Letter to John Butler and Eliza (Smith) Butler from Joseph Butler and Jane Butler

Joseph and Jane Butler send condolences for Berryman Murphy\u27s death, and describe sickness in Iowa

Current Evidence and Future Directions for Physiotherapy Intervention in Cerebral Palsy: Physical Activity and Physical Fitness

The aim of this thesis was to examine the evidence for physiotherapy intervention for children with cerebral palsy. Cerebral palsy is the most common activity limiting disability in children and adolescents with the incidence being approximately 2-3 per 1,000 live births worldwide. The severity of cerebral palsy is highly variable, but inevitably results in some degree of activity limitation due to motor impairment. However, from the physiotherapist’s point of view the presence of motor impairments – and the subsequent effect that these impairments have on a child’s activity and participation – is the most relevant for intervention. Therefore, determining the most effective form of physiotherapy intervention to address motor impairment, to promote physical activity and enable community participation is an important issue. Four studies were undertaken in this thesis. The first study was a summary of systematic reviews of physiotherapy intervention for children with cerebral palsy and was conducted in order to identify the evidence located on electronic databases. This study found evidence for six physiotherapy interventions – casting, physiotherapy intervention in conjunction with botulinum toxin type-A, electrical stimulation, constraint-induced movement therapy, strength training and cardiorespiratory training. However, the evidence for the effect of intervention was equivocal due to the small numbers of randomised controlled trials, poor reporting of data in the trials and inconclusive results. Since there were a number of trials examining cardiorespiratory training in children with cerebral palsy, which is also an important focus in other areas of physiotherapy intervention, it was decided to investigate this further. In the second study, a systematic review was conducted to examine the evidence for improving cardiorespiratory fitness in children with cerebral palsy. This review showed that it was possible to increase cardiorespiratory fitness in these children. However, the improved fitness did not carry over into their everyday activity. This raised the question of whether there was a relationship between cardiorespiratory fitness and activity and led to the third study. The third study was a feasibility study which examined whether cardiorespiratory fitness or walking capacity influenced the amount of physical activity undertaken by children with cerebral palsy who had mild impairment and were able to walk. This study found that children with cerebral palsy had low cardiorespiratory fitness levels compared to reported values in typically-developing children. However, as there was a moderate correlation between peak heart rate and oxygen uptake during the progressive exercise test, these children demonstrated that they had a normal cardiorespiratory response to exercise of increasing intensity. To control for environmental influences, the children with cerebral palsy were compared to a matched group of siblings to examine the amount of their physical activity. The results revealed that the children with cerebral palsy were performing as much daily physical activity as their age-matched siblings, but that this activity was less than recommended guidelines for both groups. Overall, no relation was found between the cardiorespiratory fitness or walking capacity of the children with cerebral palsy, and the amount of their physical activity. Given that the amount of activity was not determined by the child’s physical characteristics (cardiorespiratory fitness or walking capacity), the fourth study was undertaken in order to identify whether there were barriers which were preventing the child performing activities. Parents were asked to indicate what they saw as being the barriers which were either preventing their child from performing an activity, or which were influencing how frequently their child performed the activity. This study found that these children were regularly engaged in physical activities which are fairly representative of typically-developing children. However, parents perceived cost as being the largest barrier to their child’s activities. Of concern, was that cost was preventing the child from being engaged in activities which could be performed frequently. Generally, children with cerebral palsy just want to engage in activities alongside their typically-developing peers. For children who are ambulant and capable of physical activity, it is important that they are given the opportunity to engage in regular activity which is performed at a moderate to vigorous level. Furthermore, identifying the barriers which are preventing physical activity means that there is a greater chance that children with cerebral palsy will have a more active lifestyle

Short-Interval Cortical Inhibition and Intracortical Facilitation during Submaximal Voluntary Contractions Changes with Fatigue

This study determined whether short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF) change during a sustained submaximal isometric contraction. On 2 days, 12 participants (6 men, 6 women) performed brief (7-s) elbow flexor contractions before and after a 10-min fatiguing contraction; all contractions were performed at the level of integrated electromyographic activity (EMG) which produced 25 % maximal unfatigued torque. During the brief 7-s and 10-min submaximal contractions, single (test) and paired (conditioning–test) transcranial magnetic stimuli were applied over the motor cortex (5 s apart) to elicit motor-evoked potentials (MEPs) in biceps brachii. SICI and ICF were elicited on separate days, with a conditioning–test interstimulus interval of 2.5 and 15 ms, respectively. On both days, integrated EMG remained constant while torque fell during the sustained contraction by ~51.5 % from control contractions, perceived effort increased threefold, and MVC declined by 21–22 %. For SICI, the conditioned MEP during control contractions (74.1 ± 2.5 % of unconditioned MEP) increased (less inhibition) during the sustained contraction (last 2.5 min: 86.0 ± 5.1 %; P \u3c 0.05). It remained elevated in recovery contractions at 2 min (82.0 ± 3.8 %; P \u3c 0.05) and returned toward control at 7-min recovery (76.3 ± 3.2 %). ICF during control contractions (conditioned MEP 129.7 ± 4.8 % of unconditioned MEP) decreased (less facilitation) during the sustained contraction (last 2.5 min: 107.6 ± 6.8 %; P \u3c 0.05) and recovered to 122.8 ± 4.3 % during contractions after 2 min of recovery. Both intracortical inhibitory and facilitatory circuits become less excitable with fatigue when assessed during voluntary activity, but their different time courses of recovery suggest different mechanisms for the fatigue-related changes of SICI and ICF

Assessing the impact of sustained professional development on middle school mathematics teachers

The study reported in this paper examines the impact of the Ohio Statewide Systemic Initiative (SSI) on participating mathematics teachers. Quantitative data from 90 SSI-trained teachers and 400 teachers without training, along with qualitative data collected from seven SSI teachers who were visited in their classrooms are presented. Analysis of the quantitative data showed that SSI and Non-SSI teachers reported significantly different frequencies of reformed teaching practices and held significantly different views about the nature and pedagogy of mathematics. Qualitative data from the interviews highlighted that the SSI professional development experience, the ability to find creative ways to overcome lack of resources, and the teacher support networks formed as a result of their participation in the SSI were three major factors which enabled the SSI teachers to make significant changes to their teaching practices, and to sustain those changes

Assessing the impact of sustained professional development on middle school mathematics teachers

The study reported in this paper examines the impact of the Ohio Statewide Systemic Initiative (SSI) on participating mathematics teachers. Quantitative data from 90 SSI-trained teachers and 400 teachers without training, along with qualitative data collected from seven SSI teachers who were visited in their classrooms are presented. Analysis of the quantitative data showed that SSI and Non-SSI teachers reported significantly different frequencies of reformed teaching practices and held significantly different views about the nature and pedagogy of mathematics. Qualitative data from the interviews highlighted that the SSI professional development experience, the ability to find creative ways to overcome lack of resources, and the teacher support networks formed as a result of their participation in the SSI were three major factors which enabled the SSI teachers to make significant changes to their teaching practices, and to sustain those changes

Negotiating multiplicity : macro, meso and micro influences on the ethnic identifications of New Zealand secondary school students : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Social Anthropology at Massey University, Manawatū Campus, New Zealand

In New Zealand, the number of people who identify with more than one ethnic group is increasing. This is particularly true for adolescents and for those whose identifications include Māori or Pacific Islands ethnic groups. However, there is little understanding of what identifying with multiple ethnicities means for individuals. This research examined the multiple ethnic identities of senior secondary school students (aged between 16 and 18 years), by focusing on how they identified themselves, what decisions formed the bases of their identifications, and what influenced their identifications at three interconnecting levels: the macro (state) level, the meso (institutional) level, and the micro (family and individual) level. A mixed methods research approach was employed, including a nation-wide survey and fieldwork in one South Auckland secondary school. The fieldwork methods were participant-observation, interviews with students who identified with more than one ethnic group, and a photo elicitation exercise. Through these methods, data were collected that gave a broad understanding of multiple ethnic identifications for New Zealand adolescents, and a deep and multifaceted explanation for one group of participants. This research explored the ways that the participants negotiated their multiple ethnic group identifications, despite macro, meso and micro pressures towards singularity. It examined macro-level influences on ethnic group data collection and the ways that ethnic group identifications are shaped and constrained by data categorisation protocols. It looked at the meso-level influences of the research school on students’ ethnic identities. The school focused on cultural identity and provided opportunities for students to participate in cultural activities and speak their languages. It examined the micro level influences of family and individual decision-making around identities, and the way that the participants maintained multiple ethnic group identifications, despite family experiences that might encourage them to focus more strongly on a single identity. This research explored the complex and nuanced ways that ethnic identifications are constructed at each of the three levels, for adolescents who identify with multiple ethnic groups

Functional Role of Neural Injury in Obstructive Sleep Apnea

The causes of obstructive sleep apnea (OSA) are multifactorial. Neural injury affecting the upper airway muscles due to repetitive exposure to intermittent hypoxia and/or mechanical strain resulting from snoring and recurrent upper airway closure have been proposed to contribute to OSA disease progression. Multiple studies have demonstrated altered sensory and motor function in patients with OSA using a variety of neurophysiological and histological approaches. However, the extent to which the alterations contribute to impairments in upper airway muscle function, and thus OSA disease progression, remains uncertain. This brief review, primarily focused on data in humans, summarizes: (1) the evidence for upper airway sensorimotor injury in OSA and (2) current understanding of how these changes affect upper airway function and their potential to change OSA progression. Some unresolved questions including possible treatment targets are noted