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Despite the physical health and psychosocial benefits, few individuals with acquired physical disabilities participate in sport. This manuscript-based thesis is composed of four studies that aim to provide a more nuanced understanding of the theoretical and contextual factors that influence sport participation among this population. Study 1 investigated the predictive value of the Health Action Process Approach (HAPA). The HAPA model has been used among a variety of populations; however, it has not been used to predict sport participation among adults with acquired physical disabilities nor has athletic identity been considered as a supplement to the model. Results of the structural equation model demonstrated that the modified HAPA model explained 19% of the variance in sport participation. Study 2 explored how athletic identity was lost or (re)developed after acquiring a physical disability. Eleven adults with an acquired physical disability participated in semi-structured interviews. Participants’ stories of sport pre- and post-injury fit into three distinct narratives. The non-athlete narrative focused on physical changes in the body; the other two narratives primarily focused on present sport behaviour. Study 3 explored the influence of the perceived self and disability on participation in specific types of leisure-time physical activity (LTPA), such as sport, after injury. Fourteen participants completed semi-structured life story interviews. A structural and content analysis of participant narratives revealed that beliefs about disability and comparisons to peers were influential in motivating individuals to consider some LTPA while rejecting others, such as sport. Study 4 explored peer athlete mentors’ responses to four mentee narratives. A narrative analysis of the responses revealed that peer athletes generally tailored their responses and information to the vignette’s specific view of disability. However, deeply negative and resistant narratives elicited more variant responses from the peers, including responses that accepted the resistance to those that challenged their perceptions of disability. As a whole, this dissertation enables a more nuanced understanding of the theoretical and contextual determinants of sport among individuals with acquired physical disabilities. This dissertation will better inform and identify opportunities for interventions that increase sport participation among this population. / Thesis (Ph.D, Kinesiology & Health Studies) -- Queen's University, 2013-04-23 19:32:36.636

The aim of this study is to critically examine the experiences of disabled gay men who have accessed Manchester's commercial gay space known locally as the 'Village'. The thesis provides an initial exploration of how, in recent years, there has been an increasing rejection of the dominant medical and deficit based conceptualisation of disability. Many academics researching in this area have proposed a model of 'thinking' about disability that explicitly rejects the notion that it arises from any essentialist biological origin and have sought to highlight how it is society that disables people and not their bodies. This change of focus from the body to society has led to the development of the specific academic discipline that is today called 'Disability Studies'. Concentrating on this discipline, the thesis critically explores the dominant model for understanding disability; 'the social model of disability' and suggests that, in relation to disabled gay men, this model may only provide limited conceptual usefulness. Following on from this, an alternative conceptualisation of disability is provided that seeks to 'propose an embodied, rather than disembodied, notion of disability' (Hughes and Patterson 1997:326). Adopting such an approach, the research, through an interpretative analysis of narratives provided by 12 disabled gay men who have spent time in Manchester's commercial gay space, explores how the participants have come to understand the space and their positions within in it. The findings of the research indicate that these men viewed the Village as a space that they are both explicitly and implicitly denied access to. The participants discuss what they see as the bodily attributes that men are required to possess in order to gain access to the space. They go on to describe how a form of 'gay obsession' with bodily perfection, youthfulness, physical prowess and sexual imagery all act as regulatory agents enforcing what many perceived to be the unattainable 'entry requirements' of the space.

This thesis is about impairment, disability and health. Placed in the context of Disability Studies, it engages with the theoretical debates about how disability and impairment should be conceived. In doing so it pays particular attention to the embodiment of impairment and its relation to health matters. It also identifies and discusses the reasons for the apparent reluctance of Disability Studies to engage with health issues. The main source of data is interviews with 28 disabled people from Edinburgh and the Lothians. Using semi structured interviews, participants were encouraged to talk about their experiences of using healthcare including the access barriers they faced, the expertise they developed to manage their health care encounters and how these encounters mediated and were mediated by their lived experience as disabled people. A secondary source of data is autoethnographic writing. Through reflexivity, an assessment is made of the value and validity of using this method to explicitly incorporate the researcher’s own experiences in to the data and its analysis. Similarly reflexivity is deployed to consider the methodological issues that arise from the researcher being disabled and encountering access barriers during the research process. There were three sets of findings from the research. First, participants’ body talk suggested that in everyday life impairment and maintaining good health can be understood as something which is done by the embodied self to the body. This doing is often a taken-for-granted activity. It is also mediated through a number of factors including emotions, disabling barriers and broader social and economic structures. Second, participants’ accounts of the access barriers they faced when using the NHS suggested that there are two categories of access needs, the macro and micro. While macro needs such as ramped or flat access to premises were anticipated and routinely met without participants having to take any action, participants often felt they had to take the initiative to ensure their micro needs, such as the need for a hoist, were met. Some micro access needs were particular to a healthcare context and often emerged during diagnostic tests or treatment procedures. Healthcare professionals had to have sufficient skills and confidence to respond effectively to these clinical micro needs. The third set of findings was that some participants developed expertise to enable them to access the appropriate services to meet their needs and form a high quality relationship with healthcare professionals. However, other participants recalled situations where their expertise was not respected and felt abandoned by the NHS. The first set of findings has implications for theoretical development in Disability Studies. More work is needed to connect the doing of impairment to theoretical approaches found in sociology of the body and to empirically explore the nature and scope of impairment doing, The second and third set of findings have implications for current healthcare practice particularly in the context of the NHS’ responsibility under the Disability Discrimination Act.

INTRODUCTION: Impaired physical fitness may contribute to functional limitations and disability after stroke. Physical fitness (including cardiorespiratory fitness and muscle strength/power) can be improved by appropriate fitness training; this is of benefit to healthy people and patient groups but whether it is of benefit for people after stroke is unclear. The aim of this thesis was to determine whether physical fitness training is beneficial after stroke. OBJECTIVES: (1) Develop a rationale for fitness training by determining whether physical fitness after stroke is a) impaired, and b) associated with functional limitations and disability. (2) Develop and evaluate randomized controlled trial (RCT) evidence by a) determining the feasibility of a definitive RCT, and b) evaluating the benefits of fitness training after stroke. METHODS: (1) Systematic review of observational data and multiple linear regression of exploratory RCT baseline data determined the nature of fitness impairments and any associations with functional limitation and disability. (2) Systematic review and meta-analysis of RCTs established the effects of fitness training on disability, death and dependence. An exploratory RCT (‘STARTER’) compared the effects of a fitness training programme (cardiorespiratory plus strength training 3 days/week for 12 weeks) with an attention control (relaxation) on fitness, function, disability, mood and quality of life in 66 ambulatory people with stroke. RESULTS: (1) Systematic review of observational data showed cardiorespiratory fitness (peak oxygen uptake and economy of walking) and muscle strength were low after stroke; the impairments predicted functional limitation but links to disability were unclear. STARTER baseline data showed little impairment in economy of walking but lower limb extensor power was impaired (42-54% of values expected in healthy age and gender matched people) and this predicted functional limitation and disability. (2) The systematic review identified 12 RCTs (n=289) in 2003, and 24 RCTs (n=1147) when updated in 2007. The systematic reviews showed death was uncommon, and effects on dependence and disability were unclear. However training did improve fitness and cardiorespiratory training during rehabilitation improved ambulation. Most benefits resulted from task-related training. The STARTER fitness training intervention was feasible, with good attendance (>90%) and good compliance with intervention content (94-99%). At the end of the fitness training intervention there were small improvements in some cardiorespiratory fitness, physical function and quality of life outcomes compared with the control group, but these differences had diminished four months later. CONCLUSIONS: (1) Cardiorespiratory fitness, muscle strength and power are impaired after stroke, so there is scope to increase fitness, and there are plausible benefits. (2) Physical fitness training after stroke is feasible, it improves fitness and has some functional benefits, in particular for walking ability. Effects on disability, death and dependence are not known. Further research is required to determine the timing, mode, duration, frequency and intensity of fitness training for optimum benefits, and investigate how benefits can be retained in the long-term.

A Dissertation Submitted to the Faculty of Arts University of the Witwatersrand, Johannesburg for the Degree of Master of Arts Johannesburg 1991 / Remediation programmes were devised and implemented for two developmental dyslexics. Extensive pre-therapy psycholinguistic assessment determined the developmental stage at which their acquisition of reading skills had arrested. [Abbreviated abstract. Open document to view full version] / MT2016

A research report submitted to the Faculty of Health sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Science in Epidemiology & Biostatistics Johannesburg, October 2014 / Introduction Disability is a major public health concern worldwide. The situation in Africa is serious. It is estimated that ten percent of the world’s population is living with a disability and close to two-thirds of all people with a disability live in low-income countries. The main objective of this study was to determine the spatial distribution of disability and disability grant allocation and to identify factors associated with disability within the Gauteng Province (2007). Materials and Methods An analytical cross-sectional study design was used to analyse secondary data from the 2007 South African survey data. The population of Gauteng was the focus of the study. The prevalence of disability in Gauteng was estimated. Chi-square test of proportions was used to analyse the distribution of social and demographic characteristics among participants. Poisson regression models were constructed to determine the association between disability and socio-demographics characteristics. Results Of a sample of 133 691 individuals in Gauteng Province, 4 492 (3.4%) reported being disabled, and of these, 2 333 (51,94%) were male and 2159 (48,06%) were female. The overall prevalence of disability or disability rate was 3.4%. Most of the disabled people were older individuals aged 40 to 64 years (51,51%), followed by those aged 18 to 39 years (33,17%); the rest were individuals aged over 64 years of age (retirement age category). Most of these disabled participants were black (77,8%), with whites contributing 15,69%. Almost half (42,72%) of the disabled participants were never married. More than half of the disabled participants (59,75%) had a high school level of education, followed by those with primary school as their level of education (25,31%). Almost 18% of the disabled people were employed and the remaining percentage was unemployed (82%). More than half of the disabled population in Gauteng resided in Johannesburg (34,93%) and Ekurhuleni (26,89%), followed by Tshwane (19.08%). There was a statistically difference in disability grant allocation between the disabled males (51,34%) and (48,66%) females. About 67,93% of the disability grant was given to the older working age category (40-64 years). More than 80% of the disability grants support was issued to the black population group. More than 45 % of the disability grants support issued was given to people who had never married. More than 80% of the disability grants issued was given to the non-economically active category of disabled people. More than 60% of the disability grants support went to those in Johannesburg, Tshwane and Ekurhuleni. Variables associated with disability in Poisson regression analysis included the following: Female participants in the study showed a lower risk (40%) of disability compared to males, and this difference was statistically significant (IRR 0.6, CI 0.59-0.67, p= <0.001). The older working age category (39 to 64 years) (IRR2.9, CI 2.6-3.1, p=<0001) and retirement age category (65 years and above) (IRR 3.0, CI 2.5-3.5, p=<0.001) were respectively associated with a higher risk of disability. Coloured (IRR 1.37,CI 1.2-1.6, p <0.001) and white (IRR 1.41, CI 1.3-1.6, p<0.001) participants showed a 1.4 times greater risk of having disability compared to individuals of the black community, and these differences were statistically significant. While Indians (IRR 1.13, CI 0.9-1.4, p=0.247) had 1.1 times the risk of having disability compared to black participants but the difference was not statistically different. The risk of disability in individuals living in Tshwane (IRR 0.87,CI 0.80-0.95, p=0.001) and the West Rand (IRR 0.86,CI 0.75-0.99, p=0.037) districts was lower by 10% relative to individuals staying in the city of Johannesburg. This risk was relatively lower by 20% in Metsweding (IRR 0.77,CI 0.63-0.94, p=0.012) compared to Johannesburg. These differences were statistically significant. On the other hand, although not significant, the risk of disability was higher by 7% in Sedibeng district (IRR 1.07,CI 0.97-1.18, p=0.187). Participants in a traditional marriage (IRR 1.1, CI 0.97-1.24, p =0.14) and those who were polygamous (IRR 1.0, CI 0.33-3.21, p= 0.96) were not associated with disability compared to civil/ religiously married participants. Others categories of marital status included living together as married (IRR 1.2, CI 1.06-1.37, p=0.006); never married (IRR 1.6, CI 1.49-1.78, p< 0.001); widow/widower (IRR 1.4, CI 1.2-1.6, p <0.001); separated (IRR 1,6, CI1.34-2.08, p<0.001 and divorced (IRR 1.9,CI 1.65-2.24, p<0.001) were associated with disability and the observed differences were statistically significant. Those who had attended high school (IRR 0.48, CI 0.44-0.53, p <0.001) and those who had post matric studies (higher school)(IRR 0.34, CI 0.27-0.42, p< 0.001) were less associated with disability compared to those who only had a primary school level of education (IRR 0.8, CI 0.76-0.93, p = 0.001). Participants classified as not economically active were 7.5 times at risk of being disabled (IRR 7.5, CI6.95-8.19, p < 0.001). The observed difference was statistically significant. The least poor households were 0.7 times at risk of having a disabled member (IRR 0.7, CI 0.62-0.75, p <0.001) while the poor households had a 0.9 times the risk of having a family member with any disability (IRR 0.9, CI 0.81-0.94, p <0.001) - compared to most poor households, and the difference was statistically significant. Conclusion Gauteng showed a prevalence of individuals living with a disability in South Africa. In fact, it was found that the overall prevalence of disability in the Gauteng Province was 3,6%. During the same period Statistics South Africa estimated the whole county disability rate to be 4%. Statistically significant risk factors associated with disability in Gauteng included males aged 39 years and older; the coloured and white population group; living in the Sedibeng district; living together as married, never married, widower/widow, separated and divorced; not educated; not economically active; and most poor households. The spatial distribution of grant allocation was proportional to the disability burden per district as well as well as per local municipality, with a statistically significant relationship between disability burden and grants allocation. A higher proportion of males disabled received a grant compared to disabled females. Sedibeng district was highly associated with any disability, whilst Metsweding was the safest district.

Thesis advisor: Penny Hauser-Cram / This dissertation involved secondary analysis of data from the Early Intervention Collaborative Study (EICS), a longitudinal study of children with developmental disabilities (DD) and their families (Hauser-Cram, Warfield, Shonkoff, & Krauss, 2001). The sample for this dissertation was comprised of 133 adolescents with DD and their parents. When the target adolescent was ages 15 and 18, mothers and fathers completed measures assessing their own functioning and that of their child, as well as aspects of the home and family environment. Regression analyses were utilized to examine factors that relate to and predict functioning and well-being of adolescents with DD and that of their parents. The following research questions were addressed: (1) What parental and child factors are related to the well-being of parents of adolescents with DD? (2) How is partner satisfaction related to the parent-child relationship and family cohesion for parents of adolescents with DD? (3) How are work characteristics related to parental satisfaction with the parent-child relationship and with parental well-being? (4) What factors predict and relate to adolescent autonomy in teens with DD? Results indicated that parenting efficacy predicted parental well-being and various types of parenting stress above and beyond adolescent behavior problems. Counter to hypotheses, parent social support and adolescent autonomy did not relate to parental well-being. Additionally, the total number of adolescent behavior problems was related to greater well-being among mothers but not fathers, though externalizing behavior problems in particular related to greater total parenting stress for fathers only. Dyadic adjustment was only related to greater satisfaction with family cohesion for fathers, as was difficulty of care. For both mothers and fathers, work flexibility and job satisfaction contributed to greater parental well-being above and beyond satisfaction with the parent-child relationship. Finally, social acceptance predicted later adolescent autonomy, and adolescent self-efficacy related to autonomy above and beyond previous social acceptance. Collectively, the findings demonstrated the influence of adolescent functioning in relation to parents’ well-being, the importance of parenting efficacy for parents and peer support and self-efficacy for adolescents with disabilities, and the potential benefits of employment for this parenting group. Implications and areas for future study are discussed. / Thesis (PhD) — Boston College, 2016. / Submitted to: Boston College. Lynch School of Education. / Discipline: Counseling, Developmental and Educational Psychology.