There is a need of more evidence‐based knowledge of different treatment/training‐approaches for children with Cerebral Palsy (CP) to better describe the objectives of interventions, effects on functioning and fulfilment of health care needs. The general aim of this thesis was to evaluate the effectiveness of intensive training in groups (ITGs) with a habilitation approach and a conductive education approach. In addition, this thesis explored different meanings of participation in ITGs to parents from a parent perspective. This thesis consists of two parts, a quantitative evaluation of the effectiveness of two ITGs (paper I‐III) and a qualitative study exploring parents’ different ways of experiencing ITGs (paper IV). Fifty‐four children, 3‐16 years old, with different types of CP, intellectual capacity and level of gross motor function, participated with their parents in a four weeks ITG with a short‐term and a one‐year follow‐up (paper I‐III). The second sample was strategically composed of parents to 15 children with CP with experiences of ITGs in different settings. The results showed that the proportion of clinically significant change in gross motor capability, functional skills or self‐reported individualized goal measure didn’t show any major differences between the two ITGs. One period of ITG facilitated small clinical and parent reported improvements in functioning for the short‐term. Nine children out of 54 made a clinically significant improvement in gross motor capability (GMFM‐88 total score); 36 children improved if an improvement in any dimension A‐E was counted for. Twenty‐two children out of 52 improved in one of the domains self‐care, mobility and social function (PEDI Functional Skills). Twenty‐eight parents out of 54 perceived a clinically significant improvement on the self‐reported individualized goal measure. Most individualized goals dealt with motor activities and movement‐related body functions in both ITGs. The self‐reported individualized goal measure was not found to be more sensitive to change than the clinical measures. The one‐year follow‐up showed that children had a stable level of functioning. No child deteriorated on the clinical measures short‐term and at the one‐year follow‐up. A higher proportion of change was seen in the social function domain at the one‐year follow‐up, indicating a better potential to change in social function than in gross motor function. The majority of children had a high consumption of training delivered by the Child and Youth Habilitation and merely half of the group continued with repeated ITGs. The differences in functional outcome between children continuing with repeated ITGs compared with only customary Child and Youth Habilitation were limited to a higher proportion of improvements in social functioning. Parents perceived a high service quality in both ITGs. To parents, fulfilment of health care needs was as important as functional outcome. The probability for high service quality was associated with previous experience of the ITG, high expectations of improvements, if expectations and improvements in gross motor capability were achieved and if the child participated in the ITG with the habilitation approach. Therapists in the habilitation approach were more involved in discussions with parents about expectations for the ITG and knowledge exchange than conductors were, indicating more familycenteredness. The qualitative study points to a variety of parental needs that may be met at ITGs but also indicates some problems that should be addressed. Five overarching meaning categories of ITGs were described: ITGs as knowledge promotion, as a complementary training resource, as a bracket to ordinary life, as building up relations with therapists, and as a leisure‐activity. An additional category – “ITGs as risk for ill‐being” – subsumed different kinds of problems that may arise. Conceptions suggest that ITGs contribute to parents’ improved knowledge, support and well‐being, but ITGs could also negatively influence family‐functioning. Professionals and parents need to discuss parents’ previous experiences of ITGs, expectations of functional improvements, the functioning of the child and health care needs in order to individualize goals for ITGs and make the objectives for participation clear. There were no major differences in effectiveness between the two ITGs, a habilitation approach and conductive education approach. Various training approaches should be chosen depending on the child’s and family’s needs. In the choice between different training approaches it is of equal importance to acknowledge functional needs of the child as well as health care needs of the child and parent.

Engagement is the active involvement in experiences which allows for development. For children with severe mobility impairments however, challenges arise in accessing experience which can lead to learned helplessness. Due to these challenges powered mobility has been suggested as a mechanism for the provision of self-initiated access to experiences. However, powered mobility is out of reach of the majority of children with disabilities in South Africa hence a non-powered alternative has been sought. This study sought to determine the effect of non-powered, self-initiated mobility on the engagement of young children, with severe mobility impairment, in play. A multiple probe design across participants was used. Four participants, aged 2 years 10 months to 6 years 9 months with severe mobility impairment (Gross Motor Function Classification Scale (GMFCS) level V) underwent a minimum of 5 baseline sessions, followed by 8 intervention sessions. Engagement was measured during each session using the Individual Child Engagement Record –Revised (ICER-R). The data was analysed using visual graphic and statistical analysis. All participants demonstrated an improvement in engagement in play with the introduction of non-powered, self-initiated mobility. A reciprocal deterioration in non-engagement was also recorded. A decrease in engagement in play at the start of intervention was attributed to the focus of engagement being on mobility skills as the device was introduced but this reverted as the participants spent more time on the mobility device. Functional abilities were identified as having a greater role in engagement than age. The introduction of non-powered, self-initiated mobility correlated with the improvement of engagement of young children with severe motor impairment. Non-powered, self-initiated mobility is a viable, cost effective mechanism for mobility at a young age. / Thesis (PhD)--University of Pretoria, 2015. / Centre for Augmentative and Alternative Communication (CAAC) / PhD / Unrestricted

Title: Rehabilitation of Child with Cerebral Palsy in the Preoperative and Postoperative Period Author: Renata Šmídová Objective: During my practice I have met with a number of pediatric patients affected by cerebral palsy who underwent corrective orthopedic surgery, and which in some cases unfortunately unsuccessful. Based on the initial acquisition of information on this issue, I found a number of studies and articles on the success of orthopedic surgery in cerebral palsy. Many studies have been correctly chosen physiotherapy great help, so I decided to map physiotherapy approach on the case. In the first part of the thesis I process in detail neurological disorder cerebral palsy (CP) and surgical treatment of deformities resulting from the operation of this disease. The second part includes a case study, which also describes the rehabilitation work of the physiotherapist with a child patient who undergoes corrective surgery on the lower limb. The third section contains qualitative research, conducted on the parents. The aim was to use polling to determine success of the operation and postoperative care. The aim: To determine what aspects affect the outcome of orthopedic surgery in cerebral palsy and what rehabilitation has a key role to the success of the operation. Method: Was a case study of a...

Kunskapen om funktionshindrade människors liv över tid och om innebörden av att leva med funktionshinder under många år, att åldras och vara gammal är begränsad. Trots att Cerebral Pares (CP) är definierat som en icke progressiv hjärnskada som i första hand påverkar de motoriska funktionerna så uppstår sekundära svårigheter som förvärras över tid. Syftet med studien är att med hjälp av livsberättelser från vuxna med CP beskriva och analysera deras upplevelse av att bli äldre och hur de upplever att åldrandet påverkar deras bild av sig själv och deras livsvillkor. Studien utgår från en kvalitativ ansats och har en induktiv slutledningsform, som innebär att man utifrån olika observationer och undersökta fenomen leder till en generaliserad slutsats. Genomförandet av studien utgår från ett socialkonstruktionistiskt vetenskapligt perspektiv och en narrativ metod som grund för de kvalitativa intervjuarna. Mitt datainsamlande har bestått av 4 intervjuer med två olika intervjupersoner, med öppna frågor och följdfrågor. Resultatet visade på ett tidigare åldrande, än för personer utan funktionsnedsättning, som i sin tur resulterat i ett utanförskap ekonomiskt, hälsomässigt och arbetsmässigt. För intervjupersonen som tidigare hade klarat sig själv uppstod ett ökat hjälpbehov och minskad självständighet. Självbilden påverkas på olika sätt. För den ena intervjupersonen är funktionsnedsättningen en naturlig del av självbilden, och den andra intervjupersonen separerar på sig själv och funktionsnedsättningen beroende på den sociala kontexten. Det senaste kan vara svårare med stigande ålder då ålderssymptom förvärrar effekterna av funktionsnedsättningen. / The knowledge of disabled people's lives over time is limited. Cerebral Palsy (CP) is defined as a non-progressive brain damage which firstly affects the motor functions, it can also cause secondary difficulties which become worse with time. The aim of the study is to describe and analyze adults with CP, their experiences of getting older, the way they experience how aging affects their image of themselves and their living conditions by means of life stories. The study is based on a qualitative approach and an inductive logic, which means that based on different observations and investigated phenomena, a generalized conclusion is reached. The implementation of the study is based on a social constructionist perspective and a narrative method as the basis for the qualitative interviews. The data collection consisted of four interviews with two different interviewees, with open and follow-up questions. For the interviewee who had previously taken care of himself, an increased need for help and reduced independence occurred. Self-image is influenced differently. For one interviewee, disability is a natural part of his self-image, and the other interviewee separates himself and his disability depending on the social context. The later can be harder with increasing age as age symptoms aggravate the effects of disability.

Det övergripande syftet med denna studie var att öka kunskapen om hur små barn med Cerebral Pares (CP) deltar, kommunicerar och interagerar med sina vardagliga samtalspartners på förskolan. I studien deltog två små pojkar (2;4 och 4;3 år) med grav CP (GMFCS 5) med lite/inget talat språk. De filmades på förskolan i olika vardagliga aktiviteter tillsammans med de andra barnen och personalen. Vid analysen studerades pojkarnas samlade kommunikativa resurser och återkommande mönster i samtalen på ett detaljerat plan med hjälp av Conversation Analysis (CA). Analysen visade att samtalspartnern hade en viktig roll för att underlätta i samtalet genom att tolka och tillskriva pojkarnas bidrag betydelse. När pojkarna använde en kombination av flera kommunikativa resurser föreföll det vara lättare för samtalspartnern att tillskriva bidragen betydelse. Vilken betydelse som tillskrevs kunde bland annat påverkas av hur barnens bidrag producerades, vilken aktivitet deltagarna var involverade i, eller vilken kunskap samtalspartnern hade om pojkarna sedan tidigare. Det framkom också att pojkarnas oförmåga att sitta självständigt påverkade deltagarstukturen som i sin tur påverkade interaktionen och kommunikationen. Kvalitativa närstudier av interaktion med barn med svår motorisk nedsättning till följd av CP är viktiga då dessa kan demonstrera vilka metoder som omgivningen använder för att skapa mening i interaktion trots barnens begränsade kommunikativa resurser. Barnens signaler kan till exempel vara svårtolkade för omgivningen på grund av den motoriska funktionsnedsättningen, men de vuxna använder den aktuella aktiviteten eller samtalet för att skapa en meningsfull kontext för barnens bidrag. Detta leder till att barnen blir mindre passiva i sin kommunikation och att kommunikationen blir lättare att förstå. Nyckelord: Interaktion, Kommunikation, Cerebral Pares (CP), Conversation Analysis (CA), Kommunikativa resurser. / The aim of this study was to increase the knowledge on how young children with severe Cerebral Palsy (CP) participate, interact and communicate with naturally speaking communication partners at preechool. Two young boys (2;4 and 4;3 years) with severe CP (GMFCS 5) with little or no spoken language participated in the study. They were recorded at preschool in various everyday activities and the recorded material arose from ordinary conversations with other children or staff at the preeschool. When analyzing the data, the principals and procedures of Conversation Analysis (CA), was used to study the childrens communicative resourses and the repeating conversational patterns on a detailed level. The analysis showed that the interlocutor had a very important role in the interaction with the child. The interlocutor attributed meaning to the boys' contributions and this was closely linked to the combination of different communicative resources by the boys. Which meaning that was attributed could, among other things be affected by how the children's contributions were produced, what activity the participants were involved in, or the interlocutors previous knowledge about the boys. In addition, the boys' bodily position relative to the other participants had an influence on communication. The boys inability to sit independently affected the participants positions in interaction, witch affected interaction and communication.  Qualitative detailed studies of interaction with children with severe motor impairment, (CP) is important since these can demonstrate which methods the communicative surround uses to create meaning in interaction despite the children's limited communication resources. Children’s signals can for example be difficult for the communication partners to interpret because of the motor function, but the adults are using the current activity or conversation to create a meaningful context for the children's contributions . This leads to children becoming less passive in their communication and communication becomes easier to understand. Keywords: Interaction, Communication, Cerebral Palsy (CP), Conversation Analysis (CA), Communicative resources

Title: Rehabilitation of Child with Cerebral Palsy in the Preoperative and Postoperative Period Author: Renata Šmídová Objective: During my practice I have met with a number of pediatric patients affected by cerebral palsy who underwent corrective orthopedic surgery, which in some cases were unfortunately unsuccessful. Based on the initial acquisition of information on this issue, I found a number of studies and articles on the success of orthopedic surgery in cerebral palsy. In many studies point out that the proper choice of physiotherapy has great benefit for orthopedic intervention, so I decide to map a connections orthopedic and physiotherapy approaches on the case and describe the elements of rehabilitation used in the treatment of selected patient. In the first part of the thesis I process in detail neurological disorder cerebral palsy (CP) and surgical treatment of deformities resulting from the operation of this disease. The second part includes a case study that describes the rehabilitation work of the physiotherapist with a child patient who undergoes corrective surgery on the lower limb. The third section contains qualitative research, conducted on the parents. Using the survey was to determine the effect of parents' opinion and the whole course of therapy. The aim: Demonstrate the...

The research deals with the formation of motor skills and self-help skills in terms of family upbringing. As a result the developed program, which included: diagnosis of formation of motor skills and self-help skills; advice for parents; training activities and monitoring the formation of motor skills. The resulting research positive results allow to recommend the program developed a wide range of professionals working with children with cerebral palsy. / В диссертационном исследовании рассмотрены вопросы формирования двигательных навыков и навыков самообслуживания в условиях семейного воспитания. В результате разработана программа, в которую вошли: диагностика формирования двигательных навыков и навыков самообслуживания; консультации для родителей; тренировочная деятельность и мониторинг формирования двигательных навыков. Полученные в результате исследования положительные результаты позволяют рекомендовать разработанную программу широкому кругу специалистов, работающих с детьми ДЦП.

В диссертационном исследовании рассмотрены сущность и содержание средств коррекции двигательной дисфункции при ДЦП, а также условия совершенствования данного процесса. Разработана система абилитации детей с ДЦП, позволяющая более эффективно кооректировать признаки двигательной дисфункции у детей с ДЦП. Сформулированы практические рекомендации, врачам – реабилитологам центров реабилитации, лечебно – профилактических учреждений, которые будут полезны в их работе. Полученные в результате исследования положительные результаты позволяют рекомендовать разработанную нами систему абилитации детей с ДЦП широкому кругу специалистов в области реабилитации (методистам и врачам лечебной физической куль-туры, врачам - реабилитологам). / In the dissertation study examined the nature and the content of correction of motor dysfunction in cerebral palsy, and conditions to improve the process. The developed system of habilitation for children with cerebral palsy, enabling more efficient korektirovki signs of motor dysfunction in children with cerebral palsy. Practical recommendations are formulated, physicians – rehabilitation specialists of rehabilitation centers, medical institutions, which will be useful in their work. The resulting research positive results allow to recommend developed system of habilitation for children with cerebral palsy a wide range of professionals in the field of rehabilitation (specialists and physicians of medical physical culture, doctors, physiotherapists).

Kommunikation och interaktion är viktigt för att utveckla både språklig och social kompetens. Barn som använder alternativ och kompletterande kommunikation (AKK) får dock inte alltid samma möjligheter som talande barn att kommunicera. Speciellt svårt kan det vara att interagera och därigenom skapa relationer med jämnåriga. Det övergripande syftet med denna studie var att studera samtal mellan jämnåriga, speciellt hur de bygger upp och upprätthåller gemensam förståelse i samtal. Studien innefattade två unga pojkar som på grund av cerebral pares (CP) saknade talförmåga och därför använde bliss som AKK. De filmades under ett samtal med varsin klasskamrat. En samtalsanalytisk metod (conversation analysis, CA) användes för att identifiera mönster i interaktionen och analysera deltagarnas strategier för att etablera gemensam förståelse. De strategier som användes visade sig vara tolkningsförslag, följdfrågor, formuleringar och reparationer. Strategierna användes främst vid responspunkter efter blissyttranden, men reparationer förekom även under konstruktionen av yttranden. Analysen visade också att förståelsestrategier ibland saknades i det ena samtalet vilket då ledde till att samtalet stannade av. De talande tog större delen av ansvaret för förståelsearbetet i båda samtalen, men även de blissande pojkarna var delaktiga. Sammantaget visade analysen att samtal med AKK kan se mycket olika ut. Vilka strategier deltagarna använde sig av för att etablera gemensam förståelse var av stor betydelse i båda samtalen. Det krävdes att alla samtalsdeltagare var engagerade i förståelsearbetet för att samtalet inte skulle avstanna. / Communication and interaction are important parts in developing both linguistic and social skills. Children who uses augmentative and alternative communication (AAC) may not always have the same opportunities as talking children to communicate. It can be especially difficult to interact and thereby create relationships with peers. The aim of this study was to explore conversations between peers, more specifically in which ways they establish and maintain common understanding in the conversation. Participants in the study were two young boys with cerebral palsy (CP) causing non-intelligible speech, and therefore using blissymbolics as their AAC. The boys were videotaped during a conversation with a classmate. A Conversation Analysis method (CA) were used to identify patterns in the interaction, and to analyze the participants' strategies to establish common understanding. Strategies used were suggestions of interpretation, following up-questions, formulations and reparations. The strategies were most used in transition-relevance places, but reparations could also be found during the creation of blissymbolic utterances. The analysis also found that understanding-oriented strategies sometimes were missing in one of the conversations, which led to breakdown in the conversation. The talking individuals were responsible for establishing common understanding in the major part of both conversations, but the boys using blissymbolics did not leave the responsibility entirely to them. In total the analysis showed that conversations with AAC can differ in many ways. Which strategies the participants used to establish common understanding were of great importance in both conversations. Every participant in the conversation were obliged to engage in creating common understanding in order to not lead the conversation to a breakdown.

Master's thesis called Spiritual needs in people with cerebral palsy and their saturation in social care focuses on expressing spirituality in people with cerebral palsy (CP) and studies what the spiritual needs may be and if personal care assistants (PCAs) can help to fulfil clients' spiritual needs. The theoretical part shows the issues of CP and the view to people with this disability, with the emphasis to the options of their participation for life in society. It deals with the topic of spirituality and spiritual dimension as one of many dimensions of human personality. After presenting several important theories of needs it continuous with the role of PCAs and their role in fulfilling the clients' spiritual needs. The practical part proceeds from the combination of quantitative and qualitative research; from a questionnaire inquiring the expressiveness of the spirituality and its sharing with PCAs, and interviews seven people with CP inquiring their spiritual needs and possibilities of their fulfilling by PCAs. The results show concrete and stronger spirituality expressing in people with CP than in major population and that the spiritual needs come out from their live situation. Besides spiritual needs and forces that allow them to fulfil their needs on their own. The PCAs are also a rich...