The human vestibulo-ocular reflex (VOR) stabilizes gaze during head movement. The reflex is typically tested in a clinic or laboratory using passive rotations or artificial stimuli which measure the amount of damage the vestibular apparatus has suffered. However, during everyday activities the vestibular system is stimulated by active, self generated head movements. Head movements are often rapid and associated with the goal of achieving either gaze-fixation or re-fixation. Patients who complain of on-going symptoms will typically identify a particular position or movement that aggravates their symptoms in their everyday life. There is a need to identify objective parameters which correlate with the subjective complaints of patients whose symptoms persist after vestibular damage. In the first study, a gaze-refixation task, patients who complain of ongoing symptoms (poorly-compensated), during rapid head turns, after unilateral vestibular de-afferentation (uVD) were compared with those who did not have the same complaints (well-compensated) and normal subjects. Well- and poorly-compensated groups were sorted according to responses on a standardized questionnaire. All subjects were then located in a real-world, non-laboratory environment in which poorly-compensated subjects reported experiencing symptoms. Each subject’s head, eye and gaze displacement and velocity, head rotation frequency and blink or eye-lid closure were measured and analysed and compared between ipsi- and contra-lesional head rotations within and between subject groups. When subjects are able to generate their own active head rotations it has been suggested that a number of vestibular and extra-vestibular strategies might be employed to compensate for an impaired VOR. In subsequent studies, high resolution scleral search coils were used to identify the compensatory mechanisms used during active head rotations during a gaze-fixation task. A corrective saccade is typically observed during passive ipsilesional head rotations or “impulses” and might be potentiated during rapid, active or self-generated head rotations. The conditions which predict or contribute to the generation of the rapid, corrective eye movement were investigated. The results were compared with responses to passive head impulses of matched velocity and acceleration to determine if active head impulses could be used to identify a lesioned vestibular apparatus as is routinely clinically achieved with passive head impulses.

The human vestibulo-ocular reflex (VOR) stabilizes gaze during head movement. The reflex is typically tested in a clinic or laboratory using passive rotations or artificial stimuli which measure the amount of damage the vestibular apparatus has suffered. However, during everyday activities the vestibular system is stimulated by active, self generated head movements. Head movements are often rapid and associated with the goal of achieving either gaze-fixation or re-fixation. Patients who complain of on-going symptoms will typically identify a particular position or movement that aggravates their symptoms in their everyday life. There is a need to identify objective parameters which correlate with the subjective complaints of patients whose symptoms persist after vestibular damage. In the first study, a gaze-refixation task, patients who complain of ongoing symptoms (poorly-compensated), during rapid head turns, after unilateral vestibular de-afferentation (uVD) were compared with those who did not have the same complaints (well-compensated) and normal subjects. Well- and poorly-compensated groups were sorted according to responses on a standardized questionnaire. All subjects were then located in a real-world, non-laboratory environment in which poorly-compensated subjects reported experiencing symptoms. Each subject’s head, eye and gaze displacement and velocity, head rotation frequency and blink or eye-lid closure were measured and analysed and compared between ipsi- and contra-lesional head rotations within and between subject groups. When subjects are able to generate their own active head rotations it has been suggested that a number of vestibular and extra-vestibular strategies might be employed to compensate for an impaired VOR. In subsequent studies, high resolution scleral search coils were used to identify the compensatory mechanisms used during active head rotations during a gaze-fixation task. A corrective saccade is typically observed during passive ipsilesional head rotations or “impulses” and might be potentiated during rapid, active or self-generated head rotations. The conditions which predict or contribute to the generation of the rapid, corrective eye movement were investigated. The results were compared with responses to passive head impulses of matched velocity and acceleration to determine if active head impulses could be used to identify a lesioned vestibular apparatus as is routinely clinically achieved with passive head impulses.

Made available in DSpace on 2016-12-12T17:32:58Z (GMT). No. of bitstreams: 1 Resumo Fernanda Faria.pdf: 82029 bytes, checksum: 25840142efbe3cd3067167076476b919 (MD5) Previous issue date: 2015-06-26 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Introduction: Chronic kidney disease (CKD) is a systemic disease, which can compromise several organs and tissues in its advanced stage. In CKD patients on hemodialysis (HD) is commonly observed the decline in physical activity and the specific involvement of the respiratory system that can be affected by both the disease and by the treatment. Pulmonary congestion is a frequent change in patients with CKD. However there are no studies that have analyzed the influence of mild pulmonary congestion in physical activity of daily living (PADL) by an activity monitor. Objective: The objective of this study was to investigate the influence of mild pulmonary congestion in physical activity of daily living of patients with CKD undergoing HD, as well as to know the behavior of these patients compared to PADL in the days of HD and non HD. Methods: This was a cross-sectional study that evaluated 30 patients with CKD stage 5, of both sexes, mean age 49 ± 15 years. Patients were evaluated on two different days and all the evaluations were conducted in pre- HD period. On the first day, patients underwent the examination of thoracic ultrasound to assess pulmonary congestion. On the second day, they underwent the following ratings: anthropometry, pulmonary function test, test respiratory muscle strength, grip strength, functional classification of symptoms and physical functioning domain of the questionnaire of quality of life. The evaluation of AVFD was held for 7 consecutive days, from Monday to Sunday for 12 hours. Results: the linear regression was observed that mild pulmonary congestion influenced PADL (F = 0.009 p = 7.97). The active time and the number of steps were significantly lower (p <0.05) HD in days (113 ± 55 and 161 ± 69, respectively) compared to those without HD days (3286 ± 1798 and 4422 ± 2202, respectively) . The PADL correlated with physical functioning domain (r = 0.35; p = 0.05). In multiple regression analysis, the variables that explain the domain "physical functioning" were age (B = -0.96 p <0.001), functional classification of symptoms (B = -13.48 p <0.001), and grip strength Manual (B = 1.07 p = 0.005). Conclusion: mild pulmonary congestion influences PADL CKD patients in stage 5, contributing to the injury of PADL. Patients are less active in hemodialysis day than in those without hemodialysis days. / Introdução: A doença renal crônica (DRC) é uma doença sistêmica, que pode comprometer diversos órgãos e tecidos na sua fase avançada. Em pacientes com DRC em hemodiálise (HD) é comumente observado o declínio do nível de atividade física e o acometimento específico do sistema respiratório que pode ser afetado tanto pela doença como pelo tratamento. A congestão pulmonar é uma alteração frequente nos pacientes com DRC. Contudo não há estudos que tenham analisado a influência da congestão pulmonar leve na atividade física de vida diária (AFVD) por meio de um monitor de atividades. Objetivo: O objetivo do presente estudo foi verificar a influência da congestão pulmonar leve na atividade física de vida diária dos pacientes com DRC submetidos a HD, assim como, conhecer o comportamento desses pacientes em relação à AFVD nos dias de HD e sem HD. Métodos: Tratou-se de um estudo com delineamento transversal no qual foram avaliados 30 pacientes com DRC estágio 5, de ambos os sexos e idade média de 49 ± 15 anos. Os pacientes foram avaliados em dois dias distintos e todas as avaliações foram realizadas no período pré-HD. No primeiro dia, os pacientes realizaram o exame de ultrassom torácico para avaliar a congestão pulmonar. No segundo dia, foram submetidos às seguintes avaliações: antropometria, prova de função pulmonar, prova de força muscular respiratória, força de preensão manual, classificação funcional de sintomas e o domínio funcionamento físico do questionário de qualidade de vida. A avaliação da AVFD foi realizada durante 7 dias consecutivos, de segunda a domingo por 12 horas diárias. Resultados: na análise de regressão linear observou-se que a congestão pulmonar leve influenciou a AFVD (p=0,009 F=7,97). O tempo ativo e o número de passos foram significativamente menores (p<0,05) nos dias de HD (113 ± 55 e 161 ± 69; respectivamente) quando comparados aos dias sem HD (3286 ± 1798 e 4422 ± 2202; respectivamente). A AFVD apresentou correlação com o domínio funcionamento físico (r= 0,35; p= 0,05). Na análise de regressão múltipla as variáveis que explicam o domínio funcionamento físico foram: idade (B= -0,96 p<0,001), classificação funcional de sintomas (B= -13,48 p<0,001), e força de preensão manual (B= 1,07 p=0,005). Conclusão: a congestão pulmonar leve influencia a AFVD de pacientes com DRC em estágio 5, contribuindo para o prejuízo da AFVD. Os pacientes são menos ativos nos dias de hemodiálise do que nos dias sem hemodiálise.

Made available in DSpace on 2014-12-17T14:52:45Z (GMT). No. of bitstreams: 1 FabiolaCMD.pdf: 3573116 bytes, checksum: acf020a7332c2092c7b5a33739a67d19 (MD5) Previous issue date: 2008-08-18 / This study proposes to develop an equipment that attends the demands of tetraplegic people due to cerebral palsy and that promotes an adequate caregivers postural biomechanics during the shower activity of daily living. First, a bibliographic review was performed to define the terms refering to cerebral palsy, activity of daily living (specifically shower), and assistive technology, besides listing the wheelchairs made on the mainly national assistive technology companies. Therefore, this is a descriptive-exploratory study based on a literature review and on a based-field exploration research. On the field research a survey was adopted as a methodological procedure as it is related to a direct investigation related to a phenomenon, on the case, represented by the current shower situation of the people investigated in this study. Data were collected with the application of a form to the caregivers and consumers of the medical-therapeutic treatment and place used by the participants. Such form, which was made up of open and close questions, tried to identify, besides the personal data of evaluated users and consumers, the characteristics of the current shower activity, such as the place where it takes place in the house, the used equipmentS, in the case there is any, and how often it occurs. The form also was used to identify the caregivers and consumers desires and perceptions in relation to the present characteristics of the new dispositive besides the users and consumers anthropometric data. The evaluation of the results obtained through the form, together with the practice and clinical experience of the researchers and engineers involved in this study, made it possible to develop and make up a real shower chair prototype with the specific adjusts destined to adequate the equipment to be used according to the needs of each user and consumer / Esta pesquisa tem como proposta desenvolver um equipamento que atenda as exig?ncias motoras de indiv?duos com paralisia cerebral tetrapar?tica esp?stica e promova biomec?nica postural adequada aos cuidadores para a atividade da vida di?ria referente ao banho. Inicialmente, o levantamento bibliogr?fico buscou definir os termos referentes ? paralisia cerebral, atividade da vida di?ria especificando o banho, e tecnologia assistiva, al?m de listar cadeiras de banho fabricadas nas principais ind?strias de produtos de tecnologia assistiva do mercado nacional. Desta forma, o trabalho tem sua forma??o baseada na pesquisa do tipo descritiva-explorat?ria atrav?s de investiga??o em fontes bibliogr?ficas e em pesquisa de campo. Na pesquisa de campo foi adotado como procedimento metodol?gico o levantamento, por se tratar de uma investiga??o direta relativa a um fen?meno que se deseja aprofundar, no caso, representado pela situa??o atual do banho dos indiv?duos deste estudo. Os dados foram coletados com a aplica??o de formul?rio junto aos cuidadores/consumidores em locais de tratamento m?dico-terap?utico freq?entados pelos indiv?duos participantes. O formul?rio, atrav?s de perguntas abertas e fechadas buscou identificar, al?m dos dados pessoais dos usu?rios e consumidores, as caracter?sticas da atividade do banho atual, como o local da casa onde o banho ? realizado; qual o equipamento utilizado, no caso de haver algum; e com que freq??ncia este ocorre. Tamb?m buscou identificar os desejos e percep??es dos cuidadores/consumidores em rela??o ?s caracter?sticas presentes no novo dispositivo, al?m de dados antropom?tricos dos usu?rios e consumidores. A avalia??o dos resultados obtidos atrav?s do formul?rio, somada a experi?ncia pr?tica-cl?nica do pesquisador e da equipe de engenheiros envolvidas no projeto, possibilitou o desenvolvimento e confec??o do prot?tipo real da cadeira de banho, com ajustes espec?ficos destinados a adequar o equipamento ao uso de acordo com as necessidades individuais de cada usu?rio e consumidor

Capacidade funcional surge como novo conceito quando aborda a saúde do idoso, principalmente em se tratando de idosos com doença de Alzheimer (DA) onde o déficit cognitivo é esperado aliado ao funcional. Dessa forma as pesquisas relacionadas à capacidade funcional do idoso com DA vêm ao encontro das questões relacionadas ao cuidado desse idoso. Trata-se de um estudo observacional e transversal que teve com objetivo identificar comorbidades dos idosos com DA, mensurar nível de independência funcional, segundo a Medida da Independência Funcional (MIF), comparando com o estagiamento da demência, segundo a Avaliação Clínica da demência (Clinical Dementia Rating scale - CDR). A amostra foi constituída de 67 idosos. Os dados foram coletados em entrevistas domiciliares, utilizando-se de instrumento para identificação e perfil sociodemográfico, do Mini Exame do Estado Mental (MEEM) para avaliação do déficit cognitivo, da Medida de Independência Funcional (MIF) para avaliação da funcionalidade e, para estagiamento da demência, foi utilizada CDR. A média de idade dos idosos foi de 79 anos (+ 7,2), sendo 41,8% na faixa etária entre 75-79 anos. Houve predominio de mulheres 77,6% e viúvos 49,3%. Os idosos possuíam média de escolaridade de 5,6 anos, 73,1% tinham renda própria, 46,3% possuíam renda familiar de até 5 salários mínimos e residiam em média com 3,5 pessoas. Quanto às comorbidades existentes, 23,9 não possuíam e 53,7% tinham hipertensão arterial. O déficit cognitivo foi de 82%, e a média no MEEM de 9,3. Sobre o estagiamento da demência, 46,3% apresentavam demência grave, 22,4%% demência moderada e 31,3% demência leve. Quanto a funcionalidade, a variação dos escores observados na MIF foi igual à variação possível para MIF motora. A média geral da MIF global encontrada foi 71,1, a médias da MIF global foram 107,9; 84,5 e 39,7 para os idosos com demência leve, moderada e grave respectivamente. Os idosos com demência leve possuíam independência modificada ou necessitavam de supervisão, aqueles com demência moderada possuíam dependência mínima ou necessidade de supervisão e os idosos com demência grave eram totalmente dependentes. Foi encontrada forte correlação entre o nível de independência funcional (MIF global) com o estágio da demência e com o desempenho cognitivo (p<0,001). Não foram encontradas correlações estatisticamente significantes entre a funcionalidade e idade, sexo e presença de (co)morbidades. Concluiu-se que a capacidade funcional dos idosos com DA está relacionada ao estágio da demência, isto é, quanto mais grave a demência, maior o nível da dependência. / Functional capacity emerges as a new concept in elderly health, mainly with respect to elderly people with Alzheimers disease (AD), when a cognitive deficit is expected, connected with a functional deficit. Thus, research on functional capacity in elderly people with AD is relevant for elderly care delivery. This observational, crosssectional study aimed to identify co-morbidities of elderly people with AD, to measure the functional independence level according to the Functional Independence Measure (FIM), in comparison with the dementia staging according to the Clinical Dementia Rating scale (CDR). The sample consisted of 67 elderly. Data were collected during interviews at the elderlys home, using an identification and sociodemographic profile instrument, the Mini-Mental State Examination (MMSE) to assess cognitive deficit; the Functional Independence Measure (FIM) for functional assessment, and CDR to asses dementia staging. The mean age was 79 years (+ 7.2), with 41.8% between 75 and 79 years old. Women 77.6% and widowed people 49.3% were predominant. The elderlys mean education level was 5.6 years, 73.1% gained their own income, 46.3% gained a family income of up to 5 minimum wages and lived with an average of 3.5 people. As to existing co-morbidities, 23.9 had none and 53.7% had arterial hypertension. The cognitive deficit was 82% and the mean MMSE score 9.3. In dementia staging, 46.3% presented severe, 22.4%% moderate and 31.3% light dementia. With respect to functionality, the variation in FIM scores was equal to the possible variation for motor FIM. The mean global general FIM score was 71.1, the mean global FIM scores were 107.9 for light; 84.5 for moderate and 39.7 for severe dementia. Elderly with light dementia displayed modified independence or needed supervision; those with moderate dementia showed minimal dependence or supervision and elderly with severe dementia were fully dependent. A strong correlation was found between the functional independence level (global FIM) and dementia stage and with cognitive performance (p<0.001). No statistically significant correlations were found between functionality and age, gender and presence of co-morbidities. It was concluded that the functional capacity of elderly people with AD is related with the stage of dementia, that is, the more severe the dementia, the higher the level of dependence will be.

Le but général de la thèse consiste à mieux connaître l’influence du milieu d’évaluation (domicile vs clinique) sur la réalisation de tâches liées à la préparation de repas auprès de personnes âgées fragiles. La thèse s'articule autour de trois objectifs spécifiques, dont les résultats sont présentés dans le cadre de cinq articles scientifiques. Le premier objectif vise à faire état des connaissances relatives au concept de fragilité en ergothérapie et à l'influence du milieu d'évaluation auprès des personnes âgées fragiles. Dans un premier temps, une analyse critique d'écrits portant sur la fragilité a été effectuée. Les résultats (article 1) démontrent la pertinence du concept de fragilité en ergothérapie, en suggérant qu'une meilleure compréhension de ce concept puisse aider les ergothérapeutes à offrir aux personnes fragiles des soins et services mieux adaptés à leurs besoins. Dans un deuxième temps, une recension des études ayant comparé la réalisation d'activités de la vie domestique (AVD) entre les milieux d'évaluation a été réalisée. Les résultats (article 2) révèlent que les personnes âgées sans déficit cognitif important tendent à offrir une meilleure performance à domicile, plutôt qu'en milieu clinique, lors de la réalisation d'AVD. Quelques facteurs, tels que la familiarité avec l’environnement, contribueraient à expliquer cette différence entre les milieux d'évaluation. Cette recension critique suggère que des résultats similaires puissent être obtenus auprès de personnes âgées fragiles. Le second objectif cherche à comparer la réalisation de tâches liées à la préparation de repas entre les milieux d’évaluation auprès de personnes âgées fragiles. Pour atteindre cet objectif, trente-sept personnes âgées répondant aux critères de fragilité (Fried et al.,2001) ont été évaluées en milieux clinique et domiciliaire suivant un devis contrebalancé au moyen du Assessment of Motor and Process Skills (AMPS) et du Performance Assessment of Self-Care Skills (PASS). Les résultats (articles 3, 4 et 5) concourent, dans l'ensemble, à démontrer une meilleure performance des personnes fragiles lorsqu’elles sont évaluées à domicile. Le dernier objectif a pour but d'identifier les facteurs sociodémographiques,physiques, cognitifs, psychologiques et environnementaux susceptibles d'expliquer la différence entre les milieux d'évaluation. Les résultats de la thèse (articles 3, 4 et 5) tendent à démontrer que le déclin de certaines fonctions exécutives constitue un facteur prépondérant pour expliquer une meilleure performance à domicile. Nos analyses révèlent que d'autres facteurs cognitifs, sociodémographiques, psychologiques, physiques et environnementaux contribuent également, mais de façon moins importante, à la différence observée entre les milieux d'évaluation. Les résultats de cette thèse peuvent aider les ergothérapeutes à mieux distinguer les personnes âgées fragiles susceptibles de présenter une performance différente selon le milieu dans lequel elles sont évaluées et conséquemment, pour qui une visite à domicile devrait être préconisée. Les connaissances générées par la thèse pourraient ultimement contribuer à offrir aux personnes âgées fragiles des services mieux adaptés à leurs besoins, tout en favorisant une gestion efficiente des ressources en matière de santé. / This thesis aims to advance the state of knowledge about the impact of assessment settings (home versus clinic) on meal preparation task performance in frail older adults. The thesis has three specific objectives and the results are presented in five articles. The first specific objective aims to review current knowledge about the concept of frailty in occupational therapy and the impact of assessment settings in frail older adults. First, a critical review about frailty was conducted. The results (article 1) demonstrate that a better understanding of the concept of frailty may help occupational therapists provide health care and services better tailored to the specific needs of this population. Second, a review of studies comparing performance of instrumental activities of daily living (IADL) between assessment settings was performed. The results (article 2) reveal that older adults without significant cognitive impairments tend to perform better in IADL tasks when assessed at home. Some factors, such as familiarity with the environment, may explain this difference. Based on this review, similar results might be expected with frail elders. The second specific objective aims to compare meal preparation task performance in home and clinical settings in a population of frail older adults. Thirty-seven frail older adults were thus assessed in home and clinical settings with the Assessment of Motor and Process Skills (AMPS) and the Performance Assessment of Self-Care Skills (PASS), using a counterbalanced design. The results (articles 3, 4, 5) globally demonstrate significantly better performance of participants when assessed at home. The third specific objective aims to identify demographic, physical, cognitive, psychological and environmental factors that may explain differences between assessment settings. The results (articles 3, 4, 5) indicate that a better performance in the home setting was mostly related to a decline in certain executive functions. Other cognitive, demographic, psychological, physical and environmental factors also contribute to explain the differences between assessment settings but to a lesser extent. Our findings may help occupational therapists identify frail older adults likely to present a different performance in the clinical setting and thus for whom home assessments would be advisable. Our findings could ultimately mean that frail clients are provided with services adapted to their needs, while ensuring an efficient allocation of health care resources.

Le but général de la thèse consiste à mieux connaître l’influence du milieu d’évaluation (domicile vs clinique) sur la réalisation de tâches liées à la préparation de repas auprès de personnes âgées fragiles. La thèse s'articule autour de trois objectifs spécifiques, dont les résultats sont présentés dans le cadre de cinq articles scientifiques. Le premier objectif vise à faire état des connaissances relatives au concept de fragilité en ergothérapie et à l'influence du milieu d'évaluation auprès des personnes âgées fragiles. Dans un premier temps, une analyse critique d'écrits portant sur la fragilité a été effectuée. Les résultats (article 1) démontrent la pertinence du concept de fragilité en ergothérapie, en suggérant qu'une meilleure compréhension de ce concept puisse aider les ergothérapeutes à offrir aux personnes fragiles des soins et services mieux adaptés à leurs besoins. Dans un deuxième temps, une recension des études ayant comparé la réalisation d'activités de la vie domestique (AVD) entre les milieux d'évaluation a été réalisée. Les résultats (article 2) révèlent que les personnes âgées sans déficit cognitif important tendent à offrir une meilleure performance à domicile, plutôt qu'en milieu clinique, lors de la réalisation d'AVD. Quelques facteurs, tels que la familiarité avec l’environnement, contribueraient à expliquer cette différence entre les milieux d'évaluation. Cette recension critique suggère que des résultats similaires puissent être obtenus auprès de personnes âgées fragiles. Le second objectif cherche à comparer la réalisation de tâches liées à la préparation de repas entre les milieux d’évaluation auprès de personnes âgées fragiles. Pour atteindre cet objectif, trente-sept personnes âgées répondant aux critères de fragilité (Fried et al.,2001) ont été évaluées en milieux clinique et domiciliaire suivant un devis contrebalancé au moyen du Assessment of Motor and Process Skills (AMPS) et du Performance Assessment of Self-Care Skills (PASS). Les résultats (articles 3, 4 et 5) concourent, dans l'ensemble, à démontrer une meilleure performance des personnes fragiles lorsqu’elles sont évaluées à domicile. Le dernier objectif a pour but d'identifier les facteurs sociodémographiques,physiques, cognitifs, psychologiques et environnementaux susceptibles d'expliquer la différence entre les milieux d'évaluation. Les résultats de la thèse (articles 3, 4 et 5) tendent à démontrer que le déclin de certaines fonctions exécutives constitue un facteur prépondérant pour expliquer une meilleure performance à domicile. Nos analyses révèlent que d'autres facteurs cognitifs, sociodémographiques, psychologiques, physiques et environnementaux contribuent également, mais de façon moins importante, à la différence observée entre les milieux d'évaluation. Les résultats de cette thèse peuvent aider les ergothérapeutes à mieux distinguer les personnes âgées fragiles susceptibles de présenter une performance différente selon le milieu dans lequel elles sont évaluées et conséquemment, pour qui une visite à domicile devrait être préconisée. Les connaissances générées par la thèse pourraient ultimement contribuer à offrir aux personnes âgées fragiles des services mieux adaptés à leurs besoins, tout en favorisant une gestion efficiente des ressources en matière de santé. / This thesis aims to advance the state of knowledge about the impact of assessment settings (home versus clinic) on meal preparation task performance in frail older adults. The thesis has three specific objectives and the results are presented in five articles. The first specific objective aims to review current knowledge about the concept of frailty in occupational therapy and the impact of assessment settings in frail older adults. First, a critical review about frailty was conducted. The results (article 1) demonstrate that a better understanding of the concept of frailty may help occupational therapists provide health care and services better tailored to the specific needs of this population. Second, a review of studies comparing performance of instrumental activities of daily living (IADL) between assessment settings was performed. The results (article 2) reveal that older adults without significant cognitive impairments tend to perform better in IADL tasks when assessed at home. Some factors, such as familiarity with the environment, may explain this difference. Based on this review, similar results might be expected with frail elders. The second specific objective aims to compare meal preparation task performance in home and clinical settings in a population of frail older adults. Thirty-seven frail older adults were thus assessed in home and clinical settings with the Assessment of Motor and Process Skills (AMPS) and the Performance Assessment of Self-Care Skills (PASS), using a counterbalanced design. The results (articles 3, 4, 5) globally demonstrate significantly better performance of participants when assessed at home. The third specific objective aims to identify demographic, physical, cognitive, psychological and environmental factors that may explain differences between assessment settings. The results (articles 3, 4, 5) indicate that a better performance in the home setting was mostly related to a decline in certain executive functions. Other cognitive, demographic, psychological, physical and environmental factors also contribute to explain the differences between assessment settings but to a lesser extent. Our findings may help occupational therapists identify frail older adults likely to present a different performance in the clinical setting and thus for whom home assessments would be advisable. Our findings could ultimately mean that frail clients are provided with services adapted to their needs, while ensuring an efficient allocation of health care resources.

Syftet med denna studie var att syntetisera äldre personers erfarenheter kring användning av digital teknik samt dess betydelse för äldres delaktighet i vardagen. Studien är en metasyntes som utfördes genom en systematisk sökning av kvalitativ vetenskaplig litteratur och dess analys. Litteratursökningen genomfördes i fyra databaser och resulterade i 12 vetenskapliga artiklar som ingick i studien. Dataanalysen inleddes med en kvalitetsgranskning av artiklarna och avslutades med en syntes av datan som svarade på studiens syfte. Syntetisering ledde till 34 första nivåns teman samt tre andra nivåns teman; 1. Upplevd nytta och viljan av att använda digital teknik i äldres vardag. 2. Teknikens påverkan ger känsla av gemenskap och ökat stöd för delaktighet. 3. Upplevd begränsning och bristande vilja av användning av digital teknik. Andra nivåns teman lyftes upp och resulterade i två tredje nivåns teman; 1. Äldre entusiaster omfamnar teknikens möjligheter för känslan av trygghet och delaktighet i vardagen trots utmaningar kring dess användning. 2. Upplevelse av egna existensen i livet utanför teknikens värld och hinder för eller möjligheter till delaktighet i ett digitalt samhälle. Resultatet påvisade varierande erfarenheter av användning av digital teknik. Äldre personer lyfte upp stora möjligheter att engagera sig i samt att klara vissa vardagliga aktiviteter med hjälp av digital teknik. Positiva erfarenheter som dominerade i studierna var äldres möjlighet att kommunicera med vårdgivare och myndigheter samt att vara delaktig i sociala liv. Utöver detta visade sig att vissa äldre ansåg att digital teknik var onödig i deras liv, vilket berodde på brist på intresse eller svårigheter att hantera den. Att inte kunna eller att inte vilja hantera digital teknik har lett till upplevelse av utanförskap och minskad delaktighet i samhället. / The purpose of this study was to synthesize older people's experiences of using digital technology and its significance in their participation in everyday life. The study is a Meta-synthesis that was performed through a systematic search of qualitative scientific literature and it’s analysis. The literature search was conducted in four databases and resulted in twelve scientific articles that were included in the study. The data analysis began with a quality review of the articles and ended with a synthesis of the data that answered the purpose of the study. The synthesis led to 34 first-level themes as well as three second-level themes;            1. Perceived benefit and willingness to use digital technology in the everyday lives of the elderly, 2. The impact of technology provides a sense of community and increased support for participation, 3. Perceived limitation and unwillingness to use digital technology. Second level themes were highlighted and resulted in two third level themes; Older enthusiasts embrace the possibilities of technology for the feeling of security and participation in everyday life, despite the challenges surrounding its use. 2. Experience of one's own existence in life outside the world of technology and obstacles or opportunity to participate in a digital society. The results demonstrated varying experiences of using digital technology. Older people highlighted great opportunities to get involved in and to manage certain everyday activities with the help of digital technology. Despite functional limitations and physical barriers, there is potential to perform errands digitally. Positive experiences that dominated the studies were elderly's opportunity to communicate with healthcare providers and agencies but also opportunity to participation in their social life. In addition to this, it turned out that some older people felt that digital technology was unnecessary in their lives, which was due to lack of interest or difficulties in dealing with it. Not being able or unwilling to handle digital technology has led to the experience of exclusion and reduced participation in society.

Title: Effect of robot-assisted therapy on upper limb function in activities of daily living in patients after acquired brain injury Aims: The main aim of the thesis was to evaluate and compare the effectiveness of two therapeutic approaches using robot-assisted glove Gloreha Sinfonia to perform Activity of daily living in patients after acquired brain injury. Methods: The study is an empirical quantitative research, a monocentric randomized controlled, simply blinded study. The study compares two groups, group A (n = 20) used a robot-assisted Gloreha glove with a bimanual approach, group B (n = 20) had therapy with a robot-assisted Gloreha glove with an unimanual approach. All patients were evaluated for eligibility and underwent initial testing (T1). Patients in both groups had therapy (unimanual / bimanual) for three weeks (15x), retest (T2) was performed after completion of the intervention, and a follow-up evaluation was performed after 1 month (T3). Patients were always evaluated by the Upper Extremity Motor Activity Log (UE MAL), Motor Assessment Scale (MAS), Action Research Arm Test (ARAT), Box and Block test (BBT) and Motricity Index (MI). Results: According to the results of the MAS test in group A, there was a statistically significant improvement in upper limb function in category 8 at...

There is a sharp increase in the number of old people living alone throughout the world. More often than not, such people require continuous and immediate care and attention in their everyday lives, hence the need for round the clock monitoring, albeit in a respectful, dignified and non-intrusive way. For example, continuous care is required when they become frail and less active, and immediate attention is required when they fall or remain in the same position for a long time. To this extent, various monitoring technologies have been developed, yet there are major improvements still to be realised. Current technologies include indoor positioning systems (IPSs) and health monitoring systems. The former relies on defined configurations of various sensors to capture a person's position within a given space in real-time. The functionality of the sensors varies depending on receiving appropriate data using WiFi, radio frequency identification (RFIO), ultrawide band (UWB), dead reckoning (OR), infrared indoor (IR), Bluetooth (BLE), acoustic signal, visible light detection, and sound signal monitoring. The systems use various algorithms to capture proximity, location detection, time of arrival, time difference of arrival angle, and received signal strength data. Health monitoring technologies capture important health data using accelerometers and gyroscope sensors. In some studies, audio fingerprinting has been used to detect indoor environment sound variation and have largely been based on recognising TV sound and songs. This has been achieved using various staging methods, including pre-processing, framing, windowing, time/frequency domain feature extraction, and post-processing. Time/frequency domain feature extraction tools used include Fourier Transforms (FTs}, Modified Discrete Cosine Transform (MDCT}, Principal Component Analysis (PCA), Mel-Frequency Cepstrum Coefficients (MFCCs), Constant Q Transform (CQT}, Local Energy centroid (LEC), and Wavelet transform. Artificial intelligence (Al) and probabilistic algorithms have also been used in IPSs to classify and predict different activities, with interesting applications in healthcare monitoring. Several tools have been applied in IPSs and audio fingerprinting. They include Radial Basis Kernel (RBF), Support Vector Machine (SVM), Decision Trees (DTs), Hidden Markov Models (HMMs), Na'ive Bayes (NB), Gaussian Mixture Modelling (GMM), Clustering algorithms, Artificial Neural Networks (ANNs), and Deep Learning (DL). Despite all these attempts, there is still a major gap for a completely non-intrusive system capable of monitoring what an elderly person living alone is doing, where and for how long, and providing a quick traffic-like risk score prompting, therefore immediate action or otherwise. In this thesis, a cost-effective and completely non-intrusive indoor positioning and activity-monitoring system for elderly people living alone has been developed, tested and validated in a typical residential living space. The proposed system works based on five phases: (1)Set-up phase that defines the typical activities of daily living (TADLs). (2)Configuration phase that optimises the implementation of the required sensors in exemplar flat No.1. (3)Learning phase whereby sounds and position data of the TADLs are collected and stored in a fingerprint reference data set. (4)Listening phase whereby real-time data is collected and compared against the reference data set to provide information as to what a person is doing, when, and for how long. (5)Alert phase whereby a health frailty score varying between O unwell to 10 healthy is generated in real-time. Two typical but different residential flats (referred to here are Flats No.1 and 2) are used in the study. The system is implemented in the bathroom, living room, and bedroom of flat No.1, which includes various floor types (carpet, tiles, laminate) to distinguish between various sounds generated upon walking on such floors. The data captured during the Learning Phase yields the reference data set and includes position and sound fingerprints. The latter is generated from tests of recording a specific TADL, thus providing time and frequency-based extracted features, frequency peak magnitude (FPM), Zero Crossing Rate (ZCR), and Root Mean Square Error (RMSE). The former is generated from distance measurement. The sampling rate of the recorded sound is 44.1kHz. Fast Fourier Transform (FFT) is applied on 0.1 seconds intervals of the recorded sound with minimisation of the spectral leakage using the Hamming window. The frequency peaks are detected from the spectrogram matrices to get the most appropriate FPM between the reference and sample data. The position detection of the monitored person is based on the distance between that captured from the learning and listening phases of the system in real-time. A typical furnished one-bedroom flat (flat No.2) is used to validate the system. The topologies and floorings of flats No.1 and No.2 are different. The validation is applied based on "happy" and "unusual" but typical behaviours. Happy ones include typical TADLs of a healthy elderly person living alone with a risk metric higher than 8. Unusual one's mimic acute or chronic activities (or lack thereof), for example, falling and remaining on the floor, or staying in bed for long periods, i.e., scenarios when an elderly person may be in a compromised situation which is detected by a sudden drop of the risk metric (lower than 4) in real-time. Machine learning classification algorithms are used to identify the location, activity, and time interval in real-time, with a promising early performance of 94% in detecting the right activity and the right room at the right time.