majority of respondents provided information verbally and in writing, and had information available only in English and standard print formats, potentially disadvantaging those with visual impairment or whose first language is not English. Time constraints, patient concentration and distress, and a lack of appropriate resources were cited as barriers to providing information.Item Lower limb injury prevention in the New Zealand Army : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy (PhD) in Sport and Exercise at Massey University, Wellington, New Zealand(Massey University, 2019) Rousseau, JacquesBackground The mobility of the New Zealand Defence Force (NZDF) and its ability to deploy personnel at short notice is compromised by the high number of musculoskeletal injuries, particularly to the lower limbs. Literature searches indicated footwear may be the issue. The aim of this research is to examine the extent of the problem, which injuries and anatomical structures are most affected, the aetiology involved, and finally, the effects of a possible remedial intervention. Methodology Information from 11 years of NZDF injury records were examined. Chi square analysis was used to determine most affected joint(s), injury type and activities (sporting or military). The ankle joint appeared most vulnerable to injury, particularly during sporting or military activities involving running. Traumatic ankle sprains and strains were the most prolific injuries and this occurred when not wearing the military boot. This information was used to determine the subsequent investigations of the biomechanical and neurological aetiology underlying habitual boot-wear that might give rise to these injuries. Ankle range of motion (ROM), endurance strength, power and fatigue were measured using an isokinetic dynamometer (Biodex) in new recruits and repeated after one year of military boot-wear. Muscle activation of tibialis anterior and both the medial and lateral gastrocnemius were also measured during quiet standing on a force platform to measure postural sway. The same measures of aetiology were conducted on 65 habitual boot wearing regular force military male personnel pre and post-introduction of a low-cut flexible shoe. These 65 personnel all had served greater than two years in the NZDF. At 10 weeks, the effects of pre- and post- flexible shoe wear were measured to determine if the effects of habitual boot-wear could be reversed. Results After 12 months of habitual military boot-wear, ankle ROM was decreased in all planes of movement, endurance strength and power were significantly reduced and fatigue onset increased after one year of boot-wear. Muscle activation was increased in tibialis anterior and both the medial and lateral gastrocnemius, which coincided with significantly increased sway patterns indicating poor postural stability. After 10 weeks of transitioning from habitual military boot-wear to a flexible shoe, ankle ROM, and strength significantly increased, while fatigue, muscle activation and postural sway decreased. Conclusion Chronic military boot-wear causes mal-adaptations and is associated with the high number of ankle injuries in the NZDF, however the effects can be reversed. It was advised that when not on military manoeuvres that personnel wear a low-cut flexible garrison shoe.Item Provision of information on concussion to patients and families by videotape : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Psychology at Massey University, Wellington, New Zealand(Massey University, 2002) Scoullar, GrahameTraumatic brain injury (TBI) is a major health problem in New Zealand that results in death and disability as well as a substantial number of mild injuries. Information provision is an important part of interventions that can help to prevent long term difficulties from developing after mild TBI. This study investigated whether information provision by videotape can be a useful part of interventions for mild TBI. The research was in the form of a pilot study in that a videotape and a brochure were produced as part of the study. The participants were clients of a concussion clinic and the people who accompanied them to the clinic and they were divided into three different groups. One group received the videotape and brochure, a second group received the brochure only and the third group received neither of these resources. Specific questions about information provision were developed to gather data for the study which formed part of a larger survey of client satisfaction. The number of responses from people who accompanied the clients was insufficient and that data was therefore omitted from the study. There were no significant differences between the three groups of clients in their satisfaction with information provision or the perceived level of help they received from information provision in understanding concussion. Clients who reported that they received an appropriate rather than an insufficient or excessive amount of information were significantly more satisfied with information provision. The results also suggested that clients who did not receive the resources may not have received enough information. The majority of clients preferred to receive information on both videotape and brochure compared to either resource on its own or other options and most clients who received the information resources referred to them more than once. The findings support the use of videotapes in information provision for clients of concussion clinics when they are used alongside written resources rather than replacing them. Limitations in the study and directions for future research are discussed.Item Finding out what works and what doesn't work : caring for women with a fungating tumour of the breast : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Nursing at Massey University, Albany Campus, New Zealand(Massey University, 2002) Corlett, EricaA fungating tumour of the breast causes distress to those living with the illness and createss many challenges to the nurses who care for them. Control of malodour. exudate, haemorrhage and cosmetic acceptability creates complex wound care problems. Managing to live and maintain a sense of normality must take account of the palliative and chronic nature of this illness. This study utilises the grounded theory research method to discover the main concerns of nurses who care for this group of clients and how they continually resolve them. Three women who have this condition have provided information that adds and lends support to how the nurses provide care. This thesis argues that finding what works and what doesn't work is the core process that resolves the main concern of striving to maintain a sense of normality in life activities. Problem-solving, wound care and wider psychosocial problems initiate the process of finding what works and what doesn't work. Through making sense of the situation by gaining an understanding of the women's situations, being non-judgemental and building trusting relationships, the ability to find what works and what doesn't work is more likely to be achieved. This must take account of the physical, cultural and professional considerations that impact on the nurse's ability to provide appropriate care. The consequence of finding what works and what doesn't work is that the nurses' practice has the capacity to be transformed. This study provides insight into the creativity and complexity that characterises expert community nursing practice in caring for this particularly challenging group of clients.