Background: Physical activity questionnaires (PAQ) have been extensively used to determine physical activity (PA) levels. Most PAQ are derived from an energy expenditure-based perspective and assess activities with a certain intensity level. Activities with a moderate or vigorous intensity level are predominantly used to determine a person’s PA level in terms of quantity. Studies show that the time spent engaging in moderate and vigorous intensity PA does not appropriately reflect the actual PA behavior of older people because they perform more functional, everyday activities. Those functional activities are more likely to be considered low-intense and represent an important qualitative health-promoting activity. For the elderly, functional, light intensity activities are of special interest but are assessed differently in terms of quantity and quality. The aim was to analyze the content of PAQ for the elderly.

Rehabilitation outcomes are an important measurement of trauma system effectiveness. However, currently there is no clinically applicable trauma rehabilitation score or framework available to evaluate health and rehabilitation needs after trauma. The World report on Disability (2011) recommended the application of the World Health Organisation International Classification of Function, Disability and Health (ICF) as a framework for all aspects of rehabilitation. A standardised language, based on coded categories would aid in international efforts to evaluate health and disability globally. The ICF framework has not been applied in trauma rehabilitation or trauma systems to date. The objectives were to investigate rehabilitation needs of trauma patients and evaluate to what extent the ICF can be used as a framework to capture and assess health and rehabilitation outcome of patients following traumatic injuries. Two cohort studies with 103 and 308 patients respectively demonstrated the utility of the Rehabilitation Complexity Scale (RCS) in an acute trauma setting. The RCS outperformed other acute measures and rehabilitation complexity correlated with length of stay and discharge destination. A systematic review of 34 articles confirmed that outcome measures frequently used in trauma outcome studies represent only six percent of health concepts contained in the ICF. A quantitative international on-line questionnaire with expert clinicians working in trauma (n=217), identified 121 ICF categories pertinent to rehabilitation and health outcome of trauma patients. Qualitative patient interviews (n=32) identified nearly double the amount of ICF categories (n=234) compared to clinicians. Combined analysis of qualitative and quantitative data presents 109 ICF categories important for rehabilitation and health outcome assessment of trauma patients, using the ICF as a framework. This thesis describes the need for improved outcome evaluation of trauma patients. It demonstrates the acceptability of the ICF language and framework amongst clinicians and suggests the application of the ICF as a framework for trauma service delivery and outcome assessment.

Disability is seen as a result of an interaction between a person and that person's contextual factors. Viewing disability in the context of the built environment, a better design of this environment helps to reduce the disability faced by an individual. In spite of significant research in Universal Design (UD), the existing methods provide insufficient guidance for designers: designers demand more specific examples of, and methods for, good universal design. Within the overarching goal of improving universal product design, the specific goal of this research is to determine if the ADA guidelines for architectural design can be adapted to product design. A methodology that foresees the accessibility issues while designing a product would be constructive. The new technique should be built on the pre-existing principles and guidelines. A user activity and product function framework is proposed for this translation using actionfunction diagrams. Specific goals include determining if the function-based approach is able to anticipate a functional change that improves product accessibility. Further, generate user activity and product function association rules that can be applied to the universal design of products. Proposed research activities are to identify thirty existing universal products and compare with its typical version to identify the function that introduces an accessibility feature. Next, categorize the observed changes in a product function systematically and extract trends from accessible architectural systems to generate rules for universal design of consumer products. For validation, the task is to select around fifteen consumer product pairs for validation of the generated rules to determine if the ADA guidelines can be adapted for universal product design using the proposed framework. The results of this research show promise in using the International Classification of Functioning, Disability and Health (ICF) lexicon to model user limitation. The actionfunction diagram provides a structured way to approach a problem in the early stage of design. The rules generated in this research translate to products having similar user-product interface.

Orientador: Maria Ines Rubo de Souza Nobre / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T06:28:15Z (GMT). No. of bitstreams: 1 Zimmermann_AnaBeatriz_M.pdf: 1435162 bytes, checksum: b4c9ce47e60113462690e7d8723f2d96 (MD5) Previous issue date: 2012 / Resumo: A Medida Canadense de Desempenho Ocupacional (COPM) foi criada para favorecer uma prática centrada no cliente, tendo como foco a autopercepção da pessoa sobre seu desempenho ocupacional. Avaliações padronizadas são cada vez mais utilizadas no âmbito da reabilitação, no entanto, a maioria dos instrumentos buscam favorecer a independência em atividades pré-estabelecidas, baseadas no que é esperado pela sociedade, podendo não contemplar necessidades individuais dos clientes. Atividades e Participação são aspectos centrais da Terapia Ocupacional e os terapeutas ocupacionais reconhecem que o envolvimento e o desempenho ocupacional contribuem e apoiam à saúde. O modelo proposto na Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF), em 2001, reconhece a influência das atividades e participação, assim como dos fatores contextuais e funções e estruturas do corpo na condição de saúde. Tem-se por objetivo verificar a autopercepção do desempenho ocupacional por meio da COPM em usuários adultos e idosos de um centro de reabilitação no estado do Paraná e classificar os problemas de desempenho ocupacional segundo a CIF. Realizou-se um estudo descritivo com usuários acometidos por lesão medular ou lesão encefálica adquirida em processo de reabilitação entre o período de agosto/2010 a fevereiro /2011. A COPM foi aplicada por meio de entrevista semiestruturada e os problemas de desempenho ocupacional identificados pelos 28 usuários foram classificados segundo a CIF. Entre os 122 problemas classificados, houve maior frequência nos seguintes domínios do componente Atividade e Participação: Mobilidade (36%), Vida Comunitária Social e Cívico (24%) e Cuidado Pessoal (15%). Sugere-se que dificuldades relacionadas a Vida Comunitária, Social e Cívica são mais frequentes dependendo do tempo de lesão e do contexto de tratamento. Percebe-se a abrangência e variedade de problemas identificados por meio da COPM pode colaborar no processo de reabilitação com o estabelecimento de objetivos mais congruentes às demandas e experiências de vida diária dos clientes. Tem-se o desafio de se construir e conduzir práticas de saúde na área de reabilitação à pessoa com deficiência em conjunto com outros setores, ampliando nosso olhar de forma a contemplar as várias dimensões da funcionalidade humana. A classificação dos problemas de desempenho ocupacional de acordo com a CIF pode favorecer a comparação entre estudos que utilizam diferentes instrumentos de avaliação e que por vezes possuem terminologias distintas. Por outro lado, há desafios no processo de codificação no tocante a utilização de categorias abrangentes e inespecíficas para atividades e situações não tão comuns, pois permite interpretações variadas entre os usuários da CIF / Abstract: In the context of rehabilitation, standardized assessments are being more utilized in order to evaluate the impact of the impairment on the individual's daily routine. Most of the assessment instruments focus on favoring the independence on predefined activities, based on what is expected by society, and may not be meeting the client's individual needs. The COPM was created to facilitate a client-centered practice, allowing the client to identify his/her own limitations and restrictions lived on the occupational performance. The model proposed on CIF (International Classification of Functionality, Impairment and Health) in 2001 states that environmental and personal factors, activities and participation, body functions and structures, and health conditions are in dynamic interaction, so that any modifications in one of these components have the potential of generating changes on the others. Activity and participation are core aspects of occupational therapy. Occupational therapists recognize that the involvement and occupational performance contributes and promotes health. One of the goals is to verify self-perception of the occupational performance through COPM on adults and elderly from a rehabilitation center in the state of Paraná and classify the problems of occupational performance in CIF. A descriptive study was performed on users stricken by spinal cord injury or brain injury, obtained during the rehabilitation process between August of 2010 and February of 2011. COPM was applied through semi-structured interviews and the problems of occupational performance identified by 28 participants were classified in CIF. Among the 122 problems of occupational performance classified in CIF, there was a greater frequency on the following domains of the Activity and Participation component: Mobility (36%), Community, Social and Civic Life (24%) and Personal Care (15%). It is suggested that the difficulties related to Community, Social and Civic Life are more frequent depending on the time of injury and on the treatment context. It is noticed that the scope and variety of problems identified through COPM can collaborate in the process of rehabilitation, with the setting of objectives that are more congruent with the demands and experiences of the clients' daily lives. There is a challenge of building and conducting health practices on the area of rehabilitation to the person with disability along with other sectors, expanding our view in order to contemplate the various dimensions of human functionality. The classification of occupational performance problems in CIF can favor the comparison between studies that utilize different evaluation instruments and that sometimes have distinct terminologies. On the other hand, there are challenges related to the selection of codes: comprehensive and non-specific items can facilitate the classification of uncommon and unlikely elements, but at the same time can generate semantic accumulations and increase disagreements on the choice made by the evaluators / Mestrado / Interdisciplinaridade e Reabilitação / Mestra em Saúde, Interdisciplinaridade e Reabilitação

Purpose: In the absence of a gold standard, this study illustrates the process involved in the cross-cultural translation and adaptation of the FOCUS© and its shortened version, FOCUS-34© (the Parent Form and Instruction Sheet, as well as the Clinician Form and Instruction Sheet), while also determining the social validity and clinical applicability of the translated measure. The target language used as example was Afrikaans, one of the 11 official languages of South Africa. Method: A two-phase cross-cultural translation model was employed in which Phase 1 (comprising a six-step blind back-translation procedure) was sequentially followed by Phase 2 (social validation and clinical applicability of the measure, using focus groups with stakeholders). Result: The extensive process followed in Phase 1 resulted in a clear and appropriate translation acceptable to both stakeholder groups (parents and speech-language pathologists). Both groups questioned the meaning of certain concepts, explored cultural differences and requested the extension of some items. Parents also shared their emotional reactions towards assessment, while therapists focussed on editorial changes to the measures. Conclusion: A framework is proposed for cross-cultural translation and adaptation of assessment measures with suitability in the speech-language pathology discipline.

Background: Individuals with neurodevelopmental disorders are unemployed or underemployed at staggering rates. Employment for this population is impacted by many factors, including contextual issues. This review was conducted to enhance understanding of contextual factors influencing employment procurement for individuals with neurodevelopmental disorders. Methodology: The Arksey and O’Malley scoping review framework was utilized to examine five databases and sources of grey literature regarding the contextual factors influencing employment procurement for individuals with neurodevelopmental disorders. Articles were analyzed using the International Classification of Functioning, Disability and Health criteria for Contextual Factors, including both Environmental and Personal Factors. Results: The findings from 41 articles indicate that Contextual Factors, Environmental Factors and Personal Factors influence employment procurement by creating both barriers and facilitators to obtaining employment for individuals with neurodevelopmental disorders. Conclusion: A focus on contextual factors that impact individuals with neurodevelopmental disorders may provide further insight into the facilitators and barriers influencing employment outcomes. Further research should aim to understand the strength of relationships and to expand the use and application of the International Classification of Functioning, Disability and Health’s biopsychosocial framework. This research can aid in promoting the employment outcomes for individuals with neurodevelopmental disorders. / Thesis / Master of Science (MSc)

Background: Physical activity questionnaires (PAQ) have been extensively used to determine physical activity (PA) levels. Most PAQ are derived from an energy expenditure-based perspective and assess activities with a certain intensity level. Activities with a moderate or vigorous intensity level are predominantly used to determine a person’s PA level in terms of quantity. Studies show that the time spent engaging in moderate and vigorous intensity PA does not appropriately reflect the actual PA behavior of older people because they perform more functional, everyday activities. Those functional activities are more likely to be considered low-intense and represent an important qualitative health-promoting activity. For the elderly, functional, light intensity activities are of special interest but are assessed differently in terms of quantity and quality. The aim was to analyze the content of PAQ for the elderly.

Objective: The purpose of this study was to determine speech-language pathologists’ (SLPs’) perceptions regarding the concept of severity of speech sound disorder (SSD). Methods: An online survey of 40 questions was created using REDCap® and disseminated to currently practicing SLPs across the United States. A total of 296 responses were completed, and data were analyzed using descriptive statistics and coding according to grounded theory. Results: The top five factors SLPs consider when determining SSD severity are types of errors, intelligibility, perceptual judgment, normative data, and percentile rankings. Most SLPs were unfamiliar with the International Classification of Functioning, Disability and Health (WHO, 2001), which was reflected in how they prioritized the ICF component of body function over activity/participation and personal factors. Conclusion: SLPs need a standard, biopsychosocial model for rating SSD severity, clinical training and continuing education on the ICF, and exposure to holistic tools for assessing children with SSD.

As lesões medulares traumáticas (LMT) são comumente geradoras de deficiências e levam a limitações na execução de atividades, como também à restrição de participação em situações concretas de vida. Conhecer os indivíduos com LMT em termos de independência funcional permite aos serviços de reabilitação estruturarem-se para atenderem às demandas dessa população de forma mais eficiente. Estudo de delineamento metodológico objetivou construir e validar instrumento baseado no Core Set resumido da CIF para indivíduos com lesão medular aguda traumática. A pesquisa, aprovada pelo Comitê de Ética, foi realizada em três etapas: etapa 1:Elaboração do instrumento a partir do Core set resumido da CIF para lesão medular aguda: \"Instrumento baseado no Core set resumido da CIF para indivíduos com Lesão Medular Aguda Traumática\"; etapa 2: Validação do instrumento e coleta de dados; etapa 3: Aplicação do pré-teste.O instrumento para validação de face e conteúdo continha13 categorias que integraram os componentes da CIF: funções do corpo (3), estrutura do copo (1), atividades e participação (9), perfazendo um total de 109 itens. Em cada seção do instrumento tinha um campo para sugestões. A validade de conteúdo do instrumento foi realizada por um comitê de dezesseis juízes.Os resultados demonstraram que a maioria dos juízes de conteúdo eram do sexo feminino, jovens, com idade entre 30 e 39 anos. Quanto à titulação acadêmica e área de atuação, a maioria tinha doutorado e eram docentes, assim como, realizavam estudos sobre a CIF e à utilizavam na sua prática clinica.Cada item do instrumento foi avaliado em mais de 70% pelos avaliadores, sendo considerado aceitável para a validação de conteúdo. Na maioria dos itens, os juízes fizeram sugestões que visavam à modificação de termos, para serem substituídos ou reformulados, a partir do conceito apreendido, para que a estrutura e a propriedade do instrumento não fossem alteradas de modo significativo. Foram sugestões pertinentes que favoreceram a adequação do instrumento, a fim de facilitar a compreensão dos itens propostos pelo publico alvo. O pré-teste foi realizado no Centro de Reabilitação do HCFMRP-USP, participaram da pesquisa 10 indivíduos com diagnóstico de LTME, com até 6 meses lesão.A maioria eram do sexo masculino, com média de idade de 43 anos, sendo a principal etiologia do trauma os acidentes automobilísticos. Quanto à escolaridade verificou-se que a maioria dos participantes tinha ensino fundamental completo ou incompleto. Nesta etapa, houve substituição de alguns termos técnicos para melhor compreensão pelo público alvo. Mediante a análise entre os pesquisadores e após consenso das modificações sugeridas pelos especialistas e público alvo, foi elaborada a versão final do instrumento. Ressalta-se que o instrumento contribuíra na prática clinica como uma ferramenta inovadora a ser utilizado pela equipe multidisciplinar, na avaliação da funcionalidade para o planejamento da assistência, com foco nas necessidades individuais e nos resultados mais efetivos das intervenções no processo de reabilitação / Traumatic spinal cord injuries (TSCI) are usually the cause of disabilities and limited performance of some activities as well as limited participation in some life moments. Knowing if TSCI patients are functional dependent helps the rehabilitation services to be organized to effectively meet the demand of that population. The goal of the methodological design study was to create and validate an instrument based on summed up ICF Core Set for patients with acute traumatic spinal cord injury. The survey was approved by the Ethics Committee and it was divided in three phases: Phase 1 - Elaboration of the instrument based on summed up ICF Core Set for acute spinal cord injury: \"Instrument based on summed up ICF Core Set for patients with Acute Traumatic Spinal Cord Injury\"; Phase 2 - Validation of the instrument and data collect; Phase 3 - Implementation of the pre-test. Face and content validation tool had 13 categories which were part of ICF components: body functions (3), body structure (1), activities and participation (9); in total 109 items. Every section of the tool had a specific place for suggestions. A sixteen-judge committee validated the content. The results showed that most of the judges were 30 to 39-year-old women, with doctorate degree and they were professors who also studied ICF and applied it in their clinics. The evaluators checked more than 70% of each item of the tool and it was considered enough for the validation of the content. The judges made some suggestions for most of the items in order to replace or redesign the terms so that the structure and the effect of the tool would not be significantly changed. Those suggestions were relevant and they helped adjusting the tool to make easier for the community to understand the items. The pre-test was performed at Rehabilitation Center of HCFMRP-USP; ten patients who have had TSCI for up to 6 months participated on the survey. Most of them were 43 -year- old men, who studied up to elementary school, with a trauma caused by a car crash. At this stage some technical terms were replaced in order to help the community understanding. After the analysis of the researchers and the modifications suggested by the experts and the community, a final version of the tool was elaborated. In clinical practice this instrument was a new tool used by the multidisciplinary team when evaluating the functioning of helping individual necessities and more effective results of the interventions on the rehabilitation process

As lesões medulares traumáticas (LMT) são comumente geradoras de deficiências e levam a limitações na execução de atividades, como também à restrição de participação em situações concretas de vida. Conhecer os indivíduos com LMT em termos de independência funcional permite aos serviços de reabilitação estruturarem-se para atenderem às demandas dessa população de forma mais eficiente. Estudo de delineamento metodológico objetivou construir e validar instrumento baseado no Core Set resumido da CIF para indivíduos com lesão medular aguda traumática. A pesquisa, aprovada pelo Comitê de Ética, foi realizada em três etapas: etapa 1:Elaboração do instrumento a partir do Core set resumido da CIF para lesão medular aguda: \"Instrumento baseado no Core set resumido da CIF para indivíduos com Lesão Medular Aguda Traumática\"; etapa 2: Validação do instrumento e coleta de dados; etapa 3: Aplicação do pré-teste.O instrumento para validação de face e conteúdo continha13 categorias que integraram os componentes da CIF: funções do corpo (3), estrutura do copo (1), atividades e participação (9), perfazendo um total de 109 itens. Em cada seção do instrumento tinha um campo para sugestões. A validade de conteúdo do instrumento foi realizada por um comitê de dezesseis juízes.Os resultados demonstraram que a maioria dos juízes de conteúdo eram do sexo feminino, jovens, com idade entre 30 e 39 anos. Quanto à titulação acadêmica e área de atuação, a maioria tinha doutorado e eram docentes, assim como, realizavam estudos sobre a CIF e à utilizavam na sua prática clinica.Cada item do instrumento foi avaliado em mais de 70% pelos avaliadores, sendo considerado aceitável para a validação de conteúdo. Na maioria dos itens, os juízes fizeram sugestões que visavam à modificação de termos, para serem substituídos ou reformulados, a partir do conceito apreendido, para que a estrutura e a propriedade do instrumento não fossem alteradas de modo significativo. Foram sugestões pertinentes que favoreceram a adequação do instrumento, a fim de facilitar a compreensão dos itens propostos pelo publico alvo. O pré-teste foi realizado no Centro de Reabilitação do HCFMRP-USP, participaram da pesquisa 10 indivíduos com diagnóstico de LTME, com até 6 meses lesão.A maioria eram do sexo masculino, com média de idade de 43 anos, sendo a principal etiologia do trauma os acidentes automobilísticos. Quanto à escolaridade verificou-se que a maioria dos participantes tinha ensino fundamental completo ou incompleto. Nesta etapa, houve substituição de alguns termos técnicos para melhor compreensão pelo público alvo. Mediante a análise entre os pesquisadores e após consenso das modificações sugeridas pelos especialistas e público alvo, foi elaborada a versão final do instrumento. Ressalta-se que o instrumento contribuíra na prática clinica como uma ferramenta inovadora a ser utilizado pela equipe multidisciplinar, na avaliação da funcionalidade para o planejamento da assistência, com foco nas necessidades individuais e nos resultados mais efetivos das intervenções no processo de reabilitação / Traumatic spinal cord injuries (TSCI) are usually the cause of disabilities and limited performance of some activities as well as limited participation in some life moments. Knowing if TSCI patients are functional dependent helps the rehabilitation services to be organized to effectively meet the demand of that population. The goal of the methodological design study was to create and validate an instrument based on summed up ICF Core Set for patients with acute traumatic spinal cord injury. The survey was approved by the Ethics Committee and it was divided in three phases: Phase 1 - Elaboration of the instrument based on summed up ICF Core Set for acute spinal cord injury: \"Instrument based on summed up ICF Core Set for patients with Acute Traumatic Spinal Cord Injury\"; Phase 2 - Validation of the instrument and data collect; Phase 3 - Implementation of the pre-test. Face and content validation tool had 13 categories which were part of ICF components: body functions (3), body structure (1), activities and participation (9); in total 109 items. Every section of the tool had a specific place for suggestions. A sixteen-judge committee validated the content. The results showed that most of the judges were 30 to 39-year-old women, with doctorate degree and they were professors who also studied ICF and applied it in their clinics. The evaluators checked more than 70% of each item of the tool and it was considered enough for the validation of the content. The judges made some suggestions for most of the items in order to replace or redesign the terms so that the structure and the effect of the tool would not be significantly changed. Those suggestions were relevant and they helped adjusting the tool to make easier for the community to understand the items. The pre-test was performed at Rehabilitation Center of HCFMRP-USP; ten patients who have had TSCI for up to 6 months participated on the survey. Most of them were 43 -year- old men, who studied up to elementary school, with a trauma caused by a car crash. At this stage some technical terms were replaced in order to help the community understanding. After the analysis of the researchers and the modifications suggested by the experts and the community, a final version of the tool was elaborated. In clinical practice this instrument was a new tool used by the multidisciplinary team when evaluating the functioning of helping individual necessities and more effective results of the interventions on the rehabilitation process