Falls are a leading cause of injury and death in older adults. Numerous exercise interventions have been explored for fall prevention with their effectiveness being inconsistent. An alternative intervention based on motor learning concepts has potential to help prevent falls. Two separate studies are reported in this thesis. The purpose of the first study was to investigate if older adults exhibit short-term performance adaptation and long-term motor learning with repeated exposures to a simulated trip. While in a safety harness, participants stood on a treadmill that was quickly accelerated to simulate a trip. Improvements in trip recovery performance due to repeated exposures of a simulated trip included arresting the forward rotation of the trunk more quickly, reacting to the perturbation more quickly, and decreasing agonist/antagonist co-contraction. Overall, the results provide evidence for both short-term performance adaptation and motor learning. The purpose of the second study was to investigate if skills obtained from repeated exposure to a simulated trip transfer to recovery from an actual trip. Participants were randomly assigned to either an experimental or control group performing one trip before and after an intervention. The intervention for the experimental group consisted of trip recovery training on a treadmill while the intervention for the control group was walking on a treadmill. Overall, the results suggested beneficial effects of trip recovery training on actual trip recovery. These beneficial effects included decreasing maximum trunk angle, decreasing the time to reach maximum trunk angle, and raising minimum hip height during the initial recovery step. / Master of Science

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

Thesis (M. A.)--University of Canterbury, 2006. / Typescript (photocopy). Includes bibliographical references (leaves 202-214). Also available via the World Wide Web.

SAMMANFATTNING Bakgrund: Undernäring är ett återkommande och stort problem inom sjukvården, i genomsnitt är var tredje patient undernärd. På ett sjukhus i mellansverige finns rutiner att mellanmål ska serveras, men varje avdelning får ansvara att det serveras. I november 2015 genomfördes en intervention för att öka serveringen av mellanmål på avdelning 1. Syfte: Syftet med studien var att genom en punktprevalensmätning, Dagen nutrition, mäta i vilken grad patienter på ortopedisk avdelning 1 och 2 på ett sjukhus i mellansverige uppnår beräknat energibehov. Samt se om interventionen om servering av mellanmål har bidragit till att fler mellanmål har serverats på avdelning 1. Studien kommer även se över hur väl avdelningarna följer rutinen för att riskbedöma patienter för undernäring vid inskrivningen och uppföljningen till vårdplaner. Metod: En punktprevalensmätning utfördes på avdelning 1 och avdelning 2 under ett dygn. Under mätdygnet uppmättes även antalet serverade mellanmål och riskbedömningar på avdelningarna. Resultat: Resultatet visade att endast fyra patienter uppnådde ett energiintag på mer än 75 % på avdelningarna avdelning 1 och avdelning 2, skillnader i energiintaget mellan avdelningar förekom efter mellanmålsinterventionen. Interventionen kan ha bidragit till att fler antal mellanmål har serverats på sikt. Endast 8 % av patienterna var riskbedömda vid inskrivningen. Slutsats: Studiens huvudresultat visar att majoriteten av patienterna inte uppnår ett energiintag mer än 75 %. Anledningarna till att en låg andel patienter kommer upp i ett energiintag mer än 75 % beror förmodligen på många olika faktorer. Interventionen från november 2015, kan ha bidragit till att flera mellanmål har serverats sedan förmätningen samt att personalen fått inspiration och vägledning i arbetet med nutritionen för patienterna. För att ytterligare kunna fastställa vad som kan göras för att öka patienternas energiintag behöver forskning som redan finns implementeras i den kliniska vården. / ABSTRACT Background: Malnutrition is a frequent and serious problem in health care, on average, every third patient malnourished. At a hospital in central Sweden routines are that in-between-meal should be served, but each ward will be responsible to have it served. To increase the serving of in between meals at ward 1 a intervention was conducted in November 2015. Objective: The purpose of the study was that through a point prevalence survey, Day Nutrition, measure the degree to which patients on the orthopedic wards 1 and 2 at achieves calculated energy intake at a hospital in central Sweden. And see if the intervention of the serving of in-between-meal has helped more in-between-meal have been served on ward 1. The study will also look at how well departments are following the routine for risk assessment of patients for malnutrition at enrollment and follow-up to the care plans. Method: A point prevalence survey was conducted on wards 1 and 2 for one day. During the survey the number of served in-between-meal and risk assessments were measured. Results: The results showed that only four patients achieved an energy intake of more than 75 % of the wards 1 and 2, differences in energy intake between wards occurred after in-between-meal intervention. The intervention may have contributed to a number of more served in-between-meal. Only 8 % of patients were risk assessed at enrollment. Conclusion: The study's main results show that the majority of patients do not achieve an energy intake more than 75 %. The reasons for a low percentage of patients going into an energy intake greater than 75 % is probably due to many different factors. Intervention in November 2015 may have contributed to an increase of in-between-meal have been served since the preliminary measurement, and that staff received inspiration and guidance in the work of nutrition for there patients. To further determine what can be done to increase the patients' energy intake needs the research that already exists be implemented in clinical care.

Les jeunes de la rue sont reconnus comme étant fragile [i.e. fragiles] dans leur identité qui les entraînent plus souvent qu'autrement à délaisser le monde de l'éducation et par la suite celui du travail. L'adaptation à la vie scolaire et professionnelle des jeunes de la rue passe entre autres par le développement d'un sentiment identitaire. Notre étude tente de comprendre comment contribuer au développement du concept de soi des jeunes de la rue par les arts. Pour y arriver, un cadre conceptuel double est utilisé, soit le modèle du concept de soi de l'Écuyer (1990) concernant le sentiment identitaire et l'art comme moyen d'intervention à partir des écrits de Vygotsky (1971). L'objectif général est de décrire la façon dont l'intervention musicale dans le projet Artifice agit sur le concept de soi, du point de vue des jeunes et de l'équipe d'intervention.

La présente étude visait à identifier les caractéristiques des jeunes et des parents (telles que la présence de troubles internalisés chez le jeune, la présence de troubles externalisés chez le jeune, l'estime de soi du jeune, la détresse psychologique des parents, les ressources interpersonnelles du parent, la qualité de la communication dans la famille, la cohésion familiale, l'intensité et la fréquence des conflits conjugaux) associées à l'évolution de l'alliance thérapeutique en contexte d'intervention brève et intensive de crise familiale. Pour atteindre cet objectif, nous avons effectué une étude corrélationnelle et descriptive avec deux temps de mesure de l'alliance thérapeutique. Notre échantillon est composé de 96 familles participantes au programme d'intervention Crise-Ado-Famille-Enfance. Selon les résultats obtenus, la perception de l'évolution de l'alliance thérapeutique des jeunes participant au programme CAFE ne semble pas être influencée significativement par aucune des caractéristiques recensées pour la présente étude. Au niveau de la perception de l'évolution de l'alliance thérapeutique des parents, les résultats révèlent qu'une seule des caractéristiques des jeunes et des familles y est associée de façon significative, soit la présence de troubles internalisés chez le jeune.

Background: Studies show that being overweight and obese is the greatest health issue facing the youth today. The physical, psychological and social effects have both short and long term risks for obesity related diseases that will require healthcare. Information concering preventive methods that are available for health care personnel and nurses is a requirement. Purpose: The purpose with this literary study is to describe secondary preventive methods and their effects on overweight or obese children. Method: In this literary study, eight quantitative research papers have been examined and analysed to draw conclusions. The following databases have been used for research: PubMed and CINAHL. Manual research was also conducted. Results: The analysation of the conclusions draw resulted in headlines that describe the interventions and their effects, both short and long term. Four components could be identified: 1. ”MI- motivational iinterviewing”, 2. ”CBT- cognitive behavioral therapy”, 3. ”Social cognitive theory”, and 4. ”Combined strategies”. Conclusion: Despite varying models, positive results could be seen in every case study. Consolidated information concering secondary preventive methods is needed. This information must become readily available to health care personnel and nurses in particular. More research is a necessity. / Bakgrund: Studier visar att övervikt och fetma är det största hälsoproblemet hos barn och unga. De fysiska, psykiska och sociala effekter tillståndet medför på både kort- och lång sikt ökar risken för överviktsrelaterade sjukdomar som slutligen landar hos sjukvården. Information kring preventiva metoder är något som därför behövs. Syfte: Syftet med litteraturstudien var att beskriva sekundärpreventiva metoder och dess effekter vid barns övervikt och fetma. Metod: I denna litteraturstudie har åtta kvantitativa studier granskats och analyserats för att bilda ett resultat. Sökningar gjordes i databaserna PubMed och CINAHL. Manuella sökningar utfördes även. Resultat: Analysen resulterade i rubriker som beskriver interventionerna, deras effekter samt långsiktiga effekter. Även fyra komponenter kunde urskiljas i studierna: 1. “MI-motivational interviewing”, 2. “KBT-kognitiv beteendeterapi”, 3. “Social inlärningsteori” samt 4. “Kombinerade strategier”. Slutsats: Trots varierande modeller kunde effekter ses i alla studier som analyserats. Sammanställd information kring sekundärpreventiva metoder behövs för att lätt nå sjukvårdspersonal, och då i synnerhet sjuksköterskan. Vidare forskning inom området behövs.

Children with childhood apraxia of speech (CAS) are likely to experience severe and persistent spoken and written language disorder. There is a scarcity of intervention research, however, investigating techniques to improve the speech and literacy outcomes of this population. The series of 5 experiments reported in this thesis investigated phonological awareness and early reading development in children with CAS and trialled a new intervention designed to advance the spoken and written language development of those affected. In the first experiment (presented in Chapter 2), a comparison of 12 children with CAS, 12 children with inconsistent speech disorder (ISD), and 12 children with typical speech-language development (TD) revealed that children with CAS may be particularly susceptible to phonological awareness and reading deficits. There was no difference in the articulatory consistency and speech severity of the CAS and ISD groups, and no difference in the receptive vocabulary of the CAS, ISD, and TD groups. The children with CAS exhibited poorer phonological awareness scores than the comparison groups and had a greater percentage of participants performing below the expected range for their age on letter knowledge, real word decoding, and phonological awareness normative measures. The children with CAS and ISD performed inferiorly than the children with TD on a receptive phonological representation task. The results showed that the children with CAS had a representational component to their disorder that needed to be addressed in intervention. In the second experiment (presented in Chapter 3), a follow-up pilot study was conducted to examine the long-term effects of a previously conducted intensive integrated phonological awareness programme (7 hours of intervention over 3 weeks) on 2 children with CAS. The children aged 7;3 and 8;3 at follow-up assessment had previously responded positively to the intervention. Results showed that the children were able to maintain their high accuracy in targeted speech repeated measures over the follow-up period. One child was also able to maintain her high accuracy in phonological awareness repeated measures. The children performed superiorly on a standardised phonological awareness measure at follow-up than at pre-intervention. Non-word reading ability showed a sharp increase during the intervention period, while minimal gains were made in this measure over the follow-up period. The findings suggested that an integrated intervention was a potential therapeutic approach for children with CAS. In the third experiment (presented in Chapter 4), the effectiveness of an integrated phonological awareness programme was evaluated for the 12 children (identified in the first experiment) aged 4 to 7 years with CAS. A controlled multiple single-subject design with repeated measures was employed to analyse change in trained and untrained speech and phoneme segmentation targets. A comparative group design was used to evaluate the phonological awareness, reading, and spelling development of the children with CAS compared to their peers with TD over the intervention. The children participated in two 6- week intervention blocks (2-sessions per week) separated by a 6-week withdrawal block. Seven children with CAS made significant gains in their production of trained and untrained speech words with 7 of these children demonstrating transfer of skills to connected speech for at least one target. Ten children showed significant gains in phoneme awareness, and 8 of these children demonstrated transfer of skills to novel phoneme awareness tasks. As a group, the children with CAS demonstrated accelerated development over the intervention period in letter knowledge, phonological awareness, word decoding, and spelling ability compared to their peers with typical development. In the fourth experiment (presented in Chapter 5), the speech, phonological awareness, reading, and spelling skills of children with CAS and TD were re-evaluated 6- months following completion of the intervention programme. A measure of reading accuracy and reading comprehension in a text reading task was administered to the children with CAS. There was no difference in the performance of the children with CAS in post-intervention and follow-up assessments. The children with CAS and children with TD presented with similar relative change in phonological awareness, reading, and decoding measures over the follow-up period. The connected reading performance of children with CAS mirrored their phonological awareness and decoding skills. The findings demonstrated that children with CAS were able to maintain gains achieved during the intervention but may need further support to promote sustained development in written language. In the fifth experiment (presented in Chapter 6), the long-term effects of the integrated phonological awareness programme for identical twin boys who participated in the research intervention at pre-school were examined. The study examined Theo and Jamie's spoken language, phonological awareness, reading, and spelling development during their first year of schooling. The results pointed to the benefit of providing phonological awareness within a preventative framework for children with CAS. Theo and Jamie experienced continued growth in speech and phonological awareness skills. They exhibited age-appropriate reading and spelling development during their first year of formal literacy instruction. It was concluded from this series of experiments that children with CAS are particularly vulnerable to phonological awareness and early reading difficulty, and that an integrated phonological awareness intervention is an effective means of developing speech, phonological awareness, reading, and spelling skills in most children with CAS. The intervention appears to target processes underlying spoken and written language development in this population. The results are discussed within a phonological representation deficit hypothesis of CAS and clinical implications of the findings are highlighted.

Abstract: Hintergrund: In Deutschland leben derzeit über eine Million Menschen mit Demenz, welche vorrangig von ihren Angehörigen versorgt werden. Diese Pflege und Betreuung ist für den pflegenden Angehörigen mit erheblichen Belastungen insbesondere auf der psychischen, physischen und sozialen Ebene verbunden. Daher ist es notwendig geeignete Interventionen zur Stärkung und Entlastung der pflegenden Angehörigen zu etablieren und diese in die Versorgungslandschaft zu implementieren. Ziel der Untersuchung: Ziel der Arbeit war es, zu überprüfen, ob sich durch eine zugehende Multikomponentenintervention für pflegende Angehörige von Menschen mit Demenz, im Vergleich zum Angebot der Regelversorgung, die subjektiv empfundene Belastung der pflegenden Angehörigen verbessern lässt. Als Intervention wurde das amerikanische REACH II Programm (Resources for Enhance Alzheimer‘ Caregivers Health II) adaptiert. Methode: Die Studie wurde als prospektive randomisiert kontrollierte Studie mit einer Interventions- und einer Kontrollgruppe konzipiert. Rekrutiert wurden pflegende Angehörige von Menschen mit Demenz im Raum Leipzig, die gemeinsam in einem Haushalt wohnten. Die Interventionsgruppe erhielt über einen Zeitraum von sechs Monaten eine zugehende Multikomponentenintervention (DeREACH), welche neun Hausbesuche und drei telefonische Kontakte einschließt. Die Kontrollgruppe wurde im Rahmen der Regelversorgung behandelt. Das primäre Ergebnismaß bezog sich auf die Veränderung der Belastung der pflegenden Angehörigen nach sechs Monaten, gemessen anhand des Zarit Burden Interview. Ergebnisse: In die Studie wurden 92 pflegende Angehörige aufgenommen (Interventionsgruppe n=47, Kontrollgruppe n=45). Für das primäre Ergebnismaß konnten 82 Teilnehmer analysiert werden. Die Belastung reduzierte sich in der Interventionsgruppe nach sechs Monaten um 0,42 (SD=8,42) Skalenpunkte und verstärkte sich in der Kontrollgruppe um 7,05 (SD=8,09) Skalenpunkte. Die zusammengefasste Mittelwertdifferenz beträgt -7,47; KI95% (-11,11; -3,82) und ist zugunsten der Interventionsgruppe statistisch signifikant (p<0,000). Weitere signifikante Effekte zugunsten der Intervention bestehen für die sekundären Zielkriterien Somatisierung und psychische Gesundheit. Schlussfolgerung: Für die Intervention DeREACH bestätigt sich ein Nutzen in Bezug auf das Belastungserleben pflegender Angehöriger von Menschen mit Demenz. Die Intervention konnte in die Leipziger Versorgungslandschaft implementiert werden und wurde von den pflegenden Angehörigen sehr gut angenommen.

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