| 1. |
- Kyhlbäck, Maria, et al.
(författare)
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Physiotherapy treatment of the diabetic shoulder: health-related quality of life and measures of shoulder function regarding patients with type 1 diabetes
- 2019
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Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 41:12, s. 1435-1442
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim of this study was to investigate how health-related quality of life (HRQoL) and functional shoulder range of motion are affected among patients with diabetes with shoulder problems, treated with a specific physiotherapy programme. A further aim was to investigate how health-related quality of life, functional shoulder range of motion, pain intensity, and shoulder function correlate within the group of patients after the treatment period. Method: A pre-post treatment design was applied for a study group of ten patients with type 1 diabetes and shoulder problems. The physiotherapy treatment consisted of exercises promoting enhanced micro-circulation in the shoulder tissues, optimal shoulder co-ordination, and muscle relaxation. The Short Form-36 (SF-36), shoulder range of motion measures, the Shoulder Rating Scale - Swedish version, and pain intensity measures were used. The results regarding SF-36 were compared with the results of a control group of patients having either type 1 or type 2 diabetes and shoulder problems that did not receive any specific physiotherapy treatment. Results: As a potential result of physiotherapy training, a significant change towards higher scores was observed in the physical component summary (PCS) measure of SF-36. There was a significant improvement regarding PCS in the study group as compared with the control group. There were negative correlations between the four aspects of pain intensity and PCS and Shoulder Rating Scale - Swedish version, respectively, but a positive correlation between PCS and Shoulder Rating Scale - Swedish version. "Hand-raising" and "hand-behind-back" were significantly improved, and proved to be positively correlated with Shoulder Rating Scale - Swedish version. Conclusions: The results of this study indicate that patients with type 1 diabetes and shoulder problems, treated with a specific physiotherapy programme, may improve with respect to physical aspects of health-related quality of life, and partially regain their range of motion in the shoulder joint. Based on these results, the associated treatment protocol may be recommended for physiotherapy treatment in such patients.
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| 2. |
- Backåberg, Sofia, 1979-, et al.
(författare)
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Sustainable human movements - a threshold concept with potential to open up new perspectives in physiotherapy
- 2024
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Ingår i: European Journal of Physiotherapy. - : Taylor & Francis Group. - 2167-9169 .- 2167-9177.
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Tidskriftsartikel (refereegranskat)abstract
- There is a call to action for physiotherapists worldwide to contribute to the transition towards 'sustainable health'. In this paper, we build upon the current definition of 'sustainable health' and also on 'sustainable physical activity' to introduce and theoretically substantiate the concept of sustainable human movements, and suggest a definition thereof. Sustainable human movements will be described as a threshold concept with three aligned critical concepts; (i) movement control, including forces as causes of emerging movements, (ii) movement quality, referring to how movements are performed in terms of optimisation, and (iii) physical literacy, including motivation, confidence and physical competence. A deep understanding of these concepts, combined with a collaboration and learning approach applied together with the patient, is proposed to enable a sustainable human movement approach to permeate physiotherapy theory and practice. To facilitate this, a generic and easily accessible tool has recently been developed. It combines support for structured observational movement analysis and pedagogical support for creating a mutual and extended understanding of a patient's lived experience. This encourages the patient to become actively involved and take responsibility for promoting his/her 'sustainable health'. The aims of this paper are to a) suggest a theoretical framework for and definition of the concept sustainable human movements, and b) introduce a clinical tool that ultimately aims at promoting sustainable movements and health.
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| 3. |
- Beyaert, Christian, et al.
(författare)
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Gait post-stroke : Pathophysiology and rehabilitation strategies
- 2015
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Ingår i: Neurophysiologie clinique. - : Elsevier BV. - 0987-7053 .- 1769-7131. ; 45:4-5, s. 335-355
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Forskningsöversikt (refereegranskat)abstract
- We reviewed neural control and biomechanical description of gait in both non-disabled and post-stroke subjects. In addition, we reviewed most of the gait rehabilitation strategies currently in use or in development and observed their principles in relation to recent pathophysiology of post-stroke gait. In both non-disabled and post-stroke subjects, motor control is organized on a task-oriented basis using a common set of a few muscle modules to simultaneously achieve body support, balance control, and forward progression during gait. Hemiparesis following stroke is due to disruption of descending neural pathways, usually with no direct lesion of the brainstem and cerebellar structures involved in motor automatic processes. Post-stroke, improvements of motor activities including standing and locomotion are variable but are typically characterized by a common postural behaviour which involves the unaffected side more for body support and balance control, likely in response to initial muscle weakness of the affected side. Various rehabilitation strategies are regularly used or in development, targeting muscle activity, postural and gait tasks, using more or less high-technology equipment. Reduced walking speed often improves with time and with various rehabilitation strategies, but asymmetric postural behaviour during standing and walking is often reinforced, maintained, or only transitorily decreased. This asymmetric compensatory postural behaviour appears to be robust, driven by support and balance tasks maintaining the predominant use of the unaffected side over the initially impaired affected side. Based on these elements, stroke rehabilitation including affected muscle strengthening and often stretching would first need to correct the postural asymmetric pattern by exploiting postural automatic processes in various particular motor tasks secondarily beneficial to gait.
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| 4. |
- Elmgren Frykberg, Gunilla, 1957-, et al.
(författare)
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Correlation between clinical assessment and force plate measurement of postural control after stroke
- 2007
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081 .- 0001-5555. ; 39:6, s. 448-453
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To explore the correlation between clinical assessmentand force plate measurement of postural control after stroke when selected balance tasks are performed under similar spatial and temporal conditions, and to examine the inter-rater agreement of assessment of weight distribution during quiet stance in subjects with stroke.Design: A descriptive and correlational study.Methods: Clinical assessment of postural control using Berg Balance Scale, video recording for rating of weight distribution, and force plate measurement with the Vifor-system, were performed in 20 subjects with stroke.Results: Mean velocity of displacement of the centre of pressure in the anterior-posterior direction correlated moderately with scores from the Berg Balance Scale items “maintaining a position” in the whole sample (rs = –0.50, p <0.05) as well as in a subgroup of subjects with stroke with submaximal Berg Balance Scale scores (rs = –0.62, p < 0.05). Moderate correlation was found between ratings of each of 3 physiotherapistsand centre of pressure’s mean position in the frontal plane on the force plate, while the inter-rater agreement was poor.Conclusion: Clinical assessment of postural control and weight distribution showed moderate correlation with force plate measurement when the assessments were performed under similar conditions. The data suggest that the reliability of observational postural analysis needs to be improved.
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| 5. |
- Elmgren Frykberg, Gunilla, 1957-, et al.
(författare)
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How many trials are needed in kinematic analysis of reach-to-grasp? : A study of the drinking task in persons with stroke and non-disabled controls
- 2021
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Ingår i: Journal of NeuroEngineering and Rehabilitation. - : BioMed Central (BMC). - 1743-0003. ; 18:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Kinematic analysis of the 3D reach-to-grasp drinking task is recommended in stroke rehabilitation research. The number of trials required to reach performance stability, as an important aspect of reliability, has not been investigated for this task. Thus, the aims of this study were to determine the number of trials needed for the drinking task to reach within-session performance stability and to investigate trends in performance over a set of trials in non-disabled people and in a sample of individuals with chronic stroke. In addition, the between-sessions test–retest reliability in persons with stroke was established.Methods: The drinking task was performed at least 10 times, following a standardized protocol, in 44 non-disabled and 8 post-stroke individuals. A marker-based motion capture system registered arm and trunk movements during 5 pre-defined phases of the drinking task. Intra class correlation statistics were used to determine the number of trials needed to reach performance stability as well as to establish test–retest reliability. Systematic within-session trends over multiple trials were analyzed with a paired t-test.Results: For most of the kinematic variables 2 to 3 trials were needed to reach good performance stability in both investigated groups. More trials were needed for movement times in reaching and returning phase, movement smoothness, time to peak velocity and inter-joint-coordination. A small but significant trend of improvement in movement time over multiple trials was demonstrated in the non-disabled group, but not in the stroke group. A mean of 3 trials was sufficient to reach good to excellent test–retest reliability for most of the kinematic variables in the stroke sample.Conclusions: This is the first study that determines the number of trials needed for good performance stability (non-disabled and stroke) and test–retest reliability (stroke) for temporal, endpoint and angular metrics of the drinking task. For most kinematic variables, 3–5 trials are sufficient to reach good reliability. This knowledge can be used to guide future kinematic studies.
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| 6. |
- Elmgren Frykberg, Gunilla, 1957-, et al.
(författare)
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Impact of stroke on anterior-posterior force generation prior to seat-off during sit-to-walk
- 2012
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Ingår i: Gait & Posture. - : Elsevier BV. - 0966-6362 .- 1879-2219. ; 35:1, s. 56-60
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Tidskriftsartikel (refereegranskat)abstract
- Force generation during sit-to-walk (STW) post-stroke is a poorly studied area, although STW is a common daily transfer giving rise to a risk of falling in persons with disability. The purpose of this study was to describe and compare strategies for anterior-posterior (AP) force generation prior to seat-off during the STW transfer in both subjects with stroke and in matched controls. During STW at self-selected speed, AP force data were collected by 4 force plates, beneath the buttocks and feet from eight subjects with stroke '(>6 months after onset) and 8 matched controls. Subjects with post-stroke hemiparesis and matched controls generated a similar magnitude of total AP force impulses (F-1.71 = 0.67; p = 0.42) beneath buttocks and feet prior to seat-off during STW. However, there were significant group differences in AP force impulse generation beneath the stance buttock (i.e. the non-paretic buttock in the stroke group), with longer duration (F-1.71 = 8.78; p <0.005), larger net AP impulse (F-1.71 = 6.76; p < 0.05) and larger braking impulse (F-1.71 = 7.24; p <0.05) in the stroke group. The total braking impulse beneath buttocks and feet was about 4.5 times larger in the stroke group than in the control group (F-1.71 = 8.84; p < 0.005). An intra-and inter-limb dys-coordination with substantial use of braking impulses was demonstrated in the stroke group. This motor strategy differed markedly from the smooth force interaction in the control group. These results might be important in the development of treatment models related to locomotion post-stroke.
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| 7. |
- Elmgren Frykberg, Gunilla, 1957-
(författare)
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Movement Control after Stroke : Studies on Sit-to-walk and on the Relations between Clinical and Laboratory Measures
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aims: The principal aims of this research were 1) to extend existing knowledge of the everyday sit-to-walk (STW) transfer in subjects with stroke and in matched controls by exploring temporal, kinematic, and kinetic aspects, and 2) to investigate the relations between some clinical and laboratory measures of postural control and locomotion in stroke rehabilitation and research. Methods: Ten community-living subjects with stroke (mean age 59 years) and ten matched controls were enrolled in the STW studies (Studies I, II, and IV). In the study regarding relations between clinical and laboratory measures the same samples (part of Study II) and also 20 outpatient subjects with stroke (mean age 50 years) participated (Study III). Data collections were performed in laboratory environments with clinical assessment instruments, video cameras, force plates and a movement analysis system. Results: 1) Study I: A temporal aspect of STW was studied. Four phases were defined. The subjects with stroke used significantly more time during the 2nd STW phase, defined from seat-off to the loading peak of the 1st swing leg. Study II: A movement aspect of STW was investigated. The stroke subjects generated significantly less centre of mass momenta in horizontal and vertical directions, and the momenta peaks occurred significantly earlier than in the controls. Study IV: A force aspect of STW was explored. The subjects with stroke generated significantly larger propulsive impulse beneath the (non-paretic) stance buttock and significantly more braking impulses were exerted by both buttocks and particularly by the stance foot. 2) Part of Study II: A strong correlation was found between the clinical measure Fluidity Scale and the laboratory measure Fluidity Index. Study III: Moderate correlations were shown between Berg Balance Scale, ratings of weight distribution during quiet stance, and force measures. Conclusions: The findings of the STW studies show a changed force interaction between the lower extremities post-stroke, likely influencing movement patterns and temporal characteristics of the everyday transfer. The results are considered to reflect compensatory motor strategies. The results of the studies on relations between some clinical and laboratory measures indicate that the strength of the relation is multidimensional.
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| 8. |
- Elmgren Frykberg, Gunilla, 1957-, et al.
(författare)
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Temporal coordination of the sit-to-walk task in subjects with stroke and in controls
- 2009
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Ingår i: Archives of Physical Medicine and Rehabilitation. - : Elsevier BV. - 0003-9993 .- 1532-821X. ; 90:6, s. 1009-1017
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To explore events and describe phases for temporal coordination of the sit-to-walk (STW) task, within a semistandardized set up, in subjects with stroke and matched controls. In addition, to assess variability of STW phase duration and to compare the relative duration of STW phases between the 2 groups.Design: Cross-sectional.Setting: Research laboratory.Participants: A convenience sample of persons with hemiparesis (n=10; age 50–67y), more than 6 months after stroke and 10 controls matched for sex, age, height, and body mass index.Interventions: Not applicable.Main Outcome Measures: Relative duration of STW phases, SE of measurement in percentage of the mean, and intraclass correlation coefficients (ICCs).Results: Four STW phases were defined: rise preparation, transition, primary gait initiation, and secondary gait initiation. The subjects with stroke needed 54% more time to complete the STW task than the controls did. ICCs ranged from .38 to .66 and .22 to .57 in the stroke and control groups, respectively. SEs of measurement in percentage of the mean values were high, particularly in the transition phase: 54.1% (stroke) and 50.4% (controls). The generalized linear model demonstrated that the relative duration of the transition phase was significantly longer in the stroke group.Conclusions: The present results extend existing knowledge by presenting 4 new phases of temporal coordination of STW, within a semistandardized set-up, in persons with stroke and in controls. The high degree of variability regarding relative STW phase duration was probably a result of both the semistandardized set up and biological variability. The significant difference in the transition phase across the 2 groups requires further study.
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| 9. |
- Frykberg E, Gunilla, 1957-, et al.
(författare)
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Movement analysis of sit-to-stand : research informing clinical practice
- 2015
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Ingår i: Physical Therapy Reviews. - : Maney Publishing. - 1083-3196 .- 1743-288X. ; 20:3, s. 156-167
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Tidskriftsartikel (refereegranskat)abstract
- Background: Sit-to-stand (STS) is a crucial transfer influencing a person's independence in daily activities, as well as safety and quality of life, and is thus vital to evaluate in research and in practice. Clinical STS tests provide single values in seconds or numbers of STS. There is, however, increasing numbers of research papers reporting spatial and temporal kinematic and kinetic process STS data.Objectives: To provide an overview of research findings from laboratory-based movement analyses regarding phases and determinants of typical STS, characteristics of successful versus failed STS transfers, and finally STS performance in some neurological conditions.Major Findings: The STS transfer, previously regarded as mainly requiring lower limb muscle strength, is increasingly recognized as a complex transfer skill. Muscle strength, balance, foot position, chair height and the movement strategy are major determinants influencing STS performance. Scaling and timing of momentum generation throughout STS seems critical for success or failure. Sit-to-stand in stroke and Parkinson's disease (PD) is characterized by asymmetry in force generation and difficulties in switching movement direction, respectively. In-depth, knowledge regarding mechanisms of momentum control during STS sub-phases, STS failures, as well as exploration of variability in normal and atypical STS is still lacking.Conclusions: Recent research based on instrumented movement analyses has generated better understanding of movement control during STS, but the specifics are not yet reflected in clinical assessments. There seems to be a call for clinical tools capturing determinants and process characteristics of the STS transfer for a more comprehensive evaluation in rehabilitation.
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| 10. |
- Frykberg E, Gunilla, 1957-, et al.
(författare)
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The Arm Posture Score for assessing arm swing during gait : An evaluation of adding rotational components and the effect of different gait speeds
- 2014
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Ingår i: Gait & Posture. - : Elsevier BV. - 0966-6362 .- 1879-2219. ; 40:1, s. 64-69
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Tidskriftsartikel (refereegranskat)abstract
- In 3D gait analysis, quantification of leg movements is well established, whereas ameasure of armswing has been lacking. Recently, the Arm Posture Score (APS) was introduced to characterize arm movements in children with cerebral palsy, including information from four variables (APS(4)) in the sagittal and frontal planes. A potential limitation of the APS is that it does not include rotational movements and has not yet been evaluated with regard to gait speed. The aims of this study were (i) to investigate the effect on APS of adding two components of arm rotation (APS(6)) and (ii) to determine the influence of gait speed on the APS measures, when applied to non-disabled adults. Forty-two subjects walked 10 m at a selfselected speed (1.34 m/s), and in addition a subgroup of 28 subjects walked at a slowspeed (0.66 m/s) set by a metronome. Data were collected from markers in a whole-body set up and by eight optoelectronic cameras. The results demonstrated significantly higher APS(6) than APS(4) values for both arms, irrespective of gait speed. Speed condition, whether self-selected or slow, had a significant effect on both APS measures. The two additional arm components are suggested to provide relevant information about arm swing during walking. However, APS(6) needs to be implemented in gait analysis of individuals with gait arm pathologies in order to further examine its utility. Werecommend that gait speed should to be taken into account when using APS measures to quantify arm swing during gait. (C) 2014 Elsevier B. V. All rights reserved.
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