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| 2. |
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| 3. |
- Ageberg, Eva, et al.
(författare)
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Principles of brain plasticity in improving sensorimotor function of the knee and leg in healthy subjects: A double-blind randomized exploratory trial
- 2009
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Background: Principles of brain plasticity is used in the treatment of patients with functional limitations to improve sensorimotor function. Training is included in the treatment of knee injury to improve both patient-reported function and sensorimotor function. However, impairment in sensorimotor function often persists despite training. Therefore, it was suggested that training programs need to be more effective to improve sensorimotor function after knee injury. The aim of the current study was to investigate if principles of brain plasticity that have been successfully used on the hand and foot to improve sensorimotor function can be applied on the knee. We hypothesized that temporary anesthesia of the skin area above and below the knee would improve sensorimotor function of the ipsilateral knee and leg. Methods: In this first double-blind exploratory study, 28 uninjured subjects (mean age 26 years, range 19-34, 50% women) were randomized to temporary local cutaneous application of anesthetic (EMLA (R)) (n=14) or placebo cream (n=14). Fifty grams of EMLA, or placebo, was applied on the leg 10 cm above and 10 cm below the center of patella, leaving the area around the knee without cream. Measures of sensory function (perception of touch, vibration sense, knee kinesthesia) and motor function (knee muscle strength, hop test) were assessed before and after 90 minutes of treatment with EMLA or placebo. The paired t-test was used for comparisons within groups and the independent t-test for comparisons between groups. The number of subjects needed was determined by an a priori sample size calculation. Results: No statistically significant or clinically relevant differences were seen over time (before vs. after) in the measures of sensory or motor functions in the EMLA group or in the placebo group. There were no differences between the groups due to treatment effect (EMLA vs. placebo). Conclusion: We found no effect of temporary cutaneous anesthesia on sensorimotor function of the ipsilateral knee and leg in uninjured subjects. The principles used in this study remain to be tested in subjects with knee injury.
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| 4. |
- Ageberg, Eva, et al.
(författare)
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Principles of brain plasticity in improving sensorimotor function of the knee and leg in patients with anterior cruciate ligament injury: a double-blind randomized exploratory trial
- 2012
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 13:68
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Tidskriftsartikel (refereegranskat)abstract
- Background: Severe traumatic knee injury, including injury to the anterior cruciate ligament (ACL), leads to impaired sensorimotor function. Although improvements are achieved by training, impairment often persists. Because good sensorimotor function is associated with better patient-reported function and a potential lower risk of future joint problems, more effective treatment is warranted. Temporary cutaneous anesthesia of adjacent body parts was successfully used on the hand and foot to improve sensorimotor function. The aim of this study was to test whether this principle of brain plasticity could be used on the knee. The hypothesis was that temporary anesthesia of the skin area above and below the knee would improve sensorimotor function of the ipsilateral knee and leg in subjects with ACL injury. Methods: In this double-blind exploratory study, 39 subjects with ACL injury (mean age 24 years, SD 5.2, 49% women, mean 52 weeks after injury or reconstruction) and self-reported functional limitations and lack of trust in the knee were randomized to temporary local cutaneous application of anesthetic (EMLA (R)) (n = 20) or placebo cream (n = 19). Fifty grams of EMLA (R), or placebo, was applied on the leg 10 cm above and 10 cm below the center of patella, leaving the area around the knee without cream. Measures of sensory function (perception of touch, vibration sense, knee kinesthesia) and motor function (knee muscle strength, hop test) were assessed before and after 90 minutes of treatment with EMLA (R) or placebo. The paired t-test was used for comparisons within groups and analysis of variance between groups, except for ordinal data where the Wilcoxon signed rank test, or Mann-Whitney test, was used. The number of subjects needed was determined by an a priori sample size calculation. Results: No statistically significant or clinically relevant differences were seen over time (before vs. after) in the measures of sensory or motor functions in the EMLA (R) group or in the placebo group. There were no differences between the groups due to treatment effect (EMLA (R) vs. placebo). Conclusions: Temporary cutaneous anesthesia of adjacent body parts had no effect in improving sensorimotor function of the knee and leg in subjects with severe traumatic knee ligament injury.
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| 5. |
- Antfolk, Christian, et al.
(författare)
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A Tactile Display System for Hand Prostheses to Discriminate Pressure and Individual Finger Localization
- 2010
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Ingår i: Journal of Medical and Biological Engineering. - : Taiwanese Society of Biomedical Engineering. - 1609-0985. ; 30:6, s. 355-359
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Tidskriftsartikel (refereegranskat)abstract
- No current commercially available myoelectrically controlled prosthetic hands provide conscious sensory feedback to the user. A system aiming at relocation of sensory input from a prosthetic hand equipped with force sensors to the forearm skin of amputees, a tactile display, has been developed and constructed. The system consists of five piezoresistive force sensors or, alternatively, a prosthetic hand equipped with force sensors, five digital servomotors with a lever and a circular plastic disk pushing on the skin, control electronics based on an MSP430 microcontroller and a test application implemented in LabVIEW running on a PC. The tactile display system is intended to be integrated into the socket of a hand prosthesis and used as a conscious sensory feedback system for hand amputees using a myoelectrically controlled hand prosthesis. The system will provide continuous force feedback from sensors in the fingertips of each prosthetic finger and will likely improve the users' controllability and perception of the prosthetic hand. Here we report on tests made on "a five site" localization discrimination task and three pressure level discrimination tasks on the forearm of five healthy participants (non-amputees) using the LabView application to generate the stimulations. A mean five-finger discrimination accuracy of 86% and a mean three-level pressure discrimination accuracy of 93% were achieved, indicating the system to be a viable method of producing sensory feedback on the level of individual fingers.
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| 6. |
- Antfolk, Christian, et al.
(författare)
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Artificial Redirection of Sensation From Prosthetic Fingers to the Phantom Hand Map on Transradial Amputees: Vibrotactile Versus Mechanotactile Sensory Feedback
- 2013
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Ingår i: IEEE Transactions on Neural Systems and Rehabilitation Engineering. - 1534-4320. ; 21:1, s. 112-120
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Tidskriftsartikel (refereegranskat)abstract
- This work assesses the ability of transradial amputees to discriminate multi-site tactile stimuli in sensory discrimination tasks. It compares different sensory feedback modalities using an artificial hand prosthesis in: 1) a modality matched paradigm where pressure recorded on the five fingertips of the hand was fed back as pressure stimulation on five target points on the residual limb; and 2) a modality mismatched paradigm where the pressures were transformed into mechanical vibrations and fed back. Eight transradial amputees took part in the study and were divided in two groups based on the integrity of their phantom map; group A had a complete phantom map on the residual limb whereas group B had an incomplete or nonexisting map. The ability in localizing stimuli was compared with that of 10 healthy subjects using the vibration feedback and 11 healthy subjects using the pressure feedback (in a previous study), on their forearms, in similar experiments. Results demonstrate that pressure stimulation surpassed vibrotactile stimulation in multi-site sensory feedback discrimination. Furthermore, we demonstrate that subjects with a detailed phantom map had the best discrimination performance and even surpassed healthy participants for both feedback paradigms whereas group B had the worst performance overall. Finally, we show that placement of feedback devices on a complete phantom map improves multi-site sensory feedback discrimination, independently of the feedback modality.
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| 7. |
- Antfolk, Christian, et al.
(författare)
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Design and technical construction of a tactile display for sensory feedback in a hand prosthesis system
- 2010
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Ingår i: BioMedical Engineering Online. - 1475-925X. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- Background: The users of today's commercial prosthetic hands are not given any conscious sensory feedback. To overcome this deficiency in prosthetic hands we have recently proposed a sensory feedback system utilising a "tactile display" on the remaining amputation residual limb acting as man-machine interface. Our system uses the recorded pressure in a hand prosthesis and feeds back this pressure onto the forearm skin. Here we describe the design and technical solution of the sensory feedback system aimed at hand prostheses for trans-radial/humeral amputees. Critical parameters for the sensory feedback system were investigated. Methods: A sensory feedback system consisting of five actuators, control electronics and a test application running on a computer has been designed and built. Firstly, we investigate which force levels were applied to the forearm skin of the user while operating the sensory feedback system. Secondly, we study if the proposed system could be used together with a myoelectric control system. The displacement of the skin caused by the sensory feedback system would generate artefacts in the recorded myoelectric signals. Accordingly, EMG recordings were performed and an analysis of the these are included. The sensory feedback system was also preliminarily evaluated in a laboratory setting on two healthy non-amputated test subjects with a computer generating the stimuli, with regards to spatial resolution and force discrimination. Results: We showed that the sensory feedback system generated approximately proportional force to the angle of control. The system can be used together with a myoelectric system as the artefacts, generated by the actuators, were easily removed using a simple filter. Furthermore, the application of the system on two test subjects showed that they were able to discriminate tactile sensation with regards to spatial resolution and level of force. Conclusions: The results of these initial experiments in non-amputees indicate that the proposed tactile display, in its simple form, can be used to relocate tactile input from an artificial hand to the forearm and that the system can coexist with a myoelectric control systems. The proposed system may be a valuable addition to users of myoelectric prosthesis providing conscious sensory feedback during manipulation of objects.
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| 8. |
- Antfolk, Christian, et al.
(författare)
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Sensory feedback from a prosthetic hand based on air-mediated pressure from the hand to the forearm skin.
- 2012
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Ingår i: Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1651-2081. ; 44:8, s. 702-707
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Lack of sensory feedback is a drawback in today's hand prostheses. We present here a non-invasive simple sensory feedback system, which provides the user of a prosthetic hand with sensory feedback on the arm stump. It is mediated by air in a closed loop system connecting silicone pads on the prosthetic hand with pads on the amputation stump. The silicone pads in a "tactile display" on the amputation stump expand when their corresponding sensor-bulb in the prosthesis is touched, evoking an experience of "real touch". Methods: Twelve trans-radial amputees and 20 healthy non-amputees participated in the study. We investigated the capacity of the system to mediate detection of touch, discrimination between different levels of pressure and, on the amputees also, the ability to locate touch. Results: The results showed a median touch threshold of 80 and 60 g in amputees and non-amputees, respectively, and 90% and 80% correct answers, respectively, in discrimination between 2 levels of pressure. The amputees located touch (3 sites) correctly in 96% of trials. Conclusion: This simple sensory feedback system has the potential to restore sensory feedback in hand amputees and thus it could be a useful tool to enhance prosthesis use.
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| 9. |
- Antfolk, Christian, et al.
(författare)
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Sensory feedback in upper limb prosthetics.
- 2013
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Ingår i: Expert Review of Medical Devices. - : Informa UK Limited. - 1745-2422 .- 1743-4440. ; 10:1, s. 45-54
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Tidskriftsartikel (refereegranskat)abstract
- One of the challenges facing prosthetic designers and engineers is to restore the missing sensory function inherit to hand amputation. Several different techniques can be employed to provide amputees with sensory feedback: sensory substitution methods where the recorded stimulus is not only transferred to the amputee, but also translated to a different modality (modality-matched feedback), which transfers the stimulus without translation and direct neural stimulation, which interacts directly with peripheral afferent nerves. This paper presents an overview of the principal works and devices employed to provide upper limb amputees with sensory feedback. The focus is on sensory substitution and modality matched feedback; the principal features, advantages and disadvantages of the different methods are presented.
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| 10. |
- Antfolk, Christian, et al.
(författare)
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SmartHand tactile display: A new concept for providing sensory feedback in hand prostheses.
- 2010
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Ingår i: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery. - : Medical Journals Sweden AB. - 1651-2073. ; 44, s. 50-53
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Tidskriftsartikel (refereegranskat)abstract
- Abstract A major drawback with myoelectric prostheses is that they do not provide the user with sensory feedback. Using a new principle for sensory feedback, we did a series of experiments involving 11 healthy subjects. The skin on the volar aspect of the forearm was used as the target area for sensory input. Experiments included discrimination of site of stimuli and pressure levels at a single stimulation point. A tactile display based on digital servomotors with one actuating element for each of the five fingers was used as a stimulator on the forearm. The results show that the participants were able to discriminate between three fingers with an accuracy of 97%, between five fingers with an accuracy of 82%, and between five levels with an accuracy of 79%. The tactile display may prove a helpful tool in providing amputees with sensory feedback from a prosthetic hand by transferring tactile stimuli from the prosthetic hand to the skin at forearm level.
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| 11. |
- Antfolk, Christian, et al.
(författare)
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Transfer of tactile input from an artificial hand to the forearm: experiments in amputees and able-bodied volunteers
- 2013
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Ingår i: Disability and Rehabilitation: Assistive Technology. - : Informa UK Limited. - 1748-3115 .- 1748-3107. ; 8:3, s. 249-254
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Tidskriftsartikel (refereegranskat)abstract
- Abstract in UndeterminedPurpose:This study explores the possibilities of transferring peripheral tactile stimulations from an artificial hand to the forearm skin.Method:A tactile display applied to the forearm skin was used to transfer tactile input to the forearm from various locations on a hand displayed on a computer screen. Discernment of location, levels of pressure and a combination of the two in simulated functional grips was tested to quantify the participants' ability to accurately perceive the tactile stimulations presented. Ten participants (5 forearm amputees and 5 able-bodied volunteers) unfamiliar with the equipment participated in the three-stage experiments comprising a learning session with vision, a reinforced learning session without vision and a validation session without vision.Results:The location discernment accuracy was high in both groups (75.2% and 89.6% respectively). The capacity to differentiate between three different levels of pressure was also high (91.7% and 98.1% respectively in the two groups). Recognition of simulated grip was slightly more difficult with the groups scoring 58.7% and 68.0% respectively for accuracy in the validation session.Conclusions:This study demonstrates that it is possible, following a brief training period, to transfer tactile input from an artificial hand to the forearm skin. The level of accuracy was lower for the more complex task, simulated grip recognition, possibly because this represents a more complex task requiring higher order brain functions. These results could form the basis for developing sensory feedback in hand prostheses. [Box: see text].
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| 12. |
- Antfolk, Christian, et al.
(författare)
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Using EMG for Real-time Prediction of Joint Angles to Control a Prosthetic Hand Equipped with a Sensory Feedback System
- 2010
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Ingår i: Journal of Medical and Biological Engineering. - : Taiwanese Society of Biomedical Engineering. - 1609-0985. ; 30:6, s. 399-405
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Tidskriftsartikel (refereegranskat)abstract
- All commercially available upper limb prosthesis controllers only allow the hand to be commanded in an open and close fashion without any sensory feedback to the user. Here the evaluation of a multi-degree of freedom hand controlled using a real-time EMG pattern recognition algorithm and incorporating a sensory feedback system is reported. The hand prosthesis, called SmartHand, was controlled in real-time by using 16 myoelectric signals from the residual limb of a 25-year old male transradial amputee in a two day long evaluation session. Initial training of the EMG pattern recognition algorithm was performed with a dataglove fitted to the contralateral hand recording joint angle positions of the fingers and mapping joint angles of the fingers to the EMG data. In the following evaluation sessions, the myoelectric signals were classified using local approximation and lazy learning, producing finger joint angle outputs and consequently controlling the prosthetic hand. Sensory information recorded from force sensors in the artificial hand was relayed to actuators, integrated in the socket of the prosthesis, continuously delivering force sensory feedback stimulations to the stump of the amputee. The participant was able to perform several dextrous movements as well as functional grip tasks after only two hours of training and increased his controllability during the two day session. In the final evaluation session a mean classification accuracy of 86% was achieved.
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| 13. |
- Bjorkman, A, et al.
(författare)
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Cortical reintegration of a replanted hand and an osseointegrated thumb prosthesis
- 2007
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Ingår i: Acta Neurochirurgica. Supplementum. - 0065-1419. ; 100, s. 109-112
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Following a peripheral nerve repair the injured nerve has to re-innervate its original cortical area, a process, which is poorly understood. Errors in this cortical re-innervation have been suggested as one key reason for the generally poor clinical outcome following nerve injuries in the hand. METHOD: Functional magnetic resonance imaging (fMRI) was used to assess cortical reintegration following amputation and reattachment of bodyparts in two different situations: a patient with a hand amputation followed by immediate surgical replantation and a patient with an osseointegrated thumb prosthesis. FINDINGS: The primary motor cortex rapidly returns to a normal activation pattern after amputation followed by replantation or application of an osseointegrated prosthesis. The primary somatosenory cortex changes from an initial ipsilateral to a bilateral activation pattern. Sensory stimulation of an osseointegrated prosthesis also shows a bilateral activation pattern in the primary somatosenory cortex. CONCLUSIONS: The primary motor cortex shows a more normal activation pattern possibly because most muscles controlling the hand are proximal to the injury and can be activated after an amputation. The primary somatosensory cortex reorganises more and the activation pattern is more bilateral compared to a healthy hand. This bilateral activation pattern could represent a compensatory mechanism for the inferior tactile function in the replanted hand and the osseointegrated prosthesis.
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| 14. |
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| 15. |
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| 16. |
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| 17. |
- Björkman, Anders, et al.
(författare)
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Cortical changes in dental technicians exposed to vibrating tools.
- 2010
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Ingår i: NeuroReport. - 1473-558X. ; 21, s. 722-726
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Tidskriftsartikel (refereegranskat)abstract
- To study the cortical reorganization after long time exposure to hand-held vibrating tools, we investigated 10 dental technicians with sensory neuropathy after long time exposure to vibrating tools and 10 controls for cortical changes using functional magnetic resonance imaging at 3 T. The activated volumes corresponding to individual fingers in the hand area of S1 were significantly larger in the neuropathy group than in controls. Activation in the primary motor cortex did not differ significantly from controls. These changes are likely the result of cortical reorganization following long-term non-physiological sensory input and they can partly explain the symptoms seen in vibration-induced neuropathy.
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| 18. |
- Björkman, Anders, et al.
(författare)
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Cortical sensory and motor response in a patient whose hand has been replanted: One-year follow up with functional magnetic resonance imaging
- 2007
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Ingår i: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery. - : Informa UK Limited. - 1651-2073 .- 0284-4311. ; 41:2, s. 70-76
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Tidskriftsartikel (refereegranskat)abstract
- Functional magnetic resonance imaging (fMRI) was used to study how a replanted hand regained its cortical territory parallel to recovery. The cortical response to sensory stimulation shifts from an ipsilateral to a bilateral pattern, and then to a predominantly contralateral activation. The cortical response to motor stimulation was normal from the first investigation.
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| 19. |
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| 20. |
- Björkman, Anders, et al.
(författare)
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Phantom digit somatotopy: a functional magnetic resonance imaging study in forearm amputees.
- 2012
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Ingår i: European Journal of Neuroscience. - : Wiley. - 1460-9568 .- 0953-816X. ; 36:1, s. 2098-2106
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Tidskriftsartikel (refereegranskat)abstract
- Forearm amputees often experience non-painful sensations in their phantom when the amputation stump is touched. Cutaneous stimulation of specific stump areas may be perceived as stimulation of specific phantom fingers (stump hand map). The neuronal basis of referred phantom limb sensations is unknown. We used functional magnetic resonance imaging to demonstrate a somatotopic map of the phantom fingers in the hand region of the primary somatosensory cortex after tactile stump stimulation. The location and extent of phantom finger activation in the primary somatosensory cortex corresponded well to the location of normal fingers in a reference population. Stimulation of the stump hand map resulted in an increased bilateral activation of the primary somatosensory cortex compared with stimulation of forearm regions outside the stump hand map. Increased activation was also seen in contralateral posterior parietal cortex and premotor cortex. Ipsilateral primary somatosensory cortex activation might represent a compensatory mechanism and activation of the non-primary fronto-parietal areas might correspond to awareness of the phantom limb, which is enhanced when experiencing the referred sensations. It is concluded that phantom sensation elicited by stimulation of stump hand map areas is associated with activation of finger-specific somatotopical representations in the primary somatosensory cortex. This suggests that the primary somatosensory cortex could be a neural substrate of non-painful phantom sensations. The stump hand map phenomenon might be useful in the development of prosthetic hand devices.
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| 21. |
- Björkman, Anders, et al.
(författare)
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Rapid cortical reorganisation and improved sensitivity of the hand following cutaneous anaesthesia of the forearm.
- 2009
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Ingår i: European Journal of Neuroscience. - : Wiley. - 1460-9568 .- 0953-816X. ; 29:4, s. 837-844
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Tidskriftsartikel (refereegranskat)abstract
- The cortical representation of various body parts constantly changes based on the pattern of afferent nerve impulses. As peripheral nerve injury results in a cortical and subcortical reorganisation this has been suggested as one explanation for the poor clinical outcome seen after peripheral nerve repair in humans. Cutaneous anaesthesia of the forearm in healthy subjects and in patients with nerve injuries results in rapid improvement of hand sensitivity. The mechanism behind the improvement is probably based on a rapid cortical and subcortical reorganisation. The aim of this work was to study cortical changes following temporary cutaneous forearm anaesthesia. Ten healthy volunteers participated in the study. Twenty grams of a local anaesthetic cream (EMLA) was applied to the volar aspect of the right forearm. Functional magnetic resonance imaging was performed during sensory stimulation of all fingers of the right hand before and during cutaneous forearm anaesthesia. Sensitivity was also clinically assessed before and during forearm anaesthesia. A group analysis of functional magnetic resonance image data showed that, during anaesthesia, the hand area in the contralateral primary somatosensory cortex expanded cranially over the anaesthetised forearm area. Clinically right hand sensitivity in the volunteers improved during forearm anaesthesia. No significant changes were seen in the left hand. The clinically improved hand sensitivity following forearm anaesthesia is probably based on a rapid expansion of the hand area in the primary somatosensory cortex which presumably results in more nerve cells being made available for the hand in the primary somatosensory cortex.
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| 22. |
- Björkman, Anders, et al.
(författare)
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Recovery of nerve injury-induced alexia for Braille using forearm anaesthesia.
- 2008
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Ingår i: NeuroReport. - 1473-558X. ; 19:6, s. 683-685
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Tidskriftsartikel (refereegranskat)abstract
- Nerve injuries in the upper extremity may severely affect hand function. Cutaneous forearm anaesthesia has been shown to improve hand sensation in nerve-injured patients. A blind man who lost his Braille reading capability after an axillary plexus injury was treated with temporary cutaneous forearm anaesthesia. After treatment sensory functions of the hand improved and the patient regained his Braille reading capability. The mechanism behind the improvement is likely unmasking of inhibited or silent neurons, but after repeated treatment sessions at increasing intervals the improvement has remained at 1-year follow-up, implying a structural change in the somatosensory cortex.
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| 23. |
- Björkman, Anders, et al.
(författare)
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Sensory qualities of the phantom hand map in the residual forearm of amputees
- 2016
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1651-2081 .- 1650-1977. ; 48:4, s. 70-365
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Most amputees experience referred sensations, known as a phantom hand map, on the residual forearm, where touch on specific areas is perceived as touch on the amputated hand. The aim of this study was to evaluate the sensory qualities of the phantom hand map.METHODS: In 10 traumatic forearm-amputees touch thres-holds and discriminative touch of the phantom hand map were assessed and compared with corresponding areas on the contralateral forearm. The study assessed the localization of touch on the phantom hand map, and how distinct and similar to normal touch the referred feeling was.RESULTS: Similar touch thresholds were seen in the phantom hand map and the control site. Tactile discrimination, requiring both detection of stimulus and interpretation, was significantly better in the phantom hand map.CONCLUSION: This explorative study suggests that the phantom hand map and the superior tactile discrimination seen in the phantom hand map are based on adaptations within the brain. Further studies investigating the neural basis for the phantom hand map are needed.
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| 24. |
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| 25. |
- Carlsson, Håkan, et al.
(författare)
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Efficacy and feasibility of SENSory relearning of the UPPer limb (SENSUPP) in people with chronic stroke: A pilot randomized controlled trial
- 2022
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Ingår i: PM&R. - : Wiley. - 1934-1482 .- 1934-1563. ; 14:12, s. 1461-1473
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Tidskriftsartikel (refereegranskat)abstract
- Background Sensorimotor impairments of the upper limb (UL) are common after stroke, but there is a lack of evidence-based interventions to improve functioning of UL. Objective To evaluate (1) the efficacy of sensory relearning and task-specific training compared to task-specific training only, and (2) the feasibility of the training in chronic stroke. Design A pilot randomized controlled trial. Setting University hospital outpatient clinic. Participants Twenty-seven participants (median age; 62 years, 20 men) were randomized to an intervention group (IG; n = 15) or to a control group (CG; n = 12). Intervention Both groups received training twice weekly in 2.5-hour sessions for 5 weeks. The training in the IG consisted of sensory relearning, task-specific training, and home training. The training in the CG consisted of task-specific training. Main Outcome Measures Primary outcome was sensory function (touch thresholds, touch discrimination, light touch, and proprioception). Secondary outcomes were dexterity, ability to use the hand in daily activities, and perceived participation. A blinded assessor conducted the assessments at baseline (T1), post intervention (T2), and at 3-month follow-up (T3). Nonparametric analyses and effect-size calculations (r) were performed. Feasibility was evaluated by a questionnaire. Results After the training, only touch thresholds improved significantly from T1 to T2 (p = .007, r = 0.61) in the IG compared to the CG. Within the IG, significant improvements were found from T1 to T2 regarding use of the hand in daily activities (p = .001, r = 0.96) and movement quality (p = .004, r = 0.85) and from T1 to T3 regarding satisfaction with performance in meaningful activities (p = .004, r = 0.94). The CG significantly improved the performance of using the hand in meaningful activities from T1 to T2 (p = .017, r = 0.86). The training was well tolerated by the participants and performed without any adverse events. Conclusions Combined sensory relearning and task-specific training may be a promising and feasible intervention to improve UL sensorimotor function after stroke.
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| 26. |
- Carlsson, H., et al.
(författare)
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Experiences of SENSory Relearning of the UPPer Limb (SENSUPP) after Stroke and Perceived Effects: A Qualitative Study
- 2022
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1660-4601 .- 1661-7827. ; 19:6
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Tidskriftsartikel (refereegranskat)abstract
- Recently, it was shown that sensory relearning of the upper limb (SENSUPP) is a promising intervention to improve sensorimotor function after stroke. There is limited knowledge, however, of how participants perceive the training. Here, we explored how persons with sensory impairments in the upper limb experienced the SENSUPP protocol (combined sensory- and motor training and home exercises for 5 weeks) and its effect. Fifteen persons (mean age 59 years; 10 men; >6 months post-stroke) were individually interviewed, and data were analyzed with qualitative content analysis. An overall theme 'Sensory relearning was meaningful and led to improved ability to perform daily hand activities' and two categories with six subcategories emerged. The outpatient training was perceived as meaningful, although the exercises were demanding and required concentration. Support from the therapist was helpful and training in small groups appreciated. The home training was challenging due to lack of support, time, and motivation. Small improvements in sensory function were perceived, whereas increased movement control and ability in performing daily hand activities were reported. In conclusion, the SENSUPP protocol is meaningful and beneficial in improving the functioning of the UL in chronic stroke. Improving compliance to the home training, regular follow-ups, and an exercise diary are recommended.
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| 27. |
- Carlsson, Håkan, et al.
(författare)
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SENSory re-learning of the UPPer limb after stroke (SENSUPP) : Study protocol for a pilot randomized controlled trial
- 2018
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Ingår i: Trials. - : Springer Science and Business Media LLC. - 1745-6215. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Many stroke survivors suffer from sensory impairments of their affected upper limb (UL). Although such impairments can affect the ability to use the UL in everyday activities, very little attention is paid to sensory impairments in stroke rehabilitation. The purpose of this trial is to investigate if sensory re-learning in combination with task-specific training may prove to be more effective than task-specific training alone to improve sensory function of the hand, dexterity, the ability to use the hand in daily activities, perceived participation, and life satisfaction. Methods/design: This study is a single-blinded pilot randomized controlled trial (RCT) with two treatment arms. The participants will be randomly assigned either to sensory re-learning in combination with task-specific training (sensory group) or to task-specific training only (control group). The training will consist of 2.5 h of group training per session, 2 times per week for 5 weeks. The primary outcome measures to assess sensory function are as follows: Semmes-Weinstein monofilament, Shape/Texture Identification (STI™) test, Fugl-Meyer Assessment-upper extremity (FMA-UE; sensory section), and tactile object identification test. The secondary outcome measures to assess motor function are as follows: Box and Block Test (BBT), mini Sollerman Hand Function Test (mSHFT), Modified Motor Assessment Scale (M-MAS), and Grippit. To assess the ability to use the hand in daily activities, perceived participation, and life satisfaction, the Motor Activity Log (MAL), Canadian Occupational Performance Measure (COPM), Stroke Impact Scale (SIS) participation domain, and Life Satisfaction checklist will be used. Assessments will be performed pre- and post-training and at 3-month follow-up by independent assessors, who are blinded to the participants' group allocation. At the 3-month follow-up, the participants in the sensory group will also be interviewed about their general experience of the training and how effective they perceived the training. Discussion: The results from this study can add new knowledge about the effectiveness of sensory re-learning in combination with task-specific training on UL functioning after stroke. If the new training approach proves efficient, the results can provide information on how to design a larger RCT in the future in persons with sensory impairments of the UL after stroke.
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| 28. |
- Carlsson, Håkan, et al.
(författare)
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SENSory re-learning of the UPPer limb (SENSUPP) after stroke : development and description of a novel intervention using the TIDieR checklist
- 2021
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Ingår i: Trials. - : Springer Science and Business Media LLC. - 1745-6215. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Sensorimotor impairments of upper limb (UL) are common after stroke, leading to difficulty to use the UL in daily life. Even though many have sensory impairments in the UL, specific sensory training is often lacking in stroke rehabilitation. Thus, the aim of this paper is to provide a detailed description of the novel intervention “SENSory re-learning of the UPPer limb after stroke (SENSUPP)” that we have developed to improve functioning in the UL in persons with mild to moderate impairments after stroke. Methods: The SENSUPP protocol was designed using information from literature reviews, clinical experience and through consultation of experts in the field. The protocol integrates learning principles based on current neurobiological knowledge and includes repetitive intensive practice, difficulty graded exercises, attentive exploration of a stimulus with focus on the sensory component, and task-specific training in meaningful activities that includes feedback. For reporting the SENSUPP protocol, the Template for Intervention Description and Replication (TIDieR) checklist was used. Results: The essential features of the SENSUPP intervention comprise four components: applying learning principles based on current neurobiological knowledge, sensory re-learning (exercises for touch discrimination, proprioception and tactile object recognition), task-specific training in meaningful activities, and home-training. The training is performed twice a week, in 2.5-h sessions for 5 weeks. Conclusion: Since there is close interaction between the sensory and motor systems, the SENSUPP intervention may be a promising method to improve UL functioning after stroke. The TIDieR checklist has been very useful for reporting the procedure and development of the training. Trial registration: ClinicalTrials.govNCT03336749. Registered on 8 November 2017.
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| 29. |
- Carlsson, Ingela, et al.
(författare)
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Hand injuries and cold sensitivity: Reliability and validity of cold sensitivity questionnaires.
- 2008
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Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 30:25, s. 1920-1928
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Tidskriftsartikel (refereegranskat)abstract
- Purpose. Sensitivity to cold is a common consequence of hand injuries and other conditions, and this phenomenon has a profound effect on health-related quality of life and upper-extremity disability. The aim of the present study was to examine the reliability and validity of the Swedish version of the Cold Sensitivity Severity (CSS) scale and Cold Intolerance Symptom Severity (CISS) questionnaire and the reliability of the Potential Work Exposure Scale in a group of patients with traumatic hand-injury or vibration-induced problems. Method. We translated the self-administered questionnaires into Swedish and performed tests of reliability and validity. The questionnaire was sent to 159 patients with hand injuries. Results. Validity and internal-consistency results are based on a sample of 122. Test - retest results are based on a sample of 100. Good construct validity was demonstrated via correlation statistics. There were high correlations for both the CSS scale and CISS questionnaire scores with single questions concerning cold sensitivity, with the Disability of the Arm, Shoulder and Hand scale, and with the bodily-pain subscale of the SF-36 questionnaire. Reliability (both internal consistency and test - retest) was excellent. Conclusions. We conclude that the Swedish versions of the CSS scale and CISS questionnaire are reliable, and that this study provides evidence of the validity of the scales. The Potential Work Exposure Scale is reliable method of assessing exposure in the workplace.
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| 30. |
- Carlsson, Ingela, et al.
(författare)
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Self-reported cold sensitivity in normal subjects and in patients with traumatic hand injuries or hand-arm vibration syndrome
- 2010
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Background: Cold sensitivity is a common and disabling complaint following hand injuries. The main purpose of this study was to describe self-reported consequences of cold sensitivity and the association with disability and health-related quality of life in patients with hand injuries or hand-arm vibration syndrome (HAVS) and in normal subjects. Methods: Responses to the Cold Intolerance Symptom Severity (CISS) questionnaire, Potential Work Exposure Scale (PWES), Disability of the Arm, Shoulder and Hand (DASH) and Short-Form 36 questionnaire (SF-36) were investigated in normal subjects (n = 94), hand injured patients (amputation and nerve injuries, n = 88) and patients with HAVS (n = 30). The results are presented as median (range), percent and mean deviation from norms. The Kruskal Wallis Test or Mann-Whitney U-Test were used to identify significant differences between multiple groups or subgroups. The Spearman rank correlation was used to study the relationship between cold sensitivity and disability. Results: Abnormal cold sensitivity (CISS score > 50) was seen in 75% and 45% of patients with HAVS and a traumatic hand injury, respectively. Patients were significantly more exposed to cold in their work environment than the normal population, with a consequently negative effect on work ability due to cold sensitivity. Patients with abnormal cold sensitivity were more seriously disabled and had a poorer health-related quality of life than patients with normal cold sensitivity [higher DASH scores and e. g. significantly larger mean deviation from norms in the subscales Role Physical and Bodily Pain (SF-36)]. Conclusion: Severe and abnormal cold sensitivity may have a profound impact on work capacity, leisure, disability and health-related quality of life. It is frequently seen in patients with traumatic hand injuries and particularly apparent in patients with HAVS.
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| 31. |
- Chemnitz, Anette, et al.
(författare)
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Functional outcome thirty years after median and ulnar nerve repair in childhood and adolescence.
- 2013
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Ingår i: Journal of Bone and Joint Surgery. American Volume. - 1535-1386. ; 95:4, s. 329-337
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Tidskriftsartikel (refereegranskat)abstract
- Age at injury is believed to be a factor that strongly influences functional outcome after nerve injury. However, there have been few long-term evaluations of the results of nerve repair and reconstruction in children. Our aim was to evaluate the long-term functional outcome of nerve repair or reconstruction at the forearm level in patients with a complete median and/or ulnar nerve injury at a young age.
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| 32. |
- Chemnitz, Anette, et al.
(författare)
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Normalized activation in the somatosensory cortex 30 years following nerve repair in children- an fMRI study.
- 2015
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Ingår i: European Journal of Neuroscience. - : Wiley. - 1460-9568 .- 0953-816X. ; 42:4, s. 2022-2027
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Tidskriftsartikel (refereegranskat)abstract
- The clinical outcome following a peripheral nerve injury in the upper extremity is generally better in young children than in teenagers and in adults, but the mechanism behind this difference is unknown. In twenty-eight patients with a complete median nerve injury sustained at the ages of 1-13 years (n=13) and 14-20 years (n=15), the cortical activation during tactile finger stimulation of the injured and healthy hands was monitored at a median time since injury of 28 years using functional magnetic resonance imaging (fMRI) at 3 Tesla. The results from the fMRI were compared with the clinical outcome and electroneurography. The cortical activation pattern following sensory stimulation of the median nerve innervated fingers was dependent on the patient's age at injury. Those injured at a young age (1-13 years) had an activation pattern similar to that of healthy controls. Furthermore, they showed a clinical outcome significantly superior (p=0.001) to the outcome in subjects injured at a later age, however, electroneurographical parameters did not differ between the groups. In subjects injured at age 14-20 years, a more extended activation of the contralateral hemisphere was seen in general. Interestingly, these patients also displayed changes in the ipsilateral hemisphere where a reduced inhibition of somatosensory areas was seen. This loss of ipsilateral inhibition correlated to increasing age at injury as well as to poor recovery of sensory functions in the hand. In conclusion, cerebral changes in both brain hemispheres may explain differences in clinical outcome following a median nerve injury in childhood or adolescence. This article is protected by copyright. All rights reserved.
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| 33. |
- Chemnitz, Anette, et al.
(författare)
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Poor electroneurography but excellent hand function 31 years after nerve repair in childhood.
- 2013
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Ingår i: NeuroReport. - 1473-558X. ; 24:1, s. 6-9
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Tidskriftsartikel (refereegranskat)abstract
- Children, in contrast to adults, show an excellent clinical recovery after a peripheral nerve injury, which may be explained by better peripheral nerve regeneration and a superior plasticity in the young brain. Our aim was to study the long-term electrophysiological outcome after nerve repair in children and young adults and to compare it with the clinical outcome. Forty-four patients, injured at an age younger than 21 years, were assessed by electrophysiology (amplitude, conduction velocity and distal motor latency) at a median of 31 years after a complete median or ulnar nerve injury at the level of the forearm. Electrophysiological evaluation showed pathology in all parameters and in all patients, irrespective of age at injury. No significant differences were observed in the electrophysiological results between those injured in childhood, that is, before the age of 12 years, and those injured in adolescence, that is, between 12 and 20 years of age. In contrast, the clinical nerve function was significantly better for those injured in childhood (87% of complete recovery, P=0.002) compared with those injured in adolescence. We conclude that the mechanism behind the superior clinical outcome in children is not located at the periphery, but is explained by cerebral plasticity.
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| 34. |
- Cipriani, Christian, et al.
(författare)
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A novel concept for a prosthetic hand with bidirectional non-invasive interface: a feasibility study
- 2009
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Ingår i: IEEE Transactions on Biomedical Engineering. - 1558-2531. ; 56:11, s. 2739-2743
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Tidskriftsartikel (refereegranskat)abstract
- Abstract in Undetermined A conceptually novel prosthesis consisting of a mechatronic hand, an electromyographic classifier, and a tactile display has been developed and evaluated by addressing problems related to controllability in prosthetics: intention extraction, perception, and feeling of ownership. Experiments have been performed, and encouraging results for a young transradial amputee are reported.
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| 35. |
- Cipriani, Christian, et al.
(författare)
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Online Myoelectric Control of a Dexterous Hand Prosthesis by Transradial Amputees
- 2011
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Ingår i: IEEE Transactions on Neural Systems and Rehabilitation Engineering. - 1534-4320. ; 19:3, s. 260-270
-
Tidskriftsartikel (refereegranskat)abstract
- A real-time pattern recognition algorithm based on k-nearest neighbors and lazy learning was used to classify, voluntary electromyography (EMG) signals and to simultaneously control movements of a dexterous artificial hand. EMG signals were superficially recorded by eight pairs of electrodes from the stumps of five transradial amputees and forearms of five able-bodied participants and used online to control a robot hand. Seven finger movements (not involving the wrist) were investigated in this study. The first objective was to understand whether and to which extent it is possible to control continuously and in real-time, the finger postures of a prosthetic hand, using superficial EMG, and a practical classifier, also taking advantage of the direct visual feedback of the moving hand. The second objective was to calculate statistical differences in the performance between participants and groups, thereby assessing the general applicability of the proposed method. The average accuracy of the classifier was 79% for amputees and 89% for able-bodied participants. Statistical analysis of the data revealed a difference in control accuracy based on the aetiology of amputation, type of prostheses regularly used and also between able-bodied participants and amputees. These results are encouraging for the development of noninvasive EMG interfaces for the control of dexterous prostheses.
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| 36. |
- Egeland Ljung, Birgitta, et al.
(författare)
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Forskningsetiska frågor i flerspråkiga kontexter : Dilemman vid studier med vuxna och ungdomar med kort tidigare skolbakgrund
- 2023
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Ingår i: Språk i praktiken – i en föränderlig värld. - : Stockholms universitet. - 9789187884306 ; , s. 309-329
-
Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Syftet med detta kapitel är att bidra till en dialog gällande forskningsetik utifrånsåväl juridiska som humanistiska aspekter. Exempel hämtas från dilemman somuppstått i etnografiskt inriktade studier där deltagarna är andraspråksanvändareav svenska och där många har begränsad erfarenhet av formell utbildning ochanvändning av skrift. Det kan vara svårt att ge forskningsinformation på ett sättsom elever med olika bakgrund förstår, särskilt vad gäller konsekvenserna avinformationen, av att delta i forskningen och vad det betyder att vara anonym.En utgångspunkt för kapitlet tas i begrepp som rör etisk omtanke samt i begreppsom rör samtycke och som utvecklats inom forskning om och med barn: inlärtsamtycke och samtycke som pågående process. Samtliga begrepp behandlar på ett ellerannat sätt den makt forskaren har i relation till deltagarna. Vidare diskuteras hurdeltagares eventuella utsatthet eller sårbarhet behöver ses i relation till denaktuella kontexten snarare än utifrån på förhand definierade kategorier.Avslutningsvis belyses forskares ansvar för att hela tiden göra etiskaöverväganden i sin profession och att dessa innebär en ständig och systematiskreflektion och en mängd val. Vi ser ett samhällsintresse i att etnografisk forskninggenomförs i andraspråkssammanhang där deltagarna i olika avseenden kanbetraktas som i en utsatt position. Detta ställer krav på utveckling av nu användaformer för samtyckesförfarande.
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| 37. |
- Ehrsson, H. Henrik, et al.
(författare)
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Upper limb amputees can be induced to experience a rubber hand as their own
- 2008
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Ingår i: Brain. - : Oxford University Press (OUP). - 1460-2156 .- 0006-8950. ; 131:12, s. 3443-3452
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Tidskriftsartikel (refereegranskat)abstract
- We describe how upper limb amputees can be made to experience a rubber hand as part of their own body. This was accomplished by applying synchronous touches to the stump, which was out of view, and to the index finger of a rubber hand, placed in full view (26 cm medial to the stump). This elicited an illusion of sensing touch on the artificial hand, rather than on the stump and a feeling of ownership of the rubber hand developed. This effect was supported by quantitative subjective reports in the form of questionnaires, behavioural data in the form of misreaching in a pointing task when asked to localize the position of the touch, and physiological evidence obtained by skin conductance responses when threatening the hand prosthesis. Our findings outline a simple method for transferring tactile sensations from the stump to a prosthetic limb by tricking the brain, thereby making an important contribution to the field of neuroprosthetics where a major goal is to develop artificial limbs that feel like a real parts of the body.
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| 38. |
- Engstrand, Christina
(författare)
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Hand function in patients with Dupuytren’s disease : Assessment, results & patients’ perspectives
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Dupuytren’s Disease (DD) is a soft tissue disorder that leads to finger joint contractures affecting hand function. DD can be treated with surgery or injection and hand therapy to improve finger joint extension and thereby improve hand function. However, this does not cure the disease and recurrence is common. Previous research on DD has shown improvement in finger joint extension and in self-reported disability of the upper extremity after surgery and hand therapy for DD. However, this provides only a limited perspective on hand function, and multiple dimensions of changes in hand function (i.e. physical, psychosocial aspects and including the patients’ views of results) have not been reported as a whole.Aim: The overall aim of the thesis was to explore hand function before and after surgery and hand therapy in patients with DD, including assessment, results and patients’ perspectives.Methods: The thesis comprises three studies: Study A was a methodological study of interrater reliability in goniometry of the finger joints. Study B was a prospective cohort study with a repeated measures design. Study C was a qualitative interview study, using the model of Patient Evaluation Process and content analysis.Results: Interrater reliability was high or very high for goniometer measurement of finger joint range of motion (ROM) in patients with DD when experienced raters follow our standardized guidelines developed for the study. Changes in hand function consisted of improvement of finger joint extension while active finger flexion was significantly impaired during the first year after surgery and hand therapy. No patient reached a normal ROM, but the majority reached a functional ROM. Sensibility remained unaffected. Patients with surgery on multiple fingers had worse scar pliability than patients with surgery on a single finger. Most patients had their expectations met and were pleased or delighted with their hand function at 12 months after surgery and hand therapy. Safety issues of hand function were of greater concern than social issues. Patients reported less disability and improved health-related quality of life after surgery and hand therapy. The three variables “need to take special precautions”, “avoid using the hand in social context”, and health-related quality of life had significant importance for patients’ rating of functional recovery. Together, these variables explained 62% of the variance in functional recovery. Patients’ perspectives of undergoing a surgical intervention process were described through five categories. Previous experiences of care influenced participants’ expectations of results and the care they were about to receive. Previous experiences and expectations were used as references for appraisal of results, which concerned perceived changes in hand function, the care process, competency, and organization. Appraisal of results could also vary in relation to patient character. Appraisal of results of the intervention process influenced participants’ expectations of future hand function, health and care.Conclusions: Surgery and hand therapy for DD improve hand function and patients regain a functional ROM needed for performance of common daily activities. Despite the negative effect on finger flexion present during the first year after surgery, patients’ regards their hand function as recovered six to eight months after surgery and hand therapy. Measuring digital ROM in the finger joints with a goniometer is a reliable assessment method. However, from the patient’s perspective, it is not enough to evaluate results only in terms of digital extension or ROM. From their view, results of treatment concern consequences on daily use of the hand, what happens during the care process in terms of interaction between patient and health care provider, as well as their view of the competence and logistics of the organization providing the care.
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| 39. |
- Farserotu, John, et al.
(författare)
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Smart Skin for tactile prosthetics
- 2012
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Ingår i: [Host publication title missing]. - 9781467312349 ; , s. 1-8
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Konferensbidrag (refereegranskat)abstract
- This paper provides an overview of a concept for a Smart Skin, for enabling tactile prosthetics that provide for a natural sensation of touch. The solution embeds miniature, ultra-low power, wireless sensors into the silicone coating of the prosthetic. The solution offers advantages in terms of scalability, ability to place the sensors almost anywhere, fault tolerance and potential ease of manufacturing.
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| 40. |
- Flondell, Magnus, et al.
(författare)
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Carpal tunnel syndrome treated with guided brain plasticity : a randomised, controlled study
- 2017
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Ingår i: Journal of Plastic Surgery and Hand Surgery. - 2000-656X. ; 51:3, s. 159-164
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction: Guided plasticity, induced by cutaneous forearm anaesthesia, improves hand sensibility in patients with nerve injury and vibration-induced neuropathy. This study investigated whether patients with carpal tunnel syndrome (CTS) would benefit from cutaneous forearm anaesthesia. Methods: Seventy patients with clinical and electroneurography-verified CTS were randomised to sensory training combined with either an anaesthetic cream (EMLA®) (n = 34) or a placebo cream (n = 36) on the volar part of the forearm. The treatment was repeated at increasing intervals over 8 weeks. The primary outcome was the Boston carpal tunnel questionnaire (BCTQ) symptom severity scale after 8 weeks. Secondary outcomes included activity limitations, sensory function, and nerve conduction. This study compared the longitudinal changes between the two groups, and with correction for multiple comparisons it also compared the longitudinal change within the groups. Results: There were no significant differences in primary or secondary outcomes between the groups. However, the BCTQ symptom severity scale improved significantly within the EMLA® group over the 8-week period (p = 0.001). Apart from this, no significant improvements in activity limitations, sensory function, or nerve conduction were seen in the two groups compared to baseline. Altogether, 47% of patients in the EMLA® group and 61% in the placebo group had been operated on with carpal tunnel release by 12 months. Conclusion: An 8-week treatment protocol with cutaneous forearm anaesthesia to guide brain plasticity gave no significant subjective or objective improvements in hand function compared to placebo.
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| 41. |
- Flondell, Magnus, et al.
(författare)
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Vibration thresholds in carpal tunnel syndrome assessed by multiple frequency vibrometry : a case-control study
- 2017
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Ingår i: Journal of Occupational Medicine and Toxicology. - : Springer Science and Business Media LLC. - 1745-6673. ; 12:34, s. 34-34
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Tidskriftsartikel (refereegranskat)abstract
- Background: Carpal tunnel syndrome (CTS) is the most common compression neuropathy, but there is no gold standard for establishing the diagnosis. The ability to feel vibrations in the fingertips is dependent on the function in cutaneous receptors and afferent nerves. Our aim was to investigate vibration perception thresholds (VPTs) in patients with CTS using multi-frequency vibrometry.Methods: Sixty-six patients (16 men and 50 women) with CTS, diagnosed from clinical signs and by electroneurography, and 66 matched healthy controls were investigated with multi-frequency vibrometry. The VPTs were assessed at seven frequencies (8, 16, 32, 64, 125, 250, and 500 Hz) in the index finger and little finger bilaterally. The severity of the CTS was graded according to Padua and the patient's subjective symptoms were graded according to the Boston carpal tunnel questionnaire. Touch thresholds were assessed using the Semmes-Weinstein monofilaments.Results: Patients with CTS had significantly higher VPTs at all frequencies in the index finger and in 6 out of 7 frequencies in the little finger compared to the controls. However, the VPT was not worse in patients with more severe CTS. Patients with unilateral CTS showed significantly higher VPTs in the affected hand. There were no correlations between VPTs and electrophysiological parameters, subjective symptoms, or touch threshold.Conclusions: Patients with CTS had impaired VPTs at all frequencies compared to the controls. Since the VPTs are dependent on function in peripheral receptors and their afferent nerves, multi-frequency vibrometry could possibly lead to diagnosis of CTS.
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| 42. |
- Gil, Elisabeth G., et al.
(författare)
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Oral health-related quality of life in 4–16-year-olds with and without juvenile idiopathic arthritis
- 2022
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Ingår i: BMC Oral Health. - : Springer Science and Business Media LLC. - 1472-6831. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Few studies have investigated oral health-related quality of life (OHRQoL) in young individuals with juvenile idiopathic arthritis (JIA). Aims were to investigate whether OHRQoL differs between children and adolescents with JIA compared to controls without JIA, while adjusting for socio-demographic-, behavioral- and oral health-related covariates. Furthermore, to explore whether socio-behavioral and oral health-related covariates of OHRQoL vary according to group affiliation and finally, specifically for individuals with JIA, to investigate whether disease-specific features associate with OHRQoL. We hypothesized that participants with JIA have poorer OHRQoL compared to participants without JIA. Methods: In this comparative cross-sectional study participants with JIA (n = 224) were matched to controls without JIA (n = 224). OHRQoL was assessed according to Early Childhood Oral Health Impact Scale (ECOHIS) (4–11-years-olds) and the child version of Oral Impacts on Daily Performances (Child-OIDP) (12–16-years-olds). JIA-specific characteristics were assessed by pediatric rheumatologists and socio-demographic, behavioral and self-reported oral health information collected by questionnaires. Index teeth were examined for caries by calibrated dentists. Multiple variable analyses were performed using logistic regression, reporting odds ratio (OR) and 95% confidence interval (CI). Two-way interactions were tested between group affiliation and the socio-behavioral- and oral health-related variables on the respective outcome variables. Results: In total, 96 participants with JIA and 98 controls were evaluated according to ECOHIS, corresponding numbers for Child-OIDP was 125 and 124. Group affiliation was not associated with impaired ECOHIS or Child-OIDP in adjusted analyses (OR = 1.95, 95% CI 0.94–4.04 and OR = 0.99, 95% CI 0.46–2.17, respectively). Female adolescents with JIA were more likely than males to report oral impacts according to Child-OIDP. Continued activity or flare was found to adversely affect Child-OIDP, also self-reported outcome measures in JIA associated with Child-OIDP. Conclusions: This study did not provide consistent evidence to confirm the hypothesis that children and adolescents with JIA are more likely to have impaired OHRQoL compared to their peers without JIA. However, female adolescents with JIA were more likely than males to report impacts on OHRQoL. Furthermore, within the JIA group, adolescents with continued disease activity, flare or reporting pain, physical disability, had higher risk than their counterparts of impaired OHRQoL.
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| 43. |
- Gonzalez, Helena, 1971, et al.
(författare)
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Photostability of commercial sunscreens upon sun exposure and irradiation by ultraviolet lamps
- 2007
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Ingår i: BMC Dermatol. - 1471-5945. ; 7
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Sunscreens are being widely used to reduce exposure to harmful ultraviolet (UV) radiation. The fact that some sunscreens are photounstable has been known for many years. Since the UV-absorbing ingredients of sunscreens may be photounstable, especially in the long wavelength region, it is of great interest to determine their degradation during exposure to UV radiation. Our aim was to investigate the photostability of seven commercial sunscreen products after natural UV exposure (UVnat) and artificial UV exposure (UVart). METHODS: Seven commercial sunscreens were studied with absorption spectroscopy. Sunscreen product, 0.5 mg/cm2, was placed between plates of silica. The area under the curve (AUC) in the spectrum was calculated for UVA (320-400 nm), UVA1 (340-400 nm), UVA2 (320-340 nm) and UVB (290-320 nm) before (AUCbefore) and after (AUCafter) UVart (980 kJ/m2 UVA and 12 kJ/m2 of UVB) and before and after UVnat. If theAUC Index (AUCI), defined as AUCI = AUCafter/AUCbefore, was > 0.80, the sunscreen was considered photostable. RESULTS: Three sunscreens were unstable after 90 min of UVnat; in the UVA range the AUCI was between 0.41 and 0.76. In the UVB range one of these sunscreens was unstable with an AUCI of 0.75 after 90 min. Three sunscreens were photostable after 120 min of UVnat; in the UVA range the AUCI was between 0.85 and 0.99 and in the UVB range between 0.92 and 1.0. One sunscreen showed in the UVA range an AUCI of 0.87 after UVnat but an AUCI of 0.72 after UVart. Five of the sunscreens were stable in the UVB region. CONCLUSION: The present study shows that several sunscreens are photounstable in the UVA range after UVnat and UVart. There is a need for a standardized method to measure photostability, and the photostability should be marked on the sunscreen product.
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| 44. |
- Hagmar, L, et al.
(författare)
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Health effects of occupational exposure to acrylamide using hemoglobin adducts as biomarkers of internal dose
- 2001
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Ingår i: Scandinavian Journal of Work, Environment and Health. - : Scandinavian Journal of Work, Environment and Health. - 0355-3140 .- 1795-990X. ; 27:4, s. 219-226
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: This study assessed the health effects of occupational acrylamide exposure using hemoglobin (Hb) adducts as biomarkers of internal dose. METHODS: Two hundred and ten tunnel workers exposed for about 2 months to a chemical-grouting agent containing acrylamide and N-methylolacrylamide underwent a health examination. Blood samples were drawn for the analysis of Hb adducts of acrylamide. Fifty workers claiming recently developed or deteriorated symptoms of the peripheral nervous system (PNS) were referred to a neurophysiological examination. Workers with Hb-adduct levels exceeding 0.3 nmol/g globin attended follow-up examinations 6, 12, and 18 months after exposure cessation. RESULTS: Forty-seven workers had Hb-adduct levels within the normal background range (0.02-0.07 nmol/g globin), while the remaining 163 had increased levels up to a maximum of 17.7 nmol/g globin. Clear-cut dose-response associations were found between the Hb-adduct levels and PNS symptoms. Thirty-nine percent of those with Hb-adduct levels exceeding 1 nmol/g globin experienced tingling or numbness in their hands or feet. A no-observed adverse effect level of 0.51 nmol/g globin was estimated for numbness or tingling in the feet or legs. For 23 workers there was strong evidence of PNS impairment due to occupational exposure to acrylamide. All but two had recovered 18 months after the cessation of exposure. CONCLUSIONS: Occupational exposure to a grouting agent containing acrylamide resulted in PNS symptoms and signs. The use of Hb adducts of acrylamide as a biomarker of internal dose revealed strong dose-response associations. The PNS symptoms were, however, generally mild, and in almost all cases they were reversible.
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| 45. |
- Hansson, Thomas, et al.
(författare)
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Sights of touching activates the somatosensory cortex in humans
- 2009
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Ingår i: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery. - : Informa UK Limited. - 1651-2073 .- 0284-4311. ; 43:5, s. 267-269
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Tidskriftsartikel (refereegranskat)abstract
- We report our observations of cross-modal interactions between sight and touch using functional magnetic resonance imaging (fMRI). Experiments were devised to show that sight and touch are linked in a cross-modal arrangement, and two separate experiments were done in an MRI scanner. In the first, the subject's right hand was stimulated with a brush; in the second, a video sequence was presented to the subject inside the scanner through video goggles in visual three-dimensional stereo, showing one brushstroke every second on a hand in the same manner as the subject had just previously experienced. The result was that both the primary and the secondary somatosensory cortexes were activated in the participants when the hands were touched, and when the subjects saw only a hand being touched in the same manner. The results indicated cross-modal links between sight and touch of the hand in humans.
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| 46. |
- Jerosch-Herold, C, et al.
(författare)
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The reliability and validity of the locognosia test after injuries to peripheral nerves in the hand
- 2006
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Ingår i: Journal of Bone and Joint Surgery: British Volume. - 2044-5377. ; 88B:8, s. 1048-1052
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Tidskriftsartikel (refereegranskat)abstract
- Locognosia, the ability to localise touch, is one aspect of tactile spatial discrimination which relies on the integrity of peripheral end-organs as well as the somatosensory representation of the surface of the body in the brain. The test presented here is a standardised assessment which uses a protocol for testing locognosia in the zones of the hand supplied by the median and/or ulnar nerves. The test-retest reliability and discriminant validity were investigated in 39 patients with injuries to the median or ulnar nerve. Intraclass correlation coefficients were used to calculate the test-retest reliability. Discriminant validity was assessed by comparing the injured with the unaffected hand. Excellent test-retest reliability was demonstrated for the injuries to the median (intraclass correlation coefficient 0.924, 95% confidence interval 0.848 to 1.00) and the ulnar nerves (intraclass correlation coefficient 0.859, 95% confidence interval 0.693 to 1.00). The magnitude of the difference in scores between affected and unaffected hands showed good discriminant validity. For injuries to the median nerve the mean difference was 11.1 points (1 to 33; SD 7.4), which was statistically significant (p < 0.0001, paired t-test) and for those of the ulnar nerve it was 4.75 points (1 to 13.5; SD 3.16), which was also statistically significant (paired t-test, p < 0.0001). The locognosia test has excellent test-retest reliability, is a valid test of tactile spatial discrimination and should be included in the evaluation of outcome after injury to peripheral nerves.
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| 47. |
- Krarup, Christian, et al.
(författare)
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Sensation, mechanoreceptor, and nerve fiber function after nerve regeneration
- 2017
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Ingår i: Annals of Neurology. - : Wiley. - 0364-5134 .- 1531-8249. ; 82:6, s. 940-950
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Sensation is essential for recovery after peripheral nerve injury. However, the relationship between sensory modalities and function of regenerated fibers is uncertain. We have investigated the relationships between touch threshold, tactile gnosis, and mechanoreceptor and sensory fiber function after nerve regeneration. Methods: Twenty-one median or ulnar nerve lesions were repaired by a collagen nerve conduit or direct suture. Quantitative sensory hand function and sensory conduction studies by near-nerve technique, including tactile stimulation of mechanoreceptors, were followed for 2 years, and results were compared to noninjured hands. Results: At both repair methods, touch thresholds at the finger tips recovered to 81 ± 3% and tactile gnosis only to 20 ± 4% (p < 0.001) of control. The sensory nerve action potentials (SNAPs) remained dispersed and areas recovered to 23 ± 2% and the amplitudes only to 7 ± 1% (P < 0.001). The areas of SNAPs after tactile stimulation recovered to 61 ± 11% and remained slowed. Touch sensation correlated with SNAP areas (p < 0.005) and was negatively related to the prolongation of tactile latencies (p < 0.01); tactile gnosis was not related to electrophysiological parameters. Interpretation: The recovered function of regenerated peripheral nerve fibers and reinnervated mechanoreceptors may differentially influence recovery of sensory modalities. Touch was affected by the number and function of regenerated fibers and mechanoreceptors. In contrast, tactile gnosis depends on the input and plasticity of the central nervous system (CNS), which may explain the absence of a direct relation between electrophysiological parameters and poor recovery. Dispersed maturation of sensory nerve fibers with desynchronized inputs to the CNS also contributes to the poor recovery of tactile gnosis. Ann Neurol 2017. Ann Neurol 2017;82:940–950.
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| 48. |
- Lanzetta, M, et al.
(författare)
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Early use of artificial sensibility in hand transplantation
- 2004
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Ingår i: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery. - : Informa UK Limited. - 1651-2073 .- 0284-4311. ; 38:2, s. 106-111
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Tidskriftsartikel (refereegranskat)abstract
- Hands were transplanted from brain-dead donors for the treatment of two male unilateral amputees, aged 35 years and 32 years, involved in the Italian Hand Transplantation Programme. Each had lost his right dominant hand, in a farming accident and an explosion, respectively. In one case artificial sensibility was applied postoperatively using a Sensor Glove that transformed vibrotactile stimuli induced by touch, to stereophonic vibroacoustic stimuli perceived through earphones. The principle is based on the brain's capacity for multimodal plasticity, implying that deprivation of one sense (somatosensory) can be compensated for by another sense (auditory). Functional magnetic resonance images (fMRI) taken at regular intervals showed that cortical remodelling of the transplanted hand within the sensory-motor maps occurred early in the patient who used the artificial sensibility regimen compared with the one who did not. We conclude that postoperative use of a device using hearing as a substitution for sensation in hand transplantation may have considerable potential value for speeding up cortical integration of a transplanted hand.
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| 49. |
- Linnertz, Pär, et al.
(författare)
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Shape-texture-identification—STI—A test for tactile gnosis : Concurrent validity of STI2
- 2019
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Ingår i: Journal of Hand Therapy. - : Elsevier BV. - 0894-1130. ; 32:4, s. 470-475
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Tidskriftsartikel (refereegranskat)abstract
- Study Design: Cross-sectional study. Introduction: The shape-texture-identification (STI) test (Össur Nordic AB, Sweden) is used to evaluate one aspect of tactile gnosis in nerve disorders, and it has proven good methodological properties. Purpose of the Study: A new version of the STI test was recently introduced—STI2 (www.sensory-test.com). The purpose of this study was to test the concurrent validity in STI2. Methods: Using a cross-sectional design, this methodological study compared STI2 to the original version based on 2 cohorts; 1 including 20 persons (1 affected finger and corresponding finger on in opposite hand) with affected sensibility after hand injuries and 1 healthy group including 20 persons (digits II and V in both hands). The agreement between the 2 versions of the instrument was calculated statistically by a percentage comparison of the test results and weighted kappa. Results: The 112 tested fingers showed a complete agreement, or 1-point accepted deviation, between the 2 tests in 92% with weighted kappa of 0.74 and 95% confidence interval of 0.63-0.89. The result showed that there is no significant deviation between the 2 versions of the test. Discussion: The use of standardizes and evidence based assessment tools in clinical practice is paramount for a patient centered healthcare. Previous research has shown good psychometric proprties in the STI-test. This study contributes to the scientific evidence of the instrument. Conclusion: As the new STI2 proved good agreement within the accepted deviation, we conclude that there is evidence to use the new STI2 test in assessment of tactile gnosis.
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| 50. |
- Ljung Egeland, Birgitta, et al.
(författare)
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Forskningsetiska frågor i flerspråkiga kontexter : Dilemman vid studier med vuxna och ungdomar med kort tidigare skolbakgrund
- 2023
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Ingår i: Språk i praktiken – i en föränderlig värld. - Uppsala : Stockholms universitet. - 1100-5629 .- 2004-108X. - 9789187884306 ; , s. 309-329
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Bokkapitel (refereegranskat)abstract
- Syftet med detta kapitel är att bidra till en dialog gällande forskningsetik utifrån såväl juridiska som humanistiska aspekter. Exempel hämtas från dilemman som uppstått i etnografiskt inriktade studier där deltagarna är andraspråksanvändare av svenska och där många har begränsad erfarenhet av formell utbildning och användning av skrift. Det kan vara svårt att ge forskningsinformation på ett sätt som elever med olika bakgrund förstår, särskilt vad gäller konsekvenserna av informationen, av att delta i forskningen och vad det betyder att vara anonym. En utgångspunkt för kapitlet tas i begrepp som rör etisk omtanke samt i begrepp som rör samtycke och som utvecklats inom forskning om och med barn: inlärtsamtycke och samtycke som pågående process. Samtliga begrepp behandlar på ett eller annat sätt den makt forskaren har i relation till deltagarna. Vidare diskuteras hur deltagares eventuella utsatthet eller sårbarhet behöver ses i relation till denaktuella kontexten snarare än utifrån på förhand definierade kategorier. Avslutningsvis belyses forskares ansvar för att hela tiden göra etiska överväganden i sin profession och att dessa innebär en ständig och systematisk reflektion och en mängd val. Vi ser ett samhällsintresse i att etnografisk forskninggenomförs i andraspråkssammanhang där deltagarna i olika avseenden kan betraktas som i en utsatt position. Detta ställer krav på utveckling av nu använda former för samtyckesförfarande.
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