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This session is developed by, and presenters invited by, Cultural and Linguistic Considerations Across the Discipline. This session was developed by the Convention Program Committee to increase SLPs’ awareness regarding research and clinical applications of the International Classification of Functioning, Disability and Health (ICF) across pediatric and adult populations around the world. Discussants provide perspectives from Australia, Brazil, Canada, Jamaica, and the United States.

Participation is generally considered the ultimate rehabilitation outcome and, for individuals with progressive illnesses, elucidating the factors that impact participation is critical. Parkinson’s disease (PD) is a chronic degenerative, neurological condition affecting nearly 1 million people in the United States, making PD the second most prevalent neurodegenerative disorder. PD has a profound negative effect on functioning and activity, but limited literature exists assessing the relationship between PD and community participation. The purpose of this study was to use the World Health Organization (WHO) International Classification of Functioning, Disability, and Health (ICF) as a framework for explaining how PD affects participation. Additionally, because the ICF explains the impact of chronic illness and disability as consisting of interactions between different contextual and disease-related factors, this investigation also addressed whether the personal factors, Positive Psychological Capital (PsyCap), mediated the relationship between functioning with PD and community participation. A total of 114 individuals were surveyed from peer-led PD support groups in a Midwestern state. The study examined the individual and collective contributions of demographic characteristics, activities/functioning, environmental factors, and personal factors on community participation. Results from the hierarchical regression analysis suggest that demographic characteristics account for only 15% of the variance in participation, but when functioning was added to the model, 65% of the variance was accounted for. The addition of environmental and personal covariates did not result in any significant change in overall variance in participation. These results, along with the strong, positive linear correlations between functioning and participation (r = .78), indicate that functioning largely predicts an individual’s participation. The study also sought to identify any mediating effect of personal factors (PsyCap) on the relationship between functioning and participation. The results indicated that the completely standardized indirect coefficient was not significant, b = .065, SE = .0617, 95% CI = -.213, .029, with 0 falling within the CI, which confirms no significant effect of the mediator PsyCap. The study contributes new knowledge to the association between the symptoms associated with PD and one’s community participation. Clearly, functioning is the primary predictor of participation. The lack of mediation of PsyCap, again, supports the strength of the relationship between functioning and participation. Although PsyCap did not mediate the relationship, implications for future research are discussed.

What meanings have formerly engaged (radicalized) Salafists ascribed to their disengagement and how have they become embedded in their everyday lives? There are two narratives that can explain this question. On the one hand, there is a central inclusive narrative that suggest the institutionalization of the religious terrain in Morocco through the Institution of the Commander of the Faithful (mou’assassat imarat al mou’minine) or ICF, which allows the Monarchy to play the king-religious role as the guarantor of religion and other faiths. On the other hand, Salafi Jihadists represent the second exclusive narrative through a religious concept that has taken a violent understanding called “loyalty and disavowal” (Al Wal’a wal Bar’a) or WB. The power of this narrative lies in the ability to divide society into a near and far enemy. Put it another way, to ask how those very meanings affect their everyday lives, a change in Salafi worldview for example allows them to live lives that seemed not possible before far from violence. As a result, there is no one picture of disengagement. Disengagement happens very differently in each case. Specifically, we argue that Salafi Jihadists’ disengagement has been informed, and shaped, by the meanings they attribute to their experiences in the everyday life. As such, this thesis is not about process, or pathways, or models of engagement and disengagement it is about meanings each one assigns to his or her experience. In addition to advancing theories of violent radicalization and disengagement from violence, this thesis makes a methodological contribution to the study of the meanings of disengagement through an ethnographic fieldwork in Morocco and Jordan.

Hearing loss affects millions of Americans each year, especially targeting older Americans. Elders aged 65-75 years are affected as much as 38% and those numbers rapidly rise to over 42% affected by the time a person is 75 years of age. The rise in the numbers of older persons in the United States makes hearing loss the third most common chronic illness in the US today. Of these persons approximately 30% chose to purchase hearing aids, but an astounding 47.2% of these individuals are able to adjust to the hearing aids in order to wear them daily. Ambient sounds and physical discomfort, from the presence of the device in the ear cause individuals either to never wear the devices or stop wearing them after a short time. This dissertation focused on an intervention to assist those older persons who have purchased hearing aids, but are not wearing them, in adjusting to those aids; in order to improve hearing aid satisfaction and hours of hearing aid use. A one group pre/posttest design was implemented on a group of individuals who had previously failed to adjust to hearing aids between the ages of 65-75 years of age. The Glasgow Hearing Aid Benefit Profile (GHABP) and hours of hearing aid use time were the primary outcome variables. This intervention study occurred over a four week period of time, with weekly face-to-face meetings with participants. Findings demonstrated that the intervention was feasible to administer in a group of community dwelling older persons (aged 65-75 years). All 15 participants completed the entire intervention, meeting each of 4 times with the researcher over a four week period. 40% of volunteers later declined to participate and 48% were turned away due to the small sample size of this study. An overall increase of hearing aid use time was between 1-9 hours per day. A Wilcoxin signed rank test was performed with a result of 60 (p=<0.0001). Participants who increased their hearing aid use time >4 hours equaled 53% while 46.7% increase their hearing aid use time <4 hours. Hearing aid satisfaction as measured by the GHABP improved between 1-5 with a median of 4. The Wilcoxin signed rank test result was 22.5 with a p value of 0.0039. These results deem the intervention not only feasible, but statistically significant in improving both hearing aid use time and hearing aid satisfaction. Future studies should be aimed at advanced statistical analysis, randomized clinical trial with larger numbers to improve power, and expanding the age criteria for study inclusion. Implications for future research are great, improving communication in older persons, but also perhaps impacting third party reimbursement of hearing aids, as well as decreasing the biopsychosocial effects hearing loss has on the population as a whole.

Hearing impairment is the most common communication disability in older people. The wide-ranging impact of hearing impairment on communication means that not only does the person with hearing impairment experience the consequences but also his or her frequent communication partners. This thesis investigates the impact of hearing impairment on spouses and uses the World Health Organization’s term “third-party disability.” Third-party disability is defined as the impairments, activity limitations, and participation restrictions experienced by the family due to the health condition of their significant other, and was identified by the World Health Organization as an area for future development and application of the International Classification of Functioning, Disability and Health (ICF). Despite a number of studies previously published on the effect of hearing impairment on family members, including younger couples and carers, there remain substantial gaps in knowledge and understanding of the difficulties specifically relating to older people and factors associated with third-party hearing disability. This thesis focuses on the third-party disability experienced by normally hearing spouses (termed the “spouses” in this thesis) of older people with hearing impairment (termed the “partners” in this thesis). To add empirical data to the body of research, this series of studies first explored the lived experience of spouses of older people with hearing impairment in a qualitative study, then identified the ICF domains and categories that described third-party hearing disability, described the extent of third-party hearing disability in this population, modelled the contribution of factors to third-party hearing disability, and developed and psychometrically tested a scale to measure the third-party disability of spouses of older people with hearing impairment. Studies conducted within this thesis were therefore completed in two phases. Ten spouses of older people with hearing impairment participated in the first qualitative phase, consisting of semi-structured in-depth interviews. Results of this study showed that spouses experience a number of effects as a result of their partners’ hearing impairment including: (1) the broad ranging effects of the hearing impairment on the spouses’ everyday lives; (2) the spouses’ need to constantly adapt to their partners’ hearing impairment; (3) the effect of acceptance of the hearing impairment on the spouse; and (4) the impact of ageing and retirement. Findings were then linked to the ICF to identify the most typical and relevant domains and categories of the ICF for spouses of older people with hearing impairment. The majority of themes were able to be linked to the ICF, with most linking to codes in the activities and participation component. A number of contextual factors were also identified that influenced the spouses’ third-party disability. In the second phase, a further 100 older couples affected by hearing impairment participated in a quantitative face-to-face survey to describe the nature and degree of third-party disability in spouses, and to examine factors associated with third-party hearing disability. Concepts identified in the first qualitative study were used to formulate a 36-item tool for measuring spouses’ third-party hearing disability, namely the Significant Other Scale for Hearing Disability (SOS-HEAR). The majority of spouses in this study (98%) reported some degree of third-party hearing disability on at least one item of the SOS-HEAR. Communication difficulties between the couple were the central source of stress reported by spouses, followed by emotional problems in the spouse. Three factors were found to be significantly associated with greater third-party hearing disability: (1) lower relationship satisfaction as described by spouses; (2) a larger spouse-partner age difference; and (3) greater hearing disability in the hearing impaired partner as perceived by the spouse. The scaling properties of the SOS-HEAR were then examined, with a revised 27-item questionnaire found to be a reliable means of measuring older spouses’ third-party hearing disability. Use of the SOS-HEAR is proposed as a means of identifying spouses of older people with hearing impairment in need of intervention. If spouses are identified as experiencing third-party hearing disability, health professionals are then in a position to facilitate discussions with the couple about the impact of the hearing loss on their daily functioning. The inclusion of spouses in rehabilitation takes into account the needs of both members of the couple such that they become partners in rehabilitation. In summary, this research has shown that hearing impairment in older people has an effect on the spouse, as they too experience situations of communication activity limitations and participation restrictions. It is clear that the lives of participants in this study were considerably affected as a result of their partners’ hearing impairment, with spouses reporting a wide variety of stresses involving lifestyle changes, communication difficulties, and emotional consequences. This series of studies has highlighted the potentially important role of family-centred intervention in rehabilitation for older adults with hearing impairment, and strongly suggests the need for increased inclusion of spouses and significant others in the rehabilitation process.

Hearing impairment is the most common communication disability in older people. The wide-ranging impact of hearing impairment on communication means that not only does the person with hearing impairment experience the consequences but also his or her frequent communication partners. This thesis investigates the impact of hearing impairment on spouses and uses the World Health Organization’s term “third-party disability.” Third-party disability is defined as the impairments, activity limitations, and participation restrictions experienced by the family due to the health condition of their significant other, and was identified by the World Health Organization as an area for future development and application of the International Classification of Functioning, Disability and Health (ICF). Despite a number of studies previously published on the effect of hearing impairment on family members, including younger couples and carers, there remain substantial gaps in knowledge and understanding of the difficulties specifically relating to older people and factors associated with third-party hearing disability. This thesis focuses on the third-party disability experienced by normally hearing spouses (termed the “spouses” in this thesis) of older people with hearing impairment (termed the “partners” in this thesis). To add empirical data to the body of research, this series of studies first explored the lived experience of spouses of older people with hearing impairment in a qualitative study, then identified the ICF domains and categories that described third-party hearing disability, described the extent of third-party hearing disability in this population, modelled the contribution of factors to third-party hearing disability, and developed and psychometrically tested a scale to measure the third-party disability of spouses of older people with hearing impairment. Studies conducted within this thesis were therefore completed in two phases. Ten spouses of older people with hearing impairment participated in the first qualitative phase, consisting of semi-structured in-depth interviews. Results of this study showed that spouses experience a number of effects as a result of their partners’ hearing impairment including: (1) the broad ranging effects of the hearing impairment on the spouses’ everyday lives; (2) the spouses’ need to constantly adapt to their partners’ hearing impairment; (3) the effect of acceptance of the hearing impairment on the spouse; and (4) the impact of ageing and retirement. Findings were then linked to the ICF to identify the most typical and relevant domains and categories of the ICF for spouses of older people with hearing impairment. The majority of themes were able to be linked to the ICF, with most linking to codes in the activities and participation component. A number of contextual factors were also identified that influenced the spouses’ third-party disability. In the second phase, a further 100 older couples affected by hearing impairment participated in a quantitative face-to-face survey to describe the nature and degree of third-party disability in spouses, and to examine factors associated with third-party hearing disability. Concepts identified in the first qualitative study were used to formulate a 36-item tool for measuring spouses’ third-party hearing disability, namely the Significant Other Scale for Hearing Disability (SOS-HEAR). The majority of spouses in this study (98%) reported some degree of third-party hearing disability on at least one item of the SOS-HEAR. Communication difficulties between the couple were the central source of stress reported by spouses, followed by emotional problems in the spouse. Three factors were found to be significantly associated with greater third-party hearing disability: (1) lower relationship satisfaction as described by spouses; (2) a larger spouse-partner age difference; and (3) greater hearing disability in the hearing impaired partner as perceived by the spouse. The scaling properties of the SOS-HEAR were then examined, with a revised 27-item questionnaire found to be a reliable means of measuring older spouses’ third-party hearing disability. Use of the SOS-HEAR is proposed as a means of identifying spouses of older people with hearing impairment in need of intervention. If spouses are identified as experiencing third-party hearing disability, health professionals are then in a position to facilitate discussions with the couple about the impact of the hearing loss on their daily functioning. The inclusion of spouses in rehabilitation takes into account the needs of both members of the couple such that they become partners in rehabilitation. In summary, this research has shown that hearing impairment in older people has an effect on the spouse, as they too experience situations of communication activity limitations and participation restrictions. It is clear that the lives of participants in this study were considerably affected as a result of their partners’ hearing impairment, with spouses reporting a wide variety of stresses involving lifestyle changes, communication difficulties, and emotional consequences. This series of studies has highlighted the potentially important role of family-centred intervention in rehabilitation for older adults with hearing impairment, and strongly suggests the need for increased inclusion of spouses and significant others in the rehabilitation process.

Le gène est défini comme une unité fonctionnelle de l'hérédité. En effet, les gènes, transcrits en ARN, codent pour des protéines qui assurent l'essentiel des fonctions cellulaires. Cependant, les gènes ne représentent que 2% du génome humain. Ainsi, notre génome est presque exclusivement composé d'ADN non codant (ADNnc) qui, en raison d'une absence apparente de fonction (c'est-à-dire de transcription et de traduction), est également connu sous le terme peu élogieux d' « ADN poubelle ». De manière surprenante, la quantité d'ADNnc présente dans les cellules est proportionnelle au degré de complexité des organismes, suggérant ainsi que cet ADNnc pourrait avoir une fonction. En particulier, les centromères et des péricentromères, qui contiennent des séquences d'ADNnc de type satellite, permettent la ségrégation correcte de chromatides sœurs lors de la mitose. De plus des études récentes réalisées chez la levure S.pombe montrent que les régions péricentromériques peuvent être transcrites. Les ARNnc ainsi produits participent à l'établissement et au maintien de l'hétérochromatine péricentromérique. Bien que les mécanismes impliqués dans ces processus soient en grande partie identifiés, très peu de choses sont connues quant à la capacité transcriptionnelle de ces séquences satellites chez d'autres espèces.<br /><br />Ainsi, l'objectif de ma thèse a été d'évaluer le potentiel transcriptionnel des séquences satellites du génome humain.<br /><br />A mon arrivée dans le laboratoire, l'équipe du Pr Claire Vourc'h était particulièrement engagée dans ce projet puisqu'elle venait de mettre en évidence la transcription des séquences satellites 3 du locus 9q12 au cours de la réponse au stress. Mon travail de thèse m'a conduit à approfondir cette étude en identifiant de nouvelles séquences satellites dont la transcription est induite par le stress thermique. Par ailleurs, j'ai développé la première approche trancriptomique dédiée à l'expression des séquences satellites du génome humain : la RepChip. Le modèle de la réponse au stress m'a permis de valider cet outil. Ainsi, j'ai pu identifier non seulement de nouveaux contextes cellulaires permettant l'expression de ces séquences mais également deux mécanismes indépendants impliqués dans leur transcription. En particulier, un lien entre la capacité transcriptionnelle de ces séquences et des modifications de l'épigénome a pu être établi. Finalement, j'ai identifié un modèle d'inhibition de la transcription des séquences satellites au cours du choc thermique, le syndrome ICF (Immunodeficiency, Centromeric instability and Facial anomalies).

Given the building sector’s substantial contribution to global energy use and green house gas (GHG) emissions, it is of great importance that only the most effective building envelopes are utilized. Conventional light-frame wood building envelopes are highly popular due to their ease of construction and building economy; however the life cycle performance of the building envelope is often overlooked when this selection is made. Although insulated concrete form (ICF) building envelopes generally require a substantially higher embodied energy input, it should be considered that improvements during a building’s operation phase can offers significant energy returns, ultimately reducing the building’s life cycle energy use and GHG intensity. Therefore, an assessment is conducted regarding the life cycle energy use and GHG intensity of the ICF building envelope, in addition to two light-frame wood building envelopes; the average light wood frame envelope (U.S. Department of Energy, 2007), and a more highly insulated wood frame envelope. The operation phase of the building envelopes proves to be of greatest significance, as it is attributed to 95- 97% of the total life cycle energy use, and 93-96% of life cycle GHG emissions, assuming a 100 year life cycle. Ultimately, the life cycle performance of the ICF building envelope is superior to the two wood frame envelopes due to its improvements in the operation phase. The ICF building envelope has a life cycle energy requirement of 11% to 14% less than the two light-frame wood envelopes, and a 10% to 12% lower life cycle GHG intensity. Although the increased thermal resistance certainly contributes to the superior life cycle performance of the ICF envelope, the improved infiltration leakage area of the envelope is key to its operational performance, and subsequently to its improved life cycle performance. End of life energy use for the demolition, recycle, and disposal of the building envelopes is nearly negligible, as it is attributed to less than 0.3% of the life cycle energy for any of the envelope scenarios.

Objective. The overall aim of this thesis was to evaluate the biopsychosocial consequences after stroke and test the validity of the ICF Core Sets for Stroke during one year post-stroke. Material and Methods. Studies I, II and III were based on data from a prospective cohort study with 120 stroke survivors who were recruited at admission to stroke units in western Sweden and were followed-up at six weeks, three months and one year after stroke event. Repeated assessments were done through face-to-face interviews consisting of a battery of questions based on the Stroke ICF Core Set (59 categories of Body Functions, 59 of Activities and Participation and 37 of Environmental Factors) and several questionnaires (EuroQol-5D (EQ-5D), Stroke Impact Scale (SIS), Medical Outcome Study Short Form 36 (SF-36), Self administered Comorbidity Questionnaire (SCQ), information on health care and social services utilization and spouse support). Study IV was based on data from the multi-center cross-sectional validation study of the Stroke ICF Core Set with 757 stroke survivors from China, Germany, Italy and Sweden. Results. Study I: A total of 28 of 59 ICF categories of Body Functions and a total of 41 of 59 categories of Activities and Participation were significant problems for stroke survivors at six weeks and three months. These categories showed a good discriminative ability to distinguish between independent (≤ 2 on modified Ranking Scale (mRS)) and dependent (&gt; 2 on mRS) stroke survivors. Study II: Most stroke survivors felt satisfied with their stroke care and rehabilitation during three months post-stroke. Frequently perceived environmental facilitators could be documented with eleven of 37 ICF categories of Environmental Factors. Only physical geography, such as hills, was a common perceived barrier. Study III: Independent factors of health-related quality of life (HRQoL) varied over time. Almost all variance in HRQoL was explained by categories within Body Functions and within Activities and Participation during the first three months, while at one year only half of the variance could be explained by categories within either Body Functions or Environmental Factors. Problems with personal and energy functions, as well as limited recreational activities, were recurringly associated with poorer HRQoL. Study IV: It was possible to integrate ICF categories of Body Functions and Structures, Activities and Participation into a cross-cultural measurement with good reliability providing summary scores of the overall functioning of stroke survivors. However, the five-point ICF qualifier scale was not consistently applicable. Conclusions. The results of the present thesis showed that the ICF,particularly the ICF Core Set for Stroke, was a valid and practical tool for documenting the multi-faceted biopsychosocial problems and consequences after stroke structured with one common terminology throughout the long chain of care and rehabilitation. The opportunity to integrate ICF categories of Body Functions and Structures, Activities and Participation into a measurement provides new possibilities for monitoring, following-up and comparing overall functioning after stroke. / Syfte. Avhandlingen i sin helhet syftade till att fastställa de mångfaldiga biopsykosociala konsekvenserna under ett års tid efter stroke med hjälp av ICF och att testa validiteten av det nyetablerade Stroke ICF Core Set med avsikt att mäta funktionstillstånd efter stroke. Material och metod. I studie I, II och III ingår data från en ett års prospektiv kohortstudie med 120 personer med stroke som vårdades på strokeenheter i Västsverige och somföljdes upp efter sex veckor, tre månader och efter ett år. Datainsamlingen genomfördes med intervjuer som bestod av ett batteri av frågor grundat påStroke ICF Core Set, EuroQol-5D (EQ-5D), Stroke Impact Scale (SIS), Medical Outcome Study Short Form 36 (SF-36), Self-administered Comorbidity Questionnaire (SCQ), och information om insatser från hälso- och sjukvård, socialtjänst och familj. I studie I analyserades de 59 ICFkategorierna gällande Kroppsfunktioner och de 59 kategorier gällande Aktivitet och Delaktighet deskriptivt vid sex veckor och tre månader efter stroke. Därutöver prövades core sets förmåga att skilja mellan personer som var antingen beroende eller oberoende av hjälp efter stroke. Hur deltagarna uppfattade omgivningsfaktorernas betydelse analyserades deskriptivt utifrån de 37 ICF kategorierna från Omgivningsfaktorer i studie II vid sex veckoroch tre månader liksom skillnaderna mellan deltagarna som var hemma redan vid sex veckor och deltagarna som kom hem senare men inom tre månader. I studie III identifierades faktorerna av generell hälso-relaterad livskvalitet (EQ-5D visuell analog skala) med hänsyn till den biopsykosociala mångfaldigheten av hälsan och huruvida faktorerna ändrades under ett år efter stroke. Till detta användes korrelation- och regressionsanalys och de 155 ICF kategorier gällande Kroppsfunktioner, Aktivitet och Delaktighet samt Omgivningsfaktorer. Den pyskometriska analysen i studie IV baserades på datamaterial från WHO:s internationella multicentertvärsnittsstudie för validering av Stroke ICF Core Sets där 757 personer med stroke från Kina, Tyskland, Italien och Sverige ingår. Möjligheten att integrera 15 ICF kategorier från Brief ICF Core Set for Stroke (6 kroppsfunktioner, 2 strukturer, 7 aktiviteter och delaktighet) med dess 5-stegsbedömningsskala (från 0 till 4, inget, lätt, måttligt, stort och totalt problem) undersöktes både nationsspecifikt men också tvärkulturellt med Raschanalys. Resultat. Studie I. Signifikanta problem kunde dokumenteras med 28 ICF kategorierfrån komponenten Kroppsfunktion och med 41 ICF kategorier frånkomponenten Aktivitet och Delaktighet. Det fanns inga skillnader mellan 6veckor och 3 månader. Kategorierna hade en god förmåga att skilja mellan personer som var antingen oberoende eller beroende av hjälp efter stroke. Personer som var beroende av hjälp hade kontinuerlig mera problem inom området som gällde framförallt förflyttning, personlig vård och urinering men även kommunikation. Studie II. Deltagarna uppfattade elva omgivningsfaktorer som underlättande vid sex veckor och vid tre månader (framförallt familj, vänner och hälso- ochsjukvårdspersonal men också hjälpmedel, medicin och hälso- och sjukvårdsservice) och endast en faktor (fysisk geografi, dvs. backe, grusvägar, etc.) som hindrande. Vid tre månader uppfattades de sistnämnda faktorerna vanligare som hindrande än vid sex veckor. Vården på strokeenheten upplevdes något bättre jämfört med den senare tillkomna servicen från primär- och kommunvård. Studie III. Medan kroppsfunktioner och aktiviteter och delaktighet kunde förklara nästan all varians av självupplevd hälsa under de första tre månaderna (R2=0.80 - 0.93), så kunde bara hälften av variationen förklaras antingen med kroppsfunktioner eller med omgivningsfaktorer (R2=0.51). Problem med fritidsaktiviteter, personlighet, mental uttröttbarhet ochgångförmåga var återkommande problem som var relaterat till sämre självupplevd hälsa under året efter insjuknandet. Studie IV. Efter justeringar som innebar en minskning av bedömningsskalan till mellan två till tre svarsalternativ för vissa kategorier och en borttagning av några kategorier som inte passade in i Raschmodellen visade de resterande ICF kategorierna en bra täckning av personernas funktionstillstånd efter stroke och en god reliabilitet för att mäta funktionstillstånd. I den tvärkulturella analysen fanns det fyra kategorier sominte hade samma betydelse i de olika länderna. Därför utformades nationsspecifika kategorier. Det slutliga tvärkulturella instrumentet omfattar 20 ICF kategorier. Därmed blir det möjligt att integrera olika ICF kategorier till ett instrument och summera bedömningsvärden av de olika kategorierna till ett helhetsvärde för funktionstillstånd som underlättar uppföljning av och jämförelse mellan personer med stroke men även jämförelse mellan olika nationer. Slutsats. Studierna visar att ICF, och särskilt det specifika Stroke ICF Core Set, är ett valid och praktiskt verktyg för att strukturerat kunna dokumentera de mångfaldiga problemen och konsekvenserna efter stroke enhetlig genom hela förloppet av vårdkedjan. Strokesjukvården i Sverige upplevs som välfungerande men en god förbättringspotential finns framförallt i senare skede när primär- och kommunvård ta över ansvaret för personernas vård och rehabilitering. För dokumentation av funktionstillstånd av den typiska äldre patienten med stroke kan de 166 ICF kategorierna reduceras till 92. Faktorer som påverkar hälsorelaterad livskvalitet varierar under tiden efter insjuknandet där kroppsfunktioner och aktiviteter och delaktighet är starkt relaterade under de första tre månaderna. Vid ett år efter insjuknandet har omgivningens betydelse ökat för hälsorelaterad livskvalitet. Tidig hänsyn inte bara till gångförmåga men också till problem med personlighet och temperament, mental uttröttbarhet och återgång till fritidsaktiviteter borde kunna förbättra personernas livskvalitet efter stroke. Att konstruera ett tvärkulturellt instrument i syfte att mäta funktionstillstånd efter stroke genom integrering av ICF kategorier som omfattar kroppsfunktioner, strukturer, och aktiviteter och delaktighet är möjligt. Därmed öppnas nya potentialer för att kunna följa upp och jämföra funktionstillstånd efter stroke inte enbart på individ- och nationell nivå men även på populations- och internationell nivå. Den 5-stegs bedömningsskala (ICF qualifier) är dock inte psykometrisk användbart och fortsatt forskning behövs.