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

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

Abstract: Objective: This study aimed at describing the health concept in the Swedish follow up programme for cerebral palsy (CPUP), with main focus on how aspects of participation is expressed in the agenda of the programme. Design: Document analysis: The home-page of CPUP was searched for three types of written material; references to the nature and aim of the programme, protocols used for data collection and abstracts from articles and reports on the list of publications. Within these all expressions of health, with bio-psycho-social understanding of the concept, were extracted and condensed with manifest content analysis. The meaning units obtained were linked to the International Classification of Function, Disability and Health – Child/Youth (ICF-CY). All resulting codes of participation were further compaired to an alternative model for describing the activity/participation component where the notion of "social participation" requires an aspect of role taking. The involvement of children/ youths and parents by the follow up routines were estimated and related to the results of the coding process. Results: 1276 meaning units were identified.The health focus of the CPUP involving data collected from children was on body and movement functions. The aspects in which parents were involved included more health aspects, especially if an optional assessment protocol aiming performance was used. Defined as peformance participation accounted for 19% of the meaning units (7% whitout the optional instrument). Defined as "societal participation" the rate of participation was under 3%. Conclusion: CPUP focuses on body-related aspects of health. The participation perspective needs strengthening to ensure the information needed to plan and implement interventions that have an impact on the self image of involved children. Thereby CPUP would gain an even stronger relation with the overall goal of Swedish habilitation services. / Abstract: Syfte: Studiens syfte var att beskriva hälsobegreppet i det svenska kvalitets-registret för uppföljning av cerebral pares (CPUP). Ett speciellt intresse riktades mot hur aspekter av delaktighet återspeglades i registrets arbete. Design: Text-analys. CPUP’s hemsida genomsöktes och tre texttyper avgränsades; uttryck för vad registret "var" eller hade till syfte, rapportformulär för datainsamling och abstracts från arbeten på publikationslistan. Alla uttryck för hälsa i bio-psyko-social mening avgränsades ur texterna med manifest innehållsanalys och kondenserades. De betydelseenheter som erhölls kodades till den internationella klassifikationen av funktion, funktionshinder och hälsa för barn och ungdomar (ICF-CY). De koder för delaktighet som erhölls analyserades vidare utifrån en alternativ modell för beskrivning av aktivitet/delaktighetskomponenten, där begreppet "social delaktighet" (definierat utifrån rolltagande) tillämpades. Barn/ungdomars och föräldrars involvering i datainsamlingen uppskattades och relaterades till resultaten av kodningen. Resultat: 1276 betydelseenheter identifierades. Hälsofokus för de data i CPUP vars insamling involverade barn gällde kropp och rörelse. Hälsoaspekter som involverade föräldrar uppvisade ett något bredare spektrum, speciellt om ett valbart instrument med inriktning på performance användes. Definierat som performance utgjorde delaktighet 19% av betydelseenheterna (7% utan det valbara instrumentet). Definierat som "social delaktighet utgjorde delaktighet under 3%. Konklusion: CPUP fokuserar kroppsrelaterade hälsoaspekter. Delaktighetsperspektivet behöver stärkas för att säkra den information som behövs för att planera och implementera åtgärder med inverkan på självbilden hos deltagande barn. Därigenom skulle starkare överensstämmelse mellan CPUP och övergripande mål för svensk habilitering kunna uppnås.

As societies the world over move towards defining inclusive and effective education systems this presents the educator with the new challenge of providing an equal and democratic education environment for all students. With children the nature of functioning and environmental settings varies greatly in comparison with adults and assessing children’s involvement in activities is of particular importance to ensure effective and inclusive society building through education. Building on the existing and previous participation research this thesis specifically aims to provide a means to theorize participation from two perspectives (frequency of attending and intensity of involvement) and put in to operation using five dimensions of the environment: availability, accessibility, affordability, accommodability, and acceptability. Contextually this has been done by investigating children in need of additional support (including children with disabilities) at school. Results indicate that while research and theory take a holistic and balanced approach by using participation based on two perspectives, this has yet to filter down to practice. A new approach to measuring inclusive education using social capital, the five environmental dimensions, and the ICF-CY is proposed and tested. However, while the ICF-CY provides a consistent descriptive framework, no clear connections between social capital and inclusive education policy could be drawn and the five environmental dimensions – especially the involvement-related ones – need further development. The final paper presents evidence from the individual perspective for a third ICF-CY activities and participation qualifier to represent the subjective experience of involvement. Participation can thus be regarded as a multi-dimensional phenomenon with two main conceptual roots: sociology and developmental psychology. / MURINET project (Multidisciplinary Research Network on Health and Disability in Europe, European Commission project funded within the Sixth Framework Programme, MRTN-CT-2006-035794).

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.

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.

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.

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.

The International Classification of Function, Disability and Health-Children and Youth Version (ICY-CY), (WHO, 2007) provides an important framework for the holistic consideration of children with communication disorders such as cleft lip and palate. It allows for understanding the effects of a cleft lip and palate on a child’s ability to communicate in structured and natural contexts, going beyond a focus on body structures and functions in order to examine the ways that environmental and personal factors influence the child. Over the years, a number of researchers have applied the ICF-CY framework to children with communication impairments such as speech sound disorders, language impairments, and stuttering. While there is an emerging body of research and literature on this topic, the ICF-CY does not yet appear to be widely applied clinically to children with cleft lip and palate. The aim of the study was to conduct a comprehensive narrative review of the application of the ICF-CY to children with cleft lip and palate, in order to illustrate its use in this population, to identify research needs, and to make recommendations for clinical application to assessment and intervention and integrating the ICF-CY in cleft palate curricula. A systematic search of the literature was conducted by following a specific search strategy and a systematized selection of publications for review to limit researcher bias. Computer searches of electronic data bases, as well as hand searches, were conducted to identify publications and sources that addressed the ICF-CY or ICF in children with cleft lip and palate. Publications and sources that met the inclusion criteria were selected for review. Each source was summarized according to the author(s) and publication year, and a qualitative description of each was made according to structured review procedures and templates. Applications of the specific ICF-CY components to children with cleft lip and palate were mapped, and recommendations for clinical application and future research were described. It is suggested that the ICF-CY framework should be included in cleft palate curricula to provide future speech-language pathologists with a holistic perspective on children with cleft lip and palate and to extend their thinking about the impact of speech impairment associated with cleft lip and palate. Training to adopt the ICF-CY framework will also facilitate collaborative interdisciplinary care of children with cleft lip and palate. Using the ICF-CY framework in the assessment of children in this population will focus intervention on the ultimate goal of improvement of the child's ability to communicate in natural settings. This narrative review will also serve as the theoretical underpinning for a planned survey of the clinical assessment practices of speech-language pathologists treating children with cleft lip and palate.

No description available.