Syfte: Syftet med denna studie var att beskriva arbetsterapeuters erfarenheter av lek som aktivitet tillsammans med barn med flerfunktionsnedsättning. Metod: Studien genomfördes som en kvalitativ intervjustudie med semistrukturerade intervjuer. Det var nio arbetsterapeuter som intervjuades via Zoom eller Teams. Vid analysen av intervjuerna användes kvalitativ innehållsanalys. Resultat: Lek var huvudaktiviteten för barn enligt arbetsterapeuterna. De beskrev leken som komplex, och barn med flerfunktionsnedsättning stod inför större utmaningar än andra barn att uppnå en delaktighet och samspel i lek. Hindren som beskrevs var skillnader i utvecklingsnivå, förmåga att kommunicera eller omgivande fysiska och sociala aspekter. Arbetsterapeutens roll för barnets lek beskrevs olika. En del såg leken som en aktivitet som var avgörande för barnets livskvalitet och att leken borde utgå ifrån vad barnet tyckte var kul, andra såg leken som en aktivitet som främst specialpedagogen hade som ansvarsområde eller som ett sätt att uppnå ett mål i träningen eller i en intervention. Vuxna beskrevs vara en viktig möjliggörare för leken men det fanns även en risk att den vuxne kunde bli som en barriär mellan barnet och jämnåriga. Därmed blev barnet ofta en iakttagare i lek istället för delaktig. Kulturella skillnader kunde påverka synen på lek, och ekonomiska skillnader kunde försvåra för föräldrar att införskaffa leksaker. Föräldrar kunde därav behöva stöd att prioritera sin tid och energi, och för att hitta lämpliga leksaker. Slutsats: Studien visade att vuxna var essentiella för att inkludera barn med flerfunktionsnedsättning i lek, och otillräckligt stöd kunde resultera i isolering och psykisk ohälsa. Författarna menar att studien skulle ge kunskap om hur arbetsterapeuter arbetade med lek för barn med flerfunktionsnedsättning och även ge inspiration till att arbeta med leken som en egen och avgörande aktivitet för dessa barn. Studien lyfte fram behovet av mer forskning om lekens roll och samhällets ansvar för att främja barnens välmående och delaktighet. / Aim: The aim of this study was to describe occupational therapists experiences of play as an activity together with children with multiple disabilities. Method: The study was conducted as a qualitative interview study with semi-structured interviews. It was nine occupational therapists who were interviewed through Zoom or Teams. In the analysis of the interviews a qualitative content analysis was used. Result: Play was the main activity for children according to occupational therapists. They described play as complex, and children with multiple disabilities faced greater challenges than other children in achieving participation and interaction in play. The obstacles described included differences in developmental level, ability to communicate or surrounding physical and social aspects. The role of the occupational therapist in the child’s play was described differently. Some saw play as an activity that was crucial for the child’s quality of life and believed that play should proceed from what the child found enjoyable, while others saw play as an activity primarily under the responsibility of the special educator or as a means to achieve a goal in training or intervention. Adults were described as important facilitators for play, but there was also a risk that the adult could become a barrier between the child and peers. Resulting in the child being an observer in play rather than a participant. Cultural differences could influence the view of play, and economic differences could make it difficult for parents to acquire toys. Therefore parents might have the need for support in prioritizing their time and energy, and in finding suitable toys. Conclusion: The study showed that adults were essential for including children with multiple disabilities in play, and insufficient support could result in isolation and mental health issues. The authors hoped that the study would provide knowledge about how occupational therapists worked with play for children with multiple disabilities and also inspire work with play as an independent and crucial activity for these children. The study highlighted the need for more research on the role of play and society’s responsibility to promote the well-being and participation of children.

This diploma thesis deals with a view to the special pedagogical diagnostic issue accordance to the children with multiple disabilities. By these children whose disability is mostly the hardest character is making special pedagogical diagnostic as much as correct and accurate very difficult. This diagnostic is very important for developing an individual plan of a special pedagogical intervention. The work is focused on both the individual areas of special pedagogical diagnostic and the complex diagnostic tools. In these areas are mentioned the methods and the materials of a foreign literature which is possible to use with a group of children with multiple disabilities. In the second part of the thesis are developed the results of a survey which brings a practical look to this issue. All these collected knowledge and experience should have become the benefit which should have been a starting point for searching other partial methods. These methods are dealing, for now, with still newly making issue of special pedagogical diagnostics of children with multiple disabilities.

This thesis is focused on the play in children with multiple disabilities. The aim is to summarize theoretical bases and current findings in this topic, to help extend this findings and to highlight the importace of play for children with multiple disabilities. In the context of the theory, findings of research and methodologically oriented publications is a play in children with multiple disabilities explored through the case study, which involve the analysis of play four preschool children with multiple disabilities in children's daily rehabilitation care. The thesis attention to the specifics of play in children with multiple disabilities, how is development of play in these children is and what factors influence the development. This thesis provides information that can be used in practice for workers with children with multiple disabilities. Powered by TCPDF (www.tcpdf.org)

Introduction: The arrival of a child with multiple disabilities (MD) in a family is a difficult situation. Increased stress of parents of (MD) is often related to the non-fulfillment of the needs, leads to frustration and deprivation that can result in serious health problems. The aim is the subjectively defined and described life with a child (MD), focusing on the needs of these parents resulting from the daily care of the child. Aim: Identify, describe and analyze the needs of parents of children with MD at an early age. Methods: Qualitative approach using the biographical narrative method. The research design is a case study. Methodological triangulation: three methods of collecting data: biographical curve, in-depth interview, Cantril's ladder. Results: all cases were compared with each other. 12 parents' needs were identified. The Cantril's ladder method found significantly unmet needs: Need for rest and Need for medical care. Conclusion: The main contribution of the work is to understand the individuality and needs of parents of children with multiple disabilities, as a possibility to provide purposefully individualized early intervention, to streamline the process of planning, implementation and evaluation of provided care and thus contribute to the quality of life of the whole family.

Syfte Studiens syfte är att undersöka hur samspel och kommunikation med personer med flerfunktionsnedsättning, deras assistenter och vattendansledare under vattendans kan analyseras med multimodal interaktionsanalys, för att genom tolkning av kommunikativa uttryck identifiera upplevelse av interventionen. Ytterligare ett syfte med studien är att identifiera vilka styrkor och svagheter analysmetoden har vid studier av interaktion mellan personer med flerfunktionsnedsättning och deras assistenter. Metod I studien videoinspelades och analyserades interaktion mellan personer med flerfunktionsnedsättning, deras medföljare samt personal som höll i vattendansen. Den metod som användes var multimodal interaktionsanalys, som är en metod där man analyserar interaktion i naturligt förekommande situationer. Analysen utfördes genom observation och transkription av videoinspelad interaktion. Resultat Ett flertal uttryck identifierades med multimodal interaktionsanalys. Dessa uttryck kunde säga något om upplevelsen hos personerna med flerfunktionsnedsättning under vattendansen. De kommunikativa uttrycken analyserades alltid i den kontext där de förekom. Uttrycken betraktades som kontextberoende och inte som isolerade handlingar. De modaliteter som personerna med flerfunktionsnedsättning använde för att kommunicera var bland annat blickar, vokalisationer och ansiktsmimik. Dessa uttryck studerades i termer av vilken mening eller sinnesstämning de tycktes förmedla, hur frekvent de förekom, samt vilken respons de väckte. Tolkning av uttrycken gjordes till stor del genom att studera omgivningens respons. Under arbetets gång identifieras styrkor såväl som svagheter med analysmetoden. Att analysera materialet med någon annan metod än just multimodal interaktionsanalys hade varit svårt, eftersom det i dagsläget finns mycket få alternativa sätt att analysera och transkribera den här typen av komplex interaktion på. Slutsats Genom multimodal interaktionsanalys kunde en varierad bredd av olika kommunikativa uttryck identifieras och tolkas, och författarna fick därmed en bild av hur personerna med flerfunktionsnedsättning och deras medföljare upplevde interventionsmetoden. Överlag förefaller upplevelsen av vattendansen vara positiv för personerna med flerfunktionsnedsättning såväl som för deras medföljare. Multimodal interaktionsanalys lämpade sig väl som analysmetod för att identifiera tecken som kan säga något om personernas med flerfunktionsnedsättnings upplevelse av vattendansen. / Aim The aim of this study is to investigate whether interaction between people with multiple disabilities, their assistants and waterdance staff during waterdance can be analysed using multimodal interaction analysis, in order to identify how the people with multiple disabilities experience the intervention. Identification of experience is conducted by recognizing and interpreting communicative actions. Another aim is to identify strengths and weaknesses of the method of analysis in the study of interaction between people with multiple functional impairments and their assistants. Method Interaction between three people with multiple disabilities, their assistants and waterdance staff was video recorded and then analysed. The method used is multimodal interaction analysis, which is a method for analysing naturally occurring interaction. The analysis was performed through observation and transcription of video-recorded interaction. Results Several communicative expressions were identified with multimodal interaction analysis. These expressions could say something about the people with multiple disabilities’ experience of the waterdance. The communicative actions and expressions were analysed in the context in which they occurred. The expressions were regarded as contextually dependent, and not as isolated, independent actions. Modalities that were used for communication were among others: gaze, vocalizations and facial expressions. These communicative actions were studied regarding what meaning or mood they seemed to convey, the frequency with which they occurred in, and in what response they evoked. Interpretation of the expressions was largely conducted by studying the response from people in the environment. Strengths as well as weaknesses were identified regarding the method of analysis. To analyse the material with a method other than multimodal interaction analysis would have been difficult, since other options of methods for analysing and transcribing this complex type of interaction are very limited. Conclusions A variety of communicative expressions were identified through multimodal interaction analysis. Through interpretation of the expressions, the authors were able to better understand how the people with multiple disabilities and their assistants experienced the intervention method. Multimodal interaction analysis is well suited as an analytical method for identifying signs that may tell us something about the experience of waterdance, of the three persons with multiple disabilities.

This master's thesis is focused on the Snoezelen concept used for patients with physical or multiple disabilities. The Snoezelen concept can be applied as a therapy, an auxiliary educational method or possibility to spend free time in various facilities like schools, school facilities, rehabilitation centers or retirement homes. For that reason, Snoezelen concept can be used by many clients and professionals. However, it is mostly used for patients with mental deficiency; that is reflected in the majority of researches. Therefore, patients with physical and combined deficiency were chosen for purpose of this Master's thesis as this issue has not been yet examined enough. The Master's thesis aim is to gather relevant information of the Snoezelen concept and to make quantitative research with a questionnaire that determines rate of using the concept, awareness level and attitude of clients with physical and multiple disabilities, their representatives and professionals. From these data, a summary is created for that issue. A very low awareness level was found in clients with physical and multiple disabilities, their representatives and professionals. Therefore an information leaflet was created and is provided at the end of the Master's thesis. Powered by TCPDF (www.tcpdf.org)

To achieve the United Nations Sustainable Development Goal 11.7 aiming to create inclusiveand accessible greenspaces, there is need to involve children with profound intellectual andmultiple disabilities in research and planning practices. The aim of this study is to explore whatexperiences of accessibility children with profound intellectual and multiple disabilities haveof greenspace. Through the qualitative method of go along interviews using augmentative andalternative communication, such as pictures and sign language, children provide their opinionsabout the public park Långbroparken in southern Stockholm, Sweden. Their experiences areanalysed through the framework of environmental justice, exploring fair distribution,recognition, capabilities and functioning. The findings demonstrate that children with profoundintellectual and multiple disabilities can indeed be included in research practices throughadapted interview situations. Either the researcher needs to be skilled and experienced inalternative and augmentative communication, and preferably have previous relations with thechildren, or be able to cooperate with someone who has such abilities and connections.Individual experiences of physical and social accessibility in the park create feelings of bothoutsideness and immersing oneself into nature and highlight the interaction of person andenvironment. In conclusion, children with profound intellectual and multiple disabilities holdvaluable explanations and experiences of what constitutes inclusive and accessible greenspacesand their perspectives are required to fulfil targets such as the United Nations SustainableDevelopment Goal 11.7.

This research analyzed all available hearings from 2013 to 2015 in a national database of due process hearings regarding placement issues and determinations of the least restrictive environment for individual students with significant disabilities. The main research question was whether parents/guardians and due process hearing officers sought placements for these children with significant disabilities that considered creatively and holistically a range of options rather than just a dialogue between already extant possible programmatic offerings. The research resulted in a description and taxonomy of the types of issues and factors arising in the hearings for students with significant disabilities from 2013 to 2015. This research shows almost no evidence of creative or holistic thinking in these due process decisions, and there was little evidence of parent advocacy for general education classes and creative options for their students with significant disabilities beyond existing offerings. The most unique placements to be found in public school settings for these students were in general education classes. Twenty-four students in this analysis were offered general education classes with their typically achieving peers. In general, though, for this unique group of students with significant disabilities, very few due process hearings could be found to have demonstrated creativity, or the consideration of holistic options, for such students. In general, in due process hearings for students with significant disabilities from 2013 to 2015, parents were overwhelming advocating for, and due process hearing officers were deciding among, options on the continuum of placements already traditionally considered for students with significant disabilities.

The thesis deals with problems of burnout among special educators working in special primary schools with students with multiple disabilities. There are defined basic concepts in the theoretical part of the work - burn-out syndrome, its symptoms, causes and stages of development. Separate chapters are devoted to the diagnosis of burn-out syndrome and prevention. Furthermore, the concept of a special educator and a multiple disability is explained in the theoretical section and a special primary school is described here. The practical part focuses on quantitative research into burn-out syndrome in two selected groups - special educators in special primary schools and teachers in ordinary primary schools. The results of the investigation are then compared with each other.

A multi component training package (live training, video modeling, role playing, and feedback) was used to train teachers to assess and instruct students with profound multiple disabilities. Phase 1 of the study included training seven in-service teachers to conduct assessment in three areas: (a) preference assessment (i.e., potential reinforcing items), (b) controlled body movement assessment (i.e., gross and fin motor skills), and (c) access skill assessment (i.e., assessment of basic skills or prerequisite skills that are necessary for student to master before entering into further instruction). The assessment result yielded the following information for each student participant: (a) a list of three to four preferred items, (b) a list of body movements in which the study reliably uses to respond, and (c) a list of access skills that are mastered and not mastered. Four teacher/student pairs from Phase 1 participated in Phase 2, which consisted of using the multi component training package (same components as Phase 1) to train teachers to instruct students on non mastered access skills. Teachers were trained to use one of the following instructional strategies to teach non mastered access skills: least-to-most prompting, most-to-least prompting, time delay, or graduate guidance. A multiple baseline design across four teacher participants was used to determine if the instructional training was effective in increasing the percentage of correctly implemented instructional steps. Data from Phase 1 suggested that the multi component training package was effective in increasing teachers' skills in assessing students with profound multiple disabilities, as the percentage of correctly implemented assessment steps increased for all seven teacher participants from pre training to post training. Additionally, data from Phase 2 indicated that the training was effective in increasing the percentage of correctly implemented instructional steps from baseline to post training sessions, across multiple access skills. Data from student participants showed that overall, students were responsive to teachers' instruction, as the percentage of independently performed student responses also increased from baseline to post training sessions.