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While a number of Western personality and clinical psychologists have explored the adaptive functions of guilt-proneness in relation to a wide variety of behavioural patterns, the investigation of guilt-proneness in the Arabian-Islamic culture remains a neglected field Perhaps one reason for the absence of research dealing with guilt-proneness and its therapeutic application in the Arab world, and in the Saudi culture in particular, is the lack of an empirically-based measure of guilt-proneness. In this study, a new psychometric instrument, the Guilt-Proneness Scale (GPS), has been developed and used to investigate the role of guilt-proneness in inhibiting involvement in deviant behaviour with particular reference to juvenile illicit drug use and offending behaviour in Saudi Arabia. Exploratory factor analysis of the GPS (based on 214 Ss) has revealed three aspects of guilt-proneness phenomenon among Saudi subjects: (1) religious-related guilt (RG), (2) social-related guilt (SOG), and (3) self-oriented guilt (SG). The GPS total and these three subscales have demonstrated satisfactory levels of reliability in terms of both test-retest and internal consistency criteria. A confirmatory factor analysis examination using Structural Equation Modelling techniques (SEM), has confirmed this three-factor model for guilt-proneness. SEM was performed on the data of three subject groups: the first was 206 Ss., the second was 227 Ss., and the third (a combined group) was 433 Ss. Regarding the scale validation, the attempts to establish evidence of the criterion-related, construct, and disciminant validity of the GPS measure of guilt-proneness have been largely successful. The GPS has been utilised in investigating the role of guilt-proneness in inhibiting involvement in illicit drug taking and criminal behaviour of Saudi male juveniles. A study was conducted comparing individual differences in guilt-proneness between voluntarily admitted illicit drug patients (N = 64), convicted illicit drug users (N = 58), non-drug-abusing offenders (N = 71), and normal controls (N = 68). Based on a discussion of current theoretical and empirical approaches dealing with the relationship of guilt-proneness to involvement in illicit drug use and crime, a number of hypotheses were formed. It was hypothesised that: (H1) Normal subjects should manifest greater amount of religious-related guilt than would the voluntary drug abusers, convicted drug abusers, or offenders. (H2) Voluntarily admitted drug abusers should score higher on the three guilt-proneness subscales than would either the convicted drug abusers or the offender group. (H3) Guilt-proneness as measured by the GPS scales should be associated negatively with level of psychopathy. (H4) There should be significant differences in mean guilt-proneness scores among groups varying in their drug preference. (H5) Guilt-proneness in the offender group should be associated negatively with the number of convictions. (H6) The offenders who had committed violent crimes should display significantly lower level of guilt-proneness than those who had been involved in non-violent crimes. In addition to the these hypotheses, the interaction between guilt and selected variables was also examined. The analyses yielded promising results with regard to the measurement of individual differences in guilt predisposition between the groups tested. Both the convicted drug abusers and the non-drug-abusing offenders were marked by low susceptibility to experiencing guilt. Unlike the convicted drug abusers and the non-drug-abusing offenders, the voluntarily admitted drug abusing patients tended to maintain a healthy level of susceptibility to experiencing guilt which is postulated to be significantly influential in their decision to seek treatment. The normal controls manifested the highest religious-related guilt (RG) scale. The findings also revealed that the voluntarily admitted drug patients were distinguished from both the convicted drug takers and the non-drug-abusing offenders. However, no significant differences were found between the convicted drug takers or the offenders. An examination of the relationship of guilt-proneness to psychopathy indicated a significant negative correlation. This pattern of correlation, revealed for the first time for subjects of an Arabian culture, seems in line with most research exploring the relationship of guilt-proneness to psychopathy in Western juveniles. With regard to the examination of the individual difference in guilt-proneness between heroin users, alcohol users, and multi-drug users, it was found that all the three guilt-proneness scales differentiated significantly (p =<0.005) between the three groups of illicit drug taking. In addition, an examination of the relationship between level of guilt-proneness and experience with illicit drug use indicated that those newly involved in taking illicit drugs manifested significantly higher RG, SOG, and SG than the long-term users (p =<0.01). The results of the present study also showed that the RG, SOG, and SG scales differentiated significantly between the recidivists and first time offenders, and between offenders who had committed violent offences and those who had committed non-violent offences. Consistency of the effect of guilt-proneness in inhibiting involvement in deviant behaviour relating to the use of illicit drugs and commission of crimes, has been examined in a 33-month follow-up study. The follow-up study demonstrates that the re-admitted illicit drug patients had significantly lower GPS scores (p =<0.001) than those showing recovery from illicit drug dependence. The results derived by the follow-up also reveal an interesting relationship between relapse (readmission) and having low scores on the three GPS subscales. With regard to the offender group, the results demonstrated a significant correlation (p =<0.01) between the GPS scores of the Recidivists, taken at the time of the first and second testing with a 33 month interval. Hence evidence of the predictability of guilt-proneness as measured by the GPS scales, appears to be very promising. In general, the results of the comparison study as well as the follow-up study provide support for the positive role of guilt-proneness in inhibiting involvement in illicit drug taking and offending behaviour in the Saudi juveniles. In addition, these findings have demonstrated the effectiveness of the GPS as a measure of guilt and in predicting the occurrence of a particular class of behaviour. The final part of the present research was aimed at providing extended individual-case examples of use of the GPS. I have employed a personal construct theory approach through the use of the Repertory Grid technique. Individual GPS profiles, as well as Rep Grid data, were obtained for five in-patient illicit drug abusers and one incarcerated offender. Based on the use of cluster analysis, construct intercorrelation, and principal components analyses, the results of individual grids of each of the six cases were analysed. These demonstrated a pronounced and statistically significant agreement between GPS profiles and Rep Grid indicators of the individual's level of willingness to giving up the use of illicit drugs or involvement in crimes (p =<0.05). These findings demonstrate further the value of guilt-proneness in predicting the individual's response to rehabilitation. They clearly extend support for the GPS as a powerful and useful diagnostic tool. Its use in conjunction with the repertory grid technique with both drug abusers and criminal offenders seems very promising and encourages further research.

The purpose of the present study was to establish the prevalence of sensory, neurological and systemic impairments in the Inuit pediatric population (0-18 years) in 13 communities of the Baffin region of the Northwest Territories, Canada. / A data collection instrument (DCI) was developed to obtain clinical data from medical files in each of the Community Health Centres. Impairments rather than disabilities were described and possible causal factors were identified. Data collection took place during the month of June, 1989. / Nearly 13% of Inuit children living in the Baffin area have impairments. Of this group, 15.9% have multiple impairments. The prevalence of children with sensory impairments is 49.4/1000, with neurological impairments is 28.7/1000, with systemic impairments is 30.2/1000 and with multiple impairments is 20.5/1000 children. Over 50% of the impairments reported were due to infectious diseases such as meningitis and chronic otitis media. / The results of this study provide a basis for the development of community based programs which emphasize prevention of impairments in children. / Recommendations for the development of appropriate rehabilitation programs are discussed in the context of the policies of the Canadian government pertaining to the needs of Aboriginal persons with disabilities.

Botulinum A toxin (BTX) has become increasingly recognized as a treatment option in the management of spasticity in children with cerebral palsy (CP). Preliminary evidence suggests that certain baseline characteristics of the child may affect responsiveness to BTX. However, the contribution of these factors has not been fully elucidated. / The primary objective of the study was to examine whether specific intrinsic and extrinsic characteristics of the child were associated with responsiveness to BTX. The results indicate that age, number of treatments, parenting stress and child's motivation were associated with the degree of change in gait pattern, level of ambulation, gross motor function and functional independence. The findings suggest that the contribution of contextual factors (personal and environmental) on responsiveness to BTX is underappreciated in children with mild CP. Identification of potential factors contributing to responsiveness to BTX will assist clinicians in identifying children who would benefit most from this procedure.

The main objectives of this prospective cohort study were to examine the construct and predictive validity of the STREAM, and estimating its responsiveness. Sixty three acute stroke patients were evaluated on the STREAM and other measures of impairment and disability during the first week post-stroke, four weeks later, and three months post-stroke. The results of the study showed that STREAM scores were associated with measures of impairment and disability, and could discriminate subjects based on Balance Scale and Barthel Index scores. Moreover, the STREAM during the first week post-stroke was found to be an independent predictor of discharge destination after the acute care hospital, and of gait speed and the Barthel Index at three months post stroke. In addition, the total and subscale STREAM scores were able to mirror changes in motor performance between each evaluation. The utility and measurement properties of STREAM warrant its use in clinical practice and research.

Reduced levels of health-related quality of life (HRQL) post-stroke are an important issue to address in rehabilitation. Despite improvement in function over time, HRQL remains poor for many stroke survivors. This longitudinal study is aimed at estimating the extent to which physical performance, social, and psychological functioning influence HRQL. / Forty-three community-living persons with stroke were recruited to participate in a six-week intervention preceded and followed by a performance- and interview-based evaluation assessing different levels of disability and functioning. HRQL was measured by the VAS of the EQ-5D. / Regression models generated cross-sectionally demonstrated that physical performance, social, and psychological functioning explained up to 90% of the variation in HRQL. A GEE model revealed that, over time, only upper extremity functioning had a significant relationship with HRQL. / Much attention has already been focused on increasing physical performance in rehabilitation. However, clinicians should consider other components that affect HRQL directly or indirectly through physical performance. Only by treating the different components of functioning at various levels can HRQL be ultimately increased.

This research project investigated locomotor and postural strategies to adapt to uphill and downhill treadmill walking in healthy and spinal cord injured (SCI) subjects. In the first experiment, subjects from both groups walked uphill at three different inclinations (5, 10 and 15º) while holding on to the handrails on the treadmill. The goal of this first experiment was to characterize changes in lower limb movements and muscle activity patterns required for up-slope walking. The results showed that the key mechanism when adapting to uphill walking in healthy subjects was to lift up the swinging limb by performing a simultaneous increase in hip and knee flexion of that limb. An increase in ankle dorsiflexion was also required to place the foot properly on the inclined surface. Modifications in lower limb movements were accompanied by progressive increases in the peak amplitude of electromyographic activity of lower limb muscles as the treadmill grade went steeper. The most important increase was observed in the plantarflexor muscles during push off. This increase in muscle activity was necessary to propel the body forward and upward and counteract the resistance due to gravity in uphill conditions. In SCI subjects, a similar trend of adaptation was found only at the hip during uphill walking. Furthermore, the majority of lower limb muscles, including ankle plantarflexors, showed very limited adaptation during uphill walking. The limited changes observed in lower limb movements and muscle activity suggest that SCI subjects have to used different strategies than healthy subjects to adapt to uphill walking. These strategies could involve movements from the trunk and pelvis to compensate for lower limb deficits. / The second experiment specifically focused on the role of the trunk and pelvis in the strategies of adaptation to uphill and downhill treadmill walking in healthy and SCI subjects. Results from healthy subjects showed that walking on an inclined surface required modifications in trunk and pelvic vertical alignment in the sagittal plane. Uphill walking induced a progressive forward inclination of both trunk and pelvis whereas the opposite trend was found in downhill conditions. These modifications in trunk and pelvic alignment are necessary to counteract the effects of gravity on forward momentum at different slope conditions. In contrast to healthy subjects, SCI subjects with minor deficits in lower limb kinematic patterns showed a greater forward inclination of both trunk and pelvis during level and inclined walking, especially in downhill conditions where both segments were maintained at similar inclination as in level gait. SCI subjects with major deficits revealed analogous (but more pronounced) feature in trunk and pelvic orientation during walking. The whole group of subjects with SCI seemed to adopt this anterior posture to benefit from greater stability during level and inclined walking. Results from frontal and transverse plane motions revealed that compensatory movements from trunk and pelvis were performed only by subjects with SCI showing severe mobility dysfunctions. These compensatory movements were maintained similar across treadmill grades. Results from subjects with SCI and healthy subjects did not show any significant changes in trunk and pelvic total angular excursions in the three planes of motion when comparing level and inclined walking. This absence of changes suggests that lower limbs are mainly responsible for generating or absorbing more energy during uphill and downhill walking in these two groups of subjects.

Historic bridges are an important part of the nation's infrastructure. However, many historic bridges are not being maintained to a level that will ensure their continued use. In 2007, the I-35 W Mississippi River Bridge collapsed demonstrating significant issues with the safety of older bridges in service. Currently there are so many bridges that are considered structurally deficient that transportation authorities are continuously faced with the dilemma of distributing limited bridge funds. This situation underscores a need for cost effective and reliable maintenance and rehabilitation strategies. This thesis promotes historic preservation in two main tasks: (1) rehabilitation and repair methods are determined to guide engineers, preservationists, and other stakeholders and (2) an assessment is performed for a prototype historic bridge. More specifically, the assessment is performed in three tasks: (1) modeling of the historic bridge, (2) evaluation of the bridge using load rating procedures, and (3) rehabilitation strategies are recommended based on the results of the assessment. The prototype bridge is a 1930s variable depth T-beam bridge. The bridge did not meet requirements for flexural capacity at the mid-sections of the approach and main span interior girders. Three rehabilitation methods considered were support modification at the cantilever ends, external fiber reinforced polymer (FRP) plies, and external post-tensioning. The support modification raised the bridge to a 75-year exposure period, the highest level of evaluation, without disrupting the historical integrity of the bridge. The FRP plies raised the positive moment capacity of the bridge to legal load standards, a 5-year exposure period. The FRP retrofit was limited by de-bonding issues. The external post-tensioning raised the positive capacity to design load standards at the inventory level, a 75-year exposure period. The external post-tensioning was limited by the use of a straight tendon, but is less visible than a draped tendon. From the information in the assessment, support modification is more effective than the other methods and will not negatively affect the bridge’s historic integrity. Other factors such as the projected effects on other bridge elements including the substructure, cost, installation procedures, and durability should be considered and might lower the benefits of the considered methods.

This thesis reports two studies which compared the effects between a feedforward gait training and a standard exercise protocols on parkinsonian (PD) gait and choice reaction times (CRTs). The feedforward treatment consisted of training PD subjects to walk to preparatory signals, in the form of visual and auditory cues. Firstly, we compared the effects of 45 min of feedforward gait training, administered to 9 randomly selected PD subjects, to those of the exercise program, given to 7 PD subjects. Secondly, the effects of 3 weeks of feedforward gait training (n = 5) were compared to those of the exercises (n = 4). Gait and CRT measures were obtained at pre-test, at 45 min and 3 weeks post-treatment. Contrarily to the exercises, 45 min of feedforward gait training increased significantly the mean gait velocity, stride length and decreased the double limb support time (p $<$ 0.01). Neither of the two treatments produced significant effects on the CRTs. Three weeks of feedforward gait training did not produce any additional changes on gait and CRTs. Three weeks of exercises exerted no effects on gait and CRTs. These findings indicated that the 45 min feedforward gait training effect cannot be carried over from gait to CRTs in PD, at least under our present gait training paradigm. The role of preparatory cues in the amelioration of certain PD gait parameters may be related to the improvement of the deficiencies in the parkinsonian motor preparatory process, at the level of the motor basal ganglia.

Due to advances in medical technology, the incidence of incomplete spinal cord injury versus complete paralysis in spinal cord injury is increasing. However, little is known about the interactions between crutch use and gait in the incomplete spinal cord injured population. This thesis presents a quantitative description of five incomplete spinal cord injured subjects who use Canadian crutches, representing a wide spectrum of gait speeds, with respect to several kinetic and kinematic factors, and focuses on describing observed interactions. Results indicate that Canadian crutches are used primarily for support, balance and braking. Peak loading on the crutches in the axial direction was observed to be between 10 and 38 percent of subjects' body weight, and seemed to be related to the magnitude of lower limb loading during the gait cycle. Peak braking forces ranged from 0.13 to 0.58 percent of body weight, where the highest braking forces were seen in the subjects with the lowest gait speeds. The use of crutches for balance was observed consistently throughout the single limb support phase in the contralateral crutch in all subjects. The relationship between vertical ground reaction forces and axial forces on the crutches is supported by kinematic data and moment analysis. It is suggested that due to common factors among all subjects in the spectrum, that there may be prerequisites such as balance or lower limb strength for assisted gait with Canadian crutches. Strategies aimed at improving these requirements may aid in efficient and successful crutch walking.