| 1. |
- Bendt, Martina, et al.
(författare)
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Adults with spina bifida : Ambulatory performance and cognitive capacity in relation to muscle function
- 2022
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Ingår i: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 60:2, s. 122-128
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Cross-sectional study.OBJECTIVE: Describe and compare ambulatory performance and cognitive capacity in relation to muscle function in an adult cohort with spina bifida. Also, explore factors associated with ambulation in participants with muscle function level 3.SETTING: Specialist clinic for adults with spinal cord disorders in Stockholm, Sweden.METHODS: A total regional cohort of adults (n = 219) with spina bifida was invited, 196 (104 women, mean age 35 years, SD 13 years) participated. Mode of mobility, cognitive capacity and muscle function were investigated. For participants with muscle function level 3, factors associated with ambulation were investigated using multivariate logistic regression analysis.RESULTS: In all, 84 participants (42%) were community ambulators, 22 (12%) household ambulators and 90 (46%) wheelchair users. There was a linear association between the lower degree of muscle function and scoliosis (P < 0.001). Mode of mobility varied despite similar muscle prerequisites in participants with muscle function level 3 (n = 58). Factors associated with ambulation in participants with muscle function level 3 were the absence of scoliosis, lower BMI and higher cognitive capacity.CONCLUSIONS: Cognitive capacity and mode of mobility varied widely across the cohort. However, in participants with muscle function level 3, despite similar muscular prerequisites, a large variation in the mode of mobility was found, suggesting that other factors were involved. It is important to prevent scoliosis, support a healthy lifestyle, as well as offer cognitive screening and support to promote ambulatory function and optimise independence in the everyday lives of adults with spina bifida.
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| 2. |
- Bendt, Martina, et al.
(författare)
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Gait and dynamic balance in adults with spina bifida
- 2022
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Ingår i: Gait & Posture. - : Elsevier BV. - 0966-6362 .- 1879-2219. ; 96, s. 343-350
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Spina bifida (SB) is a complex congenital malformation, often causing impaired gait performance depending on the level and extent of malformation. Research regarding gait and balance performance in adults with SB, has not been sufficiently described yet.RESEARCH QUESTION: What are the characteristics of spatiotemporal gait parameters and balance performance in adults with SB? Further, do persons with muscle function (MF) level 3 differ regarding gait and balance performance from those with MF level 1-2?METHODS: Cross-sectional observational study at an outpatient clinic. 41 adults with SB (18-65 years), who walked regularly. Spatiotemporal parameters of gait was assessed with the APDM system and balance performance with the Mini Balance Evaluation Systems Test (Mini-BESTest). Muscle strength in the legs was assessed with 0-5 manual muscle test, and participants were classified according to level of MF into groups MF1, MF2, and MF3. Two-sided t-test was used for parametric independent variables, and Cohen's d was used for effect sizes. The Mann-Whitney U test was used for non-parametric independent data and effect size was calculated by the z value (r = z/√n).RESULTS: Mean gait speed was 0.96 (SD 0.20) m/s and mean stride length 1.08 m (SD 0.17), individuals with MF3 showed significantly slower gaitspeed and shorter stride length (p < 0.05). Lumbar rotation was 21° (SD 11), and thoracic lateral sway 15° (IQR 15) with significantley difference (p < 0.001 and p < 0.05) for individuals in MF3. Mini-BESTest showed a mean score of 11.3 (SD 6.9), and individuals with MF3 showed significantly lower scores (p ≤ 0.001).SIGNIFICANCE: Gait and balance performance was reduced compared to normative data in almost all parameters, especially in persons with less muscle function. Increased knowledge from advanced gait analysis may help healthcare professionals to design rehabilitation programmes, in order to achieve and maintain a sustainable gait and balance performance.
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| 3. |
- Butler Forslund, Emelie
(författare)
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Falls in wheelchair users with spinal cord injury : incidence, risks and concerns
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Knowledge about falls and related injuries in persons with spinal cord injuries (SCI) is limited, especially concerning wheelchair users. Further research is required in order to develop future prevention programs, as falls seem to be common and may have serious consequences for persons with SCI. Aims: to identify the incidence of falls and recurrent falls (>2 falls), and the incidence and severity of fall-related injuries in wheelchair users with SCI. Further, to investigate the validity of instruments for concerns about falling -SCI Falls Concern Scale (FCS), and fall risk prediction during one year with Downton Fall Risk Index and a question of falls the previous year. Method: 224 persons with traumatic SCI were consecutively recruited at regular follow-up at Rehab Station Stockholm / Spinalis, Sweden and Sunnaas Rehabilitation Hospital, Norway. Inclusion criteria: ≥ 18 years old, ≥ 1 year post SCI. Exclusion criteria: persons with motor complete injuries above C5. Independent variables: demographic data, previous falls, quality of life, risk willingness, functional independence, and exercise habits. Falls were prospectively reported by text messages every second week for one year and were followed-up by telephone interviews. Outcomes: incidence of falls and related injuries, risk indicators for recurrent falls and injuries. SCI-FCS was translated to Swedish and tested for validity. Results: The Swedish version of SCI-FCS showed, in general, similar psychometric properties as the original version supporting the validity of the scale. The wheelchair users reported overall low levels of concerns about falling. Pushing wheelchair in difficult situations caused most concerns. Ambulatory persons reported more retrospective falls than wheelchair users, and mode of mobility had the highest odds ratio (OR) (2.9), for reporting recurrent falls. Ability to get up from the ground (OR=2.2) and performing regular exercise (OR=1.9) increased the OR of recurrent falls for the total sample, while higher age (OR=0.96 per increasing year of age) decreased the OR of recurrent falls. Associated factors differed between wheelchair users and ambulatory persons. Sixty-four percent fell and 32% fell recurrently, when the wheelchair users reported falls prospectively during one year. Recurrent falls previous year increased the OR of recurrent falls the following year (OR=10.2), and higher quality of life reduced the OR of fall-related injuries. In total, 70 fall-related injuries were registered, of which 47 (67%) were minor, 16 (23%) moderate and 7 (10%) were severe, and 34% reported at least one injury. Most falls occurred during transfers. Downton Fall Risk Index had low accuracy for predicting falls in wheelchair users while the question of falls the previous year was more accurate (sensitivity 37 and 86%, respectively). Conclusion: Falls were common, and ambulatory persons fell more than wheelchair users. In spite of a broad perspective on contributory factors, previous falls was the only significant risk indicator for recurrent falls in the wheelchair users. SCI-FCS showed promising validity. Downton Fall Risk Index could not predict those who fell, while the question of falls previous year was more accurate.
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| 4. |
- Forslund, Emelie Butler, et al.
(författare)
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A Protocol for Comprehensive Analysis of Gait in Individuals with Incomplete Spinal Cord Injury
- 2024
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Ingår i: Methods and Protocols. - : MDPI AG. - 2409-9279. ; 7:3
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Tidskriftsartikel (refereegranskat)abstract
- This is a protocol for comprehensive analysis of gait and affecting factors in individuals with incomplete paraplegia due to spinal cord injury (SCI). A SCI is a devastating event affecting both sensory and motor functions. Due to better care, the SCI population is changing, with a greater proportion retaining impaired ambulatory function. Optimizing ambulatory function after SCI remains challenging. To investigate factors influencing optimal ambulation, a multi-professional research project was grounded with expertise from clinical rehabilitation, neurophysiology, and biomechanical engineering from Karolinska Institutet, the Spinalis Unit at Aleris Rehab Station (Sweden's largest center for specialized neurorehabilitation), and the Promobilia MoveAbility Lab at KTH Royal Institute of Technology. Ambulatory adults with paraplegia will be consecutively invited to participate. Muscle strength, sensitivity, and spasticity will be assessed, and energy expenditure, 3D movements, and muscle function (EMG) during gait and submaximal contractions will be analyzed. Innovative computational modeling and data-driven analyses will be performed, including the identification of clusters of similar movement patterns among the heterogeneous population and analyses that study the link between complex sensorimotor function and movement performance. These results may help optimize ambulatory function for persons with SCI and decrease the risk of secondary conditions during gait with a life-long perspective.
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| 5. |
- Jörgensen, Sophie, et al.
(författare)
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Sound psychometric properties of the Swedish version of the Spinal Cord Independence Measure Self-Report
- 2021
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1651-2081 .- 1650-1977. ; 53:5, s. 00197-00197
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe data completeness, targeting and reliability of the Swedish version of the Spinal Cord Independence Measure Self-Report (s-SCIM-SR). DESIGN: Translation and reliability study. SUBJECTS: Programme participants (n = 48) and peer mentors (n = 42) with spinal cord injury enrolled in the INTERnational Project for the Evaluation of "activE Rehabilitation" (inter-PEER). METHODS: The translation process was based on guidelines/recommendations, and involved expert competence, including consumers. The s-SCIM-SR was distributed online, once for programme participants and twice for peer mentors. RESULTS: Sixty-nine individuals (77%) obtained a total score. Most missing data were found in the items Respiration and Using the toilet. Cronbach's alpha for the full scale was 0.89, for Self-care 0.92, for Respiration and sphincter management 0.37 and for Mobility 0.86. The intraclass correlation coefficient was excellent for all subscales and the full scale. Measures of variability showed high sensitivity to changes and Bland Altman analyses revealed no systematic changes between evaluation points. CONCLUSION: These results support the data completeness, targeting and reliability of the Swedish version of the SCIM-SR. However, some problems were found in the subscale Respiration and sphincter management. The s-SCIM-SR can be considered psychometrically sound and suitable to assess physical independence among persons with spinal cord injury in Swedish community settings.
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| 6. |
- Kizyte, Asta, 1993-, et al.
(författare)
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Neuromuscular adaptations in ankle plantar flexor and dorsiflexor in persons with spinal cord injury
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Objective: Spinal cord injury (SCI) could lead to sensory-motor impairment of varying degree. After the injury, multiple neurophysiological changes occur, altering the neural motor control strategies. This study aims to assess the neuromuscular adaptations in the ankle plantar flexor and dorsiflexor muscles after the SCI by examining the electromyography (EMG) and motor unit parameters during sub-maximal voluntary isometric contractions and comparing these parameters to a control cohort. Methods: High-density EMG (HD-EMG) signals of tibialis anterior and soleus were recorded simultaneously with ankle joint torque during repeated sub-maximal (20% and 50% of the maximal torque) isometric voluntary contractions. Torque parameters such as normalized torque and coefficient of variation of torque during sustained contraction, EMG parameters such as amplitude and intramuscular coherence, as well as motor unit parameters such as motor unit discharge rates, recruitment thresholds, and coefficient of variation of the inter-spike intervals, were analyzed within the SCI and control groups. Results: We found that the SCI group, on average, had significantly weaker plantar flexor but not dorsiflexor muscles than the control group. Despite the increased variation of soleus motor unit inter-spike intervals post-SCI, both groups maintained constant sub-maximal torques with similar variability. However, the SCI group required up to 40.2% higher normalized EMG amplitudes to achieve the same torque level as the control group. Additionally, intramuscular coherence was found to be lower (up to 38.1% in TA and 34.6% in SOL) in the SCI group compared to the control group in the alpha frequency band during sustained sub-maximal isometric contractions. At higher force levels (50% MVC), motor units were recruited and de-recruited at lower thresholds in both muscles and fired at lower rates in the tibialis anterior muscle post-SCI. Conclusion: Through the analysis of these parameters, we observed altered force production and modulation strategies post-SCI. The observed combination of the motor unit and EMG parameter changes may indicate reduced common neural drive within the muscle and a possible shift towards larger motor units and in both TA and SOL muscles. Significance: The results of this study contribute to the knowledge of the neurophysiological modifications in the ankle dorsiflexors and plantar flexors following the SCI, which may aid future research on SCI rehabilitation.
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| 7. |
- Truong, Minh, 1994-
(författare)
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Quantifying Gait Characteristics and Neurological Effects in people with Spinal Cord Injury using Data-Driven Techniques
- 2024
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Spinal cord injury, whether traumatic or nontraumatic, can partially or completely damage sensorimotor pathways between the brain and the body, leading to heterogeneous gait abnormalities. Mobility impairments also depend on other factors such as age, weight, time since injury, pain, and walking aids used. The ASIA Impairment Scale is recommended to classify injury severity, but is not designed to characterize individual ambulatory capacity. Other standardized tests based on subjective or timing/distance assessments also have only limited ability to determine an individual's capacity. Data-driven techniques have demonstrated effectiveness in analysing complexity in many domains and may provide additional perspectives on the complexity of gait performance in persons with spinal cord injury. The studies in this thesis aimed to address the complexity of gait and functional abilities after spinal cord injury using data-driven approaches.The aim of the first manuscript was to characterize the heterogeneous gait patterns in persons with incomplete spinal cord injury. Dissimilarities among gait patterns in the study population were quantified with multivariate dynamic time warping. Gait patterns were classified into six distinct clusters using hierarchical agglomerative clustering. Through random forest classifiers with explainable AI, peak ankle plantarflexion during swing was identified as the feature that most often distinguished most clusters from the controls. By combining clinical evaluation with the proposed methods, it was possible to provide comprehensive analyses of the six gait clusters. The aim of the second manuscript was to quantify sensorimotor effects on walking performance in persons with spinal cord injury. The relationships between 11 input features and 2 walking outcome measures - distance walked in 6 minutes and net energy cost of transport - were captured using 2 Gaussian process regression models. Explainable AI revealed the importance of muscle strength on both outcome measures. Use of walking aids also influenced distance walked, and cardiovascular capacity influenced energy cost. Analyses for each person also gave useful insights into individual performance. The findings from these studies demonstrate the large potential of advanced machine learning and explainable AI to address the complexity of gait function in persons with spinal cord injury.
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| 8. |
- Truong, Minh T.N. 1994-, et al.
(författare)
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Estimation of Sensorimotor Effects on Walking Performance in people with Spinal Cord Injury
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Spinal cord injury (SCI) impairs sensorimotor pathways, reducing walking ability. Effects of sensorimotor impairments are complex due to interactions with other factors such as age, aids, injury level, and severity. Traditional regression analysis has commonly been used to capture the effects, but it assumes linearity and misses local feature impacts. Meanwhile, explainable AI methods like SHapley Addictive exPlanations (SHAP) can reveal feature importances globally and locally based on cooperative game theory. Additionally, Gaussian Process Regression (GPR) can handle limited data sets, a common challenge in medical studies with small sample sizes. In this study, we proposed and evaluated a framework applying GPR and SHAP to quantify how sensorimotor impairments impact post-SCI walking performance. Thirty four recruited individuals with SCI underwent a clinical assessment and a six-minute walk test with oxygen consumption measurement. We identified strong linear relationships between muscle strength and six-minute walk test performance wherein greater strength was associated with longer distance walked and lower energy costs. The findings also highlighted considerable impacts of walking aids and cardiovascular capacity on post-SCI mobility. Individual SHAP analyses quantified how neurological factors influenced walking performance for each participant. This study demonstrated that nonparametric regression and explainable AI could provide insights into the complex neurological factors affecting walking ability in persons with SCI.
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| 9. |
- Truong, Minh T.N. 1994-, et al.
(författare)
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Gait Stratification in People with Incomplete Spinal Cord Injury using Data-Driven Techniques
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: Incomplete spinal cord injury often causes heterogeneous locomotion function, depending on remaining sensorimotor functions below the injury. Standardized tests have limited ability to quantify diverse gait impairments. Combining clustering methods with dynamic time warping distances can objectively capture heterogeneous gait patterns without bias. Moreover, tree-based models with explainable AI can reveal important features often missed by traditional gait analyses. This study presents a framework to characterize gait heterogeneity in persons with incomplete spinal cord injury based on unsupervised learning and explainable AI. We aimed to stratify gait heterogeneity into clusters without priori identification of parameters, and to gain clinical insights into the derived clusters.Methods: A cohort of 28 individuals with incomplete spinal cord injury and 21 non-disabled control subjects were recruited. Individuals with incomplete spinal cord injury underwent physical assessment of lower extremity strength, sensory function, and spasticity. Both groups underwent 3D gait analysis. Multidimensional dynamic time warping and hierarchical agglomerative clustering were used to identify distinct gait subgroups after injury. A random forest classifier and TreeSHAP were used to identify gait predictors that distinguished each cluster from the controls. Results: Six distinct gait clusters were identified from 280 gait cycles. Walking speed and step length were smaller than controls in four clusters. Gait patterns in two clusters were relatively similar to those in control. Low maximal ankle plantarflexion during swing was found to be a common gait impairments in five of the six clusters. Overall muscle strength significantly differed between clusters.Conclusions: In this study, we describe a data-driven framework coupled with explainable AI to identify clusters of common gait patterns without priori parameter identification among the otherwise heterogeneous gait patterns in persons with spinal cord injury. This work represents an initial step in developing individualized rehabilitation programs for persons with incomplete spinal cord injury.
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