The meaning of adapted ice-skating for children and youths with disabilities.

PURPOSE: Children and youths with disabilities have low levels of physical activity and limited opportunities to participate in physical activity. This study aimed to explore the lived experiences and meaning of an adapted ice-skating approach with access to a tailored harness system as a physical activity for children and youths with disabilities in Sweden. MATERIALS AND METHODS: Semi-structured interviews were conducted with 12 guardians, 5 ice-skating trainers and 15 ice-skating children and youths with disabilities. The interviews were supplemented with participant observations of 23 children and youths with disabilities while ice-skating. RESULTS: Four categories emerged: "To grow as a person," "To arouse zest for life," "To train for life" and "To become part of society." Ice-skating was found to be a source of joy of movement, zest for life and longing, enabling children and youths with disabilities to explore and develop their abilities, social interactions, confidence, identity, and independence in a safe and joy-bringing context. CONCLUSION: The study highlights social and existential dimensions of an adapted ice-skating approach with access to a harness system tailored for children and youths with disabilities, that enables them to be included in ice-skating, regardless of disabilities, creating increased opportunities for physical activity and movement.

Adapted ice-skating, with access to ice-skating trainers, adapted facilities, and assistive devices, such as tailored harness systems, can create opportunities for children and youths with disabilities to increase their level of physical activity.Participation in adapted ice-skating seems to affect both physical, psychological, social, and existential dimensions for children and youths with disabilities, thus impacting their whole life.The knowledge contribution of this study can be a basis for investments in adapted and harness-supported ice-skating activities, which can improve the health and well-being of children and youths with disabilities.

Theorizing bodily dialogs - reflection on knowledge production in phenomenological research.

BACKGROUND: Every aspect of research engages the body in some way. PURPOSE: In this article the researchers discuss the epistemological challenges of engaging with lived experiences and the opportunities and challenges that arise in conjunction with the embodied aspects of interviewing, analysis and turning visual and oral research material into written text. METHOD: The authors draw on experience from interviewing and reflect on how phenomenological philosophy of the body can both challenge and contribute to unpacking the role of the body in research processes. RESULTS: Research on patients' experience of illness provides examples of how bodily experiences are intersubjective and subjective explored. The authors discuss how to let the bodily spoken contribute to the knowledge creation by "taking the body with them" in all parts of the research process. CONCLUSION: The article contributes with theoretical perspectives and highlights intercorporeal and inter-affective bodily communication as an essential element in physiotherapy research practice.

Anxiety management: Participants' experiences of a physiotherapeutic group treatment in Swedish psychiatric outpatient care.

Anxiety disorders are among the most persistent mental health syndromes. There is extensive research showing effectiveness of pharmacotherapy and psychotherapy interventions targeting anxiety, while knowledge is still sparse for other treatment options. The aim of this study was to explore how participants with anxiety disorders experience a physiotherapeutic group treatment in psychiatric outpatient care, and their perceived ability to manage anxiety within two months after participating in the treatment. Semi-structured interviews with participants were conducted to explore experiences of the treatment. Data were analyzed using qualitative content analysis, which resulted in one main theme: Reconnecting to the body in the supportive atmosphere of a group. Six categories reflect the main theme: (1) sharing with others supported by the group, (2) grounding oneself in the body, (3) getting to know the body and learning to manage its reactions, (4) learning to tolerate bodily sensations of anxiety, (5) gaining a more compassionate attitude toward oneself, and (6) challenging old patterns to become more active in life. The participants reported that their ability to reconnect to their bodies increased so that anxious sensations became more endurable and acceptable after treatment. The supportive group context was described as valuable, enabling the participants to feel safe enough to start exploring new ways to manage anxiety. In conclusion, this study suggests that a physiotherapeutic group treatment can be a useful add-on treatment to the standard treatment models of anxiety disorders, including psychotherapy and pharmacotherapy, since it targets the embodied, nonverbal domain of anxiety.

"Crawling Out of the Cocoon": Patients' Experiences of a Physical Therapy Exercise Intervention in the Treatment of Major Depression.

BACKGROUND: Although the effectiveness of physical exercise for depression has been studied for many years, few studies have described patients' experiences of what exercise means to them, beyond the biological focus. Moreover, exercise as a treatment for depression is rarely explored in a physical therapy context. OBJECTIVES: The purpose of this study was to explore a physical therapy exercise intervention, as experienced by people with major depression. DESIGN: This study had an inductive approach and used qualitative content analysis. METHODS: Semistructured interviews were conducted with 13 people who participated in physical therapist-guided aerobic exercise in a randomized controlled trial. All participants were diagnosed with major depression according to the Diagnostic and Statistical Manual of Mental Disorders. Data were collected and analyzed in an inductive manner using qualitative content analysis according to Graneheim and Lundman. RESULTS: Four categories emerged: (1) struggling toward a healthy self, (2) challenging the resistance, (3) feeling alive but not euphoric, and (4) needing someone to be there for you. The participants experienced that although the exercise intervention was hard work, it enhanced the feeling of being alive and made them feel that they were doing something good for themselves. These feelings were a welcome contrast to the numbness and stagnation they experienced during depression. LIMITATIONS: The study was conducted in Swedish primary care. Transferability of results must be viewed in relation to context. CONCLUSIONS: Exercise in a physical therapy context can improve the patients' perception of their physical ability and create a sense of liveliness, improving their depressed state. The therapeutic relationship is essential for supporting the patient's vulnerability and ambiguity in an empathic and perceptive way.

Cross-Cultural Adaptation, Validity and Reliability of the Arabic Version of the Falls Efficacy Scale-International (FES-I).

OBJECTIVE: The aim of this study was to evaluate the validity and reliability of an Arabic language version (Ar) of the Falls Efficacy Scale-International (FES-I) with respect to its use with Arabic-speaking elderly subjects. SUBJECTS AND METHODS: For cross-cultural adaptation, the translation of the original English version of the scale was conducted based on the protocol of the Prevention of Falls Network Europe (ProFaNE). The FES-I (Ar) was administered via face-to-face interviews to 108 community-dwelling elderly Palestinians (61 women and 47 men, aged 60-84 years). Statistical analyses were used to determine group differences with respect to age, gender and fall history. To assess validity, Spearman's rank correlation coefficient was used to examine the correlation between the total scores of FES-I (Ar) and the Timed Up and Go (TUG) test, gait speed and balance. Test-retest reliability between the two test occasions was assessed in accordance with Svensson's method. RESULTS: The FES-I (Ar) total scores were positively correlated with TUG (r(s) = 0.641, p < 0.001) and negatively correlated with gait speed (r(s) = -0.670, p < 0.001) and balance (r(s) = -0.592, p < 0.001). All items of the FES-I (Ar) indicated a high percentage agreement (from 88 to 93%), and the relative position ranged from 0.01 to 0.06. CONCLUSION: In this study, the FES-I (Ar) was shown to be a comprehensible, valid and reliable measure of the concern about falling among community-dwelling elderly subjects. In clinical practice and future research, the FES-I (Ar) instrument could be used to effectively assess concern about falling in Arabic-speaking elderly persons.

Opening toward life: experiences of basic body awareness therapy in persons with major depression.

Although there is a vast amount of research on different strategies to alleviate depression, knowledge of movement-based treatments focusing on body awareness is sparse. This study explores the experiences of basic body awareness therapy (BBAT) in 15 persons diagnosed with major depression who participated in the treatment in a randomized clinical trial. Hermeneutic phenomenological methodology inspired the approach to interviews and data analysis. The participants' experiences were essentially grasped as a process of enhanced existential openness, opening toward life, exceeding the tangible corporeal dimension to also involve emotional, temporal, and relational aspects of life. Five constituents of this meaning were described: vitality springing forth, grounding oneself, recognizing patterns in one's body, being acknowledged and allowed to be oneself, and grasping the vagueness. The process of enhanced perceptual openness challenges the numbness experienced in depression, which can provide hope for change, but it is connected to hard work and can be emotionally difficult to bear. Inspired by a phenomenological framework, the results of this study illuminate novel clinical and theoretical insight into the meaning of BBAT as an adjunctive approach in the treatment of depression.

Depression embodied: an ambiguous striving against fading.

Although depression is associated to physical discomfort, meanings of the body in depression are rarely addressed in clinical research. Drawing on the concept of the lived body, this study explores depression as an embodied phenomenon. Using a hermeneutic phenomenological approach, the analysis of narrative-based interviews with 11 depressed adults discloses a thematic structure of an embodied process of an ambiguous striving against fading. Five subthemes elicit different dimensions of this process, interpreted as disabling or enabling: feeling estranged, feeling confined, feeling burdensome, sensing life and seeking belongingness. In relation to clinical practice, we suggest that the interdisciplinary team can focus on enhancing the enabling dimensions, for example through guided physical activities to support the patient to feel more alive, capable and connected. Moreover, we suggest that the treatment process benefits from an increased awareness of the ambiguity in the patient's struggle, acknowledging both destructive and recharging elements of the withdrawing, and the perceived conflict in-between.

To sense and make sense of anxiety: physiotherapists' perceptions of their treatment for patients with generalized anxiety.

The generalized anxiety is characterized by long-term psychological and physiological discomfort. Pharmacological and psychotherapeutic interventions have been extensively examined, whereas knowledge is scant regarding other professional perspectives. This article focuses on the physiotherapeutic perspective on anxiety, exploring physiotherapists' perceptions of their treatment for patients with generalized anxiety. Semi-structured interviews were conducted with 10 physiotherapists working in psychiatry or primary health care. Data were analysed using qualitative content analysis, resulting in one main category and five subcategories. The main category "To sense and make sense of one's anxiety" reflects the idea that physiotherapy works through immediate, tangible bodily experiences to help a person understand and handle his or her anxiety better. Five subcategories reflected different aspects of this main category: (1) the body is the arena of anxiety, (2) to get in touch with oneself, (3) to get down-to-earth with oneself, (4) to make sense of bodily sensations, and (5) to gain trust in one's capability to handle anxiety. In conclusion, the gradual bodily awareness of sensations, to sense and make sense of anxiety in physiotherapy treatment, becomes an opportunity to find ways to withstand and to manage symptoms of anxiety, encouraging an embodied self-trust. The emphasis on the immediately lived body involves the potential to learn how to endure anxiety instead of running away from it, to discern and to understand different sensations, leading to an integration of anxiety as being part of oneself rather than overflowing oneself.

A transformative perspective on learning and professional development of Afghan physiotherapists.

The aim of this article is to explore factors that impacted learning of Afghan physiotherapists in a development project to improve the physiotherapy services in a disability programme implemented by a Swedish nongovernmental organisation in Afghanistan. Participant observation, recorded as field notes, was used to document the process, to gain a better understanding of professional development of physiotherapists in Afghanistan. Field notes were analysed and factors affecting learning were interpreted from a perspective inspired by transformative learning. Various factors were identified: a pattern approach to treatment, linear thinking, and socially oriented decision making affected how new things learned were put into practice; concrete representations and an instrumental view of knowledge characterised learning approaches; language barriers, different interpretations of meaning, and cultural codes challenged communication; and a prescriptive, encouraging approach of the expatriate physiotherapy development worker affected teaching and learning. Working with professional development across cultural borders is challenging, and the identified factors impacting learning can help expatriate physiotherapists in adapting training to the Afghan context. Exploring meaning perspectives and communicative learning could enhance understanding of these factors for both expatriate and Afghan physiotherapists and should be a focus in future development activities.

From idealistic helper to enterprising learner: critical reflections on personal development through experiences from Afghanistan.

There is little written about the cultural, social, and ethical challenges encountered by physiotherapists engaging in development work. This article takes a critical perspective on what it means to engage in development work as an expatriate physiotherapist, through a self-critical reflection on experiences from Afghanistan. The field notes from an ethnographic study of a development project conducted in Afghanistan were analysed to explore the transformative process of personal and professional development of the development worker. The critical reflective process entailed a change in meaning perspective, described as a shift from the position of an Idealistic Helper to an Enterprising Learner. Of importance in this process were "disorienting dilemmas" that challenged personal perceptions. Critical reflection over such dilemmas led to deeper understanding facilitating the process of change. The essential lesson learned is that the baseline for understanding others is an understanding of one's own meaning perspectives and manner of participation in relation to others and their context. The insights gained have implications for physiotherapists working in development contexts, for other development workers, and for physiotherapists working with patients in clinical practice in a nondevelopment context. Exploring how to collaborate in development contexts could be done using reflective groups with expatriate and local physiotherapists and/or patients. This could lead to greater understanding of oneself, each other, and the local context.

Quality of life in parents/caretakers of children with cerebral palsy in Kampong Cham, Cambodia.

The purpose of this study was to investigate QOL in parents/caretakers of children with cerebral palsy in the province of Kampong Cham, Cambodia. Forty parents/caretakers of children with cerebral palsy aged 1-13 years (F19/M21) participated in this study. The study was carried out using the Comprehensive Quality of life Scale A5 (ComQOL-A5) questionnaire. Results point out three major domains where quality of life is unsatisfactory: health, material well-being and emotional well-being. Of these areas, QOL in the health domain demonstrates the lowest scores. Results support a further commitment in providing comprehensive rehabilitation for parents and their children with CP in Kampong Cham. This study identifies the need for further research on QOL in parents/caretakers of children with CP in Cambodia and the need for development of valid and reliable QOL instruments targeting the developing world.

Gradual loss of homelikeness in exhaustion disorder.

Our aim with the present study was to explore the lived experiences of the process leading to exhaustion. Within a hermeneutic phenomenological perspective, semistructured interviews were conducted with eleven individuals on sick leave because of exhaustion disorder. The findings were interpreted as a process of five stages of losing one's homelikeness in the body and in the familiar world: (a) the body calling for attention, (b) loss of self-recognition, (c) uncanniness, (d) fighting for survival, and (e) existential breakdown. Findings help us to identify early signs of exhaustion disorder and highlight the need for treatments that focus on bodily experiences and habitual stress-related patterns. Helping the patient to regain homelikeness is an important treatment goal.

Physiotherapy in Afghanistan--needs and challenges for development.

PURPOSE: The aim of this paper is to describe and analyse the current situation of the physiotherapy component of the Rehabilitation of Afghans with Disability (RAD) programme, in order to identify the needs and challenges for further development. METHOD: The study was conducted as a field study with an anthropological approach by means of participant observation, unstructured and semi-structured interviews and photography. RESULTS: The therapists in RAD work in isolation with little opportunity for further education or professional development. Their approach is mainly medical, where the work is dictated by the patients' expectations and doctors' recommendations. They use primarily passive methods of treatment, and their work is affected by cultural, religious and situational factors. They demonstrate a low capacity of clinical reasoning in their practical work. CONCLUSIONS: There is a need for further development of physiotherapy in Afghanistan. Active and individually adapted treatment methods, clinical reasoning processes and evidence-based practice should be encouraged. There are several challenges in this, based on Afghan culture and traditions, gender issues, religious factors, an authoritative society, a medical approach in treatment, and isolation and limitations in access to information. By means of an Action Research project the physiotherapists could be included in further development and research to promote a sustainable and culturally relevant development.