| 1. |
- Johansen, Kine
(författare)
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Towards an evidence-based assessment of early motor performance in the child health services : Psychometric properties and clinical utility of the Structured Observation of Motor Performance in Infants
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The Swedish child health services (CHS) have a unique position in that they reach almost all children 0-6 years of age. The child health nurse has the main responsibility for developmental surveillance. Twelve scheduled visits with the nurse during the child’s first year of life make this an ideal setting to systematically identify infants with motor problems, ranging from asymmetric head positioning that may lead to plagiocephaly to more severe forms such as cerebral palsy (CP). However, the CHS lack evidence-based methods to assess motor development.The Structured Observation of Motor Performance in Infants (SOMP-I) assesses motor performance in two domains, i.e. level of motor development and quality of motor performance. SOMP-I is quick, non-invasive, requires minimal handling, and is suitable for a busy clinical setting when applied by physiotherapists. Given the importance of early detection, the increased likelihood of detecting motor problems when using evidence-based assessment methods and the key role of nurses within the CHS, the overall aim of this thesis was investigate the psychometric properties and clinical utility of SOMP-I when used by child health nurses. Furthermore, we aimed to establish the ability of SOMP-I to detect CP.Our results show that child health nurses can reliably assess the level of motor development in infants using SOMP-I. More variability was found when they assessed the infants’ quality of motor performance. Although the nurses expressed concern about introducing a more time-consuming assessment in an already tight schedule, they were able to integrate the SOMP-I assessment in routine care. The nurses reported that barriers to using SOMP-I were mostly logistic and practical in nature, and they pointed out the necessity of education and practice in order to become proficient assessors. Using SOMP-I appears to have supported the nurses in the decision-making process regarding motor performance in routine care. SOMP-I detected CP during the first months of life in neonatal intensive care recipients.To our knowledge, these studies are the first to evaluate child health nurses’ assessment of early motor performance using an evidence-based assessment method in routine care. The results are promising, but further research is warranted.
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| 2. |
- Blom Johansson, Monica, 1965-
(författare)
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Aphasia and Communication in Everyday Life : Experiences of persons with aphasia, significant others, and speech-language pathologists
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aims of this thesis were to describe the experiences of persons with aphasia and their significant others of their conversations and use of communication strategies, examine current practice of family-oriented speech-language pathology (SLP) services, and test a family-oriented intervention in the early phase of rehabilitation.The persons with aphasia valued having conversations despite perceiving their aphasia as a serious social disability. They acknowledged the importance of the communication partners’ knowledge and understanding of aphasia and their use of supporting conversation strategies. Their own use of communication strategies varied considerably. The persons with aphasia longed to regain language ability and to be active participants in society.A majority of the significant others perceived their conversations with the person with aphasia as being less stimulating and enjoyable than conversations before stroke onset. Aphasia was considered a serious problem. The significant others took on increased communicative responsibility, where two thirds had changed their communicative behaviour to facilitate conversations. Type and severity of aphasia were especially related to the communicative experiences of the significant others and their motivation to be involved in SLP services.Thirty percent of the speech-language pathologists worked with people with aphasia and typically met with their families. They considered the involvement of significant others in SLP services as very important, especially in providing information about aphasia and communication partner training (CPT). However, involvement of significant others was restricted because of a time shortage and perceived limited skills and knowledge. In addition, there were national differences regarding aphasia rehabilitation services.The intervention consisted of three sessions directed to significant others (primarily emotional support and information) and three directed to the dyads (a person with aphasia and a significant other) (primarily CPT). All six participants (three dyads) felt that their knowledge and understanding of aphasia had increased and that their conversations had improved. These improvements were also evident to some extent with formal assessments.These results suggest the following: CPT should be an integral part of SLP services, national clinical guidelines are needed, and further education of speech-language pathologists and implementation of new knowledge into clinical practice requires consideration.
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| 3. |
- Wandin, Helena, 1971-
(författare)
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Symbol-based communication intervention for individuals with Rett syndrome : Current practices, assessment of visual attention, and communication partner strategies
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Individuals with Rett syndrome need extensive support to actively participate in social interaction and to develop their communication. The overall aim of this thesis was to investigate communication intervention for individuals with Rett syndrome, especially aided symbol-based communication and partner strategies.Study I was a cross-sectional survey exploring services provided by speech language pathologists (SLPs) in Sweden. Communication aids were often used in the intervention and were found to be useful. Few SLPs used systematic tools for assessment and evaluation and communication partners were often instructed through informal conversations.In study II, a tool (AVAI) for assessing visual attention in interaction was developed and its psychometric properties were explored. AVAI was also used as an outcome measure in study III. In both studies, the tool was found to be reliable, able to detect change and acceptable to the participants.In study III, a single case experimental design was applied to evaluate an intervention consisting of aided language modelling whilst using responsive partner strategies and a gaze-controlled device. The adult participants with Rett syndrome (n=3) increased their expressive communication following individual learning patterns. The intervention was appreciated by the participants’ social network.Study IV was a case study exploring and describing a communication partner’s use of responsive and scaffolding partner strategies in interaction with individuals with Rett syndrome (n=3). The use of these strategies varied in interaction with different individuals with Rett syndrome. The communication partner responded more frequently to communication through a gaze-controlled device than unaided communication.In conclusion, gaze-controlled devices should be considered in communication intervention with individuals with Rett syndrome. Systematic tools and procedures should be applied in interventions, which is not the case in current clinical practice. Adults with Rett syndrome are able to develop their communication which highlights the need for communication support throughout their lifetime.
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| 4. |
- Brunnberg, Elinor
(författare)
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Vi bytte våra hörande skolkamrater mot döva! : Förändring av hörselskadade barns identitet och självförtroende vid byte av språklig skolmiljö
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This study is a comparative study with the aim of finding out whether the identity and self-confidence of hearing-impaired children changes when they attend schools with a different language base. The focus of the study was the interaction of hearing-impaired children with other children of the same age. The number of hearing-impaired children in this study was 29. The children were aged between 7 and 14 when the study began. In autumn 1994 special classes for hearing-impaired children in Örebro moved from a mainstream school to a special school for Deaf children. In the classroom, the hearing- impaired children in both the mainstream and the special schools were educated in spoken Swedish with signs as support. However, the dominant language outside the classroom changed from spoken Swedish to Swedish sign language. Two semi-structured interviews were conducted with the hearing-impaired children in 1994, before the move, and in 1996, after the move. At the same time the children's self-confidence was examined. In both the mainstream and the special school the children's play in the playground was video recorded. This study shows that several of the hearing-impaired children were socially isolated. Some even felt little solidarity with their classmates and were solitary. Most of the children were longing to meet more children in their spare time. The playground seemed to be the social arena where children with impaired hearing mainly met other children. The hearing-impaired children as a group were socially excluded and marginalized in the mainstream school. Most of the hearing-impaired children did not describe the same feeling of being outsiders in the special school as in the mainstream school. Most of the hearing-impaired children's confidence improved after the change of school. However, the hearing-impaired children's social situation was not perfect in the special school either. The playground is a central arena for hearing-impaired children in trying out their identity. In forming their identity children seem to look for other similarities. The hearing-impaired children experienced affiliation, equality and fellowship with other hearing-impaired children. They also expressed the opinion that Deaf children were "almost similar" to hearing-impaired children. The school situation that strengthens the identity of hearing-impaired children seems to be the school where they feel most at home with their schoolmates. That happened in the special school. However, some of the hearing-impaired children with multi-disabilities had difficulties in both the mainstream school and the special school and failed to find a secure identity as a hearing-impaired child. Unless school arrangements address their social needs, hearing-impaired youngsters could experience an identity crisis.
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| 5. |
- Glad, Johan, 1973-
(författare)
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Assessment in Evidence-Based Practice : Psychometric Properties, Clinical Utility and Professional Co-operation from Different Perspectives of the Home Observation for Measurement of the Environment in Sweden
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of the present thesis was to explore and compare professional co-operation in child welfare investigations, explore the psychometric properties, and describe the clinical utility from different perspectives of a translated Swedish version of the standardized assessment instrument the Home Observation for Measurement of the Environment (the HOME Inventory). Social workers in Sweden, Denmark, Britain, Germany, and Texas (USA) co-operated with different professionals around a fictitious child welfare case. Differences were found between and within country-based samples, indicating an unsystematic work procedure in the social work agencies studied. The psychometric properties of the translated Early Childhood version (EC-HOME) and Middle Childhood version (MC-HOME) of the HOME Inventory were explored in terms of inter-observer reliability and by Rasch analysis. The samples were authentic Swedish child welfare cases recruited from a field setting. Inter-observer reliability was satisfactory. Results were ambiguous regarding measurement construction of the two versions studied. Because of the differentiating ability of the EC-HOME and MC-HOME, total scores could provide an indication of inadequate home environments. Experiences of social work practitioners of the clinical utility of the HOME Inventory suggested that they considered the instrument to be comprehensive and have explicit potential benefits, i.e. to be clinically useful. Correspondingly, caregivers’ overall perceptions of the HOME Inventory were positive, determining the content relevant and the format acceptable. However, certain flaws have to be rectified before the HOME Inventory is to be implemented and used successfully. Further, education and the possibility to practice administering the instrument seemed to be essential conditions for future use according to social workers. When social workers and teachers’ apprehensions about support and stimulation provided by caregivers to children in their home environments were compared, preschool teachers’ apprehensions correlated poorly with the social workers’ assessment. These results suggest that the HOME Inventory is promising but cultural adaptation and further studies of psychometric properties are necessary. Different forms of support to practitioners and agencies for successful implementation are required. Awareness of the type of information provided by different sources is important when co-operating in child welfare.
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| 6. |
- Jansson, Lennart, 1949-
(författare)
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Needs of Support and Service in Mentally Disabled Clients : Population-Based Studies in a Swedish County
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The general aim of the present thesis is to investigate needs of support and service in clients with long-term mental disabilities living in the community. A further aim is to study changes in these client needs during a 3.5-year follow-up. A questionnaire, The Need of Support and Service Questionnaire (NSSQ), was developed to provide staffs in psychiatric care and social services with a brief instrument to assess how their clients live in the community and to identify their needs. The results are based on 1,759 clients. The prevalence of clients in urban and rural areas was 6.4/1,000 and 4.5/1,000 inhabitants, respectively. The clients living in the urban setting were more frequently male, older, with a diagnosis of schizophrenia and needed more support in activities of daily living than rural clients. Clients identified by staff in psychiatric care only were more often living with a partner, with children living at home and more often had a rehabilitation allowance than clients identified by social services staff. In clients assessed by both organizations similar needs at a group level were identified. However, agreements were lower at the individual level. Although clients reported fewer needs than staff in psychiatric care, the reported needs were in the same areas.A majority of the clients with unmet needs of service at baseline had their needs met at the 3.5-year follow-up. New unmet needs were also identified at the follow-up, however. The results demonstrate less improvement in clients with schizophrenia as compared with non-schizophrenic clients.In conclusion, needs of support and service present a dynamic process and both psychiatric care and social services should critically evaluate assessments of these needs.
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| 7. |
- Johansen, Kine, et al.
(författare)
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Clinical utility of the Structured Observation of Motor Performance in Infants within the child health services
- 2017
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 12:7
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Tidskriftsartikel (refereegranskat)abstract
- Aim: This study aimed to evaluate the clinical utility of the Structured Observation of Motor Performance in Infants (SOMP-I) when used by nurses in routine child healthcare by analyzing the nurses' SOMP-I assessments and the actions taken when motor problems were suspected.Method: Infants from three child health centers in Uppsala County, Sweden, were consecutively enrolled in a longitudinal study. The 242 infants were assessed using SOMP-I by the nurse responsible for the infant as part of the regular well-child visits at as close to 2, 4, 6 and 10 months of age as possible. The nurses noted actions taken such as giving advice, scheduling an extra follow-up or referring the infant to specialized care. The infants' motor development was reassessed at 18 months of age through review of medical records or parental report.Results: The assessments of level of motor development at 2 and 10 months showed a distribution corresponding to the percentile distribution of the SOMP-I method. Fewer infants than expected were assessed as delayed at 4 and 6 months or deficient in quality at all assessment ages. When an infant was assessed as delayed in level or deficient in quality, the likelihood of the nurse taking actions increased. This increased further if both delay and quality deficit were found at the same assessment or if one or both were found at repeated assessments. The reassessment of the motor development at 18 months did not reveal any missed infants with major motor impairments.Interpretation: The use of SOMP-I appears to demonstrate favorable clinical utility in routine child healthcare as tested here. Child health nurses can assess early motor performance using this standardized assessment method, and using the method appears to support them the clinical decision-making.
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| 8. |
- Terner, Annika, 1960-
(författare)
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Predefined Headings in a Multi-professional Electronic Health Record : Professionals’ Application, Aspects of Health and Health Care and Correspondence to Legal Requirements
- 2014
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to investigate predefined headings in a Swedish county council multi-professional EHR system in terms of their shared application, what aspects of health and health care they reflected, and their correspondence to legal requirements. An analysis of 3 596 predefined headings, applied to 20 398 104 occasions by eight professional groups, was conducted. Less than 2% of the predefined headings were applied by all eight professional groups, whereas 60% were not shared at all between the professional groups. A classification of the predefined headings revealed that 13% were “Specialist terms”, which were the least ambiguous predefined headings, 46% were “Terms for specific purposes”, which are less ambiguous than the “Common words” (28%), which were the most ambiguous predefined headings according to the sociolinguistic method employed. The remaining predefined headings (13%) were sorted into “Unclassified headings”. A qualitative content analysis of the predefined headings yielded 23 subcategories grouped into five categories: Description of the patient, Health care process, Resources employed, Administrative documentation, and Development and research. A comparison of the 23 subcategories to the Patient Data Act showed, first, that 15 of 23 subcategories corresponded to four legal requirements, second, that there were legal requirements with a focus on patient rights that were not being met, and third, that there were eight subcategories of predefined headings that could not be attributed to the legal provisions of the Patient Data Act. In conclusion, the proportion of shared predefined headings in the EHRs was limited. The predefined headings in the multi-professional EHRs did not constitute a joint language for specific purposes. A meaningful structure comprising categories and subcategories of different aspects of health and health care as reflected in the applied predefined headings was identified. The structure reflected a wide range of health and health care. No subcategory corresponded to the three legal requirements concerning patient rights. Future research should include professionals’ and patients’ understanding of predefined headings, the correspondence of documented notes to predefined headings and how the documentation in the EHR has had an impact on patient safety.
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| 9. |
- Umb-Carlsson, Õie, 1953-
(författare)
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Living Conditions of People with Intellectual Disabilities : A Study of Health, Housing, Work, Leisure and Social Relations in a Swedish County Population
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The general aim of this thesis is to describe mortality, health and living conditions in an administratively defined county population of people with intellectual disabilities born between 1959 and 1974 (N=213). The living conditions of persons with intellectual disabilities were compared with those of the general population. Moreover, the reports of relatives and staff were compared on the living conditions of people with intellectual disabilities. Information on the living conditions of persons with intellectual disabilities was provided by proxy (relative and staff) questionnaire reports and national welfare statistics conducted by Statistics Sweden (SCB). Medical examination and medical case records were used to obtain data on health and medical services. People with intellectual disabilities lived in the community and took part in numerous common recreational and cultural activities. However, the comparison with the general population indicated clear differences in living conditions, particularly regarding employment and social life. In contrast, surprisingly little variation in living conditions was found in people with intellectual disabilities, despite varying ages and a wide range of level of disabilities. In addition, gender related differences of persons with intellectual disabilities were few when compared with those found in the general population. A wide range of physical and mental health problems were identified in the group with intellectual disabilities. Although a majority of persons with intellectual disabilities had access to a family doctor and attended regular health checks, a number of needs of specialist examinations were identified indicating shortcomings in the quality of health care. Analyses indicated differences in the reports of relatives and staff on living conditions of most domains included in the questionnaire. In general, disagreement was higher on subjective than on objective items. Relative and staff responders contribute dissimilar information that is related to varying viewpoints and different types of information.
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| 10. |
- von Granitz, Heléne, 1969-
(författare)
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Enabling disability rights in practise : Understanding how the governance of state-funded personal assistance is fulfilling the Swedish LSS Act
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Personal assistance (PA) is stated in Article 19 of the UNCRPD as an internationally recognised disability right and is operationalised as a measure in the Swedish Act concerning Support and Service for Persons with Certain Functional Impairments (the LSS Act). The Act’s overall policy goal is to promote good living conditions for the eligible persons by enabling participation in society on equal terms with others. The governance of PA is a divided responsibility between the municipality and the Swedish Social Insurance Agency (SSIA), which assesses and grants PA-allowance if the PA applicant exceed 20 hours of certain needs per week. The overall aim of the thesis was to explore how the governance of PA-allowance enables to fulfil the LSS Act policy goals. The main findings of the thesis demonstrate a tilt in PA towards a medical model of disability, marked by a domination and an increase of healthcare activities over time. Less activities representing participation in society were found and unequal access to PA activities across age, gender and groups of persons with disabilities. The findings imply an increased risk to social and financial exclusion of PA users. Further, the LSS Act’s rationale and policy goals were shown to have a weakened impact on the SSIA instruction, the refined policy tool which outlines the PA-allowance granting process. A development towards a medicalised application of PA-allowance was found, characterised by healthcare measures to support medical conditions and a shift towards PA users with less ability to partake in the PA-allowance granting process. Factors shown to have influenced the governance of PA-allowance include: case law, changed policy priorities, weakened PA collaboration structures, inadequate monitoring of PA outcomes, strained working conditions at the SSIA and extensive complexities of the PA-allowance application. This thesis illustrates that the SSIA regime logic has thoroughly influenced the LSS policy outcome with time and emphasises the need for social reform policy tools to be continuously calibrated towards the original policy goals to uphold policy compliance. The regression of PA, by gradually resigning to a medical model of disability, demonstrates weakened conditions for Swedish disability policy through the LSS Act to fulfil Article 19 of the UNCRPD.
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