| 1. |
- Björkdahl, Ann, 1959, et al.
(författare)
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Effect of very early supported discharge versus usual care on activi-ties of daily living ability after mild stroke: a randomized controlled trial.
- 2023
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Ingår i: Journal of rehabilitation medicine. - 1651-2081. ; 55
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Tidskriftsartikel (refereegranskat)abstract
- To examine the ability to perform basic and instrumental activities of daily life after very early supported discharge vs usual discharge and referral routine during the first year after mild stroke.A secondary analysis of data from the Gothenburg Very Early Supported Discharge randomized controlled trial. Patients: A total of 104 patients (56% men; mean (standard deviation) age 75 (11) years) who had experienced a first stroke classified as mild.The primary outcome was the Activities of Daily Living Taxonomy score. Stroke Impact Scale (activities of daily living, and mobility) scores was a secondary measure. Patients were randomized to either very early supported discharge with 4 weeks of home rehabilitation provided by a multidisciplinary stroke team, or a control group discharged according to usual routine (referral to primary care when needed). Assessments were performed at discharge, 4 weeks post-discharge, and 3 and 12 months post-stroke.Instrumental activities of the Activities of Daily Living Taxonomy scores (the lower the better) in the very early supported discharge and control groups were median 4 and 6 (p=0.039) at 4 weeks post-discharge and 3 and 4.5 (p=0.013 at 3 months post-stroke, respectively. Stroke Impact Scale (Mobility) median scores (the higher the better) in the very early supported discharge and control groups at 3 months were 97 and 86 (p=0.040), respectively. There were no group differences in the 2 outcomes at 12 months post-stroke.Compared with usual discharge routine, team-based rehabilitation during the first month at home is beneficial for instrumental activity in the subacute phase, in patients with mild stroke. One year post-stroke both groups show equal results.
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| 2. |
- Danielsson, Anna, 1957, et al.
(författare)
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Physical activity and walking speed after stroke compared to control values
- 2012
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Ingår i: Neurorehabilitation and neural repair. - : SAGE Publications. - 1545-9683 .- 1552-6844. ; 26:6, s. 695-804
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Konferensbidrag (refereegranskat)abstract
- Background and Aims: Persons with stroke are often less physically active than healthy and it can be hypothesized that activity increases over time and that walking speed is important. The aim was to describe the physical activity level using a questionnaire, compare with normative data and examine relationships between physical activity level, time since stroke and walking speed. Methods: A convenience sample of 70 persons (48 men, 22 woman) with a mean age of 60 (SD 6.8) was examined at a mean of 6 (SD 3) years after first event of stroke. A population based sample of 141 persons (70 men, 71 women) between 40 and 79 years of age from the same geographical area, divided into four cohorts, served as controls. The Physical Activity Scale for the Elderly (PASE) (1) was used to estimate the self-reported physical activity level. The self-selected walking speed was measured on a 30 m track and in stroke persons motor function in the affected leg was assessed according to Fugl-Meyer (maximum score 34). Results: The mean PASE score in the stroke group was 119 (SD 74), corresponding to 72% (SD 31) of the control score. There was no correlation between PASE and time since stroke. The median Fugl-Meyer score was 29 (range 11-34). The mean self-selected walking speed in the stroke group was 1.01 (SD 0.42) m/s which corresponded to 73% of the controls’. In a regression model, the self-selected walking speed could explain the variation in the PASE to 24% (p 0.001) and 6% (p 0.002), in the stroke and control groups, respectively. Conclusions: Persons with stroke reported lower physical activity than controls several years after stroke. Self-selected walking speed could partially explain physical activity level in persons with stroke but not in controls.
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| 3. |
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| 4. |
- Danielsson, Anna, 1957, et al.
(författare)
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Energy cost during walking - a comparison of two measurement methods
- 2005
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Ingår i: European Stroke Conference, Bologna, Italy 25-28 may 2005.
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Konferensbidrag (refereegranskat)abstract
- Background and purpose Many persons with stroke walk slowly with increased energy cost. Efficient gait is an important rehabilitation goal. Measurement of energy cost adds valuable information to gait analysis in evaluation of exercise, orthoses and walking aids. Direct measurement of oxygen uptake (VO2) is golden standard, but clinically practicable methods are needed. Physiological Cost Index (PCI)1 is a clinical method based on the relation between VO2 and heart rate. The reliability and validity of PCI in stroke patients has not been investigated. The aim was to compare energy cost measured by VO2 with PCI-value, in persons with stroke and healthy reference persons. Methods 20 persons with stroke and hemiparesis and 16 healthy, reference persons 30-63 years of age were included. Individual, self-selected walking speed on a treadmill was determined. VO2 was measured by breath-by-breath analysis and heart rate by electrocardiography at rest and during 5 minutes of walking on the treadmill at the predetermined self-selected speed. Mean values from two sessions were used. PCI was calculated as the heart rate difference between rest and walking, divided by gait speed. Spearman’s rank correlation between VO2 and PCI was calculated. Results Gait speed on the treadmill was 0,48 and 1,01 m/s, in the stroke and reference group respectively. VO2 was 9,1 and 11,4 ml/kg/min, with an energy cost of 0,41 and 0,19 ml/kg/m, in the stroke and reference group respectively. PCI was 0,76 and 0,30 heartbeats/m, in the stroke and reference group respectively. The correlation coefficient between VO2/m and PCI was ρ = 0,70 for the stroke group and ρ = 0,83 for the reference group. Conclusion Both VO2 and PCI were increased in the stroke group compared to the healthy reference group. VO2 and PCI were correlated in both groups. The stroke group had a large variability, why measurement of VO2 is recommended for research purposes. PCI needs further investigation before conclusions about the applicability for stroke patients can be drawn. 1 MacGregor J. The evaluation of patient performance using long-term ambulatory monitoring technique in the domiciliary environment. Physiotherapy 1981;67(2):30-33.
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| 5. |
- Danielsson, Anna, 1957, et al.
(författare)
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Energy expenditure in stroke subjects walking with a carbon composite ankle foot orthosis.
- 2004
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Ingår i: Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977. ; 36:4, s. 165-8
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To measure walking speed and energy cost in patients with prior stroke with and without a carbon composite ankle foot orthosis. DESIGN: Within-group comparisons of 2 walking conditions. PARTICIPANTS: Convenience sample of 10 hemiparetic patients with a stroke at least 6 months earlier (average age 52 years) habituated to a carbon composite ankle foot orthosis. METHODS: Subjects walked on a treadmill at self-selected speed both with and without ankle foot orthosis for 5 minutes on each occasion. Energy expenditure was measured by breath-by-breath analysis and electrocardiography. Main outcome measures were walking speed, oxygen consumption, heart rate and energy cost per metre. RESULTS: Walking speed: without ankle foot orthosis 0.27 (SEM +/- 0.03) m/s, with 0.34 (+/- 0.06) m/s, difference 20%. Oxygen consumption: without ankle foot orthosis 8.6 (+/- 0.4) ml/kg/min, with 8.8 (+/- 0.5) ml/kg/min. Energy cost: without ankle foot orthosis 0.58 (+/- 0.07) ml/kg/m, with 0.51 (+/- 0.06) ml/kg/m, difference 12%. CONCLUSION: Use of a carbon composite ankle foot orthosis in patients with stroke may increase speed and decrease energy cost during walking.
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| 6. |
- Danielsson, Anna, 1957, et al.
(författare)
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Experience of treadmill walking and audio-visual feedback after brain injury
- 2016
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Ingår i: ACPIN-INPA International Neurophysiotherapy Conference, London UK, 17-18 March 2016.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background People with stroke often have a low physical activity level and finding ways to motivate people to become more physically active is highly important. Using virtual reality in rehabilitation has shown positive effects, however knowledge about patients’ perceptions of this type of training is needed. Purpose To explore mental and physical experiences of treadmill walking and audio – visual (AV) feedback after brain injury. Method Three woman and seven men (median age 51) with stroke/other brain injury were interviewed after walking on a treadmill with and without AV- feedback mediated as follows: the speed of a realistic movie projecting a walking path, with nature sounds and step rhythm sounds, (through earphones) were directed by software connected to movement sensors donned to the legs. Semi structured interviews were audio recorded, transcribed and analysed using qualitative content analysis (QCA). Interviews were read by both authors and a coding scheme based on key concepts related to the research questions was developed. All codes were retrieved in the interviews and grouped into categories. To catch the latent meaning, categories were formulated into themes. Results Themes comprised positive and negative experiences. Participants experienced treadmill walking as enjoyable. The AV- feedback was mainly considered as pleasurable and exiting. Patients with mental weariness were ambivalent and found the AV-feedback more or less disturbing. Therefore, they considered the experience to be too exhausting in this early stage of rehabilitation. No fall incidents occurred but patients with balance problems using hand support reported tiredness in the hand. Conclusions In general, participants liked and found this inexpensive AV –feedback motivating and more enjoyable than ordinary treadmill walking. However, to avoid perceptional overload the amount of stimuli provided should be adjusted to the each individual. Further studies are needed to investigate if AV-feedback can be used to increase exercise intensity.
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| 7. |
- Danielsson, Anna, 1957, et al.
(författare)
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Experiences of treadmill walking and audio-visual feedback after stroke – an interview study
- 2017
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Ingår i: Nordic Stroke 2017. 19th Nordic Congress on Cerebrovascular Diseases, August 23-25, Aarhus, DK.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Walking training after stroke is highly important and a high intensity is recommended. As in-patients rarely reach the recommended physical activity level, finding ways to motivate exercise is therefore a key issue in rehabilitation. Offering a variety of training methods e.g by using virtual reality, could be one option to increase exercise intensity. The purpose of the study was to explore how patients’ with stroke experience treadmill walking with a prototype for audio – visual (AV) feedback. Methods: Three woman and five men, with a median age of 52, undergoing walking training, participated during inpatient rehabilitation 2-10 months after stroke. They walked for two sessions of up to 30 minutes on a treadmill at self-selected speed, with and without AV- feedback, respectively. The AV-feedback was mediated through a realistic movie of a walking path displayed on a TV-screen. Movement sensors donned to the legs connected to software, directed the speed of the movie. In addition, nature sounds and the individual’s step rhythm were mediated through headphones. After the walking session the participants took part in an individual interview regarding their experience walking with and without the AV-feedback. Semi structured interviews were audio recorded, transcribed and analysed using qualitative content analysis. Interviews were read by both authors and a coding scheme based on key concepts related to the research questions was developed. All codes were retrieved in the interviews, grouped into categories and finally formulated into themes. Results: Three main themes; positive, negative and ambivalent experiences, were expressed. The AV- feedback was mainly considered as enjoyable, engaging and made walking on the treadmill more interesting than without. Some participants experienced dizziness and those sensitive to mental overload found parts of the feedback more or less wearing. No fall incidences occurred but patients with more pronounced balance problems reported physical fatigue in their supporting hand. Conclusions: In general, participants liked and found this inexpensive AV –feedback motivating and enjoyable. Yet, the individual’s capacity has to be taken into account when adding perceptional stimuli during treadmill walking. The additional value of virtual feedback aiming to increase exercise intensity ought to be further explored.
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| 8. |
- Danielsson, Anna, 1957, et al.
(författare)
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Is walking endurance associated with activity and participation late after stroke?
- 2011
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Ingår i: Disability and rehabilitation. - : Informa UK Limited. - 1464-5165 .- 0963-8288. ; 33:21–22, s. 2053-2057
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Tidskriftsartikel (refereegranskat)abstract
- Purpose.After stroke, impaired walking ability may affect activity and participation. The aim was to investigate whether self-reported activity and participation were associated with walking endurance late after stroke. Method.A non-randomised sample of 31 persons with a mean age of 59.7 years and time since stroke of 7-10 years was studied. Walking endurance was measured by the 6-minute walk test (6MWT). Self-reported activity and participation were measured by the Physical Activity Scale for the Elderly and the Stroke Impact Scale. Relationships were analysed with linear regression. Results.A regression model including activities of daily living and 6MWT explained 44%, mobility and 6MWT explained 25% and a model including physical activity level and 6MWT explained 21% of the variation in activity. Regarding participation, the explanatory level of the model of participation and 6MWT was 30%. Conclusions.Walking distance several years after stroke was partly associated with self-reported difficulties in activity and participation.
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| 9. |
- Danielsson, Anna, 1957, et al.
(författare)
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Measurement of energy cost by the physiological cost index in walking after stroke.
- 2007
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Ingår i: Archives of physical medicine and rehabilitation. - : Elsevier BV. - 0003-9993. ; 88:10, s. 1298-303
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To compare the Physiological Cost Index (PCI) with direct measurement of oxygen consumption (Vo(2)) as an estimate of energy cost in persons with stroke and healthy subjects. DESIGN: Test-retest on separate days. A comparison of 2 methods of measurement. Measurements with and without an orthosis. SETTING: A university hospital. PARTICIPANTS: A convenience sample of 20 persons with hemiparesis more than 6 months after stroke and 16 healthy subjects, ages 30 to 63 years. INTERVENTIONS: Five minutes of treadmill walking at self-selected speeds while recording Vo(2) levels and heart rates. Additional data was recorded for 11 of the stroke subjects with and without an ankle-foot orthosis. MAIN OUTCOME MEASURES: Vo(2) and the PCI. RESULTS: No significant differences were found in the PCI or Vo(2) between test and retest. Both PCI and Vo(2) per distance were higher for the stroke subjects compared with healthy subjects. PCI showed a larger dispersion than Vo(2) between test and retest. The regression analysis for PCI showed that the model including age, sex, group assignment, and Vo(2) could explain 53% of the variation. The PCI did not show a significant difference in walking with or without an orthosis, whereas Vo(2) differed significantly. CONCLUSIONS: The PCI showed limited reliability and validity as a measure of energy cost after stroke due to the extensive variability between test and retest.
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| 10. |
- Danielsson, Anna, 1957, et al.
(författare)
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Oxygen consumption during treadmill walking with and without body weight support in patients with hemiparesis after stroke and in healthy subjects
- 2000
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Ingår i: Archives of Physical Medicine and Rehabilitation. - 0003-9993 .- 1532-821X. ; 81, s. 953-7
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To compare oxygen consumption during walking with body weight support (BWS) with oxygen consumption during unsupported treadmill walking. Design: Patient and reference group. Comparisons between two walking conditions within each group. Setting: Research laboratory of a university hospital. Participants: Nonrandom convenience sample of 9 hemiparetic and 9 healthy subjects, mean age of 56 and 57 years, respectively. Interventions: The subjects walked on a treadmill with 0% and 30% BWS at their self-selected and maximum walking speeds. The trials were performed twice. Main Outcome Measures: Ventilatory oxygen uptake (VO2) and heart rate were measured by computerized breath-by-breath analysis and electrocardiography. Results: VO2 was lower during walking with 30% BWS than during unsupported walking. At self-selected speed the Wilcoxon's signed rank p values were <.01 for both patients and reference group; at maximum velocity, p values were p <.02 for the patients and p <.05 for the reference group. Patients' heart rates were lower when they walked with 30% BWS than at 0% BWS, at both self-selected and maximum walking speeds (p <.05 and p <.02, respectively). Conclusions: The 30% body weight supported condition requires less oxygen consumption than full weight bearing. Treadmill training with BWS can be tolerated by patients with cardiovascular problems.
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