Indiana University-Purdue University Indianapolis (IUPUI) / Cerebral Palsy (CP) is considered to be the leading cause of motor disability among children. Children with CP present with multiple physical impairments including decreased strength and range of motion (ROM), increased spasticity, and poor balance and coordination. These impairments often lead to limitations in ankle motor control that impacts balance and gait function, which puts children at a higher risk for developing other problems. In recent studies, robotic devices have been developed to address poor motor control of the upper and lower extremities. Aim: The aim of this study is to investigate the extent to which the robot-assisted, taskspecific ankle trainer improve deficits across the three domains of the International Classification of Functioning, Disability and Health (ICF) in children with CP. Method: This is a quasi-experimental, single group, repeated measure design with four time-testing points through a set training session/protocol. A convenience sample of 5 children with CP were enrolled in the study. All children received 6-weeks of ankle robot training that included two 45-60 minute sessions per week, for a total of 12 sessions. Data from Tardieu Scale of spasticity, Boyd and Graham selective motor control, Pediatric Balance Scale, goniometer, hand held dynamometer, gait mat analysis, accelerometer, LIFE-H for children questionnaires, ultrasound, and robotic evaluation were collected at the different time points (1 week and 1 month pre training and 1 week and 1 month post training). Descriptive statistics and repeated measure (ANOVA) were used with SPSS software for data analysis. Results: All participants showed improvement in 1. Body Function and Structures (ROM, tone, strength, balance, ankle control and performance, and muscle architecture), 2. Activity (gait and activity counts) and 3. Participations over the course of the study. Conclusion: The results revealed the potential of robot-assisted, task-specific ankle training to improve motor performance and capacity at the body function, activity and participation level. Training appeared to have a lasting impact as most gains were maintained one month following training.

Introduction: The World Health Organization (WHO) encourages the use of its International Classification of Functioning, Health and Disability (ICF) framework as a biopsychosocial approach for healthcare professions to understand health and disability. The ICF framework is not currently a component of the curriculum at Canadian Memorial Chiropractic College (CMCC); however its concepts adhere to the college’s program ideals and fit well into a chiropractic model of care. Purpose: To examine whether a brief educational presentation introducing the ICF to chiropractic interns could result in a detectable change in the interns' clinical thought processes, thus stimulating the incorporation of a wider variety of ICF concepts into the interns’ report-writing including notes on progress and goal setting. Methods: This study reviewed the clinical report writing style and content of chiropractic clinical interns practicing at one of two Aptus Treatment Centres in Toronto, Ontario. Reports were analyzed prior to and following an educational intervention in which the ICF was introduced to the chiropractic clinical interns with suggestions for applications into practice. Following the intervention a subset of the chiropractic interns was specifically encouraged to incorporate ICF concepts into their report writing. Three participant groups were formed: Group 1 participants attended the presentation and received post-presentation encouragement, Group 2 participants attended the presentations but did not receive direct encouragement to incorporate ICF concepts into their report writing, Group 3 participants were current clinical interns who did not attend the presentations and consented to the evaluation of their clinical reports. After being anonymized to the researchers the pre- and post-intervention reports were reviewed using a standardized evaluation scheme that categorized the use of ICF concepts. Results: This proof of concept study provided evidence that with a brief introduction to the ICF, chiropractic interns were able to incorporate a greater variety of ICF constructs into their report writing. Detectable changes were noted with Groups 1 and 2. Group 1 demonstrated a decrease in use of references to body function and structure and a marked increase in references to both personal and environmental factors. Group 2 demonstrated a decrease in use of references to body function and structure as well as a notable increase in references to both participation and environmental factors. No detectable changes were noted in the report writing of Group 3 participants who were not exposed to the ICF teaching. Conclusions: The results of this study indicate that with even short educational presentations chiropractic interns are able to adopt a well-established framework of healthcare concepts into their patient treatment plans as noted in their report writing. This was apparent in both participant groups who attended the presentations and was not dependent on direct encouragement. This knowledge may influence the chiropractic interns’ understanding of health and disability and their interprofessional communication, and affect patient outcomes. These questions should be explored in future prospective controlled studies. / Thesis / Master of Science Rehabilitation Science (MSc) / Introduction: The World Health Organization (WHO) encourages the use of its International Classification of Functioning, Health and Disability (ICF) framework as a biopsychosocial approach for healthcare professions to understand health and disability. The ICF framework is not currently a component of the curriculum at Canadian Memorial Chiropractic College (CMCC); however its concepts adhere to the college’s program ideals and fit well into a chiropractic model of care. Purpose: To examine whether a brief educational presentation introducing the ICF to chiropractic interns could result in a detectable change in the interns' clinical thought processes, thus stimulating the incorporation of a wider variety of ICF concepts into the interns’ report-writing including notes on progress and goal setting. Methods: This study reviewed the clinical report writing style and content of chiropractic clinical interns practicing at one of two Aptus Treatment Centres in Toronto, Ontario. Reports were analyzed prior to and following an educational intervention in which the ICF was introduced to the chiropractic clinical interns with suggestions for applications into practice. Following the intervention a subset of the chiropractic interns was specifically encouraged to incorporate ICF concepts into their report writing. Three participant groups were formed: Group 1 participants attended the presentation and received post-presentation encouragement, Group 2 participants attended the presentations but did not receive direct encouragement to incorporate ICF concepts into their report writing, Group 3 participants were current clinical interns who did not attend the presentations and consented to the evaluation of their clinical reports. After being anonymized to the researchers the pre- and post-intervention reports were reviewed using a standardized evaluation scheme that categorized the use of ICF concepts. Results: This proof of concept study provided evidence that with a brief introduction to the ICF, chiropractic interns were able to incorporate a greater variety of ICF constructs into their report writing. Detectable changes were noted with Groups 1 and 2. Group 1 demonstrated a decrease in use of references to body function and structure and a marked increase in references to both personal and environmental factors. Group 2 demonstrated a decrease in use of references to body function and structure as well as a notable increase in references to both participation and environmental factors. No detectable changes were noted in the report writing of Group 3 participants who were not exposed to the ICF teaching. Conclusions: The results of this study indicate that with even short educational presentations chiropractic interns are able to adopt a well-established framework of healthcare concepts into their patient treatment plans as noted in their report writing. This was apparent in both participant groups who attended the presentations and was not dependent on direct encouragement. This knowledge may influence the chiropractic interns’ understanding of health and disability and their interprofessional communication, and affect patient outcomes. These questions should be explored in future prospective controlled studies.

<p>Personer med begåvningshandikapp har inte alltid haft rätten till att leva ett självständigt liv med resterande medborgare ute i samhället. Utan istället har de gömts undan på ett liv vid institutionerna ute på landet. När kommunerna tog över ansvaret för dessa individer förändrades deras levnadsvillkor och rehabiliteringen skulle ske utifrån individernas egna förutsättningar. De skulle även få rätten till egna lägenheter ute i samhället och alla individer skulle behandlas lika. Syftet med denna studie var att ta reda på hur några personer med begåvningshandikapp på C-nivå, kunde uppleva sina egna levnadsvillkor om delaktighet i deras egna LSS insatser på gruppbostäder. Undersökningen bestod av fyra stycken deltagare som hämtades från två olika gruppbostäder. En kvalitativ undersökning valdes med semi - strukturerade intervjuer. Resultatet visar på att en del brister fortfarande fanns för dessa individer men man kunde se att levnadsförhållandena hade förändrats för dem. Alla deltagare trivdes bra i sina hem men någon önskade våga berätta mer för personalen, om hur de själva ville ha det. Man berättade också att i stora drag va de nöjda med deras godemän och personalens kontaktpersoner. Det var bara en deltagare som hade en kontaktperson. Och beroende på om deltagarna hade gått i pension eller arbetade såg deras självbestämmande för sina arbeten varierande ut.</p>

<p>This study was about disability organisations opinion concerning ICF: s importance in their work to receive the same recognition and human rights for their members as citizens. The aim has been to elucidate disability organisations awareness about and use/non use of ICF and to increase the understanding of ICF: s importance for recognition and redistribution. Three different methods have been used: literature study, questionnaire survey, both on counties' (27) - and national (26) level and interviews (5) on national level. There is also a distinct difference between the disability organisations that represents people with visible impairments, who don’t think that ICF is so useful and they that represent people with invisible impairments, who thinks that ICF is a useful tool. This difference exists both in the use of ICF and the classifications importance for recognition but not ICF: s importance for redistribution. The main conclusion of the study is that awareness about and education around ICF is needed among disability organisations. A restructuring of ICF is also needed, the language should be simplified and the codes should be faded down so that the focus will be on ICF: s intention and the mind map that the classification offers. This is also necessary so that ICF becomes accessible for everybody.</p>

Personer med begåvningshandikapp har inte alltid haft rätten till att leva ett självständigt liv med resterande medborgare ute i samhället. Utan istället har de gömts undan på ett liv vid institutionerna ute på landet. När kommunerna tog över ansvaret för dessa individer förändrades deras levnadsvillkor och rehabiliteringen skulle ske utifrån individernas egna förutsättningar. De skulle även få rätten till egna lägenheter ute i samhället och alla individer skulle behandlas lika. Syftet med denna studie var att ta reda på hur några personer med begåvningshandikapp på C-nivå, kunde uppleva sina egna levnadsvillkor om delaktighet i deras egna LSS insatser på gruppbostäder. Undersökningen bestod av fyra stycken deltagare som hämtades från två olika gruppbostäder. En kvalitativ undersökning valdes med semi - strukturerade intervjuer. Resultatet visar på att en del brister fortfarande fanns för dessa individer men man kunde se att levnadsförhållandena hade förändrats för dem. Alla deltagare trivdes bra i sina hem men någon önskade våga berätta mer för personalen, om hur de själva ville ha det. Man berättade också att i stora drag va de nöjda med deras godemän och personalens kontaktpersoner. Det var bara en deltagare som hade en kontaktperson. Och beroende på om deltagarna hade gått i pension eller arbetade såg deras självbestämmande för sina arbeten varierande ut.

This study was about disability organisations opinion concerning ICF: s importance in their work to receive the same recognition and human rights for their members as citizens. The aim has been to elucidate disability organisations awareness about and use/non use of ICF and to increase the understanding of ICF: s importance for recognition and redistribution. Three different methods have been used: literature study, questionnaire survey, both on counties' (27) - and national (26) level and interviews (5) on national level. There is also a distinct difference between the disability organisations that represents people with visible impairments, who don’t think that ICF is so useful and they that represent people with invisible impairments, who thinks that ICF is a useful tool. This difference exists both in the use of ICF and the classifications importance for recognition but not ICF: s importance for redistribution. The main conclusion of the study is that awareness about and education around ICF is needed among disability organisations. A restructuring of ICF is also needed, the language should be simplified and the codes should be faded down so that the focus will be on ICF: s intention and the mind map that the classification offers. This is also necessary so that ICF becomes accessible for everybody.

Bakgrund: Behovet av reliabla, kliniskt användbara utvärderingsinstrument för sjukgymnastinsatser inom pediatrik är stort. Studien undersöker huruvida klassifikationssystemet ICF (Klassifikation av funktionstillstånd, funktionshinder och hälsa) bidrar till detta. Syfte: Undersöka test-retest-reliabilitet för nio utvalda moment avseende ”Att gå och röra sig omkring” under kapitlet Förflyttning inom komponenten Aktivitet och Delaktighet i ICF för ungdomar med fysiska funktionshinder pga cerebral pares (CP), genom att låta ungdomarna själva och en föräldrer bedöma ungdomens funktionsförmåga. Även undersöka om det föreligger skillnader mellan ungdomarnas respektiveföräldrarnas bedömningar. Metod: Studiematerialet utgjordes av 33 ungdomar, med respektive förälder, på högstadieoch gymnasienivå, med diagnosen CP, GMFCS I-III (Gross Motor Function Classification System). Överenstämmelsen mellan bedömningstillfällena beräknades med hjälp av Spearman Correlation Coefficient samt Elisabeth Svenssons metod för stabilitet mellan två mättillfällen. Skillnader mellan ungdomarnas respektive föräldrarnas bedömningar beräknades med hjälp av Fisher’s Exact Test. Konfidensintervall och Z-score beräknades också utifrån Elisabeth Svenssons metod. Resultat: Beräkningarna avseende överensstämmelse visade sammantaget att sju av de nio momenten bedömdes äga tillfredsställande tillförlitlighet såvida föräldern genomförde bedömningen, medan så var fallet för endast tre av momenten, när ungdomen gjorde bedömningen. Beräkningar avseende skillnader mellan ungdomarnas respektive föräldrarnas bedömningar visade sammantaget signifikant skillnad för tre av momenten. Konklusion: Resultatet visade att sju av de nio testade momenten sammantaget kunde beaktas som reliabla beträffande bedömning av gång- och förflyttningsförmåga för ungdomar med CP, GMFCS I-III. Tillförlitligheten var generellt sett högre såvida föräldern gjorde bedömningen. Skillnader mellan ungdomarnas respektive föräldrarnas bedömningar förekom sammantaget för tre av momenten.

Background: Effective collaboration between health professionals can reduce medical errors and assist in interpretation of health information resulting in improved patient care. The International Classification of Functioning, Disability and Health (ICF) has been suggested as a potential framework to help health professionals develop a common language for better collaboration and to provide more holistic care. In the main, Rwandan district hospitals still utilise the hierarchical medical model of health. Aim: The aim of the study was to determine whether training on interprofessional practice, using the ICF framework, resulted in improved knowledge, attitudes and behaviour(as determined by improved recording of interprofessional assessment and management in patient records) in randomly selected Rwandan District Hospitals. Methodology: This study was composed of two phases. Phase I: Preparation. The intervention programme was developed based on a literature review and input from an international panel of experts. A feasibility study in which self-designed instruments and the training programme were tested was undertaken in one district hospital. Phase II: A Cluster Randomised Control Trial. Four district hospitals were randomly allocated to receive a day’s training in interprofessional practice using the ICF (experimental hospitals) or a short talk on the topic (control hospital). Participants included medical doctors, nurses, physiotherapists, social workers, nutritionists, and mental health nurses/clinical psychologists. Using self-designed and validated measures, pre- and postmeasurements of knowledge and attitudes towards Interprofessional Practice (IPP) were performed at baseline and after training and audit of patients’ records after discharge was performed at baseline and at two, four and six months. The independent t-test and Mann-Whitney U test were used to establish if the two sets of groups were equivalent before and after training at baseline and at two, four and six months. Repeated measures ANOVA and the post-hoc Tukey test were used to compare the audit scores at each time point. The Kruskal Wallis test was used to compare rankings of the scores of attitudes of different professions before and after the intervention. Ethical approval was obtained from the Human Research Ethics Committee of the University of Cape Town and the Rwandan National Ethics Committee.

<p>Parkinsons sjukdom är en neurologisk sjukdom, som främst drabbar motorik, men även kan påverka psykosociala och kognitiva funktioner. Studiens syfte var att kartlägga aktiviteter och upplevd delaktighet hos en grupp personer med Parkinsons sjukdom (n = 10). En semistrukturerad intervju gjordes med genomgång av aktiviteter under ett dygn. Data analyserades utifrån aktivitets- och delaktighetsdomänerna i ICF. Jämförelse med tidigare forskningsresultat visade att personerna i den aktuella undersökningsgruppen ägnade mer tid åt personlig vård, men mindre tid åt vila och TV-tittande. Upplevd delaktighet i aktiviteterna skattades generellt som hög, men en negativ korrelation sågs mellan tid sedan diagnos och delaktighet inom domänen Viktiga livsområden. En stor spridning i materialet indikerar att exempelvis rehabiliteringsinsatser bör baseras på individuell aktivitetsanalys.</p>

Parkinsons sjukdom är en neurologisk sjukdom, som främst drabbar motorik, men även kan påverka psykosociala och kognitiva funktioner. Studiens syfte var att kartlägga aktiviteter och upplevd delaktighet hos en grupp personer med Parkinsons sjukdom (n = 10). En semistrukturerad intervju gjordes med genomgång av aktiviteter under ett dygn. Data analyserades utifrån aktivitets- och delaktighetsdomänerna i ICF. Jämförelse med tidigare forskningsresultat visade att personerna i den aktuella undersökningsgruppen ägnade mer tid åt personlig vård, men mindre tid åt vila och TV-tittande. Upplevd delaktighet i aktiviteterna skattades generellt som hög, men en negativ korrelation sågs mellan tid sedan diagnos och delaktighet inom domänen Viktiga livsområden. En stor spridning i materialet indikerar att exempelvis rehabiliteringsinsatser bör baseras på individuell aktivitetsanalys.