| 1. |
- Bjerkefors, Anna, et al.
(författare)
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Effects of seated double-poling ergometer training on aerobic and mechanical power in paraplegics
- 2012
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Konferensbidrag (refereegranskat)abstract
- Introduction In wheelchair-dependent individuals with paraplegia, over 80 % would benefit from health-intervention programmes due to increased risks for cardiovascular diseases. One way to reduce the likelihood of secondary complications and/or to enhance physical capacity is to add structured exercise activities to the regular schedule throughout life. A seated double-poling ergometer (SDPE) has been developed and recently evaluated on a group of people with SCI. The results indicated that the SDPE appeared to be a suitable training tool; the shoulder movement was within a range of motion not conducive to musculoskeletal injury and it provided a large range of controllable intensities enabling both endurance and strength training.Purpose To study if regular interval training on a SDPE can increase physical capacity and hence improve performance towards maximal level with safety in individuals with spinal cord injury. Methods Thirteen healthy wheelchair users (8 M, 5 F; 47 ± 12 years, 1.75 ± 0.08 m, 67.9 ± 10.2 kg) with SCI levels ranging from T5 to L1, volunteered for the study. Years post injury varied from 3 to 35. All subjects performed 30 sessions of SDPE training during 10 weeks. Each session lasted approximately 55 min, and included a warm-up, interval training (15 s – 3 min work and 15 s – 2 min rest) and a cool-down. The intensity of the intervals was determined to lead up to 70 – 100 % of peak heart rate. Sub-maximal and maximal double-poling ergometer tests were performed before and after this training period. Oxygen uptake was measured using the Douglas Bag system. Three-dimensional kinematics were recorded using an optoelectronic system. Results Significant improvements after training were observed in oxygen uptake (23 %), ventilation (21 %) and blood lactate (22 %) during maximal exertion exercises (Table 1). Mean power per stroke and peak pole force increased with 15 % and 24 %, respectively. At sub-maximal level, significantly lower values were observed in ventilation (-13 %) and blood lactate (-25 %).Conclusion Regular interval training on the seated double-poling ergometer (SDPE) increased oxygen uptake and power out-put and can be recommended for people with paraplegia below T5 level due to SCI. Despite the high intensity training in this study, no overload symptoms were reported. On the contrary, certain types of musculoskeletal and neuropathic pain seem to benefit from training on the SDPE.
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| 2. |
- Bjerkefors, Anna, et al.
(författare)
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Effects of seated double-poling ergometer training on oxygen uptake, upper-body muscle strength and motor performance in paraplegics
- 2012
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Konferensbidrag (refereegranskat)abstract
- Background: In wheelchair-dependent individuals with paraplegia, over 80 % would benefit from health-intervention programmes due to increased risks for cardiovascular diseases. One way to reduce the likelihood of secondary complications and/or to enhance physical capacity is to add structured exercise activities throughout life.Objective: To study the effects of seated double-poling ergometer (SDPE) training on aerobic capacity, upper-body muscle strength, and cross-over effects on functional performance. Methods: Thirteen individuals with paraplegia performed 30 sessions of SDPE training during 10 weeks. Before and after the training period a) oxygen uptake was measured using the Douglas Bag system during sub-maximal and maximal double-poling ergometer tests, b) trunk, shoulder and elbow muscle strength measurements were performed during maximal voluntary contractions using an isokinetic dynamometer and c) functional tests in wheelchair were performed included; sit-and-reach test, propelling 15 m on a level surface, propelling 50 m up a 3º incline, and propelling 6 min on a 200 m indoor track. Test-retests were performed for all tests before the training began.Results: The average intra-class correlation coefficient for test-retest values was 0.91 (SD 0.07). Significant improvements after training were observed in oxygen uptake (22.7 %), ventilation (20.7 %) and blood lactate (22.0 %) during maximal exertion exercises. At sub-maximal level, significantly lower values were observed in ventilation (-12.8 %) and blood lactate (-25.0 %). Maximal isometric trunk muscle strength (17.0 %) and maximal isokinetic shoulder muscle strength (4.4 %) in flexion and extension improved after training. There were significant improvements in sit-and-reach test in forward directions (7.8 %) and in 15 m sprint test (5.2 %). Conclusion: Regular interval training on the SPDE was effective for individuals with paraplegia to improve aerobic capacity and upper-body muscle strength. Some cross-over effects on functional performance were also shown. Furthermore, the training did not cause any overload symptoms.
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| 3. |
- Flank, Peter, et al.
(författare)
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Dyslipidemia is common after spinal cord injury - independent of clinical measures
- 2015
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Ingår i: Jacobs Journal of Physical Rehabilitation Medicine. - 2469-3103. ; 1:1
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To survey the incidence of clinical risk markers and its correlation with established clinical measurements for cardiovascular disease (CVD) in a heterogeneous spinal cord injured (SCI) patient population.Design: Descriptive, cross-sectional study.Subjects: 78 patients with SCI, at different injury and functional level.Methods: Anthropometric data, blood pressure, a blood lipid panel, blood glucose and a questionnaire were analyzed.Results: Eighty-one percent of all patients had dyslipidemia (DL) and a majority of the patients with abdominal measures below the recommended cut-off levels had DL. Self-reported physical activity above the cut-off level was reported by 32.1%of the patients. There were no differences in clinical measures, serum lipid values and blood glucose between physically active and not active patients. No differences were seen between men/women, tetraplegia/paraplegia and wheelchair dependent/not wheelchair dependent patients.Conclusion: DL is common and seems to be not treated or undertreated in the studied SCI patient group with different neurological lesion and functional levels. General anthropometric clinical measures do not seem to be valid for evaluating risk for CVD in this patient group.
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| 4. |
- Flank, Peter, 1972-, et al.
(författare)
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Pain, anxiety and depression in spinal cord injured patients
- 2017
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Ingår i: Jacobs Journal of Physical Rehabilitation Medicine. - : Jacobs Publishers. - 2469-3103. ; 3:1
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To assess the prevalence of pain, anxiety and depression in a sample of chronic SCI patients in Northern Sweden.Design: Descriptive, cross-sectional study.Setting: Specialist Clinic at a University Hospital.Participants: 78 patients with chronic spinal cord injury, at different injury and functional level.Outcome measures: Patients registered presented pain above, at or below injury level on a Visual Analogue Scale (VAS). Patients currently on pain medication were also registered as having pain. Depression and anxiety were assessed by the Hospital Anxiety and Depression Rating Scale (HADS).Results: Out of 78 patients, 58 (74%) indicated current presence of pain or were on continuous pain medication. Pain above injury level was present in 32% of the patients, with a mean VAS of 15.9±20.1, range 0-60mm. Pain at injury level were present in 24% of the patients, mean VAS 11.0±17.0, range 0-50mm and 58% had pain below injury level with a mean VAS 31.4±22.3, range 0-80mm.Clinically significant psychological disorders were reported in 4 patients (5%) for both anxiety and depression.Conclusions: Pain is very common in persons with chronic SCI, but, at least in a drug-treated population, the pain is at a mild or moderate level. Anxiety and depression were found much less common than reported in other studies. Medication effects have been considered. Even in a presumably well-medicated and well-rehabilitated population, there is still a need for further optimization of pain management, including both pharmacological and non-pharmacological methods.Keywords: Tetraplegia; Paraplegia; Psychological Disorders; Visual Analogue Scale; Hospital Anxiety and Depression Scale
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| 5. |
- Flank, Peter, et al.
(författare)
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Self-reported physical activity and risk markers for cardiovascular disease after spinal cord injury
- 2014
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 46:9, s. 886-890
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Tidskriftsartikel (refereegranskat)abstract
- Objective:To examine whether self-reported physical activity of a moderate/vigorous intensity influences risk markers for cardiovascular disease in persons with paraplegia due to spinal cord injury.Design:Descriptive, cross-sectional study.Subjects:A total of 134 wheelchair-dependent individuals (103 men, 31 women) with chronic (>= 1 year) post-traumatic spinal cord injury with paraplegia.Methods:Cardiovascular disease markers (hypertension, blood glucose and a blood lipid panel) were analysed and related to physical activity.Results:One out of 5 persons reported undertaking physical activity >= 30 min/day. Persons who were physically active >= 30 min/day were significantly younger than inactive persons. Systolic and diastolic blood pressures were lower in the physically active group. When adjusting for age, the association between systolic blood pressure and physical activity disappeared. Physical activity >= 30 min/day had a tendency to positively influence body mass index and low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio. Men had significantly higher systolic and diastolic blood pressures than women, lower high-density lipoprotein cholesterol, higher low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio and higher triglycerides. No other significant differences between men and women were found.Conclusion:Self-reported physical activity >= 30 min/day in persons with spinal cord injury positively influenced diastolic blood pressure. No other reductions in cardiovascular disease risk markers were seen after controlling for age. These results indicate a positive effect of physical activity, but it cannot be concluded that recommendations about physical activity in cardiovascular disease prevention for the general population apply to wheelchair-dependent persons with spinal cord injury.
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| 6. |
- Flank, Peter, 1972-
(författare)
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Spinal cord injuries in Sweden : studies on clinical follow-ups
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A spinal cord injury is a serious medical condition, often caused by a physical trauma. An injury to the spinal cord affects the neurotransmission between the brain and spinal cord segments below the level of injury. The SCI causes a loss of motor function, sensory function and autonomic regulation of the body, temporary or permanent. Significantly improved acute care, primary comprehensive rehabilitation and life-long structured follow-up has led to persons with spinal cord injury (SCI) living longer than ever before. However, increased long-time survival has allowed secondary conditions to emerge, like diabetes mellitus and where cardiovascular disease (CVD) now is the most common cause of death among SCI patients. Other possible CVD-related comorbidities in this patient group have been reported to be pain and mood disturbances. There is still lack of, and need for more knowledge in the field of CVD-related screening and prevention after SCI.The overall aim of this thesis was to contribute to a scientific ground regarding the need for CVD-related screening and prevention after SCI.In Paper I and Paper II, patients with wheelchair-dependent post-traumatic SCI (paraplegia) were assessed. The results in paper I showed that 80% of the examined patients had at least one cardiovascular disease risk marker irrespective of body mass index (BMI). Dyslipidemia was common for both men and women at all BMI categories. The study also showed a high prevalence of hypertension, especially in men. Paper II showed a low frequency of self-reported physical activity, where only one out of 5 persons reported undertaking physical activity >30 min/day. The physically active had lower diastolic blood pressure but no significant difference in blood lipids.In paper III and IV, patients with SCI (tetraplegia and paraplegia) participated in the studies. Eighty-one percent of the patients had dyslipidemia, where also a majority of the patients with normal abdominal clinical measures had dyslipidemia. Self-reported physical activity >30min/day was reported by one third of the patients. No differences were found between physically active and not physically active patients when it came to blood glucose, serum lipid values and clinical measures (paper III). Pain was common in the patient group, however, most often on a mild to moderate level. Anxiety and depression was less common than reported in other studies (paper IV).
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| 7. |
- Hofers, Wiebke, et al.
(författare)
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Organisation of services and systems of care in paediatric spinal cord injury rehabilitation in seven countries: a survey with a descriptive cross-sectional design
- 2022
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Ingår i: Spinal Cord. - : SPRINGERNATURE. - 1362-4393 .- 1476-5624. ; 60:4, s. 339-347
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Tidskriftsartikel (refereegranskat)abstract
- Study design International multicentre cross-sectional study. Objectives To describe the organisation and systems of paediatric spinal cord injury (SCI) rehabilitation services in seven countries and compare them with available recommendations and key features of paediatric SCI. Setting Ten SCI rehabilitation units in seven countries admitting children and adolescents with SCI < 18 years of age. Methods An online survey reporting data from 2017. Descriptive and qualitative analysis were used to describe the data. Results The units reported large variations in catchment area, paediatric population and referrals, but similar challenges in discharge policy. Nine of the units were publicly funded. Three units had a paediatric SCI unit. The most frequent causes of traumatic injury were motor vehicle accidents, falls, and sports accidents. Unlike the other units, the Chinese units reported acrobatic dancing as a major cause. Mean length of stay in primary rehabilitation ranged between 18 and 203 days. Seven units offered life-long follow-up. There was a notable variation in staffing between the units; some of the teams were not optimal regarding the interdisciplinary and multiprofessional nature of the field. Eight units followed acknowledged standards and recommendations for specialised paediatric SCI rehabilitation and focused on family-centred care and rehabilitation as a dynamic process adapting to the child and the family. Conclusions As anticipated, we found differences in the organisation and administration of rehabilitation services for paediatric SCI in the ten rehabilitation units in seven countries. This might indicate a need for internationally approved, evidence-based guidelines for specialised paediatric SCI rehabilitation.
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| 8. |
- Holmlund, Tobias, et al.
(författare)
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Defining accelerometer cut-points for different intensity levels in motor-complete spinal cord injury.
- 2020
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Ingår i: Spinal Cord. - : Nature Publishing Group. - 1362-4393 .- 1476-5624. ; 58, s. 116-124
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Descriptive.OBJECTIVE: The present aim was to define accelerometer cut-point values for wrist-worn accelerometers to identify absolute- and relative-intensity physical activity (PA) levels in people with motor-complete paraplegics (PP) and tetraplegics (TP).SETTINGS: Rehabilitation facility in Sweden.METHODS: The participants were 26 (19 men, 7 women) with C5-C8, AIS A and B (TP) and 37 (27 men, 10 women) with T7-T12 (PP), AIS A and B. Wrist-worn accelerometer recordings (Actigraph GT3X+) were taken during seven standardized activities. Oxygen consumption was measured, as well as at-rest and peak effort, with indirect calorimetry. Accelerometer cut-points for absolute and relative intensities were defined using ROC-curve analyses.RESULTS: The ROC-curve analyses for accelerometer cut-points revealed good-to-excellent accuracy (AUC >0.8), defining cut-points for absolute intensity (2, 3, 4, 5, 6, 7 METs for PP and 2 to 6 METs for TP) and relative intensity (30, 40, 50, 60, 70, and 80% for PP and 40-80% for TP). The cut-points for moderate-to-vigorous physical activity was defined as ≥9515 vector magnitude counts per minute (VMC) for PP and ≥4887 VMC/min for TP.CONCLUSION: This study presents cut-points for wrist-worn accelerometers in both PP and TP, which could be used in clinical practice to describe physical activity patterns and time spent at different intensity levels.
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| 9. |
- Holmlund, Tobias, et al.
(författare)
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Energy expenditure after spinal cord injury in people with motor-complete tetraplegia or motor-complete paraplegia.
- 2018
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Ingår i: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 56:3, s. 274-283
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Cross-sectional.OBJECTIVES: This study aimed to describe and compare VO2 and energy expenditure at rest (REE) and during standardized sedentary, non-exercise physical activity, and exercise activities, in people with motor-complete tetraplegia (C5-C8). Further, REE and energy expenditure (EE) for the different activities were compared to data from a reference group of people with motor-complete paraplegia (T7-T12).SETTING: Sweden.METHODS: The sample of people with motor-complete tetraplegia consisted of 26 adults (seven women) with SCI, C5-C8 AIS A-B. REE and EE for the different activities were measured with indirect calorimetry. The results were further compared to people with motor-complete paraplegia.RESULTS: Resting VO2 was 2.57 ml O2 kg-1 min-1, 2.54 for men and 2.60 for women. The VO2 or activity energy expenditure related to body weight increased three to four times during non-exercise physical activity compared to sedentary activities for the people with motor-complete tetraplegia, and up to six times during exercise activity. No significant differences were seen in resting or sedentary activity VO2 between the people with motor-complete tetraplegia and those with motor-complete paraplegia. Activities of daily life revealed no or small differences in VO2, except for setting a table, while the people with tetraplegia had ∼50% lower VO2 during exercise activities.CONCLUSIONS: Non-exercise physical activities of daily life may be significant for increasing total daily EE in people with motor-complete tetraplegia. This might act to motivate the individual, and might be clinically important when designing adapted lifestyle intervention programs for the target group.
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| 10. |
- Holmlund, Tobias, et al.
(författare)
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Intensity of physical activity as a percentage of peak oxygen uptake, heart rate and Borg RPE in motor-complete para- and tetraplegia.
- 2019
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Ingår i: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 14:12
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The aims were to describe VO2peak, explore the potential influence of anthropometrics, demographics and level of physical activity within each cohort; b) to define common, standardized activities as percentages of VO2peak and categorize these as light, moderate and vigorous intensity levels according to present classification systems, and c) to explore how clinically accessible methods such as heart-rate monitoring and Borg rating of perceived exertion (RPE) correlate or can describe light, moderate and vigorous intensity levels.DESIGN: Cross sectional.SETTING: Rehabilitation facility and laboratory environment.SUBJECTS: Sixty-three individuals, thirty-seven (10 women) with motor-complete paraplegia (MCP), T7-T12, and twenty-six (7 women) with motor-complete tetraplegia (MCT), C5-C8.INTERVENTIONS: VO2peak was obtained during a graded peak test until exhaustion, and oxygen uptake during eleven different activities was assessed and categorized using indirect calorimetry.MAIN OUTCOME MEASURES: VO2peak, Absolute and relative oxygen consumption, Borg RPE.RESULTS: Absolute VO2peak was significantly higher in men than in women for both groups, with fairly small differences in relative VO2peak. For MCP sex, weight and time spent in vigorous-intensity activity explained 63% of VO2peak variance. For MCT sex and time in vigorous-intensity activity explained 55% of the variance. Moderate intensity corresponds to 61-72% HRpeak and RPE 10-13 for MCP vs. 71-79% HRpeak, RPE 13-14 for MCT.CONCLUSION: Using current classification systems, eleven commonly performed activities were categorized in relative intensity terms, (light, moderate and vigorous) based on percent of VO2peak, HRpeak and Borg RPE. This categorization enables clinicians to better guide persons with SCI to meet required physical activity levels.
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