| 1. |
- Truong, Minh, 1994-
(författare)
-
Quantifying Gait Characteristics and Neurological Effects in people with Spinal Cord Injury using Data-Driven Techniques
- 2024
-
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.
|
|
| 2. |
- Gabrielsson, Hanna, 1977-
(författare)
-
Adults with Spina bifida : voices from everyday life and exploration of living conditions
- 2020
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to generate knowledge about living with Spina bifida, by mapping the condition and together with the adults with Spina bifida explore their living conditions and experiences in everyday life. Methods Study I was a quantitative study with a cross-sectional design. In Study II, individual experiences of daily life were explored by deep interviews using a reflective lifeworld approach. Study III had a participatory approach including five members of a photovoice group who met for eight sessions. Photographs taken by the members served as a starting point for the dialogue about what was of interest in their daily life. A narrative analysis was conducted by the researchers, incorporating the analysis the group did together. Study IV focused on alignment with the methodology in which photovoice is grounded. By returning to the ideological cornerstones of photovoice, the empirical experiences from Study III and examples from the literature were elaborated through processes within photovoice. The findings show that those adults with Spina bifida who were >46 years old had less complex medical conditions and better physical and cognitive functions, and had attained a higher level of education. The main theme in Study II was presented as “The contradictory path towards wellbeing in daily life.” In Study III, the members’ experiences in everyday life showed that many solutions offered by society were “An adaptation for us, but it works for no one.” The findings are further presented under three themes: “Accessibility – a never-ending project,” “Tensions of a normative view” and “Power to influence.” By focusing on action and narrative in Study IV, it is shown that dialogue, action, and interaction are important aspects of using photovoice. In conclusion, not all adult persons receive the support they need in everyday life, something future generations of adult persons with Spina bifida may have a higher need for. The stories and experiences of adults with Spina bifida in this thesis paint a history of not being asked, concerning their own situation. This shows that there is insufficient integration of the persons’ experiences in society’s efforts to plan for, and support, these individuals. The photovoice method was feasible for this group, providing opportunity for being part of dialogue, action, and interaction.
|
|
| 3. |
- Bendt, Martina, et al.
(författare)
-
Adults with spina bifida : A cross-sectional study of health issues and living conditions
- 2020
-
Ingår i: Brain and Behavior. - : John Wiley & Sons. - 2162-3279 .- 2162-3279. ; 10:8
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe health issues and living conditions in a cohort of adults living with Spina bifida.MATERIAL AND METHODS: A cross-sectional study was conducted by a multidisciplinary team. Adults with spina bifida (n = 219) were invited to participate. One-hundred-and-ninety-six persons (104 women and 92 men; 18-73 years, median age 33 years) were included. Structured interviews, questionnaires, and clinical assessments for medical, social, physical, and cognitive functions were used.RESULTS: There was large variation among participants as regards the consequences of their spina bifida. Individuals < 46 years seemed to have more secondary conditions such as hydrocephalus, Chiari II malformation, tethered cord symptoms, and latex allergy. A higher proportion of the individuals >46 years and older was able to walk, and they had performed better in primary school and on tests of psychomotor speed and executive function.CONCLUSIONS: This study demonstrates that adults with spina bifida have a complex set of physical, cognitive, and social needs that need to be addressed in order to improve their health issues and living conditions. The high prevalence of urinary and fecal incontinence, pain, and overweight underline that these issues need much attention during follow-up. The future generations of older adults may need more attention in many ways, since they at a younger age do have more complex medical conditions, lower physical and cognitive functions, and lower prerequisites for independent living and participation in society than those > 46 years today. This elucidates that adults with spina bifida need systematic follow-up services and social support throughout life.
|
|
| 4. |
- Bendt, Martina, et al.
(författare)
-
Living and health conditions for adults with spina bifida in Sweden – a comprehensive prevalence group study
- 2018
-
Konferensbidrag (refereegranskat)abstract
- Introduction Seventy-five per-cents of children born with Spina Bifida (SB) are expected to live into adulthood, meaning that the adults will need more attention in the future. Adulthood involves great demands for persons with SB, but also for their families, the social well-fare and healthcare systems, as the group has a persistent need for care and support. The aim is to describe the living and health conditions for adults with Spina Bifida in different life stages including medical, physical, psychological, cognitive and social aspects. Methods A cross-sectional study conducted by a multidisciplinary team. Data collection was performed through structured interviews, questionnaires and clinical assessments. All individuals > 18 years with SB (n=219) registered at a regional outpatient clinic were offered participation; 196 persons (104 women, 92 men 18-73 years) were included. Results There was a great variation in the group concerning problems related to their congenital injury. The persons > 45 years and especially > 61 years seems to have less problems such as less prevalence of hydrocephalus, Chiari II malformation, tethered cord syndrome and they also walked to a higher extent. They passed elementary school to a higher extent and performed better on the tests for psychomotor speed and executive function. Conclusions The study shows the multifaceted problems this group is facing as adults with SB and contributes to increased knowledge concerning the living and health conditions. Increased knowledge can lead to targeted interventions and better care, thereby decreasing secondary complications, reducing costs for society and hopefully increasing quality of life for persons with SB and their families.
|
|
| 5. |
- Bengtsson, Henrik, 1971-
(författare)
-
Bone Morphogenetic Protein Receptors in the Nervous System: Neurotrophic Functions with Emphasis on Catecholaminergic Neurons
- 2001
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Members of the transforming growth factor-β (TGF-β) superfamily exhibit a range of effects on a host of different cell types. They signal through heteromeric complexes of serine/threonine kinase receptors of type I and type II. Gene targeted mutations of both factors and receptors have revealed that many of them are involved in early embryonic development. This thesis examines the receptors for this superfamily in the nervous system, especially bone morphogenetic protein receptor type II (BMPR-II). It was cloned from chicken nervous tissue, and its and other receptors’ expression in peripheral ganglia, spinal cord and brain of chicken, rat and mouse were examined. BMPR-II, ActR-II and ActR-IA were abundantly expressed throughout development in the nervous system, however with temporal regulation. One ligand of BMPR-II, BMP-7, was found to act synergistically with NT-3 and GDNF on subsets of peripheral neurons to promote survival and neurite outgrowth. A knock-in mouse was generated, encoding a truncated form of BMPR-II coupled to the endogenous tyrosine hydroxylase (TH) gene with an internal ribosome entry site (IRES). For ES-cell selection, a neomycin resistance gene was incorporated into the construct. Homozygous mice carrying the knock-in allele exhibited a small, hypokinetic phenotype. Levels of dopamine, noradrenaline and serotonin were measured, and the catecholamines were found to be lowered, dopamine as much as 97% in the caudate nucleus. The low catecholamine levels may not be an effect of the truncated BMPR-II, but rather a consequence of the knock-in construct reducing TH transcriptional rate. The TH hypomorphic mouse strain generated could find use as a model for catecholamine impaired systems, as seen in Parkinson’s disease.
|
|
| 6. |
- Kabir, Zarina Nahar, et al.
(författare)
-
Care of family caregivers of persons with dementia (CaFCa) through a tailor-made mobile app : study protocol of a complex intervention study
- 2020
-
Ingår i: BMC Geriatrics. - : BioMed Central. - 1471-2318. ; 20:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Globally, family members account for the main source of caregiving of persons with dementia living at home. Providing care to family members with dementia often has negative health consequences for caregivers such as stress, depression and low quality of life. Yet, formal support for family caregivers (FCs) is limited. Telehealth technology has the potential to provide health care and social support to FCs. This study aims to assess the effectiveness of providing support by healthcare professionals (HPs) through a mobile app in reducing stress, depressive symptoms and loneliness, and improving mental health and quality of life of FCs of persons with dementia.Methods: Using a pragmatic intervention design, this study will use pre- and post-intervention assessment to evaluate the effectiveness of the proposed intervention in a sample of 78 FCs of persons with dementia (PWD). The intervention will be implemented by approximately 5 HPs specialized in dementia care based in the municipalities in Sweden. The main thrust of the intervention is to provide professional support, with help of an interactive mobile app, to family members in their caregiving role for PWDs. Qualitative interviews with HPs and FCs form the groundwork of the development of the mobile app. By using the app on smart phone or tablet, the FC, in groups of 8-10, will communicate with peers and a HP exchanging ideas on how to deal with PWD's behavioral and cognitive changes and get support. They will also be able to discuss stressful events and access mindfulness exercises focused on themselves. Quantitative data will be collected before and at three time points after the 8-week intervention to assess changes in the health outcomes of the FCs. In-depth interviews will be conducted after the intervention to capture the experiences of FCs and HPs regarding the ease of use and acceptability of the app.Discussion: This tailor-made mobile app has the high potential to be a practical platform for supporting FCs to alleviate stress and improve mental health irrespective of distance to the nearest health care or social service center.
|
|
