Identtisten ja epäidenttisten kaksosten puhe : Monotsygoottisten ja ditsygoottisten kaksosten puheen vertailua kesto-, nopeus-, tauko- ja taajuusmittauksin

This thesis presents an experimental study of the speech prosody of identical and non-identical twins. Speech fluency, pauses, speech rate, utterance length and speech frequency were examined phonetically, auditorily, semantically and statistically. The methods included both reading tasks (reading the alphabet, numerical lists, sentences with foreign loan words, holiday theme questions as well as 1.5 pages of text with long sentences and complex words) and spontaneous speech tasks (picture description and answering holiday theme questions). The subjects were Finnish-speaking 22-28-year-old female twins: 8 identical (monozygotic) and 10 non-identical (dizygotic) pairs. One pair was male-female. Comparisons were made between twin groups and between sisters. The data was regathered from four twin pairs, to make it possible to investigate some subjects intra-individually. In addition phoneticians, phonetic students and people without knowledge of phonetic science were tested in two listening experiments. The results showed that the dizygotic twins differed more from each other than monozygotic twins and that monozygotic twin sisters shared more similarities than dizygotic twin sisters. For example, between monozygotic twin sisters smaller differences were found between word count, utterance length and speech rate in spontaneous speech tasks. Dizygotic twin sisters made more different kinds of reading mistakes with the same target words than monozygotic twin sisters, while monozygotic twin sisters made more of the same reading mistakes with the same target words than dizygotic twin sisters. The listening experiments showed that only professional phoneticians were able to recognize the twin sisters. Even though the twins had the possibility to freely choose their speech rate, pausing and speech frequency, they used their own speech patterns; these included the same average speech frequency, average speech rate, type of pausing routine or filled pauses, and other speech mannerisms throughout their speech.

Effects of unilateral vocal fold paralysis treatment with fascia augmentation on airflow mechanics, tracheal sounds and voice acoustics

Data on the influence of unilateral vocal fold paralysis on breathing, especially other than information obtained by spirometry, are relatively scarce. Even less is known about the effect of its treatment by vocal fold medialization. Consequently, there was a need to study the issue by combining multiple instruments capable of assessing airflow dynamics and voice. This need was emphasized by a recently developed medialization technique, autologous fascia injection; its effects on breathing have not previously been investigated. A cohort of ten patients with unilateral vocal fold paralysis was studied before and after autologous fascia injection by using flow-volume spirometry, body plethysmography and acoustic analysis of breathing and voice. Preoperative results were compared with those of ten healthy controls. A second cohort of 11 subjects with unilateral vocal fold paralysis was studied pre- and postoperatively by using flow-volume spirometry, impulse oscillometry, acoustic analysis of voice, voice handicap index and subjective assessment of dyspnoea. Preoperative peak inspiratory flow and specific airway conductance were significantly lower and airway resistance was significantly higher in the patients than in the healthy controls (78% vs. 107%, 73% vs. 116% and 182% vs. 125% of predicted; p = 0.004, p = 0.004 and p = 0.026, respectively). Patients had a higher root mean square of spectral power of tracheal sounds than controls, and three of them had wheezes as opposed to no wheezing in healthy subjects. Autologous fascia injection significantly improved acoustic parameters of the voice in both cohorts and voice handicap index in the latter cohort, indicating that this procedure successfully improved voice in unilateral vocal fold paralysis. Peak inspiratory flow decreased significantly as a consequence of this procedure (from 4.54 ± 1.68 l to 4.21 ± 1.26 l, p = 0.03, in pooled data of both cohorts), but no change occurred in the other variables of flow-volume spirometry, body-plethysmography and impulse oscillometry. Eight of the ten patients studied by acoustic analysis of breathing had wheezes after vocal fold medialization compared with only three patients before the procedure, and the numbers of wheezes per recorded inspirium and expirium increased significantly (from 0.02 to 0.42 and from 0.03 to 0.36; p = 0.028 and p = 0.043, respectively). In conclusion, unilateral vocal fold paralysis was observed to disturb forced breathing and also to cause some signs of disturbed tidal breathing. Findings of flow volume spirometry were consistent with variable extra-thoracic obstruction. Vocal fold medialization by autologous fascia injection improved the quality of the voice in patients with unilateral vocal fold paralysis, but also decreased peak inspiratory flow and induced wheezing during tidal breathing. However, these airflow changes did not appear to cause significant symptoms in patients.

Tumour necrosis factor receptor-associated periodic syndrome (TRAPS) : Identification of novel TNFRSF1A mutations and intracellular signalling defects

The systemic autoinflammatory disorders are a group of rare diseases characterized by periodically recurring episodes of acute inflammation and a rise in serum acute phase proteins, but with no signs of autoimmunity. At present eight hereditary syndromes are categorized as autoinflammatory, although the definition has also occasionally been extended to other inflammatory disorders, such as Crohn s disease. One of the autoinflammatory disorders is the autosomally dominantly inherited tumour necrosis factor receptor-associated periodic syndrome (TRAPS), which is caused by mutations in the gene encoding the tumour necrosis factor type 1 receptor (TNFRSF1A). In patients of Nordic descent, cases of TRAPS and of three other hereditary fevers, hyperimmunoglobulinemia D with periodic fever syndrome (HIDS), chronic infantile neurologic, cutaneous and articular syndrome (CINCA) and familial cold autoinflammatory syndrome (FCAS), have been reported, TRAPS being the most common of the four. Clinical characteristics of TRAPS are recurrent attacks of high spiking fever, associated with inflammation of serosal membranes and joints, myalgia, migratory rash and conjunctivitis or periorbital cellulitis. Systemic AA amyloidosis may occur as a sequel of the systemic inflammation. The aim of this study was to investigate the genetic background of hereditary periodically occurring fever syndromes in Finnish patients, to explore the reliability of determining serum concentrations of soluble TNFRSF1A and metalloproteinase-induced TNFRSF1A shedding as helpful tools in differential diagnostics, as well as to study intracellular NF-κB signalling in an attempt to widen the knowledge of the pathomechanisms underlying TRAPS. Genomic sequencing revealed two novel TNFRSF1A mutations, F112I and C73R, in two Finnish families. F112I was the first TNFRSF1A mutation to be reported in the third extracellular cysteine-rich domain of the gene and C73R was the third novel mutation to be reported in a Finnish family, with only one other TNFRSF1A mutation having been reported in the Nordic countries. We also presented a differential diagnostic problem in a TRAPS patient, emphasizing for the clinician the importance of differential diagnostic vigiliance in dealing with rare hereditary disorders. The underlying genetic disease of the patient both served as a misleading factor, which possibly postponed arrival at the correct diagnosis, but may also have predisposed to the pathologic condition, which led to a critical state of the patient. Using a method of flow cytometric analysis modified for the use on fresh whole blood, we studied intracellular signalling pathways in three Finnish TRAPS families with the F112I, C73R and the previously reported C88Y mutations. Evaluation of TNF-induced phosphorylation of NF-κB and p38, revealed low phosphorylation profiles in nine out of ten TRAPS patients in comparison to healthy control subjects. This study shows that TRAPS is a diagnostic possibility in patients of Nordic descent, with symptoms of periodically recurring fever and inflammation of the serosa and joints. In particular in the case of a family history of febrile episodes, the possibility of TRAPS should be considered, if an etiology of autoimmune or infectious nature is excluded. The discovery of three different mutations in a population as small as the Finnish, reinforces the notion that the extracellular domain of TNFRSF1A is prone to be mutated at the entire stretch of its cysteine-rich domains and not only at a limited number of sites, suggesting the absence of a founder effect in TRAPS. This study also demonstrates the challenges of clinical work in differentiating the symptoms of rare genetic disorders from those of other pathologic conditions and presents the possibility of an autoinflammatory disorder as being the underlying cause of severe clinical complications. Furthermore, functional studies of fresh blood leukocytes show that TRAPS is often associated with a low NF-κB and p38 phosphorylation profile, although low phosphorylation levels are not a requirement for the development of TRAPS. The aberrant signalling would suggest that the hyperinflammatory phenotype of TRAPS is the result of compensatory NF-κB-mediated regulatory mechanisms triggered by a deficiency of the innate immune response.

Primary Dislocation of the Patella : A Clinical Study

A total of 177 patients with primary dislocation of the patella (PDP) were admitted to two trauma centers in Helsinki, Finland during 1991 to 1992. The inclusion criteria were: 1. Acute (≤14 days old) first-time lateral dislocation of the patella. 2. No previous knee operations or major knee injuries. 3. No ligament injuries to be repaired. 4. No osteochondral fractures requiring fixation. 50 patients were excluded. 30 of these excluded patients would have met the inclusion criteria, 19 patients received treatment by consultants not involved in the study, 7 refused to participate and 4 had an erroneous randomization. 127 patients including, 82 females, were then randomized to have either tailor-made operative procedure (group O) or conservative treatment (group C). The aftercare was similar for both groups. The mean age of the patients was 20 (9-47) years. All patients were subjected to analysis of trauma history (starting position and knee movement during the dislocation), examination under anesthesia (EUA) and arthroscopy. 70 patients (52 females) were randomized by their odd year of birth to operative group O and 57 patients (30 females) by their even year of birth to conservative group C. The diagnosis of PDP was based on locked dislocation in 68 patients, on dislocatability in EUA in 47 patients, and on subluxation in EUA combined with typical intra-articular lesions in 12 patients. In group O, 63 patients had exploration of the injuries on the medial side of the knee and tailor made reconstruction added with lateral release in 54 cases. The medial injury was operated by suturing in 39 patients, by duplication in 18 patients and by additional augmentation of the medial patellofemoral ligament (MPFL) with adductor magnus tenodesis in 6 patients. 7 patients, without locking in trauma history and only subluxation in EUA had only lateral release for realignment. In adductor magnus tenodesis the proximal end of the distal tendinous part was rerouted to the upper medial border of the patella. In the conservative group C, the treatment was adjusted to the extent of patellar displacement in EUA. Patients with dislocation in EUA had 3 weeks’ immobilization with the knee in slight flexion. Mobilization was started with a soft patellar stabilizing orthosis (PSO) used for additional three weeks. The patients with subluxation in EUA wore an orthosis for six weeks. The aftercare was similar in group O. The outcome was similar in both groups. After an average of 25 (20-45) months´ follow-up, the subjective result was better in group C in respect of the mean Hughston VAS knee score (87 for group O and 90 for group C, p=0.04, visual analog scale), but similar in terms of the patient’s own overall opinion and the mean Lysholm II knee score. Recurrent instability episodes occurred in 18 patients in group O and in 20 patients in group C. After an average of 7 (6-9) years´ follow-up, the groups did not show statistical difference either in respect of the patient’s own overall opinion, or the mean Hughston VAS and Kujala knee scores. The proportions of stable patellae was 25/70 (36%) in group O and 17/57 (30%) in group O (p=0.5). In a multivariate risk analysis, there was a correlation between low Kujala score (<90) as dependent parameter and female gender (OR: 3.5; 95% CI: 1.4-9.0), and loose body on primary radiographs (OR: 4.1; 95% CI: 1.2-15). Recurrent instability correlated with young age at the time of PDP (OR: 0.9; 95% CI: 0.8-1.0/year). Girls with open tibial apophysis had the worst prognosis for instability (88%; 95% CI: 77-98). The most common mechanisms in trauma history of the patients were movement to flexion from a straight start (78%) and movement to extension from a well-bent start (8%). Spontaneous relocation of the patella had taken place in 13/39 of girls, in 11/21 of boys, in 26/42 of women and in 17/24 of men with skeletal maturity of the tibia. The dislocation in EUA was non-rotating in 96/126 patients followed by outward rotating dislocation in 14/126 patients. Operative treatment policy in PDP is not recommended. Locking tendency of the patella in PDP depended on the skeletal maturation. Recurrence rate after PDP was higher than expected.

Omega-3-rasvahappojen käyttö nivelrikkoisten koirien hoidossa

Nivelrikko on koirilla yleinen sairaus. Sen hoitoon yleisesti käytettävien tulehduskipulääkkeiden rinnalle etsitään hoitomuotoja tulehduskipulääkkeiden pitkäaikaiskäytöstä johtuvien haittavaikutusten takia. Tutkimuksemme tavoite oli selvittää omega-3-rasvahappojen käytön hyötyä nivelrikkoisten koirien hoidossa. Tutkimuksen alkuhetkellä tutkimusta vastaavasta aiheesta koirilla ei ollut tehty. Ihmisillä reumatoidin artriitin hoidossa omega-3-rasvahapoilla on todettu olevan positiivisia vaikutuksia, joten siihen viitaten myös nivelrikkoisilla koirilla saattaisi olla hyötyä omega-3-rasvahappojen käytöstä. Omega-3-rasvahapoilla on todettu olevan positiivisia vaikutuksia useisiin tulehduksellisiin sairauksiin. Tutkimushypoteesimme oli, että kalaöljyä syövän ryhmän kohtisuora maksimaalinen voima askelvoimalevyllä kasvaisi ja ryhmän arvioitu kivuliaisuus laskisi tutkimuksen aikana. Tutkimamme tuote oli omega-3-rasvahapporavintolisä (Doils® Nivelet, Nutraceuticoils, Belgia). Tutkimus oli satunnaistettu, kaksoissokkoutettu ja kontrolloitu kliininen tutkimus. Tutkimukseen haettiin koiria ilmoitusten perusteella. Alkukyselyn ja seulontakäynnin perusteella tutkimuksen aloitti 77 koiraa. Seulontakäynnillä koirille tehtiin kliininen yleistutkimus, ortopedinen tutkimus, suppea neurologinen tutkimus, röntgenkuvaus, askelvoimalevymittaus sekä verinäytteenotto. Koirat kävivät varsinaisen tutkimuksen aikana kahdella lähikäynnillä. Molemmilla kerroilla koirille suoritettiin röntgenkuvausta lukuun ottamatta samat toimenpiteet kuin seulontakäynnillä. Tutkimuksen aikana omistajat täyttivät kyselykaavakkeita yhteensä seitsemän kertaa. Tutkimuksessa arvioitiin nivelrikkoisten koirien kipua sekä omistajan että eläinlääkärin arvioiden avulla sekä askelvoimalevyn avulla. Arviointimenetelmistä saatuja tuloksia olivat omistajan täyttämästä kyselykaavakkeesta kipuindeksin kyselyn tulokset, liikkumisvaikeuksista kertova VAS, elämänlaadusta kertova VAS, varakipulääkkeiden käyttö, vertailevat kysymykset, omistajan arvio valmisteen tehosta ja koiran ryhmästä, eläinlääkärin arvio sekä askelvoimalevyltä saadut kaksi muuttujaa (kohtisuora maksimaalinen voima ja impulssi). Tutkimustuloksissa havaittiin omega-3-rasvahappojen käytössä nivelrikkoisten koirien hoidossa pieni hyöty. Kalaöljyryhmän ja lumeryhmän välillä ei havaittu tilastollisesti merkitsevää eroa. Ryhmien sisällä havaittiin muutamia tilastollisesti merkitseviä muutoksia. Kipuindeksin muutos paremmaksi kalaöljyryhmässä tutkimuksen aikana oli vahvasti tilastollisesti merkitsevä muutos (p=0,002). Myös askelvoimalevyn kohtisuoran maksimaalisen voiman parantuminen oli vahvasti tilastollisesti merkitsevä muutos kalaöljyä syöneessä ryhmässä(p=0,001). Myös lumeryhmässä oli kipuindeksissä ja askelvoimalevyn kohtisuorassa maksimaalisessa voimassa havaittavissa tilastollisesti merkitsevä trendi (p=0,07 & p=0,059), mutta p-arvot eivät yltäneet tilastolliseen merkitsevyyteen. Suuremmalla otoskoolla näissä muuttujissa olisi voitu havaita joko tilastollisesti merkitseviä eroja ryhmien välillä tai sitten olisimme voineet osoittaa molemmissa ryhmissä tapahtuneen positiivisia eli parantavia muutoksia. Tutkimuksessa ei havaittu sivuvaikutuksia kalaöljyryhmässä. Tutkimustulokset todistivat tutkimushypoteesimme heikosti todeksi. Omega-3-rasvahappoja voisi siis hyvin käyttää koirilla, joille ei sovi kipulääkkeet.

GAITRite®-askelvoimamaton ja GAITFour®-ohjelmiston käyttö objektiivisessa kivunarvioinnissa lonkkaniveldysplasiasta johtuvaa nivelrikkoa sairastavilla koirilla

Tutkimukseni oli osa laajempaa omega-3-rasvahappotutkimusta lonkkaniveldysplasiaa sairastavilla koirilla. Lonkkaniveldysplasia tarkoittaa lonkkanivelen epänormaalia kehitystä. Sen syntyyn vaikuttavat perintötekijät ja ympäristö. Lonkkaniveldysplasia on yleinen sairaus etenkin isoilla koiraroduilla. Se johtaa nivelrikkoon ja krooniseen kipuun. Kivun arvioinnin tulisi olla objektiivista, mutta koska eläimet eivät osaa kertoa kivustaan, niiden kivun arvioiminen perustuu usein arvioijan subjektiiviseen näkemykseen. Eläinten kivun objektiiviseen arviointiin ei ole olemassa riittävästi menetelmiä. Osatutkimukseni tarkoitus oli arvioida askelvoimamaton soveltumista kroonisen kivun arviointimenetelmäksi. Kaksoissokkoutetussa tutkimuksessa oli loppuun saakka mukana 71 koiraa. Koirat jaettiin satunnaisesti kahteen ryhmään, joista toinen söi tutkittavaa Doils-kalaöljyvalmistetta ja toinen lumevalmistetta 4 kk ajan. Tutkimukseeni liittyen koiria juoksutettiin askelvoimalevyn ja askelvoimamaton yli useita kertoja jokaisella kolmella tutkimuskäynnillä. Lisäksi omistajat vastasivat yhteensä seitsemän kertaa kyselyihin, joissa oli muun muassa kaksi visuaalista analogista asteikkoa (VAS; elämänlaatu ja liikkumisvaikeudet) ja kysymykset, joista laskettiin krooninen kipuindeksi (HCPI). Vertasimme askelvoimamatolla ja askelvoimalevyllä saatuja tuloksia toisiinsa sekä VAS:hin ja HCPI:iin. Hypoteesimme oli, että näiden eri menetelmien tulosten välillä olisi selvä korrelaatio. Jos koiran kipu vähenisi, VAS:n ja HCPI:n lukemat pienenisivät ja sekä askelvoimalevyllä (maksimaalinen kohtisuora voima/PVFz, impulssi/IMP) että askelvoimamatolla (maksimipaine ja aktivoituneiden sensoreiden lukumäärä) mitattujen parametrien arvot nousisivat ontumisen vähentyessä. Toinen hypoteesimme oli, että askelvoimamatolla ontuminen havaittaisiin helpommin käynnissä kuin ravissa. PVFz:n ja IMP:n havaittiin korreloivan huomattavasti paremmin keskenään, jos ne oli normalisoitu ajan suhteen. Täten esimerkiksi kliinisissä seurantatutkimuksissa näitä parametreja tulisi käyttää ajan suhteen normalisoituina. Molempien VAS:n jaHCPI:n välillä oli hyvä korrelaatio. Ne eivät kuitenkaan korreloineet lainkaan askelvoimalevyja askelvoimamattoparametrien kanssa. Tämä perustuu siihen, että askelvoimalevyn mittaama ontuma ei ole sama asia kuin omistajien arvioima kipu. Molemmissa ryhmissä askelvoimamaton parametrit huononivat hypoteesimme vastaisesti. Askelvoimamattomme olikin todennäköisesti rikki tutkimuksemme aikana. Tästä johtuen kaikki askelvoimamattotulokset ovat epäluotettavia, eikä niiden perusteella voi tehdä luotettavia johtopäätöksiä. Tutkimuksen perusteella ei siis saatu lisää todisteita askelvoimamaton soveltuvuudesta kroonisen kivun objektiiviseen arviointiin. On mahdollista, että askelvoimamaton sisäisiä mittauksia voitaisiin käyttää, vaikka matto onkin ollut osittain rikki. Havaitsimme, että askelvoimamaton maksimipaine ravissa korreloi loistavasti maksimipaineeseen käynnissä. Sama havainto tehtiin myös aktivoituneiden sensoreiden lukumäärässä. Tämä tulos kumoaa toisen hypoteesimme. Ontuminen siis havaittiin askelvoimamatolla käynnissä yhtä helposti kuin ravissakin. Ennen kuin voimme suositella GAITRite-askelvoimamattoa ontumatutkimuksien arviointimenetelmänä, tarvitaan lisätutkimuksia kunnossa olevalla matolla.

Pain measurement and management in elderly patients : Clinical studies in long term hospital care and after cardiac surgery

The proportion of patients over 75 years of age, receiving all different types of healthcare, is constantly increasing. The elderly undergo surgery and anaesthetic procedures more often than middle-aged patients. Poor pain management in the elderly is still an issue. Although the elderly consumes the greatest proportion of prescribed medicines in Western Europe, most clinical pharmacological studies have been performed in healthy volunteers or middle-aged patients. The aim of this study was to investigate pain measurement and management in cognitively impaired patients in long term hospital care and in cognitively normal elderly patients after cardiac surgery. This thesis incorporated 366 patients, including 86 home-dwelling or hospitalized elderly with chronic pain and 280 patients undergoing cardiac surgery with acute pain. The mean age of patients was 77 (SD ± 8) years and approximately 8400 pain measurements were performed with four pain scales: Verbal Rating Scale (VRS), the Visual Analogue Scale (VAS), the Red Wedge Scale (RWS), and the Facial Pain Scale (FPS). Cognitive function, depression, functional ability in daily life, postoperative sedation and postoperative confusion were assessed with MMSE, GDS, Barthel Index, RASS, and CAM-ICU, respectively. The effects and plasma concentrations of fentanyl and oxycodone were measured in elderly (≥ 75 years) and middle-aged patients (≤ 60 years) and the opioid-sparing effect of pregabalin was studied after cardiac surgery. The VRS pain scores after movement correlated with the Barthel Index. The VRS was most successful in the groups of demented patients (MMSE 17-23, 11-16 and ≤ 10) and in elderly patients on the first day after cardiac surgery. The elderly had a higher plasma concentration of fentanyl at the end of surgery than younger patients. The plasma concentrations of oxycodone were comparable between the groups. Pain intensity on the VRS was lower and the sedation scores were higher in the elderly. Total oxycodone consumption during five postoperative days was reduced by 48% and the CAM-ICU scores were higher on the first postoperative day in the pregabalin group. The incidence of postoperative pain during movement was lower in the pregabalin group three months after surgery. This investigation demonstrates that chronic pain did not seem to impair daily activities in home-dwelling Finnish elderly. The VRS appeared to be applicable for elderly patients with clear cognitive dysfunction (MMSE ≤17) and it was the most feasible pain scale for the early postoperative period after cardiac surgery. After cardiac surgery, plasma concentrations of fentanyl in elderly were elevated, although oxycodone concentrations were at similar level compared to middle-aged patients. The elderly had less pain and were more sedated after doses of oxycodone. Therefore, particular attention must be given to individual dosing of the opioids in elderly surgical patients, who often need a smaller amount for adequate analgesia than middle-aged patients. The administration of pregabalin reduced postoperative oxycodone consumption after cardiac surgery. Pregabalin-treated patients had less confusion, and additionally to less postoperative pain on the first postoperative day and during movement at three months post-surgery. Pregabalin might be a new alternative as analgesic for acute postoperative and chronic pain management in the elderly. Its clinical role and safety remains to be verified in large-scale randomized and controlled studies. In the future, many clinical trials in the older category of patients will be needed to facilitate improvements in health care methods.

Inkluderande teaterverksamhet. Nya möjligheter för socialt arbete

I denna pro gradu-avhandling granskas teaterns möjligheter att främja social inklusion. Genom att analysera vad drama och teater kan ge ungdomar och hur social inklusion bland unga i ett samfund kan främjas, belyses även frågan om hur socialt arbete och teater ömsesidigt kan berika varandra. Avhandlingen är en fallstudie av Half Moon Young People’s Theatre, en barn- och ungdomsteater i Tower Hamlets i östra London. Teatern arbetar med barn och unga med ett särskilt fokus på att engagera grupper som ofta marginaliserats, exempelvis på grund av sin kulturella bakgrund eller till följd av funktionshinder. I denna studie är fokus på Half Moons projekt riktade till tonåringar: Careers in Theatre, Speak Up och ungdomsteatergrupperna Lunar och Solar. Studien är kvalitativ och studiens empiriska data har främst samlats in genom deltagande observation, intervjuer och granskning av dokument. Det empiriska materialet visar på Half Moons aktiva arbete för mångfald och för att göra verksamheten och deltagandet tillgängligt för alla barn och unga. Teatern blir en mötesplats genom vilken ungdomarna kan lära sig acceptera och uppskatta mångfalden i samfundet. Teaterarbetet bidrar till en ökad känsla för samfundet och till tolerans och förståelse för andra. Det är en glädjefylld, trygg och meningsfull fritidsverksamhet där nya vänskapskontakter kan knytas och många färdigheter övas inför framtiden. Teaterarbetet ger deltagarna bekräftelse vilket bidrar till att självförtroendet växer. Personalens engagemang och osjälviska arbete för inklusion genomsyrar verksamheten. Möjligheten att ge alla en ny chans och ett jämlikt bemötande är centralt i teaterns arbete. Forskningsresultaten pekar på teaterns potential inom socialt arbete och för att främja inklusion. Teaterns möjligheter att öka klientens delaktighet och utveckla förhållandet mellan socialarbetare och klient visar på betydelsen av etablera dylik verksamhet inom socialt arbete. Att inte låta sig begränsas, utan förutsättningslöst samarbeta över sektorer ökar chanserna att finna nya kreativa idéer och verksamhetsformer.