6 Abstract The rehabilitation of patients with brain damage is an interprofessional, complex, intensive, long-lasting and individually oriented process. One frequent consequence of brain damage is hemiparesis, which also causes a disorder of the upper extremity movement pattern. The movement ability of the upper extremity is essential for an individual's self-sufficiency, the performance of common daily activities, and thus for an independent life in a family setting. Special therapeutic rehabilitation approaches should involve the training of new activities, including the motor learning mechanism that activates brain plasticity. A functional reorganization of the motor cortex occurs along with the activation of reserve neurons and the replacement of damaged synapses. One of the aims of this work was to demonstrate, using objective function methods, the possibility of influencing the movement patterns of a paretic upper extremity by means of intensive interprofessional rehabilitation even several years after the brain damage. The second aim was to demonstrate that the monitoring of motor functions in patients after brain damage leads to improved motivation, thereby improving motor functions. A study was conducted among 55 selected patients after brain damage with central hemiparesis who participated in the...

Rehabilitation of patients after brain damage is an multidisciplinary, complex, intensive, long- term and individual process. Standardized functional instruments for the assessment of the degree of disability and functional abilities of patients are not usually used in rehabilitation in the Czech Republic. Often, motor disorder post brain damage results in hemiparesis and causes impairment of upper arm movement pattern. Movement ability of the upper arm is vital for self-sufficiency, activities of daily life and maintaining an independent family life. Special rehabilitation therapeutic techniques must involve the training of new activities including the mechanism of motor learning which is responsible for functional reorganization of the motor cortex regions, and the activation of reserve neurons for reparation. The aim of the study is to demonstrate that an accelerometer is a suitable instrumet for objective monitoring of impairment of the upper arm movement pattern. Another aim of the study is to demostrate if the FIM test (Functional Independence Measures) and Jebsen-Taylor (JT) test are appropriate instruments for detecting changes of the upper arm movement pattern after intensive, individual and multidisciplinary rehabilitation brain damage patients. Clinical study was undertaken with selected...

The overall aim of this thesis was to examine the relationship between self-efficacy, individually tailored vocational rehabilitation and transition to work or studies. Study I was a cross-sectional study based on questionnaire- and registry data, investigating whether factors related to sick leave predict self-efficacy in women on long-term sick leave (n= 337) due to pain and/or mental illness. General self-efficacy was low. Anxiety and depression were the strongest predictors for low self-efficacy. Study II used longitudinal data from a randomised controlled trial, comprising partly the same women (n=401) as in Study I. Participants were allocated to either 1) assessment of multidisciplinary team and multimodal intervention (TEAM), 2) acceptance and commitment therapy (ACT), or 3) control group. Self-efficacy increased in the TEAM group in comparison with the control group. Study III had a descriptive qualitative design with individual interviews, studying participants’ (n=14) experiences with an individually tailored vocational rehabilitation project, and encounters with professionals working in it. The participants, who were on long-term sick leave due to mental illness or pain reported overall positive experiences with the project. The project was based on collaboration between authorities and motivational interviewing. The positive experiences were based on four categories: Opportunities for receiving various dimensions of support, Good overall treatment by the professionals, Satisfaction with the working methods of the project, and Opportunities for personal development. Study IV was a prospective cohort study investigating perceived self-efficacy in unemployed young adults (n= 249) aged 19-29 year with disabilities, and the association between self-efficacy and transition to work or studies. The study used questionnaire- and registry data from a vocational rehabilitation project. Higher levels of self-efficacy were associated with increased odds for ‘transition to work’. General self-efficacy was low, and young adults with lower self-efficacy reported worse self-rated health compared with those with higher self-efficacy. This thesis showed that multidisciplinary assessment with a multimodal intervention had positive effects on self-efficacy. Individually tailored vocational rehabilitation, based on cooperation and motivational interviewing, may be beneficial for individuals on long-term sick leave and the interactions between participants and the professionals may affect participants’ self-efficacy positively. Mental health needs to be considered when targeting self-efficacy in vocational rehabilitation. Furthermore, research is needed to a) clarify which components in the multidisciplinary team intervention can increase self-efficacy, b) study the effects of vocational rehabilitation based on an individual design, cooperation and motivational interviewing on self-efficacy, health and transition to work, and c) develop interventions that can increase self-efficacy and support transition to work/ studies in young adults with disabilities.