| 1. |
- Lindgren, Helena, et al.
(författare)
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End users transforming experiences into formal information and process models for personalised health interventions
- 2014
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Ingår i: Studies in Health Technology and Informatics. - 0926-9630 .- 1879-8365. ; 205, s. 378-382
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Tidskriftsartikel (refereegranskat)abstract
- Five physiotherapists organised a user-centric design process of a knowledge-based support system for promoting exercise and preventing falls. The process integrated focus group studies with 17 older adults and prototyping. The transformation of informal medical and rehabilitation expertise and older adults' experiences into formal information and process models during the development was studied. As tool they used ACKTUS, a development platform for knowledge-based applications. The process became agile and incremental, partly due to the diversity of expectations and preferences among both older adults and physiotherapists, and the participatory approach to design and development. In addition, there was a need to develop the knowledge content alongside with the formal models and their presentations, which allowed the participants to test hands-on and evaluate the ideas, content and design. The resulting application is modular, extendable, flexible and adaptable to the individual end user. Moreover, the physiotherapists are able to modify the information and process models, and in this way further develop the application. The main constraint was found to be the lack of support for the initial phase of concept modelling, which lead to a redesigned user interface and functionality of ACKTUS.
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| 2. |
- Melander-Wikman, Anita, et al.
(författare)
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Project: Early signs of mobility limitations and fall events in old age: long-term consequences and tailored preventive interventions through interactive media
- 2012
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Annan publikation (populärvet., debatt m.m.)abstract
- The aims of this project are 1) to investigate the consequences over five years of early signs of mobility limitations expressed as fallevents, a changed walking pattern with a cognitive load (dual-task costs), and decreased balance confidence on severe fall-relatedinjuries, perceived health, participation, activities of daily living, and gait performance, and 2) to develop, together with older people,and evaluate tailored fall-prevention through interactive media in a randomized controlled trial with two arms.
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| 3. |
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| 4. |
- Pohl, Petra, et al.
(författare)
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A qualitative exploration of post-acute stroke participants' experiences of a multimodal intervention incorporating horseback riding
- 2018
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 13:9
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Tidskriftsartikel (refereegranskat)abstract
- Background Multimodal rehabilitation interventions delivered in late phase of stroke recovery involve physical (motor and sensory), social, and cognitively challenging activities. Horseback riding can be incorporated within such interventions, leading to meaningful long-term improvements when applied to individuals with moderate levels of disability. There is a lack of research illuminating stroke survivors' experiences and perceptions of horseback riding in the context of multimodal interventions. To explore stroke survivors' experiences of participation in a multimodal group-based intervention that included horseback riding. An explorative interview study was conducted with individual face-to-face interviews performed on a single occasion, utilising a semi-structured interview guide. Eighteen participants were purposively selected from a larger trial (mean age 62, 12 men, 6 women) within four weeks after treatment completion. The interview duration was between 17 and 50 minutes. The data was analysed using a qualitative content analysis method. Four broad themes were identified from the analysis. These themes were: transformative experiences; human-horse interaction; togetherness and belonging; and the all-in-one solution. Interacting with the horse and peers had a profound emotional impact on the participants. The participants also reported having learned new skills, increased self-efficacy and self-esteem, and improvements in balance and gait, all of which could be transferred to everyday life. The horse itself played a central role, but other components, such as the other group members, the instructors, and the challenging tasks on the horseback, were also important. A multimodal rehabilitation intervention that includes horseback riding may provide stroke survivors in a late phase of recovery with rich pleasurable experiences that may have life-changing and profound impacts on their emotional and physical state.
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| 5. |
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| 6. |
- Pohl, Petra, et al.
(författare)
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Community-dwelling older people with an injurious fall are likely to sustain new injurious falls within 5 years : a prospective long-term follow-up study
- 2014
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Ingår i: BMC Geriatrics. - : BioMed Central. - 1471-2318. ; 14:1, s. 120-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Fall-related injuries in older people are a leading cause of morbidity and mortality. Self-reported fall events in the last year is often used to estimate fall risk in older people. However, it remains to be investigated if the fall frequency and the consequences of the falls have an impact on the risk for subsequent injurious falls in the long term. The objective of this study was to investigate if a history of one single non-injurious fall, at least two non-injurious falls, or at least one injurious fall within 12 months increases the risk of sustaining future injurious falls.METHODS: Community-dwelling individuals 75-93 years of age (n = 230) were initially followed prospectively with monthly calendars reporting falls over a period of 12 months. The participants were classified into four groups based on the number and type of falls (0, 1, ≥2 non-injurious falls, and ≥1 injurious fall severe enough to cause a visit to a hospital emergency department). The participants were then followed for several years (mean time 5.0 years ±1.1) regarding injurious falls requiring a visit to the emergency department. The Andersen-Gill method of Cox regression for multiple events was used to estimate the risk of injurious falls.RESULTS: During the long-term follow-up period, thirty per cent of the participants suffered from at least one injurious fall. Those with a self-reported history of at least one injurious fall during the initial 12 months follow-up period showed a significantly higher risk for sustaining subsequent injurious falls in the long term (hazard ratio 2.78; 95% CI, 1.40-5.50) compared to those with no falls. No other group showed an increased risk.CONCLUSIONS: In community-dwelling people over 75 years of age, a history of at least one self-reported injurious fall severe enough to cause a visit to the emergency department within a period of 12 months implies an increased risk of sustaining future injurious falls. Our results support the recommendations to offer a multifactorial fall-risk assessment coupled with adequate interventions to community-dwelling people over 75 years who present to the ED due to an injurious fall.
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| 7. |
- Pohl, Petra, et al.
(författare)
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Experiences from a multimodal rhythm and music-based rehabilitation program in late phase of stroke recovery - A qualitative study
- 2018
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Ingår i: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 13:9
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Tidskriftsartikel (refereegranskat)abstract
- Background Rehabilitative stroke interventions based on principles of multimodal stimulation have the potential to profoundly affect neuroplastic processes beyond the sub-acute phase. In order to identify important core mechanisms, there is a need to explore how interventions that combine physical, social, sensory, and cognitively challenging activities are perceived and experienced by the participants. This qualitative study, based on an interpretive interactionist perspective, explored the experiences of stroke survivors who participated in a group-based multimodal rehabilitation program based on rhythm and music. Within four weeks after completion of the multimodal rehabilitation program, face-to-face semi-structured interviews were conducted on a single occasion with 15 purposively selected individuals (mean age 65, 8 men, 7 women). The interview duration was between 13 and 44 minutes. Qualitative content analysis with an inductive approach was used to analyze data. Three categories were identified, each containing several sub-categories: To be intellectually challenged (energy-consuming activity and coordinating multiple input and output), Perceived therapeutic benefits (motor skills, cognitive skills, emotional and psychological responses), and Pros and cons with social integration (fellowship, competing with others, and instructor characteristics). From these categories, an overall theme was derived: The multifaceted layers of multimodal stimulation. Enjoying music, being part of a group with peers, a skilled instructor, and being able to manage the challenging movements, were related to positive experiences. In contrast, negative experiences were associated with not being able to perform the exercises, and with group members who dominated the conversational space. This study shows that access to a multimodal rehabilitation program with rhythm and music as operating ingredients may contribute to positive experiences for many individuals in a late phase after stroke in terms of motor, cognitive, as well as emotional enhancements. Important components were the music, the social interaction, the challenging exercises, and the skilled instructor.
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| 8. |
- Pohl, Petra, et al.
(författare)
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Fall risk awareness and safety precautions taken by older community-dwelling women and men : a qualitative study using focus group discussions
- 2015
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 10:3
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Daily life requires frequent estimations of the risk of falling and the ability to avoid a fall. The objective of this study was to explore older women's and men's understanding of fall risk and their experiences with safety precautions taken to prevent falls.Methods A qualitative study with focus group discussions was conducted. Eighteen community-dwelling people [10 women and 8 men] with and without a history of falls were purposively recruited. Participants were divided into two groups, and each group met four times. A participatory and appreciative action and reflection approach was used to guide the discussions. All discussions were audio recorded and transcribed verbatim. Data were analysed by qualitative content analysis, and categories were determined inductively.Findings Three categories describing the process of becoming aware of fall risks in everyday life were identified: 1] Facing various feelings, 2] Recognizing one's fall risk, and 3] Taking precautions. Each category comprised several subcategories. The comprehensive theme derived from the categories was "Safety precautions through fall risk awareness". Three strategies of ignoring [continuing a risky activity], gaining insight [realizing the danger in a certain situation], and anticipating [thinking ahead and acting in advance] were related to all choices of actions and could fluctuate in the same person in different contexts.Conclusions The fall risk awareness process might be initiated for various reasons and can involve different feelings and precautions as well as different strategies. This finding highlights that there are many possible channels to reach older people with information about fall risk and fall prevention, including the media and their peers. The findings offer a deeper understanding of older peoples' conceptualizations about fall risk awareness and make an important contribution to the development and implementation of fall prevention programmes.
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| 9. |
- Pohl, Petra, 1965-
(författare)
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Falls in older community-dwelling women and men : risk factors and safety strategies. Fall risk awareness, fear of falling, and preferred exercise properties from a gender perspective.
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background Falls are the leading cause for non-fatal injuries in older community-dwelling people. Compared to men, women fall more often, experience more fall-related injuries, and report fear of falling (FoF) more often. Falls may be prevented with specific exercises, but adherence is often low in long-term. One aim of the thesis was to gain a deeper understanding of the risk factors previous falls, FoF, and gender. Another aim was to explore safety strategies in older community-dwelling people in terms of fall risk awareness and actions taken to protect from falls, and to identify motives for exercising and preferred exercise properties. A gender perspective was used throughout the thesis.Methods To determine the impact of the risk factors on future falls and injurious falls, a cross-sectional design was used combined with longitudinal data. Baseline data from 230 community-dwelling people over 75 years were collected with questionnaires and performance-based tests. FoF was measured with the single item question “Are you afraid of falling?”. Monthly fall calendars were collected for one year (monitoring year). Based on status on falls, participants were classified as those with i) no falls (n=119), ii) 1 non-injurious fall (n=51), iii) ≥2 non-injurious falls (n=40), and iv) ≥1 injurious fall (n=20). These data were linked to data from an injury database (IDB) with respect to registered injurious falls for a period of about 5 years (long term follow-up). Andersen-Gill method of Cox regression for multiple events was used to estimate the risk of future injurious fall events. To find relationships between FoF, gender, and falls (defined as two or more falls), a general log-linear analysis was performed. Associations between FoF and the components of the International Classification of Functioning (ICF) were explored with a structural equation model. To explore fall risk awareness and safety strategies, and to identify motives and preferred exercise properties, qualitative study design was used. Multistage focus groups were held with 18 community-dwelling people (10 women and 8 men) between 70 and 80 years. Transcriptions were analysed with qualitative content analysis.Results Fourty-eight per cent of the 230 participants fell at least once during the monitoring year, and 23% experienced recurrent falls. Compared to men, women reported FoF more often, but did not experience more recurrent falls, and no more injurious falls. FoF was significantly associated with the ICF components Activity/Participation and Personal Factors in women and men both; but in opposite directions for women and men on Personal Factors. During the long-term follow-up, 91 injurious falls were registered in 70 participants (30%). Those with injurious falls during the monitoring year were at significant risk of experiencing new injurious falls in long-term (HR 2.78; 95% CI 1.40-5.50), compared to those with no falls. Women experienced a higher rate of fractures than did men. Analyses from the multistage focus groups resulted in three categories: Facing various feelings; Recognizing one’s fall risk; and Taking precautions. A comprehensive theme tied them together: Safety precautions through fall risk awareness. Analyses also resulted in six categories identifying preferred exercise properties in the context of falls prevention: Motives to start exercise; Barriers to start exercise; Exercise characteristics; Confirmation; Spirit lifters; and Maintenance tricks. All categories included sub-categories. Both studies revealed greater variations among women and among men than between women and men.Conclusion Community-dwelling people over 75 years who have experienced an injurious fall are at high risk of sustaining new injurious falls the forthcoming five years, and should be offered multifactorial fall risk assessments with targeted interventions to optimize the prevention of future falls. The single item question “Are you afraid of falling?” has no predictive value for future falls, and the answer may be strongly gendered. The questions should therefore be avoided in clinical practice and research in community settings. The participants of the qualitative studies implicity and explicitly described how they had become aware of fall risks in everyday life, and both women and men took precautionary actions. Raised fall risk awareness was achieved by several channels including the media, and by meeting with peers and professionals with expertise in falls prevention. A wide variety of preferred exercise properties in the context of falls prevention were identified among the older community-dwelling people. The variations of the requests were greater among women and among men than between women and men. The results should be taken into consideration when offering exercise-based falls prevention interventions to older people. The results from this thesis indicated that measures can be taken on a broad front in order to reduce the damage from injurious falls in older community-dwelling people. A gender perspective is warranted for in clinical practice and future research. Adopting a gender perspective may broaden the understanding of gender differences and similarities when implementing falls prevention activities.
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| 10. |
- Pohl, Petra, et al.
(författare)
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Gender perspective on fear of falling using the classification of functioning as the model
- 2015
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Ingår i: Disability and Rehabilitation. - : Informa Healthcare. - 0963-8288 .- 1464-5165. ; 37:3, s. 214-222
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Purpose: To investigate associations between fear of falling (FOF) and recurrent falls among women and men, and gender differences in FOF with respect to International Classification of Functioning (ICF). Methods: Community-dwelling people (n = 230, 75-93 years, 72% women) were included and followed 1 year regarding falls. Data collection included self-reported demographics, questionnaires, and physical performance-based tests. FOF was assessed with the question "Are you afraid of falling?". Results were discussed with a gender relational approach. Results: At baseline 55% women (n = 92) and 22% men (n = 14) reported FOF. During the follow-up 21% women (n = 35) and 30% men (n = 19) experienced recurrent falls. There was an association between gender and FOF (p = 0.001), but not between FOF and recurrent falls (p = 0.79), or between gender and recurrent falls (p = 0.32). FOF was related to Personal factors and Activity and Participation. The relationship between FOF and Personal factors was in opposite directions for women and men. Conclusions: Results did not support the prevailing paradigm that FOF increases rate of recurrent falls in community-dwelling people, and indicated that the answer to "Are you afraid of falling?" might be highly influenced by gendered patterns.Implications for RehabilitationThe question "Are you afraid of falling?" has no predictive value when screening for the risk of falling in independent community-dwelling women or men over 75 years of age.Gendered patterns might influence the answer to the question "Are you afraid of falling?" Healthcare personnel are recommended to be aware of this when asking older women and men about fear of falling.
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| 11. |
- Pohl, Petra, et al.
(författare)
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Group-based music intervention in Parkinsons disease : findings from a mixed-methods study
- 2020
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Ingår i: Clinical Rehabilitation. - : Sage Publications. - 0269-2155 .- 1477-0873. ; 34:4, s. 533-544
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate a group-based music intervention in patients with Parkinsons disease. Design: Parallel group randomized controlled trial with qualitative triangulation. Setting: Neurorehabilitation in primary care. Subjects: Forty-six patients with Parkinsons disease were randomized into intervention group (n = 26), which received training with the music-based intervention, and control group (n = 20) without training. Interventions: The intervention was delivered twice weekly for 12 weeks. Main measures: Primary outcome was Timed-Up-and-Go subtracting serial 7s (dual-task ability). Secondary outcomes were cognition, balance, concerns about falling, freezing of gait, and quality of life. All outcomes were evaluated at baseline, post-intervention, and three months post-intervention. Focus groups and individual interviews were conducted with the intervention group and with the delivering physiotherapists. Results: No between-group differences were observed for dual-task ability. Between-group differences were observed for Falls Efficacy Scale (mean difference (MD) = 6.5 points; 95% confidence interval (CI) = 3.0 to 10.0, P = 0.001) and for Parkinson Disease Questionnaire-39 items (MD = 8.3; 95% CI = 2.7 to 13.8, P = 0.005) when compared to the control group post-intervention, but these were not maintained at three months post-intervention. Three themes were derived from the interviews: Expectations versus Results, Perspectives on Treatment Contents, and Key Factors for Success. Conclusion: Patient-reported outcomes and interviews suggest that the group-based music intervention adds value to mood, alertness, and quality of life in patients with Parkinsons disease. The study does not support the efficacy in producing immediate or lasting gains in dual-tasking, cognition, balance, or freezing of gait.
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| 12. |
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| 13. |
- Pohl, Petra, et al.
(författare)
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Older women and men as co-creators in design of a mobile application for fall prevention
- 2013
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Konferensbidrag (refereegranskat)abstract
- There is a plethora of fall prevention programs for older community-dwelling people. The evidence for exercise-based programs is strong. There is a problem however with implementation and adherence. Motivational factors and barriers have been identified to some extent. Previous studies have shown that what works best is when exercise programs are tailor made, home based, and when people have access to personal feedback on a regular basis. Mobile applications for Smartphones with exercises have these advantages, and have been available for a long time, but these are most commonly directed to young and middle-aged people. There are no applications for fall prevention developed based on senior’s own wishes. The aim was to investigate how healthy older community-dwelling women and men reason and what exercises they prefer when participating in development and design of a fall prevention program in shape of a mobile application for Smartphones.Method Participatory and appreciative action research design with focus group interviews and workshops. Qualitative data analysis.Results The preliminary results show that when older community-dwelling men and women participate in developing a fall prevention program for Smartphones, they have many ideas, thoughts and experiences that may serve as a motivational factor for following a fall prevention program regularly.ConclusionThe implementation and adherence for evidence based fall preventative exercise programs is insufficient. This study will gain knowledge to design tailor made, home based fall prevention exercise programs among community-dwelling healthy seniors.
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| 14. |
- Pohl, Petra
(författare)
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The Ronnie Gardiner Method : An Innovative Music-Based Intervention for Neurological Rehabilitation - Theoretical Background and Contemporary Research with Focus on Parkinson`s Disease
- 2018
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Ingår i: Neurophysiology and Rehabilitation. - : Edelweiss Publications. - 2641-8991. ; 1:1, s. 32-37
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Tidskriftsartikel (refereegranskat)abstract
- The Ronnie Gardiner Method (RGM) is an innovative, practitioner-led, music-based intervention using sensorimotor and cognitive integration. RGM was originally developed by the Swedish musician Ronnie Gardiner. Since 2010, RGM has been successfully implemented within neurorehabilitation in many countries. The purpose of this article is to outline some of the theoretical assumptions underpinning the potential benefits from this intervention, using Parkinson’s disease as an example. RGM is based on principles of neuroplasticity, motor learning, and postural control, and uses energizing, beat-based music to provide multisensory input (visual, audio, kinetic, and tactile) in order to stimulate experience-dependent neuroplastic processes. It aims at stimulating cognitive and motor function (e.g., memory, concentration, executive function, multitasking, coordination, mobility, balance, and motor skills). In addition, it may aid body awareness, self-esteem, and social skills. RGM has been scientifically evaluated as a means of multimodal sensory stimulation after stroke and as a means of improving mobility and cognitive function in Parkinson’s disease. RGM is a complex multi-task intervention with the potential to be beneficial in different settings and in different neurological conditions. It can be performed either while standing up or sitting down and can be practiced with the advantages gained as a group activity or individually, which makes it very flexible. It is currently being used as rehabilitation activity for people with stroke, Parkinson’s disease, multiple sclerosis, dementia, and depression. Furthermore, RGM is used in programs targeting healthy aging, ADHD, autism, and dyslexia, and in ordinary school environments.
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| 15. |
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| 16. |
- Pohl, Petra, et al.
(författare)
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The Ronnie Gardiner Rhythm and Music Method – a feasibility study in Parkinson’s disease
- 2013
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Ingår i: Disability and Rehabilitation. - : Informa Healthcare. - 0963-8288 .- 1464-5165. ; 35:26, s. 2197-2204
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To assess the feasibility of the novel intervention, Ronnie Gardiner Rhythm and Music (RGRM™) Method compared to a control group for patients with Parkinson’s disease (PD).Method: Eighteen patients, mean age 68, participating in a disability study within a neurological rehabilitation centre, were randomly allocated to intervention group (n = 12) or control group (n = 6). Feasibility was assessed by comparing effects of the intervention on clinical outcome measures (primary outcome: mobility as assessed by two-dimensional motion analysis, secondary outcomes: mobility, cognition, quality of life, adherence, adverse events and eligibility). Results: Univariable analyses showed no significant differences between groups following intervention. However, analyses suggested that patients in the intervention group improved more on mobility (p = 0.006), cognition and quality of life than patients in the control group. There were no adverse events and a high level of adherence to therapy was observed. Conclusions: In this disability study, the use of the RGRM™ Method showed promising results in the intervention group and the adherence level was high. Our results suggest that most assessments chosen are eligible to use in a larger randomized controlled study for patients with PD.Implications for RehabilitationThe RGRM™ Method appeared to be a useful and safe method that showed promising results in both motor and cognitive functions as well as quality of life in patients with moderate PD.The RGRM™ Method can be used by physiotherapists, occupational, speech and music therapists in neurological rehabilitation.Most measurements were feasible except for Timed-Up-and-Go.
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| 17. |
- Pohl, Petra, et al.
(författare)
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Äldre män och kvinnor som med-aktörer i design av tränings-appar för fallprevention
- 2013
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Konferensbidrag (refereegranskat)abstract
- Bakgrund och syfte:Det finns en uppsjö av olika fallpreventiva evidensbaserade träningsprogram för äldre i ordinärt boende. Även om evidensgraden är hög för viss träning finns det svårigheter med att få äldre personer att utföra träningen. Vissa motivationsfaktorer och hindrande faktorer har redan identifierats och forskningen visar att skräddarsydda, hembaserade träningsprogram med möjlighet till regelbunden återkoppling är det som fungerar bäst. Applikationer till mobiltelefoner och surfplattor erbjuder denna möjlighet, och har funnits sedan en längre tid, men dessa vänder sig oftast till yngre och medelålders personer. Det finns ännu ingen applikation som är baserad på de äldres egna önskemål. Syftet med studien är att undersöka hur friska äldre män och kvinnor i ordinärt boende resonerar och vilka övningar de föredrar när de deltar i utveckling och design av ett fallpreventivt träningsprogram i form av en applikation till smarta telefoner och surfplattor. Metoder:18 deltagare > 70 år. Deltagande och uppskattande aktionsforskning samt fokusgruppsintervjuer och workshops. Kvalitativ innehållsanalys. Resultat:De preliminära resultaten visar att när äldre män och kvinnor i ordinärt boende deltar i utvecklingen av ett fallpreventivt träningsprogram för smarta telefoner och surfplattor har de många idéer, tankar och erfarenheter som kan fungera som motiverande faktorer i syfte att utföra regelbunden fallpreventiv träning. Konklusion:Implementeringen och följsamheten för evidensbaserade fallpreventiva träningsprogram är otillräcklig. Denna studie bidrar med kunskaper för att designa skräddarsydda, hembaserade fallpreventiva träningsprogram för friska äldre personer i ordinärt boende.
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| 18. |
- Rydja, Johanna, 1972-
(författare)
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Gait Characteristics, Physical Activity and Subjective Outcome after Shunt Surgery in Normal Pressure Hydrocephalus
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background Idiopathic normal pressure hydrocephalus (iNPH) is a common but under-diagnosed disease among the elderly. The condition is characterised by gait disturbance, postural instability, cognitive decline and incontinence, caused by accumulated cerebrospinal fluid within the central nerve system. The treatment is a shunt insertion to divert excess fluid. Few studies have described the detailed gait in INPH, there is a lack of research about physical activity, and patient-reported outcomes after shunt surgery are sparsely described. The overall aim of this thesis was to increase the knowledge of the gait pattern, the level of physical activity, and to evaluate the effect of a physical exercise programme in iNPH. Another aim was to evaluate the patient’s self-experienced outcome after surgery. Methods and results, study I In total 127 patients were randomised to either a supervised 12-week high-intensity exercise programme or to standard care after shunt surgery. Evaluation was performed with the iNPH scale and goal attainment after the intervention and after six months. There was low compliance to the exercise programme and no differences between the groups could be detected according to the iNPH scale at any of the follow-ups. Patients with high attendance rate achieved their set goals to a higher extent than the control group at the post intervention follow-up. Methods and results, study II In total 109 patients from the population in study I, were evaluated with an actigraphy recording of physical activity variables for seven days before and three- and six months after shunt surgery. In addition, physical performance was evaluated with the 10-meter walk test, the 6-minute walk test and 30 s chair stand test. The patients walked faster with improved results on the walking tests postoperatively. Improvement in the 30 s chair stand test was interpreted as improved postural control. The physical activity intensity was not affected by surgery. The patients had very low energy expenditure and were to a large extent sedentary, before and after shunt surgery. The exercise intervention had no effect on physical activity or the physical performance tests. Methods and results, study III In total 47 patients were included to a gait analysis with an inertial sensor system. Additionally, the patients were assessed with the Timed Up and Go test and the iNPH scale, pre- and three months postoperatively and in relation with 42 older healthy individuals. The patients walked with shorter strides, decreased velocity, increased time in stance and with decreased joint angles, especially in the ankle joint. The gait pattern im-proved after shunt surgery, but outcome on all variables were still worse compared to the healthy individuals, except for step hight that was normalised. Shunt surgery had no effect on stride length variability. Methods and results, study IV In total 58 patients rated their experienced changes three months after shunt surgery. The subjective outcome was analysed in relation to objective clinical outcomes (the iNPH scale) and questionnaires regarding, sense of coherence, quality of life, anxiety and depression. Clinical outcome and the questionnaires were evaluated before and three months after shunt surgery and in relation to 42 older healthy individuals. The patients reported most frequently some degree of positive changes after surgery. The subjective outcomes in overall experience, gait and continence correlated moderately with the corresponding objective outcomes, but there were not correlations within the cognition and balance areas. Depression and quality of life improved after surgery, but the result was still lower than for healthy individuals. There was no correlation between the patients´ sense of coherence and the subjective outcome. Conclusion Shunt surgery contributes to improved walking patterns, improved physical functions, reduced signs of depression and increased quality of life, but patients with iNPH are still more affected than healthy elderly. The patients report most frequently positive changes, but not total recovery after shunt surgery. Despite improvements within several areas the physical activity level is very low, both before and after the shunt operation. A postoperative high-intensity physical training program had no additional effect, which is explained by the fact that few patients completed the program. Patients with iNPH probably need guidance to additional improvement and to increase physical activity through meaningful activities after shunt surgery. Further research is needed to evaluate interventions that address the specific iNPH impairments.
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| 19. |
- Sandlund, Marlene, 1972-, et al.
(författare)
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Gender perspective on older people’s exercise preferences and motivators in the context of falls prevention : a qualitative Study
- 2018
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Ingår i: BioMed Research International. - : Hindawi Publishing Corporation. - 2314-6133 .- 2314-6141.
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Tidskriftsartikel (refereegranskat)abstract
- Background. Several factors have previously been identified to positively influence the uptake and adherence for fall prevention exercise programmes. There is, however, a lack of studies investigating if men and women differ in their views and preferences for fall prevention exercises. Aim. To explore exercise preferences and motivators of older community-dwelling women and men in the context of falls prevention from a gender perspective. Methods. Workshops including multistage focus group discussions were conducted with 18 older community-dwelling people with and without history of falls. Participants were purposively selected and divided into two groups. Each group met on six occasions over a period of five months. Participatory and Appreciative Action and Reflection methodology was used to guide the discussions. A qualitative content analysis approach was used in the analysis. Results. Older participants had many diverse preferences and confirmed that individually tailored exercise, in terms of mode, intensity, challenge, and social context, is important. Moreover, important factors for exercise adherence and maintenance included the experience of individual confirmation; different spirit lifters to increase enjoyment; and personal tricks to maintain exercise routines. The individual differences within genders were more diverse than the differences between women and men. Conclusion. Exercise interventions to prevent falls should be individually tailored, based on the specific needs and preferences of the older participant, and do not appear to require gender specific approaches. To increase adherence, intrinsic motivation for exercise may be encouraged by competence enhancing confirmations, energizing spirit lifters, and practical tips for exercise maintenance. The study provides an awareness about women’s and men’s preferences for fall prevention exercises, and this information could be used as guidance in designing inclusive exercise interventions.
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| 20. |
- Sandlund, Marlene, et al.
(författare)
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Gender Perspective on Older People’s Preferences for Exercises in the Context of Falls Prevention : A qualitative study
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- The aim with this study was to explore the preferences of community-dwelling older women and men regarding exercise characteristics in the context of preventing falls. Multistage focus group discussions were conducted with 18 older community-dwelling people with or without a history of falls. Participants were purposively sampled, and divided into two groups. Each group met six times. Participatory and Appreciative Action and Reflection methodology was used to guide the discussions. A qualitative content analysis approach was used in the analysis. Six categories emerged from the analysis. Two categories were related to motives and barriers for uptake, and four categories were related to adherence and maintenance: exercise characteristics; confirmation; spirit lifters and maintenance tricks. Small differences and many similarities in what women and men perceived as motivating factors in an exercise situation were displayed. To conclude, older people have many diverse preferences regarding exercise in the context of preventing falls, and the individual differences within genders seem to be greater than the differences between men and women. Exercise interventions to prevent falls should be individually tailored based on the specific needs and preferences of the older participant. In order to encourage internalization and intrinsic motivation for exercises, autonomy-supportive approaches may be applied and accompanied by competence strengthening confirmations, energizing spirit lifters and practical tips for exercise maintenance
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| 21. |
- Sandlund, Marlene, et al.
(författare)
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Gender perspectives on views and preferences of older people on exercise to prevent falls : mixed studies review
- 2017
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Ingår i: BMC Geriatrics. - : BioMed Central. - 1471-2318. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUNDTo offer fall prevention exercise programs that attract older people of both sexes there is a need to understand both women's and men's views and preferences regarding these programs. This paper aims to systematically review the literature to explore any underlying gender perspectives or gender interpretations on older people's views or preferences regarding uptake and adherence to exercise to prevent falls.METHODSA review of the literature was carried out using a convergent qualitative design based on systematic searches of seven electronic databases (PubMed, CINAHL, Amed, PsycINFO, Scopus, PEDro, and OTseeker). Two investigators identified eligible studies. Each included article was read by at least two authors independently to extract data into tables. Views and preferences reported were coded and summarized in themes of facilitators and barriers using a thematic analysis approach.RESULTSNine hundred and nine unique studies were identified. Twenty five studies met the criteria for inclusion. Only five of these contained a gender analysis of men's and women's views on fall prevention exercises. The results suggests that both women and men see women as more receptive to and in more need of fall prevention messages. The synthesis from all 25 studies identified six themes illustrating facilitators and six themes describing barriers for older people either starting or adhering to fall prevention exercise. The facilitators were: support from professionals or family; social interaction; perceived benefits; a supportive exercise context; feelings of commitment; and having fun. Barriers were: practical issues; concerns about exercise; unawareness; reduced health status; lack of support; and lack of interest. Considerably more women than men were included in the studies.CONCLUSIONAlthough there is plenty of information on the facilitators and barriers to falls prevention exercise in older people, there is a distinct lack of studies investigating differences or similarities in older women's and men's views regarding fall prevention exercise. In order to ensure that fall prevention exercise is appealing to both sexes and that the inclusion of both men and women are encouraged, more research is needed to find out whether gender differences exists and whether practitioners need to offer a range of opportunities and support strategies to attract both women and men to falls prevention exercise.
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| 22. |
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| 23. |
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| 24. |
- Sandlund, Marlene, et al.
(författare)
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Towards a mobile exercise application to prevent falls : A participatory design process
- 2016
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Ingår i: International Journal of Child Health and Human Development. - 1939-5965. ; 9:3, s. 389-398
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Tidskriftsartikel (refereegranskat)abstract
- In this cross-disciplinary project senior citizens and researchers participated in the collaborative design and development of a mobile exercise application to prevent falls. The methods Form-IT and Participator) and Appreciative Action and Reflection (PAAR) were applied in a series of workshops, facilitating the creation of new knowledge and a socio-technical platform for an end-user development process. The participation of the older people was key to understanding the broad range of preferences and motivational aspects. The outcomes emerged into prototypes, which were composed using the ACKTUS platform for end-user development, resulting in a dynamic application, easily adaptable to future needs and studies.
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| 25. |
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| 26. |
- Sandlund, Marlene, et al.
(författare)
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Towards a Mobile Exercise Application to Prevent Falls : a Participatory Design Process
- 2015
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Ingår i: Technology, Rehabilitation and Empowerment of People with Special Needs. - : Nova Science Publishers, Inc.. - 9781634827133 ; , s. 157-168
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Bokkapitel (refereegranskat)abstract
- The digitalization of society is spreading around the world and technology has become part of many people’s daily lives. It acts as a means of communication, work, education and leisure. For populations with special needs (people with some kind of disability or disorder) technology can play an essential role in their rehabilitation and treatment. It also empowers the individuals themselves. The aim of this multi-disciplinary research for decades has been to explore, develop and evaluate innovative technology to aid people with disabilities through virtual reality and associated machinery. The field engages researchers from health sectors, areas of engineering and schools of education to collaborate in order to take on a holistic approach to meet these challenges.
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| 27. |
- Sandlund, Marlene, et al.
(författare)
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Towards a Mobile Exercise Application to Prevent Falls : a Participatory Design Process
- 2016
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Ingår i: International Journal of Child Health and Human Development. - : Nova Science Publishers, Inc.. - 1939-5965. ; 9:3, s. 389-398
-
Tidskriftsartikel (refereegranskat)abstract
- In this cross-disciplinary project senior citizens and researchers participated in the collaborative design and development of a mobile exercise application to prevent falls. The methods Form-IT and Participatory and Appreciative Action and Reflection were applied in a series of workshops, facilitating the creation of new knowledge and a socio-technical platform for an end-user development process. The participation of the older adults was key to understanding the broad range of preferences and motivational aspects. The outcomes emerged into prototypes, which were composed using the ACKTUS platform for end-user development, resulting in a dynamic application, easily adaptable to future needs and studies.
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| 28. |
- van Bruggen, David, et al.
(författare)
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Developmental landscape of human forebrain at a single-cell level identifies early waves of oligodendrogenesis
- 2022
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Ingår i: Developmental Cell. - : Elsevier BV. - 1534-5807 .- 1878-1551. ; 57:11, s. 1421-1436, 1421-1436.e1-e5
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Tidskriftsartikel (refereegranskat)abstract
- Oligodendrogenesis in the human central nervous system has been observed mainly at the second trimester of gestation, a much later developmental stage compared to oligodendrogenesis in mice. Here, we characterize the transcriptomic neural diversity in the human forebrain at post-conception weeks (PCW) 8–10. Using single-cell RNA sequencing, we find evidence of the emergence of a first wave of oligodendrocyte lineage cells as early as PCW 8, which we also confirm at the epigenomic level through the use of single-cell ATAC-seq. Using regulatory network inference, we predict key transcriptional events leading to the specification of oligodendrocyte precursor cells (OPCs). Moreover, by profiling the spatial expression of 50 key genes through the use of in situ sequencing (ISS), we identify regions in the human ventral fetal forebrain where oligodendrogenesis first occurs. Our results indicate evolutionary conservation of the first wave of oligodendrogenesis between mice and humans and describe regulatory mechanisms involved in human OPC specification.
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