Title: Assessment of the effect of CDP training in patient after lower extremity amputation Objectives: The aim of this diploma thesis is to describe the influence of the individually set training programme on the computerized dynamic posturography (CDP) NeuroCom Smart EquiTest System (further referred to as EquiTest) independent of traditional therapeutic exercises in the patient after unilateral transfemoral amputation of the lower limb and to monitor the effect of this training on postural behaviour, ability of functional mobility and balance, frequency of falls and balance confidence in an individual after amputation. Methods: This is an experimental pilot case study that monitors the effect of an individually designed five-week training programme (with a frequency of exercises 2 times a week) on the EquiTest in one patient after unilateral transfemoral amputation of the lower limb. Examination of postural functions was performed by the EquiTest using SOT, MCT, and LOS tests. The ability of functional mobility and balance was tested using the functional Timed up and go test (TUG). The frequency of falls was detected from the proband's medical history. The balance confidence was determined using the Activities specific balance confidence scale (ABC). All measurements were made in two terms, i.e....

Cette recherche tente de déterminer si, dans le cadre d’un cours de physique de cinquième secondaire, l’utilisation d’un laboratoire par enquête guidée (comme complément d’enseignement basé sur une approche conceptuelle) permet aux élèves de mieux comprendre des notions de cinématique, que le laboratoire traditionnel. Elle s’inscrit dans une série d’études, réalisées au collégial ou à l’université, qui portent sur des approches d’enseignement exploitant le laboratoire comme moyen de transmission des concepts mécaniques en physique (McDermott, 1996; Beichner, 1994). Le laboratoire par enquête est associé à une approche conceptuelle axée sur le raisonnement qualitatif alors que celui qui est traditionnel est associé à une approche traditionnelle de l’enseignement de la physique. Le test TUG-K, «Test of Understanding Graphs in Kinematics » (Beichner, 1994), ainsi que des entrevues individuelles ont été utilisés afin d’évaluer la compréhension des concepts de cinématique. Il semble d’abord que le laboratoire par enquête guidé soit efficace pour enseigner la plupart des notions de cinématique. De plus, en comparant deux groupes d’une trentaine d’élèves de 5e secondaire ayant suivi deux types de laboratoires différents, l’étude a permis d’entrevoir une piste concernant la compréhension du concept d’accélération. Les résultats suggèrent qu’un laboratoire associé à une approche conceptuelle permettrait aux étudiants, à long terme, de mieux s’approprier les notions d’accélération qu’un laboratoire traditionnel. / The goal of this study is to determine whether the use of a guided inquiry laboratory (as a teaching complement based on a conceptual approach) will allow secondary five students to better understand kinematics notions than by the use of an expository laboratory. It comes within a series of college and university studies about teaching approaches using laboratories to transmit physics’ concepts in mechanics (McDermott, 1996; Beichner, 1994). The guided inquiry laboratory approach is associated to a conceptual approach based on qualitative reasoning, whereas the expository laboratory is associated to traditional approach in teaching physics. The Test of Understanding Graphs in Kinematics (TUG-K) (Beichner, 1994) and individual interviews were used to evaluate understanding of kinematics concepts. First of all, the study shows that a guided inquiry approach is an effective method to teach most of kinematics notions. Comparing the results from two groups of 38 students, the study results indicate that a conceptual approach laboratory is better than an expository laboratory for students’ long-term understanding of acceleration notions.

Cette recherche tente de déterminer si, dans le cadre d’un cours de physique de cinquième secondaire, l’utilisation d’un laboratoire par enquête guidée (comme complément d’enseignement basé sur une approche conceptuelle) permet aux élèves de mieux comprendre des notions de cinématique, que le laboratoire traditionnel. Elle s’inscrit dans une série d’études, réalisées au collégial ou à l’université, qui portent sur des approches d’enseignement exploitant le laboratoire comme moyen de transmission des concepts mécaniques en physique (McDermott, 1996; Beichner, 1994). Le laboratoire par enquête est associé à une approche conceptuelle axée sur le raisonnement qualitatif alors que celui qui est traditionnel est associé à une approche traditionnelle de l’enseignement de la physique. Le test TUG-K, «Test of Understanding Graphs in Kinematics » (Beichner, 1994), ainsi que des entrevues individuelles ont été utilisés afin d’évaluer la compréhension des concepts de cinématique. Il semble d’abord que le laboratoire par enquête guidé soit efficace pour enseigner la plupart des notions de cinématique. De plus, en comparant deux groupes d’une trentaine d’élèves de 5e secondaire ayant suivi deux types de laboratoires différents, l’étude a permis d’entrevoir une piste concernant la compréhension du concept d’accélération. Les résultats suggèrent qu’un laboratoire associé à une approche conceptuelle permettrait aux étudiants, à long terme, de mieux s’approprier les notions d’accélération qu’un laboratoire traditionnel. / The goal of this study is to determine whether the use of a guided inquiry laboratory (as a teaching complement based on a conceptual approach) will allow secondary five students to better understand kinematics notions than by the use of an expository laboratory. It comes within a series of college and university studies about teaching approaches using laboratories to transmit physics’ concepts in mechanics (McDermott, 1996; Beichner, 1994). The guided inquiry laboratory approach is associated to a conceptual approach based on qualitative reasoning, whereas the expository laboratory is associated to traditional approach in teaching physics. The Test of Understanding Graphs in Kinematics (TUG-K) (Beichner, 1994) and individual interviews were used to evaluate understanding of kinematics concepts. First of all, the study shows that a guided inquiry approach is an effective method to teach most of kinematics notions. Comparing the results from two groups of 38 students, the study results indicate that a conceptual approach laboratory is better than an expository laboratory for students’ long-term understanding of acceleration notions.

Falls and their consequences among older people are a serious medical and public health problem. Identifying individuals at risk of falling is therefore a major concern. The purpose of this thesis was to evaluate measurement tools of balance control and their predictive value when screening for fall risk in physically dependent individuals ≥65 years old living in residential care facilities, and physically independent individuals ≥75 years old living in the community. Following baseline assessments falls were monitored during six months in physically dependent individuals based on staff reports, and during one year in physically independent individuals based on self reports. In physically dependent individuals test-retest reliability of the Timed Up&Go test (TUG) was established in relation to cognitive impairment. Absolute reliability measures exposed substantial day-to-day variability in mobility performance at an individual level despite excellent relative reliability (ICC 1.1 >0.90) regardless of cognitive function (MMSE ≥10). Fifty-three percent of the participants fell at least once during follow-up. Staff judgement of their residents’ fall risk had the best prognostic value for ruling in a fall risk in individuals judged with ‘high risk’ (positive Likelihood ratio, LR+ 2.8). Timed, and subjective rating of fall risk (modified Get Up&Go test, GUG-m) were useful for ruling out a high fall risk in individuals with TUG scores <15 seconds (negative LR, LR- 0.1) and GUG-m scores of ‘no fall risk’ (LR- 0.4), however few participants achieved such scores. In physically independent individuals balance control was challenged by dual-task performances. Subsequent dual-task costs in gait (DTC), i.e. the difference between single walking and walking with a simultaneous second task, were registered using an electronic mat. Forty-eight percent of the participants fell at least once during follow-up. A small prognostic guidance for ruling in a high fall risk was found for DTC in mean step width of ≤3.7 mm with a manual task (LR+ 2.3), and a small guidance for ruling out a high fall risk with DTC in mean step width of ≤3.6 mm with a cognitive task (LR- 0.5). In cross-sectional evaluations DTC related to an increased fall risk were associated with: sub-maximal physical performance stance scores (Odds Ratio, OR, 3.2 to 3.8), lower self-reported balance confidence (OR 2.6), higher activity avoidance (OR 2.1), mobility disability (OR 4.0), and cautious walking out-door (OR 3.0). However, these other measures of physical function failed to provide any guidance to fall risk in this population of seemingly able older persons. In conclusion – Fall risk assessments may guide clinicians in two directions, either in ruling in or in ruling out a high fall risk. A single cut-off score, however, does not necessarily give guidance in both directions. Staff experienced knowledge is superior to a single assessment of mobility performance for ruling in a high fall risk. Clinicians need to consider the day-to-day variability in mobility when interpreting the TUG score of a physically dependent individual. DTC of gait can, depending on the type of secondary task, indicate a functional limitation related to an increased fall risk or a flexible capacity related to a decreased fall risk. DTC in mean step width seems to be a valid measure of balance control in physically independent older people and may be a valuable part of the physical examination of balance and gait when screening for fall risk as other measures of balance control may fail to provide any guidance of fall risk in this population.

Syftet med den här studien är att lägga en grund för framtida forskning om gymnasie- och universitetsstudents förmåga att tolka kinematikgrafer i Sverige. Det finns ett väl framarbetat bedömningsredskap som kallas "Test of understandinggraphs in kinematics" (TUG-K) som har använts internationellt för att undersöka just detta. Resultaten från dessa studier visar att generellt så har elever på många platser i världen svårt med just tolkning av kinematikgrafer. För att kunna närmare granska hur läget ser ut i Sverige så har vi i denna studie översatt TUG-K och TUG-K2 till svenska. Internationell forskning har översatts och sammanfattats, samt så har tre svenska läromedel tillhörande Fysik 1 på gymnasiet granskats och analyserats för att jämföra vad TUG-K undersöker med vad som tas upp i svenska läromedel. Allt detta för att underlätta för att svenska forskare och fysiklärare ska kunna undersöka elevers förmåga att tolka kinematikgrafer och vilket resultat som kan förväntas från svenska elever som genomför TUG-K. Resultatet i studien pekar mot att svenska läromedel skiljer sig anmärkningsvärt med vad de fokuserar på i tolkning av kinematikgrafer. De undersökta läromedlen går alla igenom och testar beräkning och tolkning av lutning i s-t och v-t grafer, samt area under v-t grafer. Endast en av läromedlen gick igenom area under a-t grafer och samtliga hade mycket få eller inga uppgifter som behandlade area under a-t grafer. När det kommer till att jämföra kinematikgrafer och att tolka rörelser mellan graf och textrepresentation så varjerade det stark mellan läromedlen. Vissa hade ett stort fokus på det men i andra var instruktion och testande av färdigheten nästintill icke existenterande. Framtida forskning i fältet rekommenderas samla in data med de översatta versionerna av TUG-K samt undersöka olika variabler som kan ha påverkan på elevers resultat, såsom använt läromedel och lärarens prioriteringar vid undervisning av kinematikgrafer.

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