"Et sted å være" : Noen kvinners erfaringer med å delta i behandlingsgruppe

Bakgrunnen for oppgaven er mange års erfaringer med behandlingsgruppe for kvinner med langvarige muskel- og skjelettsmerter. Et behandlingsopplegg, utført i samarbeid mellom fysioterapeut og lege, har bestått av øvelser fra en tradisjon kalt ”Basal Kroppskjennskap”, der det legges vekt på ”frihet” i pust og bevegelser. Samtale og undervisning om anatomi, smerte, stress og kvinnerollen har også inngått. Konklusjoner fra tidligere evaluering av opplegget har vært at behandlingen har ført til betydningsfulle erfaringer og endringer i kvinnenes liv (Steihaug 2002). Tilfeldige møter med tidligere deltakere har vist at deres tilstand er uendret med hensyn til arbeidsførhet, og at de fortsatt er i behandlingsapparatet. Med utgangspunkt i at kvinnenes ”reelle” livssituasjon viste seg å være betydelig vanskeligere, enn det forskningen hadde fått frem, ble det utviklet et nytt rehabiliteringsprosjekt der hensikten var å involvere blant annet deltakernes leger og arbeidsgivere. Hensikten var å skape en annen mulighet for at kvinnene selv kunne ta aktivt del i egen rehabilitering. Utgangspunkt for prosjektet var det allerede etablerte behandlingsopplegget, og inkluderte på nytt kvinner med langvarige muskelsmerter. Hensikten er å belyse hvordan kvinnene beskriver sine erfaringer med å delta i behandlingsgruppe. Metoden er kvalitativ, og materialet består av loggbøker som 13 deltakere har ført gjennom behandlingsperioden, og utskrift av gruppeintervju i etterkant av behandlingen. Analysen er forankret i et livsverdenperspektiv og fenomenologisk teori. Analysen er tematisk og organisert ut fra deltakernes forhold til øvelsene og til det samlede behandlingsopplegget. Resultatene peker på at ulike forventningsrammer har betydning for hvordan kvinnene beskriver egne erfaringer. Dette kan gjøre det vanskelig å overføre erfaringer fra behandlingen til andre arenaer. Kvinnenes egne forventninger til seg selv og omgivelsenes forventninger om at behandlingen skal gi synlige og målbare resultater, kan bida til å svekke kvinnene tro på egne erfaringer. Funnene belyser problematikk knyttet til å vurdere effekt av behandling. De viser at kvinners forventninger til seg selv, og hvordan de oppfatter behandlernes forventninger, ikke må ekskluderes ved forskning, men trekkes inn som en betingelse. Det diskuteres om behandlingsform med bruk av bestemte øvelser kan bidra til å låse deltakerne til et bestemt handlingsmønster, framfor å bidra til at de kan prøve ut hva som er bra for dem ut fra egen situasjon og for egen del. Abstract The study is based on experiences of many years with group treatment for women with long-lasting muscle and skeletal pain. A treatment program, carried out in cooperation between a physiotherapist and a doctor, was comprised of an exercise program from a tradition called “Body Awareness”, which emphasizes free movement and breathing. Conversation and lectures about anatomy, pain, stress and the women’s role, have also been included. Conclusions drawn form earlier evaluation of this program pointed to the fact that this treatment led to important experiences and changes for the women in their lives (Steihaug, 2002). Accidental meetings with previous participants showed, however, that their condition was unchanged relating to their ability to work. These women also reported that they still were still undergoing treatment, and some admitted to missing the treatment group. Knowing that the women’s “real” life was far more complicated than the previous research had promoted, a rehabilitation project was developed, intending to involve the patient’s doctor and employer. The aim was to create an opportunity for the women to be able to participate in an active way in their own rehabilitation. The project was based on the original treatment program, and included still women with long lasting pain. The aim of the study is to show how the women describe their experiences when they participate with this group treatment. The method used is qualitative, and the material comprises notes from 13 participants in the form of a diary, written during the treatment period, together with a transcript of the group interview which concluded the treatment. The study is based on a phenomenological perspective and theory. The text is analyzed thematically and organized according to how the participants relate to the exercise program and to the treatment program as a whole. The results show that different frame of expectations are of great significance to how the women describe their own experiences. This may be the cause why it is difficult to “transfer” experiences from the treatment room to other areas, and it also points to the difficulties in evaluating a treatment program. The women’s own expectations towards themselves, and how they experience the expectations from the therapist and the environment, should not be excludes from research, but on the contrary included as a condition for it. Discussion is made whether a treatment program, included certain exercises carried out in a certain way, restrict the participants to a certain way of acting, instead of giving them the opportunity to find out what’s good for their own sake in their own situation

Collaboration as means for sustainable tourism destination – A case study of Hardanger

The purpose of this study is to investigate collaboration´s role towards sustainable development at a tourist destination. To help identifying this, three research questions were identified, and the Hardanger region in the western part of Norway was used as a case. As a start to finding answer to the project´s purpose, literature was found and critically reviewed. This literature consisted of the three main topics: Importance of tourism, sustainable tourism and collaboration. To further answer the aim of the project, a qualitative research through a semi-structured interview was found to be the best approach. The questions were focused on the same three topics as were found important through the literature review. The interviews were transcribed and further analyzed through a thematic- and context analysis, using an open mind. The saturation level was then reached after conducting 12 interviews, with a great variation of informants, connected to all parts of the region. The findings of the research indicate to a great extent that the importance of tourism in the Hardanger region is high, and that the destination will not be able to survive without it. However, the development of the tourism industry today involves several factors and trends that are found challenging to the tourism actors in the region. One can see that actors are trying to collaborate but that the lack of resources and competence, and the fair of losing value to others is creating challenges to stay on track in the future development. Furthermore, sustainability is becoming more and more important in todays´ tourism development, but tourism actors are still not completely seeing the value of it in the Hardanger region. The majority of the informants find tourism development important. On the other hand, there are several possibilities for improvements in the Hardanger region

The role of inhibitory feedback for information processing in thalamocortical circuits

The information transfer in the thalamus is blocked dynamically during sleep, in conjunction with the occurence of spindle waves. As the theoretical understanding of the mechanism remains incomplete, we analyze two modeling approaches for a recent experiment by Le Masson {\sl et al}. on the thalamocortical loop. In a first step, we use a conductance-based neuron model to reproduce the experiment computationally. In a second step, we model the same system by using an extended Hindmarsh-Rose model, and compare the results with the conductance-based model. In the framework of both models, we investigate the influence of inhibitory feedback on the information transfer in a typical thalamocortical oscillator. We find that our extended Hindmarsh-Rose neuron model, which is computationally less costly and thus siutable for large-scale simulations, reproduces the experiment better than the conductance-based model. Further, in agreement with the experiment of Le Masson {\sl et al}., inhibitory feedback leads to stable self-sustained oscillations which mask the incoming input, and thereby reduce the information transfer significantly.Comment: 16 pages, 15eps figures included. To appear in Physical Review

"A bit of everything": Health literacy interventions in chronic conditions- a systematic review

Objective: To systematically evaluate health literacy (HL) interventions in chronic conditions by exploring theoretical perspectives, intervention content and effectiveness. Method: We searched MEDLINE, Cochrane, CINAHL, EMBASE, ERIC, Web of Science and PsycINFO. Standardised systematic review methods were used, and sequences informing our research question were extracted and analysed. The study includes a descriptive summary of the included papers. Results: We included 39 unique interventions, with diabetes and heart disease as the most targeted chronic conditions. Fifty-four percent of papers included a definition of HL, but the studies showed significant hetero-geneity of theoretical underpinnings, modes, measures and content. We identified 23 HL measures, mostlyassessing functional HL. The HL interventions were often more complex than the measures indicated. A significant change in HL was found in 28 studies. Study quality was generally poor. Conclusions: Interventions optimizing HL appear important to improve health outcomes in chronic conditions. To ensure cumulative knowledge development of this field we need theory-based interventions, consistency in methods and more tailored and comprehensive measures to capture the interventions’ complexity. Practice implications: A more valid understanding of HL interventions and measurements is needed to reach an agreed understanding of their components and intentions.publishedVersio

Critical physiotherapy: a ten-year retrospective

Critical physiotherapy has been a rapidly expanding field over the last decade and could now justifiably be called a professional sub-discipline. In this paper we define three different but somewhat interconnected critical positions that have emerged over the last decade that share a critique of physiotherapy’s historical approach to health and illness, while also diverging in the possibilities for new forms of practice and thinking. These three positions broadly align with three distinctive philosophies: approaches that emphasize lived experience, social theory, and a range of philosophies increasingly referred to as the “posts”. In this paper we discuss the origins of these approaches, exploring the ways they critique contemporary physiotherapy thinking and practice. We offer an overview of the key principles of each approach and, for each in turn, suggest readings from key authors. We conclude each section by discussing the limits of these various approaches, but also indicate ways in which they might inform future thinking and practice. We end the paper by arguing that the various approaches that now fall under the rubric of critical physiotherapy represent some of the most exciting and opportune ways we might (re)think the future for the physiotherapy profession and the physical therapies more generally.Peer reviewe

Cholinergic Activation of M2 Receptors Leads to Context-Dependent Modulation of Feedforward Inhibition in the Visual Thalamus

The temporal dynamics of inhibition within a neural network is a crucial determinant of information processing. Here, the authors describe in the visual thalamus how neuromodulation governs the magnitude and time course of inhibition in an input-dependent way

Introduction to Neurolinguistics

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