Statement of the problem. Multiple sclerosis (MS) is the most common demyelinating disease of the central nervous system. It affects over 2.5 million people worldwide and approximately 350,000 Americans with new cases diagnosed weekly. MS significantly impacts activity participation, general health status, and quality of life. An extensive literature review reveals a gap in the rehabilitation and MS literature regarding evidence of the effectiveness of occupational therapy rehabilitation programs or occupational therapy wellness programs to improve the activity participation, general health and well-being, and quality of life for people living with MS. Methods. This randomized controlled trial (RCT) compared the long-term impact of an occupational therapy rehabilitation program, an occupational therapy wellness program, and a social activity program (control), on the occupational performance, general health and well-being, and quality of life of people living with MS, through repeated measures. Assessment tools used to measure occupational performance, general health and well-being and quality of life were the Occupational Self-Assessment, the Short Form-36 version 2 and the Quality of Life Inventory. Quality of life is a primary outcome in the provision of healthcare services for the chronically ill, and is the predominant measure in this clinical research, hence the choice of these assessment tools. Results. The effect of each of the group programs, rehabilitation, wellness and a social activity group was compared. Data were analyzed with MANOVA. The results yielded that the occupational therapy wellness group demonstrated a statistically significantly positive difference in the mental component summary measure of the SF-36v2 over the occupational therapy rehabilitation group (p = .093), two months post intervention. The results further revealed that the occupational therapy wellness group demonstrated a statistically significantly positive difference in the environmental impact scale of the OSA over the occupational therapy rehabilitation group (p = .115) and the social activity group (p = .065), over a period of three months. Conclusions. In this study an occupational therapy wellness approach showed statistically significantly positive effects on the environmental impact and mental health of people with MS over the long-term. This study also demonstrated the clinical significance associated with an occupational therapy rehabilitation and an occupational therapy wellness approach. These findings therefore contribute to evidence-based practice for the most effective occupational therapy interventions for persons with MS. This study was supported by grant #NSU012001 from the National Multiple Sclerosis Foundation and the Nova Southeastern University President's Scholarship Award 2001.

In response to human impacts, river restoration and rehabilitation actions have become a priority in the United States. In the Pacific Northwest, most restoration actions are focused on repairing degraded freshwater habitat to increase or improve Pacific salmonid production. However, traditional river restoration actions remained largely unchanged for over 100 years despite a lack of definitive evidence that the actions were effective. More recently, there has been a surge in process-based restoration actions, which aim to reestablish the physical and biological processes that maintain fluvial and floodplain environments by targeting the root causes of degradation in a watershed. Cheap and cheerful restoration projects focus on restoration actions that are low impact and cost effective, can be implemented over large scales, and target degraded processes. However, because cheap and cheerful restoration is a relatively new method, the success of these types of projects has not been assessed. To address this issue, I studied the short-term physical effectiveness of a type of cheap and cheerful restoration that uses high density large woody debris (HDLWD) to restore instream habitat complexity in two wadeable tributaries to Asotin Creek in southeast Washington State. My specific research objectives included (1) assessing hydraulic and geomorphic responses in the stream channel imposed by restoration structures, (2) quantifying the changes to geomorphic channel unit assemblages post restoration, (3) quantifying changes in sediment storage post restoration, and (4) developing a geomorphic condition assessment of Asotin Creek using the River Styles Framework. Additionally, I developed a mobile database application (app) to facilitate data collection using a novel rapid restoration effectiveness assessment survey. Through analysis and a thorough review of the land use history in Asotin Creek, I determined that much of the watershed is in poor geomorphic condition based on the River Styles Framework for river classification. Many stream reaches have been degraded from their historic condition and often lack habitat complexity associated with suitable rearing habitat for juvenile salmonids. My results indicate that the structures are impose several immediate hydraulic responses following installation. These hydraulic responses increase hydraulic roughness, which results in predictable geomorphic responses following high flow events. Following restoration, the number and area of pools and bars significantly increased within treatment sites, while the number and area of planar units decreased. Likewise, it appears that the addition of the structures has led to a 25% increase in depositional volume at treatment sites compared to control sites. Results from the rapid assessment approach supported the more vetted approaches used to assess the efficacy of the treatment. However, the viability of the app and rapid protocol indicate that inter-observer variability may be high, and estimates of geomorphic unit area are not entirely consistent with the vetted approaches. Analysis of the rapid assessment approach revealed pertinent improvements to the app and rapid protocol that will be made in the future.

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal.

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal

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