This thesis reports on a multi-phased research project conducted to evaluate the use of the Cognitive Orientation to daily Occupational Performance (CO-OP) approach with adults with stroke. Current approaches to motor recovery, called systems approaches, suggest that movement arises from a dynamic interaction among several different systems, including perception, cognition, and action, all within the context of the individual and his or her environment. CO-OP is an established treatment approach for children with motor-based performance problems that takes into account interactions among several systems, as well as individual needs and environmental factors. CO-OP is a client-centred, problem solving approach based on the theoretical foundations of learning and motor learning theory. The objectives of this project were: to examine the efficacy of CO-OP to improve motor skill acquisition and performance in adults living with chronic stroke; to explore other benefits of the approach; and to identify adaptations for use with adults with stroke. Two series of single case experimental studies were conducted, with three participants completing each. In addition, semi-structured interviews were conducted. Findings from the single case experiments provide evidence that CO-OP is associated with performance improvements in both trained and untrained self-selected goals in adults more than one year post stroke. As well, pre-post measures suggest there may be changes in performance satisfaction, motor control, generalized use of the affected upper extremity, and self-efficacy. Interview findings provided valuable information about the experiences of participants with the approach; the interview respondents enjoyed the increased sense of responsibility that came with problem solving on their own, but expressed a desire to have ongoing professional support. Suggestions for modifications to CO-OP for use adults with stroke are made. CO-OP is a promising approach to improve functional independence in adults with stroke. Future research is warranted.

Problem: Many individuals with chronic illnesses such as stroke and ongoing activity limitations report self-perceived health related quality of life (HRQL) that is similar to that of healthy individuals. This phenomenon is termed response shift (RS). RS describes how people change: internal standards in assessing HRQL (recalibration), values (reprioritization), or how they define HRQL (reconceptualization), after an event such as stroke. Changes in HRQL post stroke may be inaccurate if RS is not taken into account. Increased knowledge of RS may affect the way in which HRQL measures are used, both clinically and in research. The overall objective was to assess RS in construct specific HRQL models post stroke: physical function, mental health, and participation. Methods: Data were analysed from the longitudinal study “Understanding Quality of Life Post-Stroke: A Study of Individuals and their Caregivers”. Six-hundred and seventy- eight persons with stroke at 1, 3, 6, and 12 months post stroke participated. Generic and stroke specific HRQL measures were collected. Descriptive analysis was completed with SAS, and identification of RS utilized structural equation modeling with LISREL. Results: Mean age of participants was 67 years (SD 14.8), and 45% were female. RS was identified in mental health using a framework which was developed for identifying RS statistically with multiple time points. RS was also identified in physical function where it had not been expected, possibly due to the self perceived nature of the response options. The effect size of change in physical function was affected by the presence of RS. The timing of RS in mental health and physical function was primarily around the 12 month time period, and predominantly recalibration RS. RS was also identified in participation. Conclusions: The framework that was developed was useful in identifying RS and incorporated important issues such as multiple testing and validation of the model. The presence of RS affects measurement of HRQL constructs post stroke; recalibration RS can be measured clinically with specific methods to account for RS. RS should also be measured in research studies to ensure accurate measurement of change. Future research should evaluate additional models in stroke and other populations. / October 2008

Ischemic stroke is characterized by a disruption of blood supply to a part of the brain tissue, which leads to a focal ischemic infarct. The expression and activity of MMP-9 is increased in ischemic stroke and is considered to be one of the main factors responsible for damages to the cerebral vasculature, resulting in compromised blood-brain barrier (BBB) integrity. However, the regulatory mechanisms of MMP-9 expression and activity are not well established in ischemic stroke. Since hypoxia/ischemia and reperfusion generates reactive oxygen species (ROS), I hypothesize that ROS is one of factors involved in up-regulation of MMP-9 expression in brain cells and ROS-mediated effect may occur via MAPK signaling pathway. My study has provided the evidence that ROS is responsible for an increase in MMP-9 expression in astrocytes mediated via MAPK-AP1 signaling pathway. Preliminary studies with an in vitro model of the BBB suggest that inhibition of MMP-9 is a critical component of reducing ROS-induced BBB permeability.

Industrial design is an expanding field. Through new research, discussion and explorations the definitions of what designers can and should do is constantly discussed and redefined. The starting point for my master thesis is the investigation of the concept of emotional durability. In other words, I have looked into how designers could create more meaningful relationships between users and products. It concerns product style norms, terminologies for describing relationship types, as well as a product’s meaning to a user. In order to put learning outcomes into practice, this master thesis also involves a design project where I created a proposal for a new rehabilitation product. There is great potential in investigating how meaningful medical devices for the home should be designed. During my design process I try to dig into what it means to design medical products for a home environment. At the same time, I explore how to create emotionally durable experiences for the patients and increase the motivation in their rehabilitation. My proposal is a balance exercising device that introduces a new level of user interaction, which connects back to my research on emotional durability.

Stroke is the third largest cause of death in Sweden. In 2005, 30.000 people in Sweden suffered from a stroke. The consequences of a stroke varies, but the most common disability among stroke survivors is abnormal reaching movements, which is the primer reason for limitations in activities of everyday living. Rehabilitation is essential in order to get back to everyday life. Physical assistance (or guidance) is used in rehabilitation by physiotherapists and occupational therapists to help a patient through a dicult movement for example. Today, this guidance is limited to be performed by medical personnel. With the technology of virtual environments (VE) and haptics – force feedback from a computer – there is a possibility to create guidance which does not need medical personnel. This should be used as a complement to the traditional therapy. The intention of this work is to create an invisible guidance eld, which should guide a patient's hand to a desired movement pattern, i.e. aid the patient to perform a task in a virtual environment with haptics. This guidance is added to an already existing assessment tool, which is a part of the Curictus AB rehabilitation system. The guiding system is implemented using SenseGraphics AB's H3D API. To create the feeling of guidance and a guidance eld, the Volume Haptics Toolkit, developed by Dr. Karljohan Lundin Palmerius at Linköping University, was used. The basic idea of the algorithm is to calculate an orientation vector, for every position, in which direction the guidance should guide the patient. The guidance, which is generated via a haptic device, is adaptive to the patient's movements and always guides the patient towards the target in a smooth trajectory. / Stroke är den tredje största dödsorsaken i Sverige. Under år 2005 ck 30.000 svenskar en stroke. Följderna av en stroke kan variera, men vanligast är försämrad rörlighet i en sida av kroppen, vilket också är den främsta orsaken till begränsningar i dagliga aktiviteter för  strokepatienter. Rehabilitering är nödvändig för att kunna återkomma till sitt vanliga liv. Fysisk guidning är något som sjukgymnaster och arbetsterapeuter använder sig av i rehabiliteringen för att hjälpa en patient t.ex. genom en svår rörelse. Denna hjälp är något som idag är begränsad till medicinsk personal. Med teknologi som virtuella miljöer och haptik – kraftåterkoppling från en dator – finns det möjligheter att skapa guidning som inte kräver medicinsk personal. Detta ska fungera som ett komplement till den traditionella rehabiliteringen. Avsikten med det här arbetet är att skapa ett osynligt guidningsfält som ska guida en patients hand till ett önskat rörelsemönster, d.v.s. hjälpa patienten att utföra en övning i en virtuell miljö med haptik. Denna guidning ska läggas in i ett redan existerande utvärderingsverktyg, som nns i Curictus ABs rehabiliteringssystem. Guidningssystemet är implementerat i SenseGraphics ABs H3D API. För att skapa känslan av guidning och guidningsfältet användes the Volume Haptics Toolkit, utvecklat av dr. Karljohan Lundin Palmerius vid Linköpings Universitet. Algoritmen är byggd på att för varje position, beräkna en riktningsvektor dit guidningen ska guida patienten via en haptikenhet. Guidningen, som anpassas efter patientens rörelser, guidar hela tiden mot målet i en mjuk rörelsebana.

Bakgrund: I och med att samhället utvecklas behöver arbetsterapeuter finna nya och fungerande metoder för att förbättra livskvaliteten och välmåendet hos patienterna. En av de stora patientgrupperna är äldre, denna grupp växer i och med att befolkningen lever allt längre. En annan av de stora patientgrupperna är patienter drabbade av stroke, vilket är den femte största orsaken till ohälsa. Nintendo Wii är en relativt ny metod som ibland används kliniskt men få påvisade effekter är vetenskapligt belagda. Syfte: Syftet med denna studie var att genomföra en systematisk sammanställning av användbarheten och effekterna av Nintendo Wii som åtgärd inom arbetsterapi för patienter som är äldre eller drabbade av stroke. Metod: En litteraturstudie som sammanställde resultaten från 10 vetenskapliga artiklar som hittades via systematiska databassökningar och manuell sökning. Resultat: I analysen framkom fyra områden som presenteras i resultatet. Dessa områden var 1: Praktisk användbarhet, 2: Effekter på funktions- och aktivitetsnivå, 3: Sociala relationer och 4: Livskvalitet. Slutsats: Nintendo Wii verkar vara en genomförbar åtgärd som kan användas som komplement till traditionell terapi. Det kan förhöja välmåendet och livskvaliteten hos äldre samt förbättra funktioner hos patienter drabbade av stroke. Nintendo Wii möjliggör för social interaktion att uppstå när patienter spelar tillsammans.

An LSS officer’s activities are governed by laws and regulations and it has great power in influencing the individual's situation when reweaving its case. Officer’s actions have effects on the applicant and it can use its power and not look after the individual's best. Its interest can lie in community and his own position. This study deals with the officers’ ways to assess and officers in it are working for two different municipalities in Sweden. The purpose of this study is to determine if the assessment of the right to personal assistance is consistent with what the law stipulates. The intention is to find out whether it differs between different officers, that is, if the various municipalities relate to the same principles. If municipalities do not consider the same premises, there is a risk that the individual does not get the help that it needs. For this topic I used a vignette study, which aims to find out how people are reviewing different situations. Informants may have access to one or more hypothetical situation and were asked to answer questions and talk about how they appreciate the situation. In this study, the different municipalities gave different rulings.

The purpose of this study was to investigate how patients who had undergone Hallberg's  TIA-school at Enköpings Lasarett rate their physical and mental health 18 months after participation. Another purpose was to examine whether they re-diagnosed with a TIA or suffered a stroke. The design of the quantitative study was longitudinal and descriptive. In the study 16 patients participated and to measure their mental and physical health the questionnaire SF36 was used. The results showed that none of the participants suffered a new TIA or stroke since participation in the TIA-school. The participants' self-rated health measured with SF36 showed the highest values ​​in the areas of social function, emotional role function and physical role function. Which indicates a good self-rated health in these areas. Participants were asked how their physical and mental health limited them in everyday life. The majority of participants was not limited at all during the day, either physically (50%) or psychologically (62.5%). Our results demonstrate that a TIA-school like the one at Enköpings Lasarett may have long-term effects on an individual basis, but this effect can not be demonstrated in all off the patients.

Stroke är den vanligaste orsaken till neurologisk funktionsnedsättning hos vuxna. Upp till ca 65 % får någon form av kognitionsnedsättning. Den kognitiva förmågan är avgörande för hur man klarar av att utföra dagliga aktiviteter, delta i sociala sammanhang och för känslan av livskvalitet. Arbetsterapi spelar en viktig roll för rehabilitering och förbättring av ADL-utförande samt delaktighet.Syfte: Att kartlägga arbetsterapeutiska interventioner för personer med kognitiva funktionsnedsättningar efter stroke. Metod: En systematisk litteraturstudie genomfördes med genomsökning av databaserna Amed, Cinahl, Medline och PsycINFO. Tio engelska peer review artiklar publicerade mellan år 2000-2011, med interventioner riktade till personer med kognitiva funktionsnedsättningar till följd av stroke inkluderades. Resultat: Kartläggningen resulterade i interventioner utifrån tre huvudkategorier, datorbaserade program, holistiska rehabiliteringsprogram och strategier för förbättring av aktivitetsförmåga och delaktighet samt minne. Nedsättningar som behandlades var uppmärksamhet, minne, medvetenhet, unilateralt neglekt, generell kognitiv funktionsnedsättning samt svår kognitionsnedsättning. Interventionerna innefattade både remediala och kompensatoriska element samt en kombination av de två. Samtliga studier visade positiva resultat, en del signifikanta, andra kliniskt relevanta och några med marginell signifikans.Slutsats: Det finns interventioner för behandling av personer med kognitiva nedsättningar efter stroke, som visar positiva resultat för förbättring av nedsättningar och på aktivitetsnivå. Arbetsterapeuter bör uppmärksamma, behandla och utvärdera kognitiva nedsättningar under hela rehabiliteringsprocessen. Evidensen är begränsad och mer arbetsterapeutisk forskning behövs inom området för att guida arbetsterapeutisk praxis.

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