Aim: The aim of this thesis was to map specific musculoskeletal impairments experienced by adults with physical disabilities at the Piña Palmera rehabilitation center in Mexico and to categorize them according to the ICF. Method: This cross-sectional study was conducted through observations and a survey based on predefined questions. The questions covered the individuals’ level of independence, pain, earlier treatment and biggest obstacle in daily life. The participants were observed when they received physical therapy or in their daily work at the center. The results from the survey and observations were later coded according to ICF. The participants were categorized and divided into groups depending on severity of their impairment: mild, moderate and severe. Results: This study includes 17 participants, nine women and eight men. The age of the participants ranged from 22 to 87 years (median: 44). The result shows an overview of the most common impairments that individuals’ who are visiting the center are affected by. The result also shows all the codes for each individual on the ICF-components. Conclusion: The group with severe loss of function had higher level of problem on the investigated components of ICF. Assistive device that should be prioritized is AFO. / Syfte: Syftet med denna studie är att kartlägga de specifika muskuloskelettära funktionsnedsättningarna hos vuxna människor med fysiska funktionshinder på Piña Palmera rehabiliteringscenter i Mexico samt att kategorisera dessa enligt International Classification of Functioning, Disability and Health. Metod: Denna tvärsnittsstudie genomfördes genom observationer och ett förberett frågeformulär. Frågeformuläret innehöll frågor som rörde individens självständighetsförmåga, smärta, tidigare behandlingar samt deltagarens självupplevda största hinder i vardagen. Deltagarna observerades under besök hos fysioterapeuten eller i deras vardagliga arbete på centret. Resultatet från intervjun och undersökningarna kodades enligt ICF och deltagarna delades in i grupper beroende på grad av funktionsnedsättning, mild, medel eller svår. Resultat: Denna studie inkluderar 17 deltagare, nio kvinnor och åtta män. Deltagarnas ålder är mellan 22 och 87 år (median: 44 år). Resultatet ger en överblick på de vanligaste funktionshindren hos individer som besöker centret. Resultatet visar också kodningen för varje individ för fyra olika komponenter inom ICF. Slutsats: Gruppen med svår funktionsnedsättning hade högre problemgrad på alla ICF-komponenter, vilket var väntat. De assisterande hjälpmedlen som bör prioriteras för centret är AFO.

Background According to recent research, telepresence robots are increasingly used as self-support devices to aid in social interaction in remote areas. Increased participation in leisure activities is one of the most important outcomes of the intervention. However, there is still a scarcity of prior literature on studies with special-needs children. Objective This scoping review aims to explore the participation of children with functional limitations through telepresence robots while identifying barriers and facilitators in their application. Methods A comprehensive literature search was conducted using ten databases in English and Japanese. Prior studies were screened and selected based on a systematic procedure. The literature was collected based on the following criteria and mapped according to the components of the ICF. Results Environmental and human factors are all contributing to barriers or facilitating factors. Also, six themes emerged for telepresence robot interventions: user conditions, decision-maker approval, virtual inclusion, social attitudes, rapport, and children's preferences. Conclusion Since the main daily activities for children occur in the school setting, and it is necessary to build technology and support in line with children's needs. / 背景 近年、遠隔地における社会的交流を支援するための自立支援装置として、テレプレゼンスロボットの利用が進んでいる。また余暇活動への参加率の向上は、子供達への介入の最も重要な成果の一つである。しかし、特別な支援を必要とする児童を対象とした研究の先行文献はまだ少ない。 目的 本稿のスクーピングレビューでは、テレプレゼンスロボットを活用する機能的制限のある子どもの参加について調査し、その適用における障壁と促進要因を明らかにすることを目的とする。 方法 日本語と英語のデータベースを用いて包括的な文献検索を行った。先行研究をスクリーニングし、体系的な手順に基づいて選択した。文献は基準に沿って収集し、ICFの構成要素に従いマッピングした。 結果 環境的・人的要因のすべてが障壁や促進要因となっている。また、テレプレゼンスロボットによる介入では、ユーザーの条件、意思決定者の承認、バーチャルインクルージョン、社会的態度、ラポール、子どもの嗜好の6つのテーマが浮かび上がった。 結論 子どもの主な日常生活は学校生活の中で行われるため、子どものニーズに沿った技術や支援を構築することが必要である。

Four studies were included in this doctoral dissertation aiming to investigatehow habilitation professionals perceive the ICF-CY in clinical work and to identify everyday life situations specific for children and youth aged 0-17 years. The ICF-CY was the conceptual framework and since the research was conducted on as well as with the ICF-CY, the use of the classification runs like a thread through all the work. The design was primarily qualitative and included descriptive and comparative content analyses. Study I was longitudinal, aiming to explore how an implementation of the ICF-CY in Swedish habilitation services was perceived. Studies II-IV were interrelated, aiming to explore children’s most common everyday life situations. Content in measures of participation, professionals’ perspectives, and external data on parents’ perspectives were linked to the ICF-CY and compared. Mixed methods design bridged the Studies III-IV. Results in Study I indicated that knowledge on the ICF-CY enhanced professionals’ awareness of families’ views of child functioning and pointed to the need for ICF-CY based assessment and intervention methods focusing on child participation in life situations. A first important issue in this respect was to identify everyday life situations. Two sets of ten everyday life situations related to the ICF-CY component Activities and Participation, chapters d3-d9, were compiled and adopted for younger and older children respectively, establishing a difference in context specificity depending on maturity and growing autonomy. Furthermore, key constructs in the ICFCY model were discussed, additional ICF-CY linking rules were presented and suggestions for revisions of the ICF linking rules and the ICF-CY were listed. As the sample of everyday life situations reflects the perspectives of adults, further research has to add the perspective of children and youth. The identified everyday life situations will be the basis for the development of code sets included in a screening tool intended for self- or proxy- report of participation from early childhood through adolescence.

No description available.

Darbo tikslas – įvertinti, Tarptautinės funkcionavimo, negalumo ir sveikatos klasifikacijos, bei Kanadietiško veiklos atlikimo testo tinkamumą, vertinant asmenų patyrusių galvos smegenų infarktą, veiklą. Nustatyti, šių dviejų testų sąsajas ir skirtumus. Pacientus vertinant reabilitacijos laikotarpiu, po paguldymo reabilitacijos skyriuje praėjus 1-3 dienoms ir pakartotinis vertinimas atliktas po dviejų savaičių. Veiklos ir dalyvumo sutrikimų nustatymas- svarbus, paskiriant reabilitacijos specialistus ir sudarant reabilitacijos gydymo planą. / Final aim of master work - to explore International Classification for Health, Disability and Functioning (ICF) and Canadian Occupational Performance Measure (COPM) use in evaluation people’s employment after head brain infarction. To clarify these two tests conjunction and differences. Assess the patients in rehabilitation period then they come for the medical treatment in 1-3 day’s period and repeated after two weeks. Operational problems determination is important of rehabilitation professionals and the appointment of the conclusion of the rehabilitation treatment plan.

Background: Participation in every life situation is a basic child’s right. Within health care, participation is achieved by effective patient-provider communication. Increased participation is shown to be beneficial for the well-being of the child. To achieve this, augmentative and alternative communication (AAC) could be implemented during the care.  Aim: To explore the use of communication aids with children in health care settings and to see what the outcomes are for a child’s functioning based on the ICF-CY.  Method: A systematic literature review was conducted. The databases MEDLINE, PubMed, CINAHL and Dentistry and Oral Sciences Source were searched and nine articles were included for review. Results: It was found that both typically developing children and children with a variety of disabilities have been studied, as well as a wide age range. Low-tech aids have been practised most often, particularly visual picture schedules. Five studies measured ‘Activity and participation’ outcomes and the results showed improvement of patient-provider communication and enhanced completion of a medical procedure. Six studies measured outcomes that could be identified as ‘Body functions’ and results showed a decrease in anxiety, stress or pain at some point of the medical procedure.  Conclusion: This systematic literature review shows that AAC is still an emerging concept within health care with children, but the first results suggest that it has benefits for different child populations and for different aspects of a child’s functioning. However, it is not clear what the outcomes are for participation in particular. The limited amount of studies on this topic could be due to several barriers to achieve participation and use of AAC. Future research should focus more on using specific measures for participation. Also, researchers need to explore ways to overcome the barriers to implement AAC. Finally, new technologies such as tablet devices could be studied. / Participatie in elke levenssituatie is een basisrecht van elk kind. In de gezondheidszorg betekent dit een optimale communicatie tussen de patiënt en de hulpverlener. Verhoogde participatie blijkt gunstig te zijn voor het welzijn van het kind. Augmentatieve en alternatieve communicatie (AAC) zou hiervoor gebruikt kunnen worden binnen de gezondheidszorg. Het doel van deze studie is om het gebruik van communicatiehulpmiddelen met kinderen binnen de gezondheidszorg te verkennen en om na te gaan wat de resultaten hiervan zijn voor het functioneren van het kind gebaseerd op de ICF-CY. Er werd een systematische literatuurstudie uitgevoerd. Vier databanken werden doorzocht en in totaal werden negen artikels inbegrepen.  De resultaten toonden aan dat zowel typisch ontwikkelende kinderen als kinderen met een verscheidenheid aan beperkingen binnen een groot leeftijdsbereik reeds onderzocht zijn. Lowtech communicatiehulpmiddelen werden het vaakst gebruikt in de studies, waarvan het vaakst visuele schema’s. Vijf studies meten resultaten die behoren tot ‘Activiteiten en Participatie’ en toonden een verbeterde patiënt-hulpverlener communicatie en een betere bekwaamheid tot het beëindigen van een medische procedure. Zes studies meten resultaten die behoren tot ‘Lichaamsfuncties’ en toonden aan dat de angst, stress of pijn verlaagden bij het gebruik van een communicatiehulpmiddel. Deze systematische literatuurstudie toont aan dat AAC nog steeds een groeiend concept is binnen de gezondheidszorg voor kinderen. De eerste resultaten tonen echter dat AAC voordelen heeft voor verscheidene populaties van kinderen alsook voor verscheidene aspecten van het functioneren van een kind. Desalniettemin is het onduidelijk wat de resultaten zijn voor de participatie van het kind. Het beperkt aantal studies kan verklaard worden door het bestaan van allerhande barrières om participatie te bereiken en/of om AAC te gebruiken binnen de gezondheidszorg. Toekomstig onderzoek zou meer moeten focussen op de effecten voor participatie. Ook dient er onderzocht te worden hoe de meervoudige barrières overwonnen kunnen worden en hoe nieuwe technologieën zoals tablet computers mogelijks ingezet kunnen worden als communicatiehulpmiddel.

By using a pragmatic paradigm, different research methodologies were employed in this thesis. MS-related symptoms may be exaggerated due to heatsensitivity and it is supposed that cooling garments relieve the symptoms. The effects of wearing a Rehband® vest were evaluated in a sample of 42 persons with MS in a randomised controlled crossover study. Both objective and subjective statistically significant improvements were found when a cooled Rehband® vest was worn compared to the wearing of a room-tempered vest. Using a repeated-measures design, 10m and 30m timed walks and Timed Up and Go were studied in 42 persons with MS. Reproducibility was investigated within and between test points. High reproducibility was found both within (r=0.97–0.98) and between measure points (r=0.91–0.93). The correlation between the three tests was high (r=0.85). Differences at –23% to +40% were established as being needed to detect genuine changes. Severity of MS infl uenced the size of the differences, especially for the 30m timed walk test. The 12-item MS Walking Scale was translated and used in a cross-sectional study. Out of 81 persons with MS, 89–96% perceived limitations in standing or walking. The internal consistency of the scale was acceptable for nine items (0.69–0.84). The concurrent validity between the 12-item MS Walking Scale and the investigated objective tests was low: Berg Balance Scale (r=–0.368**), Four Square Step Test (r=0.338**) and Timed Up and Gocognitive (r=0.319*). A prevalence of falling was found at 63% in a longitudinal cohort study with prospectively registered falls including 76 persons with MS. The odds of falling were fi ve fold when there was a reported need of using a walking aid indoors and outdoors and by 2.5 to 15.6 times while there was disturbed proprioception, depending on severity. The highest sensitivity was found for the Berg Balance Scale (94%) and the highest specifi city was found for the 12-item MS Walking Scale (82%). Positive predictive values at 70–83% were found for the Berg Balance Scale, Timed Up and Gocognitive, the Four Square Step Test and the 12-item MS Walking Scale. Finally, we explored and described factors that persons with MS perceive as related to accidental falls. A content analysis with a deductive approach was chosen. By conducting interviews, we found previously untargeted factors: divided attention, reduced muscular endurance, fatigue and heat-sensitivity. The content of the interviews also gave support to previously reported risk factors such as changes in gait pattern, walking disability, impaired proprioception and vision, and spasticity.

Introduction: Maintaining good oral health may be more important for children with disabilities than others, since problems with oral health may increase the impact of a disability, or the medical condition may increase the risk for poor oral health. In addition, the risk for oral health problems may be influenced by the functioning of the child. Functioning can also affect the child’s ability to cooperate in the dental setting, and how dental treatment is performed. A medical diagnosis alone does not provide enough information about a child’s functioning, nor oral health. Thus, there is a need for a holistic perspective of oral health and dental health care in children with disabilities. The International Classification of Functioning, Disability and Health - Children and Youth (ICF-CY) enables a structured assessment of the biopsychosocial consequences of a health condition. Aim: The overall aim of this thesis was to investigate how biopsychosocial factors relate to oral health and specialist dental health care in children with disabilities in a Swedish, and an international context, with special focus on the experience of dental treatment under general anaesthesia (DGA). Material and methods: The research was conducted using a quantitative, cross-sectional, comparative and descriptive design. An ICF-CY Checklist for Oral Health was completed with data from a structured interview with children 0-16 years old, referred for specialist dental health care, and their parents/carers. Additional information was retrieved from dental and medical records. Three groups were included in data analyses: one large international group of 218 children from Argentina, France, Ireland and Sweden; one large Swedish group with 99 children with complex disabilities; and one international group of children with disabilities and manifest dental caries from Argentina, France and Sweden. Results: The ICF-CY Checklist for Oral Health identified both common and varying functional, social and environmental aspects relevant for oral health and oral health care in children who had been referred to specialist dental clinics in four countries. Swedish children with caries experience had been referred to a paediatric dental specialist clinic at a significantly older age than caries-free children. The medical diagnoses were not significantly related to dental caries or child functioning in the large Swedish group with complex disabilities and low caries prevalence, nor was there a significant relationship between dental caries and child functioning. Collinearity between dental caries and problems in the functioning factor ’Interpersonal interactions andrelationships’ was observed in the international group of children with disabilities and manifest dental caries. DGA sessions with combined medical and dental treatment were common in the large Swedish study group. Children with experience of DGA had more severe problems in intellectual functions than those without experience of DGA. Problems in interpersonal interactions and relationships increased, while problems with mobility decreased, the likelihood for children having had experience of DGA. On international group level, dmft/DMFT was significantly higher in children with the experience of DGA than in those without DGA experience, but looking at Argentina, France and Sweden separately, this was not true for the Swedish children. There were significant, international differences between the prevalence of dmft/DMFT, DGA and environmental barriers. Conclusion: The biopsychosocial perspective, operationalised by the ICF-CY, contributes a holistic view on oral health and specialist dental health care in children with disabilities. In addition to certain differences, children with different health status from different countries share many functional and environmental aspects, important for oral health and dental health care. Early referral to a paediatric specialist dental clinic seemed favourable for oral health. The medical diagnosis was not related to child functioning or dental caries. Child functioning had a significant impact on DGA, and in children with disabilities and manifest dental caries, child functioning also had a correlation with caries. The dental caries burden was a stronger factor than functioning for the experience of DGA, however, dental health organisation and country context seemed to matter the most. Combining dental and medical procedures during the same GA session is good use of resources for both the individual and the society. To ensure children with complex disabilities to have the possibility of achieving equivalent good oral health as other children, DGA is one important factor.

Objetivo: aplicação do core set resumido genérico da CIFCJ para crianças e jovens de 0 a 18 anos com paralisia cerebral em um grupo de pacientes, através de um instrumento baseado no próprio core set, que operacionalize a coleta de dados funcionais. Métodos: Para algumas categorias, foi possível traçar uma relação entre o que se desejava avaliar e instrumentos escolhidos através de revisão da literatura. Nestes casos, as alternativas de resposta desses instrumentos foram agrupadas de forma que satisfizessem os critérios dos qualificadores da CIFCJ. Nos casos em que isso não fosse possível criou-se uma tabela de correspondência para cada item. Todos os pacientes foram classificados de acordo com o sistema de classificação da função motora grossa (GMFCS). Foram avaliados 33 pacientes dos ambulatórios e do Centro de Reabilitação de neurologia infantil do Hospital das Clínicas de Ribeirão Preto, divididos em 3 grupos, de acordo com sua faixa etária, e desenvolvidas tabelas para descrever os qualificadores de cada componente. Os dados do questionário do core set resumido de 0 a 18 anos da CIFCJ-PC foram inseridos em bancos de dados, digitados em planilha do Excel, e a análise descritiva simples deu-se através do programa estatístico SPSS. Resultados: Para cinco categorias foi possível utilizar escalas sem necessidade de perguntas auxiliares. A avaliação realizada apenas por perguntas objetivas, ocorreu em um item de funções do corpo, em três domínios de atividades e participação, e em todos os oito descritores do componente Fatores ambientais. A idade dos participantes variou entre 4 meses e 18 anos, com maior frequência (33%) de pacientes GMFCS III. A frequência de alguma forma de problema nas funções intelectuais foi de 75%, variando entre 63-81% nos três grupos etários. A Sensação de dor (b280) obteve a menor prevalência de deficiências de algum grau, existindo em maior número no grupo de 0 a 6 anos. Encontramos 91% das crianças e jovens avaliados apresentando limitação em algum grau para deslocar-se por diferentes locais (d460). Os principais facilitadores foram Família imediata (e310) (91%), Produtos e tecnologias para uso pessoal na vida diária (e115) (85%) e Serviços, políticas e sistemas de saúde (e580) (82%). A maior barreira entre os fatores ambientais foram Produtos e tecnologias usados em projeto, arquitetura e construção de edifícios (e150). Conclusão: O core set resumido da CIFCJ para crianças e jovens com paralisia cerebral de 0 a 18 anos permite gerar um perfil funcional dos pacientes com esta condição de saúde e identifica as áreas a serem mais bem trabalhadas para cada indivíduo. Aponta ainda as influências, deficiências e barreiras comuns a maioria desses indivíduos, podendo ajudar a diagnosticar problemas na área de saúde, economia e serviço social. / Objective: To apply the common brief ICF-CY core set for children and youth with cerebral palsy in a group of patients, through instruments based on the core set itself, that operationalize the data collection in functioning. Methods: For some categories, it was possible to correlate the domains and an instrument selected through literature review. In these cases, the response alternatives were grouped to satisfy the criteria of the ICF-CY qualifiers. When this was not possible, we created a correlation for each item. All patients were classified according to GMFCS. Thirty-three patients from the outpatient clinics and the Children\'s Neurology Rehabilitation Center (CER) of the Hospital das Clínicas de Ribeirão Preto (HCRP) were divided into three groups, according to their age group. Tables were developed to describe the qualifiers of each component. Data from the ICF-CY common brief core set for children and youth with CP were entered into databases, typed in an Excel spreadsheet, and the simple descriptive analysis was done through the SPSS statistical program. Results: For five categories, it was possible to use scales without the need for auxiliary questions. The evaluation performed with only objective questions, occurred in an item of the component functions of the body, in three domains of activities and participation, and in all eight descriptors of the Environmental factors component. The participants aged from 4 months to 18 years, with a greater frequency (33%) of GMFCS III patients. The prevalence of some sort of problem in intellectual functions was 75%, varying between 63-81% in the three age groups. Sensation of pain (b280) obtained the lowest prevalence of deficiencies, existing in a greater number in the group of 0 to 6 years. We found 91% of the children and young people evaluated, showing some degree of limitation for Moving around different locations (d460). The main facilitators were Immediate family (e310) (91%), Products and technology for personal use in daily living (e115) (85%) and Health services, systems and policies (e580) (82%). The biggest barrier in environmental factors was Design, construction and building products and technology of buildings for public use (e150). Conclusion: common brief ICF-CY core set for children and youth with cerebral palsy is very useful to generate a functional profile for patients with CP, and to identify the areas to be better worked for each individual. This core set also points out influences, deficiencies and barriers that are common for most of these children, and should help on identifying problems in health, economy and social services.

Introdução. A linguagem comum e padronizada oferecida pela Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) permite a categorização dos estados de saúde relacionados à funcionalidade e incapacidade facilitando a construção de sistemas de informação. Ainda hoje, o uso da CIF é limitado pela sua complexidade. Alguns instrumentos para facilitar sua aplicação foram criados sem, no entanto, suprir todas as necessidades para seu uso em algumas áreas. O objetivo deste trabalho é construir facilitadores para que a CIF possa ser aplicada na área de Fisioterapia. Métodos. Foram desenvolvidos três estudos: dois consensos com especialistas e uma análise do uso da CIF em um inquérito de saúde, apresentados no formato de artigos científicos. Os dois primeiros estudos estruturam ferramentas de coleta de dados por meio adaptado da técnica Delphi e o terceiro estudo explora o uso da CIF como ferramenta classificatória de resultados de um inquérito de saúde aplicado em pessoas com incapacidades. Resultados. Um conjunto de categorias relevantes da CIF para Fisioterapia Geral e para cada especialidade da área reconhecida pela Classificação Brasileira de Ocupações foi definido (primeiro artigo). Foi estruturada uma proposta de ferramenta classificatória para uso em Fisioterapia do Trabalho (segundo artigo). O terceiro artigo apresenta benefícios do uso da CIF em inquéritos de saúde como meio de geração de dados sobre a incapacidade. Conclusões. Os estudos indicam que a operacionalização da CIF será mais adequada se houver um menor número de categorias em uso. Em princípio, sugere-se três simplificações: redução do número de categorias, escolha de categorias de baixo nível de complexidade (segundo estrutura da classificação) e uso do qualificador \"não especificado\" / Introduction. The common language and standard offered by the International Classification of Functioning, Disability and Health (ICF) enables the categorization of functioning and disability, facilitating the construction of information systems. Even today, the completed use of ICF is limited by its complexity. Some tools aimed to facilitate its application were created withoutcovering all the needs for its use by some areas. The objective of this thesis is topropose facilitators to ICF application in the field of Physical Therapy. Methods. We developed three studies: two consensuses with experts and a review of the use of the ICF in a health survey, presented in the format of scientific papers. The first two studies structured data collection tools through Delphi technique adapted and the third study explores the use of the ICF as a tool for classifying the results of a health survey applied to a population with disabilities. Results. A set of ICF categories relevant to General Physiotherapy and for each specialty recognized by the Brazilian Classification of Occupations was defined (first article). We got a classification tool for use by Physiotherapists of Occupational Health (second article). The third article presents the benefits of using the ICF in health surveys as a way to generate data on disability. Conclusions. The use of the ICF is facilitated by a list with a small number of categories. Actually, it is suggested three simplifications: reducing the number of categories, selecting categories of low complexity (second classification structure) and use of the \"unspecified\" qualifier