<p>Sixty-five to 78% of sample populations of individuals with chronic spinal cord injury (SCI) have symptoms of spasticity, but current assessment tools and management strategies are inadequate. Therefore, the purpose of this thesis was to: 1) conduct a review of the definition, pathophysiology, and management of symptoms of spasticity in individuals with SCI, 2) develop and assess a new self-report scale designed to measure the impact of spasticity on daily life in people with SCI and 3) examine the effects of body-weight supported treadmill training (BWSTT) and tilt-table standing (TTS) on spasticity outcomes. 1) Spasticity was found to be a relevant concern for the SCI population and possibly responsive to activity-based intervention. A need was identified, however, for an assessment tool that allows individuals with SCI to report the impact of their spasticity. 2) In total, 89 individuals with chronic SCI participated in three phases of scale design: development, pilot testing, and evaluation of test-retest reliability and construct validity. The Spinal Cord Injury Spasticity Evaluation Tool (SCI-SET) was developed as a 7 -day recall self-report questionnaire that takes into account both the problematic and useful effects of spasticity. The internal consistency (a) and intraclass correlation coefficient of the SCI-SET were 0.90 and 0.91, respectively. Construct validity was supported by correlations (r=-0.48 to 0.68; p</p> / Doctor of Philosophy (PhD)

Bakgrund: I slutet av 1980-talet slog de aktivitetsbaserade tankegångarna igenom, i form av ABC-kalkylering. Dock visade sig metoden vara komplex att använda i praktiken och därför introducerades tankegångar kring att istället använda den aktivitetsbaserade informationen i styrningssyften, ABM. Trots detta är det ABC som har fått störst genomslag i svensk tillverkningsindustri. Syfte: Syftet med denna studie är att undersöka om svenska företag använder sig av ABM och i så fall hur de använder ABM. Dessutom är syftet att studera hur sambandet mellan ABM och ABC ser ut för att utröna om det föreligger något beroende dem emellan. Metod: Denna uppsats har genomförts med en kombinerad forskningsdesign. Det har utförts både en enkätundersökning och en fallstudie, därmed har såväl kvantitativ som kvalitativ metod använts. Slutsatser: Resultatet av föreliggande studie visar på att företag i svensk tillverkningsindustri inte känner till begreppet ABM men trots det används den aktivitetsbaserade informationen i styrningssyften. Det finns ett fåtal företag som uttryckligen säger sig använda ABM. De vanligaste användningsområdena inom ABM är kostnadsreducering och ständiga förbättringar. Dessutom visar resultaten att det inte föreligger något beroende mellan ABM och ABC. / Background: The activity-based ideas made its breakthrough in the late 1980's with the Activity-Based Costing, ABC. But the method proved to be difficult and complex to use in practice and that's the reason to the introduction of alternative ways to use the activity-based ideas, namely Activity-Based Management, ABM. But it is although ABC that has had the greatest breakthrough in the Swedish manufacturing industry. Purpose: In this study, the purpose is to investigate if companies in the Swedish manufacturing industry use ABM and if, how do they use ABM. The purpose is also to study the relation between ABM and ABC to investigate if there is any dependence between them. Method: This study has been carried out with a mixed method. Both a survey and a case study has been made, which means that both quantitative as well as qualitative research method has been used. Conclusions: The result of this study shows that the term ABM is unknown to companies in the Swedish manufacturing industry, but although use the activity-based information in control purposes, ABM. There are though a few companies that explicitly express the use of ABM. The most common used applications of ABM is cost reducing and continuous improvement. The result also shows that there are no dependence between ABM and ABC.Keywords: ABM (Activity-Based Management), ABC (Activity-Based Costing) and the ABCM-cross.

The purpose of this dissertation is to examine the effects of activity-based costing (ABC) and activity-based management (ABM) on managerial and employee behavior.

<p>Background: In the eighties the debate concerning the declining relevance of the traditional calculation started. The reason was that the method of calculating not had been changed despite that the costs and manufacturing had changed in many companies. This led to the development of activity-based costing. Management by means of activity information is called activity-based management, but there is no general accepted definition of what the term com- prises. Neither are there any studies which describe within which areas activity information is used as a base for decisions. </p><p>Purpose: The purpose of this thesis is to describe in which situations activity information is used as a base for different decisions, and to define the term activity-based management. </p><p>Method: The approach taken is qualitative. A total of 13 telephone interviews with four different companies, three producers and one wholesale firm, have been carried out. </p><p>Results: Activity information is used as a base for decisions principally in situations that concerns changes in the operational work through management of processes, price and product changes and costumer profitability. Changes within these areas may concern increases in efficiency and effectiveness, and changes in price, assortment and focus on different costumers. In a long perspective these changes may lead to an increase in the profitability. From the studied empirical applications we formulated the following definition of the ABM- term: “The use of activity information as a support for decisions, which concerns securing the companies profitability and to make activities and processes visible and in that way make improvements possible.”</p>

Background: In the eighties the debate concerning the declining relevance of the traditional calculation started. The reason was that the method of calculating not had been changed despite that the costs and manufacturing had changed in many companies. This led to the development of activity-based costing. Management by means of activity information is called activity-based management, but there is no general accepted definition of what the term com- prises. Neither are there any studies which describe within which areas activity information is used as a base for decisions. Purpose: The purpose of this thesis is to describe in which situations activity information is used as a base for different decisions, and to define the term activity-based management. Method: The approach taken is qualitative. A total of 13 telephone interviews with four different companies, three producers and one wholesale firm, have been carried out. Results: Activity information is used as a base for decisions principally in situations that concerns changes in the operational work through management of processes, price and product changes and costumer profitability. Changes within these areas may concern increases in efficiency and effectiveness, and changes in price, assortment and focus on different costumers. In a long perspective these changes may lead to an increase in the profitability. From the studied empirical applications we formulated the following definition of the ABM- term: “The use of activity information as a support for decisions, which concerns securing the companies profitability and to make activities and processes visible and in that way make improvements possible.”

A determinação do mix de produtos deve considerar fatores internos e externos à empresa. Os externos referem-se principalmente aos preços de produtos, empresas competidoras, produtos substitutos, produtos complementares, canais de distribuição, fornecedores, clientes, localização industrial, impostos, taxas de juros dentre outros. Os fatores internos estão relacionados principalmente ao uso da capacidade industrial, à oferta (preços e quantidades) de matérias-primas, de recursos humanos, aos produtos conjuntos etc. Observe-se que os fatores externos causam impactos nos preços dos produtos finais e dos insumos, enquanto os internos influenciam principalmente o custo de produtos. Em suma, a determinação do mix de produtos influencia diretamente a competitividade empresarial. Na literatura especializada identificam-se vários métodos de custeio para medir adequadamente o custo do produto, tais como: custeio direto (variável); custeio por absorção, custeio pleno (full cost), e custeio por atividades (ABCActivity Based Costing). Estes métodos divergem em função da maneira com que são apropriados os fatores que compõem o custo dos produtos. A presente pesquisa mostra o mix de produtos, o uso da capacidade industrial e os métodos de custeios analisados conjuntamente por meio de programação matemática (programação Linear), com o objetivo de simular quantitativamente a eficiência de cada método. A tradução dos diferentes paradigmas em modelos matemáticos elimina a possibilidade dos autores refutarem métodos de custeio em função de suas tendências teóricas. Para demonstrar as limitações da Teoria das Restrições e do Modelo Geral de Kee e Schmidt foi realizada uma pesquisa bibliográfica que contempla as principais referências sobre os principais métodos de custeio e modelos de tomada de decisão aplicados à possibilidade dos autores refutarem métodos de custeio e modelos de tomada de decisão aplicados à seleção de mix de produtos. O modelo ABC revelou resultados mais consistentes para definição de mix de produtos quando da expansão ou redução de capacidade produtiva, ao se considerarem os custos discricionários. / The optimal product mix selection must consider internal and external factors of a manufacturing company. The external ones are mainly products prices, industry competition, substitute and complementary products, distribution channels, industrial location, and government taxes among others. The internal factors are related mainly to the use of the industrial capacity, to raw materials and human resources supply (prices and quantities), and to joint production. The external factors cause impacts in the prices of the input and final products, while the interns influence mainly the cost of products. In short, the determination of the product mix influences directly the company competitiveness. Our research has done a bibliographical research and a comparative analysis of three important frameworks to support the product-mix optimal decision: Activity based costing (ABC), Goldratt´s Theory of Constraints and the Kee & Schmidt General Model. In specialized literature some costing methods are identified to the properly measurement of products costs, such as: direct costing, burden costing, full costing, and activity based costing (ABC). These methods differ in the way that productive factors are distributed to the products costs. This thesis shows the product mix, the use of the industrial capacity and the costing methods analyzed jointly by means of mathematical programming, aiming to simulate each method performance. The translation of different frameworks in mathematical models eliminates the possibility to refute costing methods as function of author theoretical meanings. It is shown that the ABC surpasses the two other models for presenting the biggest profit and using less resources in the productive activities, when is considered discretionary costs.

Esse estudo tem por finalidade contribuir para a discussão e o aprimoramento da gestão econômica e do desenvolvimento de ferramentas de apoio à decisão estratégica para empresas de serviços de saúde suplementar. Com base nos fundamentos teóricos sobre serviços, serviços de saúde suplementar, gerenciamento estratégico de custos e sistemas ABC/ABM, o estudo propõe um modelo de sistema de gestão de custos indiretos em planos de saúde sob a óptica do ABC/ABM, que visa proporcionar aos gestores uma visão ampla sobre o desempenho econômico dos planos e dos clientes. Assim, este estudo pretende colaborar com o desenvolvimento desse setor, que tem sofrido nos últimos anos o impacto da evolução da tecnologia e da medicina, provocando a constante elevação dos custos da assistência à saúde. Com a finalidade de justificar o estudo, o modelo é testado com a sua implementação em uma operadora de planos de saúde, possibilitando a discussão sobre as conclusões obtidas em relação ao problema abordado. / The purpose of this study is to contribute towards the indirect cost management discussion and betterment of supplementary health care services companies as well as to strategic decision supporting tools development. On the basis of the theoretical beddings on services, supplementary health care services, strategic management of costs and ABC/ABM systems, this study proposes an indirect costs management model for health insurance based on the ABC/ABM optics that provide managers a wide vision on the economic performance of medical insurance plans and customers.Thus, this study intends to contribute towards this sector development that has been suffering in the last years the impact of the technology medicine evolution provoking constant rise on health care costs. In order to justify this study, the model is tested by its implementation in a medical insurance operator making possible the discussion about conclusions obtained from the approached problem.

Esse estudo tem por finalidade contribuir para a discussão e o aprimoramento da gestão econômica e do desenvolvimento de ferramentas de apoio à decisão estratégica para empresas de serviços de saúde suplementar. Com base nos fundamentos teóricos sobre serviços, serviços de saúde suplementar, gerenciamento estratégico de custos e sistemas ABC/ABM, o estudo propõe um modelo de sistema de gestão de custos indiretos em planos de saúde sob a óptica do ABC/ABM, que visa proporcionar aos gestores uma visão ampla sobre o desempenho econômico dos planos e dos clientes. Assim, este estudo pretende colaborar com o desenvolvimento desse setor, que tem sofrido nos últimos anos o impacto da evolução da tecnologia e da medicina, provocando a constante elevação dos custos da assistência à saúde. Com a finalidade de justificar o estudo, o modelo é testado com a sua implementação em uma operadora de planos de saúde, possibilitando a discussão sobre as conclusões obtidas em relação ao problema abordado. / The purpose of this study is to contribute towards the indirect cost management discussion and betterment of supplementary health care services companies as well as to strategic decision supporting tools development. On the basis of the theoretical beddings on services, supplementary health care services, strategic management of costs and ABC/ABM systems, this study proposes an indirect costs management model for health insurance based on the ABC/ABM optics that provide managers a wide vision on the economic performance of medical insurance plans and customers.Thus, this study intends to contribute towards this sector development that has been suffering in the last years the impact of the technology medicine evolution provoking constant rise on health care costs. In order to justify this study, the model is tested by its implementation in a medical insurance operator making possible the discussion about conclusions obtained from the approached problem.

Esse estudo tem por finalidade contribuir para a discussão e o aprimoramento da gestão econômica e do desenvolvimento de ferramentas de apoio à decisão estratégica para empresas de serviços de saúde suplementar. Com base nos fundamentos teóricos sobre serviços, serviços de saúde suplementar, gerenciamento estratégico de custos e sistemas ABC/ABM, o estudo propõe um modelo de sistema de gestão de custos indiretos em planos de saúde sob a óptica do ABC/ABM, que visa proporcionar aos gestores uma visão ampla sobre o desempenho econômico dos planos e dos clientes. Assim, este estudo pretende colaborar com o desenvolvimento desse setor, que tem sofrido nos últimos anos o impacto da evolução da tecnologia e da medicina, provocando a constante elevação dos custos da assistência à saúde. Com a finalidade de justificar o estudo, o modelo é testado com a sua implementação em uma operadora de planos de saúde, possibilitando a discussão sobre as conclusões obtidas em relação ao problema abordado. / The purpose of this study is to contribute towards the indirect cost management discussion and betterment of supplementary health care services companies as well as to strategic decision supporting tools development. On the basis of the theoretical beddings on services, supplementary health care services, strategic management of costs and ABC/ABM systems, this study proposes an indirect costs management model for health insurance based on the ABC/ABM optics that provide managers a wide vision on the economic performance of medical insurance plans and customers.Thus, this study intends to contribute towards this sector development that has been suffering in the last years the impact of the technology medicine evolution provoking constant rise on health care costs. In order to justify this study, the model is tested by its implementation in a medical insurance operator making possible the discussion about conclusions obtained from the approached problem.

A determinação do mix de produtos deve considerar fatores internos e externos à empresa. Os externos referem-se principalmente aos preços de produtos, empresas competidoras, produtos substitutos, produtos complementares, canais de distribuição, fornecedores, clientes, localização industrial, impostos, taxas de juros dentre outros. Os fatores internos estão relacionados principalmente ao uso da capacidade industrial, à oferta (preços e quantidades) de matérias-primas, de recursos humanos, aos produtos conjuntos etc. Observe-se que os fatores externos causam impactos nos preços dos produtos finais e dos insumos, enquanto os internos influenciam principalmente o custo de produtos. Em suma, a determinação do mix de produtos influencia diretamente a competitividade empresarial. Na literatura especializada identificam-se vários métodos de custeio para medir adequadamente o custo do produto, tais como: custeio direto (variável); custeio por absorção, custeio pleno (full cost), e custeio por atividades (ABCActivity Based Costing). Estes métodos divergem em função da maneira com que são apropriados os fatores que compõem o custo dos produtos. A presente pesquisa mostra o mix de produtos, o uso da capacidade industrial e os métodos de custeios analisados conjuntamente por meio de programação matemática (programação Linear), com o objetivo de simular quantitativamente a eficiência de cada método. A tradução dos diferentes paradigmas em modelos matemáticos elimina a possibilidade dos autores refutarem métodos de custeio em função de suas tendências teóricas. Para demonstrar as limitações da Teoria das Restrições e do Modelo Geral de Kee e Schmidt foi realizada uma pesquisa bibliográfica que contempla as principais referências sobre os principais métodos de custeio e modelos de tomada de decisão aplicados à possibilidade dos autores refutarem métodos de custeio e modelos de tomada de decisão aplicados à seleção de mix de produtos. O modelo ABC revelou resultados mais consistentes para definição de mix de produtos quando da expansão ou redução de capacidade produtiva, ao se considerarem os custos discricionários. / The optimal product mix selection must consider internal and external factors of a manufacturing company. The external ones are mainly products prices, industry competition, substitute and complementary products, distribution channels, industrial location, and government taxes among others. The internal factors are related mainly to the use of the industrial capacity, to raw materials and human resources supply (prices and quantities), and to joint production. The external factors cause impacts in the prices of the input and final products, while the interns influence mainly the cost of products. In short, the determination of the product mix influences directly the company competitiveness. Our research has done a bibliographical research and a comparative analysis of three important frameworks to support the product-mix optimal decision: Activity based costing (ABC), Goldratt´s Theory of Constraints and the Kee & Schmidt General Model. In specialized literature some costing methods are identified to the properly measurement of products costs, such as: direct costing, burden costing, full costing, and activity based costing (ABC). These methods differ in the way that productive factors are distributed to the products costs. This thesis shows the product mix, the use of the industrial capacity and the costing methods analyzed jointly by means of mathematical programming, aiming to simulate each method performance. The translation of different frameworks in mathematical models eliminates the possibility to refute costing methods as function of author theoretical meanings. It is shown that the ABC surpasses the two other models for presenting the biggest profit and using less resources in the productive activities, when is considered discretionary costs.