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- Ehn, Maria, et al.
(författare)
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Users perspectives on interactive distance technology enabling home-based motor training for stroke patients
- 2015
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Ingår i: Stud. Health Technol. Informatics. - : IOS Press. - 9781614995159 ; , s. 145-152
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Konferensbidrag (refereegranskat)abstract
- The aim of this work has been to develop a technical support enabling home-based motor training after stroke. The basis for the work plan has been to develop an interactive technical solution supporting three different groups of stroke patients: (1) patients with stroke discharged from hospital with support from neuro team; (2) patients with stroke whose support from neuro team will be phased out and (3) patients living with impaired motor functions long-term. The technology has been developed in close collaboration with end-users using a method earlier evaluated and described [12]. This paper describes the main functions of the developed technology. Further, results from early user-tests with end-users, performed to identify needs for improvements to be carried out during further technical development. The developed technology will be tested further in a pilot study of the safety and, usefulness of the technology when applied as a support for motor training in three different phases of the post-stroke rehabilitation process.
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- Moren, Carina, et al.
(författare)
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The Effects of Physical Activity on Prescription in Persons With Transient Ischemic Attack : A Randomized Controlled Study
- 2016
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Ingår i: Journal of neurologic physical therapy. - 1557-0576 .- 1557-0584. ; 40:3, s. 176-183
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Tidskriftsartikel (refereegranskat)abstract
- Background and Purpose: Transient ischemic attack (TIA) is a strong predictor of stroke, and physical inactivity is one risk factor for TIA/stroke. Physical activity on Prescription (PaP) can increase physical activity, but the effect of PaP after TIA has not been described. Our goal was to objectively measure the effect of PaP on physical activity and physical capacity, as well as self-rated health at 3 and 6 months after TIA. Methods: The primary outcome was moderate to vigorous intensities of physical activity objectively assessed by accelerometry. Secondary outcomes were steps per day assessed by accelerometry, physical capacity assessed by the 6-minute walk test, and self-rated health assessed by EQ-5D VAS. Results: Eighty-eight individuals with TIA were randomized to an intervention group (n = 44) that received conventional treatment and PaP or to a control group (n = 44) that received conventional treatment alone. There was a 30% dropout among the participants at 6 months. No significant differences between groups were found in physical activity at 3 and 6 months. At 6 months, participants in the intervention group were significantly more likely to have improved their physical capacity than the control group. There was no significant difference between groups in self-rated health. Discussion and Conclusions: PaP did not increase physical activity after TIA; however, there was an increase in physical capacity. The nonsignificant results for physical activity may be the result of a relatively high baseline physical activity level. The results may also indicate that prior studies suggesting that PaP increases physical activity overestimated effects because of the self-reported nature of the previous outcomes.
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- Palmcrantz, Susanne, et al.
(författare)
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An interactive distance solution for stroke rehabilitation in the home setting–A feasibility study
- 2017
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Ingår i: Informatics for Health and Social Care. - : Informa UK Limited. - 1753-8157 .- 1753-8165. ; 42:3, s. 303-320
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Tidskriftsartikel (refereegranskat)abstract
- Background: In this study an interactive distance solution (called the DISKO tool) was developed to enable home-based motor training after stroke. Objectives: The overall aim was to explore the feasibility and safety of using the DISKO-tool, customized for interactive stroke rehabilitation in the home setting, in different rehabilitation phases after stroke. Methods: Fifteen patients in three different stages in the continuum of rehabilitation after stroke participated in a home-based training program using the DISKO-tool. The program included 15 training sessions with recurrent follow-ups by the integrated application for video communication with a physiotherapist. Safety and feasibility were assessed from patients, physiotherapists, and a technician using logbooks, interviews, and a questionnaire. Qualitative content analysis and descriptive statistics were used in the analysis. Results: Fourteen out of 15 patients finalized the training period with a mean of 19.5 minutes spent on training at each session. The DISKO-tool was found to be useful and safe by patients and physiotherapists. Conclusions: This study demonstrates the feasibility and safety of the DISKO-tool and provides guidance in further development and testing of interactive distance technology for home rehabilitation, to be used by health care professionals and patients in different phases of rehabilitation after stroke. © 2017 Taylor & Francis.
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- Palmcrantz, Susanne, et al.
(författare)
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Differences between younger and older individuals in their use of care and rehabilitation but not in self-perceived global recovery 1 year after stroke
- 2012
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Ingår i: Journal of the Neurological Sciences. - : Elsevier BV. - 0022-510X .- 1878-5883. ; 321:1-2, s. 29-34
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Tidskriftsartikel (refereegranskat)abstract
- Background: Although priorities in Swedish stroke care should be based on the ethical principles of equal care and greatest support to those in greatest need, being of working age (younger) or retired (older) might influence expectations on recovery and the provision of care and rehabilitation.Method: Information regarding the use of care and rehabilitation during the 1st year after stroke was retrieved from the Stockholm County Council database and the medical data was taken from the medical records. The Barthel Index was used for self-ratings of dependence pre-stroke, and the Stroke Impact Scale was used to assess self-perceived disability and a global rating of recovery at 12 months. One hundred and ninety-two individuals were included.Results: Results showed that the younger group received more care and rehabilitation than the older group. In the older group, comorbid conditions and pre-stroke dependence, estimated in accordance with the Barthel Index, were more common. The older group reported larger impact on self-perceived disability regarding strength, mobility, self-care and domestic life, while self-perceived global recovery did not differ between the groups.Conclusion: Younger individuals received more care and rehabilitation, which indicates structural inequality in the provision of health care resources. However, as no difference in self-perceived global recovery was found between the groups; the disparity in the provision of health care may also be a consequence of greatest support being given to those in greatest need. By demonstrating the necessity of involving self-rated assessments of stroke impact at different points in time and in different age groups, the results of this study add to previous knowledge of age-related differences in the provision of health care and stroke outcome. Furthermore. this suggests a way to approach evaluation of equality in the provision of health care.
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| 7. |
- Sommerfeld, Disa
(författare)
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Body function and activity after acute stroke : physiotherapy perspectives
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of the thesis was to describe body function and activity from a physiotherapy perspective in patients with stroke. Further aim was to look for feasible prognostic instruments for the length of stay in hospital or nursing home so as to facilitate planning of the subsequent level of care after acute stroke in patients 65 years and older. The thesis is based on the assessments of the patients in 3 study populations presented in 5 papers. I. We assessed 115 patients 65 years and older 10 days after stroke and at discharge for language, somatosensory and urination function; mobility: Rivermead Mobility Index (RMI); and activities of daily living (ADL): Barthel Index (BI) to find feasible prognostic instruments for the institutional length of stay (LOS), so as to facilitate planning of the subsequent level of care. Study population 1. II. We assessed 115 patients 65 years and older 10 days after stroke and at discharge to investigate the relationship between clinically assessed somatosensory function, to activity (RMI and BI), and to the LOS. Study population 1. III. We analysed those 100 patients, 65 years and older, still in hospital 10 days after stroke, at days 5 and 10 after stroke for consciousness, mental, perceptive, language, somatosensory and urination function; mobility; and ADL so as to describe and to compare functioning between days 5 and 10 after stroke. Study population 2. IV. We assessed 115 patients 65 years and older, at day 5, and if still in hospital also at day 10 (n= 100) after stroke for consciousness (Glasgow Coma Scale [GCS]), mental, emotional, perceptive, language, somatosensory and urination function; mobility; and ADL to find feasible prognostic instruments for the LOS, so as to facilitate planning of the subsequent level of care. Study population 2. V. We assessed 95 patients initially (when diagnosed to have a stroke) and 3 months after stroke so as to analyse and describe the extent to which spasticity occurs and is associated with disabilities (movement-related impairments and activity limitations). Study population 3. Results: According to multiple survival analyses the best positive predictors of LOS, i.e. a short LOS, registered 10 days after stroke, were RMI >4 points corresponding to the ability to raise from a chair in less than 15 seconds and stand there for 15 seconds with or without aid; BI >35 points; normal somatosensory function; urinary continence; and living with another person (paper 1). Normal or almost normal somatosensory function was related to high activity level and short LOS. Impaired somatosensory function was not that closely related to low activity levels and long LOS (paper II). Only consciousness and urination functions; mobility; and ADL were assessable in all patients. Small, but systematic changes (p<0.05) were seen between days 5 and 10 after stroke for most functions and activities. Of all 875 assessments registered 5 days after stroke, 72% remained unchanged by day 10, while 24% improved and 4% deteriorated (paper 111). The best positive predictors of LOS at day 10 after stroke were BI >35 points and no previous stroke. The best positive predictors of LOS at day 5 after stroke were GCS >13 points, corresponding to mild brain injury; RMI >4 points; and no previous stroke (paper IV). Spasticity was present in 19% of the patients investigated 3 months after stroke. Among the patients with severe disabilities we saw almost the same number of non-spastic as spastic patients (paper V). Conclusions: Small changes in functioning were seen between days 5 and 10 after stroke. Preferable outcome measures are at the activity level, though mental functions always have to be considered. Beside medical appraisal the "RMI >4" could be useful when deciding the subsequent level of care 5 days after acute stroke. Only a very small number of spastic patients were seen, suggesting that the focus on spasticity in stroke rehabilitation is out of step with its clinical importance. Further studies in this field are needed.
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| 8. |
- Sommerfeld, Disa K., et al.
(författare)
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Spasticity After Stroke An Overview of Prevalence, Test Instruments, and Treatments
- 2012
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Ingår i: American Journal of Physical Medicine & Rehabilitation. - 0894-9115 .- 1537-7385. ; 91:9, s. 814-820
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Forskningsöversikt (refereegranskat)abstract
- Sommerfeld DK, Gripenstedt U, Welmer A-K: Spasticity after stroke: An overview of prevalence, test instruments, and treatments. Am J Phys Med Rehabil 2012; 91: 814-820. The objective of this study was to present an overview of the prevalence of spasticity after stroke as well as of test instruments and treatments. Recent studies show that spasticity occurs in 20%-30% of all stroke victims and in less than half of those with pareses. Although spasticity may occur in paretic patients after stroke, muscle weakness is more likely to be the reason for the pareses. Spasticity after stroke is more common in the upper than the lower limbs, and it seems to be more common among younger than older people. To determine the nature of passive stretch, electromyographic equipment is needed. However, the Modified Ashworth Scale, which measures the sum of the biomechanical and neural components in passive stretch, is the most common instrument used to grade spasticity after stroke. Treatment of spasticity with physiotherapy is recommended, although its beneficial effect is uncertain. The treatment of spasticity with botulinum toxin in combination with physiotherapy is suggested to improve functioning in patients with severe spasticity. A task-specific approach rather than a neurodevelopmental approach in assessing and treating a patient with spasticity after stroke seems to be preferred.
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