Introdução. Incapacidade funcional está relacionada à dificuldade em realizar as atividades de vida diária de forma independente comprometendo sobremaneira a qualidade de vida da pessoa idosa. Requer adaptação do idoso, reorganização familiar e, muitas vezes, a presença de um cuidador. Reconhecer seu processo de instalação pode auxiliar no estabelecimento de medidas preventivas e adequação dos serviços sociais e de saúde. Objetivo: Construir escala hierárquica de dificuldades referidas no desempenho funcional de AVDs (incapacidades) em uma população de idosos do Município de São Paulo. Metodologia: Utilizando-se o método de escalonamento de Guttman, foram desenvolvidas escalas hierárquicas de incapacidades com a população idosa do Município de São Paulo utilizando a base de dados do Estudo SABE. Com a base de dados de 2000 a escala foi comparada à outra construída aproximadamente dez anos antes buscando verificar mudanças ocorridas no período e, com a base de dados de 2006 foi construída uma escala hierárquica da incidência de incapacidades nesse grupo onde foi aplicada uma escala de escores para classificação do nível funcional. Resultados: Verificou-se que a proporção de incapacidades aumentou em um período de dez anos. Para o seguimento de 2006 encontrou-se a seguinte ordem hierárquica crescente de dificuldades: comer (5,7 por cento ), higiene pessoal (6,3 por cento ), usar o banheiro (7,2 por cento ), locomover-se (7,8 por cento ), tomar banho (10,1 por cento ), vestir a parte de cima da roupa (11,9 por cento ), ser continente (fecal) (13,8 por cento ), administrar as próprias finanças (20,3 por cento ), tomar o próprio medicamento (21,2 por cento ), mobilizar-se (22,8 por cento ), usar o telefone (24,2 por cento ), vestir a parte de baixo (25,6 por cento ), fazer compras (30,5 por cento ), ser continente (urinário)(40,5 por cento ) e utilizar transporte (43,8 por cento ). Nos dois períodos, percebeu-se que os homens apresentaram maiores proporções de incapacidades, apesar de as mulheres as acumularem mais e que as dificuldades aumentaram com o avançar da idade. Conclusões: Foram verificadas mudanças no padrão de instalação e aumento das proporções de incapacidade em quase uma década. A escala hierárquica possibilitou a determinação de níveis de incapacidade / Introduction: Functional disability is related to the difficulty to perform daily life activities independently, which seriously jeopardizes elderly peoples quality of life. It requires adaptation, family reorganization and, in many cases, the presence of a caregiver. Recognizing these needs may help establish prevention measures and adequacy to social and health care services. Objective: To build a hierarchy scale on the aforementioned difficulties in the functional performance of DLAs (disabilities) in a population of elderly people in the municipality of São Paulo. Methodology: By using Guttman scaling method, hierarchy scales of disabilities were developed with the elderly population of the municipality of São Paulo with the database of SABE Study. With the 2000 database at hand, the scale was compared to another one built nearly ten years earlier seeking to find changes occurred in this period and, with the 2006 database a hierarchy scale of the occurrence of disabilities was built for this group of people, where a scale of scores was applied to rank the functional level. Results: It was found that the proportion of disabilities increased in a ten-year period. For the 2006 segment, the study found the following order of increasing difficulty: eating (5.7 per cent ), personal hygiene (6.3 per cent ), using the toilet (7.2 per cent ), walking (7.8 per cent ), bathing (10.1 per cent ), dressing the top of clothing (11.9 per cent ), being able to keep their fecal continence (13.8 per cent ), managing their own finances (20.3 per cent ), taking their own medicine properly (21.2 per cent ), moving (22.8 per cent ), using the phone (24.2 per cent ), dressing the bottom of clothing (25.6 per cent ), shopping (30.5 per cent ), being able to keep their urinary continence (40.5 per cent ) and using means of transportation (43.8 per cent ). In both periods, men were reported to show greater proportions of disabilities, despite the fact that women accumulate more of them and that their difficulties grow as age progresses. Conclusions: Changes on the pattern of installation and an increase on the proportion of disabilities were found in the course of nearly a decade. The hierarchy scale allowed the determination of the levels of disability

Orientadores: Mary Angela Parpinelli, Rodolfo de Carvalho Pacagnella / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-11-09T13:12:49Z (GMT). No. of bitstreams: 1 Silveira_Carla_D.pdf: 15249519 bytes, checksum: e7a71ee5b4f10c300a70ac60a77915bf (MD5) Previous issue date: 2015 / Resumo: Introdução: A gravidez, parto e puerpério, com ou sem morbidades associadas, podem gerar consequências negativas sobre a saúde, a qualidade de vida e a funcionalidade das mulheres, a curto e a longo prazo. Pouco se sabe a respeito dessas consequências após as seis semanas de puerpério. A Organização Mundial de Saúde (OMS) criou um instrumento de avaliação de incapacidades (WHODAS 2.0) abrangendo as dimensões física, mental e social dos indivíduos, sendo expresso em seis domínios de vida: cognição, locomoção, autocuidado, relacionamento com as pessoas, atividades de vida, e participação. WHODAS 2.0 não estava adaptado e nem validado para o português do Brasil, e ainda não tinha sido utilizado em mulheres após uma gravidez e após episódio de morbidade materna grave (MMG). Objetivos: traduzir e adaptar o instrumento para o português do Brasil, realizar a análise de suas propriedades psicométricas em mulheres em idade reprodutiva, e a avaliação de seu desempenho em identificar as alterações de funcionalidade naquelas que tiveram algum episódio de MMG. Método: Realizou-se a adaptação transcultural a partir dos procedimentos de tradução do instrumento original para o português, seguida por retro tradução do português para o inglês. Constituiu-se então uma coorte de 638 mulheres que estiveram internadas durante o ciclo grávido-puerperal no Hospital da Mulher da Universidade Estadual de Campinas, no período de julho de 2008 a junho de 2012, e que responderam ao WHODAS 2.0. Foram estudadas variáveis sociodemográficas, obstétricas, neonatais e tempo transcorrido do evento de MMG. A consistência interna foi avaliada pelo ? de Cronbach, a estrutura por análise fatorial exploratória (EFA) e análise fatorial confirmatória (CFA), e as relações entre os domínios através do coeficiente de correlação de Pearson. Utilizando-se a mesma coorte de mulheres, divididas segundo o antecedente de MMG, analisaram-se as associações entre as médias e medianas dos escores do instrumento com as variáveis maternas e do recém-nascido. O teste de Mann-Whitney e a análise multivariada pelo modelo linear generalizado foram utilizados para os escores gerais e dos domínios específicos do instrumento. Resultados: Após o pré-teste, realizou-se adequação para o português mais coloquial e as versões mostraram-se semelhantes quanto ao significado geral e referencial. O ? de Cronbach foi superior a 0,79 para as mulheres que responderam 32 e 36 questões. As análises fatoriais, exploratória e confirmatória para 32 questões apresentaram, nos seis domínios, variância total de 54,7% (KMO 0,934 p<0.001) e de 53,47% (KMO 0.934 p< 0.001), respectivamente. O escore médio geral e dos domínios referentes a locomoção, atividades de vida e participação apresentaram aumento significativo nas mulheres com antecedente de MMG. Excluindo MMG, a paridade ? 2 foi a única variável associada com aumento do escore médio geral e para o domínio de relacionamento com as pessoas. Conclusões: o instrumento WHODAS 2.0, adaptado ao português do Brasil, mostrou-se de fácil aplicação e compreensão. Apresentou boas propriedades psicométricas, e identificou que a MMG e a maior paridade foram independentemente associadas com a redução da funcionalidade em mulheres após uma gravidez, e a longo prazo / Abstract: Introduction: Pregnancy, delivery and postpartum period, with or without associated morbidities, may generate negative consequences on the health, quality of life and functioning of women. Little is known on these consequences after six weeks of postpartum period. The World Health Organization Disability Assessment Schedule (WHODAS 2.0) was built to assess individuals in their physical, mental and social areas, expressed in six domains: cognition, mobility, self-care, relationships, getting along, life activities and social participation. WHODAS had not yet been adapted nor validated for the Brazilian Portuguese and was not yet used for women after a pregnancy and after an episode of severe maternal morbidity (SMM). Objectives: to translate and cross-culturally adapt the Brazilian Portuguese version of the instrument, to assess its psychometric properties and its performance among women in the reproductive period. Method: A cross-cultural adaptation was performed using procedures of translation of the original instrument into Portuguese, followed by a back translation into English. A cohort of 638 women who were admitted during pregnancy at the Women's Hospital of the University of Campinas from July 2008 to June 2012 was then settled and they answered the WHODAS 2.0. Socio demographic, obstetric and neonatal variables, plus the time elapsed from the SMM episode were reported. The internal consistency of the instrument was assessed with ? of Cronbach, its structure by exploratory factorial analysis (EFA) and confirmatory factorial analysis (CFA), and its content and the relationships among the domains were evaluated with the Pearson's correlation coefficient. Using the same cohort of women now split according to the past history of SMM, associations between means and medians of WHODAS scores with maternal, neonatal and the six domains variables were analyzed with Mann-Whitney test and multivariate analysis with generalized linear models. Results: After the pretest, an adequation to more colloquial Portuguese was performed in the instrument and this version showed to be similar regarding its general and referential meaning. The Cronbach' ? was higher than 0.79 for the 32 and 36 questions. The exploratory and confirmatory factorial analyses for the six domains, divided in seven factors showed a total variance of 54.7% (KMO 0.934 p<0.001) and of 53.47% (KMO 0.934 p< 0.001), respectively. The mean of WHODAS general score for the total sample and some domains showed significant increase for the group with morbidity. Except to the SMM, parity ? 2 was the only other significantly associated to higher scores. Conclusions: the WHODAS 2.0 instrument adapted to the Brazilian Portuguese showed to be easily applicable and understandable. It also showed to have good psychometric properties and identified that SMM and higher parity were independently associated with a long term functioning impairment among women after a pregnancy / Doutorado / Saúde Materna e Perinatal / Doutora em Ciências da Saúde

Objetivo: Caracterizar a adequação das ações do programa de controle da hanseníase no momento do pós-alta nos municípios de Sobral e Fortaleza, Ceará, no plano de políticas públicas, organização da rede de atenção à saúde, limitação funcional e de atividades e participação social das pessoas atingidas. Metodologia: Pesquisa transversal descritiva realizada no período de agosto de 2006 a setembro de 2007. Incluiu 304 residentes afetados pela hanseníase dos dois municípios uma amostra de 10% dos que receberam alta entre 2003 e 2005. Além da construção do cenário técnico-político do pós-alta, foram realizados nos participantes exame físico dermatoneurológico, avaliação simplificada das funções neurais, caracterização sociodemográfica, caracterização da limitação de atividade e consciência de risco e caracterização da restrição à participação social. Resultados: A população era em sua maioria masculina, parda, com baixas condições socioeconômicas e com profissões/ocupações que ampliavam a vulnerabilidade para incapacidades físicas. Aqueles com marcante progressão do grau de incapacidade física eram, em sua maioria, multibacilares (87% em Sobral; 62,6% em Fortaleza). O acesso à atenção pós-alta foi frágil em relação a intervenções como cirurgias e atenção psicológica. Os estados reacionais contemplaram em grande parte a busca e oferta de atenção neste período. Aproximadamente 30% das pessoas em acompanhamento pós-alta tiveram necessidade de encaminhamentos adicionais. Esse acompanhamento não seguiu parâmetros de referência. Existiu baixa percepção de risco dos participantes (escore 0: 60,1% em Fortaleza; 56,5% em Sobral); não houve relação definida entre escala SALSA e idade ou EHF. A maioria não apresentou nenhuma restrição significativa à participação; aqueles com restrição configuravam-se principalmente no plano relativo aos aspectos do trabalho. Do ponto de vista técnico-político foram observados importantes avanços no país nas questões do pós-alta. Conclusões: Foram identificadas lacunas em termos da operacionalização da atenção às pessoas atingidas no momento do pós-alta em ambos os municípios. A análise integrada e ampliada dessa pesquisa possibilitou a verificação da fragilidade das ações voltadas ao momento do pós-alta nos municípios estudados. A abordagem das pessoas atingidas pela hanseníase mantém-se como um importante desafio para o SUS. / Objective: To characterize the performance of actions of the Hansens Disease Control Programs in Sobral and Fortaleza municipalities, Ceará State, regarding health policy planning, organization of health care networks, activity and functional limitation and safety awareness, and social participation in affected people after release from treatment. Methods: Descriptive and cross-sectional study performed from August 2006 to September 2007. In total, 304 affected residents of both municipalities were included a sample of 10% of cases released from treatment between 2003 and 2005. Besides the analysis of technical and political scenarios, the following data were collected: dermatological and neurological examination, simplified assessment of neural deficits, socio-demographic characterization, assessment of activity limitation and safety awareness, and characterization of social participation. Results: The majority of the population was male, coloured, of low socio-economic status and performing jobs with increased vulnerability for development of physical disabilities. The majority of patients presenting with a high degree of physical disability were multibacillary (87%, Sobral; 62.6%, Fortaleza). The access to specific health care after release from treatment was limited, especially to surgeries and psychological care. Most cases attended were due to Hansens disease reactions. About 30% of people followed up after release from treatment needed additional evaluations by other specialists. Guidelines were not used when following up patients. There was a low risk perception of study participants (score 0: 60.1%, Fortaleza; 56.5%, Sobral) and no clear relation between SALSA scale and age or EHF score. Most participants did not present any significant participation restriction; if restrictions were present, work-related aspects were most frequently involved. Considering operational and political aspects, a progress was observed in these questions after release from treatment. Conclusions: Problems were identified related to application of health care after release from treatment. The present comprehensive and integrated analysis detected the fragility of measures focusing on Hansens disease patients after release from treatment in both municipalities. The assessment of these people continues to be an important challenge for Brazils Unified Health System.

This diploma thesis deals with monitoring the movement of the upper limbs in patients after acquired brain injury using an accelerometer. The diploma thesis is processed from the perspective of occupational therapy. The thesis is divided into the theoretical and practical part. The main objective of the theoretical part is to collect specialist literature about monitoring the movement of the upper limbs by accelerometer in rehabilitation, especially in the occupational therapy. The practical part of the thesis has three objectives. The first objective is to find out whether monitoring of the upper limbs using the accelerometer in patients after acquired brain injury will lead to an objective improvement of the activity of daily living (ADL) in the areas of eating, washing and dressing. The second objective is to find out whether monitoring of the upper limbs using the accelerometer in patients after acquired brain injury will lead to subjective improvement in the same ADLs, and the third objective is to compare whether objective and subjective improvement is related. The practical part was prepared in the form of pilot studies. Quantitative research was used, specifically the type of pre-experiment - One Group Pretest Posttest Design. The study included 14 patients after acquired brain injury. The...

This diploma thesis deals with monitoring the movement of the upper limbs in patients after acquired brain injury using an accelerometer. The diploma thesis is processed from the perspective of occupational therapy. The thesis is divided into the theoretical and practical part. The main objective of the theoretical part is to collect specialist literature about monitoring the movement of the upper limbs by accelerometer in rehabilitation, especially in the occupational therapy. The practical part of the thesis has three objectives. The first objective is to find out whether monitoring of the upper limbs using the accelerometer in patients after acquired brain injury will lead to an objective improvement of the activity of daily living (ADL) in the areas of eating, washing and dressing. The second objective is to find out whether monitoring of the upper limbs using the accelerometer in patients after acquired brain injury will lead to subjective improvement in the same ADLs, and the third objective is to compare whether objective and subjective improvement is related. The practical part was prepared in the form of pilot studies. Quantitative research was used, specifically the type of pre-experiment - One Group Pretest Posttest Design. The study included 14 patients after acquired brain injury. The...

The human vestibulo-ocular reflex (VOR) stabilizes gaze during head movement. The reflex is typically tested in a clinic or laboratory using passive rotations or artificial stimuli which measure the amount of damage the vestibular apparatus has suffered. However, during everyday activities the vestibular system is stimulated by active, self generated head movements. Head movements are often rapid and associated with the goal of achieving either gaze-fixation or re-fixation. Patients who complain of on-going symptoms will typically identify a particular position or movement that aggravates their symptoms in their everyday life. There is a need to identify objective parameters which correlate with the subjective complaints of patients whose symptoms persist after vestibular damage. In the first study, a gaze-refixation task, patients who complain of ongoing symptoms (poorly-compensated), during rapid head turns, after unilateral vestibular de-afferentation (uVD) were compared with those who did not have the same complaints (well-compensated) and normal subjects. Well- and poorly-compensated groups were sorted according to responses on a standardized questionnaire. All subjects were then located in a real-world, non-laboratory environment in which poorly-compensated subjects reported experiencing symptoms. Each subject’s head, eye and gaze displacement and velocity, head rotation frequency and blink or eye-lid closure were measured and analysed and compared between ipsi- and contra-lesional head rotations within and between subject groups. When subjects are able to generate their own active head rotations it has been suggested that a number of vestibular and extra-vestibular strategies might be employed to compensate for an impaired VOR. In subsequent studies, high resolution scleral search coils were used to identify the compensatory mechanisms used during active head rotations during a gaze-fixation task. A corrective saccade is typically observed during passive ipsilesional head rotations or “impulses” and might be potentiated during rapid, active or self-generated head rotations. The conditions which predict or contribute to the generation of the rapid, corrective eye movement were investigated. The results were compared with responses to passive head impulses of matched velocity and acceleration to determine if active head impulses could be used to identify a lesioned vestibular apparatus as is routinely clinically achieved with passive head impulses.

The number of old people is growing and will increase future demands on healthcare services for old people. Hip fracture is one of the diagnoses that increases with age and it has become a major problem, both for those suffering a fracture and for society due to the large numbers involved, the morbidity with complications such as falls, functional decline, and the high mortality rate among those affected. The main purposes of this thesis were, to study the impact of previous hip fractures on their life among the very old, to study in-patient falls, fall-related injuries and fall-risk factors, and to evaluate a multidisciplinary, multi-factorial intervention program designed to reduce in-patient falls and to enhance functional performance among old people who have sustained a femoral neck fracture. The impact of a hip fracture was examined in a cross-sectional population-based study, among the very old (Umeå 85+). After adjustment for potential covariates, participants with a history of hip fracture were found to be more dependent in the performance of Personal/Primary Activities of Daily Living (P-ADL) (p=0.024), walked less independently (p=0.040) and used a wheelchair more frequently (p=0.017). Most of the participants with earlier hip fractures who had moved to institutional care or begun using mobility aids, as compared to before the fracture, had started to do so permanently in connection with the fracture incident. In-patient falls, fall-related injuries and fall-risk factors were studied in 97 participants, aged 70 or more, treated for a femoral neck fracture. There were 60 postoperative falls occurring among 26/97 participants (27%). Thirty-two percent of the falls resulted in injuries, 25 % were minor, and 7 % were serious. Delirium after day seven, (Hazard Rate Ratio (HRR) with a 95% Confidence Interval (CI)), 4.62 (1.30-16.37), male sex 3.92 (1.58-9.73), and sleeping disturbances 3.49 (1.24-9.86), were associated with in-patient falls. Forty-five percent of the participants were delirious on the day they fell. The effects of a multidisciplinary, multi-factorial intervention program on in-hospital falls and injuries as well as the short- and long-term effects on living conditions, walking ability and performance of activities of daily living were evaluated in a randomised controlled trial among 199 participants with femoral neck fracture, aged ≥70 years. Participants were randomised to care in a geriatric ward (intervention, n=102) or to conventional postoperative routines (control, n=97). The intervention consisted of staff education, individualized care planning and rehabilitation, systematic assessment and treatment of fall-risk factors, active prevention, and detection and treatment of postoperative complications and an intervention follow up at four-months. The staff worked in teams to apply comprehensive geriatric assessment, management and rehabilitation. Twelve participants fell a total 18 times in the intervention group compared to 26 participants suffering a total 60 falls in the control group. Only one participant with dementia fell in the intervention group compared to 11 participants with dementia in the control group. The fall incidence rate was 6.29/1000 days vs. 16.28/1000 for the intervention and control groups respectively. The Incidence Rate Ratio (IRR) was 0.38 (95% CI: 0.20-0.76, p=0.006) for the total sample and 0.07 (95% CI: 0.01-0.57, p=0.013) among participants with dementia. No new fractures were incurred in the intervention group but there were four in the control group. In addition, despite shorter hospitalization, significantly more people from the intervention group had regained independence in P-ADL performance at the four- and twelve-month follow ups, Odds Ratios (OR), with 95% CI, were 2.51 (1.00-6.30) and 3.49 (1.31-9.23) respectively. More participants in the intervention group had also regained the ability to walk independently without walking aids indoors, at the end of the study period, 3.01 (1.18-7.61). In conclusion, hip fracture among the very old seems to be associated with poorer P-ADL performance and poorer mobility. Falls and injuries are common during in-patient rehabilitation after a femoral neck fracture, delirium and sleep disturbances and male gender are factors associated with in-patient falls. Having a team apply comprehensive geriatric assessments and rehabilitation, including the prevention, detection and treatment of fall-risk factors, can successfully prevent in-patient falls and fall-related injuries, even among participants with dementia, and can also enhance the performance of Activities of Daily Living (ADL) and mobility after a hip fracture, in both short- and long-term perspectives.

Rehabilitation after brain injury is often a process which is spread over several years and runs through different phases. After sub acute in-patient rehabilitation a community based post-acute rehabilitation can follow. In this late phase after injury the rehabilitation focuses on reintegration into the community through a return to work and participation in other occupations in society. The overall aim of this dissertation was to study the long-term outcome of brain injury, with a special emphasis on the return to everyday domestic and productive occupations and the connection these have to life satisfaction as a whole. The aim was also to describe and understand the lived experience of the consequences of brain injury in these areas. This dissertation comprises four studies on different aspects of the long-term outcome of those who have had a brain injury. In a sample of 56 people, the value of occupational therapy assessments as predictors of an eventual return to work was investigated. In a longitudinal follow-up study, the life satisfaction of the participants (n 36) was reported and its correlation to a return to work was evaluated. Interviews were conducted (n 10) to explore the main characteristics of the meaning of work after brain injury in ten respondents. And, finally, in the fourth study, 157 people reported their participation in community activities. The extent of the correspondence between the level of participation and life satisfaction was calculated. The findings showed that occupational therapy assessments were useful in predicting a return to work in the late phase of the recovery after brain injury. A combination of assessments on the level of body function with assessments on activity level appeared to comprise the best predictive model. In two different studies the reported life satisfaction was found to be significantly lower than the level of life satisfaction in a sample of healthy Swedes for almost all domains. When comparing life satisfaction at two points in time with an interval of three years between them in the longitudinal study, no significant improvement was found. There was no difference reported by the participants for their overall life satisfaction regardless of whether they were back at work or in education, or not. On the other hand, participation in daily occupations in a wider perspective was found to have a positive impact on satisfaction with life as a whole. However, half or more than half of the participants claimed that their participation was restricted except for the items self-care and mobility, where a higher degree of participation was reported. The meaning of work after the brain injury had changed: Work had taken on a new place in life and the importance of work had decreased. In contrast, the social dimension of work had expanded in importance. After the brain injury, the perception of the participants’ own competence and work identity had changed and the respondents described their striving to return to normality. To conclude, brain injury has a lasting effect on a person’s life, even many years after the injury; consequently there is need for rehabilitation in this late phase. Life satisfaction, which is often used as an overriding goal for rehabilitation, did not improve over time. This finding raises the question of whether life satisfaction is too broad a concept and/or insufficiently sensitive to improvements. There is need for further research in this area to clarify the factors that have an impact on life satisfaction.

This study investigated a series of independent unassisted and device-assisted transfers from a wheelchair to vehicle mock-up and vice versa while simultaneously capturing kinematic, kinetic and electromyographic (EMG) data of impaired volunteers. The study provides a venue for observation and evaluation of upper extremity (UE) joint stresses, muscular force and functional demands associated with transfers in persons with spinal cord injury (SCI) to ultimately prevent UE injury, minimize excessive stress, preserve functionality and limit pain. If people with SCI lose function of their UEs, due to pain and/or degeneration, they must then rely on others for everyday tasks. Five paraplegic males from the Tampa Bay area were recruited to take part in the study. Participants were asked to perform a series of transfers using 4 commercially available devices or mock-ups of that device as well as an unassisted transfer, which permitted the use of no assistive device. Three data types were captured: kinematic data using motion capture, kinetic data using force transducers which were integrated into the vehicle mock-up and EMG of 5 bilateral muscle groups. Data collection took approximately 4 hours per subject. Forces occurring during the unassisted transfers were found to be the highest. This is also supported by the EMG data. Performing level transfers lessened stresses at the UE versus non-level transfers. The highest moments of the UEs were found at the shoulders with high variability between subjects. It was also found that body mass index (BMI) had an affect on a subjects ability to perform transfers. Ultimately this study found that using an assistive device is better than not using an assistive device. This is proven by EMG and force data, which were both found to be less with the use of an assistive device as opposed to transferring independently with no assistance. Performing level transfers, maintaining ones body mass and staying active are all factors that will limit stresses at the UEs during wheelchair transfers to and from a vehicle.

Introduction Occupational therapists are concerned with enabling people to perform the daily life tasks they need, want, or are expected to perform for fullest possible integration into community living and participation in society. Children with mild disabilities have problems performing personal and instrumental activities of daily living (ADL) tasks at home or school, and that can limit their full integration and participation in their homes and school lives. There is a need, therefore, to identify their specific problems with ADL task performance so as to be able to develop effective interventions. Not only, there is a need for evidence related to effectiveness of occupational therapy interventions for children with mild disabilities, but also a need for valid occupational-therapy-specific evaluation tools for use with children. Purpose The purpose of this thesis was to contribute evidence to support the valid use of the Assessment of Motor and Process Skills (AMPS) with children, including children living in Middle Europe. More specifically, I aimed to evaluate validity evidence from different sources related to the use of the AMPS in occupation-based and occupation-focused evaluation and intervention. Method This thesis consisted of four studies, implemented in two phases. Phase one focused on evaluation of a) validity evidence of the AMPS scales in relation to internal structure and stability of item difficulty calibration values for a Middle European sample compared to samples from other world regions (Study I); b) the stability of the mean AMPS measures between typically-developing children from Middle Europe and from other world regions (Study II); and c) the sensitivity of the AMPS measures to discriminate between typically-developing children and children with and at risk for mild disabilities (Study III). Participants for phase one were from both Middle Europe and from other world regions and they were selected from the AMPS database, Ft. Collins, Colorado, USA. Data were analyzed using many-facet Rasch analyses, ANOVAs, regression analyses, related post-hoc tests, and effect size calculations. Phase two of the research project focused on evaluating validity evidence for the use of the AMPS as a standardized, occupation-based, and occupation-focused evaluation tool in the context of a feasibility study with children with mild disabilities implemented in a Swiss setting (Study IV). Data were analyzed based on feasibility objectives and the principles of deductive content analysis. The evaluation of validity evidence of the AMPS in relation to consequences of testing and test fairness was a focus of all studies (Studies I to IV). Results In Study I, data for 1346 participants from Middle Europe and 144,143 participants from other world regions were analyzed. The participants were between the ages of 3 and 103 years, and they were well or had a variety of diagnoses. The results revealed that overall the item difficulty calibration values of the AMPS remained stable and that only one out of 36 ADL items of the AMPS demonstrated DIF, but this DIF did not lead to DTF (i.e., all measures fell within 95% confidence bands). In Study II, data for 11,189 typically-developing children from Middle Europe and other world regions who were between the ages of 2 and 15 were analyzed. The results of ANOVAs revealed significant effects for mean ADL motor and for ADL process ability measures by region and a significant age by region interaction effect for mean ADL process ability. Out of 168 estimated contrasts between Middle Europe and the other world regions for mean ADL motor and ADL process ability, only seven were statistically significant (4.17%), and only two were more than ±1 SE from the international means. In Study III, regression analyses of data for 10,998 children, 4 to 15 years, who were typically-developing or with mild disabilities, revealed significant age by group interaction effects. Post hoc t tests revealed significant group differences in ADL ability at all ages beyond the age of 4. ADL process ability effect sizes were moderate to large at all ages and ADL motor ability effect sizes were mostly moderate to large age 6 and above. In Study IV, the use of the AMPS within the context of a feasibility study based on data of 17 Swiss children with mild disabilities was evaluated. The analyses revealed several strengths and problems that were related to the time, equipment, and materials for administering the AMPS, the adherence to standardized administration procedures, the scope of the AMPS as a test of ADL performance, and the reliable rating by the blinded rater. Conclusion This thesis provided evidence to support the validity of the AMPS measures and scales when used to evaluate quality of ADL task performance of persons from Middle Europe. Additionally, this thesis provided evidence that the international age-normative means of the AMPS are likely applicable to children from Middle Europe. Moreover, the findings supported the sensitivity of the AMPS measures to discriminate between typically-developing children and children with and at risk for mild disabilities. When it comes to implementation of the AMPS in the context of a feasibility study, the findings indicated both strengths and problems in using the AMPS as an outcome measure that need to be considered when planning further studies.