Background: A previous systematic review found limited data regarding social participation in working-age people with aphasia (PWA). This population has many roles to fulfill, that are negatively affected by aphasia. A review of recent studies may reveal more information on the challenges in re-establishing social roles and thus may inform treatment thereof. Method: The aim was to provide an updated systematic review on social participation in PWA under 65 years of age. Studies from 2005-2017 were searched from Scopus, Pubmed and Psychinfo. Search terms were derived from the International Classification of Functioning, Disability and Health (ICF) and the Aphasia- Framework for Outcomes Measures (A-FROM). Aspects of domestic life, interpersonal relations and interactions, education and employment and community, civic and social life were investigated. Results: From 2,864 initial hits, 11 studies were identified, all of which were on the American Speech-Language-Hearing Association (ASHA) Level III of evidence. The studies indicated that participation in domestic life is reduced and PWA showed reduced social networks, loss of friendships and changes in the quality of marital relations. Few PWA returned to work or spent time on education. Limitations in community, civic and social life were noted and there were contradictory findings on the impact of contextual factors on social participation. There was an increase in research into contextual factors impacting on social participation in PWA and in the use of conceptual frameworks in the last decade. Conclusions: Social participation in working-age adults is limited across the social domains. While the ICF conceptual framework is increasingly used, no studies used the A-FROM. There is greater use of standardised assessments and larger sample sizes. / Dissertation (MA)--University of Pretoria, 2017. / Speech-Language Pathology and Audiology / MA / Unrestricted

Au cours de ma thèse, je me suis intéressée à deux modifications épigénétiques dans les cellules humaines, la méthylation de l'ADN et les modifications d'histones, et à leur relation avec deux processus cellulaires fondamentaux : l'expression génique et la réplication de l'ADN, en accordant une attention particulière aux gènes hétéro-chromatiques. J'ai étudié ces relations à travers des projets distincts en utilisant le syndrome ICF (Immunodeficiency, Centromeric instability, Facial abnormalities) comme modèle commun. Causé par un défaut épigénétique constitutif (inactivation de la DNA méthyltransfèrase 3B), le syndrome ICF (OMIM #242860) représente une source exclusive d'informations sur le rôle des modifications épigénétiques chez l'Homme. Dans un premier projet, nous avons montré que les gènes hétérochromatiques sont soumis à une hypométhylation importante et échappent à la répression transcriptionnelle dans le syndrome ICF, avec la conservation des marques d'histones. Dans une deuxième étude, nous avons observé que dans les cellules ICF la réplication du génome était plus rapide, concomitant avec une réduction de la longueur de phase S. De plus, nous avons observé un timing de réplication avancé au niveau de deux loci hétérochromatiques chez les patients ICF analysés. En parallèle de ces deux projets, j'ai mené un troisième projet, plus appliqué, centré sur le cancer colorectal.Dans ce projet, nous avons étudié la fiabilité d'un nouveau biomarqueur épigénétique (hypométhylation des loci B melanoma antigen) dans la détection des lésions pré-cancéreuses et montré que l'hypométhylation des loci BAGE est un événement précoce de la transformation des cellules du colon et est fréquent dans les adénomes histologiquement avancés. / During my PhD I studied two epigenetic modifications that occur in human cells, DNA methylation and histone modifications, and their relationship with two fundamental cellular processes: gene expression and DNA replication, with a particular attention to heterochromatic genes. I investigated this relationship in distinct projects using ICF (Immunodeficiency, Centromeric instability, Facial anomalies) syndrome as a common model. ICF syndrome (OMIM ID #242860) represents an exclusive source of information on the role of epigenetic modifications in humans, being caused by a constitutive epigenetic defect (i.e. de novo DNA methyltransferase 3B mutations). In a first project we showed that heterochromatic genes undergo hypomethylation and escape from silencing in ICF syndrome, with preservation of histone marks. In a second study we observed that whole-genome DNA replication is faster in ICF cell lines, with a concomitant shortening of the S-phase length. Besides, we observed earlier replication timing at two heterochromatic loci. In addition to these two studies, I carried out a third more applicative project focused on colorectal cancer. In this project we investigated the reliability of a new epigenetic biomarker (hypomethylation of B melanoma antigen loci) in the detection of pre-cancerous lesions and showed that BAGE loci hypomethylation is an early event in colon transformation and is frequent in histologically advanced adenomas.

Idén till denna studie har succesivt vuxit fram under flera års arbete och erfarenheter av barn med synnedsättning i kombination med ytterligare funktionsnedsättningar. Det har framförallt varit i möten med dessa barn jag fått insikten att villkoren för deras delaktighet ser så olika ut. Många insatser görs, men de inriktar sig sällan på att ta reda på hur barn samspelar med sin omgivning och hur faktorer i miljön påverkar barnets delaktighet. Studien syftar till att undersöka villkor för ett litet barns delaktighet i en inkluderande förskolemiljö. Studiens huvudperson är en 3½ årig pojke med nedsättning i syn,- motorik och begåvningsfunktioner. Studiens empiri består av 19 videoobservationer inhämtade under en period av 1½ år. Studien har två huvudsakliga frågeställningar: 1) Hur ser villkoren för delaktighet ut för barn med svår synnedsättning i kombination med ytterligare funktionsnedsättningar i en inkluderande förskolemiljö? 2) Är det möjligt att tillämpa Världshälsoorganisationen (WHO:s) Internationell klassifikation av funktionstillstånd, funktionshinder och hälsa, barn och ungdomsversionen (ICF-CY) som metod för att synliggöra villkor för barns delaktighet? Studiens ansats är kvalitativ med en tydlig explorativ karaktär. Studien har organiserats i tre steg. 1) Videoobservation och transkribering, 2) Kodning enligt ICF-CY och 3) analys enlig en modell om fem miljömässiga aspekter om delaktighet. Studiens resultat presenteras på  individ,- metod och modellnivå. På individnivå framträder bland annat kontext som villkor för ett barns delaktighet. På metodnivå gav inte ICF-CY studien tillräcklig substans för att synliggöra villkoren för delaktighet och särskilt samspelet mellan individ och miljö. Det visade sig också vara svårigheter att välja lämplig kod. På modellnivå synliggörs två perspektiv på delaktighet; det sociologiska och utvecklingspsykologiska. Dessutom visade det sig att ICF-CY tillsammans med en modell innehållande fem miljömässiga aspekter av delaktighet gav en bättre helhetsbild av situationer och samspelet mellan individ och miljö. / The idea for this study has gradationally grown under many years of work and experience with children with visual impairment in combination with additional disabilities. It has especially been in meeting these children the realization that the conditions for their participation looks very different have grown. Many efforts have been made, but they rarely concentrate on finding out how children interact with their environment and how different factors in the environment effects the child’s participation. This study’s purpose is to examine the conditions for a young child’s participation in an included preschool environment. The study’s main focus is a 3 ½ year old boy with reduction in sight - motor activity and ability functions. The study’s empirical evidence consists of 19 video-observations gathered under a period of 1½ years. The study has two main question formulations: 1) How a child’s environment effects the child’s participation? 2) Is it possible to apply World Health Organization (WHO:s) International Classification of Functioning, Disability and Health -Children and Youth (ICF-CY) as a method to make visible the factors that effects a child’s participation in an included preschool environment? The study’s start is qualitative with a clear exploratory character. The study has been organised in tree steps. 1) Video-observations and transliteration, 2) Coding according to ICF-CY and 3) analyse according to a model of five environmental aspects of participation. The study’s result presents on an individual,–method and model level. On an individual level the most apparent is context for the conditions for a child’s participation. On a method level the ICF-CY study did not give enough substance to make visible a child’s participation and a specially the interaction between the individual and the environment. It also showed to be difficult to choose the most appropriate code. On a model level two perspectives are made visible on participation; the sociological and the developmental psychological. The resultalso show that ICF-CY together with a model containing five environmental aspects of participation gave a better holistic picture of situations and interaction between the individual and the environment.

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.:Inhaltsverzeichnis I. EINLEITUNG UND PROBLEMAUFRISS 5 I.1. AKTUELLE PROBLEME UND NEUE BEDARFE IM GESUNDHEITSWESEN 5 I.2. ZIELSTELLUNG UND AUFBAU DER ARBEIT 8 I.3. EIGENE STUDIEN ZUR BEDARFSORIENTIERUNG BEWEGUNGSBEZOGENER ANGEBOTE IM GESUNDHEITSWESEN 10 II. DISEASE MANAGEMENT ALS NEUERUNG IN EINER INDIVIDUALISIERTEN VERSORGUNG 14 II.1. HINTERGRUND UND ZIELSETZUNG DER DISEASE MANAGEMENT PROGRAMME (DMP) 14 II.2. AKTUELLE BEFUNDLAGE ZUR WIRKSAMKEIT DER DMP 15 II.3. VERHALTENSORIENTIERTE BEWEGUNGSPROGRAMME ALS SUPPLEMENTÄR IN DEN DMP 16 II.3.1. ZIELE UND INHALTE DER BEWEGUNGSPROGRAMME 16 II.3.2. EFFEKTE VERHALTENSORIENTIERTER BEWEGUNGSPROGRAMME IM KONTEXT DER DMP 19 II.4. DISKUSSION DER EIGENEN BEITRÄGE 20 II.4.1. INHALTLICHE EINORDNUNG 20 II.4.2. LIMITIERUNGEN 22 III. ERFASSUNG KÖRPERLICHER AKTIVITÄT IM GESUNDHEITSORIENTIERTEN KONTEXT 24 III.1. MESSMETHODISCHE ASPEKTE ZUR BESTIMMUNG DES AKTIVITÄTSUMFANGS 24 III.2. ABLEITUNGEN AUS DEN EIGENEN BEFUNDEN ZUR ERFASSUNG KÖRPERLICHER AKTIVITÄT 28 IV. ZUSAMMENFASSUNG UND AUSBLICK 31 V. LITERATUR 34 VI. ANHANG 43 VI.1. BERÜCKSICHTIGTE VERÖFFENTLICHUNGEN 43 VI.2. SELBSTSTÄNDIGKEITSERKLÄRUNG 45

Eine zentrale Ablage für PA-Fragebögen würde den Zugriff deutlich erleichtern. Durch umfassende Suchbedingungen kann eine weitere Verbesserung der Auswahl erfolgen. Darin liegt der Ursprung dieser Arbeit. Eine zentrale Ablage für Fragebögen zu schaffen würde die Auswahl des richtigen Fragebogens deutlich erleichtern und beschleunigen. Um die Personen, welche mit Fragebögen arbeiten zu unterstützen und die Arbeit mit Fragebögen zu erleichtern ist eine zentrale Übersicht von großem Vorteil.

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. 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. 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. 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. / 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. 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. 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. 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.

An alteration in the function of the brain caused by an external force is called a Traumatic Brain Injury (TBI). There are language features located in different areas of the brain, and depending on where a person gets a TBI, the person can experience different communicative difficulties. These can manifest as aphasia, dysarthria or cognitive communicative disorders. The experiences of TBI that have been discovered in previous studies are for instance about how persons with TBI experience their diminished functions, life adjustment after the injury, the role and support of the relatives, that the environment treats them differently after the injury and emotional consequences. For the purpose of investigation and intervention, ICF is a useful tool since the difficulties that a person may have can be connected to its various components. The purpose of this study is to examine what experiences persons with TBI have regarding their brain injury and their communicative difficulties, and also how these can be connected to ICF. To answer the research questions, a qualitative method involving content analysis was used, based on semi-structured interviews with four participants. The participants expressed that their TBI had affected them in various ways, communicative, cognitive, physically and socially. The participants experienced their injuries and difficulties as limiting and that some periods had been lonely. However they also stated that there were some positive aspects in the situation, for example improved family relations and that they valued life in another way. Although the injuries, difficulties and rehabilitation of the participants have differed, the participants stories have been similar to some extent. In the future it would be interesting to conduct further studies in Sweden that examine which experiences persons with TBI have regarding the injury itself, but particularly regarding their communication after the TBI. It is important with more studies since that would give speech language pathologists a greater understanding for how people with TBI experience their situation and their communication after the injury. / Traumatisk hjärnskada (TBI) innebär att ett yttre våld har orsakat en förändring av hjärnfunktionen. I hjärnan finns språkliga funktioner som är belägna inom olika delar av hjärnan. Beroende på var i hjärnan en person får en TBI, leder det till olika kommunikativa svårigheter. Svårigheterna kan yttra sig som afasi, dysartri eller kognitiva kommunikativa störningar. De upplevelser av TBI som har framkommit i tidigare studier handlar bland annat om hur personer som har TBI upplever sina nedsatta funktioner, livsomställningen efter skadan, anhörigas roll och stöd, att omgivningen behandlar dem annorlunda efter skadan och emotionella konsekvenser. Vid utredning och behandling är ICF ett användbart verktyg eftersom att en persons svårigheter kan kopplas till ICF:s olika komponenter. Syftet med föreliggande studie är att undersöka vilka upplevelser personer som har TBI har erhållit i relation till sin hjärnskada, deras kommunikativa svårigheter samt hur dessa kan kopplas till ICF. För att besvara frågeställningarna användes en kvalitativ metod med semi-strukturerade intervjuer av fyra personer och innehållsanalys av dessa. Deltagarna i föreliggande studie uttryckte att deras TBI hade påverkat dem på olika sätt: kommunikativt, kognitivt, fysiskt och socialt. Deltagarna upplevde sina skador och svårigheter som begränsande och att de i vissa perioder hade upplevt isolering. De berättade dock att det fanns positiva aspekter av situationen såsom förbättrade familjerelationer och att livet värderades på ett annat sätt. Trots att deltagarnas skador, svårigheter och rehabilitering har skiljt sig åt, har deltagarnas berättelser haft likartad karaktär, även om de också till viss del har varierat. I framtiden vore det intressant med fler svenska studier som undersöker vilka upplevelser personer som har TBI har i relation till sina hjärnskador, men framförallt gällande sin kommunikation efter hjärnskadan. Det skulle vara betydelsefullt med fler studier eftersom att det skulle ge logopeder en större förståelse för hur personer som har TBI upplever sin situation och sin kommunikation efter skadan.

Objetivo: Construir e testar a aplicabilidade de um instrumento baseado no Core Set resumido da CIF para lesão medular em indivíduos com etiologia não-traumática. Métodos: Foi realizada uma revisão sistemática para identificarmos as escalas de avaliação funcional que tenham sido aplicadas em indivíduos com paraparesia espástica. Para o desenvolvimento do instrumento utilizamos as descrição das categorias selecionadas para o Core Set resumido de lesão medular traumática crônica e elaboramos perguntas de fácil compreensão e alternativas de respostas descritos com detalhes que satisfizessem os seus qualificadores para guiar a aplicação do instrumento e garantir a reprodutibilidade dos achados. Após esta fase realizamos a aplicação desse instrumento em 40 indivíduos com lesão medular não-traumática (mulheres: 62,5%, média de idade: 44 ± 16 anos). A prevalência de incapacidade em cada uma das categorias da CIF foi definida pela proporção de indivíduos com os qualificadores de 1 a 4. Resultados: Na revisão sistemática identificamos 10 instrumentos de avaliação funcional a usados para paraparesia espástica, dos quais somente a Escala de Osame e a SCIM-III podem ser consideradas específicas para a nossa amostra. Dentre estes instrumentos de avaliação a MIF apresentou maior número de categorias da CIF, a Escala de Osame e o Rankin apresentaram menores números de categorias da CIF e o DEFU-QV foi a escala que continha mais categorias exclusivas. Desenvolvemos um instrumento baseado no Core Set resumido da CIF para lesão medular traumática crônica, contendo 43 perguntas com subitens. O instrumento foi considerado bom e de fácil uso pelos avaliadores, levando em média 45 minutos de aplicação. Os dados foram correlacionados com a Escala de Disfunção Motora Osame (0 - 13 pontos), que foi dicotomizada em dois grupos leve (0 a 4 pontos) e grave (>= 5) para análise. A pontuação média na Escala de Osame foi 5,4 ± 2,2, a SCIM-III apresentou a pontuação média de 83,0 ± 13,0. Indivíduos do grupo grave apresentaram maior frequência de deficiências quando avaliados pelo Core Set de lesão medular, principalmente: funções sexuais, neuromusculoesqueléticas, defecação e dor. A medula espinhal foi a Estrutura do Corpo citada com maior frequência. Nas categorias de Atividades e Participação: todos os indivíduos apresentaram deficiência na utilização de transporte, bem como dificuldade para o uso da mão e do braço, andar, dirigir, deslocar-se, realizar rotina diária, trabalho e lazer. As principais barreiras identificadas referiram-se a condições de ambientes internos e externos, enquanto os principais facilitadores foram os produtos para uso pessoal na vida diária, seguido daqueles usados para mobilidade e transporte pessoal em ambientes interno e externo, família imediata e profissionais de saúde. Conclusão: O instrumento desenvolvido propõe uma forma de aplicar o Core Set de lesão medular crônica. É de fácil compreensão e aplicação pelos profissionais que o utilizaram e foi capaz de diferenciar os indivíduos mais gravemente incapacitados. Tem vantagem de identificar e ponderar o impacto dos Fatores Ambientais / Objective: Building and test the applicability of an instrument based on the brief ICF Core Set for spinal cord injury in patients with non-traumatic etiology. Methods: A systematic review was performed to identify the functional assessment scales that have been applied in individuals with spastic paraparesis. For the development of this instrument, we used the description of the selected categories for the brief Core Set of chronic traumatic spinal cord injury and easy comprehension questions were elaborated along with choices for answers described with enough details in order to satisfy their qualifiers to guide the application of the instrument and ensure the reproducibility of the findings. After this phase we applied this instrument in 40 patients with non-traumatic spinal cord injury (women: 62.5%; mean age: 44 ± 16 years). The proportion of individuals defined the prevalence of disability in each ICF category with the qualifiers from 1 to 4. Results: The systematic review enabled us to identify 10 functional assessment instruments used for spastic paraparesis, of which only Osame Scale and SCIM-III may be considered specific to the sample used herein. Among these evaluation tools MIF presented a higher number of ICF categories, the Osame Scale and Rankin had lower numbers of ICF categories and DEFU-QOL was the scale which contained more exclusive categories. We have developed a tool based on the brief ICF Core Set for chronic traumatic spinal cord injury, containing 43 questions with sub-items. This instrument was considered good and easy to use by the evaluators, taking an average of 45 minutes of application. The data was correlated with Osame Motor Disability Scale (0 - 13 points), which was dichotomized into two groups: mild (0 to 4 points), and severe (>= 5) for analysis purposes. The average score in Osame Scale was 5.4 ± 2.2, and SCIM-III presented an average of 83.0 ± 13.0. Individuals from the severe group presented a greater frequency of disabilities when evaluated by the Core Set of spinal cord injury, mainly: sexual functions, neuromusculoskeletal, defecation and pain. The spinal cord was the Body Structure most frequently cited. In the categories of Activities and Participation, all of the individuals presented limitation to use transportation as well as the use of hand and arm, walking, driving, moving, carrying out daily routine tasks, work and leisure. The main barriers identified were related to the conditions of internal and external environments, while the main facilitators were the products for personal use in daily life, followed by those used for mobility and personal transport in internal and external environments, immediate family and health professionals. Conclusion: The developed instrument proposes a form to apply the Core Set of chronic spinal cord injury. It is easy to understand and be applied by professionals who used it. Furthermore, it was able to differentiate the individuals more severely disabled. It has the advantage to identify and ponder the impact of environmental factors as well

Background: Physical activity questionnaires (PAQ) have been extensively used to determine physical activity (PA) levels. Most PAQ are derived from an energy expenditure-based perspective and assess activities with a certain intensity level. Activities with a moderate or vigorous intensity level are predominantly used to determine a person’s PA level in terms of quantity. Studies show that the time spent engaging in moderate and vigorous intensity PA does not appropriately reflect the actual PA behavior of older people because they perform more functional, everyday activities. Those functional activities are more likely to be considered low-intense and represent an important qualitative health-promoting activity. For the elderly, functional, light intensity activities are of special interest but are assessed differently in terms of quantity and quality. The aim was to analyze the content of PAQ for the elderly.

Objetivo: Construir e testar a aplicabilidade de um instrumento baseado no Core Set resumido da CIF para lesão medular em indivíduos com etiologia não-traumática. Métodos: Foi realizada uma revisão sistemática para identificarmos as escalas de avaliação funcional que tenham sido aplicadas em indivíduos com paraparesia espástica. Para o desenvolvimento do instrumento utilizamos as descrição das categorias selecionadas para o Core Set resumido de lesão medular traumática crônica e elaboramos perguntas de fácil compreensão e alternativas de respostas descritos com detalhes que satisfizessem os seus qualificadores para guiar a aplicação do instrumento e garantir a reprodutibilidade dos achados. Após esta fase realizamos a aplicação desse instrumento em 40 indivíduos com lesão medular não-traumática (mulheres: 62,5%, média de idade: 44 ± 16 anos). A prevalência de incapacidade em cada uma das categorias da CIF foi definida pela proporção de indivíduos com os qualificadores de 1 a 4. Resultados: Na revisão sistemática identificamos 10 instrumentos de avaliação funcional a usados para paraparesia espástica, dos quais somente a Escala de Osame e a SCIM-III podem ser consideradas específicas para a nossa amostra. Dentre estes instrumentos de avaliação a MIF apresentou maior número de categorias da CIF, a Escala de Osame e o Rankin apresentaram menores números de categorias da CIF e o DEFU-QV foi a escala que continha mais categorias exclusivas. Desenvolvemos um instrumento baseado no Core Set resumido da CIF para lesão medular traumática crônica, contendo 43 perguntas com subitens. O instrumento foi considerado bom e de fácil uso pelos avaliadores, levando em média 45 minutos de aplicação. Os dados foram correlacionados com a Escala de Disfunção Motora Osame (0 - 13 pontos), que foi dicotomizada em dois grupos leve (0 a 4 pontos) e grave (>= 5) para análise. A pontuação média na Escala de Osame foi 5,4 ± 2,2, a SCIM-III apresentou a pontuação média de 83,0 ± 13,0. Indivíduos do grupo grave apresentaram maior frequência de deficiências quando avaliados pelo Core Set de lesão medular, principalmente: funções sexuais, neuromusculoesqueléticas, defecação e dor. A medula espinhal foi a Estrutura do Corpo citada com maior frequência. Nas categorias de Atividades e Participação: todos os indivíduos apresentaram deficiência na utilização de transporte, bem como dificuldade para o uso da mão e do braço, andar, dirigir, deslocar-se, realizar rotina diária, trabalho e lazer. As principais barreiras identificadas referiram-se a condições de ambientes internos e externos, enquanto os principais facilitadores foram os produtos para uso pessoal na vida diária, seguido daqueles usados para mobilidade e transporte pessoal em ambientes interno e externo, família imediata e profissionais de saúde. Conclusão: O instrumento desenvolvido propõe uma forma de aplicar o Core Set de lesão medular crônica. É de fácil compreensão e aplicação pelos profissionais que o utilizaram e foi capaz de diferenciar os indivíduos mais gravemente incapacitados. Tem vantagem de identificar e ponderar o impacto dos Fatores Ambientais / Objective: Building and test the applicability of an instrument based on the brief ICF Core Set for spinal cord injury in patients with non-traumatic etiology. Methods: A systematic review was performed to identify the functional assessment scales that have been applied in individuals with spastic paraparesis. For the development of this instrument, we used the description of the selected categories for the brief Core Set of chronic traumatic spinal cord injury and easy comprehension questions were elaborated along with choices for answers described with enough details in order to satisfy their qualifiers to guide the application of the instrument and ensure the reproducibility of the findings. After this phase we applied this instrument in 40 patients with non-traumatic spinal cord injury (women: 62.5%; mean age: 44 ± 16 years). The proportion of individuals defined the prevalence of disability in each ICF category with the qualifiers from 1 to 4. Results: The systematic review enabled us to identify 10 functional assessment instruments used for spastic paraparesis, of which only Osame Scale and SCIM-III may be considered specific to the sample used herein. Among these evaluation tools MIF presented a higher number of ICF categories, the Osame Scale and Rankin had lower numbers of ICF categories and DEFU-QOL was the scale which contained more exclusive categories. We have developed a tool based on the brief ICF Core Set for chronic traumatic spinal cord injury, containing 43 questions with sub-items. This instrument was considered good and easy to use by the evaluators, taking an average of 45 minutes of application. The data was correlated with Osame Motor Disability Scale (0 - 13 points), which was dichotomized into two groups: mild (0 to 4 points), and severe (>= 5) for analysis purposes. The average score in Osame Scale was 5.4 ± 2.2, and SCIM-III presented an average of 83.0 ± 13.0. Individuals from the severe group presented a greater frequency of disabilities when evaluated by the Core Set of spinal cord injury, mainly: sexual functions, neuromusculoskeletal, defecation and pain. The spinal cord was the Body Structure most frequently cited. In the categories of Activities and Participation, all of the individuals presented limitation to use transportation as well as the use of hand and arm, walking, driving, moving, carrying out daily routine tasks, work and leisure. The main barriers identified were related to the conditions of internal and external environments, while the main facilitators were the products for personal use in daily life, followed by those used for mobility and personal transport in internal and external environments, immediate family and health professionals. Conclusion: The developed instrument proposes a form to apply the Core Set of chronic spinal cord injury. It is easy to understand and be applied by professionals who used it. Furthermore, it was able to differentiate the individuals more severely disabled. It has the advantage to identify and ponder the impact of environmental factors as well