The aim of this Swedish study was to explore and describe physiotherapists and occupational therapists’ attitudes and understanding of the place of play in habilitation. This was a qualitative study, using semi-structured interviews exploring ten habilitation professional’s experiences and attitude towards play. Interviews were analysed using content analysis. The analysis of the interviews resulted in four categories (1) Play in the present or exercise for the future (2) Play is a useful tool (3) Play needs different prerequisites (4) Play is a shared responsibility. The categories represent the professional’s attitudes and understanding of play in habilitation. Results demonstrated that enabling play for the sake of play was a low priority in habilitation, despite the acknowledgement that it is a primary concern for children. The professionals focus was mainly on interventions that were remedial: about doing the right thing for the physical body and preparing the child for his/her life as an adult. There is a need to change perspective and incorporate interventions aimed at childhood as well as adulthood. Habilitation professionals need to reframe their anxiety for the future child and reconsider the place of play in practice

Electrical stimulation has been used to treat spasticity in children with cerebral palsy.  Building on the benefits of electrical stimulation, a new assistive device, electro-​suit Mollii® with imbedded electrodes has been tested.  The aim of the study was to evaluate the possible effect of Mollii® on body function, activity and participation in self-​selected activities.  

Methods: Six children, five to ten years of age, used the electro-​suit for one hour, every other day for three months.  The impact was evaluated after four weeks and after three months by measuring passive range of motion (ROM)​, muscle tone, pain, gross motor function and participation.  

Results: All participants improved in the total score for Canadian Occupational Performance Measure (COPM)​, three of them showed significant clinical improvements.  Pain was reduced for children who estimated pain when the study started.  There were also small changes in ROM and muscle tone and gross motor function.  

Conclusion: Electro-​suit Mollii® had a positive impact on activity and participation in self-​selected activities among the children in this study.  Further studies with more children over a longer time are necessary to evaluate the impact and usefulness over time.

BackgroundThe purpose of the study was to contribute to research and practice on how the use and exchange of knowledge can facilitate change in health care, specifically methods supporting managers. The study also aimed to investigate barriers related to governance principles that may affect organizational ability to improve quality of care. To achieve the purpose, the study followed a project of hospital-based home rehabilitation after a stroke at a hospital in Norrbotten County, Sweden.

MethodsSeven individual interviews were performed to obtain information from the project members and the managers involved in the project. A group interview with the team and their immediate manager were conducted after the project ended. A thematic analysis was performed to identify and present patterns that formed the results of the study.

ResultsThe study shows how knowledge was identified, gathered, used, and disseminated in the project. The analysis pointed out how knowledge played an important role from two perspectives: in evidence-based practice in rehabilitation work and for change management. Knowledge exchange and learning across organizational boundaries increased the pace, efficiency, and effectiveness, but collaboration on knowledge, in the sense of joint activities based on a common purpose, only took place within the rehabilitation work. Furthermore, there were indications that governance principles, such as the distribution of financial responsibility and the requirements for official recommendations, influenced the pace of change.

ConclusionsIt was shown that the exchange of knowledge and collaboration can facilitate change in health care, but that communication needs to be planned and prioritised. Readiness for change was the basis for the success of the project and for ensuring commitment among those involved. There is also a need for the management to understand how governance principles may affect the efficiency of change work.

Electrical stimulation has been used for many years to treat spasticity in children with cerebral palsy and some improvements have been noted. Building on the benefits of electrical stimulation, a new assistive device, a suit with imbedded electrodes designed to reduce spasticity through electrical stimulation of the antagonistic muscles, has been tested.

Aim: The aim of this study was to describe experiences from children with cerebral palsy and their parents regarding the use of the suit. Methods: Individual interviews were conducted with six children 5 to 10 years of age and their parents. The interviews were transcribed and analyzed using a qualitative content analysis. Results: The analysis resulted in three themes: (1) the suit’s impact on image, (2) changes that make a difference and (3) dealing with a desire for change. Each of the themes included subthemes. Conclusion: All children reported some impact on their body and self and/or in some activities after the use of the suit. The parents also saw improvements during the trial period. However, the results are inconclusive and a larger study is needed to determine if the suit is useful from a longer perspective and whether it can affect activity and participation in daily activities for children with spasticity.

Integrating health care services has proven to be important from both the patient and organizational perspectives. This study explores what defines a perceived well-functioning collaboration in the inter-organizational process of providing assistive devices in Sweden. Two focus groups comprising participants with profound knowledge of collaboration were performed, and data were analyzed in five steps, resulting in a data structure. Results yield the identification of three interacting processes: coordinating efforts to patient needs, ensuring evidence-based practice, and planning for efficient use of resources. These processes affected one another, and, therefore, would likely not have been effectively managed separately. The study contributes to theories of process management and organization by specifically focusing on how to analyze and improve sustainable collaboration in health care processes at both the management and professional levels. Theoretical frameworks that show different ways of organizing collaboration, as well as the concepts of action nets and boundary objects, can support both analysis and planning of collaboration. The intention would be to develop integration in inter-organizational health care processes, resulting in more person-centered care.

Studies concerning standing in standing devices have mainly focused on the biological effects of standing on the body, such as preventing bone loss, increasing or maintaining ankle dorsiflexion, improving bone density and reducing spasticity. Little is known about the psychosocial dimensions of standing. The overall aim of this thesis was to determine the characteristics of individuals who use standing devices, to describe their reasons for standing and their experiences of using these devices as viewed from the perspectives of adults, children and their parents. This thesis includes four studies, two with a qualitative approach (Studies I and IV) and two with a quantitative approach (Studies II and III). In Study I, fifteen adults with different disabilities who were users of standing devices were interviewed about the meaning associated with standing. The data were analysed using a phenomenological hermeneutic approach. The results showed that the upright body position had an influence on the individual’s lifeworld, including the lived body, lived time, lived space and lived relationships. Studies II and III originated from a comprehensive survey of users of standing devices in five counties in Sweden. The data were analysed with descriptive statistics. The results of Study II revealed that the individuals who used standing devices ranged in age from 2 to 86 years and had different types of standing devices. Almost 50% of the respondents were totally dependent on other individuals to complete the questionnaire, and only one in four was independent in movement. The participants’ self-rated health, according to the EuroQoL visual analogue scale (EQ-VAS), was rather high. Thirty nine per cent (39%) of the respondents’ used their device one or more times per day. The youngest individuals used the devices most frequently and had the longest standing times, which was in contrast to teenagers, who used the devices least frequently. The respondents’ perceptions of how the standing position influenced how they were met by other persons differed depending on whether the individual him/herself provided the rating or someone else rated the item on the individual’s behalf. The most common reasons given for standing were to improve circulation and well-being and to reduce tension and stiffness (Study II).In Study III, the psychosocial impact of the standing device was measured using the Psychosocial Impact of Assistive Devices Scale (PIADS) questionnaire. Standing devices were shown to have a positive impact on the users according to the total score and three sub scores: adaptability, competence and self-esteem. The teenagers had the lowest scores on the scale, whereas the respondents who were 65 years of age or older had the highest scores. A high degree of independence in movement, the ability to walk and the possibility of using the device during activities also yielded high values on the scale. Study IV was an interview-based study with children who used standing devices and their parents. The children and their parents were interviewed individually. A qualitative content analysis was performed to gain insight into the participants’ experiences of using standing devices. The standing position influenced both physical and social dimensions. There was also ambivalence about using the device. In the parents' eyes, standing was a way to be like others and to enhance participation in different activities. However, some children stated that standing could be painful and interfere with participation. In conclusion, this thesis illustrates the use of standing devices from the points of view of both autonomous and non-autonomous users as well as of users’ parents. The use of these devices was widespread and frequent. The upright body position was experienced as mainly positive, with positive impacts on well-being and participation, but there was also a degree of ambivalence. Because there is a great lack of studies concerning the impacts of using standing devices, professionals should pay attention to promoting standing as a means of improving well-being and participation in this vulnerable group.

Aim: The aim of this study was to describe children’s and parents’ experiences of the significance of standing in a standing device. Methods: Individual interviews were performed with six children/teenagers (aged 7–19 years) and 14 parents. The interviews were transcribed and analyzed using a qualitative content analysis. Findings: The analysis resulted in the major theme, the duality of uprightness and the related themes: (1) the instrumental dimension of standing; (2) the social dimension of standing; and (3) the ambivalent dimension of standing. Each of the themes comprised several subthemes. Conclusions: There is an inherent duality related to the use of a standing device. Standing in a standing device was seen as a treatment of body structures and functions, as well as a possible source of pain. Standing was considered to influence freedom in activities and participation both positively and negatively. The parents experienced that standing influenced other peoples’ views of their child, while the children experienced standing as a way to extend the body and as something that gave them benefits in some activities. Physiotherapists working with children should take into account both the social and physical dimensions of using a standing device and consider both the child’s and the parents’ views.

Purpose: The aim of this study was to explore the psychosocial impact of standing devices as experienced by users. Method: This is the second part of a comprehensive survey in five counties in Sweden where all the subjects with standing devices were invited to participate. The impact of standing devices on functional independence, quality of life and wellbeing was assessed using a questionnaire, Psychosocial Impact of Assistive Devices Scale (PIADS). Results: The psychosocial impact of the standing devices was perceived as positive. The highest PIADS scores in relation to age were found in the oldest group, aged 65 years and older. The ability to walk and independence in ambulation resulted in higher scores than the use of a wheelchair and/or dependence on others. Those who stood often awarded higher scores in the PIADS questionnaire compared to those who used the device less frequently. When standing was integrated in various activities, its psychosocial impact received high scores. Conclusion: The psychosocial impact of standing devices was generally experienced positively. The main results indicated that standing in a standing device had a value and we as professionals should ask the users about the intended purpose of their standing in order to prescribe the optimal device.Implications for Rehabilitation •Standing in standing devices has positive psychosocial impact for the user.•As professionals we should broaden our view of the use of standing devices, i.e. to see the standing device as an aid that not only treats the body’s structures or improves the user’s abilities in activities, but also provides a psychosocial impact on the user’s daily life, and to find meaningful goals for the user from a psychosocial perspective

Purpose: The aim of the study was to illuminate the meaning that standing holds for persons who require standing devices. Method: The phenomenological/hermeneutical analysis of the interviews was carried out using a life world-approach. Fifteen users of standing devices lacking the ability to stand independently participated in the interviews.Result: Each person’s lived experiences of standing in their devices indicated that the upright body position opens up an opportunity for connection to the outside world. An upright body position (i) alters the person’s sense of self, (ii) augments the person’s availability to the outside world, (iii) strengthens social interplay, and (iv) changes a person’s motivation and their expectations over time. Conclusion: Standing may be something that unites the body and self. Understanding the meaning of the altered body position that the use of standing devices opens up is vital for physiotherapists and occupational therapists prescribing these devices. Furthermore, it is important to take account of the subjective body, as well as the biological one, to enhance the adoption of different body positions and the person’s experiences.

Purpose: To identify the characteristics of people who use standing devices and to explore their degree of device use, experiences with and reasons for standing, and perceived impact of the use of standing devices on well-being and quality of life (QOL). Method: Anyone with a current prescription at the time for the study in any of five counties in Sweden (n 1/4 545), according to a national register of prescribed devices, was invited to participate in a descriptive survey; the questionnaire was mailed to respondents for self-rating. Results: People between 2 and 86 years old were represented among respondents. Standing time decreased with increased age. Respondents who were totally dependent for mobilization or who had received their standing device more than 5 years earlier used their device most frequently. The most common reasons given for standing were to improve circulation and wellbeing and to reduce stiffness. Conclusion: It is important to pay attention to the experiences of standing for this vulnerable group of people, as the use of a standing device has a positive impact on well-being and QOL.