Magister Scientiae (Physiotherapy) - MSc(Physio) / Background and aim: Despite the high number of strokes globally, and among people of African origin in particular, there are few available data on stroke in most countries of sub-Saharan African (SSA), including Tanzania. In addition, the profile and challenges affecting stroke patients in these countries has not been adequately explored. The aim of this study was to determine the profile and explore the challenges experienced by stroke patients admitted at Haydom Lutheran Hospital in Tanzania. The objectives of the study were to determine the documented risk factors among the patients admitted to Haydom Lutheran Hospital, to identify the stroke on-set admission interval and length of hospital stay, to identify the process of physiotherapy for the stroke patients, and to explore the challenges experienced by stroke patients discharged from Haydom Lutheran Hospital, Tanzania. Methods: Qualitative and quantitative research designs were used to collect the data. The quantitative design used a retrospective descriptive study, in which medical records of stroke patients were reviewed. The qualitative approach included in-depth interviews to collect information regarding the challenges experienced by stroke patients residing in Haydom, Tanzania. Existing medical records were perused to obtain information related to demographic profile, medical characteristics and rehabilitation data among stroke patients admitted at Haydom Lutheran Hospital. Relevant data was captured on a data information sheet. The SPSS (14.0 version) and Microsoft Excel (2007) were used to analyse quantitative data. Descriptive Statistics were used to determine ranges, percentages, frequencies, means and standard deviations calculate. The qualitative interviews were transcribed verbatim and also translated from Kiswahili to English. Stated concepts were coded, grouped into categories, and reduced into sub-themes and main themes. Prior to conducting this study, final permission was obtained from the Senate Research Grant and Study Leave Committee at the University of the Western Cape as well as the relevant authorities of the Tanzania Ministry of Health, Tanzanian National Institute of Medical Research, and the Administration of Haydom Lutheran Hospital. Written informed consent were obtained from the participants prior to interviews. Results: A total number of 145 stroke patients were admitted to Haydom Hospital between 1st January 2004 and 31st December 2010. However, only 128 of the potential sample participants met the inclusion criteria for the sample. The mean age of the participants was 57.7years, (SD=18.673). Of these, 104 (81.2%) had haemorrhagic stroke and 24(18.7%) had ischemic strokes. HIV infection (78.1%), previous stroke (74.2%), smoking (58.5%) and hypertension (55.4%) were the most common risk factors for stroke. Among the participants, the documented impairments included emotional impairments 42(32.8%), speech impairment 47(36.7%), cognitive impairment 39(30.4%), muscle impairment 36(28.1%), and occurrence of coma 33(25.8%) respectively. The mean time from onset of stroke to admission was 1.2 days with (SD=0.42 days). The mean length of hospital stay was 12.16 days (SD=4.1 days), the majority (61.7%), started physiotherapy within 3 days after admission, mean duration of physiotherapy was 14.1 days (SD=5.79), and the mean number sessions of physiotherapy 3.7days (SD=18.8 days). The challenges that emerged during the qualitative interviews with participants were limitation in walking activities, inability to return to work and to participate in leisure activities as before the onset of stroke, and environmental factors such as physical barriers and attitude of family. Conclusion: The findings of the research reveal that stroke in Tanzanian patients occurs at a relatively young age, and that frequency of intra-cerebral haemorrhage is higher than that reported in developed countries. The clinical presentations and risk factors are similar to those in other studies. The qualitative findings revealed that the stroke patients had problems with limitation of activity, participation restrictions, and environmental challenges. They also expressed uncertainties as a result of a lack of knowledge about stroke and its effects, and discharge challenges relating to rehabilitation. These challenges should be addressed in the process of management of patients with stroke in the research setting.

Šio darbo tikslas – remiantis kalinamųjų patirtimi išanalizuoti socialinės reabilitacijos procesą Kauno tardymo izoliatoriuje. Analizuojama tema aktuali, nes sėkmingas nuteistojo integravimasis į visuomenę didele dalimi priklauso nuo socialinės reabilitacijos proceso, kuris vyksta per adaptacijos, pataisos ir integracijos etapus. Socialinės reabilitacijos proceso esmę sudaro pagrindinių asmenybės funkcijų atkūrimas. Tai fizinė ir psichinė sveikata, dorovė ir socialinis statusas. / The aim of this work - to disclose the rehabilitation process, the problems investigation in the solitary confinement cell . Analyze the topic of interest, because the sentences successful integration into society, in large part depends on the rehabilitation process, which takes place during the adaptation, correction and integration phases. Social rehabilitation process, the essence of personality consists of the main functions of the restoration. It is the physical and mental health, morals and social status.

Bakgrund: Att drabbas av en idrottsskada kan påverka en individ på många sätt och utan rätt hjälp och stöd kan det vara tufft att komma tillbaka till utgångsläget. Motivation kan beskrivas genom självbestämmandeteorin (SDT) som delar in motivation i tre delar, dessa är inre- och yttre motivation. Motivation är viktigt för att genomgå en rehabiliteringsprocess. Syfte: Syftet med studien är att granska vilka faktorer som påverkar och är viktiga för att upprätthålla en god motivation under rehabiliteringsprocessen. Metod: I studien används en kvalitativ metod av semistrukturerade intervjuer som genomfördes med sex individer, som alla genomgått en eller flera rehabiliteringsprocesser från idrottsskada. Resultat: Utifrån intervjuerna utmärktes fem kategorier som alla representerar en viktig motivationsfaktor. Dessa är Att inte kunna göra det man vill, Hjälplöshet och Smärta, Sociala stödet, Vikten av kunskap och kompetens samt Målet att komma tillbaka. Det framgår också att fyra av de sex deltagarna slutat sin idrott på grund av amotivation. Det visade sig också att individerna som var aktiva i lagidrott stannade kvar i sin idrott, medan alla som var aktiva i individuella idrotter slutade sin idrott på grund av skadan och motivationen. Diskussion: För att genomföra en bra rehabiliteringsprocess och upprätthålla en god motivation för att genomgå en rehabiliteringsprocess är det många faktorer som spelar in. / Background: Having a sport injury can affect an individual in many ways and without the right help and support it may be tough to get back to the starting point. Motivation can be described by self-determination theory (SDT), which divides motivation into three parts, these are internal and external motivation. Motivation is important to undergo a rehabilitation process. Purpose: The purpose of the study is to examine what factors affect and are important for maintaining a good motivation during the rehabilitation process. Method: The study uses a qualitative method of semistructured interviews conducted with six individuals, all of whom have undergone one or more rehabilitation processes from sport injuries. Result: Based on the interviews, five categories were identified, each representing an important motivational factor. These are Being unable to do what one wants, Helplessness and Pain, Social Support, The Importance of Knowledge and Skills, as well as The Goal of Coming Back. It is also appears that four out of six participants stopped their sports due to amotivation. It also turned out that the individuals who were active in team sports remained in their sport, while all active in individual sports ended their sports because of the injury and lack of motivation. Discussion: In order to carry out a good rehabilitation process and maintain a good motivation to undergo a rehabilitation process, there are many factors to account to.

Bakgrund: Förlossningsskador och andra besvär postpartum är vanligt förekommande. Fysioterapi har visat sig ha stark evidens för att hjälpa med smärta och funktion för dessa besvär. Trots detta används fysioterapeuter i mycket liten utsträckning inom förlossningsvården. Syfte: Syftet var att kartlägga prevalensen och omfattningen av förlossningsskador och andra besvär samt att ta reda på hur rehabiliteringsprocessen såg ut. Metod: En kvantitativ ansats med empiristisk-atomistisk design användes. Kartläggningen gjordes med hjälp av en digital enkät som delades i allmänna facebookgrupper riktade till mammor och kvinnor. Den insamlade datan analyserades med hjälp av frekvenstabeller, Pearsons korrelationskoefficient samt Chi2-test. Resultat: Över 80% av deltagarna hade fått en bristningsskada vid förlossning, där majoriteten fått grad 2. Av deltagarna uppgav 63% att de haft besvär efter förlossningen och 50% uppgav att de hade kvarstående besvär idag. Majoriteten uppgav att de haft multipla besvär, där inkontinens var vanligast förekommande. Efter återbesök hos barnmorska uppgav 54% att de inte fått någon information om sina besvär och 72% fick ingen information om rehabilitering för dem. Hälften av alla deltagare hade utfört någon form av rehabilitering efter sin förlossning, där bäckenbottenträning var det absolut vanligaste. 62% visste inte om att man kan söka hjälp hos en fysioterapeut för förlossningsrelaterade besvär.  Konklusion: Utbredningen av förlossningsrelaterade besvär är stor och många lever med kvarstående besvär långt efter sin förlossning. Fysioterapi är en outnyttjad resurs och fysioterapeuter bör med fördel kunna användas som en del av den standardiserade förlossningsvården i Sverige idag. Fler högkvalitativa studier behövs för att öka kunskapen inom ämnet. / Background: Childbirth injuries and other postpartum complications are common. Physiotherapy has shown strong evidence for helping with pain and function related to these complications. Despite this, physiotherapists are rarely used in standard maternity care.  Objective: The objective was to map the prevalence and extent of childbirth injuries and other complications, as well as to understand the rehabilitation process.  Method: A quantitative approach with an empiricist-atomistic design was used. The mapping was conducted using a digital survey shared in general Facebook groups targeted at mothers and women. The collected data were analyzed using frequency tables, Pearson’s correlation coefficient, and Chi-square tests.  Results: Over 80% of participants had suffered a perineal tear during childbirth, with the majority experiencing a second-degree tear. Of the participants, 63% reported complications after childbirth, and 50% reported having ongoing issues today. The majority reported multiple complications, with incontinence being the most common. After follow-up visits with a midwife, 54% stated they received no information about their complications, and 72% received no information about rehabilitation for them. Half of all participants had undergone some form of rehabilitation after childbirth, with pelvic floor exercises being the most common. Additionally, 62% did not know that they could seek help from a physiotherapist for childbirth-related complications.  Conclusion: The prevalence of childbirth-related complications is high, and many live with persistent issues long after childbirth. Physiotherapy is an underutilized resource, and physiotherapists should be integrated into the standardized maternity care in Sweden today. More high-quality studies are needed to increase knowledge in this field.

<p>Vocational rehabilitation is an ongoing issue that directly or indirectly affects everyone at a workplace. In recent years, laws and rules have changed. The 1st July 2008 changes were made in the General Insurance Act (SFS 1962:381). These changes have meant that there is now a so-called rehabilitation chain.  The rehabilitation chain contains time frames for when sick people will have their ability to work tested against their normal work or to other jobs. If a person is considered having enough capacity to be able to work he or she will lose their entitlement to sick pay.</p><p>The aim of our study is to investigate managers’ perceptions of the new rehabilitation chain, with a focus on vocational rehabilitation of long-term sick to get them back to work.</p><p>The method used was qualitative and data collection was done through nine semi-structured interviews. The results showed that the managers we interviewed believe that their primary responsibility in the rehabilitation work is to be the link between sick leave and workplace. The managers generally think that the introduction of the rehabilitation chain is a good thing. It has become clearer with what to do when an employee becomes ill and the timeframes provides a degree of security as the managers know when different things will happen. Our results also show that managers believe that cooperation with external actors such as social insurance has become easier since the rehabilitation chain was introduced. Some believe that the timeframes may be too tight and they are worried that the individual is forgotten in the process. The conclusion of our study was that there has been a need for a more active and transparent process of rehabilitation and this need has been met by the rehabilitation chain. Although the managers think that the rehabilitation work has become clearer, there is some disagreement in the way of working with sick leave. Some managers say for example that they are still doing so-called rehabilitation investigations, although it shifted responsibility from themselves to the Social Insurance Agency.</p>

Vocational rehabilitation is an ongoing issue that directly or indirectly affects everyone at a workplace. In recent years, laws and rules have changed. The 1st July 2008 changes were made in the General Insurance Act (SFS 1962:381). These changes have meant that there is now a so-called rehabilitation chain.  The rehabilitation chain contains time frames for when sick people will have their ability to work tested against their normal work or to other jobs. If a person is considered having enough capacity to be able to work he or she will lose their entitlement to sick pay. The aim of our study is to investigate managers’ perceptions of the new rehabilitation chain, with a focus on vocational rehabilitation of long-term sick to get them back to work. The method used was qualitative and data collection was done through nine semi-structured interviews. The results showed that the managers we interviewed believe that their primary responsibility in the rehabilitation work is to be the link between sick leave and workplace. The managers generally think that the introduction of the rehabilitation chain is a good thing. It has become clearer with what to do when an employee becomes ill and the timeframes provides a degree of security as the managers know when different things will happen. Our results also show that managers believe that cooperation with external actors such as social insurance has become easier since the rehabilitation chain was introduced. Some believe that the timeframes may be too tight and they are worried that the individual is forgotten in the process. The conclusion of our study was that there has been a need for a more active and transparent process of rehabilitation and this need has been met by the rehabilitation chain. Although the managers think that the rehabilitation work has become clearer, there is some disagreement in the way of working with sick leave. Some managers say for example that they are still doing so-called rehabilitation investigations, although it shifted responsibility from themselves to the Social Insurance Agency.

Syftet med denna studie var att undersöka hur fyra olika aktörer med skilda yrkesroller upplevde organisationens befintliga rehabiliteringsprocess med dess möjligheter och begränsningar samt deras synpunkter på vad som kan förbättras för att undvika sjukskrivningar. En förhoppning var också att kunna ge konkreta förslag på hur man kan arbeta förebyggande i syfte att undvika sjukskrivningar inom organisationen. Fyra minifokusgruppintervjuer, bestående av två till fyra personer, genomfördes där två fiktiva fall användes som diskussionsgrund. Materialet analyserades med hjälp av en induktiv tematisk analys, vilket resulterade i de fyra temaområdena; Verktyg för att förbättra hälsoarbetet, Insatser för att motverka sjukskrivningar, Begränsningar i hälsoarbetet samt Chefens roll i hälsoarbetet. I studien framkom att deltagarna ansåg att rehabiliteringsprocessen är ett bra verktyg som förenklar rehabiliteringsarbetet, men att den behöver fortsatt utveckling. Resultatet visade även att deltagarna hade många förslag på åtgärder för att förbättra den fysiska och psykosociala arbetsmiljön. / The aim of this study was to examine the experience, of four different actors’ with diverse occupational roles, of the existing rehabilitation process in the organization, with its limitations and possibilities. A further aim was to examine the preventive work and hopefully contribute with some practical solutions to counteract sick leave within the organization. Four mini focus group interviews with two to four people were carried out with two fictitious cases as a base for discussion. Data was analyzed by an inductive thematic analysis and resulted in four thematic areas; Tools to improve the health work, Efforts to avoid sick leave, Health work limitations and The manager’s role in health work. The study showed that the participants considered that the rehabilitation process was a good tool that simplifies the rehabilitation work, but it needs further development. The results also showed that the participants had many suggestions of how to improve the physical and psychosocial work environment.

Problemformulering: En av de vanligaste orsakerna till sjukskrivning i Sverige är psykiatriska diagnoser såsom depressioner och stressreaktioner. Sjukfrånvaro innebär stora kostnader både för arbetsgivare och för samhället, och är på olika sätt drabbande även för den som är sjukskriven. Det finns därmed goda skäl att undersöka olika sätt på vilka rehabiliteringsprocessen kan förbättras och göra återgången i arbete enklare. Tidigare forskning har visat att det finns ett flertal faktorer som går att förändra för att förbättra möjligheterna till återgång i arbete, såsom bättre kommunikation och bättre samordning av rehabiliteringsinsatserna. Få studier har dock undersökt hur tidigare sjukskrivna upplevt rehabiliteringsprocessen i sin helhet, från första sjukskrivningsdag till och med återgång i arbete. Syfte: Syftet med denna studie var att undersöka upplevelsen av rehabiliteringsprocessen, bland offentligt anställda i Sverige som tidigare varit sjukskrivna i psykiatriska diagnoser. Metod: Studien hade en kvalitativ design, och för att samla in data användes semistrukturerade intervjuer, vilka analyserades med hjälp av kvalitativ innehållsanalys. Deltagarna bestod av tio kvinnor som arbetade inom offentlig sektor i Sverige, hade varit sjukskrivna på 100 procent i en psykiatrisk diagnos i minst en månad samt återgått fullt i arbete. Resultat: Resultatet visade att upplevelsen av rehabiliteringsprocessen var att den förändrar en som person, att den innebär sårbarhet och att därför är viktigt med bra bemötande, tillräckliga anpassningar och en fungerande struktur kring rehabiliteringsprocessen där den sjukskrivne själv involveras utan att behöva vara ansvarig. Slutsats: Utifrån studiedeltagarnas upplevelser verkar det finnas behov av ett tydligare ramverk kring rehabiliteringsprocessen, tydligare ansvarsfördelning och vägledning till individen. Med kunskap om hur rehabiliteringsprocessen upplevs och vilka delar av processen som exempelvis anses bristfälliga, kan också förbättringar göras vilket i sin tur kan göra återgången i arbete mer hälsosam och hållbar. / Aim: The aim of this study was to examine the experience of the rehabilitation process, among Swedish public employees, who had returned to work after sick leave due to common mental disorders. Method: To examine this, qualitative method was used. To collect data, semi-structured interviews was carried out and then analyzed with qualitative content analysis. Ten women participated in the study. They were employed in the public sector in Sweden and had returned to work after being on full time sick leave. Result: The analysis resulted in six categories. Summarized, the experience of the rehabilitation process was being changed as a person, feeling vulnerable, and consequently, the importance of good treatment, appropriate work adaptations, and a functioning structure around the rehabilitation process, where the person going through rehabilitation is involved without having to be responsible. Conclusion: Based on the experiences of the study participants, there seems to be a need for a clearer framework for the rehabilitation process, clearer division of responsibilities and guidance for the individual. With knowledge of how the rehabilitation process is experienced, and of facilitating and hindering factors, improvements can be made.

This research study consisted of an examination of the role played by the educational psychologist in the emotional and social rehabilitation of the TBI adolescent. A survey of the literature reveals that traumatic brain injury during adolescence negatively impacts on their adaptation, development and functioning after the acute phase of the rehabilitation process. In order to study this phenomenon, a psycho-educational perspective was utilised. An in-depth qualitative study was undertaken by means of a case study design. The two cases being presented offers the reader insight into the cases pre-morbid functioning, the accident and its aftermath, the specific traumatic brain injuries, the emotional and social problems encountered by these adolescents as well as the psychotherapeutic interventions applied by the educational psychologist in the rehabilitation process of the cases under investigation. The conclusions reached from this investigation were that traumatic brain injury during the developmental phase of adolescence, negatively impacts on the emotional and social well being of these adolescents, and that the educational psychologist plays a valuable role in the emotional and social rehabilitation of these adolescents. / Educational Studies / M. Ed. (Guidance and Counselling)

This research study consisted of an examination of the role played by the educational psychologist in the emotional and social rehabilitation of the TBI adolescent. A survey of the literature reveals that traumatic brain injury during adolescence negatively impacts on their adaptation, development and functioning after the acute phase of the rehabilitation process. In order to study this phenomenon, a psycho-educational perspective was utilised. An in-depth qualitative study was undertaken by means of a case study design. The two cases being presented offers the reader insight into the cases pre-morbid functioning, the accident and its aftermath, the specific traumatic brain injuries, the emotional and social problems encountered by these adolescents as well as the psychotherapeutic interventions applied by the educational psychologist in the rehabilitation process of the cases under investigation. The conclusions reached from this investigation were that traumatic brain injury during the developmental phase of adolescence, negatively impacts on the emotional and social well being of these adolescents, and that the educational psychologist plays a valuable role in the emotional and social rehabilitation of these adolescents. / Educational Studies / M. Ed. (Guidance and Counselling)