Background: The main objective of this study was to investigate older people’s physical activity, their participation in various life situations, and their perceptions of their own health. This included an exploration of potential influences of urban versus rural residency on these outcomes, an evaluation of the measurement properties of a balance confidence scale, and an examination of the proposed usefulness of the International Classification of Functioning, Disability and Health (ICF) as a conceptual framework to facilitate analysis and understanding of selected outcomes. Methods: The study design was cross-sectional, population-based, with random selection from the national register of one urban and two rural municipalities in Northern Iceland. There were 186 participants, all community-dwelling, aged 65 to 88 years (mean = 73.8), and 48% of the group were women. The participation rate was 79%. Data was collected in 2004, in face-to-face interviews and through various standardized assessments. The main outcomes were total physical activity; leisure-time, household, and work-related physical activity; participation frequency and perceived participation restrictions; and self-rated health. Other assessments represented aspects of the ICF body functions, activities, environmental factors and personal factors. Moreover, Rasch analysis methods were applied to examine and modify the Activities-specific Balance Confidence (ABC) scale and the ICF used as a conceptual framework throughout the study. Results: The total physical activity score was the same for urban and rural people and the largest proportion of the total physical activity behavior was derived from the household domain. Rural females received the highest scores of all in household physical activity and rural males were more physically active than the others in the work-related domain. However, leisure-time physical activity was more common in urban than rural communities. A physically active lifestyle, urban living, a higher level of cognition, younger age, and fewer depressive symptoms were all associated with more frequent participation. Rural living and depressive symptoms were associated with perceived participation restrictions. Moreover, perceived participation restrictions were associated with not being employed and limitations in advanced lower extremity capacity. Both fewer depressive symptoms and advanced lower extremity capacity also increased the likelihood of better self-rated health, as did capacity in upper extremities, older age, and household physical activity. Rasch rating scale analysis indicated a need to modify the ABC to improve its psychometric properties. The modified ABC was then used to measure balance confidence which, however, was found not to play a major role in explaining participation or self-rated health. Finally, the ICF was useful as a conceptual framework for mapping various components of functioning and health and to facilitate analyses of their relationships. Conclusions: The results highlighted the commonalities and differences in factors associated with participation frequency, perceived participation restrictions, and self-rated health in old age. Some of these factors, such as advanced lower extremity capacity, depressive symptoms, and physical activity pattern should be of particular interest for geriatric physical therapy due to their potential for interventions. While the associations between depressive symptoms, participation, and self-rated health are well known, research is needed on the effects of advanced lower extremity capacity on participation and self-rated health in old age. The environment (urban versus rural) also presented itself as an important contextual variable to be aware of when working with older people’s participation and physically active life-style. Greater emphasis should be placed on using Rasch measurement methods for improving the availability of quality scientific measures to evaluate various aspects of functioning and health among older adults. Finally, a coordinated implementation of a conceptual framework such as ICF may further advance interdisciplinary and international studies on aging, functioning, and health.

Increasingly better living and working conditions, higher quality healthcare and social conditions are resulting in higher life expectancy more than ever. This is called population ageing. Illness or injury in older age causes various and specific problems which affect all personal areas of the elderly such as physical, emotional, social and spiritual status. It is the aim of rehabilitation to improve or restore those areas following personal injury or illness. One of the various professional disciplines contributing to the rehabilitation process is Occcupational Therapy. The main aim of the thesis is to clarify the role of Occupational Therapy in the area of elderly rehabilitation. It also aims to incorporate the World Health Organisation{\crq}s International Classification of Functioning, Disability and Health (ICF) into clinical work of Occupational Therapy and to find its practical use in this discipline.

Made available in DSpace on 2016-04-27T18:12:01Z (GMT). No. of bitstreams: 1 Final para biblioteca.pdf: 517561 bytes, checksum: 8ada3b8358b7ff570de6993d1d52b7c9 (MD5) Previous issue date: 2013-05-27 / Introduction: the International Classification of Functioning, Disability and Health offers a positive outlook of categorization to the individual that presents changes on function and/or of the structure of the body. Aims to describe the nature and severity of the limitations of functionality (OMS 2011). It is used as a statistical tool, clinical, educational, research and social policy. This classification has been incorporated and used in the sectors of health and multidisciplinary teams. Objective: to verify the applicability of the Hearing Handicap Inventory for the Elderly, to classify individuals according to the categories of the International Classification of Functioning, Disability and Health; establish the categories of the International Classification of Functioning, Disability and Health to individuals who have hearing loss and investigate the prevalence of changes to functionality in individuals with hearing loss. Method: it was applied the Hearing Handicap Inventory for the Elderly and then select the categories of the International Classification of Functioning, Disability and Health. Results: 44.83% showed severe perception of its inability. 62.1% presented: moderate hearing loss that affects the body's functions, the mental functions, perception and hearing (cod b1560.1), moderate hearing loss that affects the body's functions, sensory functions, the auditory functions and the detection of sound (cod b2300.1), qualitative change in the structure of the inner ear, in this case being characterized as sensorioneural bilateral moderate hearing loss (cod s2609.173); 62.1% does not present difficulty for situations involving conversation activities with the family (cod d 3508.0_); 58.6% does not present difficulty in hearing functions of auditory discrimination (cod b2308.0); 69.0% presents much difficulty to hear in their participation activities (cod d115.4 _), does not present difficulty in controlling emotions and impulses in complex personal interactions (cod d7202.0_), does not present difficulty to attend religious services (cod d 9309.0_); 51.7% presents great difficulties to participate in community life when it comes to ceremonies (cod d 9102.4_). Conclusion: the ICF offers important applicability to categorize individuals with hearing loss; the questionnaire used is partially applicable to classify on a complete form, the disabilities of the subjects with hearing loss / a Classificação Internacional de Funcionalidade, Incapacidade e Saúde propõe uma perspectiva positiva de categorização para o indivíduo que apresenta alterações de função e/ou da estrutura do corpo. Tem como objetivo descrever a natureza e a gravidade das limitações de funcionalidade (OMS 2011). Ë utilizada como uma ferramenta estatística, de pesquisa, clínica, pedagógica e de política social. Esta classificação vem sendo incorporada e utilizada nos setores da saúde e equipes multidisciplinares. Objetivo: verificar a aplicabilidade do Questionário de Auto-avaliação do Handicap Auditivo para Idosos, para classificar indivíduos segundo as categorias da Classificação Internacional de Funcionalidade, Incapacidade e Saúde; estabelecer as categorias da Classificação Internacional de Funcionalidade, Incapacidade e Saúde, para indivíduos que apresentem perda auditiva e investigar a prevalência de alterações na funcionalidade em indivíduos com perda auditiva. Método: foi realizado o Hearing Handicap Inventory for the Elderly e posteriormente selecionadas as categorias da Classificação Internacional de Funcionalidade, Incapacidade e Saúde. Resultados: 44,83% apresentaram percepção severa de sua incapacidade. 62,1% apresentaram: perda auditiva moderada que afeta as funções do corpo, as funções mentais, de percepção e auditiva (cod b1560.1), perda auditiva moderada que afeta as funções do corpo, as funções sensoriais, as funções auditivas e a detecção do som (cod b2300.1), alteração qualitativa na estrutura do ouvido interno, neste caso sendo caracterizada como perda auditiva sensorioneural moderada bilateral (cod s2609.173); 62,1% não apresenta dificuldade para situações que envolvam atividades de conversação com a família (cod d3508.0_); 58,6% não apresenta dificuldade nas funções auditivas de discriminação auditiva (cod b2308.0); 69,0% apresenta muita dificuldade para ouvir nas suas atividades de participação (cod d115.4_), não apresenta dificuldade em controlar emoções e impulsos nas interações pessoais complexas (cod d7202.0_), não apresenta dificuldade para frequentar serviços religiosos (cod d9309.0_); 51,7% apresenta grande dificuldade para participar na vida comunitária quando se trata de cerimônias (cod d9102.4_). Conclusão: a CIF apresenta importante aplicabilidade para categorizar indivíduos com perda auditiva; o questionário utilizado é parcialmente aplicável para classificar de forma completa as incapacidades dos sujeitos com perda auditiva

Bakgrund: En akut akillesseneruptur (ATR) resulterar i begränsning av funktion som kan kvarstå under lång tid. I litteraturen finns ett flertal reliabla och valida utvärderingsinstrument som används vid funktionsbedömningar efter ATR. Då osäkerhet angående lämpligt val av tester inför återgång i aktivitet/idrott föreligger finns ett behov av tydliga riktlinjer i fråga om kliniskt relevanta utvärderingsinstrument. Syfte: Syftet med studien var att identifiera kliniskt relevanta fysioterapeutiska utvärderingsinstrument för bedömning av funktion hos personer med akillesseneruptur samt kartlägga dessa utifrån ett validitets och reliabilitetperspektiv. Metod: En kartläggande litteraturstudie. Litteratursökningen genomfördes i databaserna PubMed, Cinahl och PEDro mellan 2023-02-07 – 2023-02-15 utifrån inklusionskriterierna: vuxna individer med akut ATR, artiklar publicerade 2013-2023, observations- och randomiserade kontrollerade studier. Av identifierade utvärderingsinstrument valdes 15 ut, baserat på kriterierna: frekvens, klinisk användbarhet samt kategorisering enligt ramverket International Classification of Functioning, Disability and Health (ICF). Valda utvärderingsinstrument kategoriserades enligt ICF samt granskades avseende reliabilitet och validitet om denna data fanns tillgänglig. Resultat: Totalt inkluderades 15 olika utvärderingsinstrument, såväl objektiva som subjektiva, för granskning utifrån reliabilitet och validitet. Fem av dessa visade både god reliabilitet och validitet samt klinisk användbarhet. Inga diagnosspecifika utvärderingsinstrument inom ICF-kategorierna personlighetsfaktorer och omgivningsfaktorer identifierades. Slutsats: Achilles Tendon Resting Angle (ATRA), Achilles Tendon Total Rupture Score (ATRS), Foot and Ankle Outcomes Score (FAOS), Heel-Rise Endurence och Heel-Rise Height är fem tillförlitliga utvärderingsinstrumnet att använda i klinik. Inför återgång till aktivitet/idrott är det nödvändigt att komplettera med idrottsspecifika utvärderingsinstrument samt instrument som utvärderar psykologiska faktorer. / Background: An acute achilles tendon rupture (ATR) results in limitations of function that remains for a long time. There are several reliabel and valid outcome measures used in functional evaluation after ATR presented in the litterature. Due to uncertainties regarding which appropriate outcome measures to use for return to activities/sports there is a need for clinical guidelines. Purpose: The purpose was to identify physiotherapeutic outcome measures for the evaluation of function in people with achilles tendon ruptures and to chart these from a perspecive of reliability and validity. Method: A scoping review. A litterature search were performed in the databases PubMed, Cinahl and PEDro between 2023-02-07 – 2023-02-15 based on the inclusion criteria: adults with acute ATR, articles published between 2013-2023, clinical trials and randomized controlled trials. From identified outcome measures 15 were selected based on the criteria frequency, clinical usability and categorized by the theoretical framework International Classification of Functioning, Disability and Health (ICF). Selected outcome measures were categorized according to ICF and reviewed for republicity of results, if this data was available. Results: 15 outcome measures, both objective and subjective, were included for evaluation regarding reliability and validity. Five of these proved good reliability, validity and clinical usability. In the ICF categories, personal factors and environmental factors, no diagnose specific outcome measures were identified. Conclusion: Achilles Tendon Resting Angle (ATRA), Achilles Tendon Total Rupture Score (ATRS), Foot and Ankle Outcomes Score (FAOS), Heel-Rise Endurence och Heel-Rise Height are five reliable outcome measures to use in clinical practice. Before return to activities/sports it is necessary to add sportspecific outcome measures and evaluation of psychological factors.

Bakgrund Femoroacetabulär impingement (FAI) syndrom är en allt vanligare rörelserelaterad funktionsnedsättning i höften, relaterat till en prematur kontakt mellan proximalafemur och acetabulum. Fysioterapi har visat god effekt vid behandlingen av FAI men aktuell forskning är begränsad och konsensus kring bästa behandlingsmetod saknas. Syfte Identifiera och kategorisera vilka fysioterapeutiska interventioner som används vid behandlingen av femoroacetabulär impingement (FAI), hur interventionerna utvärderas och presentera effekten av dessa interventioner. Metod Kartläggande litteraturöversikt. I februari 2022 genomfördes en elektronisk sökning efter vetenskapliga originalstudier från 2012, i databaserna PubMed, CINAHL och PEDRO. Totalt 1672 studier granskades varav 23 inkluderades. Huvudtyper av interventioner identifieras och kategoriserades med stöd av ICF-ramverket utifrån avsett syfte. Resultat Ur 23 inkluderade studier identifierades 36 huvudtyper av interventioner. Av dessaka tegoriseras 25 interventioner under ICF komponenten kroppsfunktioner. Hälften av interventionerna kategoriseras under neuromuskuloskeletala och rörelserelaterade funktioner. Av totalt 33 olika patientrapporterade utfallsmått (PROM) utgjorde iHOT-33, mHHS och NAHS de tre vanligast förekommande. Minst ett av de rekommenderade utfallsmåtten iHOT-12/-33, HAGOS och HOS användes i 70% av studierna. Alla inkluderade randomiserade kontrollerade studier visar signifikanta förbättringar vid användandet av fysioterapeutiska interventioner för FAI avseende PROM vid uppföljning jämfört baslinjen. Slutsats Utformningen av fysioterapeutiska interventioner vid FAI varierar, även om majoriteten syftar till att påverka neuromuskuloskeletala och rörelserelaterade funktioner. Det är möjligt att utifrån interventionens syfte klassificera interventioner vid FAI enligt ICF-ramverket. Rekommenderade diagnosspecifika PROM används i relativt hög utsträckning, till skillnad från de rekommenderade livskvalitetsmåtten. Studien belyser i likhet med tidigare forskning, bristen på konsensus gällande den fysioterapeutiska behandlingen vid FAI. / Background Femoroacetabular impingement (FAI) syndrome is an increasingly prevalent movement related disability in the hip, related to premature contact between the femur and acetabulum. Physiotherapy has shown efficacy in treating FAI, but research is limited and shows a lack of consensus regarding best conservative care. Purpose This study aims to identify and categorize the type of physiotherapeutic interventions used in treating FAI, present the effects of these interventions and to map the use of outcome measures. Methods Scoping review. In February 2022 an electronic search was conducted across the databases PubMed, CINAHL and PEDRO. A total of 1672 studies were identified of which 23 met eligibility. Main types of interventions were identified and classified based on aim using the ICF-framework. Results A total of 36 main types of interventions were identified. Out of these, 25 could be categorized under the ICF-component body functions and 18 under neuromusculoskeletal and movement-related functions. Out of 33 total PROMs, iHOT-33, mHHS and NAHS saw most use. At least one of the recommended PROMs was used in 70% of the studies. Included RCT: s show significant improvement on a variety of outcome scores. Conclusion Interventions treating FAI varies, with most targeting neuromusculoskeletal and movement-related functions. Categorization based on the aim of interventions is possible using the ICF-framework. Recommended hip-specific outcome measures are used to a greater extent compared to the more general quality of life measures. This study, in accordance with earlier research, illustrates the lack of consensus regarding the physiotherapeutic care of FAI.

Many individuals with severe motor impairments are cognitively capable, but because of their physical impairments, unable to express their intention through conventional means of communication. Access technologies are devices that attempt to translate the intention of these individuals into functional activity by harnessing their residual physical or physiological abilities. The primary objective of this thesis was to design and develop a novel non-invasive and non-contact access technology based on infrared thermal imaging. This access technology translates the local temperature change associated with voluntary mouth opening to activation of a binary switch such as a mouse click or key press. To this end, an algorithm based on motion and temperature analyses, and morphological and anthropometric filters was designed to detect mouth opening activity in thermal video in real-time. The secondary objective of this thesis was to introduce a mutual information measure for objective assessment of binary switch users’ performance. A model was suggested, in which combination of cognitive and physical abilities of the human user of a binary access switch constitute a communication channel. The proposed mutual information measure estimates the rate of information transmission in the ‘human communication channel’ during stimulus response tasks. Using this measure, in a study with ten able-bodied participants, the infrared thermal switch was validated against a conventional chin switch. Impairments in body functions and structures that may contraindicate the use of the infrared thermal switch were explored in a study with seven clients, with severe disabilities. Potential hard and soft technological solutions to mitigate the effect of these impairments on infrared thermal switch use were recommended. Finally the infrared thermal switch was tailored to meet the needs of a young man with severe spastic quadriplegic cerebral palsy, who had no other means of physical access.

Many individuals with severe motor impairments are cognitively capable, but because of their physical impairments, unable to express their intention through conventional means of communication. Access technologies are devices that attempt to translate the intention of these individuals into functional activity by harnessing their residual physical or physiological abilities. The primary objective of this thesis was to design and develop a novel non-invasive and non-contact access technology based on infrared thermal imaging. This access technology translates the local temperature change associated with voluntary mouth opening to activation of a binary switch such as a mouse click or key press. To this end, an algorithm based on motion and temperature analyses, and morphological and anthropometric filters was designed to detect mouth opening activity in thermal video in real-time. The secondary objective of this thesis was to introduce a mutual information measure for objective assessment of binary switch users’ performance. A model was suggested, in which combination of cognitive and physical abilities of the human user of a binary access switch constitute a communication channel. The proposed mutual information measure estimates the rate of information transmission in the ‘human communication channel’ during stimulus response tasks. Using this measure, in a study with ten able-bodied participants, the infrared thermal switch was validated against a conventional chin switch. Impairments in body functions and structures that may contraindicate the use of the infrared thermal switch were explored in a study with seven clients, with severe disabilities. Potential hard and soft technological solutions to mitigate the effect of these impairments on infrared thermal switch use were recommended. Finally the infrared thermal switch was tailored to meet the needs of a young man with severe spastic quadriplegic cerebral palsy, who had no other means of physical access.