Introduction: Cerebral Palsy (CP) is the most common cause of disability in children. Healthcare providers aim to facilitate optimal function and participation by working with children and their families. The success of this endeavor depends on shared understanding, collaboration, and contextual factors that affect resource availability. The aim of this thesis was to understand parents’ perspectives in Indian and North American cultures towards management of CP using an ICF lens, to evaluate the extent to which this lens is evident in literature conducted in an Indian context and to evaluate a Knowledge Translation (KT) resource to inform parents and healthcare professionals (HCP). Methods: In the five thesis papers: study 1 explored parents’ perspectives towards the management of their children with CP (qualitative design); study 2 described the contextual factors shaping parents’ perspective in India (reflective design); study 3 and 4, described the research trends in the management of CP in India (scoping review); and study 5 describes the development and evaluation of a KT resource created to inform parents about incorporating the ICFconcepts into management of CP. Results: The qualitative study identified that Indian parents focus more on Body Structure and Function (BSF) challenges and have more resource limitations, as compared to the Canadian context. The scoping review identified that research also focuses on BSF, with less research addressing activity and participation, or its environmental determinants. KT resources showing the application of the ICF concepts into CP management received widespread uptake and were perceived as helpful by parents and HCP. Discussion and Conclusion: ICF was useful for understanding and informing parents and HCP about management of CP. Despite the importance of environmental considerations and contextual factors, these were insufficiently addressed in the literature and in stakeholder perspectives. To optimize CP management across contexts, further research and KT is needed. / Thesis / Doctor of Philosophy (PhD) / Cerebral Palsy (CP) is the most common cause of physical disability in children. Parents and professionals from multiple disciplines work together to provide developmental support for children with CP. This thesis explored parents’ views about management of CP in India and Canada; assessed the scope of the scientific literature from India addressing CP; and developed and evaluated educational videos to inform parents and professionals about the use of the International Classification of Functioning, Disability and Health (ICF) in the management of CP. Parents’ views towards their children in both countries are influenced by the availability of resources, professional attitudes, and cultural beliefs. Research in India focuses on ‘fixing’ the child’s impairments. The videos developed to encourage parents and doctors to focus on increasing activity and participation in children, were judged to be useful in creating awareness about the use of the ICF in the management of CP.

Gesellschaftsstrukturelle Veränderungen sowie individuelle Verhaltensweisen wirken sich zunehmend auf das Krankheitsspektrum in Deutschland aus und stellen das Gesundheitssystem vor neue Herausforderungen. Mittlerweile zählen chronisch-degenerative Erkrankungen zu den häufigsten Gesundheitsproblemen. Die positiven Einflüsse von regelmäßig körperlicher Aktivität als adjuvante Therapie auf die Behandlung und den Verlauf sind bei den meisten chronischen Erkrankungen umfangreich dokumentiert. Dabei werden die Potenziale körperlicher Aktivität vielfältig sichtbar und lassen sich auf funktionell somatischer, psychosozialer und pädagogischer Ebene nachweisen. Die veränderten Anforderungen im Gesundheitssystem verlangen auch von sport- und bewegungstherapeutischen Ansätzen eine inhaltliche Anpassung, die gezielt den aktuellen Versorgungsbedarfen gerecht wird und erfordert zur Legitimationsprüfung dieser geeignete Assessmentverfahren, die einem biopsychosozialen Gesundheitsverständnis entsprechen. Es erscheint sinnvoll, neue Zugangswege zur Aufnahme von körperlicher Aktivität zu ebnen bzw. bestehende Strukturen intensiver zu nutzen, um diese Therapieform bedarfsorientierter im Versorgungssystem zu implementieren. Die Ergebnisse der eigenen Forschungsarbeiten zu den Effekten verhaltensorientierter Bewegungsprogramme im Versorgungskanon der Disease Management Programme weisen darauf hin, dass der gewählte Zugangsweg vielversprechendes Potenzial birgt, um die gesundheitliche Versorgung chronisch Kranker vor einem individuellen und zugleich systemischen Bedarf zu verbessern, auch wenn bei der inhaltlichen Ausgestaltung einige Inhalte diskussionswürdig bleiben. Zudem verdeutlichen und begründen die eigenen Forschungsergebnisse, dass bei der Erfassung körperlicher Aktivität im gesundheitsorientierten Sport über eine Perspektiverweiterung nachgedacht werden sollte. In der Sportwissenschaft bedient man sich einer Fülle an Fragebögen, um körperliche Aktivität zu erfassen. Dabei zielen die meisten Inventare darauf ab, den Aktivitätsumfang einer Person oder Population in einen energetischen Outcome oder Zeitumfang zu transferieren und somit zu quantifizieren. Zur Bestimmung der Dosis-Wirkungs-Beziehung von körperlicher Aktivität und bestimmten Gesundheitsparametern ist dies unumgänglich, vor einem biopsychosozialen Gesundheitsverständnis aber nicht weitreichend genug. In der abschließenden Zusammenfassung der Ergebnisse werden diese inhaltlich verknüpft, kritisch diskutiert sowie bewertet und es werden praktische Implikationen und weiterführende Forschungsfragen im Kontext der bewegungsbezogenen Versorgungsforschung erörtert.

Submitted by Ana Damasceno (ana.damasceno@unipampa.edu.br) on 2016-09-13T17:27:22Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) ESTUDOS DE MICROPROPAGAÇÃO EM CONDIÇÕES FOTOAUTOTRÓFICAS EUGENIA UNIFLORA L..pdf: 2307376 bytes, checksum: 051fc4c36e9557f153142034fa726c5a (MD5) / Made available in DSpace on 2016-09-13T17:27:23Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) ESTUDOS DE MICROPROPAGAÇÃO EM CONDIÇÕES FOTOAUTOTRÓFICAS EUGENIA UNIFLORA L..pdf: 2307376 bytes, checksum: 051fc4c36e9557f153142034fa726c5a (MD5) Previous issue date: 2016-04-28 / A Eugenia uniflora L.(Myrtaceae) é uma espécie nativa, que apresenta potencial econômico e farmacológico. A micropropagação é uma importante ferramenta na obtenção de plantas sadias e de alta qualidade. A aclimatização é uma fase limitante devido ao estresse hídrico, decorrência às baixas sobrevivência e capacidade fotossintética são causadas pelas concentrações de sacarose, a alta umidade e a baixa irradiância. A micropropagação fotoautotrófica emprega reduções do açúcar do meio de cultura e da umidade relativa nos recipientes. Também, o aumento do gás carbônico e de ventilação natural ou ventilação forçada. Este trabalho teve por objetivo de testar a micropropagação fotoautotrófica de Eugenia uniflora L., com utilização de quatro concentrações de sacarose (0, 10, 20 e 30 g) e ventilação natural. A interação dos resultados demostraram que a micropropagação fotoautotrófica testada não apresentou bom desempenho e o problema não está na concentração de gás carbônico ou na ventilação natural, mas na qualidade de luz dentro da câmara de crescimento. / Eugenia uniflora L. (Myrtaceae) is a native species, which has economic and pharmacological potential. The micropropagation is an important tool in raising healthy plants and high quality. Acclimatization is a limiting stage due to water stress, due to the low survival and photosynthetic capacity are caused by concentrations of sucrose, high humidity and low irradiance. The photoautotrophic micropropagation employs sugar reductions of the culture medium and the relative humidity in the containers. Also, the increase in carbon dioxide and natural ventilation or forced ventilation. This study aimed to test the photoautotrophic micropropagation of Eugenia uniflora L., using four sucrose concentrations (0, 10, 20 and 30 g), and natural ventilation. The interaction of the results demonstrated that the micropropagation Photoautotrophic tested did not show good performance and the problem is not in concentration of carbon dioxide or natural ventilation, but the quality of light within the growth chamber.

<p>One of the most important challenges of health and medical care is to strength the role of the patient in the treatment. In psychiatric care the patient must be seen as a resource and should be given the opportunity to participate in his treatment. The overall aim of the thesis was to investigate and describe how patients in psychiatric care perceive participation, and how existing assessments support participation.</p><p>Study I describes how patients in psychiatric institutional care perceived their opportunities to be active and to participate in their own treatment. The ICF (International Classification of Functioning Disability and Health) inspired the study. By means of a questionnaire, 61 patients reported their opinions of the value of received care, highlighting concepts such as activity and participation. Ten of those patients were then selected for a semi-structured interview. The study showed that patients who were treated according to compulsory care (LPT) were generally more dissatisfied with their opportunities to be active and participate in their own care than patients treated according to the law of health and medical care (HSL). Younger patients in particular were more dissatisfied. Some important factors in the environment were continuity and reception from the staff. Facilitating factors for activity and participation were agreement between patient and staff about the treatment plan, discussions about expectations, and creating conditions for engagement in activities and or responsibility.</p><p>Study II investigates if there is harmony between the CPRS-S-A (Comprehensive Psychopathological Rating Scale-Self-Assessment), the OCAIRS–S (Occupational Circumstances Interview and Rating Scale) and the OSA (Occupational Self Assessment), and if they can replace each other when the occupational therapist collects information about the patient. Another aim was to investigate how occupational therapist uses the collected information in the treatment plan process. Fourteen patients with depression disorders took part in the study. The study showed that even if the symptoms of the disease were improved at the end of the treatment period the patients still had problems with occupational performance, reduced self-confidence and the structure of their day. Consequently the assessments cannot replace each other. The study emphasized the importance of using both interview and self-assessments when collecting information about the patient, since these methods complement each other in identifying the needs and goals of the treatment. Many problems were related to the patient’s social environment but this was not reflected in the treatment plan; few goals were identified in this area.</p><p>In conclusion, occupational therapists should use self-assessments and interviews in order to support the patient’s participation in psychiatric care. Furthermore, it is important to use assessments for both occupational performance and medical symptoms when identifying the patient’s needs and goals of treatment since there is a discrepancy between the two areas; symptoms are reduced earlier than perceived problems in occupational performance. Regardless of what kind of law the patient is treated under, all patients have the right to participate in their own treatment. This thesis also shows that the social environment is important in enabling the participation of patients in their psychiatric care.</p> / <p>En av de viktigaste utmaningarna inom hälso- och sjukvården är att stärka patientens ställning i behandlingen. Inom psykiatrisk vård så måste patienten ses som en resurs och ges möjlighet att vara delaktig i sin behandling. Det övergripande syftet med denna avhandling var att undersöka och beskriva hur patienter inom psykiatrisk vård uppfattar delaktighet och hur existerande instrument stödjer delaktighet.</p><p>Studie I beskriver hur patienter inom psykiatrisk slutenvård uppfattar sina möjligheter till aktivitet och delaktighet under vårdtiden. ICF (Klassifikation av funktionstillstånd, funktionshinder och hälsa ) inspirerade studien. Genom en enkät svarade 61 patienter på värdet av den vård som de erhöll, där begrepp som aktivitet och delaktighet belystes. Tio patienter valdes sedan ut för en semistrukturerad intervju. Studien visar på att patienter som vårdats utifrån Lagen om Psykiatrisk Tvångsvård (LPT) var generellt mer missnöjda än de patienter som vårdats utifrån Hälso- och Sjukvårdslagen (HSL). Även yngre patienter var mer missnöjda. Några viktiga faktorer i miljön som påverkar möjlighet till delaktighet var kontinuitet och bemötande från personalen. Underlättande faktorer för aktivitet och delaktighet var att det fanns en samstämmighet mellan patient och personal i vårdplaneringen, att förväntningar diskuterades, att förutsättningar till engagemang i aktiviteter gavs och att patienten fick möjlighet att ta eget ansvar.</p><p>Studie II undersöker om det finns harmoni mellan CPRS-S-A (Comprehensive Psychopathological Rating Scale-Self-Asessment), OCAIRS-S (Occupational Circumstances Interview and Rating Scale) och OSA (Occupational Self Assessment) och om de kan ersätta varandra när arbetsterapeuten samlar information kring patienten. Ett annat syfte var att undersöka hur arbetsterapeuten använder den insamlade informationen i behandlingsplanen. Fjorton patienter med depressionssjukdom deltog i studien. Studien visar att även om de medicinska symptomen förbättras i slutet av behandlingen så har patienten fortfarande problem i aktivitetsutförande, nedsatt självkänsla och struktur på dagarna. Bedömningsinstrumenten kan inte ersätta varandra. Studien betonar vikten av att använda både intervju och självskattning vid datainsamling kring patienten, då de kompletterar varandra vid identifiering av behov och mål i behandlingen. Många problem var relaterade till patientens sociala miljö, dock saknades detta i behandlingsplanerna; få mål och åtgärder identifierades inom detta område.</p><p>Sammanfattningsvis, arbetsterapeuten bör använda självskattningar och intervjuer i syfte att stödja delaktighet inom psykiatrisk vård. Dessutom är det betydelsefullt att använda bedömningsinstrument både för aktivitetsutförande och medicinska symptom för att identifiera patientens behov och mål i behandlingen då det är en diskrepans mellan dessa två områden; medicinska symptomen reduceras tidigare än upplevda problem i aktivitetsutförandet. Oavsett vilken lag som styr vårdformen så har alla patienter rätt till delaktighet i sin egen behandling. Denna avhandling visar också på att den sociala miljön är viktigt för delaktighet för patienter inom psykiatrisk vård.</p>

Problem och syfte: Medlemsländerna i Världshälsoorganisationen söker implementera WHO: s klassifikation av funktionstillstånd, funktionshinder och hälsa. Klassifikationen ICF bygger på ett helhetstänkande där människors hälsoegenskaper inom den kontext som deras personliga livssituationer och omgivning skapar beskrivs (Socialstyrelsen, 2003). Specialpedagogiska skolmyndigheten (SPSM) föreslår en mall för kartläggning av elever enligt ICF-CY (Children &amp; Youth Version, 2007) inför upprättande av individuell utvecklingsplan eller åtgärdsprogram. Syftet med undersökningen är att utvärdera hur lärare upplever att mallen skapar förutsättningar för ett gemensamt språk. Metod: Undersökningen är kvalitativ och har en fenomenologisk ansats. Sex lärare har intervjuats enskilt genom halvstrukturerad livsvärldsintervju. Lärarna saknade tidigare erfarenhet av klassifikationen ICF. Perspektivet är språk och implementering. Resultat: Resultatet visar att lärarna upplever otydlighet i hur kartläggningsmallen informerar om bakgrund till ICF, vilka som är kartläggningens målgrupp, i instruktioner för genomförandet av kartläggningen och i de begrepp som används. Lärarnas upplevelser talar för att mallen till stora delar saknar förutsättningar för att skapa ett gemensamt språk.

No description available.

WHO:s klassifikation av funktionstillstånd, funktionshinder och hälsa antogs 2001. ICF är framtaget för att skapa ett gemensamt språk genom olika ICF koder som anses vara användbara både kliniskt och inom forskningen. Genom att länka mätinstrument som redan används, exempelvis självskattningsskalor, till ICF underlättas kommunikation och jämförelser av olika resultat internationellt. Syftet med denna uppsats var att undersöka vilken ämnesspecifik självskattningsskala inom hörselområdet som använts mest inom forskningen mellan åren 2000-2009 och länka den till ICF. Vi använde oss av en systematisk litteratur-studie i form av en totalundersökning för att hitta den mest använda självskattningsskalan inom forskningen. Vid länkningen av den mest använda självskattningsskalan till ICF utförde vi en kvalitativ latent innehållsanalys och länkade självskattningsskalans påståenden systematiskt med hjälp av ICF linking rules. Abbreviated Profile of Hearing Aid Benefit (APHAB) var den mest använda självskattningsskalan inom forskningen mellan år 2000-2009. Länkningsresultatet visade att APHAB utifrån ett ICF perspektiv mäter komponenterna aktivitet och delaktighet, kroppsfunktion och omgivningsfaktorer. Det fortsatta arbetet med utveckling av ett Core Sets for Hearing Loss kommer underlätta användningen både kliniskt och inom forskningen. Ett relevant urval för användning inom hörselområdet gör ICF mer hanterbart, och underlättar därmed användningen av ICF både inom Sverige och internationellt.

Not participating in physical activities is considered to be a risk factor for the health and well-being of children, especially children with physical disabilities. Nonetheless, children with physical disabilities tend to participate less in physical activities than children without disabilities. The aim of this study was to identify what individual and contextual facilitators are suggested to support the participation of children aged 6 to 18 with physical disabilities in physical activities. A systematic literature review was conducted in four databases. The search was limited to articles written in English, peer reviewed and published between January 2006 and March 2016. A qualitative content analysis with focus on a deductive manifest approach was used to analyze the data. Seven articles were selected for data analysis. Results show that facilitators on an individual level include awareness of health benefits, being motivated, having fun, and social aspects such as meeting friends. Facilitators on a contextual level include support from people in the child’s environment, accessibility, adaptive equipment, modifiable activities, positive attitudes from others, available information, knowledgeable instructors, financial support, and transportation. Occupational therapists need to be aware of the facilitators identified on both individual and contextual level when planning interventions. More research with younger children is needed.

No description available.

Hearing loss (HL) is a health condition that affects more than 360 million people worldwide. The findings from previous research point at the adverse relationship between adults with hearing loss and important aspects of everyday life such as social relations, communication and work-related tasks. However, the overall picture concerning the functional and disabling aspects of adults with HL re- mains incomplete. To identify the functional and disabling aspects, a conceptual and/or theoretical framework is required. The International Classification of Functioning, Disability and Health (ICF) offer a multidimensional framework based on bio-psycho-social assumptions about health. In previous research inves- tigations in which the ICF has been used, some utility problems in the linking (relating) of data to the classification have been highlighted. The aims of the present thesis were to explore the areas of functioning and disability of relevance for adults with HL and to explore how audiological data can be linked to ICF. The aims were explored by applying the methodology of the ‘interdisciplinary evidence-based approach to functioning and disability in adults with HL’, acknowledging the merging of three perspectives designated the Researcher, the Patient and the Professional perspective. Four studies that focus on the three perspectives were conducted. All results were linked to the ICF classification. The results were merged into a model designated ‘the integrative model of functioning and disability in adults with HL’. When the three perspectives were linked, the results revealed several aspects of relevance for the target group. Bodily (individual) dimensions, such as hear- ing, auditory perception, memory, attention, energy, and emotions, were acknowledged. Aspects of everyday life such as conversations, the usage of communication strategies, family relationships and work, were highlighted. Influential environmental factors, such as noise, assistive technical devices, the design of public buildings, social support and the attitudes of people in the envi- ronment, were also identified. In conclusion, interactions seemed to be vital as almost all identified aspects highlighted or were tied to this dimension of human functioning. Further, concerning the linking of the data it was acknowledged that the ICF and the research area of adult HL do not fully comply. Suggestions for improvements in future revisions of the ICF were highlighted and discussed. / <p>Funding agency: Oticon Foundation; Hörselforskningsfonden (Swedish HearingResearch Foundation); the Foundation for Audiological Research (FAR) Forskningskommitten, Region Örebro County</p>