For individuals who rely on wheeled mobility devices (WMD), performing transfers is essential to independence with activities of daily living at home and participation in the community. Transfers are required for getting to and from the device to bed, bath tub, car seat, among others. The United States Access Board develops guidelines and maintains design criteria for the built environment to maximize accessibility to public places. The objective of this study was to analyze the impact of transfer setup on performance of independent transfers. The first aim of the study was to perform an expert review of the current knowledge regarding transfers and the impact of setup. Results showed a consensus among studies that transferring to a higher surface implies greater exertion of the upper limb. Yet, there is no evidence concerning height differences, horizontal distance, and space needed next to the target surface so it can be accessible by a majority of WMD users. The second aim was to compare the current guidelines for amusement park rides with the results obtained by evaluating the impact of setup on transfer performance using a custom-built transfer station. We evaluated community-dwelling WMD users who were able to transfer independently and who represented a broad spectrum of disabilities. We evaluated the impact of height differential, gap, placement of a non removable armrest, and the effect of a grab bar. Results showed that height differentials above and below WMD height, gaps and obstacles pose serious transfer-related accessibility problems for WMD users. Current guidelines for amusement park rides fall short in terms of height recommendations and space available for the WMD and could exclude up to 72% of our sample. The third aim was to evaluate the relationship between functional performance (i.e. upper limb strength and trunk control) and transfer ability in people with spinal cord injury. Results found that trunk stability and gender are significant predictors of transfer ability. Rehabilitation plans should include balance training and core strengthening in addition to upper limb conditioning when teaching transfer skills. Improving transfer ability has the potential to increase community participation and independence among WMD users.

This thesis is composed of two studies related to wheelchair propulsion biomechanics. The first study investigated the impact of cross-slope and surface roughness on wheelchair propulsion. Fifteen manual wheelchair users propelled across a five-meter platform which were set to level, 1°, or 2° cross slope, and attached with one of three surfaces including Teflon (slippery), wood (normal), and blind guide (rough). The study found main effects of both cross slope and surface roughness on stroke number and sum of work, and a main effect of cross slope on velocity. Subjects travelled slower, used more strokes, and expended more work with increasing cross slope. Subjects also used more strokes when propelling on the slippery and rough surfaces than on the level surface. They expended more work when propelling on the rough surface than on the level surface. When looking into bilateral propulsion parameters, we found that peak resultant force, peak wheel torque, and sum of work became significantly asymmetrical with the increase of cross slopes. Exposure to biomechanics loading can be reduced by avoiding slippery, rough, and cross slopes when possible. The second study consisted of a preliminary analysis on the validity of a wheelchair propulsion monitor (WPM) in estimating wheelchair propulsion biomechanics. The WPM integrates three devices including a wheel rotation datalogger, and an accelerometry-based device on the upper arm and underneath the wheelchair seat, respectively. Five wheelchair users were asked to push their own wheelchairs fitted with a SMARTWheel over level and sloped surfaces on two separate visits. The estimated stroke number and cadence by the WPM were consistent with the criterion measures by the SMARTWheel (ICC= 0.99 for stroke number, ICC=0.97 for cadence) with less than 5% absolute percentage errors for stroke number and 9% for cadence. The peak resultant force and wheel torque could be predicted to some extent by acceleration features on an individual subject basis. The study demonstrated the potential of the WPM in tracking wheelchair propulsion characteristics in the natural environment of wheelchair users.

This thesis describes the history of the Endeavor folding wheelchair. In its current incarnation, it is an adjustable folding manual wheelchair conceptually based on a diamond shaped truss (similar to a bicycle). By disconnecting this truss at two points, the chair is able to fold flat enough to fit in the overhead bin of an airplane. It also features "airplane wheels" for maneuvering down the aisle of an airplane, taking the place of a boarding chair. The main part of the study was a clinical trial to gain feedback on the current chair design. The first phase of the study involved users performing obstacles encountered on a daily basis using the Endeavor and their personal chair. In the second phase, users took the chair home to see how the chair would function in their everyday lives. Because participants were comparing the Endeavor to their personal chairs, much of the feedback received was based primarily on the differences between the geometry and options of the Endeavor and their personal chairs. Based on the clinical results, the most important features that the Endeavor is lacking are: a more forgiving seatpan, and a more effective range of adjustability. In the future, a more organized approach based on product development methods should be used to develop better design criteria. The results of this study showed that in its current form, the Endeavor folding wheelchair may best be a special-purpose chair. By addressing all of the safety concerns, improving the ranges of adjustability to match the dimensions of the users in our focus group, and adding usability related options the chair may be able to function as an everyday wheelchair for many users. When our take-home participants were asked if they would like their chair better if they had "airplane wheels" five of the nine agreed. With some redesign to increase ease of use and decrease weight they could be marketed as their own product.

Includes bibliographical references / Thousands of women and children experience sexual assault trauma annually in South Africa. The challenge posed by recovery from sexual assault trauma is a reality that confronts the victims and survivors of sexual assault, their families and the larger community of service providers in the context of the threat of HIV/AIDS. Yet, little research has been conducted on recovery from sexual assault as a phenomenon. There are even fewer studies about the women's response to or recovery from sexual assault trauma. The purpose of the study was to explore and analyse the journey of recovery which is undertaken by women who have been sexually assaulted, with the aim of discovering and developing the grounded theory of recovery from sexual assault trauma within the first six months following the event of rape. The main research question was: What constitutes the journey of recovery undertaken by women within the first six months following sexual assault?

Osteoarthritis contributes to the burden of physical disabilities globally, as it is the most common cause of severe chronic pain impacting the function of millions of people. Osteoarthritis is more commonly reported by women who are obese and are physically inactive. These modifiable risk factors of obesity and lack of physical activity are also associated with other chronic diseases of lifestyle (CDL). A paucity of epidemiological data exists on the relationship between OA and CDL in women attending primary health care centres in Cape Town in South Africa, therefore, there was a need to further explore these inter-relationships to be able to plan and implement effective nonpharmacological management strategies to address the multidimensional health problem. To inform the development and implementation of a contextually relevant non-pharmacological intervention for women with osteoarthritis at primary health care level, several studies were conducted. The primary aim of this research project was to develop, implement and evaluate an evidence-based non-pharmacological rehabilitation intervention, advocating a patient-centred selfmanagement approach, for women with OA and CDL at primary health care centres in Cape Town. The literature review highlighted that a non-pharmacological intervention, consisting of selfmanagement principles, health education and exercise would be an effective management strategy for women with both OA and CDL. However, there is a dearth of high-quality randomised controlled trials investigating the effects of such interventions on function and health outcomes in women with OA and comorbidities at primary health care level in a South African context. Standardised outcome measures were selected and used to gather data for the different studies. The WHODAS 2 12-item questionnaire measured functional ability, EQ-5D-3L questionnaire measured health-related quality of life, Brief pain inventory (BPI) measured pain severity and pain interference, and Self-efficacy for Managing Chronic Disease 6-item Scale (SE-6) measured the level of confidence in managing chronic diseases were used and were available in English, Afrikaans, and isiXhosa languages. However, the COPCORD (survey about general health and osteoarthritis) and IPAQ (survey about physical activity levels) were not available in these languages and therefore needed crosscultural adaptation and translation.

Based on the experiences of the researcher who is a quadriplegic, people with disabilities still encounter many challenges within the built environment. As civil engineers play a central role, this study set out to address the question - How are undergraduate Civil Engineering students at the University of Cape Town (UCT) being prepared to contribute to an inclusive society that accommodates people with disabilities? Based on a conceptual theoretical framework that draws from a broader context of the Universal Declaration of Human Rights and the United Nations Convention on the Rights of People with Disabilities, a production line analogy was adopted to explore the resources, approaches and experiences of key stakeholders involved in the preparation of the students. The adopted model recognised the students as the "raw materials", the graduates as the "products", UCT as the "factory", the Engineering Council of South Africa (ECSA) as the "quality controller", the Engineering Industry "utilised and refined" the product, while people with disabilities were the "consumers". A qualitative, exploratory, multiple case design was utilised incorporating interviews with representatives of UCT, the Engineering Industry, and people with disabilities, while the contents of the website of ECSA was reviewed. ECSA has a transformation agenda that does not explicitly identify issues about disability. However, there were opportunities to incorporate the concept of Universal Design (UD) into the exit level outcomes of the undergraduate civil engineering programme. Furthermore, while UCT, Industry and people with disabilities identified legislation around disability as a major resource for the training of students, and UCT and Industry shared an open minded approach to the concept of UD, its inclusion in the education programme is still lacking. There was a conspicuous gap for collaboration between the stakeholders, which seem to hinder the adoption of a multidisciplinary approach in the preparation of the students. The study highlighted the need to formalise a platform that brings the key stakeholders together in the preparation of civil engineering students to contribute to the development of an inclusive society that accommodates people with disabilities.

Bibliography: leaves 148-159. / This qualitative, phenomenonological study describes fathers living with HIV/AIDS' experience of occupational adaptation. Rich data was collected through unstructured interviews. The data was analysed by thematic analysis. The level describing the fathers living with HIV/AIDS' experience emerged as adaptive occupations and proxy occupations.

BACKGROUND Participation in ultramarathon races is increasing globally. Although endurance running has numerous physical and psychological benefits, due to the excessive volume of training and the physical and emotional demands of completing an ultramarathon event, exercise-induced muscle damage and delayed-onset muscle soreness are common. Recovery is central to improving performance and is also a determining factor in return to training. Recovery requires both physical and psychological adaptation. However, there is limited research exploring the effect psychosocial factors play on pain recovery following competition, particularly in endurance runners. More specifically, the role fear avoidance beliefs, pain catastrophizing and self-efficacy play in pain recovery following an ultramarathon race. This information is important to contribute to the limited research on the association between psychosocial factors and recovery from pain in endurance runners. Additionally, this information may provide insight into pain recovery following the Comrades Marathon and reduce time away from running. AIMS AND OBJECTIVES The aim of this study was to investigate the relationship between psychosocial factors (fear avoidance beliefs, pain catastrophizing and self-efficacy beliefs) and pain recovery in runners following the 2017 Comrades Marathon. The specific objectives of the study were to explore whether the psychosocial factors of pain catastrophizing, fear avoidance beliefs and self-efficacy beliefs: a) predict pain in ultramarathon runners after competing in the Comrades Marathon; and b) affect recovery in runners competing in the Comrades Marathon. METHODS This study had a descriptive, longitudinal cohort design. Healthy ultramarathon runners between the ages of 20 and 60 who had qualified for and were intending to compete in the 2017 Comrades Marathon were included in this study. Participants who failed to provide informed consent, reported any signs of illness two weeks prior to the race or any relevant medical or surgical procedure that would prevent participation in the race, were diagnosed with a history of chronic pain or who did not complete the race were excluded. All participants were required to complete a medical and sports history questionnaire and baseline psychosocial questionnaires (Athlete Fear Avoidance Questionnaire, Pain Catastrophizing Questionnaire, Self-Efficacy Questionnaire) two weeks prior to the race at a presentation evening held at participating running clubs. Recovery from pain was recorded by completing a pain logbook (Pain Severity Score of the Brief Pain Inventory) starting the evening of the day on which the Comrades Marathon was run and on each night for nine days following the race, with a total of 10 entries. The questionnaires were validated in previous studies by a panel of experts and were available in both hard copy and electronic format. RESULTS The study sample consisted of 77 participants with a mean age of 41 years, 45 (58%) of whom were male and predominantly English speaking (74%). The majority of participants (78%) had completed the Comrades Marathon previously with 13% being novices to the ultramarathon distance. The average finishing time for the study participants in the 2017 Comrades Marathon was 10 hours and 16 minutes. Seventy percent reported that they had previously used pain-relieving medication after a race. The majority of participants(86%) documented a history of injury, with 55% reporting a current injury. Only 6% reported currently using chronic pain-relieving medication. The baseline psychosocial questionnaires revealed that the majority of the participants demonstrated low fear avoidance beliefs (79%), low pain catastrophizing beliefs (88%) and high self-efficacy beliefs (97%). It took five days from the day of the Comrades Marathon for 75% of the runners to score a pain rating of one or lower in the pain logbook and seven days for 75% of the runners to report no pain. There were no correlations between psychosocial factors and pain recovery in this sample of Comrades runners. There was no correlation between finishing times and pain during recovery. CONCLUSION In conclusion, this study showed that in this sample of ultramarathon runners pre-race psychosocial factors had no effect on recovery following the 2017 Comrades Marathon. High self-efficacy scores, previous experience, higher pain tolerance and better coping strategies in ultramarathon runners may be contributing factors to these results. Future research needs to explore endurance runners who do not complete the race, assess the profile of the ultramarathon race and assess different recovery markers

Includes bibliographical references. / Since no scientifically obtained information existed on engagement in EBP by Namibian-based occupational therapists, the researcher set out to explore the usefulness and feasibility of evidence-based practice (EBP) for occupational therapists in Namibia. An action research, specifically co-operative inquiry was chosen as methodology. This enabled the researchers to simultaneously raise awareness of and disseminate information reading EBP and collect experience based data from co-researchers. Purposive sampling, in particular maximum variation sampling, promised a wide yield of data; this was collected from participants' experiences as they engaged in and reflected on retrieving evidence and participation in focus group meetings. A qualitative content analysis and coding of verbatim transcriptions of focus group meetings together with written reflections of participating occupational therapists (co-researchers) revealed three themes. Co-researchers reported mixed feelings about the possibilities of evidence-based practice; they observed shifts in their understanding and skills base of EBP; and they provided suggestions on how EBP could be implemented in Namibia. An interpretation of the findings of the study suggest, however, that intent to change and gain knowledge and skills do not necessarily lead to changed behaviour; social structures, including hegemonies related to lack of access to evidence, are shown to impact negatively on implementing EBP in Namibia. It is suggested that a group approach with agreed upon targets, incorporating monitoring of attitudes and intention to perform, broadening and deepening knowledge and skills, while addressing structural constraints and bad habits, could deliver positive results.

Advancements in medicine, policy, and societal attitudes have improved life expectancy, socialization, and participation for individuals with intellectual and developmental disabilities (IDD). However, inconsistent or a lack of services may drive healthcare utilization toward expensive emergency care services. This can negatively impact health outcomes and disrupt physical therapy treatment plans, limiting their effectiveness and further placing individuals with IDD at risk for crisis episodes. Because of its subjective nature, quantifying crisis is challenging using current definitions. Rehabilitation professionals are often active members of the care team for individuals with IDD, however no evidence currently exists regarding how the profession can positively impact crisis intervention. Because these clinicians often develop long-term relationships with patients and work with them on a consistent basis, they are well-positioned to recognize early signs of crisis and make timely referrals to the appropriate health and social service providers but currently lack resources to guide in this decision-making. A better understanding of characteristics of this population related to crisis is needed in order to develop accessible and useful screening tools and to improve clinical reasoning. The purpose of this dissertation was to identify pertinent risk factors related to crisis for individuals with IDD using a novel, objective crisis definition. Using a mixed methods approach, a revised definition of crisis was developed through surveying of expert clinicians and healthcare administrators at a specialty care clinic for individuals with IDD. The addition of four crisis-related events were included in the definition: (1) unplanned hospital utilization; (2) involvement with the criminal justice system; (3) abuse/victimization; (4) unplanned change in living environment. Using retrospective chart review, these four crisis-related events were further analyzed and validated by comparing their occurrence in patients who did (N=41) and did not (N=144) receive formal crisis intervention services at the clinic between January 1, 2014 and March 1, 2019. The risk for unplanned hospital utilization was 3.4 times higher for crisis patients. The risk for involvement with the police or criminal justice system was 13.86 times higher for crisis patients. The risk for abuse and/or victimization was 6.21 times higher for crisis patients. The risk for unplanned change(s) in living environment was 12.7 times higher for crisis patients. Overall, 90% of crisis patients experienced at least one of the four crisis-related events during the study period, compared to 54.2% of non-crisis patients. Five additional risk factors were identified that increased crisis risk: hypothyroidism, bipolar disorder, intermittent explosive disorder, personality disorder, and have multiple psychiatric disorders. No statistically significant differences were found between crisis and non-crisis patients for intellectual disability severity level, mobility status, communication status, neurodevelopmental diagnosis, age, race/ethnicity, or living environment. To the best of our knowledge, the identification of hypothyroidism as a potential crisis risk factor was a novel discovery not previously reported in the literature. The findings of this dissertation have multiple implications for clinical practice and add to the body of knowledge regarding crisis experiences for individuals with IDD. First and foremost, over a fifth of our study sample (22%) utilized formal crisis management services during the study period. This suggests that crisis episodes are common in the IDD population. As the majority of individuals with IDD are community-dwelling and life expectancy continues to increase, the likelihood of physical therapists encountering adults with IDD in clinical practice will subsequently increase. However, physical therapists and physical therapy students routinely report feeling unconfident and uncomfortable treating individuals with disabilities, including individuals with IDD. There is a need, then, to improve clinician confidence and skills to ensure that individuals with IDD receive optimal care, especially into adulthood. The findings of these studies provide foundational knowledge and point toward trends in crisis experiences that can help guide physical therapists and other rehabilitation clinicians.