Licentiatavhandlingar / Institutionen för neurovetenskap och fysiologi

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    Ge alla en chans att vara med - Brukarinvolvering i forskning med och för sköra äldre personer
    (2021) Berge, Isak; Institutionen för Neurovetenskap och Fysiologi Sahlgrenska Akademin, Göteborgs Universitet
    Aims: The overall aim with this thesis was to explore how the voices of frail older people can be heard and acknowledged through user involvement in research on aging and health. Two studies are included with the specific aims; I) to explore frail older people’s experiences of involvement in research, and II) to explore nursing home staff experiences of co-designing health care services with frail older persons. Method: Study I was an individual interview study inspired by constructivist grounded theory, with a total of 17 persons above 75 years of age, screened as frail. Study II was a focus group study with 17 nursing home professionals. Findings: In study I the core category, “Challenging oneself on the threshold to the world of research”, symbolises a perceived distance between frail older people and the research world, but also challenges that frail older people could go through when choosing to be involved in research. In study II the results are summarised in the overarching theme “Moving from object towards person” which describes the co-design process as a real eye-opener for staff in terms of realising the capability of both the frail older persons and themselves. Conclusions: Frail older people should have the same rights as other groups to make their voices heard in research that concerns them. User involvement seems to be a possible way for more relevant research for frail older person. However, the opportunity to be involved in research should be based on their real capabilities, and not limited by stereotypic views of ageing and frailty.
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    Internet-based support and coaching - Exploring the feasibility of an intervention for young people with ADHD and autism spectrum disorder
    (University of Gothenburg / Göteborgs universitet, 2021) Sehlin, Helena; Institute of Neuroscience and Physiology / Institutionen för neurovetenskap och fysiologi
    Background: For individuals with Neurodevelopmental Disorders (NDDs), such as Attention-Deficit/ Hyperactivity Disorder (ADHD) and autism spectrum disorder (ASD), adolescence and young adulthood can be a vulnerable period associated with a loss of significant structure and support. They can also have a difficult time taking advantage of available support- and treatment options, due to their core deficits. There is limited research into support and treatment specifically targeting individuals with ADHD and/or ASD in this age group, and into how it can be tailored to fit their experienced needs. Methods: With the aim of evaluating the feasibility of an internet-based support and coaching model (IBSC) encompassing 8 weeks of twice weekly chat sessions (and two clinic visits), two studies were conducted using complementary methodological perspectives. Study I used a non-randomized controlled design, including 50 individuals with ADHD and/or ASD ages 15-32 years old in two naturalistic clinical settings. Participants received the intervention (n=30) or Treatment-As-Usual (TAU) (n=20). Six participants dropped out from the Intervention group. Self-report questionnaires were administered at baseline, at the end of the Intervention and after 6-months, including assessments of quality of life, sense of coherence, self-esteem, anxiety and depressive symptoms. Study II, sought to investigate the experiences of the participants taking part in IBSC, using semi-structured interviews with 16 individuals who had received IBSC and analysing data using qualitative content analysis. Results: Results from study I showed significant between-group effects regarding anxiety at post intervention and at 6-month follow-up, and for depressive symptoms at post intervention. A deterioration in the TAU group partly explained these results. The Intervention group experienced a significant increase in self-esteem and a decrease in anxiety at 6-month follow-up. Study II generated three themes; Deciding to participate, Taking part in the coaching process, and The significance of format with a total of ten subthemes. In summary, there was an appreciation of several aspects of the format that corresponded with their needs, e.g. being text-based and accessible from one´s home environment. Participants voiced unmet needs and underscored the importance of coaches’ knowledge about NDDs. Incomplete personal interaction and a desire for increased flexibility in regard to frequency and form of communication were also voiced. Conclusions: IBSC shows promise as a feasible approach to supporting adolescents and young adults with ADHD and/or ASD. Future studies should determine for which diagnostic category the model is best suited and to what degree.
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    Reconstructive upper limb surgery in patients with cervical spinal cord injury. Evaluation of postoperative treatments and examination of applicability of the Klein-Bell ADL Scale
    (2009-02-03T10:08:15Z) Dahlgren, Annika
    Aims: Studies I & II: To describe and evaluate postoperative deltoid-triceps protection of tendon elongation and long-term clinical follow-up after tenodesis to the IP joint of the thumb. Study III: To examine and explore the applicability of the Klein-Bell ADL Scale (KB Scale) in patients with cervical spinal cord injury in terms of daily activities and the association between basic ADL and upper extremity function. Method: Studies I & II data were collected retrospectively. Eleven patients were included in study I. The patients were divided postoperatively into two groups; patients using their manual wheelchair without a special armrest and patients using an electric power driven wheelchair with a special armrest. Stainless steel sutures (markers) were placed proximally and distally of the tendon-to-tendon attachment sites. The distances between markers were measured via upper extremity x-ray to evaluate tendon elongations. Thirtythree patients were included in study II. Extension, flexion and range of motion were measured to evaluate how the tenodesis of the IP joint of the thumb influenced the different movement modalities of the IP joint of the thumb. Study III: Data were collected prospectively. Fifty-five patients were included in the study. Assessments of the patients’ independence were made according to the K-B Scale. Three more analyses were performed; the first analysis was made to examine whether assistive devices and car and house adaptations could influence the patient’s independence. The last two analyses included investigations of whether arm and different grip functions and different grip phases could be detected in the items’ operational criteria. Results: In study I the total distances between markers after reconstruction of deltoid to triceps were significantly lower in the patients using an electric power driven wheelchair with special armrest compared to those without the armrest. The largest difference in tendon elongation between the groups occurred in the proximal tendon transfer. Elbow extension deficit was decreased in the group using the electric power wheelchair with an armrest, although not significantly as compared to those without the armrest. In study II treatment with a thumb splint after tenodesis to the IP joint of the thumb gave a pliable and well balanced IP joint with comparable results in extension, flexion and ROM at six months and 12 months postoperatively. In study III only the raw sum score and not the weight scheme in the K-B scale discriminated the patient’s independence in daily activities (ADL). Assistive devices and car and house adaptations made the patients more independent. Lack of grip function decreased the patient’s ability to become independent. Conclusion: The use of an electric power driven chair with a special armrest and thumb splint has shown that relatively simple adjuncts can positively influence the effectiveness of operations performed. The cooperation between the hand surgeons and the therapist to develop these treatments has been important for improved results in these studies. The K-B Scale can be used to assess basic ADL and can discriminate between cervical SCI patients’ independence in ADL. To become a useful tool, the K-B Scale’s structural properties in conjunction with arm and grip function must be further investigated.