The elderly population is estimated to increase worldwide. One of the major health determinants identified in this population are injuries where one of the most prevalent causes are falls. The overall aim of this thesis was to describe and explore visual impairment and falls of inpatients and independently living elderly in the community and how daily life activities were influenced by visual ability and risk of falling. Methods in the studies were a quantitative retrospective descriptive design for study I followed by two quantitative retrospective and explorative studies where in study II perceived vision related quality of life and in study III performance-based visual ability were investigated. Study IV was a qualitative explorative study using classic grounded theory. In study I all falls of inpatients at a medical clinic 65 years and older (n=68) were registered during one year. In study II and III a random sample (n=212) of independently living elderly between 70 and 85 years of age participated in both studies. In study IV seven women and six men between 73 and 85 years of age from the two previous studies and six visual instructors (n=19) participated. The data in study I was collected during 2004, study II and III between February 2009 to March 2010 and study IV December 2009 to January 2013. The results in study I showed that most falls in five hospital wards occurred at night and those most affected had an established visual impairment. Almost half the population in study II and III fell at least once. Perceived vision when performing daily life activities showed a positive association between visual impairment and falls in men but not in women (II). No associations were found between performance-based measured visual ability and falls (III). Visually impaired elderly did not consider risk of falling as a problem (􀀪􀀷). Their main concern is to remain themselves as who they used to be which is managed by self- preservation while maintaining their residual selves and resisting self decay. Maintaining residual self is done by living in the past mostly driven by inertia while resisting self decay is a proactive and purposeful driven strategy. It is a complex issue to do fall risk assessments and planning fall preventive action where the individual’s entire life situation has to be taken into consideration.

The aim of the research presented in this thesis was to improve the characterisation of the changes in brain structure and function that occur at different stages of Alzheimer’s disease (AD) progression, from pre-symptomatic AD, to mild cognitive impairment (MCI), to clinically evident dementia, using magnetic resonance imaging (MRI) techniques. Baseline structural MRI data from a cohort of healthy older adults who were followed prospectively for ten years, during which time some developed MCI and some AD, were analysed. It was found that structural MRI could detect volume loss in medial-temporal lobes up to 7-10 years before clinical symptoms of AD appear. In addition, volumetric variability of medial-temporal regions detected by structural MRI across cognitively healthy older adults correlated with their performance on a task of visuospatial associative memory, and functional activation of the same regions occurred during successful performance of the same task on functional MRI (fMRI). Three groups of participants - cognitively healthy controls, people with MCI, and patients with probable AD - were then recruited and underwent a multimodal MRI protocol, which included functional sequences acquired at rest and during the execution of two different cognitive tasks (visuospatial associative memory and self-appraisal). Cross-sectional comparisons showed: (i) that successful visuospatial associative memory performance was associated with increased functional activity (measured with task fMRI) in lateral prefrontal regions in AD patients relative to controls and (ii) that increased functional activity overlapped with frontal brain networks showing increased functional connectivity (measured with resting fMRI) in the same AD patients. Further, by demonstrating group- and condition-specific decreased frontal activity in AD patients relative to controls during a self-appraisal fMRI task, it was shown the specific utility of fMRI to unravel cognitive mechanisms underlying specific neuropsychological symptoms such as unawareness of cognitive impairment (anosognosia) in MCI and AD. In conclusion, structural MRI can detect morphological changes in the preclinical stage of AD, possibly earlier than previously described, and these reliably match cognitive functioning in older adults. In the MCI and AD stages, once symptoms of cognitive impairment are clinically evident and measurable, task-related and resting functional MRI can inform on residual brain function detectable over and above the known changes in brain morphology and cognitive performance that have already occurred at these stages, emerging as a sensitive marker of residual ability that could potentially be used to measure the effect of new treatments.

Purpose: This study aimed to understand the effects of the Cognitive Orientation to daily Occupational Performance (CO-OP) on successful engagement in desired occupations (goals), health-related quality of life, and caregiver stress for individuals with Parkinson’s Disease (PD)-related cognitive impairment and their caregivers. Methods: A mixed methods single-subject design was used. Quantitative and qualitative data were combined to gain a comprehensive understanding of results. Results: Participants successfully engaged in all three trained goals and both untrained goals, generalized CO-OP strategies to perform trained goals outside of treatment sessions, and transferred CO-OP strategies to perform untrained goals independently. Conclusions: Individuals with PD-related cognitive impairment are capable of successfully engaging in self-selected treatment goals that are trained during CO-OP sessions, generalizing CO-OP strategies they have learned in treatment in order to perform the same goals outside of treatment, and transferring CO-OP strategies in order to perform untrained goals independently. / October 2016

There are some human beings who live their lives at the extremes of the human condition because of some gross intellectual, cognitive, neurological, or developmental impairment to their human nature. The evidence from practices of care and concern towards such people – the profoundly impaired – suggests that they are acknowledged and respected as moral peers within the human community. Such pre-reflective intuitions and commonplace practices lend credence to the anthropological claim that the profoundly impaired are recognisably persons. Yet what might an argument in support of this intuition look like? How is it that the profoundly impaired are recognisably persons among fellow persons? This thesis is a theological response to that question. The presupposition underpinning the question is that there is something at stake for the humanity of the profoundly impaired in their being the particularly conditioned human beings that they are. There are, however, those who do not allow for the personhood of the profoundly impaired precisely because of the impaired condition in which they live their lives, and there are others who do uphold the personhood of the profoundly impaired precisely by sidelining their impairment. Peter Singer is representative of the first position. Christian theology can and should make an effective response to Singer’s challenge. An emerging field in Christian theology seeks to do so by proposing a distinct theology of disability that re-imagines Christian anthropology. The aim is to secure the humanity of the disabled without the condition of their humanity becoming an obstacle to their moral status within the community of persons. Key to this re-imagining is the adoption of a paradigm of inclusion towards the disabled. However, a critique will be offered of those theological re-imagined Christian anthropologies that centre on a paradigm of inclusion, and on a commitment to separating out the condition of the profoundly impaired from the question of their humanity. The Dutch Protestant theologian Hans Reinders proposes one such re-imagined anthropology in his recent major work, Receiving the Gift of Friendship: Profound Disability, Theological Anthropology, and Ethics. His claim is that the humanity of the profoundly disabled cannot be secured by the traditionally held Christian doctrine of the imago Dei because that doctrine treats personhood as something intrinsic to human beings, thereby making it inaccessible to the profoundly disabled who do not have the personalising capacities of reason and will. Instead, he proposes ‘being chosen as a friend’ by God as the only way in which the humanity of the profoundly disabled can be secured, thereby rejecting an immanent reading of the imago Dei in favour of a transcending conception of friendship. This thesis will argue that Reinders’ anthropological project fails because his transcendent concept cannot do for the humanity of the profoundly disabled what it sets out to do. Consequently, a return will be made to that tradition of Christian anthropology centred on the imago Dei to see what may be retrieved from it, such that the condition under which the profoundly impaired live their lives is central to them being recognisably the persons that they are. This is a proposition which says that the personal presence of the profoundly impaired among other persons is not to be denied to them (contra Singer), nor only extended to them as a means of belonging (contra a paradigm of inclusion), nor simply eschewed of them so that they may thereby be included by other means (contra Reinders). In placing the doctrine of the imago Dei at the heart of the creaturely life of human beings, the Catholic Church has made this doctrine the structural centre of any theological account of the personhood of the profoundly impaired. It will be the positive task of this thesis to uncover the theological import of this Catholic anthropological imagination. The two authors most significantly engaged with in undertaking this task will be C S Lewis and Josef Pieper.

Memory impairment is common following traumatic brain injury (TBI). In recent years, researchers have demonstrated that the processes underlying memory formation (working memory, encoding, consolidation, and retrieval) are interrelated but dissociable events.The following study was designed to determine how these processes contribute to memory impairment following experimental TBI in the rat. Experiment 1 indicated thatTBI induces severe working memory deficits in a delayed non-matching-to-place task.Although all animals displayed intact acquisition, only injured animals displayed poor performance as the delay between the sample and choice phases was increased.Experiment 2 was designed to determine if TBI produces a transient period of posttraumatic amnesia (PTA) following TBI. During the early post-injury period, injured animals displayed intact short-term (3min) object recognition memory but impaired long-term (1 and 24hrs) memory. However, during the chronic post-injury period (days 14-17), no recognition memory deficits were observed in injured animals, indicating thatPTA resolves by 14 days post-injury. Experiment 3 was designed to determine the mechanism of anterograde memory impairment following TBI. Animals were injured and then trained to a pre-determined criterion in a 1 -day water maze procedure.Although injured animals required more trials to reach criterion, the rate of forgetting was identical among sham and injured groups up to 24hrs post-training. This suggests that the amount of information encoded into long-term memory, not more rapid forgetting, is the primary mechanism of anterograde memory impairment following TBI. InExperiment 4, animals were trained in the water maze and then injured 1 (recent memory) or 14 (recent memory) days post-training. Fourteen days post-injury, animals were given a retention probe trial followed by a reminding procedure and a second probe trial. Injured animals in both the recent and remote memory conditions displayed impaired performance on the first probe trial. However, injured animals benefited from the reminding procedure, and animals in the remote memory group were identical to shams during the second probe trial. These results indicate that retrograde memory impairment following TBI is mediated primarily by retrieval deficits at the time of testing, while the quality of the memory trace remains largely intact.

The following project is a compilation of three separate articles all utilizing a database extracted from the UNUM/Provident Life Insurance Company, including all consecutive short-term disability (STD) claims filed with UNUM from January 1, 1994 to December 31, 1996 from claimants who were also insured for long-term disability (LTD) by UNUM. The resulting sample includes 77,297 claims.The results of these studies are part of a larger investigation that documented the Progression of Disability Benefits (PODB) phenomenon. PODB refers to the migration of workers with work-limiting disabilities through a system of economic benefits resulting in their placement onto Social Security Disability Insurance (SSDI). Claimant and employer demographics were found to influence the PODB. The following articles study three unique ways in which the PODB measure can be informative.The first of the articles tracts the experience of 400 individuals with neurological impairments through the PODB, and compares them with a general disability population on key demographic characteristics. In general, it is found that persons with neurological conditions have greater progression on to advanced disability levels than other types of disabilities. Individual claimants are also younger and male.The second article explores the relationship of integrated disability management(IDM) practices with PODB. It proposes that while the efficacy of IDM programs has been measured by the bottom line, that PODB can be used as an additional tool to assess effectiveness of DM programs. It finds that employers with higher levels of IDM activity will experience a reduced PODB rating.The third and final article examines one industry, Healthcare. It studies how demographics can be used to predict claimant industry as well as PODB performance. Findings reveal that men were more likely to move on to advanced disability benefits while workers in the Healthcare industry were less likely to move on to advanced statuses than employees in other industries. Furthermore, disability type is the greatest predictor of PODB, followed by age for all but one category in which employment sector was the next predictor of PODB. This finding leads to questions regarding how the workplace may contribute to disability and the PODB.

Adolescents with Sluggish Cognitive Tempo (SCT) show symptoms of slowness, mental confusion, excessive daydreaming, low motivation, and drowsiness/sleepiness. Although many symptoms of SCT reflect internalizing states, no study has evaluated the utility of self-report of SCT in an ADHD sample. Further, it remains unclear whether SCT is best conceptualized as a unidimensional or multidimensional construct. In a sample of 262 adolescents comprehensively diagnosed with ADHD, the present study evaluated the dimensionality of a SCT scale and compared CFA and bifactor model fits for parent- and self-report versions. Analyses revealed the three-factor bifactor model to be the best fitting model. In addition, SCT factors predicted social and academic impairment and internalizing symptoms. Therefore, SCT as a multidimensional construct appears to have clinical utility in predicting impairment. Also, multiple reporters should be used, as they predicted different areas of functioning and were not invariant, suggesting that each rater adds unique information.

Depressive symptoms are very common among people with neurocognitive disorder. The comorbidity of both diseases and the overlap of their symptoms complicates correct diagnosis and thus also the initiation of a correct treatment. The instruments of depression measuring in seniors with a severe cognitive deficit are also a discussed issue. The subject of the theoretical part is to describe the issue of depression and cognitive disorders in the old age with a focus on Alzheimer's disease, which is the most common mental disorder in the elderly together with depression. The goal of the empirical part of the thesis is to research based on the interviews with seniors if the most frequently used method of depression measuring in the elderly, Geriatric Depression Scale (GDS), is a suitable measuring instrument also in seniors with a cognitive deficit and further examine how these seniors actually experience the individual mood qualities which are the subjects of items in GDS. Forty seniors with a various degree of cognitive deficit participated in the research. The study results showed that the questionnaire is usable for seniors with a mild cognitive impairment and mild dementia. To detect the border of the cognitive deficit, below which it is not suitable to use the depression measuring method GDS, a...

The aim of this thesis was to evaluate the level of comprehension of czech sentences with a different syntactic complexity in children with specific language impairment (SLI) and children at family risk for dyslexia (experimental groups) compared to typically developing peers (control group). Statistically significant differences were proven both between the SLI group and the family risk group and between the SLI group and control group. The assumed descending tendency of achievement in the test blocks was not substantiated.

1 Summary The thesis deals with the quality of everyday life of the hearing impaired. Part of the text defines the concept of the quality of life and points out the present common problems concerning the life of hearing impaired people. The issues of education, job opportunities, identity and personal realization of a hearing impaired individual in the context of the current view of the quality of life are highlighted. The text also focuses on the heterogeneity of the hearing impaired population and emphasizes their different status in mainstream society relating to the communication code they use. The goal of this thesis is to bring closer the problems of the quality of life of the hearing impaired, with the emphasis on the current problem areas which need further improvement. The practical part contains an analysis and evaluation of a questionnaire survay focused on specific areas of the quality of life quality of the hearing impaired - the qualification, employability, job opportunities and ways of communication. The final part of the practical part contains the commentaries on these reasearch results. Key definitions: Quality of life Hearing impairment Communication codes Minority