BACKGROUND Given that triathlon is recognised as an official sport by the International Olympic Committee (IOC), a focus on injury prevention strategies for participation in triathlon is necessary. A model for injury prevention programme development that is used currently is the Translating Research into Injury Prevention Practice (TRIPP) model. The literature on iron-distance is currently limited to the first two stages of this model, which focus on injury and illness epidemiology. Current research has predominantly investigated injuries and illness in professional or Olympic distance (OD) triathletes. Iron-distance triathlon is a popular form of triathlon, evidenced by the recent growth in participation in the sport from recreational to elite levels. However, there is limited evidence regarding injury or illness epidemiology for iron-distance triathlon. The impact of training loads on injury and illness in iron-distance triathletes is also poorly understood. AIMS The aim of this study was to determine the impact of training load on injury and illness in a 12-week training period for an iron-distance triathlon. SPECIFIC OBJECTIVES The objectives of this study were to (1) Describe the average weekly training load in amateur iron distance triathletes over a 12-week training period prior to an IRONMAN™ race; (2) Describe the total and weekly average prevalence of overuse injury, substantial overuse injury and illness, and the average severity of overuse injuries and illness in amateur iron-distance triathletes over a 12-week training period prior to an IRONMAN™ race; (3) Determine the incidence and severity of acute injuries in amateur iron-distance triathletes over a 12-week training period prior to an IRONMAN™ race; (4) Determine the average weekly training load threshold above which there is a significantly increased risk of injury or illness in amateur iron-distance triathletes over a 12-week training period prior to an IRONMAN™ race; and (5) Determine any associations between the prevalence of overuse injury and risk factors associated with injury (including age, gender, history of previous injuries and triathlon experience) in amateur iron-distance triathletes over a 12-week training period prior to an IRONMAN™ race. METHODS This study had a prospective, longitudinal, descriptive cohort design. Thirty-seven amateur triathletes who were training for the IRONMAN™ 2018 African Championships were included. All participants had entered for the event prior to the start of the data collection process. Participants were excluded if two or more weeks of training data were missing. Online questionnaires were used to collect weekly training load, injury and illness data over a 12-week training period. Internal training load was measured as sessional Rate of Perceived Exertion (sRPE), while external training load was measured as volume (hours). Acute training load and the acute:chronic workload ratio were used to relate training load to injuries and illness. Total and weekly average prevalence and severity of overuse injuries, substantial overuse injuries and illness were obtained. RESULTS Participants trained for 10.5 ± 2.8(7)(7)(7) hours per week on average, with a weekly average sRPE of 13.1 ± 1.7. The average weekly training load of participants was 8 170 ± 3 565 arbitrary units (AU). The total prevalence of injury and illness were 65% (n = 35) and 62% (n = 47) respectively. The average weekly prevalence of injury and illness were 19% (n = 7) and 9% (n = 4) respectively. The injury incidence was 9.1 per 1 000 training hours. Overuse injuries were more common than acute injuries, with a prevalence of 89% and an incidence of 8.1 per 1 000 hours. The severity of injuries was mostly mild, and the severity of illness mostly moderate. Most injuries occurred during training, and the predominant location of the injury was the knee. Illness symptoms that were reported most commonly included fatigue or malaise. There were no significant relationships between low, moderate or high training loads and injury or illness respectively. CONCLUSION This study identified a relatively high prevalence of injury and illness in amateur iron-distance triathletes. The small sample size significantly limited our interpretation of potential associations between training load and the prevalence of injury and illness. Future studies should consider the next step in the TRIPP protocol, namely by investigating the specific aetiology of the risks associated with injury and illness, including training load. The findings of this study highlight the importance of furthering our understanding of factors contributing to the development of injury and illness in iron distance triathletes to support safe participation and improve performance.

Introduction The purpose of this qualitative descriptive study was to describe the meaning of what the occupation of nurturing was for Early Childhood Development (ECD) practitioners practicing in Khayelitsha educares. This information gave rise to a shared understanding of what the occupation of nurturing was for ECD practitioners. An occupation not explored on the national or international platforms though greatly needed in supporting a thriving learning environment for young children. The Aim The aim was to describe the experiences of ECD practitioner’s occupation of nurturing within educares in a low socio- economic environment of Khayelitsha. The Objectives To describe the ECD practitioners experience of participating in the four-day psychosocial Healing Arts training workshop facilitated by Bambelela. To explore how the ECD practitioner’s self-awareness informed their understanding of their occupation of nurturing in providing a nurturing learning environment. To describe what the enablers and barriers were as experienced by ECD practitioners in fulfilling their occupation as nurturer. To describe practitioner’s understanding of how their behaviour influenced the learning environment in how children learn. The Methodology Application of the qualitative approach utilized the descriptive tradition of inquiry which captured the nurturing experiences of the participants. The application of purposeful sampling in the selection of participants guided by the inclusion and exclusion criteria ensured a standardized baseline of skills and training. Data collected used semi structured interviews, document reviews, researcher notes and member checking for data verification. The data analyses process was guided by the application of the five stages as described by 4 Pope, Ziebland and May namely familiarization, thematic framework development, indexing, charting and mapping. The data analyses stages were guided through familiarization of the saturated data collected, which led to the identification of a thematic framework. This framework informed a structured process, which linked participant’s responses to the study’s objectives. The indexing comprised of the development of codes from the data, after further sorting and clustering the categories evolved. The charting process provided more information as the data was sorted into categories. This process further collapsed the categories, which informed the development of three themes. The mapping of categories per theme was undertaken, which informed the various facets interacting and diverging in the occupation of nurturing. Guba’s model guided the scientific rigour of the study by focusing on credibility, transferability, dependability and confirmability. Findings Three themes emerged The Journey, The Awakening and The Game Changers. The findings showed the value in sharing life experiences through interaction with peers, which led to healing. Practitioners shared their positive and negative attitudes towards child handling as well as the power of knowledge and self-regulation. Exploration of the technical skills needed for child stimulation and management, characteristics of a practitioner, and environmental enablers and barriers. Conclusion The findings elucidated that practitioners became aware of the attributes and skills needed to provide children with a positive, caring and stimulating foundation within an educare. They achieved this through guided group facilitation in the psychosocial training workshop, which in turn ignited a healing process. The holistic approach to the practitioner training created the awareness and motivation for them to explore their occupation of nurturing. They articulated the critical enablers and barriers to their role as practitioner in fulfilling this occupation.

Background: Globally, tuberculosis (TB) continues to be a major health problem. In the most recent World Health Organisation (WHO) Global Tuberculosis Report of 2019, TB was ranked as the leading cause of death from an infectious disease ahead of the human immunodeficiency virus (HIV) and acquired immune-deficiency syndrome (AIDS). In the 2019 WHO Global Report on TB, there is little information relating to TB post-cure effects and management. Although there is evidence that successful completion of TB treatment does not equate to normal lung function, there is growing need for research, both during and after TB treatment, on the extent of lung function abnormalities and how these impact on the individual's quality of life (QoL). Pulmonary rehabilitation programmes may provide a continuum of care for individuals with TB to address both lung function abnormalities as well as positively impacting on QoL. Objectives: The present PhD thesis aimed to provide insight into the extent of pulmonary disease in individuals with pulmonary TB during and near completion of TB treatment as well as to establish whether provision of a pulmonary rehabilitation programme (PRP) could address the research gap. To achieve this, three linked studies were undertaken in the form of observational (prevalence) study (Study 1), a systematic review (Study 2), and a randomised control trial (Study 3). Study One: Observational Study Objectives: The overall aim of the present observational study was to ascertain the prevalence of lung function abnormalities in first time, drug sensitive individuals living with TB, with or without HIV coinfection, at near completion (at least four months) of TB treatment. The specific objectives were to determine: i) baseline clinical and socio-economic profile, ii) baseline information pertaining to the QoL outcome measures of EQ-5D-3L and the St George's Respiratory Questionnaire (SGRQ), iii) measure lung function parameters, iv) establish the proportion of participants with normal or abnormal (obstructive, restrictive, or mixed) lung function and the severity of these, v) whether a correlation of lung function abnormalities with chest x-ray (CXR) abnormalities exist, vi) establish whether a relationship exists between lung function and QoL measures, and vii) identify the predictors of lung function abnormality in individuals being treated for active TB. Methods: A cross-sectional observational study using a sample of convenience was conducted. Inclusion criteria included all adult male and females between the age of 18-80 years with confirmed (smear positive or by CXR) drug-susceptible TB who were receiving treatment, with or without HIV coinfection, for at least four months (16 weeks). ii Participants were excluded from Study 1 if they were adult patients who had had previous TB episodes, recent severe chest trauma (within the previous three months), a recent history of pneumonia, known atopic asthma, chronic bronchitis, emphysema, bronchiectasis prior to TB diagnosis, cardiac failure, or any other unrelated respiratory disease as reported in their medical folder. Participants completed two QoL questionnaires (EQ-5D-3L and SGRQ), a self-designed clinical research form to collect descriptive data, a six-minute walk test (6MWT), CXR, and spirometry once off. Results: The sample of 305 participants were predominantly male (n=168:55; 1%), had a median age of 36 years (IQR:28-43), and had median time of 19 weeks (IQR:18-22) on TB treatment. Overall, 32% of the sample presented with abnormal lung function (obstructive=11%, restrictive=15%, and mixed=6%). Only 2.2% of the total sample had two or more co-morbidities. There was no statistically significant difference (p=0.29) in distance covered by participants who had obstructive compared to restrictive lung function abnormality. After logistic regression analysis of clinical and sociodemographic variables (multi-variate), only being older (56–65 years old) and being obese were statistically significant (p=0.02 and p=0.04 respectively). When considering QoL, only the domain of mobility for the EQ-5D-3L questionnaire was statistically associated with abnormal lung function (p=0.02). Linear regression modelling for continuous variables of lung function (FEV1, FVC, FEV1/FVC and percentage predicted of FEV1, FVC, and FEV1/FVC) with SGRQ, 6MWD, and CXR scores yielded no predictor. Conclusion: Overall, 32% of participants presented with abnormal lung function, which is lower than comparator studies investigating lung function in TB populations. Quality of life measures for most participants was considered good at the time of assessment. Limitations to Study 1 related to the absence of normative data for a healthy population relating to lung function and 6MWD to compare the findings in this TB population. Recommendations for future research would be to establish normative data for these outcome measures. Regarding lung function testing, it is recommended that training of correct execution of the spirometry techniques is performed prior to assessment as the technique may be unfamiliar compared to the routine tests done at clinic visits for individuals receiving TB treatment. iii Study Two: Systematic Narrative Review A systematic review was conducted to establish the evidence of the impact of non-pharmacological intervention programmes (pulmonary rehabilitation) in the rehabilitation of individuals living with TB on lung function outcomes. Methods: MEDLINE via Pubmed, CENTRAL, CINAHL, PEDro, Web of Science, Scopus, Science Direct, and African Index Medicus, including Google Scholar were searched (from January 1995 to December 2016 with an updated search in November 2018) for randomised control trials, quasi-experimental and pre-post-test studies on PRPsfor adult individuals with TB specifically with lung function measures as primary outcome. Results: In total, 1 705 studies were obtained from the search. Once duplicate studies were removed, 1 220 studies remained. The titles and abstracts of these studies were screened resulting in 1 210 studies being excluded. Therefore, 10 studies were potentially eligible. Once the full-text articles were assessed, four studies met the inclusion criteria. Of the included studies, only one was a randomised control trial, two studies were single arm before and after studies, and one study was a prospective non-randomised open trial (two arms). In total, there were 178 participants in these studies, with sample sizes ranging from 10 to 67 participants. All four selected studies had both male and female participants; however, overall, male participants were the majority with 69% versus 21% females. The mean age across the studies was 70 years. No statistically significant difference (p>0.05) was found regarding lung function parameters and the PRPs. No meta-analysis could be performed as data could not be pooled due to the differences in study characteristics and outcome measures. Conclusion: This review was unable to support or negate the use of pulmonary rehabilitation for individuals with TB primarily due to the lack of well-designed and executed randomised control trials. The studies showed that no effect on FEV1 was demonstrated. The researchers recommended that future research investigates the extent of pulmonary sequelae in patients after completion of TB chemotherapy in large-scale studies. Long-term follow-up in those who have had TB without surgical intervention should be prioritised to see the extent of lung function disorders in this population, particularly in countries on the high-burden list for the disease. A further recommendation is that well executed randomised control trials that control for biases to investigate pulmonary rehabilitation in populations of individuals with TB should be prioritised as there is a need to develop an evidencebased continuum of care. iv Study Three: Randomised Controlled Trial Objectives: The overall objective of study three was to determine what the impact of a contextually relevant PRP would have on individuals living with TB, with or without HIV co-infection, on outcomes related to lung function, functional capacity, and QoL. Methods: A pilot randomised, single blinded, pre-test-post-test design was used. Inclusion criteria were all adult males and females between 18-65 years with TB confirmed by Gene Xpert, irrespective of number of TB episodes, HIV status, or having chronic obstructive pulmonary disease. Participants had to be within their first week of TB treatment. Participants with only extra-pulmonary TB, recent severe chest trauma (within the last three months), a recent history of pneumonia (within one month), known atopic asthma, cardiac failure, or any other unrelated respiratory disease as reported in their medical folders or who had defaulted on their treatment were excluded. In addition to this, if participants failed the pre-participation health screening and were non-ambulate due to paralysis or amputation, they were also excluded. Fifty-eight participants were randomised into a control group (CG) receiving only pharmacological therapy and the intervention group (IG) who received pulmonary rehabilitation in addition to pharmacological therapy. The PRP was held for 12 weeks and consisted of two weekly sessions with a duration of 45 minutes each, which was delivered at a community centre. Participants completed two QoL questionnaires (EQ-5D-3L and SGRQ), a self-designed clinical research form to collect descriptive data, a three-minute step test, and spirometry at three time points (enrolment, at six weeks, and at 12 weeks). T-tests were conducted to determine the difference between means of the CG and IG for lung function parameters, functional capacity, and QoL outcomes. Results: There were 29 participants in each group. Regarding sex, age, and number of co-morbidities the two groups were well matched. Regarding HIV status, the CG had more participants that were HIV positive (n=22) and on anti-retroviral therapy (n=11) than their IG counterparts (n=13 and n=5 respectively). Nearly half of the participants had a first time TB diagnosis, with the participants in the IG having reported more recurring TB incidences overall (n=16 vs. n=13). A t-test for difference between means showed no statistical significance for the CG and IG regarding FEV1, FVC, and FEV1/FVC ratio for absolute or percentage predicted values. Forty-three percent of participants in the total sample had normal lung function at baseline, with the remaining participants being classified as having either obstructive (26%), restrictive (21%), or mixed (10%) lung function. At baseline, 48% of participants in the CG had abnormal lung function compared to 67% in the IG. At six weeks there was no change in the CG regarding lung abnormalities. However, the IG only had 33% abnormal lung function at the same time point. v Although there was no statistical significance for any of the lung function categories, there was a 42% improvement in normal lung function at six weeks in the IG compared to the CG at baseline. The median baseline number of steps taken by the CG was 79 steps (IQR:42-134) compared to 117 steps by the IG (IQR:84-154). A t-test conducted to test the difference between means for the CG and IG was statistically significant for the step test (p=0.002) at six weeks for the IG, but not at 12 weeks (p=0.13). No correlation was found between the SGRQ (QoL parameter) and any lung function parameter (p>0.05) at 12 weeks. Conclusion: Although the changes in lung function, functional capacity, and QoL did not reach statistical significance at completion of the PRP for the IG, the continued improvement in all the outcomes for the IG from 0 weeks to 12 weeks holds potential clinical significance.

Objective: To determine the differences in postural stability measures and neurocognitive function between sport-related concussion, also known as mild head injury (MHI), subjects and healthy subjects. To determine the correlating factors of postural stability and neurocognitive function. Design and Setting: This descriptive study design assessed postural stability and neurocognitive function within 7 days of athletes sustaining a sport-related MHI and compared the group to a control group of healthy subjects. All testing was completed at the University of Pittsburgh Neuromuscular Research Laboratory. Subjects: Twenty subjects (10 healthy, 10 MHI) participated. Measurements: All subjects completed a single testing session consisting of a computerized neurocognitive test and postural stability assessment, including kinematics and force plate data collection, during which two balance tasks were performed three times each. Results: There were no significant differences in postural stability between groups. There were no significant differences in neurocognitive function. Additionally, no relationship existed between postural stability and neurocognitive function. Conclusions: Although not significant, hip flexion and extension was larger in the control subjects, indicating that there may be difficulty for MHI subjects to adopt either a hip or ankle strategy to maintain postural stability. While no significance was found in the study, there may be trends to suggest that visual memory (p=0.11) and reaction time (p=0.17) are different. The low number of subjects and time of testing with relation to injury may be contributing factors in the lack of significant results in the majority of test variables.

Several studies have been conducted investigating the biomechanics of pitching [1-9]. These previous studies all report high compressive and distractive forces for shoulder external rotation, elbow flexion with a maximum varus torque, shoulder adduction torque, and elbow extension. These characteristics may be exacerbated with increased pitch counts. The purpose of this study was to quantify changes in shoulder and elbow mechanics as a result of increased pitch count, by evaluating joint angles, accelerations, and velocities. Subjects each completed one testing session. Intercollegiate baseball pitchers pitched a simulated game, with 17 pitches per inning over the course of 9-innings. Shoulder and elbow kinematic data were evaluated for a fastball every tenth pitch of the simulated pitch count for each subject. Our overall hypothesis was that as the pitch count increased, abnormal throwing mechanics would result.

Transfers are crucial for independent mobility. However, transfers can cause problems if appropriate precautions are not considered. For instance, transfers can result in skin damage, overstretching of the low back, wrist and fingers, excessive motion in unstable spinal segments, and shoulder injury. The purpose of this study was to develop and evaluate a transfer measurement system, to determine an objective method to delineate the different phases of a transfer, and to determine the peak dynamic joint forces and moments at the wrist, elbow, and shoulder experienced by wheelchair users with paraplegia during a level tub bench transfer. A transfer measurement system was developed which consists of a steel frame, two unistruts, two handrail attachments, two aluminum-mounting plates and two force-plates. A mock trial was conducted to determine whether the transfer systems performed correctly. The types of the transfer surfaces that we can evaluate include a tub bench, a toilet seat, and car seat. The phases of transfer from wheelchair to tub bench and back were identified based on force plate data and position and velocity of trunk marker (C7). The phase identification method was used to identify the approximate force coming on the hand during tub bench transfer using force plate data. We studied nine paraplegic subjects transferring from wheelchair to level tub bench and back. We modeled the arm as a serial linkage mechanism in analyzing the peak dynamic joint forces and moments. It was found that peak net joint dynamic forces at the joints are greater in the trailing arm than in the leading arm. It was observed that the peak joint forces were minimum at the wrist and maximum at the shoulder in all nine subjects with paraplegia. The moments at the wrist were lower than the moments at the shoulder. In wheelchair to tub bench transfer, there was an inverse relationship between wrist force and transfer time. Examining leading and trailing arm forces in conjunction with transfer time may assist in modifying transfer styles in individuals with weakness, strength imbalance and shoulder pathologies.

Rehabilitation counselors work with the clients family, friends, and employer to increase employment opportunities by means of their roles as counselor, coordinator, and consultant. Increasing employment opportunities often includes purchasing and learning to use assistive technology devices, equipment modification, improving accessibility, etc. The objective of this research is to examine knowledge and experience of OVR counselors in a common area of assistive technology: wheeled mobility device. A survey, given to public rehabilitation counselors in Pennsylvania, obtained information about counselors caseloads, their knowledge of wheeled mobility and their use of good evaluation and selection strategies. This study shows that counselors with in-depth knowledge of AT devices seem more likely to: (1) support their clients in making informed choices about their technology needs, (2) consider the relationship between wheelchair features and job demands, and (3) listen to their clients opinion. Further study is needed on the relationship between OVR counselors knowledge about AT devices and factors that influence recommending or purchasing wheeled mobility devices.

There is a current focus on job satisfaction and how it is related to occupational injury, specifically musculoskeletal disorders (MSD) since they are the most common injuries employees experience. Job satisfaction has been defined as an employees satisfaction with the reinforcers found on the job (Weiss, Dawis, England, & Lofquist, 1967). Numerous reinforcers exist, but the Minnesota Satisfaction Questionnaire (MSQ) has been developed to measure what has been found to be most involved in gauging employees level of job satisfaction. This study attempted to compare the job satisfaction of hospital employees with a history of occupational MSD to their non-injured counterparts. Problems with recruitment, which resulted in a small study sample, forced the specific aims of this study to be modified. The findings showed only a few areas of statistically significant difference between groups of employees in levels of satisfaction for the 21 attributes measured by the MSQ. These findings, however, must be viewed with caution because of the small sample size and subsequent subgroups used for the analyses. Two of the subscales of the MSQ were found to be correlated with age. Isolation of the dissatisfied employees did not indicate that history of MSD was affecting the satisfaction scores of any of the attributes. Results of this study may be useful for rehabilitation counselors working with individuals who are working with individuals who have, or are interested in, careers in healthcare. The attributes seen as high and low satisfaction areas for the study sample may carry over to the general population of healthcare workers, giving some insight into what the client values as important in a job. Differences found between groups may have clinical significance, alerting a counselor to focus more on these areas with certain individuals. Information gained from this study can also assist with the formulation, or modification, of an employee return to work program to increase the chances for a successful return to work.

The primary objective of this study was to collect descriptive data on the mobility characteristics and activity levels of manual wheelchair users in two different environments: at the National Veterans Wheelchair Games (NVWG) and in the subjects residential setting. This was accomplished using a custom data logging device. A secondary objective was to identify demographic factors that might influence the mobility characteristics and activity levels of the wheelchair users in their home environment. Thirty nine subjects were recruited to participate in this study over a two year period. A data logging device was instrumented on each subjects wheelchair for a total of six days at the NVWG and an additional one or two weeks in the home environment, depending on year of enrollment. The participants were also asked to complete a brief demographic survey. It was found that subjects traveled significantly (P=0.000) further and were active for significantly (P=0.000) more hours during an average day at the NVWG compared to their residential setting. The subjects traveled on average 6566.84 ± 3203.90 meters and were active for an average 12.00 ± 3.56 hours per day at the NVWG. In their home environment, subjects traveled an average distance of 1994.09 ± 1851.20 meters and were active for 7.13 ± 4.85 hours per day. When comparing the speed traveled in the two environments, no significant differences were found. It was found that the activity levels of the subjects at the NVWG were significantly greater when compared to their home environment. Analysis of demographic factors revealed that subjects who used a wheelchair for more years were found to travel significantly further and accumulate more minutes of movement per day. Also, employment was found to be a demographic factor that influenced wheelchair usage in the home environment. The findings of this study provide a more objective measure of wheelchair usage patterns in two real world environments: one that facilitates participation in activities and one that contains barriers that the subjects need to overcome. The results also indicate that there are demographic factors that influence wheelchair usage patterns in the residential setting.

Objective: The goal of this project was to describe the characteristics related to motor vehicle transportation among wheelchair users, who remain in their wheelchair while in the vehicle. Particular focus was placed on identifying how these individuals utilize occupant restraint and wheelchair securement devices. Also, the study examined the epidemiology of motor vehicle related injuries, and reports on the relationship between these injuries and the identified use of occupant restraint and wheelchair securement systems. Methods: A 12-page survey was completed, via mail, by 336 wheelchair users, who self-reported that they remain seated in their wheelchair at least some point in their transportation use. These individuals were recruited through various nationwide disability related service and advocacy organizations, as well as through disability related internet message boards. Descriptive, chi-square and t-test analysis was completed using SPSS statistical software. Results: The results of this study show that traveling as a private vehicle passenger is the most common manner in which motor vehicle transportation is used by wheelchair occupants, with 70.2% of the sample population reporting to using this mode within the past month and 50.0% reporting this mode as their primary means of transportation. Limited significant difference existed in regard to subjects gender, age, disability or wheelchair type and the reported use of either an occupant restraint device or a wheelchair securement system. There were also limited significant findings seen in regard to the use of either an occupant restraint device or wheelchair securement system and the occurrence/severity of a motor vehicle crash, or non-crash related injury. Finally, in regard to motor vehicle related adverse events that resulted in an injury, descriptive statistics showed that there were limited events (crash: n = 15, non-crash: n = 71), with even less resulting in an injury requiring the need to seek medical attention (crash: n = 10, non-crash: n = 9). Conclusion: This study is one of the first efforts to describe the real-world transportation characteristics of wheelchair-seated passengers, as well as an examination of the relationship between the use of either occupant restraints or wheelchair securement devices and the occurrence of motor vehicle related injuries. These data demonstrate that private vehicles are the most widely used form of motor vehicle transportation, suggesting that research focused in this area may be beneficial. Also, limited significant findings were seen in regard to the relationships between the use of either an occupant restraint or wheelchair securement, independent of each other, and the occurrence of motor vehicle related injuries. These results may be interpreted in two ways 1) that these safety systems are not being used effectively, or 2) that use of an occupant restraint and wheelchair securement independent of one another may not reduce injury risk in a motor vehicle crash or non-crash incident. The analysis of the use of a 3-point occupant restraint, together with a forward facing wheelchair securement system, as recommended by the SAE J2249, may produce different results. It should also be noted that based on descriptive statistics alone, it is evident that for those individuals who were injured severely enough in a non-crash incident to require medical attention, there was limited reported usage of wheelchair securement and occupant restraints. These findings may suggest that the use of such devices may decrease the number of severe non-crash related injuries. Based on the limitations of this study and trends seen within the descriptive statistics, more research in this area is required to develop more inferential findings between the use of these devices and the occurrence of injuries related to motor vehicle transportation.