| 1. |
- Algurén, Beatrix, et al.
(författare)
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Factors Associated With Health-Related Quality of Life After Stroke: A 1-Year Prospective Cohort Study.
- 2012
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Ingår i: Neurorehabilitation and neural repair. - : SAGE Publications. - 1552-6844 .- 1545-9683. ; 26:3, s. 266-274
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In line with patient-centered health care, it is necessary to understand patients' perceptions of health. How stroke survivors perceive their health at different time points after stroke and which factors are associated with these feelings provide important information about relevant rehabilitation targets. OBJECTIVE: This study aimed to identify the independent factors of health-related quality of life (HRQoL) from a biopsychosocial perspective using the methods of multivariate regression at 3 different time points poststroke. METHODS: Included in the study were 99 patients from stroke units with diagnosed first-ever stroke. At admission and at 6 weeks, 3 months, and 1 year poststroke, HRQoL was assessed using the EuroQoL-5D Visual Analogue Scale (EQ-5D VAS). Consequences in Body Functions and Activities and Participation, and Environmental Factors were documented using 155 categories of the International Classification of Functioning, Disability and Health (ICF) Core Set for Stroke. RESULTS: For a period of 1 year, problems with recreation and leisure, personality functions, energy and drive functions, and gait pattern functions were repeatedly associated with worse HRQoL. Whereas Body Functions and Activities and Participation explained more than three-fourths of the variances of HRQoL at 6 weeks and 3 months (R (2) = 0.80-0.93), the variation at 1 year was best explained by either Body Functions or Environmental Factors (R (2) = 0.51). CONCLUSIONS: The results indicate the importance of Body Functions and Activities and Participation (mainly personality functions and recreation and leisure) on HRQoL within 3 months poststroke, but increased impact of Environmental Factors on HRQoL at 1 year.
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| 2. |
- Alt Murphy, Margit, 1970, et al.
(författare)
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Kinematic Variables Quantifying Upper-Extremity Performance After Stroke During Reaching and Drinking From a Glass.
- 2011
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Ingår i: Neurorehabilitation and Neural Repair. - : SAGE Publications. - 1552-6844 .- 1545-9683. ; 25:1, s. 71-80
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: . Three-dimensional kinematic analysis provides quantitative and qualitative assessment of upper-limb motion and is used as an outcome measure to evaluate impaired movement after stroke. The number of kinematic variables used, however, is diverse, and models for upper-extremity motion analysis vary. OBJECTIVE: . The authors aim to identify a set of clinically useful and sensitive kinematic variables to quantify upper-extremity motor control during a purposeful daily activity, that is, drinking from a glass. METHODS: . For this purpose, 19 participants with chronic stroke and 19 healthy controls reached for a glass of water, took a sip, and placed it back on a table in a standardized way. An optoelectronic system captured 3-dimensional kinematics. Kinematical parameters describing movement time, velocity, strategy and smoothness, interjoint coordination, and compensatory movements were analyzed between groups. RESULTS: . The majority of kinematic variables showed significant differences between study groups. The number of movement units, total movement time, and peak angular velocity of elbow discriminated best between healthy participants and those with stroke as well as between those with moderate (Fugl-Meyer scores of 39-57) versus mild (Fugl-Meyer scores of 58-64) arm impairment. In addition, the measures of compensatory trunk and arm movements discriminated between those with moderate and mild stroke impairment. CONCLUSION: . Kinematic analysis in this study identified a set of movement variables during a functional task that may serve as an objective assessment of upper-extremity motor performance in persons who can complete a task, such as reaching and drinking, after stroke.
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| 3. |
- Alt Murphy, Margit, 1970, et al.
(författare)
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Movement kinematics during a drinking task are associated with the activity capacity level after stroke.
- 2012
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Ingår i: Neurorehabilitation and neural repair. - : SAGE Publications. - 1552-6844 .- 1545-9683. ; 26:9, s. 1106-15
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Tidskriftsartikel (refereegranskat)abstract
- Kinematic analysis is a powerful method for an objective assessment of movements and is increasingly used as an outcome measure after stroke. Little is known about how the actual movement performance measured with kinematics is related to the common traditional assessment scales. The aim of this study was to determine the relationships between movement kinematics from a drinking task and the impairment or activity limitation level after stroke.
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| 4. |
- Alt Murphy, Margit, 1970, et al.
(författare)
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Responsiveness of Upper Extremity Kinematic Measures and Clinical Improvement During the First Three Months After Stroke.
- 2013
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Ingår i: Neurorehabilitation and neural repair. - : SAGE Publications. - 1552-6844 .- 1545-9683. ; 27:9, s. 844-853
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: . Kinematic movement analysis is increasingly used as an outcome measure in evaluation of upper extremity function after stroke. Little is known, however, about what observed longitudinal changes in kinematics mean in the context of an individual's functioning. In this study, the responsiveness and expected change in kinematic measures associated with clinically meaningful improvement in the upper extremity were evaluated. METHODS: . Kinematic movement analysis of a drinking task and Action Research Arm Test (ARAT) were performed early (9 days poststroke) and at 3 months after stroke in 51 subjects. The receiver-operating characteristic curve and linear regression analyses were used to evaluate responsiveness of kinematic parameters. RESULTS: . Movement time, smoothness, and trunk displacement discriminated those subjects demonstrating clinically meaningful improvements. Significant associations of 31% to 36% were found between the change in ARAT and kinematic measures. A real clinical improvement in kinematics lies in the range of 2.5 to 5 seconds, 3 to 7 units, and 2 to 5 cm in movement time, smoothness, and trunk displacement, respectively. CONCLUSIONS: . All kinematic measures reported in this study are responsive measures for capturing improvements in the upper extremity during the first 3 months after stroke. Approximate estimates for the expected change in kinematics associated with clinically meaningful improvement in upper extremity activity capacity illustrate the usefulness of the linear regression analysis for assessing responsiveness. This knowledge facilitates the selection of kinematic measures for clinical and movement analysis research as well as for technology-based devices.
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| 5. |
- Arnadottir, Gudrun, 1955-, et al.
(författare)
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Dimensionality of nonmotor neurobehavioral impairments when observed in the natural contexts of ADL task performance
- 2009
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Ingår i: Neurorehabilitation and neural repair. - : SAGE Publications. - 1545-9683 .- 1552-6844. ; 23:6, s. 579-586
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To examine diverse nonmotor neurobehavioral impairments (NBIs) that impact activities of daily living (ADL) task performance and to verify if such impairments can be viewed as one dimension when evaluated in an ecologically-relevant context. Methods. Rasch analysis was performed on data from 206 individuals diagnosed with dementia or cerebral vascular accident (CVA) who had been scored on 50 standardized NBIs from the A-ONE Neurobehavioral Impairment scale, based on naturalistic observation of ADL task performance. Evaluation of mean square (MnSq) infit and outfit values and principal components analysis (PCA) of residuals were used to evaluate unidimensionality of the items. Two evaluations were implemented: (1) to evaluate if there is a single global dimension common for persons with either dementia or CVA, and (2) to evaluate if the 50 NBIs are unidimensional, but comprised of different diagnosis-specific global hierarchies (dementia, left CVA, and right CVA). Results. The PCA indicated that 56.8% of variance was explained by the global measure (Rasch factor) of NBIs, with 4.9% of the unexplained variance explained by the first contrast. Four items showed outfit misfit to the common hierarchy. Developing diagnosis-specific global hierarchies resulted in improved PCA results for all 3 diagnostic groups (Rasch factor = 79.2% to 85.5%; unexplained variance in first contrast = 1.7% to 3.4%) after removal of 2 to 3 misfitting items. Conclusions. Nonmotor NBIs, when evaluated based on naturalistic performance of ADL, can be considered unidimensional, but the hierarchical structure of the dimension likely varies across diagnostic groups. Further study is needed with larger samples to verify these results.
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| 6. |
- Broeren, Jurgen, et al.
(författare)
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Assessment and training in a 3-dimensional virtual environment with haptics: a report on 5 cases of motor rehabilitation in the chronic stage after stroke.
- 2007
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Ingår i: Neurorehabilitation and Neural Repair. - : SAGE Publications. - 1545-9683 .- 1552-6844. ; 21:2, s. 180-189
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Tidskriftsartikel (refereegranskat)abstract
- Objective. This exploratory study assessed the possible effectiveness of hemiparetic upper extremity training in subjects with chronic stroke with computer instrumentation (haptic force feedback) and 3-dimensional visualization applied to computer games, as well as to evaluate concurrent computer-assisted assessment of the kinematics of movements and test whether any improvement detected in the computer environment was reflected in activities of daily living (ADLs). Methods. A single-subject repeated-measures experimental design (AB) was used. After baseline testing, 5 patients were assigned to the therapy 3 times a week for 45 min for 5 weeks. Velocity, time needed to reach, and hand path ratio (reflecting superfluous movements) were the outcome measures, along with the Assessment of Motor and Process Skills and the Box and Block test. The follow-up phase (C) occurred 12 weeks later. Results. Improvements were noted in velocity, time, and hand path ratio. One patient showed improvement in occupational performance in ADLs. Conclusions.The application of this strategy of using virtual reality (VR) technologies may be useful in assessing and training stroke patients. The results of this study must be reproduced in further studies. The VR systems can be placed in homes or other nonclinical settings.
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| 7. |
- Bustrén, Eva-Lena, et al.
(författare)
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Movement Kinematics of the Ipsilesional Upper Extremity in Persons With Moderate or Mild Stroke.
- 2017
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Ingår i: Neurorehabilitation and neural repair. - : SAGE Publications. - 1552-6844 .- 1545-9683. ; 31:4, s. 376-386
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Tidskriftsartikel (refereegranskat)abstract
- An increasing number of studies have indicated that the ipsilesional arm may be impaired after stroke. There is, however, a lack of knowledge whether ipsilesional deficits influence movement performance during purposeful daily tasks.The aim of this study was to investigate whether, and to what extent, movement impairments are present while performing an ipsilesional upper extremity task during the first 3 months after stroke.Movement kinematics describing movement time, smoothness, velocity, strategy, and pattern were captured during a standardized drinking task in 40 persons with first-ever stroke and 20 controls. Kinematics were measured early and at 3 months poststroke, and sensorimotor impairment was assessed with Fugl-Meyer Assessment in stroke.Half of the ipsilesional kinematics showed significant deficits early after stroke compared to controls, and the stroke severity had a significant impact on the kinematics. Movements of the ipsilesional arm were slower, less smooth, demonstrated prolonged relative time in deceleration, and increased arm abduction during drinking. Kinematics improved over time and reached a level comparable with controls at 3 months, except for angular velocity of the elbow and deceleration time in reaching for those with more severe motor impairment.This study demonstrates that movements of the ipsilesional arm, during a purposeful daily task, are impaired after stroke. These deficits are more prominent early after stroke and when the motor impairment is more severe. In clinical studies and praxis, the use of less-affected arm as a reference may underestimate the level of impairment and extent of recovery.
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| 8. |
- Conradsson, D, et al.
(författare)
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The Effects of Highly Challenging Balance Training in Elderly With Parkinson's Disease: A Randomized Controlled Trial
- 2015
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Ingår i: Neurorehabilitation and neural repair. - : SAGE Publications. - 1552-6844 .- 1545-9683. ; 29:9, s. 827-836
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Tidskriftsartikel (refereegranskat)abstract
- Background. Highly challenging exercises have been suggested to induce neuroplasticity in individuals with Parkinson’s disease (PD); however, its effect on clinical outcomes remains largely unknown. Objective. To evaluate the short-term effects of the HiBalance program, a highly challenging balance-training regimen that incorporates both dual-tasking and PD-specific balance components, compared with usual care in elderly with mild to moderate PD. Methods. Participants with PD (n = 100) were randomized, either to the 10-week HiBalance program (n = 51) or to the control group (n = 49). Participants were evaluated before and after the intervention. The main outcomes were balance performance (Mini-BESTest), gait velocity (during normal and dual-task gait), and concerns about falling (Falls Efficacy Scale–International). Performance of a cognitive task while walking, physical activity level (average steps per day), and activities of daily living were secondary outcomes. Results. A total of 91 participants completed the study. After the intervention, the between group comparison showed significantly improved balance and gait performance in the training group. Moreover, although no significant between group difference was observed regarding gait performance during dual-tasking; the participants in the training group improved their performance of the cognitive task while walking, as compared with the control group. Regarding physical activity levels and activities of daily living, in comparison to the control group, favorable results were found for the training group. No group differences were found for concerns about falling. Conclusions. The HiBalance program significantly benefited balance and gait abilities when compared with usual care and showed promising transfer effects to everyday living. Long-term follow-up assessments will further explore these effects.
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| 9. |
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| 10. |
- Danielsson, Anna, 1957, et al.
(författare)
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Physical activity and walking speed after stroke compared to control values
- 2012
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Ingår i: Neurorehabilitation and neural repair. - : SAGE Publications. - 1545-9683 .- 1552-6844. ; 26:6, s. 695-804
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Konferensbidrag (refereegranskat)abstract
- Background and Aims: Persons with stroke are often less physically active than healthy and it can be hypothesized that activity increases over time and that walking speed is important. The aim was to describe the physical activity level using a questionnaire, compare with normative data and examine relationships between physical activity level, time since stroke and walking speed. Methods: A convenience sample of 70 persons (48 men, 22 woman) with a mean age of 60 (SD 6.8) was examined at a mean of 6 (SD 3) years after first event of stroke. A population based sample of 141 persons (70 men, 71 women) between 40 and 79 years of age from the same geographical area, divided into four cohorts, served as controls. The Physical Activity Scale for the Elderly (PASE) (1) was used to estimate the self-reported physical activity level. The self-selected walking speed was measured on a 30 m track and in stroke persons motor function in the affected leg was assessed according to Fugl-Meyer (maximum score 34). Results: The mean PASE score in the stroke group was 119 (SD 74), corresponding to 72% (SD 31) of the control score. There was no correlation between PASE and time since stroke. The median Fugl-Meyer score was 29 (range 11-34). The mean self-selected walking speed in the stroke group was 1.01 (SD 0.42) m/s which corresponded to 73% of the controls’. In a regression model, the self-selected walking speed could explain the variation in the PASE to 24% (p 0.001) and 6% (p 0.002), in the stroke and control groups, respectively. Conclusions: Persons with stroke reported lower physical activity than controls several years after stroke. Self-selected walking speed could partially explain physical activity level in persons with stroke but not in controls.
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| 11. |
- Franzen, E, et al.
(författare)
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Light and heavy touch reduces postural sway and modifies axial tone in Parkinson's disease
- 2012
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Ingår i: Neurorehabilitation and neural repair. - : SAGE Publications. - 1552-6844 .- 1545-9683. ; 26:8, s. 1007-1014
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Tidskriftsartikel (refereegranskat)abstract
- Background. Light touch with a stable object reduces postural sway by increasing axial postural tone in healthy subjects. However, it is unknown whether subjects with Parkinson’s disease (PD), who have more postural sway and higher axial postural tone than healthy subjects, can benefit from haptic touch. Objective. To investigate the effect of light and heavy touch on postural stability and hip tone in subjects with PD. Methods. Fourteen subjects with mid-stage PD and 14 healthy control subjects were evaluated during quiet standing with eyes closed with their arms ( a) crossed, ( b) lightly touching a fixed rigid bar in front of them, and ( c) firmly gripping the bar. Postural sway was measured with a forceplate, and axial hip tone was quantified using a unique device that measures the resistance of the hips to yaw rotation while maintaining active stance. Results. Subjects with PD significantly decreased their postural sway with light or heavy touch ( P < .001 vs arms crossed), similarly as control subjects. Without touch, hip tone was larger in PD subjects. With touch, however, tone values were similar in both groups. This change in hip tone with touch was highly correlated with the initial amount of tone (PD, r = −.72 to −.95; controls, r = −.74 to −.85). Conclusions. The authors showed, for the first time, that subjects with PD benefit from touch similarly to control subjects and that despite higher axial postural tone, PD subjects are able to modulate their tone with touch. Future studies should investigate the complex relationship between touch and postural tone.
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| 12. |
- Holmefur, Marie, 1968-, et al.
(författare)
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Neuroradiology can predict the development of hand function in children with unilateral cerebral palsy
- 2013
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Ingår i: Neurorehabilitation and Neural Repair. - : Sage Publications. - 1545-9683 .- 1552-6844. ; 27:1, s. 72-78
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Much variation is found in the development of hand function in children with unilateral cerebral palsy (CP).OBJECTIVE: To explore how anatomic brain abnormalities can be used to predict the development of hand function.METHODS: A total of 32 children with unilateral CP (16 boys and 16 girls) were evaluated at least once a year by the Assisting Hand Assessment (AHA). The data collection covered an age range from 18 months to 8 years (mean time in study, 4 years and 6 months). Computerized tomography or magnetic resonance imaging of the brain were assessed for patterns of brain damage, including the location of gray and extent of white-matter damage. The children were divided into groups according to lesion characteristics, and a series of univariate models were analyzed with a nonlinear mixed-effects model. The rate and maximum limit of development were calculated.RESULTS: The highest predictive power of better development of hand function was the absence of a concurrent lesion to the basal ganglia and thalamus, independent of the basic type of brain lesion. This model predicted both the rate of increasing ability and hand function at age 8 years. Hand function was also predicted by the basic pattern of damage and by the extent of white-matter damage. The presence of unilateral or bilateral damage had no predictive value.CONCLUSIONS: Neuroradiological findings can be used to make a crude prediction of the future development of the use of the affected hand in young children with unilateral CP.
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| 13. |
- Jacob, Louis, et al.
(författare)
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Predictors of Access to Rehabilitation in the Year Following Traumatic Brain Injury : A European Prospective and Multicenter Study
- 2020
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Ingår i: Neurorehabilitation and Neural Repair. - : Sage Publications. - 1545-9683 .- 1552-6844. ; 34:9, s. 814-830
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Tidskriftsartikel (refereegranskat)abstract
- Background: Although rehabilitation is beneficial for individuals with traumatic brain injury (TBI), a significant proportion of them do not receive adequate rehabilitation after acute care.Objective: Therefore, the goal of this prospective and multicenter study was to investigate predictors of access to rehabilitation in the year following injury in patients with TBI.Methods: Data from a large European study (CENTER-TBI), including TBIs of all severities between December 2014 and December 2017 were used (N = 4498 patients). Participants were dichotomized into those who had and those who did not have access to rehabilitation in the year following TBI. Potential predictors included sociodemographic factors, psychoactive substance use, preinjury medical history, injury-related factors, and factors related to medical care, complications, and discharge.Results: In the year following traumatic injury, 31.4% of patients received rehabilitation services. Access to rehabilitation was positively and significantly predicted by female sex (odds ratio [OR] = 1.50), increased number of years of education completed (OR = 1.05), living in Northern (OR = 1.62; reference: Western Europe) or Southern Europe (OR = 1.74), lower prehospital Glasgow Coma Scale score (OR = 1.03), higher Injury Severity Score (OR = 1.01), intracranial (OR = 1.33) and extracranial (OR = 1.99) surgery, and extracranial complication (OR = 1.75). On contrast, significant negative predictors were lack of preinjury employment (OR = 0.80), living in Central and Eastern Europe (OR = 0.42), and admission to hospital ward (OR = 0.47; reference: admission to intensive care unit) or direct discharge from emergency room (OR = 0.24).Conclusions: Based on these findings, there is an urgent need to implement national and international guidelines and strategies for access to rehabilitation after TBI.
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| 14. |
- Johansson, H, et al.
(författare)
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Dual-Task Effects During a Motor-Cognitive Task in Parkinson's Disease: Patterns of Prioritization and the Influence of Cognitive Status
- 2021
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Ingår i: Neurorehabilitation and neural repair. - : SAGE Publications. - 1552-6844 .- 1545-9683. ; 35:4, s. 356-366
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Tidskriftsartikel (refereegranskat)abstract
- People with Parkinson’s disease (PD) experience greater difficulties during dual task (DT) walking compared to healthy controls, but factors explaining the variance in DT costs remain largely unknown. Additionally, as cognitive impairments are common in PD it is important to understand whether cognitive status influences the strategies used during DT paradigms. The study aimed to (1) explore DT costs on gait and cognition during DT walking, (2) investigate factors associated with DT costs, and (3) to investigate to what extent patterns of DT costs and prioritization differed according to cognitive status. A total of 93 people with Parkinson’s disease were examined when walking in single and DT conditions. Information regarding demographics, PD severity, mobility, and cognitive and affective symptoms was collected, and an extensive neuropsychological test battery was used to classify whether participants had mild cognitive impairment (PD MCI) or not (PD non-MCI). Dual task costs were observed across all gait domains except asymmetry. Cognitive status was associated with DT costs on both gait and cognition. Nonmotor experiences of daily living were further associated with DT cost on cognition, and TUG-cog associated with DT cost on gait. People with PD MCI had larger DT costs on gait than PD non-MCI. Strategies differed according to cognitive status, whereby PD MCI used a posture-second strategy, and PD non-MCI used a posture-first strategy. Once verified in future studies, these results can inform clinicians and researchers when tailoring DT training paradigms to the specific characteristics of people with PD.
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| 15. |
- Klang, Andrea, et al.
(författare)
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Access to Rehabilitation After Hospitalization for Traumatic Brain Injury : A National Longitudinal Cohort Study in Sweden
- 2023
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Ingår i: Neurorehabilitation and Neural Repair. - : Sage Publications. - 1545-9683 .- 1552-6844. ; 37:11-12, s. 763-774
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Rehabilitation is suggested to improve outcomes following traumatic brain injury (TBI), however, the extent of access to rehabilitation among TBI patients remains unclear.OBJECTIVE: To examine the level of access to rehabilitation after TBI, and its association with health and sociodemographic factors.METHOD: We conducted a longitudinal cohort study using Swedish nationwide healthcare and sociodemographic registers. We identified 15 880 TBI patients ≥18 years hospitalized ≥3 days from 2008 to 2012 who were stratified into 3 severity groups; grade I (n = 1366; most severe), grade II (n = 5228), and grade III (n = 9268; least severe). We examined registered contacts with specialized rehabilitation or geriatric care (for patients ≥65 years) during the hospital stay, and/or within 1 year post-discharge. We performed a generalized linear model analysis to estimate the risk ratio (RR) for receiving specialized rehabilitation or geriatric care after a TBI based on sociodemographic and health factors.RESULTS: Among TBI patients, 46/35% (grade I), 14/40% (grade II), and 5/18% (grade III) received specialized rehabilitation or geriatric care, respectively. Being currently employed or studying was positively associated (RR 1.7, 2.3), while living outside of a city area was negatively associated (RR 0.36, 0.79) with receiving specialized rehabilitation or geriatric care. Older age and a prior substance use disorder were negatively associated with receiving specialized rehabilitation (RR 0.51 and 0.81).CONCLUSION: Our results suggest insufficient and unequal access to rehabilitation for TBI patients, highlighting the importance of organizing and standardizing post-TBI rehabilitation to meet the needs of patients, regardless of their age, socioeconomic status, or living area.
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| 16. |
- Kwakkel, G., et al.
(författare)
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Standardized Measurement of Quality of Upper Limb Movement After Stroke: Consensus-Based Core Recommendations From the Second Stroke Recovery and Rehabilitation Roundtable
- 2019
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Ingår i: Neurorehabilitation and Neural Repair. - : SAGE Publications. - 1545-9683 .- 1552-6844. ; 33:11, s. 951-958
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Tidskriftsartikel (refereegranskat)abstract
- The second Stroke Recovery and Rehabilitation Roundtable "metrics" task force developed consensus around the recognized need to add kinematic and kinetic movement quantification to its core recommendations for standardized measurements of sensorimotor recovery in stroke trials. Specifically, we focused on measurement of the quality of upper limb movement. We agreed that the recommended protocols for measurement should be conceptually rigorous, reliable, valid and responsive to change. The recommended measurement protocols include four performance assays (i.e. 2D planar reaching, finger individuation, grip strength, and precision grip at body function level) and one functional task (3D drinking task at activity level) that address body function and activity respectively. This document describes the criteria for assessment and makes recommendations about the type of technology that should be used for reliable and valid movement capture. Standardization of kinematic measurement protocols will allow pooling of participant data across sites, thereby increasing sample size aiding meta-analyses of published trials, more detailed exploration of recovery profiles, the generation of new research questions with testable hypotheses, and development of new treatment approaches focused on impairment. We urge the clinical and research community to consider adopting these recommendations.
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| 17. |
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| 18. |
- Lindberg, Påvel G., et al.
(författare)
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Cortical Activity in Relation to Velocity Dependent Movement Resistance in the Flexor Muscles of the Hand After Stroke
- 2009
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Ingår i: Neurorehabilitation and neural repair. - : SAGE Publications. - 1545-9683 .- 1552-6844. ; 23:8, s. 800-810
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Tidskriftsartikel (refereegranskat)abstract
- Background. The role of spinal networks in spasticity is well investigated, but little is known about possible cortical contributions to hypertonicity across a joint. Objective. The authors hypothesized that there are cortical activation correlates to spasticity in stroke patients with increased muscle tone of the wrist flexors. Methods. Stroke patients and controls were scanned using event-related functional magnetic resonance imaging (fMRI) during slow and fast passive movements of the hand with simultaneous recording of passive movement resistance (PMR). Results. Control participants had velocity-dependent activity (greater for slow than fast movements) of 2 types, in areas that were also more active in passive movement than rest (eg, relative increase in activation in contralateral S1 and M1 was greater for slow than fast) and in areas that were also more active in rest than passive movement (eg, relative decrease in activation in occipital areas and ipsilateral precentral gyrus was greater for fast than slow). In the patient group, with large interindividual variation of spasticity, we found an association between PMR and the velocity-dependent activity in ipsilateral S1 (area 3b) extending into M1 (area 4a), contralateral cingulate cortex, supplementary motor area (SMA), Brodmann Area 45 (BA 45), and cerebellum. Post hoc testing also revealed a similar correlation in S1 and M1 bilaterally in controls and showed that patients activated ipsilateral S1 and M1 more than controls in the velocity-dependent condition. Conclusions. The findings suggest the possibility of ipsilateral sensory and motor cortical involvement in spasticity after stroke, which warrant further investigation.
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| 19. |
- Lindberg, Påvel G., et al.
(författare)
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Use-dependent up- and down-regulation of sensorimotor brain circuits in stroke patients
- 2007
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Ingår i: Neurorehabilitation and Neural Repair. - : SAGE Publications. - 1545-9683 .- 1552-6844. ; 21:4, s. 315-326
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To examine whether cerebral activity during passive movements decreases with time after stroke, and if reduced activity in the representation for the upper extremity can be reversed with training. Methods. Brain activity was measured by functional magnetic resonance imaging (fMRI) during passive wrist flexion-extension in 7 patients at varying time points after stroke, in a cross-sectional design. Upper limb function was also measured in all patients. Five of the patients took part in a training program and were measured again, behaviorally and with fMRI posttraining. Healthy control individuals of comparable age were also studied. Results. In patients, reduced activity over time after stroke was found for the group in the supplementary motor area (SMA), contralateral primary motor cortex, and prefrontal and parietal association areas along with ipsilateral cerebellum. Activity in most of these areas was also reduced in the patient group as compared to the control group. After a half-hour of daily training for 4 weeks with repetitive passive and active arm movements, cerebral activation increased in the pre-SMA and SMA, ipsilateral primary sensory cortex and intraparietal sulcus, and contralateral cerebellum in parallel with functional improvements of the upper limb. Areas common to both analyses included the SMA, pre-SMA, primary sensory cortex, intraparietal sulcus, and cerebellum. Conclusions. Our findings suggest that a down-regulation of sensorimotor activity occurs progressively over time as a result of inactivity and that training may reverse the reduced brain activity.
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| 20. |
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| 21. |
- Lindberg, PG, et al.
(författare)
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Validation of a new biomechanical model to measure muscle tone in spastic muscles
- 2011
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Ingår i: Neurorehabilitation and neural repair. - : SAGE Publications. - 1552-6844 .- 1545-9683. ; 25:7, s. 617-625
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Tidskriftsartikel (refereegranskat)abstract
- Background. There is no easy and reliable method to measure spasticity, although it is a common and important symptom after a brain injury. Objective. The aim of this study was to develop and validate a new method to measure spasticity that can be easily used in clinical practice. Methods. A biomechanical model was created to estimate the components of the force resisting passive hand extension, namely ( a) inertia (IC), ( b) elasticity (EC), ( c) viscosity (VC), and ( d) neural components (NC). The model was validated in chronic stroke patients with varying degree of hand spasticity. Electromyography (EMG) was recorded to measure the muscle activity induced by the passive stretch. Results. The model was validated in 3 ways: ( a) NC was reduced after an ischemic nerve block, ( b) NC correlated with the integrated EMG across subjects and in the same subject during the ischemic nerve block, and ( c) NC was velocity dependent. In addition, the total resisting force and NC correlated with the modified Ashworth score. According to the model, the neural and nonneural components varied between patients. In most of the patients, but not in all, the NC dominated. Conclusions. The results suggest that the model allows valid measurement of spasticity in the upper extremity of chronic stroke patients and that it can be used to separate the neural component induced by the stretch reflex from resistance caused by altered muscle properties.
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| 22. |
- Lindberg, Påvel, et al.
(författare)
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Wallerian degeneration of the corticofugal tracts in chronic stroke : A pilot study relating diffusion tensor imaging, transcranial magnetic stimulation, and hand function
- 2007
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Ingår i: Neurorehabilitation and Neural Repair. - : SAGE Publications. - 1545-9683 .- 1552-6844. ; 21:6, s. 551-560
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Tidskriftsartikel (refereegranskat)abstract
- Objective. This study tested the hypothesis that degeneration of the corticofugal tracts (CFTs) is related to poor functional outcome in the upper limb after stroke. Methods. The authors used diffusion tensor imaging to determine the degree of white matter integrity of the CFT (FAAH/UH) in chronic stroke patients and controls. The functional integrity of the corticospinal pathway was examined using transcranial magnetic stimulation. Recruitment curves and silent period duration were measured. The relationship between FA AH/UH and functional outcome of the upper limb was also assessed using a battery of upper limb function tests. Results. In patients, FA AH/UH correlated positively with the slope of recruitment curves (RC AH/UH) and grip strength. FAAH/UH also correlated negatively with the silent period duration (SPAH/UH). According to the FA AH/UH, patients were also classified into groups with minimal or extensive Wallerian degeneration (WD). Patients with more extensive WD had poorer grip strength, dexterity, and range of movement. Conclusions. The authors' results suggest that structural and functional integrity of the CFT is essential to maintain function of the upper limb after stroke.
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| 23. |
- Meyer, S, et al.
(författare)
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Somatosensory Impairments in the Upper Limb Poststroke: Distribution and Association With Motor Function and Visuospatial Neglect
- 2016
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Ingår i: Neurorehabilitation and neural repair. - : SAGE Publications. - 1552-6844 .- 1545-9683. ; 30:8, s. 731-742
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Tidskriftsartikel (refereegranskat)abstract
- Background. A thorough understanding of the presence of different upper-limb somatosensory deficits poststroke and the relation with motor performance remains unclear. Additionally, knowledge about the relation between somatosensory deficits and visuospatial neglect is limited. Objective. To investigate the distribution of upper-limb somatosensory impairments and the association with unimanual and bimanual motor outcomes and visuospatial neglect. Methods. A cross-sectional observational study was conducted, including 122 patients within 6 months after stroke (median = 82 days; interquartile range = 57-133 days). Somatosensory measurement included the Erasmus MC modification of the (revised) Nottingham Sensory Assessment (Em-NSA), Perceptual Threshold of Touch (PTT), thumb finding test, 2-point discrimination, and stereognosis subscale of the NSA. Upper-limb motor assessment comprised the Fugl-Meyer assessment, motricity index, Action Research Arm Test, and Adult-Assisting Hand Assessment Stroke. Screening for visuospatial neglect was performed using the Star Cancellation Test. Results. Upper-limb somatosensory impairments were common, with prevalence rates ranging from 21% to 54%. Low to moderate Spearman ρ correlations were found between somatosensory and motor deficits ( r = 0.22-0.61), with the strongest associations for PTT ( r = 0.56-0.61) and stereognosis ( r = 0.51-0.60). Visuospatial neglect was present in 27 patients (22%). Between-group analysis revealed somatosensory deficits that occurred significantly more often and more severely in patients with visuospatial neglect ( P < .05). Results showed consistently stronger correlations between motor and somatosensory deficits in patients with visuospatial neglect ( r = 0.44-0.78) compared with patients without neglect ( r = 0.08-0.59). Conclusions. Somatosensory impairments are common in subacute patients poststroke and are related to motor outcome. Visuospatial neglect was associated with more severe upper-limb somatosensory impairments.
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| 24. |
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| 25. |
- Parkkonen, E., et al.
(författare)
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Strength of similar to 20-Hz Rebound and Motor Recovery After Stroke
- 2017
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Ingår i: Neurorehabilitation and Neural Repair. - : SAGE Publications. - 1545-9683 .- 1552-6844. ; 31:5, s. 475-486
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Tidskriftsartikel (refereegranskat)abstract
- Background. Stroke is a major cause of disability worldwide, and effective rehabilitation is crucial to regain skills for independent living. Recently, novel therapeutic approaches manipulating the excitatory-inhibitory balance of the motor cortex have been introduced to boost recovery after stroke. However, stroke-induced neurophysiological changes of the motor cortex may vary despite of similar clinical symptoms. Therefore, better understanding of excitability changes after stroke is essential when developing and targeting novel therapeutic approaches. Objective and Methods. We identified recovery-related alterations in motor cortex excitability after stroke using magnetoencephalography. Dynamics (suppression and rebound) of the similar to 20-Hz motor cortex rhythm were monitored during passive movement of the index finger in 23 stroke patients with upper limb paresis at acute phase, 1 month, and 1 year after stroke. Results. After stroke, the strength of the similar to 20-Hz rebound to stimulation of both impaired and healthy hand was decreased with respect to the controls in the affected (AH) and unaffected (UH) hemispheres, and increased during recovery. Importantly, the rebound strength was lower than that of the controls in the AH and UH also to healthy-hand stimulation despite of intact afferent input. In the AH, the rebound strength to impaired-hand stimulation correlated with hand motor recovery. Conclusions. Motor cortex excitability is increased bilaterally after stroke and decreases concomitantly with recovery. Motor cortex excitability changes are related to both alterations in local excitatory-inhibitory circuits and changes in afferent input. Fluent sensorimotor integration, which is closely coupled with excitability changes, seems to be a key factor for motor recovery.
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| 26. |
- Raty, S., et al.
(författare)
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Resting-state Functional Connectivity After Occipital Stroke
- 2022
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Ingår i: Neurorehabilitation and Neural Repair. - : SAGE Publications. - 1545-9683 .- 1552-6844. ; 36:2, s. 151-163
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Tidskriftsartikel (refereegranskat)abstract
- Background Resting-state functional magnetic resonance imaging (rsfMRI) reflects spontaneous activation of cortical networks. After stroke, these networks reorganize, both due to structural lesion and reorganization of functional connectivity (FC). Objective We studied FC in chronic phase occipital stroke patients with homonymous visual field defects before and after repetitive transorbital alternating current stimulation (rtACS). Methods This spin-off study, embedded in the randomized, sham-controlled REVIS trial, comprised 16 chronic occipital stroke patients with visual field defect and 12 healthy control subjects. The patients underwent rsfMRI at baseline, after two weeks of rtACS or sham treatment, and after two months of treatment-free follow-up, whereas the control subjects were measured once. We used a multivariate regression connectivity model to determine mutual prediction accuracy between 74 cortical regions of interest. Additionally, the model parameters were included into a graph to analyze average path length, centrality eigenvector, centrality degree, and clustering of the network. The patients and controls at baseline and the two treatment groups were compared with multilevel modeling. Results Before treatment, the patients and controls had similar whole-network prediction accuracy and network parameters, whereas centrality eigenvector differed in perilesional regions, indicating local modification in connectivity. In line with behavioral results, neither prediction accuracy nor any network parameter changed systematically as a result of rtACS rehabilitation compared to sham. Conclusions Whole-network FC showed no difference between occipital stroke patients and healthy population, congruent with the peripheral location of the visual network in relation to the high-density cortical core. rtACS treatment in the given setting did not affect FC.
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| 27. |
- Schertz, M., et al.
(författare)
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Imaging Predictors of Improvement from a Motor Learning-Based Intervention for Children with Unilateral Cerebral Palsy
- 2016
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Ingår i: Neurorehabilitation and Neural Repair. - : Sage Publications. - 1545-9683 .- 1552-6844. ; 30:7, s. 647-660
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Tidskriftsartikel (refereegranskat)abstract
- Background:Motor-learning interventions may improve hand function in children with unilateral cerebral palsy (UCP) but with inconsistent outcomes across participants. Objective. To examine if pre-intervention brain imaging predicts benefit from bimanual intervention.Method:Twenty children with UCP with Manual Ability Classification System levels I to III, aged 7-16 years, participated in an intensive bimanual intervention. Assessments included the Assisting Hand Assessment (AHA), Jebsen Taylor Test of Hand Function (JTTHF) and Children's Hand Experience Questionnaire (CHEQ) at baseline (T1), completion (T2) and 8-10 weeks post-intervention (T3). Imaging at baseline included conventional structural (radiological score), functional (fMRI) and diffusion tensor imaging (DTI).Results:Improvements were seen across assessments; AHA (P = 0.04), JTTHF (P <.001) and CHEQ (P < 0.001). Radiological score significantly correlated with improvement at T2; AHA (r =.475) and CHEQ (r =.632), but negatively with improvement on unimanual measures at T3 (JTTFH r = -.514). fMRI showed negative correlations between contralesional brain activation when moving the affected hand and AHA improvements (T2: r = -.562, T3: r = -0.479). Fractional Anisotropy in the affected posterior limb of the internal capsule correlated negatively with increased bimanual use on CHEQ at T2 (r = -547) and AHA at T3 (r = -.656).Conclusions: Children with greater structural, functional and connective brain damage showed enhanced responses to bimanual intervention. Baseline imaging may identify parameters predicting response to intervention in children with UCP.
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| 28. |
- Stockley, Rachel C., et al.
(författare)
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Criteria and Indicators for Centers of Clinical Excellence in Stroke Recovery and Rehabilitation: A Global Consensus Facilitated by ISRRA
- 2024
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Ingår i: NEUROREHABILITATION AND NEURAL REPAIR. - 1545-9683 .- 1552-6844.
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Tidskriftsartikel (refereegranskat)abstract
- Background. The aim of the International Stroke Recovery and Rehabilitation Alliance is to create a world where worldwide collaboration brings major breakthroughs for the millions of people living with stroke. A key pillar of this work is to define globally relevant criteria for centers that aspire to deliver excellent clinical rehabilitation and generate exceptional outcomes for patients.Objectives. This paper presents consensus work conducted with an international group of expert stroke recovery and rehabilitation researchers, clinicians, and people living with stroke to identify and define criteria and measurable indicators for Centers of Clinical Excellence (CoCE) in stroke recovery and rehabilitation. These were intentionally developed to be ambitious and internationally relevant, regardless of a country's development or income status, to drive global improvement in stroke services.Methods. Criteria and specific measurable indicators for CoCE were collaboratively developed by an international panel of stroke recovery and rehabilitation experts from 10 countries and consumer groups from 5 countries.Results. The criteria and associated indicators, ranked in order of importance, focused upon (i) optimal outcome, (ii) research culture, (iii) working collaboratively with people living with stroke, (iv) knowledge exchange, (v) leadership, (vi) education, and (vii) advocacy. Work is currently underway to user-test the criteria and indicators in 14 rehabilitation centers in 10 different countries.Conclusions. We anticipate that use of the criteria and indicators could support individual organizations to further develop their services and, more widely, provide a mechanism by which clinical excellence can be articulated and shared to generate global improvements in stroke care.
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| 29. |
- Svensson, Martina, et al.
(författare)
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Effects of Physical Exercise on Neuroinflammation, Neuroplasticity, Neurodegeneration, and Behavior: What We Can Learn From Animal Models in Clinical Settings.
- 2015
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Ingår i: Neurorehabilitation and Neural Repair. - : SAGE Publications. - 1552-6844 .- 1545-9683. ; 29:6, s. 577-589
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Tidskriftsartikel (refereegranskat)abstract
- Physical exercise is a cornerstone in the management of many neurodegenerative disorders, such as Parkinson's disease, dementia, and stroke. However, much of its beneficial effects on improving motor functions and cognition as well as decreasing neurodegeneration and neuroinflammation are not yet well understood. The obvious limitations of studying the protective mechanisms behind exercise, for example, brain plasticity and neurodegeneration, could be overcome by generating novel animal models of neurodegenerative disorders. In this narrative review, we discuss the beneficial effects of exercise performed in animal models of neurodegenerative disorders and how the results from animal studies can be used in clinical settings. From preclinical studies, the positive effects of exercise have been related to increased levels of neurotrophic factors, elevated expression of anti-inflammatory cytokines, and reduced levels of pro-inflammatory cytokines and activated microglia. It is clear that parameters influencing the effect of exercise, such as intensity, still remain to be investigated in animal studies in order to find the optimal program that can be translated into exercise interventions for patients with neurodegenerative diseases.
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| 30. |
- Walker, Marion F, et al.
(författare)
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Improving the Development, Monitoring and Reporting of Stroke Rehabilitation Research: Consensus-Based Core Recommendations from the Stroke Recovery and Rehabilitation Roundtable.
- 2017
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Ingår i: Neurorehabilitation and neural repair. - : SAGE Publications. - 1552-6844 .- 1545-9683. ; 31:10-11, s. 877-884
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Tidskriftsartikel (refereegranskat)abstract
- Recent reviews have demonstrated that the quality of stroke rehabilitation research has continued to improve over the last four decades but despite this progress, there are still many barriers in moving the field forward. Rigorous development, monitoring and complete reporting of interventions in stroke trials are essential in providing rehabilitation evidence that is robust, meaningful and implementable. An international partnership of stroke rehabilitation experts committed to develop consensus-based core recommendations with a remit of addressing the issues identified as limiting stroke rehabilitation research in the areas of developing, monitoring and reporting stroke rehabilitation interventions. Work exploring each of the three areas took place via multiple teleconferences and a two-day meeting in Philadelphia in May 2016. A total of 15 recommendations were made. To validate the need for the recommendations, the group reviewed all stroke rehabilitation trials published in 2015 (n=182 papers). Our review highlighted that the majority of publications did not clearly describe how interventions were developed or monitored during the trial. In particular, under-reporting of the theoretical rationale for the intervention and the components of the intervention call into question many interventions that have been evaluated for efficacy. More trials were found to have addressed the reporting of interventions recommendations than those related to development or monitoring. Nonetheless, the majority of reporting recommendations were still not adequately described. To progress the field of stroke rehabilitation research and to ensure stroke patients receive optimal evidence-based clinical care, we urge the research community to endorse and adopt our recommendations.
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| 31. |
- Abdur Rafeh, Mir, et al.
(författare)
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The effect of consumer-perceived COVID-19 ad value on health-protective behavior: Mediating role of engagement
- 2024
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Ingår i: Health Marketing Quarterly. - : Routledge. - 1545-0864 .- 0735-9683.
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Tidskriftsartikel (refereegranskat)abstract
- Though the pandemic has passed, social media-based messaging continues to exhibit COVID-19-related cues (e.g., wearing a face mask to stay safe), continuing to foster consumers’ health-protective behavior. However, it remains unclear how social media communications (e.g., advertising) affect such behavior, exposing an important literature-based gap. Addressing this gap, we deploy Ducoffe’s advertising value model to examine how pandemic-related advertisements (e.g., those urging consumers to stay safe, including post-the pandemic) impact their health-protective behavior. We also examine how consumer engagement (CE) mediates these associations. To explore these issues, we collected data from a sample of 301 Gen Z consumers, which was analyzed using partial least squares structural equation modeling (PLS-SEM). We find that informative, credible, irritating, and obtrusive ads raise consumer engagement and health-protective behavior. Engagement was also found to strengthen these associations, revealing their strategic value. We conclude by outlining important theoretical and practical implications that arise from our analyses.
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| 32. |
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| 33. |
- Alt Murphy, Margit, 1970, et al.
(författare)
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Movement deficits in the ipsilesional “less-affected” arm after stroke. Part of the Stroke Arm Longitudinal study at Gothenburg University, SALGOT-study
- 2016
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Ingår i: Neurorehabilitation and Neural Repair. - 1545-9683.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Objectives Increasing body of literature indicates that motor function at the ipsilesional side after stroke can be affected, but these deficits can be difficult to detect using traditional clinical scales. In addition, the ipsilesional side is commonly used as reference, representing a normal movement in assessments, which may affect the test results. The study aims to determine whether and to what extent the movements in the ipsilesional upper limb are affected after stroke. Methods In total, 44 individuals with stroke and 20 healthy controls were included. An optoelectronic motion capture system was used to measure kinematics and Fugl-Meyer Assessment for Upper Extremity to assess sensorimotor impairment in to subgroups (moderate 32-57, mild 58-66). Kinematic measures describing movement time, velocity, smoothness, strategy and compensatory movements in drinking task at two time points, early during the first month and at 3 months after stroke, were analyzed. Results The entire stroke group showed ipsilesional deficits in 6 and the subgroup of moderate impairment in 9 of the 12 kinematic measures early after stroke. In moderate impairment group the movements were slower, less smooth, the deceleration phase was longer and a larger abduction of the arm was used during drinking activity compared to healthy controls. A statistically significant improvement was also detected over time in 6 kinematic measures, but a deficit was still present in angular velocity of elbow and deceleration time in reaching 3 months poststroke. Conclusions This study demonstrates that motor deficits are common in ipsilesional upper extremity early after stroke and these deficits are more prominent in persons with poor controlesional motor function. The ipsilesional arm should be assessed early after stroke, preferably using measures that are sensitive to detect minor deficits. Clinical scales using the “less-affected” arm as reference, indicating normal movement, should be used with caution early after stroke.
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| 34. |
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| 35. |
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| 36. |
- Hyder, Akmal S., 1952-, et al.
(författare)
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Medical tourism in emerging markets : The role of trust, networks, and word-of-mouth
- 2019
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Ingår i: Health Marketing Quarterly. - : Taylor & Francis. - 0735-9683 .- 1545-0864. ; 36:3, s. 203-219
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Tidskriftsartikel (refereegranskat)abstract
- Despite the growing popularity of medical tourism (MT) in emerging markets (EMs), little is known about how healthcare providers operationalize. This article analyzes how healthcare providers meet different challenges to market MT in an EM setting. A qualitative method was used for data collection and conducting case studies on healthcare services in the Philippines. The results show that trust and network building are necessary for mitigating the unfavorable characteristics, instability and lack of legitimacy caused by institutional constraints in EM. Word-of-mouth is found to be important to attract new customers and disseminate information about MT services.
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| 37. |
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| 38. |
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| 39. |
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| 40. |
- Prinsloo, Mélani, et al.
(författare)
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Using demographics to predict smoking behavior
- 2008
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Ingår i: Health Marketing Quarterly. - : Informa UK Limited. - 0735-9683 .- 1545-0864. ; 25:3, s. 289-301
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Tidskriftsartikel (refereegranskat)abstract
- Smoking and nicotine addiction are among the major preventable causes of disease and mortality. Being able to target promotional campaigns effectively relies on a good understanding of the demographics of smokers and potential smokers. This study reports on the results of a large sample survey of the demographics of smoker and non-smokers in South African townships. Using logistical regression, it finds that smokers tend to be significantly, older males who are less educated, and somewhat surprisingly, with no religious affiliation. Implications for public health policy are identified, and avenues for future research recognized.
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| 41. |
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