Sammanfattning Sedan början av 2000-talet har det skett en markant ökning av studier gällande barn och ungdomar och Autism. Dock är det så att den mesta forskningen fortfarande är inom det medicinska området. Endast ett fåtal av studierna rör vuxna med Asperger syndrom (AS) som studerar på högskola/universitet. Samtidigt sker en ökning av personer med AS som söker högre utbildning såsom högskola/universitet, vilket gör forskning gällande personer med diagnosen AS högaktuell. Antalet studenter med kognitiva funktionshinder, dit AS räknas, som sökt pedagogiskt stöd på högskola/universitet i Sverige, har ökat från 1 427 studenter 2010 till 1 943 studenter 2012. När man studerar på högskola/universitet så finns det pedagogiska stöd att tillgå, och till vardagen finns Lagen om stöd och service till vissa funktionshindrade (LSS) och Socialtjänstlagen (SoL) som personer med AS har möjligheter att söka stöd genom.  Personer med AS kan ibland ha svårt att utnyttja stödsystem som kräver att man själv identifierar och uttalar sina behov av stöd. Denna avhandling fokuserar på personer med AS i högre utbildning och stöd. I doktorsavhandlingen ingår två studier: Studie I som är en fallstudie och Studie II, som är en enkätstudie. Bindningspunkten för studierna är studenter med AS som fått pedagogiskt stöd i sin utbildning vid högskola/universitet. Studie I Studie I består av en fallstudie (Merriam, 1994, 2009; Patton, 2002) som innefattade tre fall. Studien redovisas i artikel I och II, där artikel I bygger på studenternas berättelser och artikel II på anhörigas och samordnares berättelser. Insamlandet av data har byggt på berättelser genom samtal (Doecke, Brown, & Loughran, 2000; Hydén & Brockmeier, 2008; Johansson, 2005; Skott, 2004). Valet av berättelser som metod, innebär att man som forskare fokuserar på att få möjligheter att lära känna en annan person, få kunskap om denna persons erfarenheter, känslor och förväntningar. För att säkerhetsställa undersökningens validitet, användes triangulering mellan tre olika källor: intervjuer med studenter, anhöriga och samordnare. Urvalet av högskola/universitet gjordes med avsikten att inkludera högskolor/universitet från olika delar av Sverige, olika stora högskolor/universitet med olika studieinriktningar. Syfte med Studie I är att undersöka hur studenter med AS i högre utbildning beskriver och förstår sin livshistoria och sin studievardag, vilket redovisas i artikel I och i kappans resultat. Anhöriga är en central resurs för personer med AS. Därför undersöks i den andra artikeln hur anhöriga uppfattar sina barns eller syskons studier och det stöd de tidigare fått i skolan och på högskola/universitet. I artikeln redovisas även hur man upplever det pedagogiska stöd som högskola/universitet erbjuder. Samordnare för studenter med funktionshinder har en central roll i vilka pedagogiska stöd som beslutas att students ska få, därför är det också av vikt att undersöka hur samordnare beskriver den stödverksamhet som finns på högskola/universitet. Även detta redovisas i andra artikeln samt i kappans resultat. Vid insamling av data var fokus på studenternas berättelser om sin studievardag och hur de beskrev sina skolerfarenheter, från förskola fram till högskola/universitet samt hur de såg på sin framtid (Hydén & Brockmeier, 2008). Vid samtalen med anhöriga och samordnare använde forskaren sina yrkeserfarenheter som berör AS, diagnossättande, mediciner, lagar och forskning samt personliga erfarenheter. De anhöriga som intervjuades bestämdes av studenterna och bestod av en mamma, en pappa och en syster. Samordnarna bestod av de som arbetade på den högskola/universitet som studenten studerade på. Samtalsmanual har använts som stöd vid varje samtal. Totalt har tolv samtalsmanualer använts. Samtalens längd för studenterna varierade mellan 1 timma och 4 minuter till 4 timmar och 50 minuter. Samtalens längd varierade mellan 1 timma och 10 minuter till 3 timmar och 23 minuter för de anhöriga. Samtalens längd varierade mellan 1 timma och 13 minuter till 3 timmar och 40 minuter för samordnare. Varje samtal anpassades helt efter varje anhörigs och samordnares intresse av att vilja samtala.  De tre fallbeskrivningarna omfattade femton transkriberade samtal: tre vardera för varje student, en för vardera anhörig och en för vardera samordnare. Första steget i analysen var att forskaren läste igenom det transkriberade materialet kring varje student upprepade gånger så att en känsla för helheten uppstod. Vid tredje genomläsningen gjordes noteringar i form av nyckelord som beskrev innehållet. Därefter plockades de meningar ut som innehöll information som byggde på nyckelorden och var relevanta för frågeställningarna. Den omgivande texten togs med så att sammanhanget kvarstod, det bildade meningsbärande enheter. De meningsbärande enheterna i samtalstexterna kondenserades i syfte att korta ner texten men ändå behålla innehållet. De kodades därefter och grupperades i kategorier som återspeglade det centrala budskapet i samtalen i relation till studenterna. Samma process gjordes med de anhörigas och samordnarnas transkriberade material. I Studie I framkom det att studenter med AS ofta behöver stöd i sin studievardag, det vill säga både i studierna och i vardagslivet, för att klara sina studier. Personer med AS har en kognitiv funktionsnedsättning som kan ge svårigheter i deras studievardag, och de har ofta en nedsatt förmåga att beskriva sina svårigheter och kan därför inte alltid redogöra för vilka behov de har. När man söker stöd bygger ansökan på att man själv kan beskriva sina behov av stöd och framför allt välja bland de stöd som finns utifrån det behov och de svårigheter man har, det vill säga man ges en stor valfrihet. För studenter med AS kan detta bli till en stor svårighet då de ofta inte själva vet vilka stöd de har behov av och vad de olika stöden skulle innebära för de studiesvårigheter de har. Studenterna i studierna angav att när de fick stöd hade de svårt att förstå hur stödet skulle fungera och hur det skulle kunna förbättra deras studier, och att det pedagogiska stödet i stället blev till ytterligare ett hinder, som tog tid och fokus från studierna. Stödinsatsen med vidhängande valfrihet kan ses som ett uttryck för en ekvifinalitet: stödsystemet har designats för att ge olika funktionshindrade samma möjlighet, och utgångspunkten är att valfrihet är bra för alla. Många av studenterna har beskrivit att de känner sig socialt begränsade och har kommunikationssvårigheter och de upplever att de är stigmatiserade och känner sig alienerade. I analysen av studenternas beskrivning av sin livshistoria och studievardag framstod två teman, Kamp och Utanförskap. Anhöriga beskrev att kraven på fokusering, både på vardags- och studentaktiviteter, blev övermäktiga för deras barn eller syskon. De kunde se att deras barn eller syskon hade svårigheter med att planera inköp av exempelvis mat, att laga mat, att tvätta och sköta andra vardagsrutiner i hemmet. Samordnare för studenter med funktionshinder utryckte att även om de kunde se att studenter hade problem med vardagsrutiner i hemmet,  kunde de inte ge något stöd för detta. De hade också svårt att erbjuda stöd i vissa studietekniska frågor. Samordnarna beskrev att det är svårt att ställa frågor om en students funktionshinder, diagnos och livssituation och att det är svårt att få grepp om vilket stöd som skulle kunna bli bra för varje enskild student. Sammantaget så har det framkommit att studenter med AS har behov av både pedagogiskt stöd och stöd i vardagsrutiner och det framkom också i studierna att de olika stöden behöver samordnas så att studenter med AS erhåller stöd i hela studievardagen. Det framkom också att det finns behov av ett kunskaps- och kommunikationsverktyg för framför allt samordnare och studenter. Detta verktyg skulle kunna användas av samordnare och student så att en tydlig agenda upprättas och följs vid samtalen och beslut om vad eller vilka pedagogiska stöd som studenten skulle kunna få som stöd i studierna. Studie II Studie II består av en enkätstudie, bestående av 55 frågor med både öppna och slutna svarsalternativ, riktat till studenter med AS, studenter med rörelsehinder (RH) och studenter med hörselnedsättning (HN). Även i denna studie står studenter med AS i fokus, men med mer generell frågeställningar: Hur beskriver studenter med AS, RH och HN upplevda problem, erhållet stöd och upplevt stöd? Finns det skillnader och likheter mellan dessa tre grupper av studenter? Resultatet redovisas i artikel III samt kappans resultat. Syftet med studie II är också att undersöka vilka karaktäristika för studenter med AS som kan identifieras och bedömas som så viktiga att de med stöd av Internationella klassifikation för funktionstillstånd, funktionshinder och hälsa kan behöva ingå i ett code set. Resultatet redovisas i artikel IV samt i kappans resultat. Under arbetet med Studie I uppkom funderingar på om det fanns studentgrupper med andra funktionshinder som har samma erfarenheter som studenter med AS. Därför utökades urvalet till studenter RH och HN. Studie II var beskrivande med en mixed methods design. Den första delen hade en huvudsakligen kvantitativ ansats med data insamlade via en enkät. Till enkätstudien tillfrågades alla högskolor/universitet om de var intresserade att delta i undersökningen. Det var 14 samordnare på 12 högskolor/universitet som tackade ja till att medverka och de tillfrågade sedan de studenter som kunde vara aktuella att medverka i undersökningen. Respondenter blev 34 studenter som studerade vid 12 svenska högskolor/universitet, 16 studenter med AS, 11 med RH och 7 med HN. Eftersom endast 34 studenter kunde rekryteras betraktas detta som en pilotstudie. Den kan ge en första antydan om hur studievardagen upplevs av studenter med funktionshinder och om det finns någon skillnad mellan de tre undersökta grupperna av studenter när det gäller svårigheter och behov av stöd.  I den andra delen av studie II togs ett första steg till ett code set, en början till ett kommunikationsverktyg, det vill säga en samtalsmanual mellan samordnare och studenter, samt som information till anhöriga. Analysen hade en deduktiv, kvalitativ ansats. Data från flera olika källor, bland annat enkäterna, analyserades och jämfördes genom att innehållet länkades till ICF-koder. Avsikten var att identifiera preliminärt innehåll i ett code set.   Analysen av enkäterna var kvantitativ så långt materialet medgav det, och grupperna jämfördes genom så kallad korstabulering. Nästa steg i analysen (Code set förberedelsen) fokuserade endast på studenter med AS. Information i enkäten länkades kvalitativt deduktivt till ICF tillsammans med information från fem olika källor som representerar olika perspektiv: 1) Studenters egna beskrivningar, 2) Internationella diagnosklassifikationer, 3) Nationella policy-dokument för högre utbildning, 4) Hälso- och sjukvården, 5) Brukarorganisationen Autism och Aspergerförbundet. De fem olika källorna innefattade tio dokument som valts utifrån inklusionskriterierna målgruppen AS, åldersgruppen unga vuxna, undervisning/utbildnings-krav för högre utbildning, insatser/behov av stöd samt nationella/internationella källor med anknytning till målgruppen. Syftet var att integrera flera olika perspektiv på behov av stöd i studievardagen för studenter med AS. Därmed kunde en första lista med ICF-koder identifieras som underlag till ett code set för studenter med AS på högskola/universitet. I Studie II framkom det att även om studenter med AS verkade rapportera samma svårigheter, varierade förklaringarna som gavs till problemen mellan grupperna. När det gällde förklaringar verkade det för studenter med AS vara kopplat till kognitiva svårigheter medan det för studenter med rörelsehinder (RH) och hörselnedsättning (HN) var kopplat till fysiska svårigheter. På ytan kan de olika gruppernas svårigheter alltså se lika ut och de kommer då att erbjudas samma pedagogiska stöd från sin högskola/universitet. I enkätsvaren framhölls att det var väldigt viktigt för studenterna att kunna få ett arbete efter avslutade studier för att därmed få möjligheter att kunna försörja sig och leva ett vanligt liv som alla andra. Innan dess måste dock studierna genomföras och i den studievardag som beskrevs, talades det om kamp och utanförskap. Några av de erfarenheter som lyftes fram av alla grupperna studenter var, stress och koncentrationssvårigheter, trötthet, och social begränsning . I Studie II framkom alltså samma problem som i Studie I med att tydligt uttrycka svårigheter och behov. Det indikerar att det finns behov av ett kunskaps- och kommunikationsverktyg för samtal mellan samordnare och studenter. Ett ICF baserat code set för högre utbildning för studenter med AS skulle kunna vara ett sådant verktyg. Ett code set består av ett antal kategorier från ICF och beskriver de svårigheter som studenter med AS kan ha och som kan bilda en checklista att arbeta utifrån vid samtal, planering av stöd och information till annan personal. Det ska vara så tydligt att det kan ges till studenten i förväg så att studenten får möjligheter att förbereda sig på vad samtalet och mötet innebär. Avslutningsvis har det framkommit att om studenter med AS ska bli inkluderade i högre utbildning och om uteslutningsmekanismer såsom stigmatisering och alienation ska motverkas, krävs det troligen tydligt strukturerade individuella lösningar: Stödet ska ge en öppning mot en multifinalitet istället för den ekvifinalitet som idag råder vid erbjudande av stöd. Lösningar och stöd ska inte bara vara baserade på en diagnos, utan på en analys av varje students upplevda svårigheter sett ur perspektivet hela studievardagen. Först då kan stöden bli till de verkligt frigörande möjligheter som är avsikten. / Summary Since the beginning of the 21st century there has been a significantly increased number of studies on children and young adults with Autism Spectrum disorder (ASD). Most of this research falls within the domain of Medicine and only limited number of studies focusses on adults with Asperger Syndrome (AS) as students at university. Considering that there is an increase in numbers of individuals diagnosed with AS attending tertiary education researching this group of individuals is both timely and opportune. The number of students with cognitive disabilities, such as AS, seeking assistance to help their study efforts along at universities has increased in Sweden from 1427 students in 2010 to 1943 students in 2012. It should be noted that support in everyday student-life is guaranteed by legislation (that is, by Social Service Act (SoL) and  Support and Service for Persons with Certain Functional Impairments (LSS)) and that this same guarantee is valid also of studying at university. However, individuals with AS may at times have difficulty using available support, since they must identify their own needs and also communicate the nature of their need. This doctoral thesis is focusing on individuals with AS in need of such support in tertiary education. The thesis is comprised by two main studies: Study I, which is a case study, and Study II, which is a survey. Their common denominator is students with AS who have received legally guaranteed support as university students. study I The first study is a case study of three cases. This research is reported in the two first articles of the four articles comprising the entire thesis. The first article focusses on student narratives, whereas article two rather focusses on the accounts of next of kin as well as those of university coordinators I charge of assisting students in need. Data were collected through conversations.  The particular choice of method allows for the researcher to acquire more intimate knowledge of the participants learning of their experiences, feelings and expectations. To secure validity the data from students, next of kin and university coordinators was triangulated. Number and type of universities included in the study were sampled on the principle that there should be included universities from different parts of Sweden, of different sizes and with different academic profiles. The aim of Study I was to investigate how students with AS, as students in tertiary education, describe their life history and their everyday student-life. This particular focus is reported in the first article. Next of kin are central to individuals with AS. In the second article therefore, the perceptions of next of kind and how these understand their children’s or sibling’s university studies as well as the available support for them are accounted for. Also university coordinators in charge of study assistance at universities are of considerable importance. They decide the manner of support provided. It is therefore important to also describe how these outline and assess the existing support. This too is the focus of the second article. During data collection the focus was on students’ narratives of their everyday student-life at university as well as how they experienced their entire education experience from pre-school and to tertiary education. The views of their own future was also an issue that was addressed. The conversations with participants were facilitated by the researcher in terms of conveying previous research results on the nature of AS individuals’ experience of university education; of the researcher’s professional experiences of the situation and also of herself being next of kin to an individual with an AS diagnosis. As a means of helping conversations with next of kin and coordinators along the researcher used her own professional experience in relation to AS individuals, diagnosing, medication, legal framework, previous research and personal experience. Which next of kin to be interviewed - a mother, father and a sibling - was decided by the participating students themselves. For each university there is generally only one coordinator. These participated in the study. A conversation manual has been used as support for each data collecting conversation. In all, twelve such manuals have been used. The length of the conversations with participating students varied between 1 hour and 4 minutes to 4 hours and 50 minutes. Conversations with next of kind varied between 1 hour and 10 minutes to 3 hours and 23 minutes and for coordinators the duration varied between 1 hour and 10 minutes to 3 hours and 40 minutes. Every conversation was entirely adapted to each participating individual and their willingness to converse about the subject matter. The three cases were comprised of 15 transcribed conversations: three for each student, one for each next of kin, and also one for each university coordinator. As a first step in analysing the data the researcher read transcriptions multiple times to lay foundations for an understanding of entirety. During the third read notes were taken in the form of key words significant to content. Extraction of sentences containing these keywords followed. Key words were always significant in relation to the research questions. The surrounding text was taken too in order to preserve context. Together the keywords, the sentences and the surrounding contexts constituted meaningful units of text. These units, in every transcribed conversation, were condensed in order to shorten texts but still maintain the essence of its meaningful content. The condensed text units were coded and grouped in categories that reflected the essential and meaningful content of the conversations. Data culled from the next of kin and the coordinators were submitted to the same process of data analysis. Results showed that students with AS often do need assistance at university both in terms of studying as well as in their daily life off campus in order to manage an existence as students. Individuals with AS however have a cognitive disability that may challenge their efforts as students. In addition, they have difficulties describing their problems and often find it hard to define which needs for assistance they do have. When applying for assistance students are required to specify their special needs of support, and more importantly, also choose what kind of assistance they require. In other words, they are given a considerable freedom of choice. To students with AS this presents an obstacle. They often do not know what kind of assistance they require and what a certain kind of support would entail. Participating students reported that it was difficult for them to grasp how the support would actually function and how it would improve their studying. Instead, the possibility of acquiring support became yet another problem which made studying even more difficult for them. The availability of support with the accompanying freedom of choice as to the manner and content of the support may be seen as an expression of equifinality. That is, the support system has been designed to provide each disabled individual with equal opportunity of attaining support. The basic value underpinning the support system is that freedom of choice is valuable to each and every one. However, many students with AS have reported that they feel socially limited, alienated even stigmatised and that they communicate poorly. In analysing the narratives of students’ life histories as well as their everyday student-life as students two themes emerged: Struggle and Alienation. The next of kin described the demands of focus, both on and off campus, to be overwhelming for their children or siblings. They observed difficulties with planning ahead to shop for groceries, to do laundry, to cook or to do sundry domestic chores at home. University coordinators understood that students had such problems off campus but could not offer assistance relating to off-campus difficulties. However, they also found it difficult to offer these students assistance pertaining to certain aspects of student life. They found it tricky to pose questions regarding students’ disability, diagnosis and general life situation. It was thus a problem for them to acquire an understanding of what kind of assistance that would be suitable for each individual student. In all, the research clearly showed that students with AS are in need of both educational support and everyday student-life support and that these two aspects of assistance need to be coordinated. Results also suggested the need of a tool for knowledge and communication, especially for students and university coordinators. Such a tool would facilitate the communication and would serve as a basis in deciding what kind of remedial action that needs to be taken for the benefit of students with AS. Study II The second study was operationalized as a survey study employing a questionnaire consisting of 55 questions of which some were open-ended. This instrument was administered to students with Asperger Syndrome (AS), to students with mobility impairment (MD) and to students with impaired hearing (HD). Note that abbreviations relate to the Swedish nomenclature for these disabilities. This study also focussed on students with AS but addressed more general questions: How do students with AS, MD and HD describe problems, provided support and the experience of being given support? Are there similarities or differences between these three groups of students? This research is presented in the third article of the doctoral thesis. The aim of the second study was also to explore what characteristics of students with AS could be identified as particularly important in an effort to classify them as a code set with the framework of the International Classification of Functioning, Disability and Health (ICF). A code set consists of a number of categories derived from the ICF classification system. It describes the type and nature of difficulties that for example students with AS may experience, thus constituting a checklist from which to work when university coordinators and students discuss the nature and manner of support needed and then succinctly be able to convey such information to other relevant staff. Such a tool will need to be straight-forward and given to students prior to meeting the coordinators in order to help students prepare for the meeting being fully informed of its content and purpose. The result of this exploratory second study is presented in the fourth article.  As the study of AS student cases progressed there arose questions regarding other students with different kinds of disability also. Do they have the same or similar problems? For this reason a second study was launched and mobility impaired students (MD) and hearing impaired students (HD) were included also. This study was descriptive but operationalized as a mixed methods design. The first part of it consisted of a quantitatively based questionnaire. All Swedish universities and higher education institutions were invited to take part. Fourteen coordinators from 12 universities accepted. They in turn asked students to take part. In all, 34 students decided to participate. These were divided into the following categories: 16 (AS), 11 (MD) and 7 (HD). Due to the relatively low number of participants the study is best considered to be a pilot study. It could be suggestive in reference to how everyday student-life on campus might be experienced by students with different disabilities and whether there are differences between the three studied groups in need of support. In the second part of the second study a first step was taken towards creating a code set; the beginning of a communication tool serving as a conversation manual between coordinator and students. The analysis of the data was qualitative but deductive. Data from several sources, including the questionnaire, were analysed, compared and linked to ICF-codes in order to identify a tentative content of a potential code set. The data culled by the questionnaires was first cross-tabulated. The next phase of the analysis was the code set preparation, focussing only on students with AS. Analysed data were linked qualitatively and deductively to ICF together with information from five different sources: 1) Student narratives, 2) International diagnosis classifications, 3) National policy-documents of higher education, 4) National healthcare and 5) The Swedish Autism and Asperger Syndrome Association. In all, 10 documents were included on the basis of  the AS target group, age group young adults, education and education guidelines for higher education, remedial work, need of support as well as national and international sources relating to the target group. The aim was to integrate several perspectives of needs of support in reference to AS students and their everyday student-life on a university campus. Results of the second study showed that even though other groups also reported problems similar to those of the AS students their explanations varied. While the problems of AS students appeared linked to cognitive difficulties, the problems of mobility impaired students (MD) and hearing impaired students (HD) were linked to physical difficulties. The difficulties and each group would appear similar at first sight which in practical terms means that they also would be offered the same kind of support as students at university The analysis of the questionnaire suggested the importance of students acquiring a job after graduation, to be able to earn a living and lead a normal everyday student-life like most others. However, prior to such a possible future studies must be completed and participants’ experiences of being university students appeared not the best. They spoke of struggle and alienation. Some of the experiences common to all three groups were stress and concentration difficulties, fatigue and social limitations. Hence, the second study, just like the first study, clearly showed both problems and needs, which suggested the necessity of a knowledge and communication tool for coordinators and students. An ICF-based code set for students with AS in higher education could serve as such a tool. In conclusion, results also suggested that if students with AS are to be included in higher education, and exclusion mechanisms such as stigmatisation and alienation be overcome, then clearly structured solutions - individual to each student - are also needed. Offered support must conform to multifinality rather than to equifinality as is currently the case in Sweden. Individual support cannot be based entirely on a diagnosis but also on an analysis of each student’s experienced difficulties in their immediate university environment of studying. Then, possibly, the available and legally guaranteed support would become as empowering as it was intended to actually be.

Under våren 2021 har det organiserade lärande nätverket för chefer, Nätverk för engagerat ledarskap i Region Jönköpings län, haft digitala träffar genom mötesplattformen Cisco eller Skype i stället för fysiska träffar p.g.a. de rådande samhällsrestriktionerna. Rapporten belyser samtalsledares och nätverks-deltagares mellanmänskliga interaktion och deras anpassningar till digitala arbetssätt, under en tidsperiod där digitaliseringen inom hälso- och sjukvården påskyndats av covid-19-pandemin. Undersökningens syfte är att beskriva samtalsledares erfarenheter av digitala nätverksträffar (vid Nätverket för engagerat ledarskap i Region Jönköpings län) med fokus på kommunikation och vad de beskriver för möjliga förbättringar, utifrån ett delaktighetsperspektiv. Samtliga 40 samtalsledare blev tillfrågade att medverka i undersökningen, varav sex (6) gjorde intresseanmälan. En av dem avbokade dagen innan och fem (5) genomförde gruppintervjun digitalt på mötesplattformen Zoom. Intervjun spelades in efter samtycke och varade 60 minuter. Materialet bearbetades först genom en förenklad induktiv tematisk analys, med stöd av en analysguide inspirerad av Braun och Clarke (2006). Därefter beskrevs analysresultatet utifrån ICF:s första nivå för att belysa resultatet ur ett delaktighetsperspektiv. Fyra teman framkom; digitala utmaningar, mellanmänskliga interaktioner, framtidens behov och ”kriterier” för framgångsrikt digitalt nätverkande. Ett stort problem vid de digitala nätverksträffarna har varit bristande eller fördröjd feedback. Ett annat problem har varit svårigheter med sammanhållningen och att skapa tillit i det digitala rummet. Examensarbetet har gett upphov till förbättringsförslag för ett framgångsrikt digitalt nätverkande ur ett delaktighetsperspektiv. Digitala nätverksträffar kan ses som ett alternativ eller komplement till fysiska träffar även i framtiden. Kanske kan vi framöver hitta det ”bästa receptet” för digitala nätverksträffar för en effektiv och jämlik hälso- och sjukvårdsorganisation? / During the spring of 2021, the organized learning network for managers, Network for Engaged Leadership in Region Jönköping County, has held digital meetings in applications provided by Cisco and Skype instead of having physical meetings due to the current societal restrictions. The report highlights interpersonal interaction between moderators and networking participants, and their adaptations to digital ways of working, in a time where digitalization in healthcare has been accelerated due to the COVID-19 pandemic. The purpose of the survey is to describe moderators' experiences with digital networking meetings (at the Network for Engaged Leadership in Region Jönköping County). The study focuses on communications and how improvements can be made to increase the participation and the engagement of the participants. All 40 moderators within the network were asked to participate in the survey, of which six (6) made expressions of interest. One of them canceled the day before and five (5) participated in the group interview digitally using the application Zoom. The interview was recorded with consent and lasted 60 minutes. The material was first processed through a simplified inductive thematic analysis, supported by a guide inspired by Braun and Clarke (2006). The results were then described, using the first level of the ICF, in terms of participation. Four themes were deduced: digital challenges, interpersonal interactions, future needs, and "criteria" for successful digital networking. The lack or delay of feedback has caused major issues at the meetings. Other difficulties have been the lack of affinity and trust within the group. This study has resulted in several proposals for improving digital networking by increasing accessibility. Digital networking meetings can be seen as an alternative or a complement to physical meetings. Perhaps we can find the "best recipe" for digital networking meetings for an effective and equal healthcare organization? / <p>Examen i vårdadministration, YH-utbildning: 20 Yh-poäng.</p>

Made available in DSpace on 2016-04-27T18:12:01Z (GMT). No. of bitstreams: 1 Final para biblioteca.pdf: 517561 bytes, checksum: 8ada3b8358b7ff570de6993d1d52b7c9 (MD5) Previous issue date: 2013-05-27 / Introduction: the International Classification of Functioning, Disability and Health offers a positive outlook of categorization to the individual that presents changes on function and/or of the structure of the body. Aims to describe the nature and severity of the limitations of functionality (OMS 2011). It is used as a statistical tool, clinical, educational, research and social policy. This classification has been incorporated and used in the sectors of health and multidisciplinary teams. Objective: to verify the applicability of the Hearing Handicap Inventory for the Elderly, to classify individuals according to the categories of the International Classification of Functioning, Disability and Health; establish the categories of the International Classification of Functioning, Disability and Health to individuals who have hearing loss and investigate the prevalence of changes to functionality in individuals with hearing loss. Method: it was applied the Hearing Handicap Inventory for the Elderly and then select the categories of the International Classification of Functioning, Disability and Health. Results: 44.83% showed severe perception of its inability. 62.1% presented: moderate hearing loss that affects the body's functions, the mental functions, perception and hearing (cod b1560.1), moderate hearing loss that affects the body's functions, sensory functions, the auditory functions and the detection of sound (cod b2300.1), qualitative change in the structure of the inner ear, in this case being characterized as sensorioneural bilateral moderate hearing loss (cod s2609.173); 62.1% does not present difficulty for situations involving conversation activities with the family (cod d 3508.0_); 58.6% does not present difficulty in hearing functions of auditory discrimination (cod b2308.0); 69.0% presents much difficulty to hear in their participation activities (cod d115.4 _), does not present difficulty in controlling emotions and impulses in complex personal interactions (cod d7202.0_), does not present difficulty to attend religious services (cod d 9309.0_); 51.7% presents great difficulties to participate in community life when it comes to ceremonies (cod d 9102.4_). Conclusion: the ICF offers important applicability to categorize individuals with hearing loss; the questionnaire used is partially applicable to classify on a complete form, the disabilities of the subjects with hearing loss / a Classificação Internacional de Funcionalidade, Incapacidade e Saúde propõe uma perspectiva positiva de categorização para o indivíduo que apresenta alterações de função e/ou da estrutura do corpo. Tem como objetivo descrever a natureza e a gravidade das limitações de funcionalidade (OMS 2011). Ë utilizada como uma ferramenta estatística, de pesquisa, clínica, pedagógica e de política social. Esta classificação vem sendo incorporada e utilizada nos setores da saúde e equipes multidisciplinares. Objetivo: verificar a aplicabilidade do Questionário de Auto-avaliação do Handicap Auditivo para Idosos, para classificar indivíduos segundo as categorias da Classificação Internacional de Funcionalidade, Incapacidade e Saúde; estabelecer as categorias da Classificação Internacional de Funcionalidade, Incapacidade e Saúde, para indivíduos que apresentem perda auditiva e investigar a prevalência de alterações na funcionalidade em indivíduos com perda auditiva. Método: foi realizado o Hearing Handicap Inventory for the Elderly e posteriormente selecionadas as categorias da Classificação Internacional de Funcionalidade, Incapacidade e Saúde. Resultados: 44,83% apresentaram percepção severa de sua incapacidade. 62,1% apresentaram: perda auditiva moderada que afeta as funções do corpo, as funções mentais, de percepção e auditiva (cod b1560.1), perda auditiva moderada que afeta as funções do corpo, as funções sensoriais, as funções auditivas e a detecção do som (cod b2300.1), alteração qualitativa na estrutura do ouvido interno, neste caso sendo caracterizada como perda auditiva sensorioneural moderada bilateral (cod s2609.173); 62,1% não apresenta dificuldade para situações que envolvam atividades de conversação com a família (cod d3508.0_); 58,6% não apresenta dificuldade nas funções auditivas de discriminação auditiva (cod b2308.0); 69,0% apresenta muita dificuldade para ouvir nas suas atividades de participação (cod d115.4_), não apresenta dificuldade em controlar emoções e impulsos nas interações pessoais complexas (cod d7202.0_), não apresenta dificuldade para frequentar serviços religiosos (cod d9309.0_); 51,7% apresenta grande dificuldade para participar na vida comunitária quando se trata de cerimônias (cod d9102.4_). Conclusão: a CIF apresenta importante aplicabilidade para categorizar indivíduos com perda auditiva; o questionário utilizado é parcialmente aplicável para classificar de forma completa as incapacidades dos sujeitos com perda auditiva

The purpose of the present work was to study hand impairments and manual ability in children with cerebral palsy (CP) as well as to clarify their relationship. Appraising the degree of hand impairments requires normative data to differentiate the real dysfunctions of CP children from the normal difficulties according to their age, sex, or handedness. As there is no normative data for gross manual and fine finger dexterity, a first experiment focused on the normal development of manipulative functions was conducted to establish these norms. A second experiment was carried out to develop and validate through the Rasch model a measure of manual ability in children with CP since such a measure was not yet available. The invariance of the ABILHAND-Kids questionnaire was also tested across relevant demographic and clinical subgroups of CP children. Finally, a third experiment was performed to quantify the hand impairments in children with CP and to investigate their relationship with manual ability as measured with the ABILHAND-Kids questionnaire. Hand motor impairments, markedly more prevalent than hand sensory impairments, were moderately correlated with manual ability measures and predicted 58% of their variance. Consequently, manual ability cannot simply be inferred from hand impairments and should be measured and treated per se. / L'objectif de ce travail était d'étudier les déficiences de la main et l'habileté manuelle chez les enfants infirmes moteurs d'origine cérébrale (IMOC) ainsi que de clarifier leur relation. Apprécier la gravité des déficiences de la main nécessite des données normatives afin de différencier les dysfonctionnements réels des enfants IMOC des difficultés normales compte tenu de leur âge, sexe, ou latéralité. Etant donné l'absence de normes quant à la dextérité manuelle grossière et la dextérité digitale fine, une première étude a été réalisée afin d'examiner le développement normal de ces deux types de dextérité. Des normes sur les dextérités manuelle grossière et digitale fine ont ainsi pu être établies. Une deuxième étude a été effectuée afin de développer et valider à travers le modèle de Rasch une mesure de l'habileté manuelle chez les enfants IMOC. L'invariance du questionnaire ABILHAND-Kids a également testée à travers différents sous-groupes démographiques et cliniques d'enfants IMOC. Enfin, une troisième étude a été réalisée afin de quantifier les déficiences de la main chez les enfants IMOC et d'investiguer leur relation avec l'habileté manuelle. Les déficiences motrices de la main, plus prévalentes que les déficiences sensitives, étaient modérément corrélées avec les mesures d'habileté manuelle et prédisaient 58% de leur variance. En conséquence, l'habileté manuelle ne peut être simplement inférée à partir des déficiences de la main et devrait donc être mesurée et traitée pour elle-même.

The purpose of the present work was to study hand impairments and manual ability in children with cerebral palsy (CP) as well as to clarify their relationship. Appraising the degree of hand impairments requires normative data to differentiate the real dysfunctions of CP children from the normal difficulties according to their age, sex, or handedness. As there is no normative data for gross manual and fine finger dexterity, a first experiment focused on the normal development of manipulative functions was conducted to establish these norms. A second experiment was carried out to develop and validate through the Rasch model a measure of manual ability in children with CP since such a measure was not yet available. The invariance of the ABILHAND-Kids questionnaire was also tested across relevant demographic and clinical subgroups of CP children. Finally, a third experiment was performed to quantify the hand impairments in children with CP and to investigate their relationship with manual ability as measured with the ABILHAND-Kids questionnaire. Hand motor impairments, markedly more prevalent than hand sensory impairments, were moderately correlated with manual ability measures and predicted 58% of their variance. Consequently, manual ability cannot simply be inferred from hand impairments and should be measured and treated per se. / L'objectif de ce travail était d'étudier les déficiences de la main et l'habileté manuelle chez les enfants infirmes moteurs d'origine cérébrale (IMOC) ainsi que de clarifier leur relation. Apprécier la gravité des déficiences de la main nécessite des données normatives afin de différencier les dysfonctionnements réels des enfants IMOC des difficultés normales compte tenu de leur âge, sexe, ou latéralité. Etant donné l'absence de normes quant à la dextérité manuelle grossière et la dextérité digitale fine, une première étude a été réalisée afin d'examiner le développement normal de ces deux types de dextérité. Des normes sur les dextérités manuelle grossière et digitale fine ont ainsi pu être établies. Une deuxième étude a été effectuée afin de développer et valider à travers le modèle de Rasch une mesure de l'habileté manuelle chez les enfants IMOC. L'invariance du questionnaire ABILHAND-Kids a également testée à travers différents sous-groupes démographiques et cliniques d'enfants IMOC. Enfin, une troisième étude a été réalisée afin de quantifier les déficiences de la main chez les enfants IMOC et d'investiguer leur relation avec l'habileté manuelle. Les déficiences motrices de la main, plus prévalentes que les déficiences sensitives, étaient modérément corrélées avec les mesures d'habileté manuelle et prédisaient 58% de leur variance. En conséquence, l'habileté manuelle ne peut être simplement inférée à partir des déficiences de la main et devrait donc être mesurée et traitée pour elle-même.

The overall aim of this research project was to explore and describe the significance of assistive devices in daily life. The project involves two qualitative and two quantitative studies. Three of these studies were from the perspective of persons with stroke and one from the perspective of spouses of persons with stroke. A hermeneutic phenomenological lifeworld approach was used in the qualitative studies and data was obtained through conversational interviews with the two study groups, 22 persons with stroke and 12 spouses of persons with stroke, after the devices had been used for about a year. The results indicated that the lived experiences of assistive devices in respect of the different lifeworld existentials (lived body, lived space, lived time, lived human relation) are closely interconnected in both study groups. The lived body existential included aspects of habits, feelings and the incorporation, figuratively speaking, of the devices into their own bodies. Lived space concerned the gradual development of a new view of the environment and the devices’ role as a prerequisite for being able to live at home. The devices brought about a changed relation to lived time with respect to the temporal perspectives of past, present and future. To be able to take control of one’s own time was an important experience that the devices facilitated. Assistive devices were an integral part of the lived human relation between the couples in the study groups, as well as between the disabled persons/spouses and other people, including the health-care professionals. The devices contributed either to the maintenance or the change of social roles, but they sometimes also gave rise to the experience of being stigmatised. The results in the case of both study groups showed that the use of different devices is complex and often contradictory, especially when it comes to persons with stroke. Overall the persons’ experiences of the advantages of the devices overshadowed their experiences of the disadvantages. The quantitative studies included a pre- and post-assessment design. Thirty-two persons with disabilities after stroke were included. The impact of an outdoor powered wheelchair on activity and participation (IPPA, WHODAS II) and quality of life (PIADS, EQ-5D) was measured. Statistical analysis with mainly non-parametric tests was used to determine significant within-group and between-group changes after intervention. The conceptual framework ICF was used in one of the quantitative studies when classifying the participants’ stated problems. The results showed that the outdoor powered wheelchair is an essential device for persons with disabilities after stroke with regard to overcoming activity limitation and participation restrictions in everyday life. Furthermore it mostly has a positive impact on such users’ quality of life. However, it is also important to highlight the negative experiences of a few with regard to the use of powered wheelchairs. In sum, these results will enable prescribers to better understand the individual experiences of using assistive devices and the individuals’ and the families’ need for support in connection with the prescription of assistive devices, the particular example being powered wheelchairs.

Any disability can bring disadvantages in many aspects of human lives. This often affects physical, mental and social areas of life. It depends on many circumstances and factors to what extent and at what intensity disability influences the way of life. The research part of my diploma thesis confirms this fact. Not only the type of disability and its prognosis, the personality and his/her ability to handle difficult situations in life, but also the quality of social relationships and the strength of the social safety net are important factors. Irreplaceable role in caring for people with a disability has comprehensive rehabilitation, which helps not only to improve the health condition, to restore job skills and self-sufficiency, but mainly supports a successful return to the home environment as well as to the regular everyday life.The aim of my thesis was to learn about individual life stories of people struggling with a disability of physical functions, whether due to an illness, injury or another disability, resulting in movement disorders, and to find out how the disability affects their lives. I tried to analyze specific aspects of life and social consequences of disability (coping with disabilities,value orientation, interpersonal relationships, future plans, self-realization). The base of my work is the holistic, i.e. bio-psycho-socio-spiritual approach, I respect the individuality of each individual, his/her attitude to life with a handicap (disability).

Abstract Unemployed are known to be in poorer health and to use less health care services compared to those employed. However, evidence on the work ability of the unemployed remains scarce. The methods of assessing work ability are very divergent, not least because a shared understanding on the concept of work ability is lacking. Furthermore, the aspect of marginalization gives rise to further challenges when assessing work ability among the unemployed. This study explored the work ability of long-term unemployed, their needs for medical care and rehabilitation as well as the methods of assessing work ability. The aims were to find out to which amount and how the work ability was restricted among the unemployed and to clarify the needs for medical care and rehabilitation among them. Additionally, differences between the methods for assessing the disease-oriented and multidimensional work ability, as well as the need for rehabilitation were analysed. Both qualitative and quantitative methods were used in this multi-method research in three different studies. The multidimensional work ability assessments were conducted among long term unemployed individuals in three Labour Force Service Centres (Oulu, Raahe region and Kainuu) and in one municipality (Paltamo). Furthermore, an illustrated case study was conducted to compare the materials and background theories of disease-oriented and multidimensional work ability assessment methods. The work ability was significantly decreased for a great proportion of long term unemployed, mostly because of mental disorders. In one municipality, 27% of the long term unemployed were found disabled for open labour market, in addition 20% of them were considered to need medical care and rehabilitation to enable return to work. By using multidimensional work ability assessment method, restrictions in work ability as well as the needs for rehabilitation appeared to get identified more accurately than by using the disease-oriented method. The latter had missed potential rehabilitation avenues and had led to under-rehabilitation, misrehabilitation and over-rehabilitation. The results indicate that the practices of assessing work ability should be based on biopsychosocial and not only on biomedical approach of health and therefore existing information from the multidisciplinary network concerning the clients’ functioning should be routinely collected and used. The health care services as well as the work ability assessment procedures should be tailored to meet the special needs of the long term unemployed to support their work ability and potential of returning to work. / Tiivistelmä Työttömien terveydentila on heikompi ja he käyttävät vähemmän terveyspalveluja kuin muu samanikäinen väestö. Sen sijaan työttömien työkyvystä ei ole olemassa kattavaa tutkimustietoa. Toisaalta työkyvyn arvioinnin menetelmät ovat epäyhtenäiset, koska työkyvyn käsitteestäkään ei ole yhtenäistä ymmärrystä. Syrjäytymiseen liittyvät ilmiöt aiheuttavat työttömien työkyvyn arviointiin omat erityishaasteensa. Tämän tutkimuksen kohteena olivat pitkäaikaistyöttömien työkyky, sairauksien hoitoon ja kuntoutukseen liittyvät tarpeet sekä työkyvyn arvioinnin menetelmät. Tavoitteena oli selvittää, kuinka suurella osalla ja millä tavoin pitkäaikaistyöttömien työkyky on heikentynyt sekä minkälaista hoidon ja kuntoutuksen tarvetta heillä on. Lisäksi selvitettiin sairauslähtöisen ja monialaisen työkyvyn ja kuntoutustarpeen arvioinnin eroja. Monimenetelmätutkimuksen kolmessa osatutkimuksessa käytettiin sekä laadullisia että määrällisiä menetelmiä. Aineistoina olivat kolmen työvoiman palvelukeskuksen (Oulu, Raahen seutukunta ja Kainuu) ja yhden kunnan (Paltamo) alueella asuville vaikeasti työllistyville henkilöille monialaisesti toteutetut työkyvyn arvioinnit. Lisäksi aineistona analysoitiin sairauslähtöisessä ja monialaisessa työkyvyn arvioinnissa käytettävät tietoaineistot ja tulokset yhdellä esimerkkiasiakkaalla havainnollistaen. Suurella osalla pitkäaikaistyöttömistä työkyky oli merkittävästi heikentynyt, sairausluokista eniten mielenterveyden häiriöiden takia. Yhden kunnan kaikista pitkäaikaistyöttömistä todettiin avoimille työmarkkinoille työkyvyttömiksi 27 % ja näiden lisäksi 20 %:lla todettiin työkykyä kohentavan hoidon ja kuntoutuksen tarvetta. Monialaisen arviointimallin avulla tunnistettiin työkyvyn heikkeneminen ja kuntoutustarve osuvammin kuin perinteisellä sairauslähtöisellä toimintatavalla, joka hukkaa kuntoutuksen potentiaalia ja johtaa alikuntoutukseen, väärinkuntoutukseen tai ylikuntoutukseen. Tulosten perusteella työkyvyn arvioinnin käytännöt tulisi perustaa biopsykososiaaliseen eikä vain biomedikaaliseen terveyskäsitykseen ja niissä tulisi nykyistä enemmän hyödyntää monialaisessa verkostossa olevaa informaatiota tutkittavan toimintakyvystä. Työkyvyn tukemiseksi työttömien terveyspalvelut sekä työkyvyn ja kuntoutustarpeen arvioinnit tulisi aiempaa enemmän suunnitella ja kohdentaa pitkäaikaistyöttömien erityistarpeet huomioiden.

Ce manuscrit présente une nouvelle formulation de l’Interaction Laser-Plasma (ILP) à l’échelle hydrodynamique, qui couple la dynamique du plasma avec les processus d’ILP linéaires et non-linéaires. Le modèle standard du tracé de rayon (Ray-Tracing), basé sur l’Optique Géométrique, est peu adapté pour modéliser l’ILP non-linéaire car la distribution de l’intensité laser dans le plasma n’est pas directement disponible. Nous proposons un modèle alternatif spécifiquement formulé pour un code hydrodynamique Lagrangien, basé sur l’Optique Géométrique Complexe Paraxiale qui décrit la propagation de faisceaux Gaussiens. Cette méthode est ensuite adaptée à la description de faisceaux laser non Gaussiens, et permet de reproduire la statistique d’intensité, l’enveloppe et le contraste de faisceaux lissés par une Lame de Phase. Nous proposons des modèles en ligne pour décrire l’échange d’énergie entre faisceaux croisés (CBET) et la génération d’électrons rapides par l’ILP non-linéaire, en utilisant PCGO. Le modèle en ligne de CBET est validé par comparaison avec un code de propagation d’une onde électromagnétique paraxial conventionnel dans le cas d’un plasma inhomogène en vitesse. Un bon accord est trouvé après une période transitoire de l’ordre de la picoseconde, notamment en ce qui concerne la distribution spatiale de l’intensité laser et des perturbations de densité du plasma. Ce modèle appliqué à une configuration d’attaque directe de Fusion par Confinement Inertiel (FCI) montre que le CBET réduit le couplage laser-cible, réduit le facteur de convergence, et amplifie les modes basse fréquence de déformation de la capsule. Le modèle de génération d’électrons rapides par l’ILP non-linéaire modélise les propriétés des faisceaux d’électrons rapides, i.e. leur flux, énergie moyenne, dispersions angulaire et direction, à partir de l’intensité laser prédite par PCGO et à partir d’expressions simplifiées, basées sur des modèles théoriques et des lois d’échelles obtenues à l’aide de simulations cinétiques. La propagation et le dépôt d’énergie par les électrons rapides est décrite à partir d’une approximation de diffusion angulaire adaptée en deux dimensions, pour des faisceaux de profil transverse d’intensité Gaussien, de distribution d’énergie exponentielle et d’ouverture angulaire arbitraire. Ce modèle couplé rend compte de (i) la compétition pour l’énergie laser entre les différentes instabilités et avec l’absorption collisionnelle, (ii) le couplage entre l’ILP non-linéaire et la dynamique du plasma à travers les faisceaux d’électrons rapides, et(iii) la perte de couplage laser-plasma due à la diffusion Raman arrière. Les performances de ce modèle sont évaluées par comparaisons avec des expériences d’allumage par choc conduites sur les installations laser Omega et Pals. Ce modèle multi-échelle est ensuite utilisé pour interpréter plusieurs expériences. On trouve notamment que les électrons générés par l’ILP non-linéaire augmentent la vitesse du choc et la pression en aval de ce dernier, tout en réduisant sa force et la pression d’ablation. Une application à la phase fortement non-linéaire de l’allumage par choc en FCI suggère que ces électrons sont néfastes pour l’implosion de la capsule en ce qui concerne les cibles conventionnelles : ceux-ci causent une augmentation de la masse du point chaud et des pertes radiatives. Ce modèle peut être appliqué à la modélisation hydrodynamique des expériences laser-cible de physique des hautes densités d’énergie pour les régimes d’interaction pertinents pour les instabilités évoquées ci dessus. / This manuscript presents a novel formulation of the Laser-Plasma Interaction (LPI) at hydrodynamical scales, that couples the plasma dynamics with linear and nonlinear LPI processes. The standard Ray Tracing model, based on Geometrical Optics, is not well suited for that purpose because it does not readily describe the laser intensity distribution in plasma. We propose an alternative model formulated for a Lagrangian hydrodynamic code. It is based on the ray-based Paraxial Complex Geometrical Optics (PCGO) that describes Gaussian optical beamlets. A method for modeling non-Gaussian laser beams smoothed by Phase Plates is presented, that allows to create intensity variations that reproduce the beam envelope, contrast and high-intensity statistics predicted by paraxial laser propagation codes. We propose inline reduced models for the non-linear laser-plasma interaction, in the case of the Cross-Beam Energy Transfer (CBET) and the generation of Hot Electrons (HE). The inline CBET model is validated against a time-dependent conventional paraxial electromagnetic wave propagation code, in a well-defined plasma configuration with density and velocity profiles corresponding to an inhomogeneous plasma. Good agreement is found past a transient period on the picosecond time scale, notably for the spatial distribution of density perturbations and laser intensities in the interaction region. Application of the model to a direct-drive Inertial Confinement Fusion (ICF) configuration shows that CBET significantly degrades the irradiation symmetry by amplifying low frequency modes and reducing the laser-capsule coupling efficiency, ultimately leading to large modulations of the shell areal density and lower convergence ratios. The LPI/HE model predicts the HE fluxes, temperatures, angular dispersion and direction from the laser intensity of PCGO beamlets from simplified expressions based on theoretical models and scaling laws obtained in kinetic simulations. The HE beams propagation and energy deposition in plasma is described in the angular scattering approximation, adapted to two-dimensional, transversally Gaussian, multigroup HE beams of arbitrary angular distribution. This model accounts for (i) competition for the laser energy between the various instabilities and with the linear collisional absorption, (ii) coupling between nonlinear LPIs and plasma dynamics via the high energy electron beams and(iii) loss of coupling due to backscattered Raman light. Its performance is confirmed by comparison with measurements of shock timing, laser absorption, HE fluxes and temperatures in experiments conducted on Omega and Pals laser facilities. This multiscale inline LPI-HE model is used to interpret several Shock Ignition experiments. It is found that HEs from parametric instabilities significantly increase the shock pressure and velocity in the target, while decreasing its strength and the overall ablation pressure. Applications to the high-intensity regime of shock ignition ICF suggest that HEs generated by the nonlinear LPI are nefarious to the capsule implosion in conventional target designs, as they lead to a dramatic increase in the hotspot mass and losses by Bremsstrahlung radiation. This model is readily applicable to hydrodynamic description of laser-target experiments of High Energy Density Physics, in the interaction regimes involving the above-mentioned non-linear LPI processes.

The aim of this dissertation thesis is to develop a complex diagnostic-therapeutic programme for adults who stutter. The thesis is divided into two parts: theoretical and empirical. The theoretical part consists of 4 chapters and is based on an analysis of foreign and Czech specialized literature, studies and electronic media. This part presents the theoretical basis of the dissertation and shows the topic of stuttering from a broader perspective. It describes how people who stutter (PWS) are affected by this disorder, its effect on speech, how PWS try to cope with it and how their perception, opinions and feelings change. The dissertation describes stuttering in children, adolescents and adults. It deals with the critical period of the onset of stuttering by specifying various risk factors. It also includes a description of other fluency disorders. A special attention is paid to the personality of the therapist and his/her impact on the therapy process. The dissertation also explains the application of ICF (International Classification of Functioning, Disability and Health) model as a starting point for diagnosis and therapy of PWS as proposed by Yaruss and Quesal (2004). The empirical part is divided into two chapters. The first part consists of a case study which presents the experimental use of...