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1.
  • Magnusson, Lina (författare)
  • Prosthetic and Orthotic Services in Developing Countries
  • 2014
  • 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)
  • From Eye to Us : Prerequisites for and levels of participation in mainstream school of persons with Autism Spectrum Conditions
  • 2013
  • 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)
  • Applying the ICF-CY to identify everyday life situations of children and youth with disabilities
  • 2011
  • 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)
  • Hörselscreening av en population med utvecklingsstörning : Utvärdering av psykoakustisk testmetod och av OAE-registrering som komplementär metod
  • 2013
  • 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)
  • Cognitive deafness : The deterioration of phonological representations in adults with an acquired severe hearing loss and its implications for speech understanding
  • 2001
  • 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)
  • Dealing with Digits : Arithmetic, Memory and Phonology in Deaf Signers
  • 2014
  • 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)
  • Participation in physical activity among adolescents with autism spectrum disorder : the perspectives of adolescents, parents and professionals
  • 2022
  • 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)
  • Assessment of participation in people with a mild intellectual disability
  • 2013
  • 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)
  • Children with profound intellectual and multiple disabilities and their participation in family activities
  • 2014
  • 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)
  • Varför får jag icke följa med dit fram? : Medborgarskapet och den offentliga debatten om dövstumma och blinda 1860–1914
  • 2005
  • 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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11.
  • Bertills, Karin (författare)
  • Different is cool! Self-efficacy and participation of students with and without disabilities in school-based Physical Education
  • 2019
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Background: Self-efficacy predicts school achievement. Participation is important for life outcomes. Functioning affects to what degree you can participate in everyday life situations. Participation-related constructs such as self-efficacy and functioning work both as a means of participation and as an end outcome. Learning takes place in this interrelationship. How relationships between participation and these constructs vary, depending on whether impacted by disability or not, how they develop over time and outcomes of these processes need to be explored.Method: In this three-year longitudinal study developmental processes of student self-efficacy (PE specific and general), aptitude to participate and functioning were explored. The context is school-based Physical Education (PE) in mainstream inclusive secondary school in Sweden. Data was collected from student and teacher questionnaires and observations of PE lessons. Students self-rated their perceived self-efficacy, aptitude to participate and functioning in school years seven and nine. Teachers self-rated their teaching skills. Student engagement, teaching behaviors, interactions and activities in Swedish school-based PE were observed in year eight. Relationships between the constructs and how they develop over time were studied in a total sample of 450 students (aged 12,5-15,5). Specifically focusing on three student groups, students with diagnosed disabilities (n=30), students with low grades in PE (n=36), and students with high grades (n=53) in PE.Results: Adapted instruments to measure self-efficacy (PE specific and general), aptitude to participate in PE, and functional skills (physical and socio-cognitive were developed and validated. PE specific self-efficacy is closely related to the aptitude to participate and has effects on student engagement and general self-efficacy. Over time PE specific self-efficacy increase in adolescents, but students with disabilities initially responded negatively if their PE teachers rated their teaching skills high. They were also more sensitive to the social environment, which was associated with PE grades over time. During this time the relationship between perceived physical functional skills and PE specific self-efficacy accelerated for students with disabilities. They were observed to be equally highly engaged in PE lessons as their peers. However, students with disabilities were observed to be closer to their teacher and tended to be less social and alone than their peers. Observed teaching skills as measured by level of alignment with syllabus, and affective tone when giving instructions showed differences in complexity and efficiency. Students in the study sample were more engaged in high-level teaching and were more frequently in communicative proximity to their teacher. In conditions of high-level teaching, teachers gave more instructions and used more materials for teaching purposes. Lessons were more often structured into whole group activities and lessons were more focused.Conclusion: PE specific self-efficacy measures students’ perceived knowledge and skills in PE and is related to students’ aptitude to participate, general self-efficacy and functioning. The overall findings imply that the developmental processes of perceived self-efficacy (PE specific and general), aptitude to participate and functioning differ between the student groups. PE specific self-efficacy and socio-cognitive functioning improve over time in all groups. Stronger associations of PE specific self-efficacy with aptitude to participate and functional skills, and weaker with general self-efficacy were found in students with disabilities compared to their typically functioning peers. Individual factors are vital to learning, but students with disabilities seem to be more sensitive to environmental factors than their peers. The aptitude to participate declines in students with disabilities, probably due to their experience of having physical restrictions. However, while participating in PE, they were similarly relatively highly engaged as their typically functioning peers. Instructions in PE indicate differences in complexity and efficiency of PE teaching. More complex lesson content requires more  instructions and more purposeful materials. Time was used more efficiently in high-level teaching conditions. Lessons were more focused and had more flow, leaving students with less time to socialize. Space was also used more efficiently, and teachers were closer to their students. Indicating that more individual support, feed-back and feedforward was provided. Students with disabilities were more frequently close to their teacher than their typically functioning peers. The use of more whole group formats indicate that teaching is more differentiated in high-level teaching. When activating students physically, teachers may choose simpler self-sustaining activities, i.e. sports games. Small group formats may be used for individual development of motor skills or drills.
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12.
  • Birberg Thornberg, Ulrika (författare)
  • Fats in Mind : Effects of Omega-3 Fatty Acids on Cognition and Behaviour in Childhood
  • 2011
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The aim of this thesis was to examine possible effects of omega-3 fatty acids on children’s cognition and behavior. Longitudinal as well as cross-sectional comparisons were made among children with typical development and children with ADHD /at risk developing ADHD.The specific purposes were to examine (1) breast-feeding in relation to cognition; (2) relation between long chain poly unsaturated fatty acids (LCPUFAs) in mothers breast-milk and children´s cognition; (3) effects of EPA supplementation on cognition and behavior in children with ADHD; (4) if LCPUFAs have differential effects on working memory, inhibition, problem-solving and theory of mind (ToM).The main conclusions were as follows; (1) duration of breast-feeding was positively correlated to children levels of intelligence (IQ); (2) LCPUFAs in breast-milk was related to children’s ToM and IQ, the quotient DHA/AA, together with length of breastfeeding and gestation week explained 76% of the variance of total IQ; (3) subtypes of children with ADHD responded to EPA supplementation with significant reductions in symptoms, but there were no effects in the whole group with ADHD; (4) ToM ability was related to LCPUFAs, but not to any other cognitive measures as working memory, inhibition and problem-solving.To conclude, these results indicate that fatty acid status in breast-milk at birth affect general cognitive function in children at 6.5 years of age, including ToM. Short-term intervention with omega-3 fatty acids does not affect cognition in children with ADHD, but improves clinical symptoms as assessed by means of teacher ratings. These results further indicate that hot executive function and social cognition may be an area of interest for future research.
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13.
  • Bjarnason, Sif (författare)
  • Jobbet är kommunikation : om användning av arbetshjälpmedel för personer med hörselnedsättning
  • 2011
  • Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • To facilitate participation in hearing situations at work sites persons with hearing loss may use assistive listening devices (ALDs). Compared to personal hearing aids ALDs have received little research attention. The aim of this study was dual; firstly to describe ALD-users in Sweden and the usefulness of various equipment in relation to specified hearing situations at work. Secondly, to describe favorable and non favorable conditions for using ADL at everyday situations at work. Seventy ADL-users answered a questionnaire and eleven of these persons were subsequently interviewed. The concept of stigma has been identified in research on hearing loss as a strong factor of denial and resistance for the use of both hearing aids and ALDs, depending on the negative connotations related to visible means for hearing. In this study overcoming stigmatization was further analyzed using social recognition as a theoretical approach. In a concluding discussion, where both categorizations and themes from the interviews were used, it issuggested that the use of visible ALDs is a way of overcoming stigmatization and that their visibility function as a mechanism in developing mutual social recognition in the work group.Though the results show a fairly high degree of usefulness from ALDs, work place adaptations should to a greater extent pay attention to environmental factors (e.g. noise and bad acoustics) influencing the use of this technology. More information on such factors is needed from studies of realistic situations at concrete work sites. Conclusions from this study are mainly valid for this sample; knowledge of the population is small due to lack of registers kept by the providers of this technology. To facilitate further studies on employed persons with hearing loss available statistics could be significantly improved by keeping records on both medical data and all kinds of rehabilitative adaptations measures.
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14.
  • Blomberg, Rina, 1974- (författare)
  • Auditory Distraction in ADHD : From Behaviour to the Brain
  • 2022
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • ADHD is a heterogenous disorder encompassing neurodevelopmental deficits in cognitive control. Auditory distraction is a common clinically reported symptom in ADHD, yet empirical research investigating the manifestation of auditory distraction in the disorder is remarkably scarce. Findings from cognitive hearing science highlight the crucial role cognitive control plays in an individual’s ability to gate, attenuate and/or compensate for auditory distraction. However the field is yet to extensively test hypotheses in normal hearing populations with neurodevelopmental deficits in cognitive control such as ADHD. This thesis contributes to narrowing the gap within these two fields of research by studying auditory distraction in this clinical population to a greater extent than previous reports in the literature.Using a combination of both behavioural and neuroimaging methods, the research presented here was able to show that adults and adolescents with ADHD are inherently more susceptible to auditory distraction than their non-ADHD counterparts. At the behavioural level, impaired task performance due to auditory distraction was more likely to manifest in ADHD participants when the working memory system was under high processing load. At the neural level, functional aberrancy in auditory attention was evident at early stages of sensory processing in a variety of tasks, implicating both exogenous and endogenous control systems in ADHD. Furthermore, the distribution of ADHD-symptom severity across participants was shown to correlate with increases in both cortical activity to auditory distractors and intrinsic functional connectivity between auditory and exogenous attention networks.In line with evidence from cognitive hearing science, the general findings of this thesis demonstrate that cognitive control plays an important role in the ability to perceive sound under suboptimal listening conditions and hamper distraction. In addition, findings challenge theories of ADHD that question the extent in which sensory-related attentional control is impaired. More empirical research on the auditory modality in ADHD is therefore encouraged in order to revise models, improve diagnostic tools, and develop evidence-based interventions targeting study/work environments.
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15.
  • Boman, Tomas (författare)
  • Situationen på den svenska arbetsmarknaden för personer med funktionsnedsättning : en sekundäranalys om sysselsättning, yrkesnivå, diskriminering, stöd och anpassning för personer med olika typer av funktionsnedsättning
  • 2019
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The overall aim of this thesis is to explore how the labour market situation appears to persons with different types of disabilities in Sweden. Study I (n=4 359) examined the importance of the person’s type of disability for the possibility of having a job. Study II (n=3 396) examined whether there were differences in occupational attainment between persons with different types of disabilities and between persons with and without a disability (n=19 004). Study III (n=4 359) examined perceived discrimination in the workplace among persons with different types of disabilities. Study IV (n=2 268) examined whatsupport and adaptation persons with different types of disabilities need in their actual workplace or to enter the labour market. In studies I–III the respondents were divided into six disability types, and in study IV the respondents were divided into four disability types.Overall, it can be concluded that a person’s type of disability is of importance for the situation in the labour market, where persons with psychological disabilities encounter barriers to a greater extent than other groups, both difficulties at the present workplace and difficulties entering the labour market. Further, they were subjected to discrimination and they expressed a great need for adaptations to acquire employment and at their actual workplace. It can also be concluded that there are discriminatory mechanisms against women, who have more difficulties than men in acquiring employment, and that men, despite lower education, can more easily progress in the labour market. It is suggested that, in order to achieve inclusion and recognition, factors in the environment, such as existing support systems, need to be changed and developed, and social prejudices vis-à-vis people with disabilities must also be addressed.
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16.
  • Boström, Katrin, 1955- (författare)
  • Living with deteriorating and hereditary disease : experiences over ten years of persons with muscular dystrophy and their next of kin
  • 2005
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The overall aim of this thesis was to elucidate haw persona with muscular dystrophy (MD) and their next of kin experience and describe their daily lives over the last ten years. MD is a group of inherited disorders characterised by muscular weakness caused by muscle wasting. Both qualitative and quantitative methods were used. Forty-isx individuals with MD and 36 next of kin were interviewed (Studies I, III, IV). Both groups completed the questionnaire Subjective Quality of Life (SQoL), (Study V). Persons with MD also completed the questionnaires Sickness Impact Profile and Self-report ADL (Study II). The interviews were subjected to qualitative content analysis. The persons with MD described the change from being independent to being an individual in need of assistive devices and/or personal support to manage activities of every day life (StudyI). Besides muscular weakness persons with MD have hte strain it means to have a hereditary disease, which also affects the family (Study III). The deterioration during a decennium was primarily with regard to ambulation. The number of persons walking without assistive devices has decreased from 40 to 23 and that of those working has almost been halved, from 21 to 11 (Study II). Next of kin have a special vulnerability in form of an emotional and practical lonliness in addition to actual and anticipatory losses. The relationship was described as related to obligation and/or love. To have an orientation towards tasks (obligation) was linked to a feeling of being weighed down by demands, while having an orientation towards relationship (love) was linked to a feeling of quality in life (Study IV). The persons with MD scored lower on most items in the SQoL than the next of kin (Study V). Patients without a partner scored lower on QoL as a whole than those with a partner. Those with an early onset of disease scored lower on personal economy. Next of kin who gave daily help assessed their relationships to friends lower than those who gave weekly help (Study V). This thesis provides knowledge of the trajectory with MD over time on the basis of a ten-year follow up. It also broadens the knowledge of how the hereditary aspect is experienced both by those with MD and their next of kin. How the next of kin of adult persons with MD experience their situation is an issue that has been overlooked in previous research.
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17.
  • Boström, Marianne, 1953- (författare)
  • Vardagslivets aktiviteter. Handlingen som terapeutiskt redskap vid återhämtning för personer med svårare psykiska funktionshinder : En analys av arbetsterapeuters berättelser med utgångspunkt i G H Meads teori om social handling
  • 2017
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • There is a need of community-based treatment methods with focus on everyday occupations, for persons with severe mental disabilities. The importance of occupation in achieving health has been highlighted in large mental hospitals and community-based service/support designed for people with severe mental disabilities who today live in society. Despite this support these people are in a vulnerable position, as they often have extensive difficulties in carrying out daily occupations which also leads to poorer well-being and health conditions. In the rehabilitation process, it is necessary to enable the person to use her own effort to perform activities. Occupational therapy has a unique role in community-based efforts for people with severe mental disabilities through their person-centered practices approaches and knowledge of daily occupations and how these can be used as therapeutic means of recovery and development of the self.The purpose of the study is to use theory about social action to contribute theoretical understanding about how everyday occupations are used as a therapeutic means for people with severe mental disabilities in occupational therapy, with the goal of contributing to their recovery and development of self. A qualitative, interpretative approach is used in the study to examine how everyday life can be used as a therapeutic tool. Empirical data of 11 events were generated from interviews with four occupational therapists. A theoretical tool developed by George Herbert Mead’s social psychological theory of the social act, were used as a frame for new-descriptions. Through abductive analyses reconstructed events are given new (theoretical) understanding.The result indicate that the social acts have met such difficulties that they have almost ceased and at the same time risk losing their meaning. The therapist adjusts the activity to find the level at which the person can participate with his/her own experience in the implementation of the everyday action. This gives the person with severe mental disabilities opportunities to use one self in the social process which eventually makes the person regain the ability to perform everyday activities
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18.
  • C. Manchaiah, Vinaya K., 1983- (författare)
  • Evaluating the process of change : Studies on patient journey, hearing disability acceptance and stages-of-change
  • 2013
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Person with hearing impairment (PHI) and their Communication partners (CPs) have a range of experiences and milestones before, during and after their audiological assessment and/or rehabilitation sessions. The term ‘patient journey’ refers to understanding the experiences and the processes the patient goes through during the course of the disease and the treatment regime. The aims of the current thesis were: (1) to further develop patient journey models of individuals with gradual-onset hearing impairment and CPs by taking their views into consideration; (2) to develop the patient journey model for PHI of sudden-onset; (3) to develop a self-reported measure of hearing disability acceptance and to study its construct and concurrent validity; (4) to investigate the health behaviour change characteristics of people noticing hearing difficulties using the stages-of-change model. Papers I (n=32) and III (n=9) were aimed at further developing the journey model of PHI and their CPs proposed by the Ida Institute. Both studies employed qualitative methods (i.e., focus groups and interviews for data collection and thematic analysis for data analysis), and defined the models based on the perspectives of PHI and CPs both of which had seven main phases. These data were compared with the professionals’ perspectives of the journey as reported in the Ida Institute model which had six main phases. Our studies highlight new phases (i.e., self-evaluation in PHI journey and adaptation in CP journey) and also various commonalities and differences in the perspectives expressed by professionals and patients.Paper II included a pilot study to explore the patient journey of sudden-onset acquired hearing impairment from both professionals (n=16) and patients (n=4) perspectives. Both identified all the six main phases, which include: awareness; movement; diagnostics; rehabilitation; self-evaluation; and resolution. The pre-awareness phase may hinder the realisation of hearing loss in persons with gradual onset hearing loss, whereas it is far more straightforward in persons with sudden-onset due to its nature of onset.Papers IV and V employed a cross-sectional design (n=90). Paper IV was aimed at developing a Hearing Disability Acceptance Questionnaire (HDAQ), and to study its construct and concurrent validity. Results suggested that the HDAQ has a two factor structure which explains 75.7% of the variance and had good internal consistency (Cronbach’s alpha of 0.86). Also, the scale had good concurrent validity in relation to self-reported hearing disability, self-reported anxiety and depression and readiness to change measures. Paper V was aimed at understanding the stages-of-change in adults with hearing disability using the University of Rhode Island Change Assessment Scale.  As predicted a high percentage of participants (over 90%) were in the contemplation and preparation stages, supporting the stages-of-change model.Overall, the papers presented in this thesis may contribute to a better understanding of process of change through hearing impairment in PHI and their CPs. 
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19.
  • Classon, Elisabet, 1965- (författare)
  • Representing sounds and spellings : Phonological decline and compensatory working memory in acquired hearing impairment
  • 2013
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • This thesis examined phonological processing in adults with postlingually acquired moderate-to-severe hearing impairment (HI) and whether explicit working memory processing of phonology and individual working memory capacity (WMC) can compensate for degraded phonological representations in this group (papers I-III). A second aim was to provide reference data for a test of WMC, the reading span test, and to examine the relation between reading span test performance and speech recognition in noise in a larger sample of 50-89 year olds with HI (paper IV). Non-auditory tasks of phonological processing, episodic long-term memory and WMC were used in papers I-III, and both behavioral and electrophysiological measures were collected. Results showed that phonological processing was impaired in the group with HI but that WMC and explicit working memory processing of phonology could be employed to compensate for degraded phonological representations. However, this compensation may come at the cost of interfering with episodic memory encoding. An  electrophysiological marker of HI in text-based rhyme judgments was found. Paper IV presented reference data for reading span test performance in two versions of the test in individuals with HI, and results suggesting that WMC may be differentially predictive of speech recognition in noise in different age groups of older adults with HI. The clinical implications of the present results concerns the double disadvantage of individuals with lower WMC and HI. A structured assessment of WMC in rehabilitative settings would help to identify these individuals and tailor treatment to their needs. The reading span test is suggested as a suitable future candidate for clinical WMC assessment.
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20.
  • Dahlström, Örjan, 1973- (författare)
  • Focus on Chronic Disease through Different Lenses of Expertise : Towards Implementation of Patient-Focused Decision Support Preventing Disability: The Example of Early Rheumatoid Arthritis
  • 2009
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Introduction: Rheumatoid arthritis (RA) is a chronic inflammatory disease. Treatment strategies emphasize early multi-professional interventions to reduce disease activity and to prevent disability, but there is a lack of knowledge on how optimal treatment can be provided to each individual patient.Aim: To elucidate how clinical manifestations of early RA are associated to disease and disability outcomes, to strive for greater potential to establish prognosis in early RA, and to facilitate implementation of decision support through analyses of the decision-making environment in chronic care.Methods: Multivariate statistics and mathematical modelling, as well as field observations and focus group interviews.Results: Decision support: A prognostic tree that predicted patients with a poor prognosis (moderate or high levels of DAS-28) at one year after diagnosis had a performance of 25% sensitivity, 90% specificity and a positive predictive value of 76%. Implementation of a decision support application at a rheumatology unit should include taking into account incentive structures, workflow and awareness, as well as informal communication structures. Prognosis: A considerable part of the variance in disease activity at one year after diagnosis could be explained by disease progression during the first three months after diagnosis. Using different types of knowledge – different expertise – prior to standardized data mining methods was found to be a promising when mining (clinical) data for new patterns that elicit new knowledge. Disease and disability: Women report more fatigue than men in early RA, although the difference is not consistently significant. Fatigue in early RA is closely and rather consistently related to disease activity, pain and activity limitation, as well as to mental health and sleep disturbance.Conclusion: A decision tree was designed to identify patients at risk of poor prognosis at one year after the diagnosis of RA. When constructing prediction rules for good or poor prognosis, including more measures of disease and disability progressions showed promise. Using different types of knowledge – different lenses of expertise – prior to standardized data mining methods was also a promising method when mining (clinical) data for new patterns that elicit new knowledge.
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21.
  • Danielsson, Henrik, 1974- (författare)
  • Facing the Illusion Piece by Piece : Face Recognition for Persons with Learning Disability
  • 2006
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Avhandlingens övergripande syfte var att undersöka ansiktsigenkänning för personer med och utan utvecklingsstörning. Tre specifika forskningsfrågor undersöktes:1. Hur ser interaktionen ut mellan familjaritet med ansikten och familjaritet med miljöer när det gäller bildigenkänning för personer med utvecklingsstörning?2. Kan någon av de 2 teoretiska ansatserna till förklaring av falska minnen (sammanblandning av olika minnen), bindingsansatsen och dubbelprocessansatsen, förklara prestationen för både personer med och utan utvecklingsstörning?3. Hur förhåller sig arbetsminnesförmåga till prestation i studier av falska minnen?Resultaten i de 4 artiklarna som ingår i avhandlingen gav svar på frågorna:1. Interaktionen mellan familjaritet med personer och miljöer kan förklaras med förhållandet mellan personen och miljön, som antingen kan vara frånvarande, närvarande eller osannolikt. Dessa semantiska relationer bestämmer prestationen och en ”lat” semantisk strategi föreslogs.2. Beroende på uppgiftens svårighetsgrad framkom olika interaktionsmönster mellan grupp och typ av igenkänningsbild, och då särskilt olika antal sammanblandade bilder. Dessa mönster kunde inte förklaras av någon av de 2 teoretisk ansatserna. Därför föreslås ett nytt sätt att tolka resultaten som inkluderar arbetsminne.3. Hög arbetsminneskapacitet gav 2 effekter: för det första, igenkänning av fler ansiktsdelar, och för det andra, igenkänning av fler ansiktskonfigurationer. Vid höga arbetsminneskrav så används den första effekten mer på bekostnad av den andra.Det visade sig också att prestationen för personer med utvecklingsstörning på uppgifter med låga arbetsminneskrav liknade prestationen för åldermatchade kontrollpersoner utan utvecklingsstörning på uppgifter med höga arbetsminneskrav. Detta indikerar att utvecklingsstörning kan ”simuleras” genom högre arbetsminneskrav, åtminstone på denna typ av igenkänningsuppgifter. Resultatens implikationer för vittnespsykologi och användandet av fotografier som kognitivt stöd diskuteras.
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22.
  • Edvardsson, Tanja (författare)
  • Consequences of brain tumours from the perspective of the patients and of their next of kin
  • 2008
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • A disease has consequences not only for the afflicted person but also for those who interact with him or her. A low-grade glioma is a brain tumour whose regarding its psychosocial implications for adult patients and their next of kin has received little attention in the literature. In the light of this the overall aim of the present thesis was to provide increased knowledge about how patients with low-grade glioma and their next of kin experience and deal with everyday life.The methods of the studies were mainly qualitative. Thirty-nine patients and 28 next of kin were interviewed and all except one next of kin completed a quality of life questionnaire.The onset of low-grade glioma was described from the patients’ perspective as a process, either rapid (up to a few months) or prolonged over several years. This phase of low-grade glioma encompassed repeated visits to physicians and care institutions. The onset of low-grade glioma was accompanied by stress, anxiety and uncertainty in the case of both the patients and those nearest. The symptoms and problems the patients experienced covered a broad range of consequences, physical, psychological and social. The patients presented a wide range of ways to cope with illness-related problems.The next of kin were often deeply involved in the patients’ situation and many of them experienced extremely stressful emotions mainly in the early period of the illness. They had experience of positive encounters in health care but more often they had had a sense both of powerlessness and of being invisible and neglected. Relations and roles changed in ways that mostly were experienced as negative. Enabling strength in everyday life had to do with alleviation of strain and having a positive outlook upon life. By means of the questionnaire Subjective estimation of Quality of Life (SQoL) the patients and those nearest estimated their quality of life as being comparatively high. Only one variable, among the patients the absence of work/meaningful occupation and among the next of kin the absence of own children, being estimated at below 60% of the maximum score.
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23.
  • Ehn, Mattias, 1972- (författare)
  • Life Strategies, Work and Health in People with Usher Syndrome
  • 2020
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Introduction: People with Usher syndrome (USH) have an inherited disorder causing congenital deafness or hearing loss combined with progressive vision loss and, in some cases, balance problems. Previous research has shown that people with USH have poor physical and psychological health. Research has, however, demonstrated that there are in-group health differences that have not yet been explored and that there is a lack of studies on life strategies as well as health in relation to working life.Aim: The aim was to explore the relationship between work and health in people with USH1 and 2 and to explore the experiences of life strategies in people with USH 2.Methods: A quantitative and a qualitative explorative design was employed comprising two cross-sectional studies of the relationship between work and health in people with USH2 (n=67) and USH1 (n=47). The third study, of life strategies, comprised focus group interviews with people with USH2a (n=14) analyzed by content analysis. The fourth study explored the lived experiences of working life by interviewing people with USH2 (n=7) using an interpretative phenomenological approach.Results: Study 1 and 2 demonstrated significant differences in health between working and nonworking people. Nonworking people showed significantly poorer health. In study 3, a variety of strategies to prevent and resolve challenges in life, as well as to comfort oneself was identified. The lived experiences of working life in people with USH2 (study 4) disclosed feelings of satisfaction, striving towards a work life balance. Work also disclosed feelings of limitations and uncertainty about the future.Conclusion: The results, which are discussed in relation to the Meikirsh model of health, demonstrated a complexity. Individual life strategies, psychological flexibility and environmental aspects, such as social determinants have to be considered to receive a comprehensive picture of the relationship between work and health in people with USH. This thesis provides new insights into the health of people with USH.
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24.
  • Englund, Ulrika, 1976- (författare)
  • Samverkansprojekt, och sen då? : en uppföljande studie av samverkansprocessen kring barn och unga som far illa eller riskerar att fara illa
  • 2017
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Satisfactory collaboration regarding children and youth in need of a comprehensive support is particularly important. Despite extensive research on collaborative work, knowledge of long term development of the collaboration process is lacking. The present thesis concerns inter-organizational collaboration within the framework of a former Swedish policy effort – focusing collaboration between schools, social services, police and the child and youth psychiatry – for the benefit of children and young people in distress or at risk. Applying a critical realist perspective, the overall aim of the thesis is to describe how former collaboration projects develop over time, and to identify significant mechanisms within this development. Through three questionnaire studies, the collaborative process development within the same collaborative settings is described (n=66) over a period of close to seven years. Estimations of 58 collaboration quality indicators within three categories *rules and regulations, *structural aspects and *shared perspectives/ consensus were collected at baseline in 2008, after one year at the final project stage in 2009, as well as five years after the project period (and the policy effort) ended, in 2014 (n=38). Two developmental trends occur: I) an overall positive trend and II) a negative trend on a comprehensive level. I) Collaboration on the target group has increased over time, are mainly incorporated into permanent organizational structures and is judged to have worked well/very well over time. II) Overall deteriorations of high estimates of the 58 quality indicators for collaborations is seen over the five year period, following the project period. However, less dramatic changes is noted on quality indicators concerning shared perspectives/consensus than on matters regarding rules and regulations and structural aspects. Five mechanisms of particular importance for the collaboration development are identified: anchoring, holistic perspectives, engagement, knowledge and clarity.
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25.
  • Ferreira, Janna, 1973- (författare)
  • Sounds of silence : Phonological awareness and written language in children with and without speech
  • 2007
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Avhandlingens övergripande syfte var att undersöka fonologisk medvetenhet och skriftspråklig förmåga hos talande eller icke-talande barn, med lässvårigheter eller motoriska talsvårigheter. De huvudsakliga fynden i denna avhandling var: (1) För barn med lässvårigheter som befinner sig på en tidig nivå i sin läsutveckling bör intervention kring läs- och skrivförmågor fokusera på barnets svaghet snarare än styrkan vad gäller ordavkodning. (2) För barn med lässvårigheter hade såväl fonologisk som ortografisk intervention effekt på förmågan att läsa och skriva. Fonologisk intervention hade effekt även på barnen med lägst läsförmåga. (3) För barn med motoriska talsvårigheter var det signifikanta skillnader mellan de bästa och de sämsta läsarna vad gäller auditiv fonemdiskrimination och generella språkförmågor. (4) För barn med motoriska talsvårigheter hade fonologisk intervention effekt på förmågan att stava ord men inte på läsförmågan. (5) I en analys av nonsensord undersöktes stavfel hos en flicka med anartri. Fler stavfel återfanns i längre ord och en högre grad av fel återfanns i mitten av ord, vilket tyder på svårigheter med arbetsminne och med att segmentera ord.Fynden diskuteras i relation till fonologisk informationsbearbetning inom fyra delområden: fonologiska representationer, fonologisk produktion, fonologiskt minne och fonologisk medvetenhet. Talets betydelse för läs- och skrivförmågan är komplex. Även ett gravt avvikande tal kan ge fonologisk återkoppling och för barn med anartri tycks bristen på tal spela en viss roll.Denna avhandling har ett handikappvetenskapligt synsätt och bidrar till den övergripande förståelsen av fonologisk medvetenhet och skriftspråklig förmåga. Flera av fynden är direkt applicerbara i kliniska sammanhang.
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26.
  • Fredriksson, Carin, 1954- (författare)
  • Att lära sig leva med förvärvad hörselnedsättning sett ur par-perspektiv : om anpassningsstrategiers funktionella och sociala innebörder
  • 2001
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The aim of the present thesis was to describe the everyday life of couples where one of the spouses has an acquired hearing loss. The main focus was on how they perceived their communicative possibilities in relation to the hearing loss and the role of acceptance in the process of learning to live with acquired hearing loss. The thesis is a longitudinal study based on the perspectives of couples. A combination of data sources was used; interviews, functional auditory assessments, a rating-scale and diary, the main source of information being the interviews.The main results of the thesis are; that the adjustment was a mutual process, and couples developed different patterns of responsibility for the adjustment process over time. The adjustment strategies were functional as well as social in their significance. The main strategy was prioritisation. Several situational strategies were also found. They showed a variation in communicative activities and participation. The habits and routines of everyday life played an important role for the manifestation of the disability and at times as a hindrance for acting strategically. The habits and routines call for special treatment for inclusion, special treatment in the sense of accommodating to the needs of the individual. The process of accepting played a mediating role between the individual needs and the needs of social flexibility. Some common features of the consequences of the hearing loss were crystallised despite different ways of examining the phenomenon. Finally implications for rehabilitation based on a couple-perspective were discussed.
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27.
  • Frölander, Hans-Erik, 1966- (författare)
  • Deafblindness : Theory-of-mind, cognitive functioning and social network in Alström syndrome
  • 2016
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • This thesis addresses young adults with Alström syndrome (AS). AS causes acquired deafblindness, a severe, progressive, combined auditory and visual impairment affecting daily life and self-reliance to a degree that full participation depends on help from others and society. AS is an autosomal, recessively inherited single-gene disorder that affects the ALMS1 gene. AS has a multi-systemic pathology including a high incidence of additional multiple endocrine abnormalities, cardiomyopathy, pulmonary fibrosis, restrictive lung disease and progressive hepatic and renal failure leading to reduced life expectancy. The focus in the present thesis is on the development of Theory-of-mind (ToM) and on how ToM relates to the development of certain cognitive skills and the characteristics of the individual social network. ToM refers to the ability to understand the thoughts and feelings of others.The results reveal that individuals with AS displayed a significantly higher degree of heterogeneity in the performance of ToM tasks, and some individuals with AS performed on an equal level with nondisabled individuals. ToM performance was predicted by verbal ability and executive functioning (EF), whereas working memory capacity (WM) proved to be an indirect predictor. Later onset of visual loss further characterized AS individuals with better ToM. The sizes of the social networks of individuals with AS were smaller relative to those of nondisabled individuals, and many of the acquaintances were professionals working with individuals with AS. The number of friends correlated with ToM performance.Methods to improve verbal ability and EF, and interventions to enhance social participation in childhood of individuals with AS might prove to be fruitful. In addition assistive technology to establish and maintain friendships in adulthood is required.
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28.
  • Germundsson, Per, 1956- (författare)
  • Lärare, socialsekreterare och barn som far illa : om sociala representationer och interprofessionell samverkan
  • 2011
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The aim of the thesis is, through use of the theory of social representations, to increase knowledge about the meeting between social workers and teachers, as professional groups, during collaboration with regard to the target group, children at risk. The thesis intends to capture the parties’ perceptions of one another and of that about which they are cooperating, as well as to discuss possible consequences of these perceptions in the context of interprofessional collaboration on children at risk. Empirical data was collected through an association study. The informants consisted of 200 teachers and social workers who had participated in various collaborative projects concerning the target group of children at risk. The study shows that the two professional groups have similar representations of children at risk. The social workers’ representations of the teachers are mostly positive, but the teachers are perceived, in many cases, to lack knowledge about social workers and their field of expertise. Teachers’ representations of social workers are colored to a much greater extent by negative associations. The negative image is primarily related to social services as an organization, not to social workers as individuals. In relation to the specific area of interprofessional collaboration on children at risk, the study indicates that the involved parties’ social representations play a significant role in the collaboration process. The research of this thesis has shown that the theory of social representations provides an effective framework for the study of the collaborating professionals’ group perceptions of one another and of children at risk. A preliminary model that seeks to illuminate the role of social representations, trust, and communication in the collaborative process has been presented.
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29.
  • Granberg, Sarah, 1973- (författare)
  • Functioning and disability in adults with hearing loss : the preparatory studies in the ICF Core sets for hearing loss project
  • 2015
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Hearing loss (HL) is a health condition that affects more than 360 million people worldwide. The findings from previous research point at the adverse relationship between adults with hearing loss and important aspects of everyday life such as social relations, communication and work-related tasks. However, the overall picture concerning the functional and disabling aspects of adults with HL re- mains incomplete. To identify the functional and disabling aspects, a conceptual and/or theoretical framework is required. The International Classification of Functioning, Disability and Health (ICF) offer a multidimensional framework based on bio-psycho-social assumptions about health. In previous research inves- tigations in which the ICF has been used, some utility problems in the linking (relating) of data to the classification have been highlighted.The aims of the present thesis were to explore the areas of functioning and disability of relevance for adults with HL and to explore how audiological data can be linked to ICF. The aims were explored by applying the methodology of the ‘interdisciplinary evidence-based approach to functioning and disability in adults with HL’, acknowledging the merging of three perspectives designated the Researcher, the Patient and the Professional perspective. Four studies that focus on the three perspectives were conducted. All results were linked to the ICF classification. The results were merged into a model designated ‘the integrative model of functioning and disability in adults with HL’.When the three perspectives were linked, the results revealed several aspects of relevance for the target group. Bodily (individual) dimensions, such as hear- ing, auditory perception, memory, attention, energy, and emotions, were acknowledged. Aspects of everyday life such as conversations, the usage of communication strategies, family relationships and work, were highlighted. Influential environmental factors, such as noise, assistive technical devices, the design of public buildings, social support and the attitudes of people in the envi- ronment, were also identified. In conclusion, interactions seemed to be vital as almost all identified aspects highlighted or were tied to this dimension of human functioning. Further, concerning the linking of the data it was acknowledged that the ICF and the research area of adult HL do not fully comply. Suggestions for improvements in future revisions of the ICF were highlighted and discussed.
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30.
  • Gustafson, Stefan, 1968- (författare)
  • Varieties of reading disability : Phonological and orthographic word decoding deficits and implications for interventions
  • 2000
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The general aim of this thesis was to examine variations in the word decoding skills of reading disabled children. These variations were related to possible cognitive, developmental, and environmental causes of reading disability. Possible implications for educational interventions were also analysed. The thesis critically examines the inclusion of the concept of intelligence in the definition of developmental dyslexia. It is suggested that variations in word decoding skills should offer a more solid basis for a study of varieties of reading disability. The empirical studies showed that a) in young children there was a shift from phonological to orthographic word decoding; b) phonological type children (weak in phonological decoding) were characterised by specific phonological deficits; c) surface type children (weak in orthographic decoding) showed more global cognitive deficits suggesting a general developmental delay; d) surface type children showed impaired visual implicit memory for words, which might be associated with limited print exposure; e) an improvement in phonological awareness only transferred to an improved text reading ability for some reading disabled children; f) children who did not benefit from a phonological intervention seemed to rely on orthographic word decoding in text reading. Thus, the thesis suggests that variations in phonological and orthographic word decoding skills offer a useful basis for the study of varieties of reading disability and that educational interventions should pay regard to what the child is already attempting to do when reading.
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31.
  • Gustafsson, Johanna, 1975- (författare)
  • Supported employment i en svensk kontext : förutsättningarnär personer med funktionsnedsättning når,får och behåller ett arbete
  • 2014
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The overall aim of this thesis is to discover, to value and to explain, if and why Supported Employment functions in a Swedish context and to also highlight those mechanisms which provide meaningful conditions within that context, when a person with a disability reaches, procures and retains employment. The empirical part consists of four studies that examine (1) whether SE has an effect on the employment rate, disposable income and sum of allowances, (2) the employer´s perspective of employing people with disabilities, (3) how employers perceive support from SE in the employment process and (4) how employees with disabilities perceive their work situation and social inclusion in the workplace. The studies within the thesis show that in a Swedish context, SE is encompassed by norm structures, production structures and economical structures which affect conditions for people with disabilities to reach, procure and retain employment. Supported Employment’s mode of practice and the ability to meet, co-exist and co-operate with these social structures has, in many ways, affected the prerequisites for people with disabilities to reach employment. These structures do not in themselves however, constitute a sufficient frame of ideas to enable an understanding of how SE works in a Swedish context, or how to explain the factors that affect conditions when people with disabilities reach, procure and retain employment. In the qualitative studies, trust features prominently and is considered an important mechanism in holding the process together.
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32.
  • Gustavsson Holmström, Marie, 1965- (författare)
  • Föräldrar med funktionshinder : om barn, föräldraskap och familjeliv
  • 2002
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • An increasing number of people with disabilities are choosing to become parents. However, several official goverment reports and other evidence points to the fact that parents with disabilities sometimes experience negative bias and distrust of their capacities as parents. The aim of this study is to describe and analyse aspects of parenthood in the families including parents with disabilities and/or chronic illness, as well as to illuminate concepts of an thoughts on parenthood and disability in these families. This is a qualitative interview study, complemented with structured diaries and network maps. The impairments or chronic illness of the parents in the eleven families of the study are cerebral palsy, spinal cord injury and multiple sclerosis.The different areas of the study are: the parents' reflections on becoming parents, the impact of the surrounding environment on the family, the effects of impairment or chronic illness in the family's everyday life and the parents' reflections on children and parenthood. The parents first and foremost describe their families as like any other families, but at the same time describe the special circumstances they live under. They work to handle the possibilities of negative consequences for the children with different strategies. The parents describe what they regard as the special experiences and knowledge that their children acquire which will benefit them as adults. The study recognises some dichotomous concepts relevant to different areas of family life in families with disabilities. The feeling the parents express of living in a world of double standpoints can be understood as ambivalence or in terms of embrace of paradox.
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33.
  • Henricson, Cecilia (författare)
  • Cognitive capacities and composite cognitive skills in individuals with Usher syndrome type 1 and 2
  • 2015
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The present thesis belongs to the research area disability research and deal with specific aspects of cognition in individuals with Usher syndrome type 1 and 2. The subject has been investigated and is discussed within an interdisciplinary framework, though the theories applied and described are derived from the area of cognitive psychology. Usher syndrome is a rare genetic condition causing a combination of visual and hearing impairment: deafblindness. There is a congenital hearing loss that is profound in type 1 and moderate to severe in type 2. During mid-childhood symptoms of visual impairment, e.g. light sensitivity, emerge and a progressive loss of visual field follows as a result of the genetically caused eye disease Retinitis Pigmentosa. The syndrome has previously been well described with respect to the genetical and medical aspects, but there has been very little research with a cognitive perspective on the population. Studies 1 and 2 in the present thesis focused on children with Usher syndrome type 1 with cochlear implants and investigated phonological skills, lexical access, working memory and reading skill in the group. Studies 3 & 4 investigated the same cognitive abilities and theory of mind in adults with Usher syndrome type 2. In study 4 the performance on theory of mind in the adults with Usher syndrome type 2 was also compared to that of another group with genetically caused deafblindness: individuals with Alström syndrome.The results were that both the children and adults with Usher syndrome had significantly poorer phonological processing than the control groups with normal hearing. There was a large variation on performance on lexical access, especially in the group of children, however several individuals performed at the same level as the control group. Reading skill was found to be at level with the control groups’. There was also great variation in performance on ToM, however the majority of individuals performed similar to the control group with normal hearing and vision. The present project has resulted in some new knowledge on cognitive performance in  individuals with Usher syndrome type 1 and type 2. Performance in the participants with Usher syndrome can to a large extent can be understood by application of the models developed in previous research on populations with hearing impairment or deafness for understanding the impact of hearing with a hearing aid or cochlear implant. However, individuals with Usher syndrome experience additional difficulties in accessing information due to the progressive visual loss and the impact this has on performance is still largely unknown. Hence, the present project would recommend that interventions and support would be designed specifically to each individuals’ needs, with consideration of both the visual impairment and the hearing impairment.
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34.
  • Hesser, Hugo, 1982- (författare)
  • Tinnitus in Context : A Contemporary Contextual Behavioral Approach
  • 2013
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Tinnitus is the experience of sounds in the ears without any external auditory source and is a common, debilitating, chronic symptom for which we have yet to develop sufficiently efficacious interventions. Cognitive behavioral therapy (CBT) has evolved over the last 20 years to become the most empirically supported treatment for treating the adverse effects of tinnitus. Nevertheless, a significant proportion of individuals do not benefit from CBT-based treatments. In addition, the theoretical underpinnings of the CBT-model are poorly developed, the relative efficacy of isolated procedures has not yet been demonstrated, and the mechanisms of therapeutic change are largely unknown. These significant limitations preclude scientific progression and, as a consequence, leave many individuals with tinnitus suffering.To address some of these issues, a contextual multi-method, principle-focused inductive scientific strategy, based on pragmatic philosophy, was employed in the present thesis project. The overarching aim of the thesis was to explore the utility of a functional dimensional process in tinnitus: Experiential avoidance—experiential openness/acceptance (EA). EA is defined as the inclination to avoid or alter the frequency, duration, or intensity of unwanted internal sensations, including thoughts, feelings or physical sensations. The thesis is based on experimental work (Study II, VI), process and mediation studies (Study I, III, V), and on randomized controlled trials (Study III, IV).Three main sets of findings supported the utility of EA in tinnitus. First, an acceptance-based treatment (i.e.,Acceptance and Commitment Therapy, ACT) was found to be effective in controlled trials. Study III demonstrated that face-to-face ACT was more effective than a wait-list control and a habituation-based sound therapy. Study IV showed that internet-delivered ACT was more effective than an active control condition (internet-discussion forum) and equally effective as an established internet-delivered CBT treatment. Second, processes research (Study I, III, V) showed that key postulated processes of change were linked to the specific technology of ACT and that these changes in processes were associated with therapeutic outcomes. Specifically, Study V found evidence to that decreases in suppression of thoughts and feelings over the course of treatment were uniquely associated with therapeutic gains in ACT as compared with CBT. Third, experimental manipulations of experiential avoidance and acceptance processes provided support to the underlying dimension (Study II, VI). That is, Study II, employing an experimental manipulation, found that controlling background sounds were associated with reduced cognitive efficiency and increased tinnitus interference over repeated experimental trials. In addition, in normal hearing participants, experimentally induced mindfulness counteracted reduced persistence in a mentally challenging task in the presence of a tinnitus-like sound stemming from initial effortful suppression of the same sound (Study VI). It is concluded that a principle-, contextual-focused approach to treatment development may represent an efficient strategy for scientific progression in the field of psychological treatments of tinnitus severity.
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35.
  • Hillborg, Helene, 1968- (författare)
  • Erfarenheter av rehabiliteringsprocessen mot ett arbetsliv : brukarens och de professionellas perspektiv
  • 2010
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Erfarenheter av rehabiliteringsprocessen mot ett arbetsliv - brukarens och de professionellas perspektiv. Örebro, Studies from the Swedish Institute of Disability Research No 34, 107 pp.The overall aim of this dissertation is to (1) describe and analyse perceived barriers and opportunities from the perspective of the individual receiving vocational rehabilitation services as a result of unemployment and psychiatric disability (2) describe and analyse perceived barriers and opportunities in services for unemployed people with psychiatric disabilities from the perspective of professionals working in the area of vocational rehabilitation and (3) utilize empowerment theory to explore and develop a deeper understanding of the experiences and perceptions described by these individuals and professionals. The data consists of open-ended interviews with service users and professionals’ working in the area of vocational rehabilitation. A content analysis together with an interpretive approach was used to analyse the data. The results revealed that support and the psychosocial work environment are important factors that influence the rehabilitation process for the individual. These factors can facilitate opportunities to develop skills in contacts with fellow employees, increase belief in one’s own abilities, and can contribute to the achievement of specified goals. These factors are also seen as supporting empowerment and active participation in the rehabilitation process. However, the results also revealed that the rehabilitation process is negatively effected by environmental factors to which the professionals and their organizations contributed. Barriers related to interagency collaboration contributed to barriers to a successful rehabilitation for the individual. The professionals were consistent in what they viewed as enabling factors in the rehabilitation process but the results also showed how difficult it was for the service system to create a rehabilitation context in line with their knowledge and experience.Keywords: Psychiatric disabilities, vocational rehabilitation, empowerment, interagency collaboration, support system.
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36.
  • Holmer, Emil, 1983- (författare)
  • Signs for Developing Reading : Sign Language and Reading Development in Deaf and Hard-of-Hearing Children
  • 2016
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Reading development is supported by strong language skills, not least in deaf and hard-of-hearing (DHH) children. The work in the present thesis investigates reading development in DHH children who use sign language, attend Regional Special Needs Schools (RSNS) in Sweden and are learning to read. The primary aim of the present work was to investigate whether the reading skills of these children can be improved via computerized sign language based literacy training. Another aim was to investigate concurrent and longitudinal associations between skills in reading, sign language, and cognition in this population. The results suggest that sign language based literacy training may support development of word reading. In addition, awareness and manipulation of the sub-lexical structure of sign language seem to assist word reading, and imitation of familiar signs (i.e., vocabulary) may be associated with developing reading comprehension. The associations revealed between sign language skills and reading development support the notion that sign language skills provide a foundation for emerging reading skills in DHH signing children. In addition, the results also suggest that working memory and Theory of Mind (ToM) are related to reading comprehension in this population. Furthermore, the results indicate that sign language experience enhances the establishment of representations of manual gestures, and that progression in ToM seems to be typical, although delayed, in RSNS pupils. Working memory has a central role in integrating environmental stimuli and language-mediated representations, and thereby provides a platform for cross-modal language processing and multimodal language development.
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37.
  • Hua, Håkan (författare)
  • Employees with Aided Hearing Impairment : An Interdisciplinary Perspective
  • 2014
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • In Sweden 13% of the general adult population (16-84 years), with or without hearing aids (HAs), report that they have difficulties following a conversation when more than two people are involved. This means that more than one million people in Sweden (9 500 000 inhabitants in total) report subjective hearing difficulties. Observations further indicate that that people with hearing impairment (HI) have an unfavorable position in the labor market. Individuals with HI report poorer health more frequently and estimate their own health to be worse than their normally-hearing peers. Increased unemployment, early health-related retirement and sick leaves are also more common for people with hearing loss compared to the population at large.The focus of the present thesis is employees with mild-moderate aided HI in the labor market. The research project had three general aims: 1) to develop knowledge about how HI interacts with cognitive abilities, and different types of work-related sound environments and workrelated tasks, 2) develop tests and assessment methods that allow for the analysis and assessment of perceived problems in clinical settings and 3) to develop knowledge that enables the possibility to provide recommendations of room acoustics and work-related tasks for employees with HI. Four studies were carried out. The studies presented in papers I-III are quantitative laboratory studies focusing on health related quality of life, cognition and effort and disturbance perceived in different types of occupational noise (daycare, office and traffic). Paper IV is a qualitative interview study aiming at exploring the conceptions of working life among employees with mild-moderate aided HI.The results from papers I-IV clearly demonstrate that noise has negative effects on employees with mild-moderate aided HI. In addition to generating significantly greater effort and disturbance, it is further reported from the participants that noise at work in combination with a HI has an impact on daily life. This includes a sense of exposure during work hours, physical and mental fatigue after work, and withdrawal from social situations in the work environment and leisure activities. None of the participants with HI performed significantly worse on the visual working tasks employed in this project compared to their normallyhearing peers. This thesis shows that employees with HI objectively perform the employed  working tasks at a level similar to a well-matched normally-hearing control group. Instead, the findings of this thesis indicates that working in a noisy environment with a HI occurs at the expense of this group reporting significantly worse results on subjective measurements, including greater effort and disturbance, and lower physical health status. Interviews with these participants further confirm that these effects are indeed mostly due to noise at the workplace which could have a negative impact both physically, mentally and socially during and after work hours.The main findings of this thesis demonstrate that there is a need for extensive services for employees with HI even after a HA fitting. This thesis therefore emphasizes the importance of identifying the need for assistive listening devices, examining the room acoustics of the individual’s work setting and providing the workplace with information about the consequences of having a HI in order to facilitate communication at work. The latter is especially important as colleagues showing support and employers making adjustments at the workplace (technically or acoustically) are facilitating factors that would benefit both employees with HI and those with normal hearing. Additional research should focus on including and comparing other types of cognitive tests, work-related noises and working tasks. More research is also needed to unravel the complex area of research between factors such as cognitive processes, hearing and effort.
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38.
  • Hultman, Elin (författare)
  • Barnperspektiv i barnavårdsutredningar : med barns hälsa och barns upplevelser i fokus
  • 2013
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Avhandlingens övergripande syfte var att fördjupa kunskapen om hur socialtjänsten synliggör barns fysiska och psykiska hälsa samt barns egna upplevelser i barnavårdsutredningar. Resultaten diskuteras utifrån rättsliga förutsättningar samt teorier om barn som subjekt och sociala aktörer. De fyra delstudierna visar att det finns begränsningar i hur hälsan samt barns upplevelser beskrivs om man vill förstå deras behov av stöd. En anledning till detta kan vara att den rättsliga regleringen inte per automatik ger barn status som subjekt och aktörer. Resultaten tyder på att barnperspektivet i både den rättsliga regleringen och genomförandet av barnavårdsutredningar har stärkts jämfört med vad som visats i tidigare forskning men det behövs en utvecklad analys och argumentation kring barns upplevelser och barns hälsa. En sådan förståelse ger förutsättningar för att barn blir synliggjorda utifrån sina unika förutsättningar vilket säkerställer att socialtjänsten tar hänsyn till deras unika behov.
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39.
  • Hällgren, Mathias, 1972- (författare)
  • Hearing and cognition in speech comprehension. Methods and applications
  • 2005
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Central auditory processing is complex and can not be evaluated by a single method. This thesis focuses on assessment of some aspects of central auditory functions by the use of dichotic speech tests and cognitive tests that tax functions important for speech processing.Paper A deals with the cognitive effects in dichotic speech testing in elderly hearing-impaired subjects. It was found that different listening tasks in the dichotic tests put different demands on cognitive ability, shown by a varying degree of correlation between cognitive functions and dichotic test parameters. Age-related cognitive decline was strongly connected with problems to perceive stimuli presented to the left ear.Paper B presents a new cognitive test battery sensitive for functions important for speech processing and understanding, performed in text, auditory and audiovisual modalities. The test battery was evaluated in four groups, differing in age and hearing status, and has proven to be useful in assessing the relative contribution of different input-modalities and the effect of age, hearingimpairment and visual contribution on functions important for speech processing.In Paper C the test battery developed in Paper B was used to study listening situations with different kinds of background noise. Interfering noise at +10 dB signal-to-noise ratio has significant negative effects on performance in speech processing tasks and on the effort perceived. Hearing-impaired subjects showed poorer results in noise with temporal variations, and elderly subjects were more distracted by noise with temporal variations, especially by noise with meaningful content. In noise, all subjects, particularly those with impaired hearing, were more dependent upon visual cues than in the quiet condition.Hearing aid benefit in speech processing with and without background noise was studied in Paper D. The test battery developed in Paper B was used together with a standard measure of speech recognition. With hearing aids, speech recognition was improved in the background condition without noise and in the background condition of ordinary speech. Significantly less effort was perceived in the cognitive tests when hearing aids were used, although only minor benefits of hearing aid amplification were seen. This underlines the importance of considering perceived effort as a dimension when evaluating hearing aid benefit, in further research as well as in clinical practice.The results from the studies contribute to the knowledge about speech processing but also to the search for more specific evaluation of speech understanding, incorporating both sensory and cognitive factors.
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40.
  • Ingo, Elisabeth, 1987- (författare)
  • Climbing up the hearing rehabilitation ladder
  • 2019
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Hearing impairment is a major public health problem, affecting communication and participation, and is associated with a range of health problems. Most individuals with perceived hearing impairment do not seek help, do not opt for rehabilitation (hearing aids), and do not use prescribed hearing aids adequately. Reducing the impact of hearing impairment and supporting healthy aging are important public health goals. Motivation, access to hearing health care, and poor societal awareness about hearing impairment, consequences, and rehabilitation options influence help-seeking. Offering online hearing screening has been proposed to improve hearing help-seeking, access to hearing health care, and to increase public knowledge about hearing and hearing impairment. Applying theories from health psychology (i.e. the Stages of change model) could help audiologists and other hearing health care professionals understand the psychological barriers that prevent people with hearing problems to seek help and take up rehabilitation. The overarching aim of this thesis was to investigate behaviors related to hearing rehabilitation (help-seeking, hearing aid uptake, and hearing aid use) in adults who fail an online hearing screening. A second aim was to explore the usefulness of the Stages of change model in predicting hearing rehabilitation related behavior in a self-selected online hearing screening sample. Studies I–IV show tentative support for offering online hearing screening and for supplementary interventions for increasing help-seeking and provide tentative support for Stages of change as a useful classification tool to indicate individual needs for further information and guidance. Future studies should contemplate integrating screening for multiple health-related factors associated with hearing impairment and to provide a clear and tailored pathway for each participant (e.g. referral to adequate health care or equivalent online intervention).
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41.
  • Jansson, Marie, 1960- (författare)
  • Två kön eller inget alls : politiska intentioner och vardagslivets realiteter i den arbetslivsinriktade rehabiliteringen
  • 2003
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • This dissertation poses questions concerning the shaping of the welfare state and the implications of citizenship. Citizenship in democratic welfare states is based on the idea that everyone is of equal value. Who it is that constitutes the norm for "everyone" is examined in this analysis by applying feminist theory as a complement to more traditional political theories.By following developments within an area of social insurance – vocational rehabilitation - from the 1940s until the year 2000, changes over the years in the norms and values of the welfare state become apparent, from a recognition of both gainful employment and household work to an almost total disavowal of unpaid work. This analysis shows that development of the welfare state can be very well explained by social liberal theory when citizenship based on a male norm constitutes the frame of reference. When feminist theory adds the private sphere, and the realities of everyday life are taken into consideration, citizenship is no longer equally accessible to both sexes.In the Swedish welfare model, gainful employment is encouraged, and by using various incentives the state tries to induce women to take part in gainful employment to the same extent as men. This has not succeeded, which according to feminist theory is because the policy focuses only on citizens in the public sphere. According to liberal tradition, family life is a protected zone, implying that the division of work between spouses is something the state should not attempt to change. The realities of everyday life and political intentions end up in conflict, and as a consequence women cannot enjoy full citizenship to the same extent as men.This dissertation demonstrates the importance of adding a gender perspective to critiques of the welfare state. Looking at the conditions of both men and women in both the private and public spheres poses new questions and also provides new answers to old questions.
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42.
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43.
  • Jerlinder, Kajsa, 1976- (författare)
  • Rättvis idrottsundervisning för elever med rörelsehinder : dilemma kring omfördelning och erkännande
  • 2005
  • Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Licentiate dissertation, written in Swedish with an English abstract.The educational goal of “a school for all” creates many challenges. Issues of socialjustice and equity are central tenets of the concept of inclusive education. Despitethe goal of comprehensive education for all children, for many pupils with physicaldisabilities in an inclusive school system PE (Physical Education) teaching canresult in experiences of injustice. In the struggle to achieve social equity and createeducational experiences where disability does not matter, it seams to matter verymuch.The aim of this study is to illustrate a dilemma and its potential outcomeswhere demands for justice for pupils with physical disabilities are raised in inclusivephysical education. In the study, based on theories of redistribution andrecognition, two empirical examples are presented.The first example, in the context of the decentralisation of Swedish compulsoryschools, illustrates degrees of awareness about numbers of pupils with physicaldisabilities attending compulsory schools located in a case municipality. Foursources, with varying responsibilities for disabled children, all reported differentnumbers of pupils. Thus, with no congruent data at municipality level, distribu-tion and redistribution of necessary resources becomes difficult.In the second example of a ten year old boy with a physical disability,experiences of participation in inclusive physical education are described, fromthe perspective of five different actors (the boy himself, his PE teachers (2), hisparents, classmates, and his personal assistant).Data for this case study was gathered through interviews and systematic ob-servation. In this particular case, the outcome of inclusive PE was judged to besuccessful. The example illustrates the importance of recognition needing to befulfilled at several distributive levels. The positive outcome is discussed in terms ofthe combination of identification of particular special needs, sensitive adaptation,and general respect for the child with physical disability.Dilemmas of justice for disabled pupils in physical education are best studiedwithin a multi-level context. Recognition and redistribution demands need to besimultaneously addressed in order to fulfil the goal of equitable education forpupils with physical disabilities attending PE within the compulsory school sys-tem. An attempt to combine these different ideological approaches is discussedfrom the perspective of social status.The outcome of the two empirical examples presented in this study illustrategeneral dilemmas reaching beyond the educational challenges facing pupils withphysical disabilities and the responses of the compulsory school system to them.
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44.
  • Jerlinder, Kajsa, 1976- (författare)
  • Social rättvisa i inkluderande idrottsundervisning för elever med rörelsehinder : en utopi?
  • 2010
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    •  The aim of this thesis is to contribute to the knowledgebase of inclusion and inclusive education and to outline possible consequences that may arise from an educational ideology of inclusion. The thesis describes a potential dilemma that is both theoretical and practical. The dilemma consists of, on the one hand, a need of identification and categorisation of specific groups in society in order to allocate and redistribute available resources, while, on the other hand, there is a need of social recognition of diversity in educational settings in order to achieve social justice and parity of participation. The inclusion of pupils with physical disabilities in the school subject of physical education (PE) is used as a particular example to illustrate a general dilemma. The specific aims were: i) to describe and apply a theoretical framework of ‘social status’ as a possible means of resolving the dilemma (study I); ii) to study PE teachers’ attitudes toward inclusive physical education (studies II and III); and iii) using a case study, to explore the experience of physical education through the eyes of a pupil with a physical impairment and his parents, classmates, PE teachers and personal assistant (study IV). Results show that Swedish PE teachers at primary school level are positive to inclusive PE for pupils with physical disabilities. Factors found to contribute to these positive attitudes were adequate training in inclusive education strategies, supportive school environments and personal resources. In a systematic review of international research PE teachers, in general, were found to have ambivalent attitudes to inclusive PE. This ambivalence was found over cultural borders among the 1200 respondents covered in the 15 articles reviewed and may indicate a latent awareness of the dilemma. Previous experience of having taught PE to pupils with physical disabilities, together with proper education in inclusion, mediated a more positive attitude. The case study of a 10-year-old boy with physical disabilities and significant others in his educational life proved to be a signal example of successful inclusion. Honneth’s three levels of social recognition were used in the analysis. Social recognition at individual, legal and value dimensions is a prerequisite for achieving social justice in inclusive PE settings. Finally, these findings, taken together, indicate a need to address social recognition and redistribution demands simultaneously in order to meet goals of equitable education for pupils with physical disabilities in inclusive PE teaching. Societal (external) and individual factors need to be combined when addressing the issue of social justice in inclusive education. A model of social status, developed by Fraser (2001; 2003), used in conjunction with the notion of plural identities is suggested as a possible resolution to the dilemma described in the thesis.  
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45.
  • Josephson, Iréne (författare)
  • Utrymme för deltagande : Beslutsprocesser i möten mellan patienter med ospecifika ländryggsbesvär och sjukgymnaster i primärvård
  • 2013
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Hälso- och sjukvårdsmöten som föranleds av medicinskt ospecifika symptom innebär utmaningar för både patient och vårdprofessionell. Samtidigt erbjuder det ospecifika ett mer flexibelt utrymme för patienters aktiva deltagande i beslutsprocesser än vad som är fallet vid specifika hälsoproblem med ett begränsat antal vedertagna behandlingsalternativ. Syftet med forskningsprojektet var att undersöka utmaningar relaterade till utrymmet för patienters deltagande i beslutsprocesser avseende intervention. Avhandlingen baseras på fyra artiklar som undersöker erfarna sjukgymnasters föreställningar om, och interagerande i möten med patienter med ospecifika ländryggsbesvär.Forskningsprojektet genomfördes med explorativ empirisk ansats kombinerat med fokuserad etnografi. Det betyder att forskningen grundas på erfarenhetsbaserad kunskap som samlas in i naturligt förekommande verksamhet. Data samlades in via fokusgrupper med sjukgymnaster, samt via deltagande observationer av det första mötet mellan sjukgymnast och patient. Samtliga sammankomster videofilmades och transkriberades, och analyserades med fokus på beslutsprocesser avseende intervention.Forskningsprojektet resulterade i tre mönster: i) kontrasten mellan sjukgymnasternas förställningar om helhetsperspektiv i förhållande till det biomedicinska intresse som de utövade, ii) omvandlingen av patienternas resursorientering till biomedicinskt hälsoproblem, samt iii) överensstämmelse mellan sjukgymnasternas inställning till, och deras hantering av andra aktörer. Resultatet tyder på att sjukgymnasterna resonerade om element från flera systemnivåer men fattade beslut på sin egen systemnivå, det vill säga utifrån professionell metodik och teori. Det innebär att utrymmet för patienters aktiva deltagande i beslutsprocesser avseende intervention inte togs tillvara i den omfattning som var möjlig. Genom att vårdprofessionella utvecklar kommunikativa och interaktiva förmågor kan patienters resurser bättre tas tillvara i intervention, vilket indirekt kan leda till ökad nöjdhet och bättre funktionsförmåga.
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46.
  • Karlsson, Elin, 1990- (författare)
  • Assessment of everyday functioning for adults with hearing loss : Development of Hearing and Functioning in Everyday life Questionnaire (HFEQ)
  • 2022
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Aim: The overall aim of the current thesis was to develop a self-assessmentinstrument with a focus on everyday functioning for adults with hearingloss and to investigate its psychometric properties.Methods: Three different methods were applied in the current studies; a scoping review (Study I), two quantitative studies using two different datacollection processes (Study II and IV) and a qualitative study, including anitem-generation workshop and cognitive group interviews (Study III).Results: The scoping review (Study I) showed that the validation process ofICF Core Sets has varied between studies, including studies that used bothqualitative and quantitative methodology. Most of the validation studieshave been conducted in Western, high-income countries and have only useda single population.The validation of the Brief ICF Core Set for Hearing Loss (Study II) was conducted internationally, including four continents and both middle- and high-income countries. The results demonstrated satisfactory content validity and internal consistency. However, two ICF categories (b126 and d810) arerecommended to be specified if they are used in a future instrument. In study III HFEQ was developed by international experts in the field ofaudiology and/or ICF. The HFEQ was then validated in two studies withfocus on the content validity (Study III) and the construct validity (StudyIV). Altogether, the results showed satisfying levels of content and construct validity for the HFEQ, as well as internal consistency reliability, feasibility and comprehensibility. Minor adjustments such as rewording arerecommended in the future. The results of study II-IV strengthen the hypothesis that everyday functioning seems to be a relevant and valid phenomenon to measure within audiology. Conclusion: ICF Core sets have been validated using several methods. The Brief ICF Core Set for Hearing Loss has satisfactory validity for adults with hearing loss and is a relevant foundation for a new self-assessment instrument. The HFEQ is a valid self-assessment measure for assessing everyday functioning for adults with hearing loss.
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47.
  • Keselman, Olga (författare)
  • Restricting participation : Unaccompanied children in interpreter-mediated asylum hearings in Sweden
  • 2009
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The overall goal of this thesis was to highlight different communicative aspects of participation in interpreter-mediated asylum hearings with unaccompanied Russianspeaking children who had applied for asylum in Sweden between 2001 and 2005. Participation in the asylum process is guaranteed to these children by the Swedish Administrative Law and the Convention on the Rights of the Child (CRC), which are incorporated in the Swedish Aliens Act. The Migration authorities in their work with asylum seeking minors have integrated principles of the best interests of the child and the principle of respecting the children’s views on matters concerning them.In this thesis, we have studied the conditions of participation in a highly complex, hybrid activity type, where participants face contradictory demands. Hybridity can be traced in communicative dilemmas which are difficult to solve and handle for all the participants involved, including the caseworkers, interpreters and children. The caseworkers are expected to control an interview in which whole of the communicative exchange is rendered by interpreters who influence the progress of the encounter. Contradiction lies in the fact that the caseworkers are expected to treat all asylum seekers equally both as a group and individually, by relating to general legal regulations and at the same time, take into account the interests and individual needs of an individual child. It might be difficult for these caseworkers to stay neutral and meet underage clients whose life stories and experiences, conduct and needs differ considerably from what is usually ascribed to children.Asylum seeking children come to Sweden to stay. Our results have shown that they take an active role in their attempts to lead to a positive outcome in their cases. In this respect, children’s testimonies and the impression they make as informants play a salient role. The communicative tasks faced by the adolescents are, however, difficult to achieve. Previous life conditions, vulnerability, psychosomatic problems, and memory and concentration difficulties may affect their performance. Other factors which might further impede these children from achieving their task is the pragmatic and linguistic deficiency, which they experience in a context where they lack communicative means and are not fully aware of the norms and regulations relevant for the encounter. Despite hese limitations, it seems that these minors try hard to shoulder their role as asylum seekers and informants actively and strategically. One strategy chosen by the children was to disclose information selectively. They tried to avoid answering questions which could reveal their age, origin or the whereabouts of their caregivers and thereby enable authorities to establish their identity and send them back. To compensate for their uncooperativeness in this area, the adolescents tended to provide information which had not been asked for.Our studies have shown that children could have been prevented by both the caseworkers and interpreters from expressing their views and opinions in a free and self-chosen way. In this respect, interpreters’ contributions were salient for what information was forwarded to the caseworkers. In some cases, they changed both the language and the format of the responses provided by the children. Some of the communicative strategies which were initiated by the interpreters could be linked to both their professional skills and to the hybridity and the complexity of the situation. Interpreters had difficulties staying neutral in relation to the children and orient them in the encounters. Age differences between the participants could also have an impact on how the children were treated and the respect and importance attributed to their voices. We have identified sequences where interpreters initiated monolingual exchanges with one of the interlocutors where they actively tried to exclude and discredit the children’s voices, something which often happened with the tacit approval of the caseworkers.Thus, it can be seen that communicative premises which are inherent in the asylum hearings influence the participant statuses of the children and their possibilities to express their asylum claims.
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48.
  • Kilman, Lisa (författare)
  • Lost in Translation : Speech recognition and memory processes in native and non-native language perception
  • 2015
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • This thesis employed an integrated approach and investigated intra- and inter-individual differences relevant for normally hearing (NH) and hearing-impaired (HI) adults in native (Swedish) and non-native (English) languages in adverse listening conditions. The integrated approach encompassed the role of cognition as a focal point of interest as well as perceptualauditory and linguistic factors. Paper I examined the extent to which proficiency in a non-native language influenced native and non-native speech perception performance for NH listeners in noise maskers compared to native and non-native speech maskers. Working memory capacity in native and non-native languages and non-verbal intelligence were also assessed. The design of paper II was identical to that of paper I, however the participants in paper II had a hearingimpairment. The purpose of paper III was to assess how NH and HI listeners subjectively evaluated the perceived disturbance from the speech- and noise maskers in the native and nonnative languages. Paper IV examined how well native and non-native stories that were presented unmasked and masked with native and non-native speech were recalled by NH listeners. Paper IV further investigated the role of working memory capacity in the episodic long-term memory of story contents as well as proficiency in native and non-native languages. The results showed that generally, the speech maskers affected performance and perceived disturbance more than the noise maskers did. Regarding the non-native target language, interference from speech maskers in the dominant native language is taxing for speech perception performance, perceived disturbance and memory processes. However, large inter- individual variability between the listeners was observed. Part of this variability relates to non-native language proficiency. Perceptual and cognitive effort may hinder efficient long-term memory encoding, even when stimuli are appropriately identified at a perceptual level. A large working memory capacity (WMC) provides a better ability to suppress distractions and allocate processing resources to meet assigned objectives. The relatively large inter-individual differences in this thesis, require an individualized approach in clinical or educational settings when non-native persons or people with hearing impairment need to perceive and remember potentially vital information. Individua  differences in the very complex process of speech understanding and recall need to be further addressed by future studies. The relevance of cognitive factors and language proficiency provides opportunities for individuals who face difficulties to compensate using other abilities.
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49.
  • Klang, Nina, 1978- (författare)
  • Applicability of the ICF-CY to describe functioning and environment of children with disabilities
  • 2012
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The aim of the thesis, with four empirical studies, was to explore the applicability of the International Classification of Functioning, Disability and Health, version for children and youth (ICF-CY) to describe functioning and environment of children with disabilities. The components and categories in the ICF-CY were explored by studying items in ICF-CY based questionnaires in studies I and II and by linking texts of individual habilitation plans to the ICF-CY in studies III and IV. Professionals’ perceptions of the applicability of the ICF-CY and the ICFCY questionnaire were investigated in study II. In study IV changes in focus on ICF-CY components in documentation of individual habilitation plans were explored after in-service training in the ICF-CY. Studies I and II found variations in ratings of questionnaire items based on the performance qualifier in component Activities and participation. The variations may be explained by the context in which ratings were made and by expectations and perceptions of those who made ratings. The results indicated challenges in constructing universal measures of the performance qualifier. The studies also indicated limitations in the use of items based on Environmental factors, when used separately from items in Activities and participation. Studies II and III found that the categories in the components Body functions and Activities and participation were interrelated. Study III indicated challenges in describing family situation and children’s psychosocial environment in the Environmental factors. In study II the professionals described advantages and challenges in the use of the ICFCY and suggested necessary changes to the ICF-CY questionnaire. Study IV found that the professionals in child and youth habilitation described children’s functioning more precisely and in more detail after in-service training. Overall, the results suggest both advantages and challenges of the ICFCY when used to describe functioning and environment of children with disabilities. The results call for a need of a combined use of the categories from all the ICF-CY the components.
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50.
  • Käcker, Pia, 1952- (författare)
  • Nycklar till Kommunikation : Kommunikation mellan vuxna personer med grav förvärvad hjärnskada och personernas närstående, anhöriga och personal
  • 2007
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Studien fokuserar kommunikation mellan vuxna personer med grav förvärvad hjärnskada och deras närstående. Syftet är att med utgångspunkt från de närståendes berättelser beskriva hur kommunikationen manifesteras, samt att ge en teoretisk beskrivning av vilka faktorer som understödjer respektive motverkar kommunikationen. Elva gravt hjärnskadade personer ingår i studien. Orsaken till hjärnskadan är stroke, traumatisk hjärnskada eller syrebristskada. Personernas ålder varierar från 16 till 64 år vid skadetillfället. Samtliga har som en följd av hjärnskadan grava språkstörningar och kognitiva funktionshinder. Datamaterialet baseras på intervjuer och videofilm. Den teoretiska utgångspunkten är symbolisk interaktionism och den metod som används är grundad teori.Resultatet presenteras i en empiriskt grundad teoretisk modell för hur kommunikation hos studiens aktörer manifesteras. Kommunikationsmodellen innehåller kärnprocessen, kommunikationsnycklar. De öppnande nycklarna består av inledande och vidmakthållande faktorer, samt av den betryggande faktorn. Den senare får stor betydelse, utan den kommer inte kommunikationen till stånd. Resultatet diskuteras i förhållande till sociala kommunikationsteorier och begreppet kommunikativ kompetens. Teorin förväntas ge de närstående stöd i hur de förhåller sig i mötet med en person som har ett kommunikativt funktionshinder.
  •  
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