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Berginström, Nils, 1984-
(författare)
Fatigue after traumatic brain injury : exploring novel methods for diagnosis and treatment
2019
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
Background: Traumatic brain injury (TBI) is one of the most common causes of disability and mortality. While some patients recover quickly, especially at the mild side of the injury severity continuum, many will experience symptoms for years to come. In this chronic phase, patients report a wide array of symptoms, where fatigue is one the most common. This fatigue makes huge impact in several areas of these patients’ lives. Despite the prevalence of fatigue after TBI, the underlying mechanisms are unclear. Further, there are no standardized way for assessment and diagnosis, and there are no treatments with satisfying empirical support. The aim of this thesis was to examine the effects of the novel compound OSU6162 on fatigue in patients with TBI, and to explore functional and structural brain imaging correlates of fatigue after TBI.Methods: Studies I and III were based on a placebo-controlled, double-blinded clinical trial examining the effects of the monoaminergic stabilizer OSU6162 on fatigue in patients in the chronic phase of traumatic brain injury. In study I, self-assessment scales of fatigue and neuropsychological tests were used as outcomes, while functional magnetic resonance imaging (fMRI) blood-oxygen-level dependent (BOLD) signal was the primary outcome in study III. Studies II and IV used cross-sectional designs, comparing patients with TBI with age- and gender matched healthy controls. Study II examined whether fMRI BOLD signal could be used to detect and diagnose fatigue in patients with TBI, and study IV whether white matter hyperintensities (WMH) contribute to lower cognitive functioning and presence of fatigue after TBI.Results: Study I revealed no effects of OSU6162 during 28 days of treatment at maximum doses of 15 mg twice daily on measures of fatigue or any other outcome. The results from study II indicated that fatigue after TBI is linked to alterations in striato-thalamic-cortical loops, and suggested that fMRI could be a promising technique to use in the diagnosis of fatigue after TBI. In study III the results revealed effects of treatment in the right occipitotemporal and orbitofrontal cortex. In these areas, the BOLD response was normalized in the OSU6162 group as compared to healthy controls, while the placebo group showed a steady low activity in these areas. The regional effects were located outside the network shown to be linked to fatigue in study II, which might explain why there were no effects on fatigue after treatment with OSU6162 in study I. Study IV showed that WMH lesions increased with increased TBI severity, but the presence and extent of lesions did not explain lower neuropsychological functioning or fatigue in subjects with previous TBI.Conclusions: In summary, although no effects on fatigue after treatment with OSU6162 were seen, the results provide support to the theory that fatigue after TBI is linked to alterations in striato-thalamic-cortical loops, and on how fatigue after TBI could be assessed or diagnosed using fMRI. Structural damage within white matter was however not related to fatigue.
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Brogårdh, Christina, et al.
(författare)
A 1-year follow-up after shortened constraint-induced movement therapy with and without mitt poststroke.
2010
Ingår i: Archives of Physical Medicine and Rehabilitation. - : Elsevier BV. - 0003-9993 .- 1532-821X. ; 91:3, s. 460-464
Tidskriftsartikel (refereegranskat) abstract
OBJECTIVE: To explore the long-term benefits of shortened constraint-induced movement therapy (CIMT) in the subacute phase poststroke. DESIGN: A 1-year follow-up after shortened CIMT (3h training/d for 2 wk) where the participants had been randomized to a mitt group or a nonmitt group. SETTING: A university hospital rehabilitation department. PARTICIPANTS: Poststroke patients (N=20, 15 men, 5 women; mean age 58.8 y; on average 14.8 mo poststroke) with mild to moderate impairments of hand function. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Sollerman hand function test, the modified Motor Assessment Scale, and the Motor Activity Log test. Assessments were made by blinded observers. RESULTS: One year after shortened CIMT, participants within both the mitt group and the nonmitt group showed statistically significant improvements in arm and hand motor performance and on self-reported motor ability compared with before and after treatment. No significant differences between the groups were found in any measure at any time. CONCLUSIONS: Shortened CIMT seems to be beneficial up to 1 year after training, but the restraint may not enhance upper motor function. To determine which components of CIMT are most effective, larger randomized studies are needed.
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Brogårdh, Christina, et al.
(författare)
Construct Validity of a New Rating Scale for Self-Reported Impairments in Persons With Late Effects of Polio.
2013
Ingår i: PM & R : the journal of injury, function, and rehabilitation. - : Wiley. - 1934-1563 .- 1934-1482. ; 5:3, s. 176-181
Tidskriftsartikel (refereegranskat) abstract
OBJECTIVE: To evaluate the construct validity of a new rating scale for self-reported impairments in persons with late effects of polio. DESIGN: Psychometric analysis of data on self-perceived impairments in persons with prior polio. PARTICIPANTS: Two hundred and seventy-three persons with prior polio (119 men and 154 women; mean age, 63.5 years). METHOD: Rasch analysis of a 13-item rating scale with 5 response categories, in which the participants rated how much they have been bothered by various post-polio-related impairments during the past 2 weeks. RESULTS: The initial analysis showed disordered categories, misfit with some of the items, multidimensionality, and local dependency. After adjustment of the categories, which resulted in a 4-category rating scale, fit to the model was achieved, but the scale still showed signs of multidimensionality. Analyses of local dependency revealed correlations among some of the items, which resulted in a 5 testlet solution, which gave fit to the model and unidimensionality. CONCLUSION: After adjustment of the categories and local dependency, this new rating scale, Self-Reported Impairments in Persons With Late Effects of Polio, can be considered as unidimensional. The good psychometric properties implies that the Self-Reported Impairments in Persons With Late Effects of Polio scale could be a useful rating scale that would increase our understanding of the impairments that persons with late effects of polio can experience. With further refinements, this scale may assist in the planning and evaluation of appropriate rehabilitation interventions.
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Brogårdh, Christina, et al.
(författare)
Effects of cardiorespiratory fitness and muscle-resistance training after stroke
2012
Ingår i: PM&R. - : Wiley. - 1934-1482 .- 1934-1563. ; 4:11, s. 901-907
Tidskriftsartikel (refereegranskat) abstract
Stroke is a leading cause of long-term disability. The physical and cognitive impairments after an ischemic or hemorrhagic stroke often lead to activity limitations and participation restrictions. Many persons after stroke have a sedentary lifestyle, are physically inactive, and have a low fitness level. Physical fitness training is known to be beneficial for persons with a number of comorbid conditions or risk factors for stroke. Although exercise and physical activity are considered valuable, the evidence of their benefits after stroke is still insufficient. In this review, we summarize published randomized controlled trials regarding the effects of cardiorespiratory fitness and muscle-resistance training after stroke on physical function, activity, participation, life satisfaction, and mood. We discuss various barriers that can impede the ability to perform exercise, and the importance of reducing these barriers to increase physical fitness levels after the completion of usual stroke rehabilitation, thereby enhancing leisure, well-being, and participation in society
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Brogårdh, Christina, et al.
(författare)
Falls, Fear of Falling, Self-Reported Impairments, and Walking Limitations in Persons With Late Effects of Polio.
2014
Ingår i: PM&R. - : Wiley. - 1934-1563 .- 1934-1482. ; 6:10, s. 900-907
Tidskriftsartikel (refereegranskat) abstract
To investigate fall frequency during the past year, circumstances relating to falls, fear of falling, self-reported impairments, and walking limitations in persons with mild to moderate late effects of polio.
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