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Doktorgrad Berit Heir Bunkan


ABSTRAKTER

What are the basic dimensions of body posture? An empirical evaluation of the Comprehensive Body Examination. I.

Svein Friis, Berit H. Bunkan, Anne Elisabeth Ljunggren, Oddmar Moen, Stein Oppjordsmoen
Nord J Psychiatry 1998;52:319-326. Oslo. ISSN 0803-9488

Abstract
Background: There has been a lack of psychometrically sound scales for physiotherapeutic body examinations. The purpose of this paper is to evaluate the psychometric properties of the body posture items of the Comprehensive Body Examination (CBE). Ninety-nine persons were examined: 17 pain syndrome patients, 27 patients with psychoses, 4 patients with non-psychotic mental disorder, and a comparison group consisting of 51 students and staff members. On the basis of a factor analysis 2 posture sub-scales were made: Peripheral flexion. (PF) with seven items and Spinal flexion (SF) with five items. Chronbach’s alpha was 0.81 for the PF and 0.61 for the SF sub-scale. The PF sub-scale proved to discriminate significantly between patient groups and normal controls, even when we controlled for the use of medication. The second sub-scale did not distinguish significantly among the groups. The results indicate that the 12 posture items of the CBE form 2 sub-scales with satisfactory psychometric properties.

Key Words: Body posture, Comprehensive Body Examination, Factor analysis, Psychometric properties.

What are the basic dimensions of respiration?
A psychometric evaluation of The Comprehensive Body Examination. II.

BH Bunkan, S Opjordsmoen, O Moen, AE Ljunggren, S Friis
Nord J Psychiatry 1999;53:361-369.Oslo. ISSN 0803-9488.

Abstract
There has been a lack of psychometrically sound scales for physiotherapeutic body examinations. The purpose of this study was to evaluate the psychometric properties of the respiration items of the Comprehensive Body Examination (CBE). Ninety-nine persons were examined: 17 pain syndrome patients (PSP group), 27 psychotic patients (PP group), 4 non-psychotic patients (NPP group), and a comparison group consisting of 51 students and staff (SS group). On the basis of factor analysis five respiration sub-scales were made: 1) Lac of Changeability (LC) with five items; 2) Movements Supine (MS) with five items; 3) Tension (T) with six items; 4) Movements Upright (MU) with three items and 5) Position of the Thorax (PT) with four items. The sub-scales were weakly intercorrelated, and showed high internal consistency (Chronbach’s alpha: .71 - .84). The LC sub-scale proved to distinguish significantly between the SS and both the PSP and the PP group; the MS sub-scale distinguished between the SS group and the PP group, the T sub-scale distinguished between the SS group and the PSP group. These three sub-scales distinguished significantly between patient groups and controls, even when we controlled for use of medication. The MU and PT sub-scales did not distinguish between groups. The results indicate that the respiration items form five clinically meaningful sub-scales with satisfactory psychometric properties.
Key Words: Emotions, Psychometric properties. Respiratory movements.
Berit Heir Bunkan. Mag.art. Oslo College. Faculty of Health Sciences. Physiotherapy Program. N-0167 Oslo, Norway.

What are the Basic Dimensions of Movements? A Psychometric Evaluation of the Comprehensive Body Examination. IV.

Bunkan BH., Ljunggren A., Moen, Opjordsmoen S., Friis S, M..
The Oslo College, Faculty of Health Science, Education of Physiotherapy
Nord J Psychiatry 2000,55; 33-40

Abstract
The movements were examined in accordance with the Comprehensive Body Examination. The study objects were 99 persons: 17 pain syndrome patients (PSP group), 27 psychotic patients (PP group), 4 non-psychotic patients (NPP group), and a comparison group consisting of 51 students and staff members (SS-group). On the basis of factor analysis 3 sub-scales were made: 1) Resistance to Passive Movements (RPM), with nine items, 2) Assistance to Passive Movements (APM), with six items, and 3) Movement Disturbances (MD), with three items. The internal consistency of the sub-scales was high (Chronbach’s Alpha, .81 - .96), and the intercorrelation low to moderate. The RPM sub-scale distinguished significantly between the SS-group and both patient groups; the APM and MD sub-scales distinguished between the SS-group and the PP-group. The MD sub-scale also distinguished between patients taking drugs and those who did not, but there was no difference between patients without a medication and the SS- group.

Key Words: Body movements, Emotions, Psychometric properties.

What are the basic dimensions of muscular consistency?
A psychometric evaluation of The Comprehensive Body Examination [CBE]. IV

Bunkan BH, Opjordsmoen S, Moen O, Ljunggren AE, Friis S.
J of Musculoskeletal Pain. 2003; 11:21-30.

Abstract
Objectives: The present study aims at evaluating the psychometric properties of a palpatory examination of skeletal muscles.
Methods: Fifty-one non-patients [NP group], 17 Patients with Pain Syndromes [PSP group], 27 Patients with Psychosis [PP group] and four patients with non-psychotic mental disorders were examined by palpation.
Results: Through factor analyses four sub-scales emerged: 1) Peripheral Slackness [PS], 2) Central Hardness [CH], 3) Peripheral Hardness [PH] and 4) Central Slackness [CS]. The sub-scales showed high internal consistency [Chronbach’s alpha: .72 - .92] and were slightly to moderately inter-correlated. The PS, CH and CS sub-scales discriminated significantly between the NP and PP groups. Compared with males, the females were characterized by more slack and less hard muscular consistency. No significant differences for any of the sub-scales emerged when comparing scores for patients with and without medication.
Conclusions: The new sub-scales will be relevant for physiotherapists, physicians and psychologists who want to study the state of muscular consistency in individuals with various mental disorders.

Key Words: Muscular tension, psychiatric disorders, pain, psychometric properties.

Interrater reliability of the Comprehensive Body Examination

Bunkan BH, Opjordsmoen S, Moen O, Ljunggren AE, Friis S
Physiotherapy Theory and Practice. 2002; 18: 121-129.

Abstract
The purpose of this study was to examine the inter-rater reliability of the Comprehensive Body Examination (CBE) sub-scales. These are psychometrically based sub-scales developed to measure the dimensions of body posture, respiration, movements and muscular consistency. Three independent raters examined 25 individuals (23 patients and 2 students). . Seventeen of patients had personality disorders, 3 had been psychotic and 3 were chronic pain patients attending an ordinary physiotherapy clinic. One of the students had bronchial asthma; the other was a refugee with muscular pain. The inter-rater reliability was estimated as intra-class correlations (ICC(1.1). This coefficient was chosen as it is sensitive both to random and systematic variation between raters. The ICC(1.1) for sub-scales ranged from 0.79 to 0.99 (median 0.94) indicating that properly trained raters can obtain very accurate ratings.

Key Words: Body examination, inter-rater reliability.

The Comprehensive Body Examination (CBE): From global impressions to specific sub-scales.

Friis S, Bunkan BH, Ljunggren AE, Opjordsmoen S, Moen O.
Advances in Physiotherapy 2002; 4:162-168

Abstract
In order to get a global perspective of bodily expressions of tensions and feelings in patients, physiotherapists have made comprehensive clinical examinations comprising the following domains: Posture, Respiration, Movements and Muscles. However, in reporting the results one mostly has relied on global impressions or used overall global scores.
The purpose of this study was to determine to what extent clearly defined, and psychometrically sound sub-scales can contribute to a more specific evaluation.
By use of the Comprehensive Body Examination (CBE) we examined 99 individuals and calculated the correlation between global scores, domain scores and sub-scale scores. Furthermore, we investigated to what extent the scores discriminated among three groups of individuals. The global and domain scores discriminated very well between three groups of individuals. However, some of the sub-scales were almost as good at discriminating. Three sub-scales were very strongly correlated with the global score. The scores of two of these sub-scales could explain 95 % of the variance in the global scores. To discriminate between groups of patients, only a few sub-scales are necessary. However, to get the full clinical picture, and to discriminate within diagnostic groups, the full range of sub-scales seems valuable.

Key words: Movements, muscles, pain, posture, respiration

1. Department of Psychiatry, Ullevaal University Hospital, Oslo
2. The Oslo College, Faculty of Health Science, Education of Physiotherapy
3. Division for Physical Therapy Science, University of Bergen,
and Research Forum, Ullevaal University Hospital, Oslo

Address for correspondence:
Bunkan BH, The Oslo University College, Faculty for Health Sciences, Physiotherapy program. 0167 Oslo, Norway Phone: +47 22 45 25 06 Fax: + 47 22 45 25 05 E-mail:beritheir.bunkan@hf.hio.no

Psykomotorisk Fysioterapi prinsipper og retningslinjer
Berit Heir Bunkan
Tidsskrift for Den norske lægeforening 2001

Norsk psykomotorisk fysioterapi omfatter hele kroppen og virker på følelsene. Metoden omfatter massasje, spesifikke kroppsbevegelser og noe samtale. Respirasjonsforholdene bestemmer doseringen. Et lite smerteknip i muskulaturen benyttes for å få frem pasientens spenningsmønster ved ubehag. Pasienten lærer å finne frem til adekvate måter å motvirke ubehag og spenninger på i et empatisk, terapeutisk klima
Indikasjonsområdet er først og fremst økte eller reduserte muskelspenninger og myofacial smerte med bakgrunn i ergonomi, uheldige vaner og lettere emosjonelle problemer.
Legen vurderer pasienten og henviser til behandlingen. Psykomotorikeren undersøker kroppsholdning, respirasjon, bevegelser og muskelkonsistens. Ved betydelige avvik fra normene for ideelle kroppsforhold anbefales annen type fysioterapi. Målet med norsk psykomotorisk fysioterapi er smertefrihet eller reduserte smerter i en stabil og fleksibel kropp hvor pusten har full tilpasningsevne både til fysisk aktivitet og følelser.
Det fins ca. 360 fysioterapeuter med videreutdanning i norsk psykomotorisk fysioterapi. I 1997 ble norsk psykomotorisk fysioterapi en høgskoleutdanning. Tilfanget psykomotorikere per år stipuleres til ca. 40. Metoden ble utarbeidet av psykiater Trygve Braatøy i et samarbeide med fysioterapeut Aadel Bülow-Hansen. Det humanistiske grunnsyn hos Braatøy gjennomsyrer anvendelsen av metoden.

Avhandling og Bøker:

1.
The Comprehensive Body Examination. Doktorgradsavhandling. Medisinsk fakultet. Universitetet i Oslo 2003.

2.
Den Omfattende kroppsundersøkelsen. Manual. Gyldendal academisk. 2003.

3.
Medisinsk Massasje. Universitetsforlaget.1999 (2 forfatter Cathrine Melbye Schultz)

4.
Psykomotorisk behandling. (Redaktør). Universitetsforlaget 1982

5.
Hva er psykomotorisk fysioterapi? Universitetsforlaget 1985 (2. forfatter. 1 forfatter Eline Thornquist)

6.
What is psychomotor therapy. Universitetsforlaget 1991 (2. forfatter,1 forfatter Eline Thornquist)

7.
The Comprehensive Body Examination. Manual. Gyldendal academisk, Oslo 2003

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