| 1. |
- Pohl, Petra, et al.
(författare)
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A qualitative exploration of post-acute stroke participants' experiences of a multimodal intervention incorporating horseback riding
- 2018
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 13:9
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Tidskriftsartikel (refereegranskat)abstract
- Background Multimodal rehabilitation interventions delivered in late phase of stroke recovery involve physical (motor and sensory), social, and cognitively challenging activities. Horseback riding can be incorporated within such interventions, leading to meaningful long-term improvements when applied to individuals with moderate levels of disability. There is a lack of research illuminating stroke survivors' experiences and perceptions of horseback riding in the context of multimodal interventions. To explore stroke survivors' experiences of participation in a multimodal group-based intervention that included horseback riding. An explorative interview study was conducted with individual face-to-face interviews performed on a single occasion, utilising a semi-structured interview guide. Eighteen participants were purposively selected from a larger trial (mean age 62, 12 men, 6 women) within four weeks after treatment completion. The interview duration was between 17 and 50 minutes. The data was analysed using a qualitative content analysis method. Four broad themes were identified from the analysis. These themes were: transformative experiences; human-horse interaction; togetherness and belonging; and the all-in-one solution. Interacting with the horse and peers had a profound emotional impact on the participants. The participants also reported having learned new skills, increased self-efficacy and self-esteem, and improvements in balance and gait, all of which could be transferred to everyday life. The horse itself played a central role, but other components, such as the other group members, the instructors, and the challenging tasks on the horseback, were also important. A multimodal rehabilitation intervention that includes horseback riding may provide stroke survivors in a late phase of recovery with rich pleasurable experiences that may have life-changing and profound impacts on their emotional and physical state.
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| 2. |
- Pohl, Petra, et al.
(författare)
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Experiences from a multimodal rhythm and music-based rehabilitation program in late phase of stroke recovery - A qualitative study
- 2018
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Ingår i: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 13:9
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Tidskriftsartikel (refereegranskat)abstract
- Background Rehabilitative stroke interventions based on principles of multimodal stimulation have the potential to profoundly affect neuroplastic processes beyond the sub-acute phase. In order to identify important core mechanisms, there is a need to explore how interventions that combine physical, social, sensory, and cognitively challenging activities are perceived and experienced by the participants. This qualitative study, based on an interpretive interactionist perspective, explored the experiences of stroke survivors who participated in a group-based multimodal rehabilitation program based on rhythm and music. Within four weeks after completion of the multimodal rehabilitation program, face-to-face semi-structured interviews were conducted on a single occasion with 15 purposively selected individuals (mean age 65, 8 men, 7 women). The interview duration was between 13 and 44 minutes. Qualitative content analysis with an inductive approach was used to analyze data. Three categories were identified, each containing several sub-categories: To be intellectually challenged (energy-consuming activity and coordinating multiple input and output), Perceived therapeutic benefits (motor skills, cognitive skills, emotional and psychological responses), and Pros and cons with social integration (fellowship, competing with others, and instructor characteristics). From these categories, an overall theme was derived: The multifaceted layers of multimodal stimulation. Enjoying music, being part of a group with peers, a skilled instructor, and being able to manage the challenging movements, were related to positive experiences. In contrast, negative experiences were associated with not being able to perform the exercises, and with group members who dominated the conversational space. This study shows that access to a multimodal rehabilitation program with rhythm and music as operating ingredients may contribute to positive experiences for many individuals in a late phase after stroke in terms of motor, cognitive, as well as emotional enhancements. Important components were the music, the social interaction, the challenging exercises, and the skilled instructor.
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| 3. |
- Pohl, Petra, et al.
(författare)
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Group-based music intervention in Parkinsons disease : findings from a mixed-methods study
- 2020
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Ingår i: Clinical Rehabilitation. - : Sage Publications. - 0269-2155 .- 1477-0873. ; 34:4, s. 533-544
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate a group-based music intervention in patients with Parkinsons disease. Design: Parallel group randomized controlled trial with qualitative triangulation. Setting: Neurorehabilitation in primary care. Subjects: Forty-six patients with Parkinsons disease were randomized into intervention group (n = 26), which received training with the music-based intervention, and control group (n = 20) without training. Interventions: The intervention was delivered twice weekly for 12 weeks. Main measures: Primary outcome was Timed-Up-and-Go subtracting serial 7s (dual-task ability). Secondary outcomes were cognition, balance, concerns about falling, freezing of gait, and quality of life. All outcomes were evaluated at baseline, post-intervention, and three months post-intervention. Focus groups and individual interviews were conducted with the intervention group and with the delivering physiotherapists. Results: No between-group differences were observed for dual-task ability. Between-group differences were observed for Falls Efficacy Scale (mean difference (MD) = 6.5 points; 95% confidence interval (CI) = 3.0 to 10.0, P = 0.001) and for Parkinson Disease Questionnaire-39 items (MD = 8.3; 95% CI = 2.7 to 13.8, P = 0.005) when compared to the control group post-intervention, but these were not maintained at three months post-intervention. Three themes were derived from the interviews: Expectations versus Results, Perspectives on Treatment Contents, and Key Factors for Success. Conclusion: Patient-reported outcomes and interviews suggest that the group-based music intervention adds value to mood, alertness, and quality of life in patients with Parkinsons disease. The study does not support the efficacy in producing immediate or lasting gains in dual-tasking, cognition, balance, or freezing of gait.
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| 4. |
- Pohl, Petra
(författare)
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The Ronnie Gardiner Method : An Innovative Music-Based Intervention for Neurological Rehabilitation - Theoretical Background and Contemporary Research with Focus on Parkinson`s Disease
- 2018
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Ingår i: Neurophysiology and Rehabilitation. - : Edelweiss Publications. - 2641-8991. ; 1:1, s. 32-37
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Tidskriftsartikel (refereegranskat)abstract
- The Ronnie Gardiner Method (RGM) is an innovative, practitioner-led, music-based intervention using sensorimotor and cognitive integration. RGM was originally developed by the Swedish musician Ronnie Gardiner. Since 2010, RGM has been successfully implemented within neurorehabilitation in many countries. The purpose of this article is to outline some of the theoretical assumptions underpinning the potential benefits from this intervention, using Parkinson’s disease as an example. RGM is based on principles of neuroplasticity, motor learning, and postural control, and uses energizing, beat-based music to provide multisensory input (visual, audio, kinetic, and tactile) in order to stimulate experience-dependent neuroplastic processes. It aims at stimulating cognitive and motor function (e.g., memory, concentration, executive function, multitasking, coordination, mobility, balance, and motor skills). In addition, it may aid body awareness, self-esteem, and social skills. RGM has been scientifically evaluated as a means of multimodal sensory stimulation after stroke and as a means of improving mobility and cognitive function in Parkinson’s disease. RGM is a complex multi-task intervention with the potential to be beneficial in different settings and in different neurological conditions. It can be performed either while standing up or sitting down and can be practiced with the advantages gained as a group activity or individually, which makes it very flexible. It is currently being used as rehabilitation activity for people with stroke, Parkinson’s disease, multiple sclerosis, dementia, and depression. Furthermore, RGM is used in programs targeting healthy aging, ADHD, autism, and dyslexia, and in ordinary school environments.
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| 5. |
- Pohl, Petra, et al.
(författare)
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The Ronnie Gardiner Rhythm and Music Method – a feasibility study in Parkinson’s disease
- 2013
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Ingår i: Disability and Rehabilitation. - : Informa Healthcare. - 0963-8288 .- 1464-5165. ; 35:26, s. 2197-2204
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To assess the feasibility of the novel intervention, Ronnie Gardiner Rhythm and Music (RGRM™) Method compared to a control group for patients with Parkinson’s disease (PD).Method: Eighteen patients, mean age 68, participating in a disability study within a neurological rehabilitation centre, were randomly allocated to intervention group (n = 12) or control group (n = 6). Feasibility was assessed by comparing effects of the intervention on clinical outcome measures (primary outcome: mobility as assessed by two-dimensional motion analysis, secondary outcomes: mobility, cognition, quality of life, adherence, adverse events and eligibility). Results: Univariable analyses showed no significant differences between groups following intervention. However, analyses suggested that patients in the intervention group improved more on mobility (p = 0.006), cognition and quality of life than patients in the control group. There were no adverse events and a high level of adherence to therapy was observed. Conclusions: In this disability study, the use of the RGRM™ Method showed promising results in the intervention group and the adherence level was high. Our results suggest that most assessments chosen are eligible to use in a larger randomized controlled study for patients with PD.Implications for RehabilitationThe RGRM™ Method appeared to be a useful and safe method that showed promising results in both motor and cognitive functions as well as quality of life in patients with moderate PD.The RGRM™ Method can be used by physiotherapists, occupational, speech and music therapists in neurological rehabilitation.Most measurements were feasible except for Timed-Up-and-Go.
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| 6. |
- Rydja, Johanna, 1972-
(författare)
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Gait Characteristics, Physical Activity and Subjective Outcome after Shunt Surgery in Normal Pressure Hydrocephalus
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background Idiopathic normal pressure hydrocephalus (iNPH) is a common but under-diagnosed disease among the elderly. The condition is characterised by gait disturbance, postural instability, cognitive decline and incontinence, caused by accumulated cerebrospinal fluid within the central nerve system. The treatment is a shunt insertion to divert excess fluid. Few studies have described the detailed gait in INPH, there is a lack of research about physical activity, and patient-reported outcomes after shunt surgery are sparsely described. The overall aim of this thesis was to increase the knowledge of the gait pattern, the level of physical activity, and to evaluate the effect of a physical exercise programme in iNPH. Another aim was to evaluate the patient’s self-experienced outcome after surgery. Methods and results, study I In total 127 patients were randomised to either a supervised 12-week high-intensity exercise programme or to standard care after shunt surgery. Evaluation was performed with the iNPH scale and goal attainment after the intervention and after six months. There was low compliance to the exercise programme and no differences between the groups could be detected according to the iNPH scale at any of the follow-ups. Patients with high attendance rate achieved their set goals to a higher extent than the control group at the post intervention follow-up. Methods and results, study II In total 109 patients from the population in study I, were evaluated with an actigraphy recording of physical activity variables for seven days before and three- and six months after shunt surgery. In addition, physical performance was evaluated with the 10-meter walk test, the 6-minute walk test and 30 s chair stand test. The patients walked faster with improved results on the walking tests postoperatively. Improvement in the 30 s chair stand test was interpreted as improved postural control. The physical activity intensity was not affected by surgery. The patients had very low energy expenditure and were to a large extent sedentary, before and after shunt surgery. The exercise intervention had no effect on physical activity or the physical performance tests. Methods and results, study III In total 47 patients were included to a gait analysis with an inertial sensor system. Additionally, the patients were assessed with the Timed Up and Go test and the iNPH scale, pre- and three months postoperatively and in relation with 42 older healthy individuals. The patients walked with shorter strides, decreased velocity, increased time in stance and with decreased joint angles, especially in the ankle joint. The gait pattern im-proved after shunt surgery, but outcome on all variables were still worse compared to the healthy individuals, except for step hight that was normalised. Shunt surgery had no effect on stride length variability. Methods and results, study IV In total 58 patients rated their experienced changes three months after shunt surgery. The subjective outcome was analysed in relation to objective clinical outcomes (the iNPH scale) and questionnaires regarding, sense of coherence, quality of life, anxiety and depression. Clinical outcome and the questionnaires were evaluated before and three months after shunt surgery and in relation to 42 older healthy individuals. The patients reported most frequently some degree of positive changes after surgery. The subjective outcomes in overall experience, gait and continence correlated moderately with the corresponding objective outcomes, but there were not correlations within the cognition and balance areas. Depression and quality of life improved after surgery, but the result was still lower than for healthy individuals. There was no correlation between the patients´ sense of coherence and the subjective outcome. Conclusion Shunt surgery contributes to improved walking patterns, improved physical functions, reduced signs of depression and increased quality of life, but patients with iNPH are still more affected than healthy elderly. The patients report most frequently positive changes, but not total recovery after shunt surgery. Despite improvements within several areas the physical activity level is very low, both before and after the shunt operation. A postoperative high-intensity physical training program had no additional effect, which is explained by the fact that few patients completed the program. Patients with iNPH probably need guidance to additional improvement and to increase physical activity through meaningful activities after shunt surgery. Further research is needed to evaluate interventions that address the specific iNPH impairments.
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| 7. |
- Sandlund, Marlene, 1972-, et al.
(författare)
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Gender perspective on older people’s exercise preferences and motivators in the context of falls prevention : a qualitative Study
- 2018
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Ingår i: BioMed Research International. - : Hindawi Publishing Corporation. - 2314-6133 .- 2314-6141.
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Tidskriftsartikel (refereegranskat)abstract
- Background. Several factors have previously been identified to positively influence the uptake and adherence for fall prevention exercise programmes. There is, however, a lack of studies investigating if men and women differ in their views and preferences for fall prevention exercises. Aim. To explore exercise preferences and motivators of older community-dwelling women and men in the context of falls prevention from a gender perspective. Methods. Workshops including multistage focus group discussions were conducted with 18 older community-dwelling people with and without history of falls. Participants were purposively selected and divided into two groups. Each group met on six occasions over a period of five months. Participatory and Appreciative Action and Reflection methodology was used to guide the discussions. A qualitative content analysis approach was used in the analysis. Results. Older participants had many diverse preferences and confirmed that individually tailored exercise, in terms of mode, intensity, challenge, and social context, is important. Moreover, important factors for exercise adherence and maintenance included the experience of individual confirmation; different spirit lifters to increase enjoyment; and personal tricks to maintain exercise routines. The individual differences within genders were more diverse than the differences between women and men. Conclusion. Exercise interventions to prevent falls should be individually tailored, based on the specific needs and preferences of the older participant, and do not appear to require gender specific approaches. To increase adherence, intrinsic motivation for exercise may be encouraged by competence enhancing confirmations, energizing spirit lifters, and practical tips for exercise maintenance. The study provides an awareness about women’s and men’s preferences for fall prevention exercises, and this information could be used as guidance in designing inclusive exercise interventions.
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| 8. |
- Sandlund, Marlene, et al.
(författare)
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Gender perspectives on views and preferences of older people on exercise to prevent falls : mixed studies review
- 2017
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Ingår i: BMC Geriatrics. - : BioMed Central. - 1471-2318 .- 1471-2318. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUNDTo offer fall prevention exercise programs that attract older people of both sexes there is a need to understand both women's and men's views and preferences regarding these programs. This paper aims to systematically review the literature to explore any underlying gender perspectives or gender interpretations on older people's views or preferences regarding uptake and adherence to exercise to prevent falls.METHODSA review of the literature was carried out using a convergent qualitative design based on systematic searches of seven electronic databases (PubMed, CINAHL, Amed, PsycINFO, Scopus, PEDro, and OTseeker). Two investigators identified eligible studies. Each included article was read by at least two authors independently to extract data into tables. Views and preferences reported were coded and summarized in themes of facilitators and barriers using a thematic analysis approach.RESULTSNine hundred and nine unique studies were identified. Twenty five studies met the criteria for inclusion. Only five of these contained a gender analysis of men's and women's views on fall prevention exercises. The results suggests that both women and men see women as more receptive to and in more need of fall prevention messages. The synthesis from all 25 studies identified six themes illustrating facilitators and six themes describing barriers for older people either starting or adhering to fall prevention exercise. The facilitators were: support from professionals or family; social interaction; perceived benefits; a supportive exercise context; feelings of commitment; and having fun. Barriers were: practical issues; concerns about exercise; unawareness; reduced health status; lack of support; and lack of interest. Considerably more women than men were included in the studies.CONCLUSIONAlthough there is plenty of information on the facilitators and barriers to falls prevention exercise in older people, there is a distinct lack of studies investigating differences or similarities in older women's and men's views regarding fall prevention exercise. In order to ensure that fall prevention exercise is appealing to both sexes and that the inclusion of both men and women are encouraged, more research is needed to find out whether gender differences exists and whether practitioners need to offer a range of opportunities and support strategies to attract both women and men to falls prevention exercise.
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