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- Fjellman-Wiklund, Anncristine, 1955-
(författare)
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Musicianship and teaching : aspects of musculoskeletal disorders, physical and psychosocial work factors in musicians with focus on music teachers
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Musculoskeletal disorders are common among musicians at all levels of performance. Since music teachers train our future musicians it is important to understand their work environment. By creating good examples of a healthy work environment, they can teach their students how to stay healthy and to prevent pain. The aim of this thesis was to study the work environment of music teachers at municipal music schools, with regard to physical and psychosocial factors and musculoskeletal disorders with the focus on neck and shoulder disorders. An additional aim was to investigate the variability of the playing technique in string players and to investigate if they could play with greater variation in the trapezius muscle activity pattern after a training intervention program.In a cross-sectional study at 23 municipal music schools, 171 out of the 208 (82%) music teachers reported that they had experienced work related musculoskeletal disorders (WMSDs) during the previous year. Women reported significantly more symptoms in the neck, the shoulders and the upper back compared to men. Both physical and psychosocial work factors were associated with neck and shoulder disorders. For women “high mental work demands” and “teaching at many schools” could be seen as risk factors and for men “lifting”, “playing the guitar” and “low social support at work” were risk factors.The occurrence of WMSDs was also investigated, over an eight-year period, in music teachers at one music school. The result showed that neck, shoulder and lower back disorders were common and tended to be of long duration and to increase over the years.In an interview study, nine music teachers focused on what they perceived to be important for their health and well-being. Replenishing and using up energy was found to be the core category. Creativity in the music and working with other musicians were perceived as sources of energy, while the goals of the organisation were experienced as stressful and used up energy. Whether the work was regarded as pedagogical or musical could affect the perception of health and the strategies for dealing with the strains of work.In two studies using electromyography, the variation in the trapezius muscle activity pattern in string musicians was investigated. The results suggested that each musician could repeat their muscular activity pattern in a similar way between two playing sessions. No difference was found in the trapezius muscle activity between five violinists who trained basic Body Awareness Therapy (BAT), a technique having its roots in Tai Chi Chuan tradition, compared to a reference group of nine violinists who did not take part in any training. However, the training group perceived positive changes in breathing, muscular tension, postural control and concentration during practice sessions.Neck and shoulder disorders were associated with physical and psychosocial factors at work. A process of replenishing and using up energy was important for music teachers’ health. The playing technique in string musicians seemed to be repeatable but difficult to affect over a short-term period. For future musicians it is crucial to learn good working technique at an early age. In the learning process the music teacher is a vital role model.
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- Oldfors Engström, Lena, 1948-
(författare)
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Att förstå patienters bristande deltagande i individualiserat rehabiliteringsprogram
- 2002
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this investigation was to elucidate and describe those patients who had discontinued their participation and/or paticipated infrequently in physiotherapy treatment based on their own activity and responsibility. The ambition was to understand the phenomenon of compliance/adherence from various perspectives in behavioural as well as social science.In study I the phenomenon compliance/adherence was studied in relation to Health Locus of Control and Health Belief variables. This study was based on a questionnaire that was answered by all patients before beginning of treatment. Questions concerning the patients´conceptions about both health locus of control and health beliefs were the focus.The definitions of compliance/adherence were completed treatment period and exercise frequency, respectively. Those patients who completed the treatment were also studied regarded exercise frequency.The results of study I showed that those who discontinued their treatment reported a higher perceived threat from their health condition (higher level of dysfunction (higher pain intensity) and a higher perceived severity of their health condition (higher level of dysfunction, worse general health) than those who completed treatment. The results also showed that those who exercised once a week or less often valued the significance of the caring situation as lower (HLC), perceived a higher threat from their health condition (higher pain intensity), a higher severity of their health condition (higher level of dysfunction, worse general health, greater distrution of impairment), more barriers to treatment (lower expectations), and had certain differences in demographic variables (younger individuals, more women) than those who exercised more often (HB).Study II investigated patients´descriptions of their reasons for discontinuing the treatment, whether those reasons varied, and if so how they varied. Sixteen patients who had discontinued their treatment were interviewed with open-ended questions. The inteviews began with a question about the background to the physiotherapy treatment. There were questions concerning carrying out the treatment as well as concerning what they thought about their impairment. The patients were also asked about their priotities in daily life, as these wre presumed to be anobstacle to the treatment over a shorter or longer period of time. The third domain concerned how they experiebced the patient/physiotherapist relationship. The interviews were anlysed qualitatively.Analysis of study II resulted in four different descriptions of reasons for treatment discontinuation. A) It was about time to end treatment and continue on alone. B) The treatment was not the most important activity to spend time on. C) An agreement with the physiothreapist to discontinue treatment due to lack of effect. D) No viewpoint as to why they discontinued the treatment. In further analysis of category D, this group appeared to experience varoius forms of powerlessness. They felt their trustworthiness was often questioned. They experienced frustration in their life situation as others made the important descisions and they themselves had little to say.They defended themselves by talking about their own conceptions of the reasons for their impairment and what should be done about them. In comparing category D with categories A, B, C it was found that those in the latter three categories experienced varying degrees of control in different situations, whereas those in category D did not experience a feeling of control.Conclusion: The concept of compliance in physiotherapy is ambiguous. The concept involves one part defining what will concern the other part. It is clear that the physiotherapist and the patient do not always agree about the aim of the treatment. Instead, we should develop the concept of concordance in encounters with the patients and abandon the reasoning of compliance.
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- Samuelsson, Kersti, 1953-
(författare)
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Active wheelchair use in daily life : considerations for mobility and seating
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Wheelchair fit and prescription are central in the rehabilitation process of a spinal cord injured client with an impaired walking ability. The knowledge and consequences of wheelchair use in active wheelchair users is deficient, which might lead to unnecessary problems and disabilities.Objective: The general aim of the research underlying this thesis was to increase and deepen the knowledge of wheelchair use, considering both mobility and seating aspects.Methods: The thesis includes five different studies, two of them with a focus on wheelchair mobility, two with a focus on secondary complications common in wheelchair users and one intervention study with a focus on wheelchair seating. Methods used to measure and describe wheelchair use from mobility and seating aspects are well-standardized, valid and reliable methods, custom-made newly developed forms and client estimations.Results: The power output and mechanical efficiency of wheelchair propulsion was found to be low compared to arm-crank ergometry in a group of experienced wheelchair users. Another study found that it was not possible to affect this mechanical efficiency in a uniform positive way, by a change in rear-wheel position. A significant change in propulsion technique was found which, however, did not correlate to physical effort. Secondary complications such as back pain, spinal defonnities and shoulder pain were common in clients with a spinal cord injury. In the intervention study a change in seating prerequisites had a positive effect on estimated seating comfort, posture and activity.Conclusion: Wheelchair propulsion and seating mean high physical and musculoskeletal load on the individual with a risk for secondary complications. A prescriber of hand-rim wheelchairs to clients who will spend many years in their wheelchairs has a major responsibility to understand and use available knowledge, to carefully examine the physical prerequisites of each client, and to interrelate these findings to individual needs and wishes. There is a great need for continuous development of new methods and knowledge in this area in order to avoid unnecessary complications due to wheelchair use. There is also a need for new thinking in the construction and design of new wheelchairs.
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