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1.
  • Magnusson, Lina (author)
  • Prosthetic and Orthotic Services in Developing Countries
  • 2014
  • Doctoral thesis (other academic/artistic)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 (author)
  • From Eye to Us : Prerequisites for and levels of participation in mainstream school of persons with Autism Spectrum Conditions
  • 2013
  • Doctoral thesis (other academic/artistic)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- (author)
  • Applying the ICF-CY to identify everyday life situations of children and youth with disabilities
  • 2011
  • Doctoral thesis (other academic/artistic)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 (author)
  • Hörselscreening av en population med utvecklingsstörning : Utvärdering av psykoakustisk testmetod och av OAE-registrering som komplementär metod
  • 2013
  • Licentiate thesis (other academic/artistic)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.
  • Andin, Josefine (author)
  • Dealing with Digits : Arithmetic, Memory and Phonology in Deaf Signers
  • 2014
  • Doctoral thesis (other academic/artistic)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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6.
  • Arvidsson, Patrik, 1969- (author)
  • Assessment of participation in people with a mild intellectual disability
  • 2013
  • Doctoral thesis (other academic/artistic)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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7.
  • Axelsson, Anna Karin (author)
  • Children with profound intellectual and multiple disabilities and their participation in family activities
  • 2014
  • Doctoral thesis (other academic/artistic)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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8.
  • Birberg Thornberg, Ulrika (author)
  • Fats in Mind : Effects of Omega-3 Fatty Acids on Cognition and Behaviour in Childhood
  • 2011
  • Doctoral thesis (other academic/artistic)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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9.
  • Bjarnason, Sif (author)
  • Jobbet är kommunikation : om användning av arbetshjälpmedel för personer med hörselnedsättning
  • 2011
  • Licentiate thesis (other academic/artistic)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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10.
  • C. Manchaiah, Vinaya K., 1983- (author)
  • Evaluating the process of change : Studies on patient journey, hearing disability acceptance and stages-of-change
  • 2013
  • Doctoral thesis (other academic/artistic)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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11.
  • Classon, Elisabet, 1965- (author)
  • Representing sounds and spellings : Phonological decline and compensatory working memory in acquired hearing impairment
  • 2013
  • Doctoral thesis (other academic/artistic)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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12.
  • Germundsson, Per, 1956- (author)
  • Lärare, socialsekreterare och barn som far illa : om sociala representationer och interprofessionell samverkan
  • 2011
  • Doctoral thesis (other academic/artistic)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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13.
  • Gustafsson, Johanna, 1975- (author)
  • Supported employment i en svensk kontext : förutsättningarnär personer med funktionsnedsättning når,får och behåller ett arbete
  • 2014
  • Doctoral thesis (other academic/artistic)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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14.
  • Hesser, Hugo, 1982- (author)
  • Tinnitus in Context : A Contemporary Contextual Behavioral Approach
  • 2013
  • Doctoral thesis (other academic/artistic)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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15.
  • Hillborg, Helene, 1968- (author)
  • Erfarenheter av rehabiliteringsprocessen mot ett arbetsliv : brukarens och de professionellas perspektiv
  • 2010
  • Doctoral thesis (other academic/artistic)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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16.
  • Hua, Håkan (author)
  • Employees with Aided Hearing Impairment : An Interdisciplinary Perspective
  • 2014
  • Doctoral thesis (other academic/artistic)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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17.
  • Hultman, Elin (author)
  • Barnperspektiv i barnavårdsutredningar : med barns hälsa och barns upplevelser i fokus
  • 2013
  • Doctoral thesis (other academic/artistic)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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18.
  • Jerlinder, Kajsa, 1976- (author)
  • Social rättvisa i inkluderande idrottsundervisning för elever med rörelsehinder : en utopi?
  • 2010
  • Doctoral thesis (other academic/artistic)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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19.
  • Josephson, Iréne (author)
  • Utrymme för deltagande : Beslutsprocesser i möten mellan patienter med ospecifika ländryggsbesvär och sjukgymnaster i primärvård
  • 2013
  • Doctoral thesis (other academic/artistic)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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20.
  • Klang, Nina, 1978- (author)
  • Applicability of the ICF-CY to describe functioning and environment of children with disabilities
  • 2012
  • Doctoral thesis (other academic/artistic)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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21.
  • Mineur, Therese, 1970- (author)
  • Skolformens komplexitet : elevers erfarenheter av skolvardag och tillhörighet i gymnasiesärskolan
  • 2013
  • Doctoral thesis (other academic/artistic)abstract
    • The Swedish upper secondary education consists of different types of schools. One type of school is the upper secondary for pupils who have assessed as having an intellectual disability. The aim of this study is to increase the knowledge and understanding of pupils’ experiences of everyday life in school, and how they perceive the significance of their sense of belonging to this type of school. An additional aim of the study is to increase the knowledge about different ways of organizing the education and teaching. The collection of data started with a national questionnaire survey which was directed to headteachers at the schools. Based on the results from the survey five schools were selected. By participant observations at the schools and repeated interviews with 14 young women and 12 young men, the first person perspective has been studied and analysed through an interpretive approach. The analysis showed that knowledge about the schools different ways of organizing the teaching are of importance, to understand pupils’ diverse experiences of school life. As an example it has an impact on how the pupils evaluate different types of knowledge, but also how they view their future opportunities. Any clear connection between the schools different ways of organizing the education and teaching and pupils’ experiences of their sense of belonging to this type of school has not emerged. Instead pupils’ awareness, confidence, uncertainty, dejection and determination are to be seen as a framework of understanding, telling us about their experiences of their school affiliation. Together they demonstrate a complexity surrounding pupils’ situation, associated to both advantages and disadvantages in school, but also their thoughts about identity and how they perceive being categorized as deviant by others. The analysis also showed that expectations on the pupils, and their possibilities in the school context, are related to a special school culture and to gender differences.
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22.
  • Mishra, Sushmit, 1981- (author)
  • Exploring Cognitive Spare Capacity : Executive Processing of Degraded Speech
  • 2014
  • Doctoral thesis (other academic/artistic)abstract
    • Cognitive resources, specifically working memory capacity are used for listening to speech, especially in noise. Cognitive resources are limited, and if listeners allocate a greater share of these resources to recovering the input signal in noise, fewer resources are available for interpreting and encoding its linguistic content. Although the importance of CSC for individual success in communicative situations has been acknowledged, this concept has not hitherto been explored experimentally. In this thesis, a CSC test (CSCT) was developed and administered to young adults with normal hearing and older adults with age-related hearing loss. CSCT required executive processing of speech at different memory loads with and without visual cues in different noise conditions. A free recall task using the same material was administered for comparison purposes and a battery of cognitive tests was administered to understand the relation between CSC and established cognitive concepts. The aims of the thesis were to investigate how CSC is influenced by 1) different executive demands and memory loads; 2) background noise; 3) visual cues; 4) aging and concomitant hearing loss. The results showed that 1) CSC was sensitive to memory load, and updating demands reduced CSC more than inhibition demands; 2) CSC was reduced in background noise compared to quiet; 3) visual cues enhanced CSC especially in noise; 4) CSC was reduced with ageing and concomitant hearing loss especially when visual cues were absent, memory demands were  increased and background noise was speech-like. The main finding of this thesis was that visual cues enhanced CSC for older individuals with hearing loss, specifically in adverse listening conditions. This demonstrates the importance of audiovisual testing in audiological assessment. Further, specific cognitive resources depleted during listening in noise were at least partially compensated by other cognitive functions. This thesis is the first step towards a theoretical understanding of CSC and in future, tests of CSC may play a crucial role in planning rehabilitation of persons with hearing loss.
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23.
  • Moradi, Shahram (author)
  • Time is of the essence in speech perception! : Get it fast, or think about it
  • 2014
  • Doctoral thesis (other academic/artistic)abstract
    • The present thesis examined the extent to which background noise influences the isolation point (IP, the shortest time from the onset of speech stimulus required for correct identification of that speech stimulus) and accuracy in identification of different types of speech stimuli (consonants, words, and final words in high-predictable [HP] and low-predictable [LP] sentences). These speech stimuli were presented in different modalities of presentation (auditory, visual, and audiovisual) to young normal-hearing listeners (Papers 1, 2, and 5). In addition, the present thesis studied under what conditions cognitive resources were explicitly demanded in identification of different types of speech stimuli (Papers 1 and 2). Further, elderly hearing-aid (EHA) users and elderly normal-hearing (ENH) listeners were compared with regard to the IPs, accuracy, and under what conditions explicit cognitive resources were demanded in identification of auditory speech stimuli in silence (Paper 3). The results showed that background noise resulted in later IPs and reduced the accuracy for the identification of different types of speech stimuli in both modalities of speech presentation. Explicit cognitive resources were demanded in identification of speech stimuli in the auditory-only modality, under the noisy condition, and in the absence of a prior semantic context. In addition, audiovisual presentation of speech stimuli resulted in earlier IPs and more accurate identification of speech stimuli than auditory presentation. Furthermore, a pre-exposure to audiovisual speech stimuli resulted in better auditory speech-in-noise identification than an exposure to auditory-only speech stimuli (Papers 2 and 4). When comparing EHA users and ENH individuals, the EHA users showed inferior performance in the identification of consonants, words, and final words in LP sentences (in terms of IP). In terms of accuracy, the EHA users demonstrated inferior performance only in the identification of consonants and words. Only the identification of consonants and words demanded explicit cognitive resources in the EHA users. Theoretical predictions and clinical implications were discussed.
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24.
  • Mårdh, Selina (author)
  • Cognitive erosion and its implications in Alzheimer’s disease
  • 2013
  • Doctoral thesis (other academic/artistic)abstract
    • The aim of the present thesis was twofold, first to map the semantic memory decline in Alzheimer patients over time, second to take the patient’s perspective and create a multifaceted picture of the individual with Alzheimer’s disease through the study of memory, awareness, central coherence and emotions. Further issues concerned how Alzheimer individuals handled their cognitive erosion in everyday life and if they were well calibrated with their spouse in disease related matters.Two studies were performed, the first involved a longitudinal study of sematic deterioration, the second had a mixed methods design involving both quantitative and qualitative measures as in neuropsychological assessment and interviews.Through the longitudinal study it could be concluded that the nature of semantic deterioration is best described as loss of memory information rather than problems in accessing the information. It was further concluded that semantic concepts gradually lose their specific features during course of illness.The results from the second study revealed that the Alzheimer individuals were aware of their disease although they could not foresee the implications of their cognitive shortcomings in their everyday life. They evidenced weak central coherence, in that they were unable to infer details into a meaningful whole. This implies that they perceive their surrounding world in a fragmented way as consisting of separate objects rather than a comprehensible context. Concerning emotions it was found that they responded to negatively valenced words in the same way as normal ageing individuals, although being impaired in their response to positively and neutral words. Finally, the Alzheimer individuals and their spouses were not well calibrated regarding disease related issues.The findings of the present thesis have important clinical implications and gives valuable input to the understanding of the individual with Alzheimer’s disease.
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25.
  • Nakeva von Mentzer, Cecilia (author)
  • Rethinking Sound : Computer-assisted reading intervention with a phonics approach for deaf and hard of hearing children using cochlear implants or hearing aids
  • 2014
  • Doctoral thesis (other academic/artistic)abstract
    • In the present thesis, computer-assisted reading intervention with a phonics approach was examined in deaf and hard of hearing children (DHH) aged 5, 6 or 7 years old using cochlear implants, hearing aids or a combination of both. Children with normal hearing (NH), matched for non-verbal intelligence and age, served as a reference group. Deaf and hard of hearing children constitute a heterogenetic population regarding cognitive and academic achievement. Many of them do not reach age appropriate levels in language and reading ability during their school years, with negative consequences for later training facilities and job opportunities. Finding relevant intervention methods to promote early language learning and literacy development that are easy to implement is therefore of great importance. In this thesis three aspects of cognitive ability (phonological processing skills, lexical access and working memory capacity), and reading ability was examined at three points in time; baseline 1, pre intervention and post intervention. Additionally, computer-assisted training delivered by  means of the Internet in the children’s homes was explored in order to determine whether it would be a useful and efficient method for the DHH population. Overall, the results from the present thesis support the notion that offering a computer-assisted intervention program delivered at home, is an alternative way to support not only NH children with reading difficulties but also to support DHH children’s phonological development and decoding proficiency.
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26.
  • Ng, Hoi Ning Elaine (author)
  • Cognition in Hearing Aid Users : Memory for Everyday Speech
  • 2013
  • Doctoral thesis (other academic/artistic)abstract
    • The thesis investigated the importance of cognition for speech understanding in experienced and new hearing aid users. The aims were 1) to develop a cognitive test (Sentence-final Word Identification and Recall, or SWIR test) to measure the effects of a noise reduction algorithm on processing of highly intelligible speech (everyday sentences); 2) to investigate, using the SWIR test, whether hearing aid signal processing would affect memory for heard speech in experienced hearing aid users; 3) to test whether the effects of signal processing on the ability to recall speech would interact with background noise and individual differences in working memory capacity; 4) to explore the potential clinical application of the SWIR test; and 5) to examine the relationship between cognition and speech recognition in noise in new users over the first six months of hearing aid use. Results showed that, for experienced users, noise reduction freed up cognitive resources and alleviated the negative  impact of noise on memory when speech stimuli were presented in a background of speech babble spoken in the listener’s native language. The possible underlying mechanisms are that noise reduction facilitates auditory stream segregation between target and irrelevant speech and reduces the attention captured by the linguistic information in irrelevant speech. The effects of noise reduction and SWIR performance were modulated by individual differences in working memory capacity. SWIR performance was related to the self-reported outcome of hearing aid use. For new users, working memory capacity played a more important role in speech recognition in noise before acclimatization to hearing aid amplification than after six months. This thesis demonstrates for the first time that hearing aid signal processing can significantly improve the ability of individuals with hearing impairment to recall highly intelligible speech stimuli presented in babble noise. It also adds to the literature showing the key role of working memory capacity in listening with hearing aids, especially for new users. By virtue of its relation to subjective measures of hearing aid outcome, the SWIR test can potentially be used as a tool in assessing hearing aid outcome.
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27.
  • Rydberg, Emelie, 1978- (author)
  • Deaf people and the labour market in Sweden : education - employment - economy
  • 2010
  • Doctoral thesis (other academic/artistic)abstract
    • This thesis focuses on deaf people’s educational attainment, position on the labour market and sources of revenue. These issues are interrelated, for instance a higher level of educational attainment seems to be associated with a lower unemployment rate and higher levels of income. The national context is Sweden and the Swedish welfare state in 2005. All studies in the thesis compare a deaf population, consisting of 2,144 persons born between 1941 and 1980 who have attended a school for the deaf in Sweden, with a general reference population, consisting of 100,000 randomly chosen persons from the total Swedish population born between 1941 and 1980. Data for all studies consisted of registered information about the persons in the year 2005. The results show that there are differences between the deaf and the reference population regarding level of educational attainment, position on the labour market and sources of revenue and disposable income, with the deaf population having a poorer position than the reference population in all areas. There are also differences between the workplaces of the deaf and the people in the reference population, and it is twice as common for people in the deaf population than for people in the reference population to have a higher level of educational attainment than is required for their occupation. These differences between the deaf and the reference population cannot be associated with differences in the independent factors, as for instance sex, age and immigration background, for which the results have been adjusted. This thesis shows that being part of the deaf population appears to be of importance. Factors in conjunction with deafness that can increase our understanding of the differences between the deaf and the reference populations in an educational context, labour market context and economic context are discussed in the thesis.
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28.
  • Rönnberg, Niklas, 1973- (author)
  • Assessing cognitive spare capacity as a measure of listening effort using the Auditory Inference Span Test
  • 2014
  • Doctoral thesis (other academic/artistic)abstract
    • Hearing loss has a negative effect on the daily life of 10-15% of the world’s population. One of the most common ways to treat a hearing loss is to fit hearing aids which increases audibility by providing amplification. Hearing aids thus improve speech reception in quiet, but listening in noise is nevertheless often difficult and stressful. Individual differences in cognitive capacity have been shown to be linked to differences in speech recognition performance in noise. An individual’s cognitive capacity is limited and is gradually consumed by increasing demands when listening in noise. Thus, fewer cognitive resources are left to interpret and process the information conveyed by the speech. Listening effort can therefore be explained by the amount of cognitive resources occupied with speech recognition. A well fitted hearing aid improves speech reception and leads to less listening effort, therefore an objective measure of listening effort would be a useful tool in the hearing aid fitting process.In this thesis the Auditory Inference Span Test (AIST) was developed to assess listening effort by measuring an individual’s cognitive spare capacity, the remaining cognitive resources available to interpret and encode linguistic content of incoming speech input while speech understanding takes place. The AIST is a dual-task hearing-innoise test, combining auditory and memory processing, and requires executive processing of speech at different memory load levels. The AIST was administered to young adults with normal hearing and older adults with hearing impairment. The aims were 1) to develop the AIST; 2) to investigate how different signal-to-noise ratios (SNRs) affect memory performance for perceived speech; 3) to explore if this performance would interact with cognitive capacity; 4) to test if different background noise types would interact differently with memory performance for young adults with normal hearing; and 5) to examine if these relationships would generalize to older adults with hearing impairment.The AIST is a new test of cognitive spare capacity which uses existing speech material that is available in several countries, and manipulates simultaneously cognitive load and SNR. Thus, the design of AIST pinpoints potential interactions between auditory and cognitive factors. The main finding of this thesis was the interaction between noise type and SNR showing that decreased SNR reduced cognitive spare capacity more in speech-like noise compared to speech-shaped noise, even though speech intelligibility levels were similar between noise types. This finding applied to young adults with normal hearing but there was a similar effect for older adults with hearing impairment with the addition of background noise compared to no background noise. Task demands, MLLs, interacted with cognitive capacity, thus, individuals with less cognitive capacity were more sensitive to increased cognitive load. However, MLLs did not interact with noise type or with SNR, which shows that different memory load levels were not affected differently in different noise types or in different SNRs. This suggests that different cognitive mechanisms come into play for storage and processing of speech information in AIST and for listening to speech in noise. Thus, the results suggested that a test of cognitive spare capacity seems to be a useful way to assess listening effort, even though the AIST, in the design used in this thesis, might be too cognitively demanding to provide reliable results for all individuals.
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29.
  • Saremi, Amin G. (author)
  • Effects of Specific Cochlear Pathologies on the Auditory Functions : Modelling, Simulations and Clinical Implications
  • 2014
  • Doctoral thesis (other academic/artistic)abstract
    • A hearing impairment is primarily diagnosed by measuring the hearing thresholds at a range of auditory frequencies (air-conduction audiometry). Although this clinical procedure is simple, affordable, reliable and fast, it does not offer differential information about origins of the hearing impairment. The main goal of this thesis is to quantitatively link specific cochlear pathologies to certain changes in the spectral and temporal characteristics of the auditory system. This can help better understand the underlying mechanisms associated with sensorineural hearing impairments, beyond what is shown in the audiogram. Here, an electromechanical signal-transmission model is devised in MATLAB where the parameters of the model convey biological interpretations of mammalian cochlear structures. The model is exploited to simulate the cell-level cochlear pathologies associated with two common types of sensorineural hearing impairments, 1: presbyacusis (age-related hearing impairment) and, 2: noise-induced hearing impairment. Furthermore, a clinical study, consisting of different psychoacoustic and physiological tests, was performed to trace and validate the model predictions in human. The results of the clinical tests were collated and compared with the model predictions, showing a reasonable agreement. In summary, the present model provides a biophysical foundation for simulating the effect of specific cellular lesions, due to different inner-ear diseases and external insults, on the entire cochlear mechanism and thereby on the whole auditory system. This is a multidisciplinary work in the sense that it connects the ‘biological processes’ with ‘acoustic modelling’ and ‘clinical audiology’ in a translational context.
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30.
  • Sundewall Thorén, Elisabet (author)
  • Internet Interventions for Hearing Loss : Examing rehabilitation, self-report measures and internet use for hearing-aid users
  • 2014
  • Doctoral thesis (other academic/artistic)abstract
    • In the future, audiological rehabilitation of adults with hearing loss will be more available, personalized and thorough due to the possibilities offered by the internet. By using the internet as a platform it is also possible to perform the process of rehabilitation in a cost-effective way. With tailored online rehabilitation programs containing topics such as communication strategies, hearing tactics and how to handle hearing aids it might be possible to foster behavioral changes that will positively affect hearing aid users.Four studies were carried out in this thesis. The first study investigated internet usage among adults with hearing loss. In the second study the administration format, online vs. paper- and pencil, of four standardized questionnaires was evaluated. Finally two randomized controlled trials were performed evaluating the efficacy of online rehabilitation programs including professional guidance by an audiologist. The programs lasted over five weeks and were designed for experienced adult hearing-aid users. The effects of the online programs were compared with the effects of a control group.It can be concluded that the use of computers and the internet overall is at least at the same level for people with hearing loss as for the general age-matched population in Sweden. Furthermore, for three of the four included questionnaires, the participants’ scores remained the same across formats. It is however recommended that the administration format remain consistent across assessment points. Finally, results from the two concluding intervention studies provide preliminary evidence that the internet can be used to deliver education and rehabilitation to experienced hearing aid users who report residual hearing problems and that their problems are reduced by the intervention; however the content and design of the online rehabilitation program requires further investigation.
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31.
  • Sundqvist, Annette (Anett), 1968- (author)
  • Knowing me, knowing you : Mentalization abilities of children who use augmentative and alternative communication
  • 2010
  • Doctoral thesis (other academic/artistic)abstract
    • The present thesis investigated several components important to the understanding of mentalization for children who use augmentative and alternative communication (AAC). The result of the thesis demonstrated that non-verbal mental age correlated significantly with mentalization tasks, and that the participants did not significantly differ compared to a nonverbal age-matched group of children without disabilities. Different expression of active participation, which is necessary to be able to display mentalization in dialogue, was observed in analysed interaction. The children’s social networks were limited and consisted of very few peers, thus limiting the possibilities of active participation. The number of peers in the children’s social networks correlated significantly with aspects of the children’s mentalization ability. Children who use AAC display their mentalization abilities independently in social interaction and through e-mail messages to peers. A wider construct that will have relevance to mentalization in ordinary situations is described encompassing several different abilities. The development of these abilities is dependent on the child’s capacity for adapting a cognitive flexibility when reflecting and theorizing on what is happening in a given situation. The development of mentalization is also dependent on a child’s close friendships, active participation in interaction, functional language ability, and varied social networks consisting of both peers and adults.
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32.
  • Thorslund, Birgitta, 1976- (author)
  • Effects of hearing loss on traffic safety and mobility
  • 2014
  • Doctoral thesis (other academic/artistic)abstract
    • The aim of this PhD thesis was to investigate traffic safety and mobility for individuals with hearing loss (HL). Three studies were conducted: 1. a questionnaire survey aimed to evaluate differences in choice of transportation that might be related to HL, 2. a driving simulator study that looked into compensatory strategies and evaluated the efficiency of a tactile signal to alert the driver, and 3. a field study to evaluate these effects in real traffic and to evaluate a navigation system with a supportive tactile signal. The effects of HL discovered in this thesis add to the knowledge and understanding of the influence of HL on traffic safety and mobility. Differences found consistently point to a generally more cautious behavior. Compensatory and coping strategies associated with HL are bound to driving complexity and appear when complexity increases. These strategies include driving at lower speeds, using a more comprehensive visual search behavior and being less engaged in distracting activities. Evaluation of a tactile signal showed that by adding a tactile modality, some driver assistance systems can also be made accessible to drivers with HL. At the same time, the systems might be more effective for all users, since the driver can be more focused on the road. Based on the results in this thesis, drivers with HL cannot be considered an increased traffic safety risk, and there should be no need for adjustments of the requirements of hearing for a license to drive a car.
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33.
  • Zetterqvist (f.d. Westin), Vendela, 1980- (author)
  • Tinnitus – an acceptance-based approach
  • 2011
  • Doctoral thesis (other academic/artistic)abstract
    • Tinnitus is a highly prevalent health condition creating moderate or severe interference on mood, sleep and daily functioning for a group of those affected. The aims of this thesis were 1) to explore the role of acceptance and psychological flexibility in understanding tinnitus interference both experimentally and with a longitudinal design 2) to evaluate the immediate and long-term outcomes of an acceptance based behaviour therapy (Acceptance and Commitment Therapy; ACT) in the treatment of people with tinnitus and, 3) to investigate the relationship between treatment outcome and processes assumed to be the active ingredients of treatment (acceptance and cognitive defusion).Study I (n=47) was an experiment comparing the impact of acceptance to that of thought suppression or a neutral instruction on the ability to maintain attention on an imagery task. Results indicated that participants could benefit from an acceptance strategy when performing the task. Study II (n=47) was a longitudinal trial studying the mediating role of acceptance on the relationship between tinnitus interference at baseline and tinnitus interference, anxiety, life quality, and depression at a seven-month follow-up. Full mediation was found for life quality and depression, and partial mediation for tinnitus interference. Study IV (n=64) was a randomised controlled trial evaluating the immediate and long-term effects of ACT in comparison to those of Tinnitus Retraining Therapy (TRT) and to a wait list control. Results showed that ACT had large immediate effects on tinnitus interference in comparison to wait list, and medium long-term effects in comparison to TRT. Results were also seen on secondary outcome. Self-reported tinnitus acceptance significantly mediated the immediate outcome of ACT. Study III (n=24) was a process study where the video recorded sessions of ACT from study IV were observed and rated with regard to client behaviour. Results showed that in-session acceptance and defusion behaviours rated early in therapy were predictors of sustained positive treatment effects of ACT. These associations continued to be substantial even when controlling for the prior improvement in outcome. This whereas prior symptom change could not predict process variables rated late in therapy. Participants in all trials were chronic tinnitus patients, mainly from different departments of audiology. These findings implicate that 1) acceptance and psychological flexibility may contribute to the understanding of tinnitus interference 2) ACT can reduce tinnitus interference in a group of normal hearing tinnitus patients and 3) acceptance and cognitive defusion are important processes in ACT, related to outcome.
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