| 1. |
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| 2. |
- Bergqvist, Maria, et al.
(författare)
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The impact of visuospatial and executive function on activity performance and outcome after robotic or conventional gait training, long-term after stroke—as part of a randomized controlled trial
- 2023
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Ingår i: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 21:3
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Visuospatial and executive impairments have been associated with poor activity performance sub-acute after stroke. Potential associations long-term and in relation to outcome of rehabilitation interventions need further exploration.Aims: To explore associations between visuospatial and executive function and 1) activity performance (mobility, self-care and domestic life) and 2) outcome after 6 weeks of conventional gait training and/or robotic gait training, long term (1–10 years) after stroke.Methods: Participants (n = 45), living with stroke affecting walking ability and who could perform the items assessing visuospatial/executive function included in the Montreal Cognitive Assessment (MoCA Vis/Ex) were included as part of a randomized controlled trial. Executive function was evaluated using ratings by significant others according to the Dysexecutive Questionnaire (DEX); activity performance using 6-minute walk test (6MWT), 10-meter walk test (10MWT), Berg balance scale, Functional Ambulation Categories, Barthel Index and Stroke Impact Scale.Results: MoCA Vis/Ex was significantly associated with baseline activity performance, long-term after stroke (r = .34-.69, p < .05). In the conventional gait training group, MoCA Vis/Ex explained 34% of the variance in 6MWT after the six-week intervention (p = 0.017) and 31% (p = 0.032) at the 6 month follow up, which indicate that a higher MoCA Vis/Ex score enhanced the improvement. The robotic gait training group presented no significant associations between MoCA Vis/Ex and 6MWT indicating that visuospatial/executive function did not affect outcome. Rated executive function (DEX) presented no significant associations to activity performance or outcome after gait training.Conclusion: Visuospatial/executive function may significantly affect activity performance and the outcome of rehabilitation interventions for impaired mobility long-term after stroke and should be considered in the planning of such interventions. Patients with severely impaired visuospatial/executive function may benefit from robotic gait training since improvement was seen irrespective of visuospatial/executive function. These results may guide future larger studies on interventions targeting long-term walking ability and activity performance.
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| 3. |
- Boldt, Martin, et al.
(författare)
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Alarm prediction in cellular base stations using data-driven methods
- 2021
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Ingår i: IEEE Transactions on Network and Service Management. - : Institute of Electrical and Electronics Engineers Inc.. - 1932-4537. ; 18:2, s. 1925-1933
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Tidskriftsartikel (refereegranskat)abstract
- The importance of cellular networks continuously increases as we assume ubiquitous connectivity in our daily lives. As a result, the underlying core telecom systems have very high reliability and availability requirements, that are sometimes hard to meet. This study presents a proactive approach that could aid satisfying these high requirements on reliability and availability by predicting future base station alarms. A data set containing 231 internal performance measures from cellular (4G) base stations is correlated with a data set containing base station alarms. Next, two experiments are used to investigate (i) the alarm prediction performance of six machine learning models, and (ii) how different predict-ahead times (ranging from 10 min to 48 hours) affect the predictive performance. A 10-fold cross validation evaluation approach and statistical analysis suggested that the Random Forest models showed best performance. Further, the results indicate the feasibility of predicting severe alarms one hour in advance with a precision of 0.812 (±0.022, 95 % CI), recall of 0.619 (±0.027) and F1-score of 0.702 (±0.022). A model interpretation package, ELI5, was used to identify the most influential features in order to gain model insight. Overall, the results are promising and indicate the potential of an early-warning system that enables a proactive means for achieving high reliability and availability requirements. IEEE
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| 4. |
- Boldt, Martin, et al.
(författare)
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Anomaly detection of event sequences using multiple temporal resolutions and Markov chains
- 2020
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Ingår i: Knowledge and Information Systems. - : Springer London. - 0219-1377 .- 0219-3116. ; 62, s. 669-686
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Tidskriftsartikel (refereegranskat)abstract
- Streaming data services, such as video-on-demand, are getting increasingly more popular, and they are expected to account for more than 80% of all Internet traffic in 2020. In this context, it is important for streaming service providers to detect deviations in service requests due to issues or changing end-user behaviors in order to ensure that end-users experience high quality in the provided service. Therefore, in this study we investigate to what extent sequence-based Markov models can be used for anomaly detection by means of the end-users’ control sequences in the video streams, i.e., event sequences such as play, pause, resume and stop. This anomaly detection approach is further investigated over three different temporal resolutions in the data, more specifically: 1 h, 1 day and 3 days. The proposed anomaly detection approach supports anomaly detection in ongoing streaming sessions as it recalculates the probability for a specific session to be anomalous for each new streaming control event that is received. Two experiments are used for measuring the potential of the approach, which gives promising results in terms of precision, recall, F 1 -score and Jaccard index when compared to k-means clustering of the sessions. © 2019, The Author(s).
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| 5. |
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| 6. |
- Borg, Jörgen, et al.
(författare)
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Amino-terminal anchored surface display in insect cells and budded baculovirus using the amino-terminal end of neuraminidase.
- 2004
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Ingår i: Journal of Biotechnology. - : Elsevier BV. - 1873-4863 .- 0168-1656. ; 114:1-2, s. 21-30
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Tidskriftsartikel (refereegranskat)abstract
- Methods currently used for surface display on insect cells and budded baculovirus, all utilize the sequences from class I transmembrane proteins. This gives rise to some problems when handling unknown genes or cDNAs encoding full-length proteins. First, the stop codon from the cloned gene will be located upstream of the sequence for the transmembrane region. Second, the chance of getting the sequences encoding the signal peptide and the transmembrane region in frame with the cloned gene is small. To minimize these problems, we here present a method by which cDNAs or genes of interest can be cloned and fused to the codons for the signal peptide and transmembrane region of neuraminidase (NA), a class II transmembrane protein of the influenza virus. By placing both the signal peptide and transmembrane region at the amino-terminal, potential problems regarding stop codons are eliminated and errors in frame-shift minimized. To obtain proof of principle, the gene encoding enhanced green fluorescent protein, EGFP, was subcloned into a shuttle vector downstream of the neuraminidase sequence and the fusion product was then transferred to a baculovirus vector and transfected into insect cells (Sf9). Using this method, EGFP was found to be expressed on the surface of both infected cells and budded virus in an accessible manner.
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| 7. |
- Borg, Jörgen, et al.
(författare)
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Cerebral pares, CP
- 2006
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Ingår i: Neurologi (fjärde upplagan). - : Liber. ; , s. 337-343
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Bokkapitel (populärvet., debatt m.m.)
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| 8. |
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| 9. |
- Borg, Jörgen
(författare)
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Hjärnskakning kan ge långvariga bevär : Identifiering av riskpatienter lika viktigt som det akuta omhändertagandet
- 2008
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 105, s. 1828-1829
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Hjärnskakning är förenad med låg risk för akuta, intrakraniella komplikationer och högre risk för postkommotionella besvär. Akut datortomografi medger säker diagnostik av intrakraniella komplikationer. Kliniska faktorer kan identifiera riskpatienter för selektiv datortomografi, eventuellt med stöd av biokemiska skademarkörer. Icke-skaderelaterade faktorer påverkar långtidsutfallet efter hjärnskakning och erbjuder mål för intervention.
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| 10. |
- Borg, Jörgen, et al.
(författare)
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Neurologisk rehabilitering
- 2000
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Ingår i: Neurologi. ; , s. 495-
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 11. |
- Borg, Jörgen
(författare)
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Perilipin expression in the islets of Langerhans and Surface expression in the baculovirus/insect cell system
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Surface display in insect cells: Systems available for surface display that utilize bacterial phages are insufficient for displaying a number of eukaryotic proteins. By instead presenting proteins on the surface of eukaryotic cells or virus, some of these problems might be overcome. The baculovirus/insect cell system, which has a high expression rate and post-translational mashinery closely resembling the one found in mammalian cells, could possibly be used for this purpose. Earlier methods developed for surface display in the baculovirus system have been adequate when handling a single known gene but been hampered with a number of insurmountable drawbacks when handling unknown genes or complete cDNA libraries. By utilizing the signal-anchor sequence of a class II transmembrane protein some of these problems can be overcome. We have demonstrated that the signal-anchor sequence from the class II transmembrane protein neuraminidase is capable of directing proteins to all membranes, including the cell surface. Proteins fused to the signal-anchor sequence from neuraminidase are also present on the surface of budded virus. Fused proteins are displayed on the cell surface in an accessible manner, enabling selection for protein-protein interactions on a cellular level. Deletion mutants of the transmembrane region were also made in order to enhance the likelihood for successful translation of cDNAs encoding proteins in all reading frames. Perilipin in pancreatic beta-cells: Increased levels of fatty acids in the plasma, a defect associated with obesity and type II diabetes, can cause lipid deposition in non-adipose tissue and lead to toxic effects, a process termed lipotoxicity. In the islets of Langerhans, a prolonged exposure to fatty acids leads to an increased basal insulin secretion, a blunted stimulated insulin response and ultimately apoptosis. However, non-esterified fatty acids have also been shown to have a positive effect by taking part in the lipid-signaling needed for a normal glucose-stimulated insulin secretion. Perilipin is a protein known to be involved in the regulation of lipolysis and hence the release of non-esterified fatty acids in the cytosol. Perilipin has previously been detected in adipocytes and steroidogenic tissues, where it is able to both increase and decrease the release of non-esterified fatty acids and cholesterol We have now detected the expression of perilipin also in the islets of Langerhans. By overexpressing perilipin in the beta-cell line INS-1, we have demonstrated an increased resistance against lipotoxic levels of non-esterified fatty acids. Cells overexpressing perilipin had a lower level of lipolysis, despite larger triacylglycerol stores, after palmitate exposure. An increased ability to store lipids and a lower rate of lipolysis, in the cells overexpressing perilipin, preserved the stimulated insulin response and overall viability. In contrast, control cells had a completely abrogated insulin response and a decreased overall viability after exposure to the same lipotoxic levels of palmitate.
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| 12. |
- Borg, Jörgen, et al.
(författare)
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Perilipin is present in islets of Langerhans and protects against lipotoxicity when overexpressed in the beta-cell line INS-1.
- 2009
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Ingår i: Endocrinology. - : The Endocrine Society. - 0013-7227 .- 1945-7170. ; 150:7, s. 3049-3057
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Tidskriftsartikel (refereegranskat)abstract
- Lipids have been shown to play a dual role in pancreatic beta-cells - a lipid-derived signal appears to be necessary for glucose-stimulated insulin secretion, whereas lipid accumulation causes impaired insulin secretion and apoptosis. The ability of the protein perilipin to regulate lipolysis prompted an investigation of the presence of perilipin in the islets of Langerhans. In this study evidence is presented for perilipin expression in rat, mouse and human islets of Langerhans as well as in the rat clonal beta-cell line INS-1. In rat and mouse islets, perilipin was verified to be present in beta-cells. In order to examine if the development of lipotoxicity could be prevented by manipulating the conditions for lipid storage in the beta-cell, INS-1 cells with adenoviral-mediated overexpression of perilipin were exposed to lipotoxic conditions for 72 hours. In cells exposed to palmitate, perilipin overexpression caused increased accumulation of triacylglycerols and decreased lipolysis compared to control cells. Whereas glucose-stimulated insulin secretion was retained following palmitate exposure in cells overexpressing perilipin, it was completely abolished in control beta-cells. Thus, overexpression of perilipin appears to confer protection against the development of beta-cell dysfunction following prolonged exposure to palmitate by promoting lipid storage and limiting lipolysis.
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| 13. |
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| 14. |
- Borg, Jörgen, et al.
(författare)
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Rehabiliteringsmedicin - bakgrund och aktuell roll i sjukvården
- 2006. - 1
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Ingår i: Rehabiliteringsmedicin-Teori och praktik. - Lund : Studentlitteratur. - 9144045077 - 9789144045078 ; , s. 11-19
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Kapitel om rehabiliteringsmedicinens utveckling och nuvarande plats i sjukvården samt begrepp och metodik inleder boken. I två delar ges därefter rehabiliteringsmedicinska aspekter på de dominerande sjukdomsgrupperna - komplexa smärttillstånd respektive skador och sjukdomar i nervsystemet. Som avslutning beskrivs bland annat stressrelaterade tillstånd. Läroboken är avsedd för grundutbildning av läkare, arbetsterapeuter och sjukgymnaster, logopeder samt för läkare under AT-tjänstgöring. Den är också lämplig som introduktion i specialistutbildningen i rehabiliteringsmedicin, geriatrik, neurologi och smärtlindring. Vidareutbildningar av olika vårdyrkesgrupper kan ha nytta av boken och den kan också användas som referenslitteratur av yrkesverksamma med intresse för rehabiliteringsmedicin.
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| 15. |
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| 16. |
- Borg, Jörgen, et al.
(författare)
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Traumatisk hjärnskada
- 2006
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Ingår i: Rehabiliteringsmedicin. - : Studentllitteratur. - 9144045077
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 17. |
- Brudin Borg, Camilla, 1965, et al.
(författare)
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Contemporary ecocritical methods
- 2024
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Bok (övrigt vetenskapligt/konstnärligt)abstract
- Ecocriticism has grown into one of the most innovative and urgent fields of the humanities, and many useful ecocritical approaches for addressing our environmental crisis have been developed, discussed, and reconsidered during the last decade. From various perspectives, ecocriticism both adopts and criticizes traditional analytical and theoretical models, resulting in an impressive methodological diversity, pushing the boundaries of the humanities. Contemporary Ecocritical Methods exemplifies this methodological variety and serves as a practical entry into the field. Fourteen chapters, written by scholars from various ecocritical sub-fields of environmental humanities, introduce a rich set of perspectives and their analytical tools.
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| 18. |
- Brudin Borg, Camilla, 1965, et al.
(författare)
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Introduction
- 2024
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Ingår i: Contemporary Ecocritical Methods / edited by Camilla Brudin Borg, Rikard Wingård and Jørgen Bruhn.. - Lanham : Lexington. - 9781666937893 ; , s. 1-14
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Introduces ecocriticism and the anthology's fourteen chapters, written by scholars from various ecocritical sub-fields of environmental humanities, introduce a rich set of perspectives and their analytical tools.
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| 19. |
- Brudin Borg, Camilla, 1965, et al.
(författare)
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Introduktion
- 2022
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Ingår i: Ekokritiska metoder / Camilla Brudin Borg, Jørgen Bruhn, Rikard Wingård (red.).. - Lund : Studentlitteratur. - 9789144156620 ; , s. 7-22
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 20. |
- Cancelliere, Carol, et al.
(författare)
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Protocol for a systematic review of prognosis after mild traumatic brain injury : an update of the WHO Collaborating Centre Task Force findings
- 2012
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Ingår i: Systematic Reviews. - : Springer Science and Business Media LLC. - 2046-4053. ; :1, s. 17-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Mild traumatic brain injury (MTBI) is a major public-health concern and represents 70-90% of all treated traumatic brain injuries. The last best-evidence synthesis, conducted by the WHO Collaborating Centre for Neurotrauma, Prevention, Management and Rehabilitation in 2002, found few quality studies on prognosis. The objective of this review is to update these findings. Specifically, we aim to describe the course, identify modifiable prognostic factors, determine long-term sequelae, and identify effects of interventions for MTBI. Finally, we will identify gaps in the literature, and make recommendations for future research.Methods: The databases MEDLINE, PsychINFO, Embase, CINAHL and SPORTDiscus were systematically searched (2001 to date). The search terms included 'traumatic brain injury', 'craniocerebral trauma', 'prognosis', and 'recovery of function'. Reference lists of eligible papers were also searched. Studies were screened according to pre-defined inclusion and exclusion criteria. Inclusion criteria included original, published peer-reviewed research reports in English, French, Swedish, Norwegian, Danish and Spanish, and human participants of all ages with an accepted definition of MTBI. Exclusion criteria included publication types other than systematic reviews, meta-analyses, randomized controlled trials, cohort studies, and case-control studies; as well as cadaveric, biomechanical, and laboratory studies. All eligible papers were critically appraised using a modification of the Scottish Intercollegiate Guidelines Network (SIGN) criteria. Two reviewers performed independent, in-depth reviews of each eligible study, and a third reviewer was consulted for disagreements. Data from accepted papers were extracted into evidence tables, and the evidence was synthesized according to the modified SIGN criteria.Conclusion: The results of this study form the basis for a better understanding of recovery after MTBI, and will allow development of prediction tools and recommendation of interventions, as well as informing health policy and setting a future research agenda.
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| 21. |
- Cancelliere, Carol, et al.
(författare)
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Systematic review of prognosis and return to play after sport concussion : results of the international collaboration on mild traumatic brain injury prognosis
- 2014
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Ingår i: Archives of Physical Medicine and Rehabilitation. - : Elsevier. - 0003-9993 .- 1532-821X. ; 95:3, Suppl, s. S210-S229
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Forskningsöversikt (refereegranskat)abstract
- ObjectiveTo synthesize the best available evidence on prognosis after sport concussion.Data SourcesMEDLINE and other databases were searched (2001–2012) with terms including “craniocerebral trauma” and “sports.” Reference lists of eligible articles were also searched.Study SelectionRandomized controlled trials and cohort and case-control studies were selected according to predefined criteria. Studies had to have a minimum of 30 concussion cases.Data ExtractionEligible studies were critically appraised using a modification of the Scottish Intercollegiate Guidelines Network (SIGN) criteria. Two reviewers independently reviewed and extracted data from accepted studies into evidence tables.Data SynthesisEvidence was synthesized qualitatively according to modified SIGN criteria, and studies were categorized as exploratory or confirmatory based on the strength of their design and evidence. After 77,914 records were screened, 52 articles were eligible for this review, and 24 articles (representing 19 studies) with a low risk of bias were accepted. Our findings are based on exploratory studies of predominantly male football players at the high school, collegiate, and professional levels. Most athletes recover within days to a few weeks, and American and Australian professional football players return to play quickly after mild traumatic brain injury. Delayed recovery appears more likely in high school athletes, in those with a history of previous concussion, and in those with a higher number and duration of postconcussion symptoms.ConclusionsThe evidence concerning sports concussion course and prognosis is very preliminary, and there is no evidence on the effect of return-to-play guidelines on prognosis. Our findings have implications for further research. Well-designed, confirmatory studies are urgently needed to understand the consequences of sport concussion, including recurrent concussion, across different athletic populations and sports.
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| 22. |
- Cancelliere, Carol, et al.
(författare)
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Systematic review of return to work after mild traumatic brain injury : results of the international collaboration on mild traumatic brain injury prognosis
- 2014
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Ingår i: Archives of Physical Medicine and Rehabilitation. - : Elsevier. - 0003-9993 .- 1532-821X. ; 95:3, Suppl, s. S201-S209
-
Forskningsöversikt (refereegranskat)abstract
- ObjectiveTo synthesize the best available evidence on return to work (RTW) after mild traumatic brain injury (MTBI).Data SourcesMEDLINE and other databases were searched (2001–2012) with terms including “craniocerebral trauma” and “employment.” Reference lists of eligible articles were also searched.Study SelectionControlled trials and cohort and case-control studies were selected according to predefined criteria. Studies had to assess RTW or employment outcomes in at least 30 MTBI cases.Data ExtractionEligible studies were critically appraised using a modification of the Scottish Intercollegiate Guidelines Network criteria. Two reviewers independently reviewed and extracted data from accepted studies into evidence tables.Data SynthesisEvidence was synthesized qualitatively according to modified Scottish Intercollegiate Guidelines Network criteria and prioritized according to design as exploratory or confirmatory. After 77,914 records were screened, 299 articles were found eligible and reviewed; 101 (34%) of these with a low risk of bias were accepted as scientifically admissible, and 4 of these had RTW or employment outcomes. This evidence is preliminary and suggests that most workers RTW within 3 to 6 months after MTBI; MTBI is not a significant risk factor for long-term work disability; and predictors of delayed RTW include a lower level of education (<11y of formal education), nausea or vomiting on hospital admission, extracranial injuries, severe head/bodily pain early after injury, and limited job independence and decision-making latitude.ConclusionsOur findings are based on preliminary evidence with varied patient characteristics and MTBI definitions, thus limiting firm conclusions. More well-designed studies are required to understand RTW and sustained employment after MTBI in the longer term (≥2y post-MTBI).
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| 23. |
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| 24. |
- Ehn, Maria, et al.
(författare)
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Users perspectives on interactive distance technology enabling home-based motor training for stroke patients
- 2015
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Ingår i: Stud. Health Technol. Informatics. - : IOS Press. - 9781614995159 ; , s. 145-152
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Konferensbidrag (refereegranskat)abstract
- The aim of this work has been to develop a technical support enabling home-based motor training after stroke. The basis for the work plan has been to develop an interactive technical solution supporting three different groups of stroke patients: (1) patients with stroke discharged from hospital with support from neuro team; (2) patients with stroke whose support from neuro team will be phased out and (3) patients living with impaired motor functions long-term. The technology has been developed in close collaboration with end-users using a method earlier evaluated and described [12]. This paper describes the main functions of the developed technology. Further, results from early user-tests with end-users, performed to identify needs for improvements to be carried out during further technical development. The developed technology will be tested further in a pilot study of the safety and, usefulness of the technology when applied as a support for motor training in three different phases of the post-stroke rehabilitation process.
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| 25. |
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Ekokritiska metoder
- 2022
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Samlingsverk (redaktörskap) (övrigt vetenskapligt/konstnärligt)abstract
- Under de senaste åren har fältet ekokritik vuxit mycket snabbt och inte minst har många kunskapsteoretiska positioner kommit att omprövas inom det. Utifrån olika perspektiv både omhuldar och kritiserar ekokritiken den traditionella vetenskapliga modellen. Detta har lett till en metodologisk mångfald som i vissa fall söker sig mot mer naturvetenskapligt betonade metoder, än vad de flesta humanistiska discipliner i regel gör, och i andra fall utforskar metoder som tänjer på gränserna för vad som inom den akademiska världen överhuvudtaget betraktas som vetenskap. Ekokritiska metoder introducerar denna metodologiska flora, som inte bara är av intresse för ekokritiker utan för alla som vill fördjupa sig i metodfrågor, skaffa sig underlag för diskussion eller finna inspiration till egen forskning. Ekokritiska metoder är den första samlade svenska ingången till ekokritiken som läsmetod, och den har skrivits av forskare från olika svenska forskningsmiljöer - och innehåller dessutom en nyöversatt bidrag från forskningsfronten. Ekokritiska metoder lämpar sig väl som grundbok på kurser i ekokritik eller kurser där metodologi står i fokus.
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| 26. |
- Elmgren Frykberg, Gunilla, 1957-, et al.
(författare)
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Correlation between clinical assessment and force plate measurement of postural control after stroke
- 2007
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081 .- 0001-5555. ; 39:6, s. 448-453
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To explore the correlation between clinical assessmentand force plate measurement of postural control after stroke when selected balance tasks are performed under similar spatial and temporal conditions, and to examine the inter-rater agreement of assessment of weight distribution during quiet stance in subjects with stroke.Design: A descriptive and correlational study.Methods: Clinical assessment of postural control using Berg Balance Scale, video recording for rating of weight distribution, and force plate measurement with the Vifor-system, were performed in 20 subjects with stroke.Results: Mean velocity of displacement of the centre of pressure in the anterior-posterior direction correlated moderately with scores from the Berg Balance Scale items “maintaining a position” in the whole sample (rs = –0.50, p <0.05) as well as in a subgroup of subjects with stroke with submaximal Berg Balance Scale scores (rs = –0.62, p < 0.05). Moderate correlation was found between ratings of each of 3 physiotherapistsand centre of pressure’s mean position in the frontal plane on the force plate, while the inter-rater agreement was poor.Conclusion: Clinical assessment of postural control and weight distribution showed moderate correlation with force plate measurement when the assessments were performed under similar conditions. The data suggest that the reliability of observational postural analysis needs to be improved.
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| 27. |
- Elmgren Frykberg, Gunilla, 1957-
(författare)
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Movement Control after Stroke : Studies on Sit-to-walk and on the Relations between Clinical and Laboratory Measures
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aims: The principal aims of this research were 1) to extend existing knowledge of the everyday sit-to-walk (STW) transfer in subjects with stroke and in matched controls by exploring temporal, kinematic, and kinetic aspects, and 2) to investigate the relations between some clinical and laboratory measures of postural control and locomotion in stroke rehabilitation and research. Methods: Ten community-living subjects with stroke (mean age 59 years) and ten matched controls were enrolled in the STW studies (Studies I, II, and IV). In the study regarding relations between clinical and laboratory measures the same samples (part of Study II) and also 20 outpatient subjects with stroke (mean age 50 years) participated (Study III). Data collections were performed in laboratory environments with clinical assessment instruments, video cameras, force plates and a movement analysis system. Results: 1) Study I: A temporal aspect of STW was studied. Four phases were defined. The subjects with stroke used significantly more time during the 2nd STW phase, defined from seat-off to the loading peak of the 1st swing leg. Study II: A movement aspect of STW was investigated. The stroke subjects generated significantly less centre of mass momenta in horizontal and vertical directions, and the momenta peaks occurred significantly earlier than in the controls. Study IV: A force aspect of STW was explored. The subjects with stroke generated significantly larger propulsive impulse beneath the (non-paretic) stance buttock and significantly more braking impulses were exerted by both buttocks and particularly by the stance foot. 2) Part of Study II: A strong correlation was found between the clinical measure Fluidity Scale and the laboratory measure Fluidity Index. Study III: Moderate correlations were shown between Berg Balance Scale, ratings of weight distribution during quiet stance, and force measures. Conclusions: The findings of the STW studies show a changed force interaction between the lower extremities post-stroke, likely influencing movement patterns and temporal characteristics of the everyday transfer. The results are considered to reflect compensatory motor strategies. The results of the studies on relations between some clinical and laboratory measures indicate that the strength of the relation is multidimensional.
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| 28. |
- Elmgren Frykberg, Gunilla, 1957-, et al.
(författare)
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Temporal coordination of the sit-to-walk task in subjects with stroke and in controls
- 2009
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Ingår i: Archives of Physical Medicine and Rehabilitation. - : Elsevier BV. - 0003-9993 .- 1532-821X. ; 90:6, s. 1009-1017
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To explore events and describe phases for temporal coordination of the sit-to-walk (STW) task, within a semistandardized set up, in subjects with stroke and matched controls. In addition, to assess variability of STW phase duration and to compare the relative duration of STW phases between the 2 groups.Design: Cross-sectional.Setting: Research laboratory.Participants: A convenience sample of persons with hemiparesis (n=10; age 50–67y), more than 6 months after stroke and 10 controls matched for sex, age, height, and body mass index.Interventions: Not applicable.Main Outcome Measures: Relative duration of STW phases, SE of measurement in percentage of the mean, and intraclass correlation coefficients (ICCs).Results: Four STW phases were defined: rise preparation, transition, primary gait initiation, and secondary gait initiation. The subjects with stroke needed 54% more time to complete the STW task than the controls did. ICCs ranged from .38 to .66 and .22 to .57 in the stroke and control groups, respectively. SEs of measurement in percentage of the mean values were high, particularly in the transition phase: 54.1% (stroke) and 50.4% (controls). The generalized linear model demonstrated that the relative duration of the transition phase was significantly longer in the stroke group.Conclusions: The present results extend existing knowledge by presenting 4 new phases of temporal coordination of STW, within a semistandardized set-up, in persons with stroke and in controls. The high degree of variability regarding relative STW phase duration was probably a result of both the semistandardized set up and biological variability. The significant difference in the transition phase across the 2 groups requires further study.
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| 29. |
- Eriksson, Gunilla, et al.
(författare)
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Occupational gaps in everyday life 1-4 years after aquired brain injury
- 2006
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 38:3, s. 159-65
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore adaptation, by examining the occupational gaps occurring between what individuals want to do and what they actually do in terms of their everyday activities before and after brain injury. In addition, the relationships between occupational gaps and impairment/activity limitations and the time lapse since the brain injury were explored. Design: A cross-sectional study. Subjects: A total of 187 persons, affected by traumatic brain injury or subarachnoid haemorrhage 1–4 years previously. Methods: A postal questionnaire encompassing questions concerning gaps in the performance of activities in everyday life before and after the brain injury and perceived impairment/activity limitations. Results: The numbers of occupational gaps increased after the injury, with the number of gaps having increased from 46% to 71%. The number of occupational gaps was significantly related to executive impairment/activity limitations, and motor impairment/activity limitations and other somatic impairments, such as headache, also had an impact. The time lapse since the brain injury had no significant effect on the number of occupational gaps. Conclusion: The results suggests that there is a need for adaptation in everyday activities, even several years after a brain injury, which indicates that follow-up and access to individualized rehabilitation interventions in the long-term are required.
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| 30. |
- Eriksson, Gunilla, et al.
(författare)
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Relationship between occupational gaps in everyday life, depressive mood and life satisfaction after acquired brain injury
- 2009
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 41:3, s. 187-194
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore the relationship between occupational gaps, depressive mood and life satisfaction in persons who have acquired a brain injury during the past 1-4 years and to test the Occupational Gaps Questionnaire. Design: A cross-sectional study. Subjects: A total of 116 persons with traumatic brain injury or subarachnoid haemorrhage acquired 1-4 years previously. Methods: A postal survey with questions on occupational gaps, focusing on the domains instrumental activities of daily living, social life, leisure and work (Occupational Gaps Questionnaire), life satisfaction (LiSat-11 checklist) and depressive mood (Hospital Anxiety and Depression Scale). Rasch analyses and principal component analyses were performed to ensure that data from the LiSat-11 and Occupational Gaps Questionnaire could be used subsequently as valid unidimensional measures in regression and correlational analyses. Results: Calibration of the Occupational Gaps Questionnaire and the LiSat-11 revealed that the items and persons demonstrated acceptable goodness-of-fit to the Rasch models respectively, supporting internal scale validity and person-response validity. In addition, principal component analyses revealed that the measures could be used as valid uni-dimensional estimations of occupational gaps and life satisfaction. There was a strong relationship between the extent of occupational gaps and perceived life satisfaction, a weaker relationship with depressive mood and a non-significant relationship with the aetiological diagnoses and life satisfaction. The factors explained 32% (occupational gaps), 6% (depressive mood), and 2% (diagnosis), respectively, of the total explained variance (40%). Conclusion: There was a strong correlation between participation in desired everyday occupations and life satisfaction 1-4 years after an acquired brain injury. This indicates that individually perceived occupational gaps, as recorded by the for tailored interventions in order to improve life satisfaction among clients with acquired brain injuries.
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| 31. |
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| 32. |
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| 33. |
- Frykberg, Gunilla, 1957-, et al.
(författare)
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Locomotor coordination during the sit-to-walk transfer is different in subjects with stroke and controls
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Objectives: To describe and to compare coordination of centre of mass (COM) horizontal and vertical momenta, and fluidity during the sit-to-walk (STW) transfer in subjects with stroke and in matched controls. Design: Cross-sectional. Setting: Research laboratory. Participants: Ten subjects with stroke in the post-acute phase (> 6 months) and ten control subjects, matched for sex, age, height and weight, were recruited through a convenience sample. Interventions: Not applicable. Main Outcome Measures: Magnitudes and timing of COM peak horizontal and peak vertical momenta, scores on the Fluidity Scale (FS) and values of the Fluidity Index (FI). Results: The stroke subjects generated significantly less COM peak horizontal and peak vertical momenta. Latencies from STW-onset and seat-off to the peaks differed significantly between the two groups. The subjects with stroke displayed significantly lower scores on the FS as well as lower percentages of the FI. Conclusions: While rising to walk, scaling and timing parameters of COM horizontal and vertical momenta differed significantly between subjects with stroke and matched controls. This atypical motor strategy needs to be further investigated before it is possible to make clinical recommendations.
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| 34. |
- Godbolt, Alison K., et al.
(författare)
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Associations between care pathways and outcome 1 year after severe traumatic brain injury
- 2015
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Ingår i: The journal of head trauma rehabilitation. - Philadelphia : Lippincott Williams & Wilkins. - 0885-9701 .- 1550-509X. ; 30:3, s. E41-E51
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To assess associations between real-world care pathways for working-age patients in the first year after severe traumatic brain injury and outcomes at 1 year.Setting and Design: Prospective, observational study with recruitment from 6 neurosurgical centers in Sweden and Iceland. Follow-up to 1 year, independently of care pathways, by rehabilitation physicians and paramedical professionals.Participants: Patients with severe traumatic brain injury, lowest (nonsedated) Glasgow Coma Scale score 3 to 8 during the first 24 hours and requiring neurosurgical intensive care, age 18 to 65 years, and alive 3 weeks after injury.Main Measures: Length of stay in intensive care, time between intensive care discharge and rehabilitation admission, outcome at 1 year (Glasgow Outcome Scale Extended score), acute markers of injury severity, preexisting medical conditions, and post-acute complications. Logistic regression analyses were performed.Results: A multivariate model found variables significantly associated with outcome (odds ratio for good outcome [confidence interval], P value) to be as follows: length of stay in intensive care (0.92 [0.87-0.98], 0.014), time between intensive care discharge and admission to inpatient rehabilitation (0.97 [0.94-0.99], 0.017), and post-acute complications (0.058 [0.006-0.60], 0.017).Conclusions: Delays in rehabilitation admission were negatively associated with outcome. Measures to ensure timely rehabilitation admission may improve outcome. Further research is needed to evaluate possible causation.
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| 35. |
- Godbolt, Alison K., et al.
(författare)
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Opportunity for Inpatient Brain Injury Rehabilitation for Persons in a Vegetative State Survey of Swedish Physicians
- 2011
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Ingår i: American Journal of Physical Medicine & Rehabilitation. - 0894-9115 .- 1537-7385. ; 90:6, s. 482-489
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to document physicians' opinions on inpatient rehabilitation care for working-age patients in vegetative state after new acquired brain injury, given the absence of an established standard of post-acute care. Design: A postal survey of 3259 Swedish physicians was conducted. Results: Survey response rate was 33%. Of survey respondents, 51% reported that they knew the definition of vegetative state. Transfer of vegetative patients from acute care to inpatient rehabilitation was considered always warranted by 54% and never or only sometimes warranted by 31% of survey respondents, whereas 15% did not know or did not answer. Rehabilitation physicians most often considered an inpatient rehabilitation stay of around 3 mos to be appropriate, but there was a lack of consensus. Discharge from acute care direct to social care at least sometimes was reported by 39% of physicians. Conclusions: Physicians' opinions vary considerably on appropriate post-acute care for patients in vegetative state after acquired brain injury. This may impact on rates of referral and admission to rehabilitation units. Consensus is needed on a minimum period for and extent of rehabilitation interventions. Educational interventions should be targeted broadly to reach the wide range of specialties that may have responsibility for acute care of these patients.
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| 36. |
- Gäverth, Johan, et al.
(författare)
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Sensitivity of the NeuroFlexor method to measure change in spasticity after treatment with botulinum toxin A in wrist and finger muscles
- 2014
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Ingår i: Journal of Rehabilitation Medicine. - : Foundation for Rehabilitation Information. - 1650-1977 .- 1651-2081. ; 46:7, s. 629-634
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The NeuroFlexor objectively quantifies the neural, elastic and viscous components of passive movement resistance in wrist and finger flexor muscles. In this study we investigated the sensitivity of the NeuroFlexor to changes in spasticity induced by treatment with botulinum toxin type A (BoNT-A).DESIGN: Prospective observational design.SUBJECTS: A convenience sample of 22 adults with post-stroke upper limb spasticity scheduled for botulinum toxin treatment.METHODS: BoNT-A was given according to individual treatment plans. NeuroFlexor assessments were made before treatment and 4 and 12 weeks after.RESULTS: At group level, spasticity decreased significantly at 4 weeks (expected time of maximum effect) (p = 0.04). At 12 weeks, spasticity had rebounded and no longer differed significantly from baseline (p = 0.64), i.e. in line with the pharmacodynamics of BoNT-A. At the individual level, 7 participants showed a reduction in spasticity greater than the measurement error. The reduction was dose-dependent (r(20) = 0.66, p < 0.001), and largest in participants with the highest dose.CONCLUSION: At the group level, the sensitivity of NeuroFlexor is good enough to detect reduction in spasticity after treatment with BoNT-A. Further work is needed to establish the sensitivity of NeuroFlexor on an individual level.
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| 37. |
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| 38. |
- Hybbinette, Helena, et al.
(författare)
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Longitudinal changes in functional connectivity in speech motor networks in apraxia of speech after stroke
- 2022
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Ingår i: Frontiers in Neurology. - : Frontiers Media S.A.. - 1664-2295. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveThe cerebral substrates of apraxia of speech (AOS) recovery remain unclear. Resting state fMRI post stroke can inform on altered functional connectivity (FC) within cortical language networks. Some initial studies report reduced FC between bilateral premotor cortices in patients with AOS, with lowest FC in patients with the most severe AOS. However, longitudinal FC studies in stroke are lacking. The aims of the present longitudinal study in early post stroke patients with AOS were (i) to compare connectivity strength in AOS patients to that in left hemisphere (LH) lesioned stroke patients without a speech-language impairment, (ii) to investigate the relation between FC and severity of AOS, aphasia and non-verbal oral apraxia (NVOA) and (iii) to investigate longitudinal changes in FC, from the subacute phase to the chronic phase to identify predictors of AOS recovery. MethodsFunctional connectivity measures and comprehensive speech-language assessments were obtained at 4 weeks and 6 months after stroke in nine patients with AOS after a LH stroke and in six LH lesioned stroke patients without speech-language impairment. Functional connectivity was investigated in a network for speech production: inferior frontal gyrus (IFG), anterior insula (aINS), and ventral premotor cortex (vPMC), all bilaterally to investigate signs of adaptive or maladaptive changes in both hemispheres. ResultsInterhemispheric vPMC connectivity was significantly reduced in patients with AOS compared to LH lesioned patients without speech-language impairment. At 6 months, the AOS severity was associated with interhemispheric aINS and vPMC connectivity. Longitudinal changes in FC were found in individuals, whereas no significant longitudinal change in FC was found at the group level. Degree of longitudinal AOS recovery was strongly associated with interhemispheric IFG connectivity strength at 4 weeks. ConclusionEarly interhemispheric IFG connectivity may be a strong predictor of AOS recovery. The results support the importance of interhemispheric vPMC connection in speech motor planning and severity of AOS and suggest that also bilateral aINS connectivity may have an impact on AOS severity. These findings need to be validated in larger cohorts.
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| 39. |
- Jacobsson, Lars
(författare)
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Long-term outcome after traumatic brain injury : studies of individuals from northern Sweden
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- As traumatic brain injury (TBI) is as one of the major causes of long-term disability, there is an increasing interest in the long-term outcome of TBI. The overall aim of this thesis was to increase our knowledge and understanding of the situation for individuals many years post injury, with regard to demographics, injury characteristics and primary outcome, long-term functioning and disability, health-related quality of life, life satisfaction, self-appraisal of the impact of the TBI and sense of coherence.In study I, data was retrospectively collected on those individuals in Norrbotten, northern Sweden, with a computed tomography (CT) verified TBI and brain injury symptoms, who had been transferred for neurosurgical care between 1992 to 2001. A total of 332 individuals, 250 men and 82 women, were registered. The findings revealed that a majority were older men with a mild TBI following a fall. Younger individuals were fewer in number but more often had a severe TBI from a traffic accident. Most individuals received post-acute care and brain injury rehabilitation. A majority had a moderate or severe disability, but many were discharged back from hospital and sent home with no major changes in their physical or social environment. In study II, 88 individuals (age between 18 and 65 at the time of assessment, to represent individuals of working age) were included and their functioning and disability were assessed with internationally established TBI outcome measures, on average 10 years (range 6-15 years) post injury. There was an improvement in overall outcomes from the time of discharge from inpatient rehabilitation to follow-up, and many had a high degree of motor and cognitive functioning, which enabled them to live independently in their own home without assistance. There remained, however, a disability related to community reintegration and social participation. This affected their productivity and to some degree their marital stability, factors which were related to the age at the time of injury and the severity of the injury. In study III, health-related quality of life (HRQoL) and life satisfaction (LS) were assessed in 67 individuals, and compared with reference values from the general population. HRQoL, as well as LS, was lower compared with the general population. Multivariate statistical analyses showed that the individuals’ own appraisal of the impact of the TBI, along with vocational productivity, were most strongly associated with their current physical health and overall satisfaction with life. In study IV, sense of coherence (SOC) and the influence on self-rated LS of SOC, along with measures of functioning and disability, sex, age at injury, injury severity and time since injury were assessed in 66 individuals. SOC did not differ from the general population, and there was a strong relationship between SOC and LS indicating that the individuals’ sense of preservation of good health was strongly associated with high LS. High LS was also strongly associated with emotional factors and social participation, together with longer time post-injury and a more severe injury sustained at a later age.In conclusion, the results indicate that many individuals with a TBI can achieve and maintain a high degree of functioning many years after the injury. However, emotional and inter-relational problems remain and impact on social activities and participation. Many individuals experienced a reduced HRQoL and LS. The individuals’ perception of the low impact of the injury and their positive SOC were firmly associated with high LS. These results confirm that TBI can lead to long-term disability and emphasize the need for support systems and rehabilitation programmes that can meet the individuals’ needs, with regard to emotional factors, social participation and overall satisfaction with life, in a long-term perspective.
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| 40. |
- Jurgilaitis, Andrius, et al.
(författare)
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Measurements of light absorption efficiency in InSb nanowires
- 2014
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Ingår i: Structural Dynamics. - : AIP Publishing. - 2329-7778. ; 1:1
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Tidskriftsartikel (refereegranskat)abstract
- We report on measurements of the light absorption efficiency of InSb nanowires. The absorbed 70 fs light pulse generates carriers, which equilibrate with the lattice via electron-phonon coupling. The increase in lattice temperature is manifested as a strain that can be measured with X-ray diffraction. The diffracted X-ray signal from the excited sample was measured using a streak camera. The amount of absorbed light was deduced by comparing X-ray diffraction measurements with simulations. It was found that 3.0(6)% of the radiation incident on the sample was absorbed by the nanowires, which cover 2.5% of the sample. (C) 2013 Author(s). All article content, except where otherwise noted, is licensed under a Creative Commons Attribution 3.0 Unported License.
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| 41. |
- Jurgilaitis, Andrius, et al.
(författare)
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Time-Resolved X-ray Diffraction Investigation of the Modified Phonon Dispersion in InSb Nanowires
- 2014
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Ingår i: Nano letters (Print). - Washington, DC : American Chemical Society (ACS). - 1530-6984 .- 1530-6992. ; 14:2, s. 541-546
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Tidskriftsartikel (refereegranskat)abstract
- The modified phonon dispersion is of importance for understanding the origin of the reduced heat conductivity in nanowires. We have measured the phonon dispersion for 50 nm diameter InSb (111) nanowires using time-resolved X-ray diffraction. By comparing the sound speed of the bulk (3880 m/s) and that of a classical thin rod (3600 m/s) to our measurement (2880 m/s), we conclude that the origin of the reduced sound speed and thereby to the reduced heat conductivity is that the C44 elastic constant is reduced by 35% compared to the bulk material. © 2014 American Chemical Society.
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| 42. |
- Krakau, Karolina, 1968-, et al.
(författare)
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Energy balance and metabolism after severe traumatic brain injury : A pilot study using doubly labelled water
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Objective: To explore the course of energy balance in patients with severe traumatic brain injury, from time of injury until twelve weeks post injury. Method: This prospective desriptive study included six patients with isolated, closed severe traumatic brain injury and an expected hospital stay of ≥2-3 months. Energy balance was calculated from energy intake compared to total energy expenditure measured by continuous indirect calorimetry and doubly labelled water. Clinical and laboratory variables with possible influence on metabolism and nutritional delivery were recorded simultaneously. Intermittent indirect calorimetry measurements were used to differentiate components of the energy expended. Results: Patients were roughly in energy balance while on mechanical ventilation, but in negative energy balance from the 3rd week post injury. The total energy expenditure then increased while the daily energy intake declined. Concurrent with this period were difficulties in retaining enteral and/or parenteral nutrition delivery routes until oral feeding was satisfactory. Nitrogen balance was back to normal at about 1.5 months and the inflammatory period with increased C-reactive protein levels continued for 12 to 58 days from time of injury. During the first and second month post injury, patients lost 8-19% of their initial body weight. Conclusion: Data suggests that negative energy balance after a severe TBI could not only be explained by the elevated metabolic rate and catabolism induced by the trauma, but also by difficulties in securing alternative nutritional routes in the distressed patient.
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| 43. |
- Krakau, Karolina, 1968-
(författare)
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Energy Balance out of Balance after Severe Traumatic Brain Injury
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of the research presented here was to expand the knowledge on metabolic course and nutritional outcome in patients with severe traumatic brain injury and to analyze the use and accuracy of different methods of assessment. Study I, a systematic review of 30 articles demonstrated consistent data on increased metabolic rate, of catabolism and of upper gastrointestinal intolerance in the majority of the patients during early post injury period. Data also indicated a tendency of less morbidity and mortality in early fed patients. Study II, a retrospective survey, based on medical records of 64 patients from three regions in Sweden, showed that the majority of patients regained their independence in eating within six months post injury. However, energy intake was set at a low level and 68 % of the patients developed malnutrition with 10 to 29 % loss of initial body mass during the first and second month post injury. Study III, a questionnaire based study addressed to 74 care units caring for patients with severe traumatic brain injury showed that resources in terms of qualified staff members were reportedly good, but nutritional guidelines were adopted in less than half of the units, screening for malnutrition at admission was rarely performed and surveillance of energy intake declined when oral intake began. Moreover, assessment of energy requirements relied on calculations and the profession in charge to estimate energy requirement varied depending on nutritional route and unit speciality. At transferral between units nutritional information was lost. Study IV and V, a prospective descriptive study on metabolic course, energy balance and methods of assessment in six patients showed that patients were in negative energy balance from 3rd week post injury and lost 8-19 % of their initial body weight. Concurrent nutritional problems were difficulties in retaining enteral and/or parenteral nutrition delivery routes until oral feeding was considered satisfactory. The majority of methods for predicting energy expenditure agreed poorly with measured energy expenditure. The Penn-State equation from 1998 was the only valid predictive method during mechanical ventilation. This thesis concludes that patients with moderate or severe traumatic brain injury exhibit a wide range of increased metabolic rate, catabolism and upper gastrointestinal intolerance during the early post-injury period. Most patients regain independence in eating, but develop malnutrition. Suggested explanations, other than the systemic disturbances early post injury, could be the use of inaccurate predictions of energy expenditure, deficient nutritional routines and difficulties in securing alternative nutritional routes until oral feeding is satisfactory. The impact of timing, content and ways of administration of nutritional support on neurological outcome after a severe traumatic brain injury remains to be demonstrated.
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| 44. |
- Krakau, Karolina, et al.
(författare)
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Metabolism and nutrition in patients with moderate and severe traumatic brain injury : A systematic review
- 2006
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Ingår i: Brain Injury. - : Informa UK Limited. - 0269-9052 .- 1362-301X. ; 20:4, s. 345-67
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Tidskriftsartikel (refereegranskat)abstract
- PRIMARY OBJECTIVE: To examine the evidence on the metabolic state and nutritional treatment of patients with moderate-to-severe traumatic brain injury (TBI). Research design: A systematic review of the literature. METHODS AND PROCEDURES: From 1547 citations, 232 articles were identified and retrieved for text screening. Thirty-six studies fulfilled the criteria and 30 were accepted for data extraction. MAIN OUTCOMES AND RESULTS: Variations in measurement methods and definitions of metabolic abnormalities hampered comparison of studies. However, consistent data demonstrated increased metabolic rate (96-160% of the predicted values), of hypercatabolism (-3 to -16 g N per day) and of upper gastrointestinal intolerance in the majority of the patients during the first 2 weeks after injury. Data also indicated a tendency towards less morbidity and mortality in early fed patients. CONCLUSIONS: The impact of timing, content and ways of administration of nutritional support on neurological outcome after TBI remains to be demonstrated.
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| 45. |
- Krakau, Karolina, et al.
(författare)
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Nutritional treatment of patients with severe traumatic brain injury during the first six months after injury
- 2007
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Ingår i: Nutrition Journal. - : Elsevier BV. - 1475-2891. ; 23:4, s. 308-317
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Tidskriftsartikel (refereegranskat)abstract
- Objective: This study explored current nutritional treatment policies and nutritional outcome in patients with severe traumatic brain injury. Methods: We performed a retrospective, structured survey of the medical records of 64 patients up to 6 months after injury or until the patients were independent in nutritional administration. Results: Enteral nutrition was administered to 86% of patients. Fourteen patients (22%) had a gastrostomy; after 6 months four were still in use. At 6 months, 92% of patients received all food orally and 84% had gained nutritional independence. Energy intake was equal to the calculated basal metabolic rate throughout the first month after injury and increased by 21% during the second month. Sixty-eight percent exhibited signs of malnourishment with weight losses of 10-29%. Conclusion: This study suggests that most patients with severe traumatic brain injury regain their nutritional independence within the first 6 months after injury, but also that most develop signs of malnutrition.
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| 46. |
- Krakau, Karolina, 1968-, et al.
(författare)
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Prediction of energy expenditure in patients with severe traumatic brain injury : A validation study by use of continuous indirect calorimetry and doubly labelled water
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Objective: The aim was to evaluate the accuracy of methods to predict energy expenditure (EE) in patients with severe traumatic brain injury (TBI). Method: To this prospective descriptive study, a small cohort of patients (n6) with isolated, severe TBI and an expected hospital stay of ≥2-3 months were included. The EE was measured at two intervals: by continuous indirect calorimetry during mechanical ventilation and by doubly labelled water from 3rd to 5th week post injury. Different equations for prediction of EE and a portable monitor, the SenseWear Armband were compared to the measured EE. Result: The majority of methods for predicting EE agreed poorly with the measured EE during indirect calorimetry period. A good agreement was found only with the three Penn-State equations, but two were biased according to Bland Altman analysis. The Penn-State equation from 1998 was the only valid predictive method, with a mean difference per day close to zero (+22 kcal), an excellent agreement (ICC 0.82) with 72% (n54/75) accurately assessed days (±10% of the measured EE) and with all patients within clinically acceptable levels, i.e. ±15% of the measured EE. During doubly labelled water period, observations were too few for any conclusive statement. Conclusion: These data support use of the Penn-State equation from 1998 to estimate EE in patients with severe TBI while on mechanical ventilation.
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| 47. |
- Krakau, Karolina, 1968-, et al.
(författare)
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Resources and routines for nutritional assessment of patients with severe traumatic brain injury
- 2010
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 24:1, s. 3-13
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To describe the resources and routines for nutritional management until 6 months after severe traumatic brain injury. Methods: Data collection was performed by use of questionnaires to staff professionals at three regional neurosurgical intensive and 75 other care units and a retrospective survey of medical and nursing records from 64 patients treated at these units. Results: Resources in terms of qualified staff members were reportedly good, while nutritional guidelines were adopted in less than half of the units. Screening for malnutrition at admission was rarely performed and the nutritional data in medical and nursing records were incomplete, i.e. there was a lack of body weight measurements in more than one-third of the care unit episodes and of body height data in more than half of the patients and a declining surveillance of energy intake when patients changed from parenteral or enteral nutrition to oral intake. Assessment of energy requirements relied on calculations and the assignment of who was to estimate it varied depending on which nutritional route was used and also between unit specialities. Finally, information on energy requirement, weight development and body mass index was present in only 16%, 7% and in 2% of the transferrals. Conclusions: Despite good resources of qualified staff, the nutritional assessment routines were deficient, resulting in incomplete nutritional data and lost nutritional information.
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| 48. |
- Lannsjö, Marianne, et al.
(författare)
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Brain pathology after mild traumatic brain injury : An exploratory study by repeated magnetic resonance examination
- 2013
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 45:8, s. 721-728
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Tidskriftsartikel (refereegranskat)abstract
- Objective:To explore brain pathology after mild traumatic brain injury by repeated magnetic resonance examination.Design:A prospective follow-up study.Subjects:Nineteen patients with mild traumatic brain injury presenting with Glasgow Coma Scale (GCS) 14-15.Methods:The patients were examined on day 2 or 3 and 3-7 months after the injury. The magnetic resonance protocol comprised conventional T1- and T2-weighted sequences including fluid attenuated inversion recovery (FLAIR), two susceptibility-weighted sequences to reveal haemorrhages, and diffusion-weighted sequences. Computer-aided volume comparison was performed. Clinical outcome was assessed by the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), Hospital Anxiety and Depression Scale (HADS) and Glasgow Outcome Scale Extended (GOSE).Results:At follow-up, 7 patients (37%) reported ≥ 3 symptoms in RPQ, 5 reported some anxiety and 1 reported mild depression. Fifteen patients reported upper level of good recovery and 4 patients lower level of good recovery (GOSE 8 and 7, respectively). Magnetic resonance pathology was found in 1 patient at the first examination, but 4 patients (21%) showed volume loss at the second examination, at which 3 of them reported < 3 symptoms and 1 ≥ 3 symptoms, all exhibiting GOSE scores of 8.Conclusion:Loss of brain volume, demonstrated by computer-aided magnetic resonance imaging volumetry, may be a feasible marker of brain pathology after mild traumatic brain injury.
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| 49. |
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| 50. |
- Lannsjö, Marianne, 1956-
(författare)
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Mild Traumatic Brain Injury : Studies on outcome and prognostic factors
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objectives: To explore the prevalence and structure of self-reported disability after mild traumatic brain injury and the impact of traumatic brain pathology on such outcome.Material and methods: In study 1-3, symptoms data were collected by use of Rivermead Post-concussion Symptoms Questionnaire (RPQ) and data on global function by use of Glasgow Outcome Scale Extended (GOSE) from 2602 patients at 3 months after MTBI. RPQ data were subject to factor and Rasch-analyses Head CT data from 1262 patients were used in a prediction analysis that also included age and gender. In study 4, MRI and symptoms data were collected at 2-3 days and at 3-7 months follow-up after MTBI in 19 patients. Global function was assessed at follow-up by use of the Rivermead Head Injury Follow-Up Questionnaire (RHIFUQ) and GOSE.Results: I. Most respondents reported no remaining symptoms but 24% reported ≥3 and 10% ≥7 remaining symptoms. The factor analysis demonstrated that all symptoms are correlated but also identified subgroups of symptoms. II. Rasch-analysis of RPQ showed disordered category function, local dependency of items, poor targeting of persons to items and indications of 3 or more dimensions. There was no differential item functioning. III. Head CT pathology with no need for acute intervention was observed in 52 patients (4%) but was not associated with either frequency of remaining symptoms or global outcome at 3 months post injury. Female gender and age over 30 years were associated with less favourable outcome with respect to symptoms and GOSE. IV. Post-acute MRI indicated trauma-related pathology in one patient and follow-up MRI indicated loss of brain volume in 4 patients.Conclusions: A substantial proportion of patients with MTBI report remaining problems at three months after MTBI. RPQ is useful but not optimal to assess symptoms outcome after MTBI and calculation of a total sum score is not recommended. Female gender and older age are negative prognostic factors while brain pathology according to CT has no effect on self-reported outcome. Loss of brain volume after MTBI according to MRI may be a sensitive marker of traumatic brain pathology and deserves further studies.
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