School of Health Sciences
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Item The effects of a pragmatic community exercise programme in adolescents and young adults with Cerebral Palsy(Queen Margaret University, Edinburgh, 2017) Zanudin, AsfarinaEvidence suggests that the walking ability of people with cerebral palsy (CP) often deteriorates in early adulthood. This is especially problematic as the health care for young people with disabilities changes considerably over the course of the transition from paediatric to adult health care services. This suggests the importance of providing young people with the appropriate tools for managing their disability on a largely independent basis if they hope to reduce or delay this physical decline. One such strategy is the introduction of young people to an exercise programme which may be carried out independently of the health care system. Therefore, the main aim of this thesis was to investigate the feasibility and effectiveness of an 18-week pragmatic community exercise programme in adolescents and young adults with CP. Acknowledging the importance of assessing the effects of exercise studies using outcome measures (OMs) which are reliable, valid and responsive to change, a secondary aim of this thesis was to synthesise the psychometric evidence for the measures of gait quality and walking performance currently used for adolescents and young people with CP through a systematic review. Additional psychometric evidence for measures commonly used to assess the efficacy of exercise interventions was provided by a test-retest reliability study as part of this thesis. A standardised quality checklist (COSMIN) was used in the systematic review (Study 1) to measure methodological quality. The strength of the evidence was rated using standardised guidelines. The synthesis of best evidence was scored according to the Cochrane criteria, which indicated that the reliability (inter-rater) of the Functional Mobility Scale was characterised by a 'strong' level of evidence. The evidence for the responsiveness for all OMs included in this review was rated as 'unknown'. Only one study reported on measurement error when reporting on reliability. In Study 2, test-retest reliability (Intraclass Correlation Coefficient (ICC) and Minimal Detectable Change) was calculated for physical function, habitual physical activity (HPA), quality of life (QoL) and self-esteem measures in a group of adolescents and young adults with CP (n=8) and their age-matched peers (n=14). The ICCs for physical function and HPA OMs ranged from moderate to good but were poor for the measures of QoL and self-esteem. The RCT (Study 3) showed no statistically significant improvement following the exercise programme in any of the OMs at 6 weeks (experimental n=9, control n=7). A small effect size (d=0.54) in favour of the experimental group was found for the Canadian Occupational Performance Measure (COPM). Considering the experimental group only, a statistically significant improvement was found for the COPM at 12 weeks (n=7, p=0.02) compared to the baseline. Feasibility issues were also identified. This study was limited by its small sample size. This thesis contributes to the evidence base on pragmatic community exercise programmes for adolescents and young adults with CP and confirms the test-retest reliability (consistency) of physical function and HPA OMs commonly used to assess the efficacy of exercise interventions in CP.Item Community-based creative dance for adolescents and their feelings of social wellbeing(Queen Margaret University, 2009) Oliver, SueThe thesis contextualises creative dance as art in a community setting. The participants were teenage members of a community-run creative dance company. The aim was to explore any links young people make between their creative dance experience in a community class and their feelings of social well-being. The literature gives a brief historical overview of dance as a performing art and of the nature of aesthetics and creativity. It considers the art of dance as a form of communication, and the conditions for creativity to flourish. It looks at Bourdieu‘s (2005) theory of ‗habitus‘ and ‗field‘ in understanding the social experience which the dancers derived through creative dance. Consideration is given to theories and accounts of adolescent development and how community interaction can affect the dancers‘ feelings of social wellbeing. The methodological approach is hermeneutic phenomenology, with influences from ethnomethodology and social constructionism. The ontological principle is that personal meaning is socially constructed. Epistemologically the study is informed by the belief that knowledge is generated through the creative dance experience. The main data collection method was semi-structured interviews with the dancers (n=10), supported by observation of dance classes (n=7; filmed: n=4), group discussions (n=3) and graffiti walls (n=8, completed by the dancers). The data were organised and analysed thematically using a method of presentation inspired by Bourdieu‘s concept of a ‗social trajectory‘ - a lifetime journey of social encounters – offering headings under which the data were loosely organised. Selected observations are presented on DVD. The responses suggested a dance ‗journey‘ from preparation to performance, which allowed further organisation of data. The emergent themes included the dancers‘ motivation for dancing, their feelings about the creative process, experiences of social interaction and of taking control of one‘s own identity, through all the stages of experimenting with movement, refining the dances and performing. The main findings are: the dancers attached importance to company membership because it offered a means to clarifying self-identity through physical and artistic endeavour; the creative dance context gave them freedom to explore their movement capabilities and to interact socially, and thus gave them a means of negotiating their ‗habitus‘, i.e. adopting and adjusting social norms and values on their own terms. Performing was a celebration of achievement and confirmation of identity as a dancer. The study contributes to the understanding of how adolescents make sense of their identity in their social context through their creative dance experience and how that influences their feelings of social wellbeing.