A two-dimensional axisymmetric implementation of the smoothed particle hydrodynamics (SPH) technique, called for short AxisSPH, has been described in this thesis, along with a number of basic tests and realistic applications. The main goal of this work was to fill a gap on a topic which has been scarcely addressed in the published literature concerning SPH. Although the application of AxisSPH to the simulation of real problems is restricted to those systems which display the appropriate symmetry there are, however, many interesting examples of physical systems which evolve following the axisymmetric premise. These examples belong to a variety of scientific and technological areas such as, for example, astrophysics, laboratory astrophysics or inertial confinement fusion. Additionally AxisSPH can be also useful in convergence studies of the standard 3D-SPH technique because the higher resolution achieved in 2D can be used to benchmark the three-dimensional codes. The main improvements implemented in AxisSPH with respect existing axisymmetric SPH formulations are summarized as follows: 1) We have derived simple analytical expressions for correction factors which largely improves the calculation of density and velocity in the vicinity of the z-axis. These expressions and their derivatives were given as a function of an adimensional parameter and do not increase the computational load of the scheme. 2) We have obtained the appropriate expression of the fluid Euler equations containing the new correction functions and their derivatives. Far enough from the singular axis, the scheme reduces to the standard formulation discussed by Brookshaw (2003). 3) A novel expression for the heat conduction term, which has to be added to the energy equation was devised and checked. This new term improves the description of the heat flux for those particles located at the axis neighborhoods. 4) Until now axisymmetric SPH hydrocodes handle artificial viscosity using a crude approach because it was treated as a simple restriction of the standard 3D Cartesian viscosity to 2D. Here we propose to calculate the viscous pressure as a combination of two terms, the first one is the (standard) Cartesian part and the second is the axis-converging part of the viscosity respectively. As expected this last term is of special relevance to simulate implosions. 5) We have developed an original method to incorporate gravity into AxisSPH. First the direct ring to ring force was found as a function of the Euclidean distance between the 2D particles. In second place the gravitational force on a given particle was obtained by summing the contributions of all N particles. We have also developed a more efficient scheme to obtain the gravitational force calculating the potential of the ring, instead the force because it involves lesser algebraic operations. The scheme has been checked using a large number of tests cases. These tests range from very specific oriented to check a particular algorithm or a piece of physics, to rather complex ones intended to analyze the behavior of the scheme in potential real applications (ICF, jets, astrophysics). At least in one case, the head on collision of a pair of white dwarfs, the result of the simulations carried out using AxisSPH brings new, unpublished, scientific material. / En esta tesis se ha desarrollado un código, que hemos llamado AxisSPH, en dos dimensiones axisimétrico a partir de la técnica conocida como SPH (“smooothed particle hydrodynamics”). AxisSPH ha sido validado después de realizar una serie de tests básicos y algunas simulaciones de situaciones reales. El objetivo principal de este trabajo ha sido llenar, en parte, el vacío existente al respecto en la literatura sobre SPH. Aunque sólo se puede aplicar AxisSPH en problemas reales que presenten la apropiada simetría, existen muchos ejemplos interesantes de sistemas físicos que presentan la simetría axial demandada. Existen ejemplos en campos de aplicación tanto científica como tecnológica, por ejemplo en astrofísica, en el llamado laboratorio de astrofísica o en fusión por confinamiento inercial (ICF). Otra interesante aplicación de AxisSPH puede ser su utilización en estudios de convergencia con otros códigos 3D-SPH debido a su mayor resolución, al tratarse de un código 2D. Las mejoras implementadas en el código AxisSPH en comparación con otros códigos axisimétricos SPH existentes se pueden resumir en los siguientes puntos: 1) Hemos deducido expresiones analíticas simples para unos factores de corrección que mejoran el cálculo de la densidad y la velocidad en las proximidades del eje z. Dichas expresiones y sus derivadas dependen de un parámetro adimensional que no incrementa mucho el peso computacional del esquema propuesto. 2) Hemos obtenido las expresiones adecuadas de las ecuaciones de Euler que contienen estas nuevas funciones correctoras y sus derivadas. Lejos del eje de singularidad estas ecuaciones se transforman en las de la formulación estándar propuesta por Brookshaw (2003). 3) Una expresión novedosa del término de conducción, que debe de añadirse a la ecuación de la energía, se ha propuesto y validado. Este nuevo término mejora la evolución del flujo de calor de las partículas situadas en las proximidades del eje z. 4) Hasta el momento los códigos hidrodinámicos SPH axisimétricos existentes trabajaban con una aproximación poco elaborada de la viscosidad artificial ya que consistían en una restricción a dos dimensiones de la viscosidad estándar 3D. En este trabajo proponemos el cálculo de la presión debida a la viscosidad como combinación de dos términos, el primero reflejo de la parte cartesiana y la segunda da cuenta de la parte relacionada con la convergencia en el eje. Como era de esperar este último término es de relevante importancia en la simulación de implosiones. 5) Hemos desarrollado un método original para incorporar el cálculo de la gravedad en el código AxisSPH. En primer lugar la fuerza directa de anillo a anillo y en segundo lugar la fuerza de la gravedad que sufre una determinada partícula a partir de la contribución del resto de las N partículas existentes. También hemos desarrollado un esquema más eficiente para calcular la gravedad a partir del cálculo del potencial del anillo en lugar del cálculo directo de la fuerza ya que implica un menor número de operaciones algebraicas. El método ha sido verificado con un gran número de test numéricos. Desde los más específicos orientados a comprobar la validez de un algoritmo particular o la capacidad para simular un fenómeno físico en particular, hasta simulaciones bastante más complejas, con la intención de validar la capacidad de simular aplicaciones potencialmente más reales (ICF, jets, astrofísica). Así, en al menos un caso, en la colisión frontal de dos enanas blancas, los resultados de la simulación utilizando AxisSPH pueden aportar material científico publicable.

Disability is seen as a result of an interaction between a person and that person's contextual factors. Viewing disability in the context of the built environment, a better design of this environment helps to reduce the disability faced by an individual. In spite of significant research in Universal Design (UD), the existing methods provide insufficient guidance for designers: designers demand more specific examples of, and methods for, good universal design. Within the overarching goal of improving universal product design, the specific goal of this research is to determine if the ADA guidelines for architectural design can be adapted to product design. A methodology that foresees the accessibility issues while designing a product would be constructive. The new technique should be built on the pre-existing principles and guidelines. A user activity and product function framework is proposed for this translation using actionfunction diagrams. Specific goals include determining if the function-based approach is able to anticipate a functional change that improves product accessibility. Further, generate user activity and product function association rules that can be applied to the universal design of products. Proposed research activities are to identify thirty existing universal products and compare with its typical version to identify the function that introduces an accessibility feature. Next, categorize the observed changes in a product function systematically and extract trends from accessible architectural systems to generate rules for universal design of consumer products. For validation, the task is to select around fifteen consumer product pairs for validation of the generated rules to determine if the ADA guidelines can be adapted for universal product design using the proposed framework. The results of this research show promise in using the International Classification of Functioning, Disability and Health (ICF) lexicon to model user limitation. The actionfunction diagram provides a structured way to approach a problem in the early stage of design. The rules generated in this research translate to products having similar user-product interface.

(シンポジウム『生活機能向上に対する理学療法技術』,第41回日本理学療法士協会全国学術研修大会(長崎)(テーマ : 生活機能向上に対する理学療法技術))

There are many tools available for the study of post-translational modifications. The majority of these tools is specific towards the individual modification and involves separation of modified proteins from non-modified ones. The drawback of using a modification specific method is that there is a lack of flexibility in its usage for other modifications. The goal of these studies was to investigate the possibility of obtaining a similar separation effect by fractionating post-translationally modified proteins based on the physical properties of proteins. The post-translational modification chosen to be the basis of this study was the O-GlcNAc modification. Using the C2C12 mouse myoblast cell line, it was determined that the optimal conditions for producing lysates containing increased yields of O-GlcNAc modified proteins was to treat differentiated C2C12 cells with 10nM insulin, 12g/L glucose and 2mM of the O-GlcNAcase inhibitor Streptozotocin for 24 hours. Using the optimized lysis buffer, it was shown that protein separation by surface charge using standard anion exchange separation did not provide enough resolution or material to obtain any identifications of modified proteins. However, when a chromatofocusing method which separates proteins on the basis of their isoelectric points was used, a separation scheme with larger capacity and higher resolution was possible. Using this separation method followed by gel electrophoresis of individual fractions, proteins which are potentially O-GlcNAc modified were identified by mass spectrometry. It was evident from the number of protein bands observed per fraction on the Coomassie stained gels and the number of proteins identified per protein band by mass spectrometry that further reduction in sample complexity was required to assist in the positive identification of O-GlcNAc modified proteins. Among the identified proteins, 32 percent were metabolic proteins, 21 percent were protein processing proteins, 16 percent were structural proteins and the remainder a mix of other proteins. Unfortunately, it was not possible to validate the presence or absence of the O-GlcNAc modification on these proteins using available methodologies such as immunoprecipitation. As such, further work is required to optimize the separation strategy and to verify the usefulness of this separation strategy in identifying O-GlcNAc/post-translationally modified proteins.

Due to the profound impact that aphasia has on both the person with aphasia and their close family members, aphasia is a family problem. Aphasia is a communication disorder, most commonly caused by stroke. It is associated with impairments in spoken language, understanding, reading, and writing that impact upon daily activities, participation in society, and the quality of life of those with the condition and their family members. However, family-centred rehabilitation programs, policy, and funding are not well established. In the International Classification of Functioning, Disability and Health (ICF), the World Health Organization introduced the term “third-party disability” and identified the need for further investigation into family members’ functioning and disability in relation to a significant other’s health condition. In this thesis, the term “third-party functioning” is used to describe positive and/or neutral changes to a family member’s functioning as a consequence of a significant other’s health condition; “third-party disability” describes negative changes. The overall aims of this thesis are to: i) describe third-party functioning and disability in family members of people with aphasia post-stroke, and ii) develop the Significant other Scale for family members of people with Aphasia (SOS-Aphasia), a scale for measuring third-party functioning and third-party disability in this population. Two systematic reviews were conducted to provide a summary of the current literature related to family members’ third-party functioning and third-party disability secondary to aphasia. Positive/neutral and negative findings were extracted from included articles, then synthesized and mapped to the ICF. These reviews showed that family members experienced third-party functioning and third-party disability secondary to aphasia in the Body Functions and Activities and Participation components of the ICF, in addition to the development and exacerbation of health conditions. The results laid the groundwork for the qualitative-quantitative sequential mixed methods study that followed. In the first phase of the study, qualitative methods were used to explore the positive and negative effects of aphasia on family members, thus expanding and confirming our existing understanding of third-party functioning and third-party vii  disability. Twenty family members participated in individual in-depth semi-structured interviews, which were analysed using qualitative content analysis with research codes subsequently mapped to the ICF. The results revealed five categories of positive/neutral aphasia-related changes, including: (1) emotions (e.g., focusing on the positive); (2) communication (e.g., talking to the person with aphasia more); (3) relationships (e.g., making new friends); (4) recreational activities and social life (e.g., taking up new hobbies); and (5) paid/volunteer work or education (e.g., volunteering to help people with aphasia). In addition, seven categories that described the negative effects of aphasia on family members were revealed: (1) physical, mental, and emotional health (e.g., tired); (2) communication (e.g., difficulty communicating with the person with aphasia); (3) relationships (e.g., lack of physical intimacy between spouses); (4) recreational activities and social life (e.g., restricted social activities); (5) paid/volunteer work or education (e.g., took extended time off work); (6) domestic and caregiving responsibilities (e.g., transporting the person with aphasia places); and (7) finances (e.g., loss of person with aphasia’s income). Research codes were mapped to two domains within the Body Functions component (i.e., Mental functions and Functions of the digestive, metabolic and endocrine systems) and eight domains within Activities and Participation components of the ICF (i.e., Learning and applying knowledge, General tasks and demands, Communication, Self-care, Domestic life, Interpersonal interactions and relationships, Major life areas, and Community, social and civic life). Health conditions (e.g., depression and anxiety) associated with the aphasia of a significant other were also identified in family members. Mapping of the qualitative research codes to the ICF demonstrated how the ICF framework could be applied to family members. The second phase of the study involved the development and validation of the SOS-Aphasia. The SOS-Aphasia items were derived from the constructs of third- party functioning and third-party disability identified in the qualitative study and the response scale format was based on the ICF. Following the development of the SOS- Aphasia, 104 family members completed the original 34-item version. Factor analysis and Rasch analysis were used to examine the underlying structure and internal construct validity of the SOS-Aphasia. Test-retest reliability and feasibility were also investigated. Based on the analysis, five SOS-Aphasia subscales were identified and viii 10 items marked for deletion. The revised 24-item SOS-Aphasia demonstrated preliminary evidence of good psychometric properties. In summary, this series of studies demonstrates that family members experience third-party functioning and third-party disability, as well as changes to their health, secondary to a significant other’s aphasia. In addition, the SOS-Aphasia shows validity and reliability in measuring third-party functioning and third-party disability. Together, these findings provide the motivation for the inclusion of family members of people with aphasia in a family-centred care model with implications for research, practice, and policy.

Problem: Designing the user experience is a growing trend in product design; however this trend has not greatly benefited people with impairments and disabilities. There are no practical tools to broadly assist with this issue. There is a need for standardized measures to quantify impairment, a model to predict how designs may perform and a need for data regarding how people with impairments interact with consumer technology. Purpose: To conduct a usability analysis with an industry partner on their powered wheelchair controller using participants with varying impairments. The industry partner was seeking better insight into the benefits of formal user testing. Method: Forty consenting adults were given a score representing their level of impairment using six measures from the International Classification of Functioning (ICF). These measures were identified by the researcher to affect interaction with a device. Performance was measured by time taken to complete tasks, errors made, reported task difficulty and reported controller usability. Results: Performance was reduced in participants with a higher ICF score and age. An ICF score less than or equal to 2 was 117 times more likely to not complete the tasks, greater than or equal to 3 was not able to complete the experiment. Age >50 years took an average 79 seconds longer than <35 years to complete a task and reported greater difficulty, more errors and a lower usability for the controller. Implications: Low to moderate levels of impairment has a significantly negative effect on the usability of common devices. Difficulties were mostly cognitive with participants unable to create an accurate mental model of the system. Participants with lower performance tended to be overly optimistic about their abilities. Mistakes were the greatest source of error followed by lapses and almost no reported or observed slip errors. Original Contribution: The ICF has never been used as a metric for usability testing. This study successfully applied the ICF alongside other measures to prove its validity. Based on the results and current literature the Task Process Model was created to provide a simple and practical way to describe the interaction of people completing a task of basic to moderate complexity.

Bicycle riding plays a central role in the social and physical lives of most children, however, many children with special needs do not acquire the skills to successfully ride a two-wheeled bicycle. This study explored barriers and facilitating factors associated with learning to ride a two-wheeled bicycle. Participants were children (n = 25; and their parents) enrolled in an adapted bike riding camp. The camp was organized by therapists from the Queen Alexandra Centre for Children’s Health (QACCH) and facilitated by Lose the Training Wheels staff. The program involved changing the dynamics of the bicycle and the demands of the environment to help children with special needs learn to ride a conventional two-wheeled bicycle. Riding progression, self-efficacy toward cycling, and perceptions of physical competence were assessed pre-camp, immediately post-camp and at a 3-6 month follow-up post-camp. Semi-structured interviews were also conducted with parents at follow-up. None of the children were riding independently at pre-test; however, 96% were riding independently in a controlled environment post-camp. Paired t-test revealed self-efficacy toward bike riding increased significantly from pre- to post-camp (Mpre = 16.3, SD=5.6; Mpost = 21.7, SD=4.9, p = .001), but perceptions of competence did not (Mpre = 22.9, SD = 4.5; Mpost = 23.5, SD = 4.7, p = .503). Semi-structured interviews with 10 parents at follow-up revealed that transfer to home was problematic. Five children were no longer riding and four required adult supervision in controlled environments. Common barriers included inaccessible environments, parents unable to help their children, and the re-emergence of children’s fear and hesitation. Changes in pre to post-camp skill and self-efficacy were not accompanied by an increase in perceptions of competence, likely due the very high pre-test scores (ceiling effect). At follow-up, most children were not riding in their home environment. Parents were pleased with the camp program overall, but felt that an extension of the program and supports for the transition to home were needed. / Graduate / 0523 / alishawitter@gmail.com

There are many tools available for the study of post-translational modifications. The majority of these tools is specific towards the individual modification and involves separation of modified proteins from non-modified ones. The drawback of using a modification specific method is that there is a lack of flexibility in its usage for other modifications. The goal of these studies was to investigate the possibility of obtaining a similar separation effect by fractionating post-translationally modified proteins based on the physical properties of proteins. The post-translational modification chosen to be the basis of this study was the O-GlcNAc modification. Using the C2C12 mouse myoblast cell line, it was determined that the optimal conditions for producing lysates containing increased yields of O-GlcNAc modified proteins was to treat differentiated C2C12 cells with 10nM insulin, 12g/L glucose and 2mM of the O-GlcNAcase inhibitor Streptozotocin for 24 hours. Using the optimized lysis buffer, it was shown that protein separation by surface charge using standard anion exchange separation did not provide enough resolution or material to obtain any identifications of modified proteins. However, when a chromatofocusing method which separates proteins on the basis of their isoelectric points was used, a separation scheme with larger capacity and higher resolution was possible. Using this separation method followed by gel electrophoresis of individual fractions, proteins which are potentially O-GlcNAc modified were identified by mass spectrometry. It was evident from the number of protein bands observed per fraction on the Coomassie stained gels and the number of proteins identified per protein band by mass spectrometry that further reduction in sample complexity was required to assist in the positive identification of O-GlcNAc modified proteins. Among the identified proteins, 32 percent were metabolic proteins, 21 percent were protein processing proteins, 16 percent were structural proteins and the remainder a mix of other proteins. Unfortunately, it was not possible to validate the presence or absence of the O-GlcNAc modification on these proteins using available methodologies such as immunoprecipitation. As such, further work is required to optimize the separation strategy and to verify the usefulness of this separation strategy in identifying O-GlcNAc/post-translationally modified proteins.

Hearing impairment is the most common communication disability in older people. The wide-ranging impact of hearing impairment on communication means that not only does the person with hearing impairment experience the consequences but also his or her frequent communication partners. This thesis investigates the impact of hearing impairment on spouses and uses the World Health Organization’s term “third-party disability.” Third-party disability is defined as the impairments, activity limitations, and participation restrictions experienced by the family due to the health condition of their significant other, and was identified by the World Health Organization as an area for future development and application of the International Classification of Functioning, Disability and Health (ICF). Despite a number of studies previously published on the effect of hearing impairment on family members, including younger couples and carers, there remain substantial gaps in knowledge and understanding of the difficulties specifically relating to older people and factors associated with third-party hearing disability. This thesis focuses on the third-party disability experienced by normally hearing spouses (termed the “spouses” in this thesis) of older people with hearing impairment (termed the “partners” in this thesis). To add empirical data to the body of research, this series of studies first explored the lived experience of spouses of older people with hearing impairment in a qualitative study, then identified the ICF domains and categories that described third-party hearing disability, described the extent of third-party hearing disability in this population, modelled the contribution of factors to third-party hearing disability, and developed and psychometrically tested a scale to measure the third-party disability of spouses of older people with hearing impairment. Studies conducted within this thesis were therefore completed in two phases. Ten spouses of older people with hearing impairment participated in the first qualitative phase, consisting of semi-structured in-depth interviews. Results of this study showed that spouses experience a number of effects as a result of their partners’ hearing impairment including: (1) the broad ranging effects of the hearing impairment on the spouses’ everyday lives; (2) the spouses’ need to constantly adapt to their partners’ hearing impairment; (3) the effect of acceptance of the hearing impairment on the spouse; and (4) the impact of ageing and retirement. Findings were then linked to the ICF to identify the most typical and relevant domains and categories of the ICF for spouses of older people with hearing impairment. The majority of themes were able to be linked to the ICF, with most linking to codes in the activities and participation component. A number of contextual factors were also identified that influenced the spouses’ third-party disability. In the second phase, a further 100 older couples affected by hearing impairment participated in a quantitative face-to-face survey to describe the nature and degree of third-party disability in spouses, and to examine factors associated with third-party hearing disability. Concepts identified in the first qualitative study were used to formulate a 36-item tool for measuring spouses’ third-party hearing disability, namely the Significant Other Scale for Hearing Disability (SOS-HEAR). The majority of spouses in this study (98%) reported some degree of third-party hearing disability on at least one item of the SOS-HEAR. Communication difficulties between the couple were the central source of stress reported by spouses, followed by emotional problems in the spouse. Three factors were found to be significantly associated with greater third-party hearing disability: (1) lower relationship satisfaction as described by spouses; (2) a larger spouse-partner age difference; and (3) greater hearing disability in the hearing impaired partner as perceived by the spouse. The scaling properties of the SOS-HEAR were then examined, with a revised 27-item questionnaire found to be a reliable means of measuring older spouses’ third-party hearing disability. Use of the SOS-HEAR is proposed as a means of identifying spouses of older people with hearing impairment in need of intervention. If spouses are identified as experiencing third-party hearing disability, health professionals are then in a position to facilitate discussions with the couple about the impact of the hearing loss on their daily functioning. The inclusion of spouses in rehabilitation takes into account the needs of both members of the couple such that they become partners in rehabilitation. In summary, this research has shown that hearing impairment in older people has an effect on the spouse, as they too experience situations of communication activity limitations and participation restrictions. It is clear that the lives of participants in this study were considerably affected as a result of their partners’ hearing impairment, with spouses reporting a wide variety of stresses involving lifestyle changes, communication difficulties, and emotional consequences. This series of studies has highlighted the potentially important role of family-centred intervention in rehabilitation for older adults with hearing impairment, and strongly suggests the need for increased inclusion of spouses and significant others in the rehabilitation process.

This thesis uses the International Classification of Functioning, Disability and Health (ICF) model (World Health Organisation, 2001) to explore the multidimensional presentation of strengths and problems in young people with cystic fibrosis (CF), firstly examining its theoretical “fit” to the health condition, and secondly using it to characterise the performance of those with CF. Few studies in the literature demonstrate such an holistic approach to the physiotherapy assessment and management of this population. It was expected that this description of performance would provide a framework for identifying key areas for physiotherapy exercise intervention. This then formed the basis for further studies to examine the effect of a targeted exercise program (compared to current exercise practice) on inpatient outcomes, as well as on outcomes of outpatient management. The position paper included provides theoretical support for the ICF model as an appropriate tool in the management of young people with CF. Building on this, Study 1 explored the practical utility of the ICF model for describing the presentation of young inpatients and outpatients with CF. Eighty-four participants with CF were recruited as a consecutive series who satisfied selection criteria to provide a cross-sectional view at younger (7-12 years, n=51) and older (13-17 years, n=33) ages. Musculoskeletal, respiratory and physiological measures represented the body structures and functions domain, the six-minute walk test and jump tests were included in the activities domain, and participation was described by the Cystic Fibrosis Questionnaire–Revised Version and Fels Physical Activity Questionnaire. Contextual factors were also considered (age, gender, inpatient/outpatient status). In this exploratory study, performance of this population was compared to normative data where available. Also, correlations between measures within and between ICF domains were examined as suggested by the model itself. Finally, effects of contextual factors on performance were investigated using univariate analysis of variance. This first study and the position paper support the ICF model as an effective tool for describing performance of young people with CF, and for investigating functional relationships within and between domains. Results showed significant differences in this population compared to normative data, and interrelationships were identified within and between ICF domains. Between inpatients and outpatients in the specified age groups, there was a statistically significant difference in means for a number of measures, whereby inpatients displayed consistently poorer mean scores than outpatients, with this effect significantly stronger in the older age group. The application of the ICF model was useful for highlighting areas to target in physiotherapy exercise intervention, and for substantiating selected measures to assess the program’s effectiveness across domains. Study 2 was a randomised controlled trial with blinded assessor, which investigated the effectiveness of a 10-14 day inpatient-based exercise program (the Cystic Fibrosis: Fitness Challenge) (CF:FC) tailored for young people with CF (7-17 years). The CF:FC program (n=15) included exercise strategies based on recommendations from previous work in the field, and from findings from Study 1. This program included a portable exercise package (FitKitTM) designed to be adaptable to limited space environments such as at the hospital bedside, important when inpatients with CF are isolated according to infection control procedures. Participants in the control program (n=16) received the current exercise practice provided for young people with CF at a tertiary hospital, which included mainly aerobic-type activities to affect airway clearance. Performance on study measures (scoped within the framework of the ICF model, presented in Study 1) were compared pre- and post-intervention (admission and completion of the inpatient exercise program) between the groups. This trial showed significant improvements for participants in both groups from admission to discharge for a range of measures, including respiratory function, muscle strength and quality of life measures. Participants in the intervention group showed significantly greater improvements for some measures, for example: ankle dorsiflexor strength, six-minute walk distance and perception of their respiratory status. The continuation of the intervention and control programs into the outpatient setting was the focus of Study 3. The FitKitTM was provided for the intervention group, incorporating strategies to enhance adherence including a physical activity log (PAL) and internet-based follow-up. The control home exercise program consisted of the current practice provided on discharge. Interestingly, the control group improved significantly in hip abductor strength and six-minute walk distance during the outpatient period, whereas the intervention group sustained the improvements gained in the inpatient period but generally showed no further significant improvement. When the change from inpatient admission to outpatient follow-up was considered, it was apparent that greater improvements during the inpatient period provided a ‘buffer’ to accommodate for possible deteriorations in function in the outpatient phase. Issues regarding adherence to exercise programs during the outpatient period are discussed. This thesis confirms the usefulness of the ICF model for describing young people with CF, guiding assessment and review processes to achieve comprehensive management, and strengthening the evidence-base for targeted physiotherapy exercise intervention. A novel, tailored exercise program is introduced which is effective during inpatient periods, and provides a maintenance effect during outpatient periods, but strategies to enhance adherence during outpatient periods require further investigation.