| 61. |
- Näslund, Annika, et al.
(författare)
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Reach performance and postural adjustments during standing in children with severe spastic diplegia using dynamic ankle-foot orthoses
- 2007
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081 .- 0001-5555. ; 39:9, s. 715-23
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate the co-ordination between reaching, ground reaction forces and muscle activity in standing children with severe spastic diplegia wearing dynamic ankle-foot orthoses compared with typically developing children. DESIGN: Clinical experimental study. SUBJECTS: Six children with spastic diplegia (Gross Motor Function Classification System level III-IV) and 6 controls. METHODS: Ground reaction forces (AMTI force plates), ankle muscle activity (electromyography and displacement of the hand (ELITE systems) were investigated while reaching for an object. RESULTS: For the children with severe spastic diplegia who were wearing dynamic ankle-foot orthoses, co-ordination between upward and forward reach velocity differed regarding the temporal sequencing and amplitude of velocity peaks. During reaching, these children lacked interplay of pushing force beneath the reach leg and braking force beneath the non-reach leg and co-ordinated ankle muscle activity, compared with controls. CONCLUSION: The results suggest differences in reach performance and postural adjustments for balance control during a reaching movement in standing between children with spastic diplegia Gross Motor Function Classification System level III-IV, wearing dynamic ankle-foot orthoses compared with typically developing children.
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| 62. |
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| 63. |
- Oldfors Engström, Lena, 1948-
(författare)
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Att förstå patienters bristande deltagande i individualiserat rehabiliteringsprogram
- 2002
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this investigation was to elucidate and describe those patients who had discontinued their participation and/or paticipated infrequently in physiotherapy treatment based on their own activity and responsibility. The ambition was to understand the phenomenon of compliance/adherence from various perspectives in behavioural as well as social science.In study I the phenomenon compliance/adherence was studied in relation to Health Locus of Control and Health Belief variables. This study was based on a questionnaire that was answered by all patients before beginning of treatment. Questions concerning the patients´conceptions about both health locus of control and health beliefs were the focus.The definitions of compliance/adherence were completed treatment period and exercise frequency, respectively. Those patients who completed the treatment were also studied regarded exercise frequency.The results of study I showed that those who discontinued their treatment reported a higher perceived threat from their health condition (higher level of dysfunction (higher pain intensity) and a higher perceived severity of their health condition (higher level of dysfunction, worse general health) than those who completed treatment. The results also showed that those who exercised once a week or less often valued the significance of the caring situation as lower (HLC), perceived a higher threat from their health condition (higher pain intensity), a higher severity of their health condition (higher level of dysfunction, worse general health, greater distrution of impairment), more barriers to treatment (lower expectations), and had certain differences in demographic variables (younger individuals, more women) than those who exercised more often (HB).Study II investigated patients´descriptions of their reasons for discontinuing the treatment, whether those reasons varied, and if so how they varied. Sixteen patients who had discontinued their treatment were interviewed with open-ended questions. The inteviews began with a question about the background to the physiotherapy treatment. There were questions concerning carrying out the treatment as well as concerning what they thought about their impairment. The patients were also asked about their priotities in daily life, as these wre presumed to be anobstacle to the treatment over a shorter or longer period of time. The third domain concerned how they experiebced the patient/physiotherapist relationship. The interviews were anlysed qualitatively.Analysis of study II resulted in four different descriptions of reasons for treatment discontinuation. A) It was about time to end treatment and continue on alone. B) The treatment was not the most important activity to spend time on. C) An agreement with the physiothreapist to discontinue treatment due to lack of effect. D) No viewpoint as to why they discontinued the treatment. In further analysis of category D, this group appeared to experience varoius forms of powerlessness. They felt their trustworthiness was often questioned. They experienced frustration in their life situation as others made the important descisions and they themselves had little to say.They defended themselves by talking about their own conceptions of the reasons for their impairment and what should be done about them. In comparing category D with categories A, B, C it was found that those in the latter three categories experienced varying degrees of control in different situations, whereas those in category D did not experience a feeling of control.Conclusion: The concept of compliance in physiotherapy is ambiguous. The concept involves one part defining what will concern the other part. It is clear that the physiotherapist and the patient do not always agree about the aim of the treatment. Instead, we should develop the concept of concordance in encounters with the patients and abandon the reasoning of compliance.
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| 64. |
- Rehn, Börje, et al.
(författare)
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Symptoms of musculoskeletal disorders among drivers of all-terrain vehicles in northern Sweden
- 2005
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Ingår i: Noise and Vibration Worldwide. - : SAGE Publications. - 0957-4565 .- 2048-4062. ; 36:1, s. 13-18
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Tidskriftsartikel (refereegranskat)abstract
- All-terrain vehicles (ATVs) are a group of machines that do not operate on prepared roads. Off-road use of these fast-moving machines results in the driver being exposed to high magnitudes of vibration and shock. It is estimated that there are up to 20,000 people in Sweden that uses ATVs during their work, such as forest machines, snowmobiles, snowgroomers, motorcycles, and three- and four-wheeled vehicles. The aim of this cross-sectional study was to investigate the risk for musculoskeletal symptoms of the neck, shoulders, upper and lower back among professional drivers of ATVs. Data from 215 male drivers of forest machines, 137 drivers of snowmobiles, 79 drivers of snowgroomers and 167 men randomly selected from the general population to act as a control group were collected. All subjects were from the four most northern counties in Sweden. Musculoskeletal symptoms during the previous year were assessed using the standardised Nordic questionnaire. Prevalence rate ratios were adjusted for age, smoking and job strain. Results showed that all driver categories had significantly increased prevalence rate ratios (1.5-2.9) for experiencing symptoms in the neck-shoulder and thoracic regions. Unlike findings from previous epidemiological studies, there was not an increased risk of low back pain among any of the driver categories compared to the control group. The higher prevalence of musculoskeletal problems is thought to be due to long-term exposure to physical factors, such as, whole-body vibration (WBV) and shock, static muscle overload and extreme body postures. The findings in this study highlight the fact that working with ATVs may cause, aggravate or prevent resolution of musculoskeletal symptoms. However, the exact cause of these problems is unclear and the interaction between vibration and body posture is not known. The authors believe however that it is necessary to reduce exposure to WBV and shock to decrease the high prevalence of musculoskeletal symptoms among professional ATV drivers. This may be done by implementing preventative measures, such as selecting the best vehicle model or seat, optimising driving style and minimizing use in rough terrain. Health surveillance seems to be important for people that regularly use ATVs in their work.
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| 65. |
- Röding, Jenny, 1972-
(författare)
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Stroke in the younger : Self-reported impact on work situation, cognitive function, physical function and life satisfaction - A national survey
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The majority of people affected by stroke are older however one fifth of all persons with stroke are younger than 65 years. In Sweden the mean age at the time of a stroke is 75 years and about 5 % of those who suffer a stroke are 55 years or younger. The aim of this thesis was to describe and analyse the consequences of stroke in the younger population in terms of experiences of the rehabilitation process, return to work, self-reported physical and cognitive function and life satisfaction. Sex differences, as well as gender specific associations regarding factors of importance for return to work, deteriorated physical ability and satisfaction with life as a whole, were also studied. This thesis was based on an in-depth interview study and self reported data collected from a questionnaire answered by 1068 individuals, 18-55 years old with a first ever stroke registered in Riks-Stroke, the Swedish national quality register for stroke care. The questionnaire concerned aspects of current health condition, living and social arrangements, physical and cognitive functions, activities in daily life, relationships, social life, leisure pursuits, self-perception, participation, work and life satisfaction. Most of the questions aimed to investigate differences between the present time and before stroke onset. In-depth interviews with two men and three women aged 37-54, living at home after their stroke generated the hypotheses that younger persons with stroke are frustrated and feel invisible and outside. Rehabilitation for the young was perceived as in adequate due to the fact that the rehabilitation setting does not acknowledge the specific needs that younger persons with stroke have. Prior to the stroke 855 of 1068 (80%) of the participants, had been in paid employment. After the stroke, 65% of the men and 66 % of the women returned to work. Factors of importance for return to work were associated with the self-reported data: the feeling that it was important to work (OR 5.1), not perceiving oneself as a burden to others (OR 3.3), not having a deteriorated ability to run a shorter distance (OR 2.8) and having support for return to work (OR 3.7). Changes in self-reported physical and cognitive functions as compared with pre-stroke condition was explored in 867 (513 men and 354 women) P-ADL independent persons with stroke. Deteriorated physical abilities were reported in 56-79% and deteriorated cognitive abilities in 48- 68% of the participants. Women were significantly more affected in terms of both physical and cognitive deterioration than the men. Seventy-two percent of the participants did not know how much they could physically exert themselves after their stroke, women significantly more than men. In addition, significant associations were found between deteriorated physical function and deteriorated cognitive function as well as fear of physical exertion. The strongest association for deteriorated ability to move in crowded environments was the risk factors deteriorated cognitive ability (OR of 5.4) and being afraid of physical exertion (OR of 3.1). Life Satisfaction and factors associated with not being satisfied with life as a whole in 1068 (631 men and 437 women) persons with stroke was assessed with the LiSat 9, baseline data from Riks- Stroke and self-reported answers from the questionnaire. Fifty-three percent of the participants were not satisfied with life as a whole. Men and women were analyzed separately in terms of associations with not being satisfied with life as a whole. Women who had a haemorrhage (OR 3.9) and a deteriorated ability to concentrate (OR 2.1) had a higher risk of not being satisfied. For men the risk was associated with living without a significant other (OR 3.2), not working (OR 2.3) and deteriorated ability to concentrate (OR 2.0). In conclusion, younger individuals who have experienced a stroke feel frustrated and invisible due to the fact that their needs are not acknowledged. Age and gender have an impact on outcome of present rehabilitation programs and the problems of younger persons with stroke can be detected at an earlier stage by developing appropriate instrument and delivering information directly aimed at physical functioning. Further studies on gender specific differences in stroke outcome concerning physical and cognitive functions as well as life situation after stroke are needed. In order to optimize rehabilitation in terms of return to work, external support and motivation seem to be important factors to consider. Key words: Adult, cognition disorders, gender differences, middle aged, motor activity, quality of life,questionnaires, stroke, work
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| 66. |
- Samuelsson, Kersti, 1953-
(författare)
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Active wheelchair use in daily life : considerations for mobility and seating
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Wheelchair fit and prescription are central in the rehabilitation process of a spinal cord injured client with an impaired walking ability. The knowledge and consequences of wheelchair use in active wheelchair users is deficient, which might lead to unnecessary problems and disabilities.Objective: The general aim of the research underlying this thesis was to increase and deepen the knowledge of wheelchair use, considering both mobility and seating aspects.Methods: The thesis includes five different studies, two of them with a focus on wheelchair mobility, two with a focus on secondary complications common in wheelchair users and one intervention study with a focus on wheelchair seating. Methods used to measure and describe wheelchair use from mobility and seating aspects are well-standardized, valid and reliable methods, custom-made newly developed forms and client estimations.Results: The power output and mechanical efficiency of wheelchair propulsion was found to be low compared to arm-crank ergometry in a group of experienced wheelchair users. Another study found that it was not possible to affect this mechanical efficiency in a uniform positive way, by a change in rear-wheel position. A significant change in propulsion technique was found which, however, did not correlate to physical effort. Secondary complications such as back pain, spinal defonnities and shoulder pain were common in clients with a spinal cord injury. In the intervention study a change in seating prerequisites had a positive effect on estimated seating comfort, posture and activity.Conclusion: Wheelchair propulsion and seating mean high physical and musculoskeletal load on the individual with a risk for secondary complications. A prescriber of hand-rim wheelchairs to clients who will spend many years in their wheelchairs has a major responsibility to understand and use available knowledge, to carefully examine the physical prerequisites of each client, and to interrelate these findings to individual needs and wishes. There is a great need for continuous development of new methods and knowledge in this area in order to avoid unnecessary complications due to wheelchair use. There is also a need for new thinking in the construction and design of new wheelchairs.
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| 67. |
- Sjödahl, Jenny, 1979-
(författare)
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Pregnancy-related pelvic girdle pain and its relation to muscle function
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Pregnancy-related lumbopelvic pain affects approximately 50% of all pregnant women. For the majority the pain disappears during the first months after delivery; however, for a significant number of women, the pain is persistent, with little improvement for more than three months after delivery. Moreover, women who experience persistent lumbopelvic pain three months postpartum are at substantial risk for new episodes or for chronic lumbopelvic pain later in life. Hence, pregnancy-related lumbopelvic pain should be considered a major public health issue. In order to develop and offer specific treatment strategies, it is important to identify different subgroups of lumbopelvic pain based on different clinical presentations. Pelvic girdle pain (PGP) is one of the major subgroups of pain related to pregnancy. There is no consensus regarding the underlying mechanisms although instability in the pelvis has been proposed as one of the possible mechanism; thus, further studies are necessary to determine how to treat these women. The local lumbopelvic muscle system, including the pelvic floor muscles (PFM) is thought to contribute to the stabilization of the pelvis and they are also the target for many treatment strategies for lumbopelvic pain.The overall aim of this thesis was to improve rehabilitation for women with persistent postpartum PGP by investigating three areas, including: 1) the postural response of the PFM, 2) the effect of home-based specific stabilizing exercises (SSE) that target the local lumbopelvic muscle system and, 3) predictors for disability at 15 months postpartum.The thesis comprises three studies: A) a methodological study, B) an experimental study, and C) a clinical randomized controlled trial (RCT). The data is mainly based on muscle function, including recordings of electromyographic (EMG) activation, muscle endurance, and muscle strength. We also collected subjective ratings of disability, healthrelated quality of life, and pain.The methodological study showed that the designed protocol, which included limb movements performed at a comfortable speed in both standing and supine positions, was useful for detecting a postural response in the PFM. The experimental study demonstrated that women with persistent postpartum PGP and those free of pain exhibited a feed-forward mechanism in the PFM that responded in anticipation to leg lifts performed in a supine position. However, we cannot rule out the possibility that women with difficulties in transferring load between the trunk and legs (i.e., those with functional pelvic instability) might have a different postural response in the PFM. In the present study, one woman with persistent postpartum PGP failed to present a feed-forward mechanism in the PFM, in agreement with previous studies on other parameters of the PFM from other similar groups.The clinical RCT demonstrated that the concept of home-based SSE with visits every second week with the treating physiotherapist was not more effective than the clinical natural course for improving subjective ratings or muscle function in women with persistent postpartum PGP.A linear regression analysis revealed a complex picture that suggests that disability 15 months postpartum in women with persistent PGP could be partially predicted by two interaction effects comprising factors from different dimensions: biological, physical functioning, and self-rated function. The proposed association between muscle function and PGP was strengthen. New approaches are most likely needed to further identify subgroups of patients with persistent postpartum PGP that can be considered homogeneous for treatment.
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| 68. |
- Stensdotter, Ann-Katrin, 1961-
(författare)
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Motor control of the knee : kinematic and EMG studies of healthy individuals and people with patellofemoral pain
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Patellofemoral pain (PFP) is believed to be associated with deficits in coordination between the different heads of the quadriceps muscle; however, considerable debate exists in the literature regarding the presence of such a deficit. Discrepancies between studies may be explained by differences in experimental tasks, such as whether the task is performed with open (OKC) or closed kinetic chain (CKC), or whether the activity is voluntary or triggered. Particular interest has been directed toward the function of the vastus medialis obliquus (VMO), which is a short muscle with limited ability to exert torque across the knee joint, but probably has a particular role in controlling patellofemoral joint position. Another short muscle that may influence knee joint position control is popliteus (POP), which is located in the back of the knee.This thesis investigates task specific activity of quadriceps in CKC versus OKC and studies the relative activity between the four heads of the quadriceps in PFP subjects compared to controls without knee pain in voluntary activity (CKC and OKC) and postural responses to balance perturbations. In addition, this thesis investigates the presumed function of POP for control of joint position in postural tasks in healthy individuals.All subjects were of normal weight and height and between 18 and 40 years. Quadriceps activity was tested for isometric with identical joint configuration in CKC and OKC, and it was performed as a reaction time task. Balance perturbations were elicited by unpredictable anterior and posterior translations of the support surface. Function of POP was investigated in unpredictable support surface translations and in self induced provocations to balance by moving the arms. Muscle activity was recorded with electromyography (EMG). Optic kinematic analysis was used to obtain specific movement responses to perturbations of balance.The quadriceps muscles were activated differently in CKC and OKC. VMO was activated earlier and to a greater degree in CKC. Rectus femoris was activated earlier and to a greater degree in OKC. PFP subjects reacted slower in both CKC and OKC, but there was no difference between groups in the relative activity between the different heads of the quadriceps. In the unpredictable support surface translation in the anterior direction, PFP subjects responded with earlier onset of VMO and with greater trunk and hip flexion in the anterior translation. POP activation in response to support surface translations in both directions occurred before all other muscles measured. In the self-initiated provocations of balance, POP was activated after the initiation of the balance provocation.This thesis concludes that quadriceps activity was task specific. The lack of difference between groups in OKC and CKC, and the difference between groups in postural responses suggest that variations in motor behaviour may occur only in tasks habitually performed. Differences in muscle activation patterns may be related to compensatory strategies to unload the quadriceps muscles and the patellofemoral joint. Furthermore, this thesis suggests that POP muscle may have a particular role in active control of the knee joint.
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| 69. |
- Stensdotter, Ann-Katrin, et al.
(författare)
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Quadriceps activation in closed and in open kinetic chain exercise.
- 2003
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Ingår i: Medicine & Science in Sports & Exercise. - 0195-9131 .- 1530-0315. ; 35:12, s. 2043-2047
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: For treatment of various knee disorders, muscles are trained in open or closed kinetic chain tasks. Coordination between the heads of the quadriceps muscle is important for stability and optimal joint loading for both the tibiofemoral and the patellofemoral joint. The aim of this study was to examine whether the quadriceps femoris muscles are activated differently in open versus closed kinetic chain tasks. METHODS: Ten healthy men and women (mean age 28.5 +/- 0.7) extended the knees isometrically in open and closed kinetic chain tasks in a reaction time paradigm using moderate force. Surface electromyography (EMG) recordings were made from four different parts of the quadriceps muscle. The onset and amplitude of EMG and force data were measured. RESULTS: In closed chain knee extension, the onset of EMG activity of the four different muscle portions of the quadriceps was more simultaneous than in the open chain. In open chain, rectus femoris (RF) had the earliest EMG onset while vastus medialis obliquus was activated last (7 +/- 13 ms after RF EMG onset) and with smaller amplitude (40 +/- 30% of maximal voluntary contraction (MVC)) than in closed chain (46 +/- 43% MVC). CONCLUSIONS: Exercise in closed kinetic chain promotes more balanced initial quadriceps activation than does exercise in open kinetic chain. This may be of importance in designing training programs aimed toward control of the patellofemoral joint.
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| 70. |
- Sundelin, Gunnevi
(författare)
-
Editorial
- 2012
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Ingår i: Advances in Physiotherapy. - : Informa UK Limited. - 1403-8196 .- 1651-1948. ; 14:4, s. 141-145
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Tidskriftsartikel (refereegranskat)
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