Employment is considered to be an important predictor of life satisfaction and success. Statistics on unemployment rates are of concern among our society, especially when the statistics involve individuals with disabilities. In an era where the American with Disabilities Act and Rehabilitation Act have pushed for the community and workforce to become more accessible, unemployment rates among individuals with disabilities still remain high. Spinal cord injury (SCI) is an interesting population in that individuals, who want to work, can work with the appropriate technology and accommodations. Yet, over half of the individuals with SCI who worked prior to their injury remain unemployed years later. Many of the past and current studies investigating employment recruit subjects who are at least 18 years of age, with some recruiting individuals who are 16 years of age. Children with disabilities have a plethora of resources and services offered to them within the school district. From Individualized Education Programs (IEP) to transition services, many individuals work with the child to help them become an active participant in society. This study looks specifically at SCI of pediatric-onset. Examining already existing data collected by the NSCID, we investigated: a) employment and education rates among individuals with pediatric-onset SCI (PO-SCI) compared with adult-onset SCI (AO-SCI); b) variables that may contribute to vocational outcomes among this population; and c) if acquiring an SCI at a young age is positively correlated with higher rates of employment and levels of education. Statistical results yielded no difference between PO-SCI and AO-SCI with respect to employment rates (working vs. not working). Differences were noted in level of education achieved between PO-SCI and AO-SCI, with individuals who had PO-SCI more likely to pursue additional education and higher levels of education post-injury. Results do indicate that post-injury level of education does correlate with post-injury employment status; higher levels of education yielded higher employment levels at follow-up. Results from the study also indicate that individuals with spinal cord injury, regardless of age at injury, still remain unemployed years after their injury. Rehabilitation counselors can play a crucial role in helping individuals with SCI overcome employment barriers.

Rationale: Many community-dwelling stroke survivors receive care from their family, often daughters. However, we lack in-depth information on the caregiver/care-recipient relationship and its impact on adult daughter caregivers (ADCs). Objective: To systematically review the caregiving literature and qualitatively explore the pre-and post-stroke parent-to-child relationship and its association with ADCs’ well being. Method: A qualitative descriptive methodology used in-depth interviews of 23 ADCs. Analyses generated themes. Findings: Four themes were revealed: 1) The pre-stroke ADC-to-parent relationship is associated with the decision to take on the caregiving role; 2) Changes in the parent-to-child relationship occur as a result of providing care; 3) Changes to an ADC’s relationships with others arises from providing care to a parent and 4) Changes to caregiver lifestyle, outlook and physical and emotional well being arise from caregiving. Conclusion: There is a need for interventions that focus on role strains and issues related to relationship loss.

The recommendations for stroke best practice suggest that mild stroke patients could receive their therapy within an ambulatory environment. However, a significant number of mild stroke patients continue to be admitted to inpatient rehabilitation. A retrospective chart audit was conducted for acute stroke discharges from two centres in Ontario. Stroke cases with a Projected Full FIM® > 80, we're stratified into two groups: discharged home - discharged to inpatient rehabilitation. There were 813 patients eligible for inclusion. Overall, 33% of mild stroke patients were admitted to inpatient rehabilitation. The results did not explain why so many mild stroke patients are admitted to inpatient rehabilitation. The two groups did not differ in rates of recurrent stroke or re-admission to hospital at follow-up. According to the results, milder stroke patients may effectively be managed in the community where rehabilitation services are available.

Rationale: Many community-dwelling stroke survivors receive care from their family, often daughters. However, we lack in-depth information on the caregiver/care-recipient relationship and its impact on adult daughter caregivers (ADCs). Objective: To systematically review the caregiving literature and qualitatively explore the pre-and post-stroke parent-to-child relationship and its association with ADCs’ well being. Method: A qualitative descriptive methodology used in-depth interviews of 23 ADCs. Analyses generated themes. Findings: Four themes were revealed: 1) The pre-stroke ADC-to-parent relationship is associated with the decision to take on the caregiving role; 2) Changes in the parent-to-child relationship occur as a result of providing care; 3) Changes to an ADC’s relationships with others arises from providing care to a parent and 4) Changes to caregiver lifestyle, outlook and physical and emotional well being arise from caregiving. Conclusion: There is a need for interventions that focus on role strains and issues related to relationship loss.

The recommendations for stroke best practice suggest that mild stroke patients could receive their therapy within an ambulatory environment. However, a significant number of mild stroke patients continue to be admitted to inpatient rehabilitation. A retrospective chart audit was conducted for acute stroke discharges from two centres in Ontario. Stroke cases with a Projected Full FIM® > 80, we're stratified into two groups: discharged home - discharged to inpatient rehabilitation. There were 813 patients eligible for inclusion. Overall, 33% of mild stroke patients were admitted to inpatient rehabilitation. The results did not explain why so many mild stroke patients are admitted to inpatient rehabilitation. The two groups did not differ in rates of recurrent stroke or re-admission to hospital at follow-up. According to the results, milder stroke patients may effectively be managed in the community where rehabilitation services are available.

A disabling farm injury affects both the farmer and the farmers spouse. In Canada, injuries rank third as a leading cause of death and second as a leading cause of medical spending. There have been studies of agriculture-related injury and death, including research on the prevalence, incidence, and causes of farm injuries. There is a lack of empirical data on the impact of agricultural injuries on farm families. This qualitative study explored the lived experiences of wives of Saskatchewan farmers who experienced a disabling farm injury and returned to farming. Potential study participants were contacted and invited to participate in the study with the assistance of the extension division of the Institute of Agriculture, Rural, and Environmental Health (IAREH) and the Farmers with Disabilities Program of the Saskatchewan Abilities Council of Saskatoon. Between October 2002 and October 2004 seven Saskatchewan farm women volunteered to participate and were interviewed. Participants who contacted the researcher to indicate their interest in the study were sent cameras and information inviting them to take photographs depicting their lives since the occurrence of the disabling farm injury. They were contacted later to set up the interviews. The grounded theory method of constant comparison was used for the thematic analysis of the interviews. Seven common themes emerged from the analysis: My world just crashed, Superwoman, Somethings got to give, Survival tactics, Definitely impacted them, Support, and Advice for others. The experiences of the seven Saskatchewan farm women have been heard. Their successes and the hardships they experienced with the injury event and the farmers return to farming have been recorded. Implications for health practice, the development of an Internet based support program, education of health care providers on the needs of people who have experienced a disabling farm injury, and future research are considered.

Underlying this thesis is the McKenzie school of thought, a physiotherapy approach that teaches clinicians to recommend particular exercises to their clients in an attempt to accelerate recovery/ prevent recurrence of disc prolapse. The recommendations are based on an untested clinical theory that movements opposite to those that cause disc prolapse can achieve reversal of disc prolapse. Little consideration has been given scientifically to the reversal of the failure process of the lumbar discs. Three in vitro and one in vivo study were designed to attain a greater understanding of both disc failure and the mechanics of its clinical treatment responses and thereby provide a foundation for evidence-based practice. The first in vitro study in this thesis compared in vitro and in vivo herniated discs in an attempt to link the two and provide a more thorough understanding of the in vitro model proposed to test the mechanical theory underlying the McKenzie derangement approach. Ten C3/4 osteoligamentus porcine specimens were repeatedly flexed or flexed and side bent to result in posterior migration of the nucleus. Three of the 10 specimens had posterior migration of the nucleus. Statistically significant (p < 0.01) and clinically significant (>33%) disc height loss occurred in all 10 specimens. The results provide a sub-classification of in vitro herniated discs that is similar to the spectrum of herniated discs that occurs in vivo. Continuing from the disc height loss sub-classification of post-herniated in vitro discs, the second in vitro study in this thesis pursues alternate methods of creating herniation with the goal of creating herniation without causing more than thirty three percent disc height loss of the specimens. Repeated flexion of porcine cervical specimens under a lower compression level (1kN) resulted in disc herniation but with loss of 50% of the pre-test disc height (p < 0.001). Re-hydrating specimens by injecting the disc after a period of failure testing with a barium sulphate nucleus mix (n = 5) or by placing the specimen in a saline bath for an extended period of time (n = 4) resulted in a significant increase of the disc height of the specimens. Further flexion testing of the specimens significantly reduced the disc height again. Intermittent saline injection of specimens (n = 3) during the failure procedure did not prevent or reduce the disc height loss that occurred in the absence of saline injections. Using higher compression levels (2 and 2.596kN, n = 4), failure testing under torque control (n = 3), non-physiologically starting the annular rupture (n = 5) and using hypolordotic thoracic porcine spines (n = 9) instead of porcine cervical spines were unsuccessful attempts at creating herniations. This study indicated that the in vitro model used in the first in vitro study displayed features from one end of the spectrum of damage seen clinically but was then the best-available. Combined these two studies provide a framework for interpretation of the results of the subsequent and third in vitro study in this thesis. The focus of the third study is the mechanical investigation of the McKenzie clinical theory of the treatment response seen in vivo in prolapsed discs, which is that movements or positioning can alter the location of a displaced portion of nucleus in a prolapsed disc. This study is a proof of the principle on which this aspect of the McKenzie approach is based and provides, to the author’s knowledge, the first scientific evidence supporting the theory that repeating movements opposite to those that caused posterior migration of the nucleus can centralize the prolapsed material. The results indicate that the McKenzie approach works on some prolapsed discs and not on others. Consideration of the changes in disc height of the specimens during the testing procedures offers some understanding of the varied success of this approach and exposes a vast area of future research that will refine the clinical approach and mechanical understanding of this specific disc pathology. The fourth study, an in vivo study, provides a first look at the kinematics and kinetics of the current in vivo application of this approach. Twenty asymptomatic subjects volunteered to participate in this study and performed frequently prescribed McKenzie exercises and a selection of activities of daily living during which a 3-SPACE Isotrak system measured their three dimensional lumbar kinemetics. One subject underwent a series of McKenzie exercises while electromyography and three-dimensional lumbar motion were measured. Mean peak extension of extension in standing and extension in lying exercises were within 3% (SD 22.33%) of each other. An additional 6.75% (SD 11.18%) of extension occurred when the extension in lying exercise was combined with a Grade 3 Maitland extension mobilization to L3, a passive physiotherapy technique that involves the therapist applying intermittent low amplitude oscillations to, in this case, the posterior aspect of the spinous process with the goal of subsequently increasing the range of active motion in the direction of the mobilization. The peak extension during the extension in lying exercise was increased after the mobilization relative to the pre-mobilization range. The mean peak right side bend in the right side glide exercise, normalized to the full right side bend range, was 61% (SD 17.4%). The L4-5 forces at the position of peak extension in extension in lying and extension in standing were 828.97N and 1368.86N respectively. The peak flexion ranges of the activities of daily living investigated match those previously used to create disc prolapse when applied at high repetitions and under moderate axial compression. The lumbar spine ranges achieved in commonly prescribed McKenzie rehabilitative and preventative exercises and those that occur in seemingly non-problematic activities of daily living were quantified. The results of this study will enhance clinical practice by providing quantitative evidence of the relative peak motion of the McKenzie exercises as well as highlighting seemingly benign activities of daily living that involve levels of flexion, side bend and rotation sufficient to cause disc damage and even prolapse. The macroscopic goal of this thesis was to attain a greater understanding of the mechanics of both disc failure and its clinical treatment responses and thereby provide a foundation for evidence-based practice, a goal that was successfully achieved. This thesis ultimately challenged and increased our understanding of pathological discs while simultaneously adding information to assist clinical decision making. Several new contributions to the existing knowledge of lumbar spine biomechanics and clinical concepts of treating disc prolapse have been made.

The tradition of the summer cottage in Ontario is a testament to Canadians’ close identification with the wilderness. This thesis establishes a link between the Ontario cottage and the ancient villa originating in classical Roman culture, a building type that for over two millennia has given architectural expression to man’s relationship with nature. In the twenty-first century, this relationship is characterized by a deep sense of crisis. This thesis proposes a new classification of the cottage: Villa Canadensis, a synthesis of the fundamental agricultural instincts of the ancient villa and the satisfaction of a productive relationship with the landscape, with the Canadian desire to experience nature in a wilderness setting. The Villa Canadensis will be actively engaged in the cultivation and rehabilitation of the wilderness. The site for rehabilitation is a decommissioned suburban gravel pit near Cambridge, Ontario. It sprawls over 200 acres, and encroaches on several sensitive ecosystems that are unique to the Waterloo region. The proposal is for a community of cottages to be built on the disused site. Through the combination of regenerative architecture and an ecosystem approach to the devastated landscape, the occupants of Villa Canadensis will participate in the stabilization and remediation of the site, and will eventually become stewards of an enhanced ecosystem, a cultivated wilderness that they have helped to create.

Underlying this thesis is the McKenzie school of thought, a physiotherapy approach that teaches clinicians to recommend particular exercises to their clients in an attempt to accelerate recovery/ prevent recurrence of disc prolapse. The recommendations are based on an untested clinical theory that movements opposite to those that cause disc prolapse can achieve reversal of disc prolapse. Little consideration has been given scientifically to the reversal of the failure process of the lumbar discs. Three in vitro and one in vivo study were designed to attain a greater understanding of both disc failure and the mechanics of its clinical treatment responses and thereby provide a foundation for evidence-based practice. The first in vitro study in this thesis compared in vitro and in vivo herniated discs in an attempt to link the two and provide a more thorough understanding of the in vitro model proposed to test the mechanical theory underlying the McKenzie derangement approach. Ten C3/4 osteoligamentus porcine specimens were repeatedly flexed or flexed and side bent to result in posterior migration of the nucleus. Three of the 10 specimens had posterior migration of the nucleus. Statistically significant (p < 0.01) and clinically significant (>33%) disc height loss occurred in all 10 specimens. The results provide a sub-classification of in vitro herniated discs that is similar to the spectrum of herniated discs that occurs in vivo. Continuing from the disc height loss sub-classification of post-herniated in vitro discs, the second in vitro study in this thesis pursues alternate methods of creating herniation with the goal of creating herniation without causing more than thirty three percent disc height loss of the specimens. Repeated flexion of porcine cervical specimens under a lower compression level (1kN) resulted in disc herniation but with loss of 50% of the pre-test disc height (p < 0.001). Re-hydrating specimens by injecting the disc after a period of failure testing with a barium sulphate nucleus mix (n = 5) or by placing the specimen in a saline bath for an extended period of time (n = 4) resulted in a significant increase of the disc height of the specimens. Further flexion testing of the specimens significantly reduced the disc height again. Intermittent saline injection of specimens (n = 3) during the failure procedure did not prevent or reduce the disc height loss that occurred in the absence of saline injections. Using higher compression levels (2 and 2.596kN, n = 4), failure testing under torque control (n = 3), non-physiologically starting the annular rupture (n = 5) and using hypolordotic thoracic porcine spines (n = 9) instead of porcine cervical spines were unsuccessful attempts at creating herniations. This study indicated that the in vitro model used in the first in vitro study displayed features from one end of the spectrum of damage seen clinically but was then the best-available. Combined these two studies provide a framework for interpretation of the results of the subsequent and third in vitro study in this thesis. The focus of the third study is the mechanical investigation of the McKenzie clinical theory of the treatment response seen in vivo in prolapsed discs, which is that movements or positioning can alter the location of a displaced portion of nucleus in a prolapsed disc. This study is a proof of the principle on which this aspect of the McKenzie approach is based and provides, to the author’s knowledge, the first scientific evidence supporting the theory that repeating movements opposite to those that caused posterior migration of the nucleus can centralize the prolapsed material. The results indicate that the McKenzie approach works on some prolapsed discs and not on others. Consideration of the changes in disc height of the specimens during the testing procedures offers some understanding of the varied success of this approach and exposes a vast area of future research that will refine the clinical approach and mechanical understanding of this specific disc pathology. The fourth study, an in vivo study, provides a first look at the kinematics and kinetics of the current in vivo application of this approach. Twenty asymptomatic subjects volunteered to participate in this study and performed frequently prescribed McKenzie exercises and a selection of activities of daily living during which a 3-SPACE Isotrak system measured their three dimensional lumbar kinemetics. One subject underwent a series of McKenzie exercises while electromyography and three-dimensional lumbar motion were measured. Mean peak extension of extension in standing and extension in lying exercises were within 3% (SD 22.33%) of each other. An additional 6.75% (SD 11.18%) of extension occurred when the extension in lying exercise was combined with a Grade 3 Maitland extension mobilization to L3, a passive physiotherapy technique that involves the therapist applying intermittent low amplitude oscillations to, in this case, the posterior aspect of the spinous process with the goal of subsequently increasing the range of active motion in the direction of the mobilization. The peak extension during the extension in lying exercise was increased after the mobilization relative to the pre-mobilization range. The mean peak right side bend in the right side glide exercise, normalized to the full right side bend range, was 61% (SD 17.4%). The L4-5 forces at the position of peak extension in extension in lying and extension in standing were 828.97N and 1368.86N respectively. The peak flexion ranges of the activities of daily living investigated match those previously used to create disc prolapse when applied at high repetitions and under moderate axial compression. The lumbar spine ranges achieved in commonly prescribed McKenzie rehabilitative and preventative exercises and those that occur in seemingly non-problematic activities of daily living were quantified. The results of this study will enhance clinical practice by providing quantitative evidence of the relative peak motion of the McKenzie exercises as well as highlighting seemingly benign activities of daily living that involve levels of flexion, side bend and rotation sufficient to cause disc damage and even prolapse. The macroscopic goal of this thesis was to attain a greater understanding of the mechanics of both disc failure and its clinical treatment responses and thereby provide a foundation for evidence-based practice, a goal that was successfully achieved. This thesis ultimately challenged and increased our understanding of pathological discs while simultaneously adding information to assist clinical decision making. Several new contributions to the existing knowledge of lumbar spine biomechanics and clinical concepts of treating disc prolapse have been made.

The tradition of the summer cottage in Ontario is a testament to Canadians’ close identification with the wilderness. This thesis establishes a link between the Ontario cottage and the ancient villa originating in classical Roman culture, a building type that for over two millennia has given architectural expression to man’s relationship with nature. In the twenty-first century, this relationship is characterized by a deep sense of crisis. This thesis proposes a new classification of the cottage: Villa Canadensis, a synthesis of the fundamental agricultural instincts of the ancient villa and the satisfaction of a productive relationship with the landscape, with the Canadian desire to experience nature in a wilderness setting. The Villa Canadensis will be actively engaged in the cultivation and rehabilitation of the wilderness. The site for rehabilitation is a decommissioned suburban gravel pit near Cambridge, Ontario. It sprawls over 200 acres, and encroaches on several sensitive ecosystems that are unique to the Waterloo region. The proposal is for a community of cottages to be built on the disused site. Through the combination of regenerative architecture and an ecosystem approach to the devastated landscape, the occupants of Villa Canadensis will participate in the stabilization and remediation of the site, and will eventually become stewards of an enhanced ecosystem, a cultivated wilderness that they have helped to create.