Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 5 uppsatser.

The overarching theme of this thesis is the prevention of progressive-type disability. Unlike catastrophic disability, progressive disability is gradual and more common in older adults. Because progressive disability can take years to develop, it is often conceptualized as a continuum, from less to more disabled. Disability prevention, by definition, is designed to identify people who are as yet nondisabled but at high risk for future functional decline by identifying an early functional state associated with increased risk of subsequent disability (Fried & Guralnik, 1997). This thesis sought to address two challenges associated with identifying an early functional state of disability. The first challenge relates to instrument calibration. Traditional instruments (based on self-report) used for assessing disability, scales of activities of daily living (ADL) and instrumental activities of daily living (IADL), were originally developed to describe levels of functional status in institutionalized older adults. Thus, these instruments poorly discriminate, as well as underestimate disability in the early stages of development. Poor discrimination refers to tasks or activities (i.e., scale items) that prove unresponsive to changes in a particular person’s ability level. Performance measures on the other hand, such as walk time or grip strength, have proven to be quite responsive to early declines in functional status. Despite the popularity of performance measures used to assess health status in epidemiology or gerontological research, evidence suggests that they measure a somewhat different construct than self-reported activities of daily living. ADLs have a long history of use in the medical community, yet it has been proposed that the relative standing of ADLs, in relation to communitydwelling older adults, could be enhanced by improving construct validities that are at least equivalent to those of physical performance measures. Item response theory (IRT) methodology can be used to improve the structure of ADL scales so that they are more sensitive in detecting the early stages of functional decline within relatively high functioning older adults; a stage that has been shown to be more responsive to clinical interventions aimed at prevention of overt disability or frailty. IRT can improve ADL scales in multiple ways: by confirming an underlying uni-dimensional continuum of disability, establishing interval level measurement or item hierarchies, and increasing scale precision. As part of this thesis I conducted a systematic review of functional status scales, applied to community-dwelling older adults, which employed IRT procedures. The review was useful in that it draws attention to areas of functional assessment that can be improved upon, most notably, the topic of establishing interval level data and construct under-representation. Using data from the Cardiovascular Health Study, I was able to show that a common hierarchy of functional decline was observed for a diverse set of conditions and diseases that are prevalent among community-dwelling older adults. Such an indicator could be used to identify hierarchical declines relating to severity in diverse patient populations. Improvements in validity of functional status scales can also lead to the use of ADL-IADLs as potential determinates of disability, rather than simply acting as outcome measures of disability. Again using data from the Cardiovascular Health Study, I examined the predictive power of IADL (mobility-type) items on later disability. Self reported difficulty in 2 or 3 of the most difficult IADL items increased the odds of being disabled eight years later by a factor of 3.5. The odds of being disabled fell to 1.9 for those reporting difficulty with one item. The second challenge of this thesis relates to defining determinants of functional decline that manifest themselves at the earliest stages of the disablement process. As previously stated physical performance measures have been shown to be sensitive to early stages of functional decline. However, can other measures, potentially spanning multiple domains, be used to identify those at high risk for future disability? In particular I was interested in whether psychosocial and cognitive variables could be used to detect changes in functional status at the preclinical stages of the disablement process. With regard to the Cardiovascular Health Study, I was able to show that, for subjects within the normal range of cognitive functioning, performance in the lowest quartile of the Digit Symbol Substitution Test resulted in a 2.2 increase in the odds of being disabled. Performance on this measure, as well as selfreported mobility noted above, could detect decrements in functional status as much as 8 years prior. With the use of the Lothian Birth Cohort sample I explicitly investigated the psychosocial domain. I found that the level of depressive symptoms increased the odds of being disabled by 56%. Again, these symptoms were assessed as much as eight years prior to self-reported disability. The general findings of this thesis indicate that refinements in ADL-IADL measures can aid in the detection of disability at the pre-clinical level, and that cognitive function and intra-individual factors play a pivotal role in speeding up or slowing down the disablement process.

The prostheses used by the majority of persons with upper limb amputations today offer a limited range of motion. Relative to anatomical joints transradial (below the elbow) prosthesis users lose at least two of the three degrees of freedom provided by the wrist and forearm. Some myoeletric prostheses currently allow for forearm pronation and supination (rotation about an axis parallel to the forearm) and the operation of a powered prosthetic hand. Body-powered prostheses, incorporating hooks and other cable driven terminal devices, have even fewer active degrees of freedom. In order to perform activities of daily living, an amputee must use a greater than normal range of movement from other anatomical body joints to compensate for the loss of movement caused by the amputation. By studying this compensatory motion of prosthetic users, the mechanics of how they adapt to the loss of range of motion in a given limb and specific tasks were analyzed. The purpose of this study is to create a robotic based kinematic model that can predict the compensatory motion of a given task using given subject data in select tasks. The tasks used in this study are the activities of daily living: opening a door, drinking from a cup, lifting a box, and turning a steering wheel. For the model the joint angles necessary to accomplish a task are calculated by a simulation for a set of prostheses and tasks. The simulation contains a set of configurations that are represented by parameters that consist of the joint degrees of freedom provided by each prosthesis, and a set of task information that includes joint constraints and trajectories. In the simulation the hand or prosthesis follows the trajectory to perform the task. Analysis of tasks is done by attaching prosthetic constraints to one of the arms of the upper body model in the simulation, other arm maintains an anatomical configuration. By running the model through this simulation with different configurations the compensatory motions were found. Results can then be used to select the best prosthesis for a given user, design prostheses that are more effective at selected tasks, and demonstrate some possible compensations given a set of residual joint limitations with certain prosthetic components, by optimizing the configuration of the prostheses to improve their performance.

No description available.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18858号 / 医博第3969号 / 新制||医||1008(附属図書館) / 31809 / 京都大学大学院医学研究科医学専攻 / (主査)教授 福原 俊一, 教授 古川 壽亮, 教授 村井 俊哉 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Doctor of philosophy (PhD) / Abstract As one of the most culturally diverse countries in the world, Australia has a high proportion of minority communities. However, its ageing population, particularly within these ethnic minorities, faces a range of barriers or difficulties in gaining access to and using health and aged care services. This study aims to identify the acculturation factors that affect the health status of Iranian-born elderly immigrants to Australia and their utilisation of health and community aged care services. The results of this study will be of value to Iranian elders, their families, and Australian aged health care service providers. The findings could also contribute towards enriched multicultural policy and improved social fairness, access to services, and equity for the aged from different ethnic backgrounds. 302 Iranian migrants aged 65 years who had lived in the Sydney Metropolitan area for at least six months were surveyed via a written questionnaire, face-to-face interviews, and telephone interviews. The results were analysed using SPSS and then compared to the findings from a 1999 survey of NSW elderly. The results indicate that Iranian migrants suffer higher levels of psychological distress and are more limited in their physical functioning than the general population of older Australians. They are in greater need of assistance with activities of daily living, have a lower sense of wellbeing, and are far less likely to utilise aged care services. Iranian migrant who do not speak English at home experience these disadvantages to an even greater extent English language proficiency was the only acculturation factor found to affect whether Iranian elderly utilised health and community aged care services, while ability to engage in activities of daily living (ADL) was the only health variable associated with their utilisation of community supportive aged care services. This variable did not predict the use of community aged care services in the broader sample of NSW respondents. Since limited proficiency in English placed elderly Iranian migrants at greater health risk and impeded their access to necessary assistance, the findings suggest that they would clearly benefit from English classes and from access to health and community care services and information regarding these services in the Farsi language.

Doctor of philosophy (PhD) / Abstract As one of the most culturally diverse countries in the world, Australia has a high proportion of minority communities. However, its ageing population, particularly within these ethnic minorities, faces a range of barriers or difficulties in gaining access to and using health and aged care services. This study aims to identify the acculturation factors that affect the health status of Iranian-born elderly immigrants to Australia and their utilisation of health and community aged care services. The results of this study will be of value to Iranian elders, their families, and Australian aged health care service providers. The findings could also contribute towards enriched multicultural policy and improved social fairness, access to services, and equity for the aged from different ethnic backgrounds. 302 Iranian migrants aged 65 years who had lived in the Sydney Metropolitan area for at least six months were surveyed via a written questionnaire, face-to-face interviews, and telephone interviews. The results were analysed using SPSS and then compared to the findings from a 1999 survey of NSW elderly. The results indicate that Iranian migrants suffer higher levels of psychological distress and are more limited in their physical functioning than the general population of older Australians. They are in greater need of assistance with activities of daily living, have a lower sense of wellbeing, and are far less likely to utilise aged care services. Iranian migrant who do not speak English at home experience these disadvantages to an even greater extent English language proficiency was the only acculturation factor found to affect whether Iranian elderly utilised health and community aged care services, while ability to engage in activities of daily living (ADL) was the only health variable associated with their utilisation of community supportive aged care services. This variable did not predict the use of community aged care services in the broader sample of NSW respondents. Since limited proficiency in English placed elderly Iranian migrants at greater health risk and impeded their access to necessary assistance, the findings suggest that they would clearly benefit from English classes and from access to health and community care services and information regarding these services in the Farsi language.

© [2015] American Physical Therapy Association. / 京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第19641号 / 人健博第33号 / 新制||人健||3(附属図書館) / 32677 / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 市橋 則明, 教授 山田 重人, 教授 妻木 範行 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

The author examined current literature supporting the use of innovative, music-based interventions to support young children with autism spectrum disorder and other developmental disabilities engage in the things that they want, need, and desire to do. The author introduced Song-based Interventions for Navigating Gains in Occupational Therapy (SING-OT), as an innovative, music-based educational intervention program designed to support the engagement, participation, and performance needs of young children with disabilities. SING-OT uses an evidenced-supported, client-centered, and interests and strengths-driven approach. This proposed multi-phase program focuses on improving knowledge on the literature connecting evidence to song-based interventions and providing access to uniquely composed, occupation-inspired songs, that support children’s performance and participation needs. Additionally, conducting an initial feasibility study that assesses the effectiveness of task completion in a common personal hygiene and grooming task within the preschool setting was recommended. Future developments extend to improving caregiver health and wellness outcomes through training opportunities. The author provided a comprehensive program evaluation plan that highlights key stakeholders, a proposal for a single-subject study design, and implications of the program. The SING-OT program can be utilized as (1) an additional intervention tool for practicing occupational therapy practitioners and other professionals, (2) an avenue for interprofessional collaboration, and (3) a vehicle for improving the occupational performance outcomes among young children with disabilities.

京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第21306号 / 人健博第62号 / 新制||人健||5(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 黒木 裕士, 教授 恒藤 暁, 教授 坂井 義治 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM