| 1. |
- Magnusson, Lina
(författare)
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Prosthetic and Orthotic Services in Developing Countries
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim of this thesis was to generate further knowledge about prosthetic and orthotic services in developing countries. In particular, the thesis focused on patient mobility and satisfaction with prosthetic and orthotic devices, satisfaction with service delivery, and the views of staff regarding clinical practice and education.Methods: Questionnaires, including QUEST 2.0, were used to collect self-reported data from 83 patients in Malawi and 139 patients in Sierra Leone. In addition, 15 prosthetic/orthotic technicians in Sierra Leone and 15 prosthetists/orthotists in Pakistan were interviewed.Results: The majority of patients used their prosthetic or orthotic devices (90% in Malawi, and 86% in Sierra Leone), but half of the assistive devices in use needed repair. Approximately one third of patients reported pain when using their assistive device (40% in Malawi and 34% in Sierra Leone). Patients had difficulties, or could not walk at all, with their prosthetic and/or orthotic device in the following situations; uneven ground (41% in Malawi and 65% in Sierra Leone), up and down hills (78% in Malawi and 75% in Sierra Leone), on stairs (60% in Malawi and 66% in Sierra Leone). Patients were quite satisfied or very satisfied with their assistive device (mean 3.9 in Malawi and 3.7 in Sierra Leone out of 5) and the services provided (mean 4.4 in Malawi and 3.7 in Sierra Leone out of 5), (p<0.001), but reported many problems (418 comments made in Malawi and 886 in Sierra Leone). About half of the patients did not, or sometimes did not, have the ability to access services (71% in Malawi and 40% in Sierra Leone). In relation to mobility and service delivery, orthotic patients and patients using above-knee assistive devices in Malawi and Sierra Leone had the poorest results. In Sierra Leone, women had poorer results than men. The general condition of devices and the ability to walk on uneven ground and on stairs were associated with both satisfaction of assistive devices and service received. Professionals’ views of service delivery and related education resulted in four themes common to Sierra Leone and Pakistan: 1) Low awareness and prioritising of prosthetic and orthotic services; 2) Difficulty managing specific pathological conditions and problems with materials; 3) The need for further education and desire for professional development; 4) Desire for improvements in prosthetic and orthotic education. A further two themes were unique to Sierra Leone; 1) People with disabilities have low social status; 2) Limited access to prosthetic and orthotic services.Conclusion: High levels of satisfaction and mobility while using assistive devices were reported in Malawi and Sierra Leone, although patients experienced pain and difficulties when walking on challenging surfaces. Limitations to the effectiveness of assistive devices, poor comfort, and limited access to follow-up services and repairs were issues that needed to be addressed. Educating prosthetic and orthotic staff to a higher level was considered necessary in Sierra Leone. In Pakistan, prosthetic and orthotic education could be improved by modifying programme content, improving teachers’ knowledge, improving access to information, and addressing issues of gender equality.
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| 2. |
- Falkmer, Marita
(författare)
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From Eye to Us : Prerequisites for and levels of participation in mainstream school of persons with Autism Spectrum Conditions
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Children with Autism Spectrum Conditions (ASC) are included and thus expected to participate in mainstream schools. However, ASC are characterized by poor communication and difficulties in understanding social information; factors likely to have negative influences on participation. Hence, this thesis studied body functions hypothesized to affect social interaction and both perceived and observed participation of students with ASC in mainstream schools.Case-control studies were conducted to explore visual strategies used for face identification and required for recognition of facially expressed emotions in adults with ASC. Consistency of these visual strategies was tested in static and interactive dynamic conditions. A systematic review of the literature explored parents’ perceptions of factors contributing to inclusive school settings for their children with ASC. Questionnaires were used to investigate perceived participation in students with ASC and their classmates. Correlations between activities the students wanted to do and reported to participate in were identified. Teachers’ accuracy in rating their students with ASCs’ perception of participation was investigated. Furthermore, correlations between the accuracy of teachers’ ratings and the teachers’ self-reported professional experience, support and personal interest were examined. Correlations between teachers’ ratings and their reported classroom actions were also analysed. The frequency and level of engagement in social interactions of students with ASC and their classmates were also observed. Correlations between observed frequencies and self-rated levels of social interactions were explored.The International Classification of Functioning, Disability and Health-Version for Children and Youth (ICF-CY) has been used as a structural framework, since ICF-CY enables complex information to be ordered and possible interactions between aspects in different components and factors to be identified. In regard to Body Functioning, difficulties identifying faces and recognizing basic facially expressed emotions in adults with ASC were established. The visual strategies displayed a high stability across stimuli conditions. Teachers’ knowledge about their students with ASC, in addition to their ability to implement ASCspecific teaching strategies, was emphasized as enhancing Environmental Factors for participation. Students with ASC reported less participation and fewer social interactions than their classmates, which could be interpreted as activity limitations and participation restrictions. However, in regard to some activities, they may have participated to the extent they wanted to. Compared with classmates, observations of students with ASC showed that they participated less frequently in social interactions, but were not less involved when they actually did. No correlations were found between perceived participation and observed social interactions in students with ASC.Teachers rated their students with ASCs’ perceived participation with good precision. Their understanding of the students with ASCs’ perception correlated with activities to improve the attitudes of classmates and adaptation of tasks. No such correlations were found in regard to reported activities aimed at enhancing social relations.The ability to process faces is usually well established in adults. Poor face processing can impact social functioning and the difficulties in face processing found in adults with ASC are probably the result ofdevelopmental deviations during childhood. Therefore, monitoring and assessing face processing abilities in students with ASC is important, in order to tailor interventions that aim to enhance participation in the social environment of mainstream schools.Since participation is a complex construct, interventions need to be complex, as well. In order to facilitate positive peer relations, teachers need to provide Activities adapted to the interests and social abilities of the students with ASC, and in which students with and without ASC can experience positive interactions. This requires that teachers assess all aspects that can affect Participation, including Environmental Factors, and the student’s functioning in regard to Activities and Body Functions. To enhance social interactions, interventions must be planned based on these assessments. If needed, interventions may require teaching students with ASC visual strategies, in order to enhance face processing and thereby the ability to recognize faces and facially expressed emotions. Observations together with self-reported information regarding the students’ preferences and their involvement constitute a basis for the planning and evaluating of such interventions. To include self-determination aspects could allow for possible interventions to be tailored in line with the students’ perceived needs and their own wishes, rather than primarily meeting a standard set by a control group. However, good insight into the students’ perception of Participation may not be enough. In order to adapt teaching instructions, communication and activities teachers also need ASC specific knowledge.
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| 3. |
- Adolfsson, Margareta, 1950-
(författare)
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Applying the ICF-CY to identify everyday life situations of children and youth with disabilities
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Four studies were included in this doctoral dissertation aiming to investigatehow habilitation professionals perceive the ICF-CY in clinical work and to identify everyday life situations specific for children and youth aged 0-17 years. The ICF-CY was the conceptual framework and since the research was conducted on as well as with the ICF-CY, the use of the classification runs like a thread through all the work. The design was primarily qualitative and included descriptive and comparative content analyses. Study I was longitudinal, aiming to explore how an implementation of the ICF-CY in Swedish habilitation services was perceived. Studies II-IV were interrelated, aiming to explore children’s most common everyday life situations. Content in measures of participation, professionals’ perspectives, and external data on parents’ perspectives were linked to the ICF-CY and compared. Mixed methods design bridged the Studies III-IV. Results in Study I indicated that knowledge on the ICF-CY enhanced professionals’ awareness of families’ views of child functioning and pointed to the need for ICF-CY based assessment and intervention methods focusing on child participation in life situations. A first important issue in this respect was to identify everyday life situations. Two sets of ten everyday life situations related to the ICF-CY component Activities and Participation, chapters d3-d9, were compiled and adopted for younger and older children respectively, establishing a difference in context specificity depending on maturity and growing autonomy. Furthermore, key constructs in the ICFCY model were discussed, additional ICF-CY linking rules were presented and suggestions for revisions of the ICF linking rules and the ICF-CY were listed. As the sample of everyday life situations reflects the perspectives of adults, further research has to add the perspective of children and youth. The identified everyday life situations will be the basis for the development of code sets included in a screening tool intended for self- or proxy- report of participation from early childhood through adolescence.
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| 4. |
- Andersson, Eva
(författare)
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Hörselscreening av en population med utvecklingsstörning : Utvärdering av psykoakustisk testmetod och av OAE-registrering som komplementär metod
- 2013
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Populationer med utvecklingsstörning behöver kontinuerlig hörseltestning, men konsensus om lämplig testmetod saknas.Syfte: Syftet med Studie I var att utvärdera psykoakustisk testmetod och med Studie II att utvärdera OAE-registrering som komplementär metod.Studie I. 1478 barn och vuxna med lätt till djup utvecklingsstörning, i åldrarna 7-91 år deltog i studien. De testades med tonaudiometri på sex frekvenser på screeningnivån 20 dB HL med lätt modifierad testutrustning. Kriterierna för remittering var tröskelnivåer på ≥ 25 dB HL på två frekvenser eller flera på ett öra eller båda. 1470 (99,5%) barn och vuxna medverkade i screeningen och 1325 (90%) testades på båda öronen på samtliga sex frekvenser. En majoritet, 987 (67,1%), medverkade i vanlig tonaudiometri, 234 (15,9%) i lekaudiometri, och 249 (16,9%) testades med observationsaudiometri. 669 (45%) visade normala värden medan 809 (55%) visade onormala värden relaterat till screeningkriterierna. Av de 809 accepterade 441 (54,5%) remittering för hörselutredning.Studie II. 38 vuxna med måttlig till djup utvecklingsstörning, i åldrarna 31-73 år deltog i studien, alla med ofullständiga testresultat vid tonaudiometri. Portabel utrustning, ILO 288 Echoport och dator Compaq LTE 5100 med mjukvara ILO 88 V 4.2, användes. Otoskopi och tympanometri kompletterade registreringen. Kriterierna för emissioner var S/N 3 dB eller mer och reproducerbarhet på 60% eller mer på åtminstone tre frekvensband. Kriterierna för partiella emissioner var desamma men för en eller två frekvenser. Två personer behövdes för att genomföra testningen: en för att hålla testpersonen lugn och tyst och den andra för att sköta testapparaturen. Reproducerbara TEOAE-svar registrerades från 11 öron (7 personer), partiella svar från 6 öron (4 personer), inga emissioner kunde registreras från 15 öron (10 personer) och 4 öron (4 personer) med otit eller vaxpropp testades inte. Registreringen från 24 öron (13 personer) kunde inte värderas p g a alltför mycket yttre och inre störningar. 8 personer vägrade delta i testningen. Endast 4 personer visade emissioner på båda öronen. Resultatet av undersökningen blev att 34 personer (89.5%) behövde testas om eller bli remitterade för ytterligare utredning, 21 av dem (55%) beroende på störningar vid registreringen eller p g a vägran att medverka.Konklusion: Tonaudiometri med lätt modifiering kan användas för screening av en population med lätt till djup utvecklingsstörning. TEOAE-registrering, som den genomfördes, kan inte uppfylla kraven på en fungerande testmetod för en population med måttlig till djup utvecklingsstörning. I det enskilda fallet kan TEOAE-registrering vara ett komplement till andra hörseltest. Det mest utmanande och tidskrävande är att introducera testprocedurerna på ett sätt som begränsar oro och skapar tillit. Oberoende av testmetod är en audionom med tålamod och vana att samarbeta med personer med utvecklingsstörning en viktig förutsättning för framgångsrik och säker testning.
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| 5. |
- Andersson, Ulf, 1963-
(författare)
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Cognitive deafness : The deterioration of phonological representations in adults with an acquired severe hearing loss and its implications for speech understanding
- 2001
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of the present thesis was to examine possible cognitive consequences of acquired hearing loss and the possible impact of these cognitive consequences on the ability to process spoken language presented through visual speechreading or through a cochlear implant.The main findings of the present thesis can be summarised in the following conclusions: (a) The phonological processing capabilities of individuals who have acquired a severe hearing loss or deafness deteriorate progressively as a function of number of years with a complete or partial auditory deprivation. (b) The observed phonological deterioration is restricted to certain aspects of the phonological system. Specifically, the phonological representations of words in the mental lexicon are of less good quality, whereas the phonological system in verbal working memory is preserved. (c) The deterioration of the phonological representations has a negative effect on the individual's ability to process speech, either presented visually (i.e., speechreading) or through a cochlear implant, as it may impair word recognition processes which involve activation of and discrimination between the phonological representations in the lexicon. (d) Thus, the present research describes an acquired cognitive disability not previously documented in the literature, and contributes to the context of other populations with phonological disabilities by showing that a complete or partial deprivation of auditory speech stimulation in adulthood can give rise to a phonological disability. (e) From a clinical point of view, the results from the present thesis suggest that early cochlear implantation after the onset of an acquired severe hearing loss is an important objective in order to reach a high level of speech understanding with the implant.
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| 6. |
- Andin, Josefine
(författare)
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Dealing with Digits : Arithmetic, Memory and Phonology in Deaf Signers
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Deafness has been associated with poor abilities to deal with digits in the context of arithmetic and memory, and language modality-specific differences in the phonological similarity of digits have been shown to influence short-term memory (STM). Therefore, the overall aim of the present thesis was to find out whether language modality-specific differences in phonological processing between sign and speech can explain why deaf signers perform at lower levels than hearing peers when dealing with digits. To explore this aim, the role of phonological processing in digit-based arithmetic and memory tasks was investigated, using both behavioural and neuroimaging methods, in adult deaf signers and hearing non-signers, carefully matched on age, sex, education and non-verbal intelligence. To make task demands as equal as possible for both groups, and to control for material effects, arithmetic, phonological processing, STM and working memory (WM) were all assessed using the same presentation and response mode for both groups. The results suggested that in digit-based STM, phonological similarity of manual numerals causes deaf signers to perform more poorly than hearing non-signers. However, for digit-based WM there was no difference between the groups, possibly due to differences in allocation of resources during WM. This indicates that similar WM for the two groups can be generalized from lexical items to digits. Further, we found that in the present work deaf signers performed better than expected and on a par with hearing peers on all arithmetic tasks, except for multiplication, possibly because the groups studied here were very carefully matched. However, the neural networks recruited for arithmetic and phonology differed between groups. During multiplication tasks, deaf signers showed an increased reliance on cortex of the right parietal lobe complemented by the left inferior frontal gyrus. In contrast, hearing non-signers relied on cortex of the left frontal and parietal lobes during multiplication. This suggests that while hearing non-signers recruit phonology-dependent arithmetic fact retrieval processes for multiplication, deaf signers recruit non-verbal magnitude manipulation processes. For phonology, the hearing non-signers engaged left lateralized frontal and parietal areas within the classical perisylvian language network. In deaf signers, however, phonological processing was limited to cortex of the left occipital lobe, suggesting that sign-based phonological processing does not necessarily activate the classical language network. In conclusion, the findings of the present thesis suggest that language modality-specific differences between sign and speech in different ways can explain why deaf signers perform at lower levels than hearing non-signers on tasks that include dealing with digits.
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| 7. |
- Arnell, Susann, 1971-
(författare)
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Participation in physical activity among adolescents with autism spectrum disorder : the perspectives of adolescents, parents and professionals
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Findings from previous research show generally lower levels of physical activity (PA) among adolescents with autism spectrum disorder (ASD). The reasons for the low PA participation are complex and depend on several factors, often described as barriers to PA. However, the overall picture concerning participation in PA among adolescents with ASD remains incomplete, as it lacks the adolescents’ own perspectives. The mission to promote healthy PA habits is shared by several actors, including the family or parents and the education, health and municipal services. In order to understand and comprehensively describe these adolescents’ PA participation, different PA contexts and perspectives need to be included. The overall aim of this thesis was therefore to study participation in PA among adolescents with ASD from the adolescents’ (study I), parents’ (study II) and professionals’ (study III) perspectives. The findings from study I showed a conditional participation behaviour in PA among adolescents with ASD. In studies II and III, the results revealed a need to give PA issues increased priority and support through collaborative efforts. Complementary roles are needed to promote participation in PA. In study IV, the feasibility of using a Q-sort tool to map conditions for participation in PA was investigated. The results showed that Q-sort is a feasible method that can be used to offer tailored support according to the adolescents’ individual-specific conditions for participation. In conclusion, a condition-controlled behaviour when participating in PA was described in all four studies. When promoting participation in PA, these individual-specific conditions for participation need to be recognized and tailored support offered.
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| 8. |
- Arvidsson, Patrik, 1969-
(författare)
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Assessment of participation in people with a mild intellectual disability
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this doctoral thesis was to explore an assessment of participation according to the International Classification of Functioning, Disability and Health (ICF) in people with a mild intellectual disability.Study I used secondary data and explored how participation can be assessed. Study II-IV explored participation empirically regarding 68 everyday activities from all nine life domains according to the ICF. Study II explored assessment of self-rated participation by investigating to what extent perceived ability, actual performance and perceived importance correlated. Study III-IV explored the contribution of perceived importance to an assessment of participation; study III by investigating frequencies of everyday activities regarding performance and importance separately as well as regarding combined measures of performance and perceived importance, and study IV by comparing proxy ratings with self-rated measures regarding ability and measures of participation. Study III also correlated measures of participation with a single-item measure of subjective general well-being and study II and IV investigated internal consistency in terms of Cronbach’s alpha. Study II and III included 55 and 69 individuals with intellectual disability respectively. Study IV included 40 individuals with intellectual disability and 40 proxy persons. The informants from the target group were partly the same.Study II and IV supported the suggestions from study I that participation should be assessed by self-ratings and study II found that this is an appropriate method also to people with a mild intellectual disability. Study III showed that participation is related to subjective well-being. Study III-IV found somewhat different results if measuring participation as performance solely or as a combination of performance and perceived importance. Overall, the results of the thesis suggest that performance solely might be sufficient to assess participation at a group level but in a clinical context, when the knowledge of a certain individual is of interest, the perceived aspect of involvement is necessary to include in an assessment of participation.
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| 9. |
- Axelsson, Anna Karin
(författare)
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Children with profound intellectual and multiple disabilities and their participation in family activities
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background. Families are essential parts of any community and throughout childhood one’s family serves as the central setting wherein opportunities for participation are offered. There is a lack of knowledge about participation of children with profound intellectual and multiple disabilities (PIMD) in family activities and how improved participation can be reached. Gathering such knowledge could enable an improvement in child functioning and wellbeing and also ease everyday life for families of a child with PIMD.Aim. The overall aim of this thesis was to explore participation seen as presence and engagement in family activities in children with PIMD and to find strategies that might facilitate this participation.Material and Methods. The research was cross-sectional and conducted with descriptive, explorative designs. First a quantitative, comparative design was used including questionnaire data from 60 families with a child with PIMD and 107 families with children with typical development (TD) (I, II). Following that, a qualitative, inductive design was used with data from individual interviews with parents of 11 children with PIMD and nine hired external personal assistants (III). Finally a mixed method design was conducted where collected quantitative data was combined with the qualitative data from the previous studies (IV).Results. It was found that children with PIMD participated less often, compared to children with TD, in a large number of family activities, however they participated more often in four physically less demanding activities. Children with PIMD also participated in a less diverse set of activities. Additionally, they overall had a lower level of engagement in the activities; however, both groups of children showed higher engagement in enjoyable, child-driven activities and lower engagement in routine activities. The motor ability of the child with PIMD was found to be the main child characteristic that affected their presence in the family activities negatively and child cognition was found to be the personal characteristic that affected their engagement in the activities. The child’s presence and engagement were influenced to a lesser extent by family socio-economic factors when compared to families with children with TD. Parents and hired external personal assistants described several strategies to be used to improve participation of the children with PIMD, such as by showing engagement in the activities oneself and by giving the child opportunities to influence the activities. The role of the hired external personal assistant, often considered as a family member for the child, was described as twofold: one supporting or reinforcing role in relation to the child and one balancing role in relation to the parents/the rest of the family, including reducing the experience of being burdened and showing sensitivity to family life and privacy. Conclusion. A child with PIMD affects the family’s functioning and the family’s functioning affects the child. Child and environmental factors can act as barriers that have the result that children with PIMD may experience fewer and less varied activities that can generate engaged interaction within family activities than children with TD do. Accordingly, an awareness and knowledge of facilitating strategies for improved participation in family activities is imperative. There needs to be someone in the child’s environment who sets the scene/stage and facilitates the activity so as to increase presence and engagement in proximal processes based on the child’s needs. The family, in turn, needs someone who can provide respite to obtain balance in the family system. External personal assistance includes these dual roles and is of importance in families with a child with PIMD.
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| 10. |
- Bengtsson, Staffan, 1970-
(författare)
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Varför får jag icke följa med dit fram? : Medborgarskapet och den offentliga debatten om dövstumma och blinda 1860–1914
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Different kinds of cultural studies can be used in order to learn more about disability, social policies, attitudes and citizenship. The purpose of this study is to outline some aspects of disability and Swedish society during the 19th century. The ambition is to analyse the issue of the integration of the deaf-mutes and the blind. How did politicians and educators motivate the establishment of compulsory schooling? How was the issue of correction of the body treated? How did they deal with the situation on the labour market? What kind of compensation was contemporary society willing to support? Social policies in the past are likely to be described in terms of control, repression and barriers. This study looks at disability from a more anthropological view which implies the use of hermeneutics, seeking to identify the agent’s own understanding of a problem in order to learn more about how social categorisation and citizenship are integrated and how they change. The use of original sources, such as records from the Swedish parliament and conferences held by experts as well as periodicals, makes this kind of approach possible.This thesis argues that disability must be understood as something that is constantly in the arena of a more dialectical struggle where a number of visions and interests have melted together. In the course of state interventionism and growing social justice, citizenship and disability to a greater extent became a question of honour. Being granted certain rights meant that the individual had passed the test and was now sanctioned as disabled, one who deserved the right to rights. This transition promoted a growing group consciousness. A more dialectical approach perforates the border between social control and humanity since they were not always mutually exclusive.
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