| 1. |
- Bjerkefors, Anna, et al.
(författare)
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Effects of seated double-poling ergometer training on aerobic and mechanical power in paraplegics
- 2012
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Konferensbidrag (refereegranskat)abstract
- Introduction In wheelchair-dependent individuals with paraplegia, over 80 % would benefit from health-intervention programmes due to increased risks for cardiovascular diseases. One way to reduce the likelihood of secondary complications and/or to enhance physical capacity is to add structured exercise activities to the regular schedule throughout life. A seated double-poling ergometer (SDPE) has been developed and recently evaluated on a group of people with SCI. The results indicated that the SDPE appeared to be a suitable training tool; the shoulder movement was within a range of motion not conducive to musculoskeletal injury and it provided a large range of controllable intensities enabling both endurance and strength training.Purpose To study if regular interval training on a SDPE can increase physical capacity and hence improve performance towards maximal level with safety in individuals with spinal cord injury. Methods Thirteen healthy wheelchair users (8 M, 5 F; 47 ± 12 years, 1.75 ± 0.08 m, 67.9 ± 10.2 kg) with SCI levels ranging from T5 to L1, volunteered for the study. Years post injury varied from 3 to 35. All subjects performed 30 sessions of SDPE training during 10 weeks. Each session lasted approximately 55 min, and included a warm-up, interval training (15 s – 3 min work and 15 s – 2 min rest) and a cool-down. The intensity of the intervals was determined to lead up to 70 – 100 % of peak heart rate. Sub-maximal and maximal double-poling ergometer tests were performed before and after this training period. Oxygen uptake was measured using the Douglas Bag system. Three-dimensional kinematics were recorded using an optoelectronic system. Results Significant improvements after training were observed in oxygen uptake (23 %), ventilation (21 %) and blood lactate (22 %) during maximal exertion exercises (Table 1). Mean power per stroke and peak pole force increased with 15 % and 24 %, respectively. At sub-maximal level, significantly lower values were observed in ventilation (-13 %) and blood lactate (-25 %).Conclusion Regular interval training on the seated double-poling ergometer (SDPE) increased oxygen uptake and power out-put and can be recommended for people with paraplegia below T5 level due to SCI. Despite the high intensity training in this study, no overload symptoms were reported. On the contrary, certain types of musculoskeletal and neuropathic pain seem to benefit from training on the SDPE.
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| 2. |
- Bjerkefors, Anna, et al.
(författare)
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Effects of seated double-poling ergometer training on oxygen uptake, upper-body muscle strength and motor performance in paraplegics
- 2012
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Konferensbidrag (refereegranskat)abstract
- Background: In wheelchair-dependent individuals with paraplegia, over 80 % would benefit from health-intervention programmes due to increased risks for cardiovascular diseases. One way to reduce the likelihood of secondary complications and/or to enhance physical capacity is to add structured exercise activities throughout life.Objective: To study the effects of seated double-poling ergometer (SDPE) training on aerobic capacity, upper-body muscle strength, and cross-over effects on functional performance. Methods: Thirteen individuals with paraplegia performed 30 sessions of SDPE training during 10 weeks. Before and after the training period a) oxygen uptake was measured using the Douglas Bag system during sub-maximal and maximal double-poling ergometer tests, b) trunk, shoulder and elbow muscle strength measurements were performed during maximal voluntary contractions using an isokinetic dynamometer and c) functional tests in wheelchair were performed included; sit-and-reach test, propelling 15 m on a level surface, propelling 50 m up a 3º incline, and propelling 6 min on a 200 m indoor track. Test-retests were performed for all tests before the training began.Results: The average intra-class correlation coefficient for test-retest values was 0.91 (SD 0.07). Significant improvements after training were observed in oxygen uptake (22.7 %), ventilation (20.7 %) and blood lactate (22.0 %) during maximal exertion exercises. At sub-maximal level, significantly lower values were observed in ventilation (-12.8 %) and blood lactate (-25.0 %). Maximal isometric trunk muscle strength (17.0 %) and maximal isokinetic shoulder muscle strength (4.4 %) in flexion and extension improved after training. There were significant improvements in sit-and-reach test in forward directions (7.8 %) and in 15 m sprint test (5.2 %). Conclusion: Regular interval training on the SPDE was effective for individuals with paraplegia to improve aerobic capacity and upper-body muscle strength. Some cross-over effects on functional performance were also shown. Furthermore, the training did not cause any overload symptoms.
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| 3. |
- Flank, Peter, et al.
(författare)
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Dyslipidemia is common after spinal cord injury - independent of clinical measures
- 2015
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Ingår i: Jacobs Journal of Physical Rehabilitation Medicine. - 2469-3103. ; 1:1
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To survey the incidence of clinical risk markers and its correlation with established clinical measurements for cardiovascular disease (CVD) in a heterogeneous spinal cord injured (SCI) patient population.Design: Descriptive, cross-sectional study.Subjects: 78 patients with SCI, at different injury and functional level.Methods: Anthropometric data, blood pressure, a blood lipid panel, blood glucose and a questionnaire were analyzed.Results: Eighty-one percent of all patients had dyslipidemia (DL) and a majority of the patients with abdominal measures below the recommended cut-off levels had DL. Self-reported physical activity above the cut-off level was reported by 32.1%of the patients. There were no differences in clinical measures, serum lipid values and blood glucose between physically active and not active patients. No differences were seen between men/women, tetraplegia/paraplegia and wheelchair dependent/not wheelchair dependent patients.Conclusion: DL is common and seems to be not treated or undertreated in the studied SCI patient group with different neurological lesion and functional levels. General anthropometric clinical measures do not seem to be valid for evaluating risk for CVD in this patient group.
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| 4. |
- Flank, Peter, 1972-, et al.
(författare)
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Pain, anxiety and depression in spinal cord injured patients
- 2017
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Ingår i: Jacobs Journal of Physical Rehabilitation Medicine. - : Jacobs Publishers. - 2469-3103. ; 3:1
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To assess the prevalence of pain, anxiety and depression in a sample of chronic SCI patients in Northern Sweden.Design: Descriptive, cross-sectional study.Setting: Specialist Clinic at a University Hospital.Participants: 78 patients with chronic spinal cord injury, at different injury and functional level.Outcome measures: Patients registered presented pain above, at or below injury level on a Visual Analogue Scale (VAS). Patients currently on pain medication were also registered as having pain. Depression and anxiety were assessed by the Hospital Anxiety and Depression Rating Scale (HADS).Results: Out of 78 patients, 58 (74%) indicated current presence of pain or were on continuous pain medication. Pain above injury level was present in 32% of the patients, with a mean VAS of 15.9±20.1, range 0-60mm. Pain at injury level were present in 24% of the patients, mean VAS 11.0±17.0, range 0-50mm and 58% had pain below injury level with a mean VAS 31.4±22.3, range 0-80mm.Clinically significant psychological disorders were reported in 4 patients (5%) for both anxiety and depression.Conclusions: Pain is very common in persons with chronic SCI, but, at least in a drug-treated population, the pain is at a mild or moderate level. Anxiety and depression were found much less common than reported in other studies. Medication effects have been considered. Even in a presumably well-medicated and well-rehabilitated population, there is still a need for further optimization of pain management, including both pharmacological and non-pharmacological methods.Keywords: Tetraplegia; Paraplegia; Psychological Disorders; Visual Analogue Scale; Hospital Anxiety and Depression Scale
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| 5. |
- Flank, Peter, et al.
(författare)
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Self-reported physical activity and risk markers for cardiovascular disease after spinal cord injury
- 2014
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 46:9, s. 886-890
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Tidskriftsartikel (refereegranskat)abstract
- Objective:To examine whether self-reported physical activity of a moderate/vigorous intensity influences risk markers for cardiovascular disease in persons with paraplegia due to spinal cord injury.Design:Descriptive, cross-sectional study.Subjects:A total of 134 wheelchair-dependent individuals (103 men, 31 women) with chronic (>= 1 year) post-traumatic spinal cord injury with paraplegia.Methods:Cardiovascular disease markers (hypertension, blood glucose and a blood lipid panel) were analysed and related to physical activity.Results:One out of 5 persons reported undertaking physical activity >= 30 min/day. Persons who were physically active >= 30 min/day were significantly younger than inactive persons. Systolic and diastolic blood pressures were lower in the physically active group. When adjusting for age, the association between systolic blood pressure and physical activity disappeared. Physical activity >= 30 min/day had a tendency to positively influence body mass index and low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio. Men had significantly higher systolic and diastolic blood pressures than women, lower high-density lipoprotein cholesterol, higher low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio and higher triglycerides. No other significant differences between men and women were found.Conclusion:Self-reported physical activity >= 30 min/day in persons with spinal cord injury positively influenced diastolic blood pressure. No other reductions in cardiovascular disease risk markers were seen after controlling for age. These results indicate a positive effect of physical activity, but it cannot be concluded that recommendations about physical activity in cardiovascular disease prevention for the general population apply to wheelchair-dependent persons with spinal cord injury.
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| 6. |
- Flank, Peter, 1972-
(författare)
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Spinal cord injuries in Sweden : studies on clinical follow-ups
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A spinal cord injury is a serious medical condition, often caused by a physical trauma. An injury to the spinal cord affects the neurotransmission between the brain and spinal cord segments below the level of injury. The SCI causes a loss of motor function, sensory function and autonomic regulation of the body, temporary or permanent. Significantly improved acute care, primary comprehensive rehabilitation and life-long structured follow-up has led to persons with spinal cord injury (SCI) living longer than ever before. However, increased long-time survival has allowed secondary conditions to emerge, like diabetes mellitus and where cardiovascular disease (CVD) now is the most common cause of death among SCI patients. Other possible CVD-related comorbidities in this patient group have been reported to be pain and mood disturbances. There is still lack of, and need for more knowledge in the field of CVD-related screening and prevention after SCI.The overall aim of this thesis was to contribute to a scientific ground regarding the need for CVD-related screening and prevention after SCI.In Paper I and Paper II, patients with wheelchair-dependent post-traumatic SCI (paraplegia) were assessed. The results in paper I showed that 80% of the examined patients had at least one cardiovascular disease risk marker irrespective of body mass index (BMI). Dyslipidemia was common for both men and women at all BMI categories. The study also showed a high prevalence of hypertension, especially in men. Paper II showed a low frequency of self-reported physical activity, where only one out of 5 persons reported undertaking physical activity >30 min/day. The physically active had lower diastolic blood pressure but no significant difference in blood lipids.In paper III and IV, patients with SCI (tetraplegia and paraplegia) participated in the studies. Eighty-one percent of the patients had dyslipidemia, where also a majority of the patients with normal abdominal clinical measures had dyslipidemia. Self-reported physical activity >30min/day was reported by one third of the patients. No differences were found between physically active and not physically active patients when it came to blood glucose, serum lipid values and clinical measures (paper III). Pain was common in the patient group, however, most often on a mild to moderate level. Anxiety and depression was less common than reported in other studies (paper IV).
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| 7. |
- Hofers, Wiebke, et al.
(författare)
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Organisation of services and systems of care in paediatric spinal cord injury rehabilitation in seven countries: a survey with a descriptive cross-sectional design
- 2022
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Ingår i: Spinal Cord. - : SPRINGERNATURE. - 1362-4393 .- 1476-5624. ; 60:4, s. 339-347
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Tidskriftsartikel (refereegranskat)abstract
- Study design International multicentre cross-sectional study. Objectives To describe the organisation and systems of paediatric spinal cord injury (SCI) rehabilitation services in seven countries and compare them with available recommendations and key features of paediatric SCI. Setting Ten SCI rehabilitation units in seven countries admitting children and adolescents with SCI < 18 years of age. Methods An online survey reporting data from 2017. Descriptive and qualitative analysis were used to describe the data. Results The units reported large variations in catchment area, paediatric population and referrals, but similar challenges in discharge policy. Nine of the units were publicly funded. Three units had a paediatric SCI unit. The most frequent causes of traumatic injury were motor vehicle accidents, falls, and sports accidents. Unlike the other units, the Chinese units reported acrobatic dancing as a major cause. Mean length of stay in primary rehabilitation ranged between 18 and 203 days. Seven units offered life-long follow-up. There was a notable variation in staffing between the units; some of the teams were not optimal regarding the interdisciplinary and multiprofessional nature of the field. Eight units followed acknowledged standards and recommendations for specialised paediatric SCI rehabilitation and focused on family-centred care and rehabilitation as a dynamic process adapting to the child and the family. Conclusions As anticipated, we found differences in the organisation and administration of rehabilitation services for paediatric SCI in the ten rehabilitation units in seven countries. This might indicate a need for internationally approved, evidence-based guidelines for specialised paediatric SCI rehabilitation.
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| 8. |
- Holmlund, Tobias, et al.
(författare)
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Defining accelerometer cut-points for different intensity levels in motor-complete spinal cord injury.
- 2020
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Ingår i: Spinal Cord. - : Nature Publishing Group. - 1362-4393 .- 1476-5624. ; 58, s. 116-124
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Descriptive.OBJECTIVE: The present aim was to define accelerometer cut-point values for wrist-worn accelerometers to identify absolute- and relative-intensity physical activity (PA) levels in people with motor-complete paraplegics (PP) and tetraplegics (TP).SETTINGS: Rehabilitation facility in Sweden.METHODS: The participants were 26 (19 men, 7 women) with C5-C8, AIS A and B (TP) and 37 (27 men, 10 women) with T7-T12 (PP), AIS A and B. Wrist-worn accelerometer recordings (Actigraph GT3X+) were taken during seven standardized activities. Oxygen consumption was measured, as well as at-rest and peak effort, with indirect calorimetry. Accelerometer cut-points for absolute and relative intensities were defined using ROC-curve analyses.RESULTS: The ROC-curve analyses for accelerometer cut-points revealed good-to-excellent accuracy (AUC >0.8), defining cut-points for absolute intensity (2, 3, 4, 5, 6, 7 METs for PP and 2 to 6 METs for TP) and relative intensity (30, 40, 50, 60, 70, and 80% for PP and 40-80% for TP). The cut-points for moderate-to-vigorous physical activity was defined as ≥9515 vector magnitude counts per minute (VMC) for PP and ≥4887 VMC/min for TP.CONCLUSION: This study presents cut-points for wrist-worn accelerometers in both PP and TP, which could be used in clinical practice to describe physical activity patterns and time spent at different intensity levels.
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| 9. |
- Holmlund, Tobias, et al.
(författare)
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Energy expenditure after spinal cord injury in people with motor-complete tetraplegia or motor-complete paraplegia.
- 2018
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Ingår i: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 56:3, s. 274-283
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Cross-sectional.OBJECTIVES: This study aimed to describe and compare VO2 and energy expenditure at rest (REE) and during standardized sedentary, non-exercise physical activity, and exercise activities, in people with motor-complete tetraplegia (C5-C8). Further, REE and energy expenditure (EE) for the different activities were compared to data from a reference group of people with motor-complete paraplegia (T7-T12).SETTING: Sweden.METHODS: The sample of people with motor-complete tetraplegia consisted of 26 adults (seven women) with SCI, C5-C8 AIS A-B. REE and EE for the different activities were measured with indirect calorimetry. The results were further compared to people with motor-complete paraplegia.RESULTS: Resting VO2 was 2.57 ml O2 kg-1 min-1, 2.54 for men and 2.60 for women. The VO2 or activity energy expenditure related to body weight increased three to four times during non-exercise physical activity compared to sedentary activities for the people with motor-complete tetraplegia, and up to six times during exercise activity. No significant differences were seen in resting or sedentary activity VO2 between the people with motor-complete tetraplegia and those with motor-complete paraplegia. Activities of daily life revealed no or small differences in VO2, except for setting a table, while the people with tetraplegia had ∼50% lower VO2 during exercise activities.CONCLUSIONS: Non-exercise physical activities of daily life may be significant for increasing total daily EE in people with motor-complete tetraplegia. This might act to motivate the individual, and might be clinically important when designing adapted lifestyle intervention programs for the target group.
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| 10. |
- Holmlund, Tobias, et al.
(författare)
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Intensity of physical activity as a percentage of peak oxygen uptake, heart rate and Borg RPE in motor-complete para- and tetraplegia.
- 2019
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Ingår i: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 14:12
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The aims were to describe VO2peak, explore the potential influence of anthropometrics, demographics and level of physical activity within each cohort; b) to define common, standardized activities as percentages of VO2peak and categorize these as light, moderate and vigorous intensity levels according to present classification systems, and c) to explore how clinically accessible methods such as heart-rate monitoring and Borg rating of perceived exertion (RPE) correlate or can describe light, moderate and vigorous intensity levels.DESIGN: Cross sectional.SETTING: Rehabilitation facility and laboratory environment.SUBJECTS: Sixty-three individuals, thirty-seven (10 women) with motor-complete paraplegia (MCP), T7-T12, and twenty-six (7 women) with motor-complete tetraplegia (MCT), C5-C8.INTERVENTIONS: VO2peak was obtained during a graded peak test until exhaustion, and oxygen uptake during eleven different activities was assessed and categorized using indirect calorimetry.MAIN OUTCOME MEASURES: VO2peak, Absolute and relative oxygen consumption, Borg RPE.RESULTS: Absolute VO2peak was significantly higher in men than in women for both groups, with fairly small differences in relative VO2peak. For MCP sex, weight and time spent in vigorous-intensity activity explained 63% of VO2peak variance. For MCT sex and time in vigorous-intensity activity explained 55% of the variance. Moderate intensity corresponds to 61-72% HRpeak and RPE 10-13 for MCP vs. 71-79% HRpeak, RPE 13-14 for MCT.CONCLUSION: Using current classification systems, eleven commonly performed activities were categorized in relative intensity terms, (light, moderate and vigorous) based on percent of VO2peak, HRpeak and Borg RPE. This categorization enables clinicians to better guide persons with SCI to meet required physical activity levels.
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| 11. |
- Kerstin, Wahman, et al.
(författare)
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What promotes physical activity after spinal cord injury? : An interview study from a patient perspective
- 2006
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Ingår i: Disability and Rehabilitation. - : Informa Healthcare. - 0963-8288 .- 1464-5165. ; 28:8, s. 481-488
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Physical activity in people with traumatic spinal cord injury (SCI) is of importance not only for maintaining health but also for increasing the possibilities of living an independent life. Physical inactivity leads to poorer muscular and cardiovascular conditioning and sub-optimal levels of functioning. To help people with SCI to achieve optimum physical activity, it is important to understand what promotes the incorporation of regular physical activity into daily life. The aim of this study was thus to identify factors that may promote participation in physical activity among people with spinal cord injuries.METHOD: Qualitative multiple case studies. Sixteen participants with SCI were interviewed.RESULT: Four main themes of promoting factors could be identified. They were: using cognitive and behavioural strategies; finding supporting environmental solutions; exploring motivation post injury; and capturing new frames of reference.CONCLUSION: By utilising the motivational power of role models, together with the other motivational factors identified in this study, such as identifying relevant individual motives post injury and capturing new frames of reference, the process towards physical active life may be facilitated.
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| 12. |
- Lindberg, Thomas, et al.
(författare)
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Effects of seated double-poling ergometer training on aerobic and mechanical power in individuals with spinal cord injury
- 2012
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 44:10, s. 893-898
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To determine whether regular interval training on a seated double-poling ergometer can increase physical capacity and safely improve performance towards maximal level in individuals with spinal cord injury.METHODS: A total of 13 subjects with spinal cord injury (injury levels T5-L1) performed 30 sessions of seated double-poling ergometer training over a period of 10 weeks. Sub-maximal and maximal double-poling ergometer tests were performed before (test-retest) and after this training period. Oxygen uptake was measured using the Douglas Bag system. Three-dimensional kinematics were recorded using an optoelectronic system and piezoelectric force sensors were used to register force in both poles.RESULTS: The mean intra-class correlation coefficient for test-retest values was 0.83 (standard deviation 0.11). After training significant improvements were observed in people with spinal cord injury in oxygen uptake (22.7%), ventilation (20.7%) and blood lactate level (22.0%) during maximal exertion exercises. Mean power per stroke and peak pole force increased by 15.4% and 23.7%, respectively. At sub-maximal level, significantly lower values were observed in ventilation (-12.8%) and blood lactate level (-25.0%).CONCLUSION: Regular interval training on the seated double-poling ergometer was effective for individuals with spinal cord injury below T5 level in terms of improving aerobic capacity and upper-body power output. The training was safe and did not cause any overload symptoms.
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| 13. |
- Norrbrink, Cecilia, et al.
(författare)
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Effects of an exercise programme on musculoskeletal and neuropathic pain after spinal cord injury - results from a seated double-poling ergometer study
- 2012
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Ingår i: Spinal Cord. - : Nature Publishing Group. - 1362-4393 .- 1476-5624. ; 50:6, s. 457-461
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To assess pain relieving effects of an intensive exercise programme on a seated double-poling ergometer in individuals with spinal cord injury (SCI).SETTING: Stockholm, Sweden.METHODS: A total of 13 wheelchair-dependent individuals with a thoracic or lumbar SCI were recruited to a 10-week training period (three times weekly) assessing the effects of regular training on upper-body strength, aerobic and mechanical power, and crossover effects on functional performance, as well as cardiovascular risk factors. Eight of the participants reported pain and were included in this exploratory pain protocol and assessed using the International SCI Basic Pain Data set, the Wheelchair Users' Shoulder Pain Index and International SCI Quality of Life Basic Data set.RESULTS: For those with neuropathic pain, median pain intensity ratings decreased from 5 on a 0-10 numerical rating scale at base-line to 3 at the end of study, and four of seven participants reported an improvement on the Patient Global Impression of Change scale. For those with musculoskeletal pain (n = 5), median pain intensity ratings improved from 4 at baseline to 0 at the end of study. All but one rated no musculoskeletal pain at all at the end of study and number of days with pain per week decreased from 5.5 to 0.7. None of the participants developed pain, because of overuse during the training period and few reported unwanted side effects.CONCLUSION: Considering its promising effects and safety, an intensive exercise programme can be tried for treating musculoskeletal pain and also neuropathic pain following SCI.
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| 14. |
- Roaldsen, Kirsti Skavberg, et al.
(författare)
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Pediatric spinal cord injury rehabilitation : A protocol for an international multicenter project (SINpedSCI)
- 2022
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Ingår i: Journal of Pediatric Rehabilitation Medicine. - : IOS Press. - 1874-5393 .- 1875-8894. ; 15:2, s. 395-403
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Children and adolescents (<18 years old) who sustain a spinal cord injury (SCI) should ideally be managed in specialized rehabilitation services. This project aims to describe the organization of pediatric SCI in ten rehabilitation units in seven countries and to qualitatively explore psychosocial aspects of adolescents living with SCI. METHODS: A multicenter cross-sectional project is planned, using quantitative (web survey) and qualitative (interview) methods in ten rehabilitation units from Norway, Sweden, United States, Israel, PR China, Russia and Palestine. Individual interviews will be conducted with >= 20 adolescents aged 13-17 years at least 6 months post rehabilitation. RESULTS: Units involved will be described and compared, according to funding, attachment to an acute SCI unit, catchment area, number of beds, admittance and discharge procedures, availability of services, staff/patient ratio, content and intensity of rehabilitation programs, length of stay, measurement methods, follow-up services, health promotion services, and pediatric SCI prevention acts. The semi-structured interview guide will include experiences from acute care and primary rehabilitation, daily life, school, contact with friends, leisure time activities, peers, physical and psychological health, and the adolescents plans for the future. CONCLUSION: Based on the present protocol, this project is likely to provide new insight and knowledge on pediatric SCI rehabilitation and increase the understanding of pediatric SCI in adolescents and their families internationally.
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| 15. |
- Wahman, Kerstin
(författare)
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Cardiovascular disease prevention after spinal cord injury : a new challenge
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Spinal cord injury (SCI) typically leads to permanent infralesional motor and sensory functional losses, pathophysiological aberrations in most organ systems and a lasting vulnerability for a variety of complicating conditions. Improvements in acute and rehabilitative management during the last decades have increased long term survival after SCI. Additionally, older persons now sustain and survive SCI. Thus, aging-related issues after SCI have arisen for the first time in history. One such issue is cardiovascular disease (CVD), which now has emerged as a leading cause of morbidity and mortality in subjects with chronic SCI. However, it is not clear whether this reflects persons with SCI constituting a true high-risk population for CVD, or whether the epidemiological shifts merely reflect a normalization of the morbidity and mortality pattern due to the current increasingly effective management of previous SCI-specific causes of disease and death in this patient population. The overall aim of the thesis was to assess and explore the need for CVD prevention after SCI, and also to compare CVD risk in this population with that of the general population. One hundred thirty-five participants (88 % of the total regional cohort), with traumatic wheelchair dependent paraplegia were assessed regarding CVD risk and was also compared with that of the general population (papers II-IV). Additionally, persons with paraplegia (n=8/16) and tetraplegia (n=8/16) were interviewed for the purpose of identifying facilitating factors for physical activity after SCI. Wheelchair-dependent persons with traumatic paraplegia had an 8,5-fold increased prevalence of myocardial infarction as well as increased prevalence of dyslipidemia (83.1 %), hypertension (39.3%) and diabetes mellitus/impaired fasting glucose (10%). Further, 66-75% of subjects were overweight according adjusted BMI scores. An extensive clustering of cardiovascular risk factors according to authority guidelines was found. From a future intervention perspective, among others the following promoting factors to increase physical activity were identified; to gain and maintain independence, accepting assistance, finding environmental solutions, learning to live with narrower margins. Further, to have a role model and to be a role model was also important. Conclusions: There is a high and increased CVD risk in persons with chronic wheelchair dependent paraplegia. Thus, regular CVD screening is indicated. CVD prevention including therapeutic lifestyle intervention needs to be developed, evaluated and then systematically implemented. Lifestyle interventions need to be tailored to the specific needs of this patient group.
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| 16. |
- Wahman, Kerstin, et al.
(författare)
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Cardiovascular disease risk and the need for prevention after paraplegia determined by conventional multifactorial risk models : the Stockholm spinal cord injury study
- 2011
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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 .- 1650-1977. ; 43:3, s. 237-242
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To assess the need for intervention on cardio-vascular disease risks in persons with paraplegia according to: (i) two multifactorial risk models; and (ii) these models in combination with the additional risk of overweight/obesity.DESIGN: Cross-sectional.SUBJECTS: A total of 134 out of 153 persons, comprising more than 80% of a regional prevalence population with traumatic paraplegia (American Spinal Injury Association Impairment Scale A-C) of minimum one year duration.METHODS: Participants were screened for cardiovascular disease risk using two multifactorial risk models: the Systematic Coronary Risk Evaluation and the Framingham Risk Equation. Risk factors included were: age, gender, systolic blood pressure, antihypertensive medication, smoking, total cholesterol, high-density lipoprotein cholesterol, and total cholesterol/total cholesterol ratio. In addition, overweight/obesity was assessed by body mass index.RESULTS: Twenty-seven percent to 36% of the cohort was eligible for cardiovascular disease risk intervention, depending on the risk model used. When overweight/obesity (spinal cord injury adjusted cut-score body mass index ≥ 22) was also considered, over 80% of the participants qualified for intervention.CONCLUSION: Almost one-third of persons with paraplegia were eligible for cardiovascular disease risk intervention according to authoritative assessment tools. The number in need of intervention was dramatically increased when overweight/obesity as a cardiovascular disease risk was considered.
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| 17. |
- Wahman, Kerstin, et al.
(författare)
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Cardiovascular disease risk factors in persons with paraplegia : the Stockholm spinal cord injury study
- 2010
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 42:3, s. 272-278
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To examine cardiovascular disease risk factors and risk clusters in Swedish persons with traumatic wheelchair-dependent paraplegia.DESIGN: Prospective examination.SUBJECTS: A total of 135 individuals aged 18-79 years with chronic (>or= 1 year) post-traumatic paraplegia.METHODS: Cardiovascular disease risk factors; dyslipidemia, impaired fasting glucose, hypertension, overweight, smoking, and medication usage for dyslipidemia, hypertension, and diabetes mellitus, were analyzed according to authoritative guidelines. Stepwise regression tested the effects of age, gender, and injury characteristics on cardiovascular disease risks.RESULTS: High-prevalence risk factors were dyslipidemia (83.1%), hypertension (39.3%), and overweight (42.2%) with pervasive clustering of these risks. Being older was related to increased cardiovascular disease risk, except for dyslipidemia. Hypertension was more common in low-level paraplegia. Prevalence of impaired fasting glucose was lower than previously reported after paraplegia. A high percentage of persons being prescribed drug treatment for dyslipidemia and hypertension failed to reach authoritative targets for cardiovascular disease risk reduction.CONCLUSION: Swedish persons with paraplegia are at high risk for dyslipidemia, hypertension, and overweight. Impaired fasting glucose was not as common as reported in some previous studies. Pharmacotherapy for dyslipidemia and hypertension often failed to achieve recommended targets. Population-based screening and therapeutic countermeasures to these cardiovascular disease risks are indicated.
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| 18. |
- Wahman, Kerstin, et al.
(författare)
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Hälsoboken : en guide för dig som lever länge med ryggmärgsskada
- 2006
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Bok (övrigt vetenskapligt/konstnärligt)abstract
- This book, written in Swedish, is specifically directed at the person with a spinal cord injury (SCI), wishing to know how to promote a healthy lifestyle in the face of living with a life-long disability. A more recent book by Kerstin Wahman and Annacarin Lagerström - available in Swedish and in English - incorporates most if not all of the messages in this book, and is thus to be recommended. Still, I feel proud to having had the opportunity to help putting lifestyle issues "on the map" for SCI, as this without a doubt is a high risk group for lifestyle-related morbidity (and mortality) due to an increased vulnerability. This important fact has been all-too-long neglected, at the peril of the patients.
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| 19. |
- Wahman, Kerstin, et al.
(författare)
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Increased cardiovascular disease risk in Swedish persons with paraplegia : the Stockholm spinal cord injury study
- 2010
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 42:5, s. 489-492
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Comparison of prevalence of cardiovascular disease risks in persons with chronic traumatic paraplegia with those in the general population.DESIGN: Cross-sectional comparative study.SUBJECTS: A total of 135 individuals, age range 18-79 years, with chronic (> or = 1 year) traumatic paraplegia.METHODS: The prevalences of diabetes mellitus, dyslipidaemia, hypertension, overweight, and smoking, were assessed in the study population and were compared with an age- and gender-matched sample of the general population in the region under study. History of myocardial infarction and medication for dyslipidaemia, hypertension, and diabetes mellitus were also recorded. chi2 tests were used to compare the paraplegic cohort with the general population sample.RESULTS: Significantly more persons with paraplegia reported a history of myocardial infarction (5.9%) than those in the comparison group (0.7%). The prevalences of diabetes mellitus (5.9%), dyslipidaemia (11.1%), and hypertension (14.1%) were also significantly higher in the paraplegic group, as were drug treatment for these disorders.CONCLUSION: Persons with paraplegia report increased prevalences of diabetes mellitus, hypertension, and dyslipidaemia, in particular, compared with the general population. Population-based screening and therapeutic counter-measures for these conditions may therefore be particularly indicated for this patient group.
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| 20. |
- Wahman, Kerstin, et al.
(författare)
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Translation and validation of two International Spinal Cord Injury (SCI) Data Sets : a modified process
- 2019
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Ingår i: Spinal Cord Series and Cases. - : Springer Nature. - 2058-6124. ; 5:1
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Tidskriftsartikel (refereegranskat)abstract
- Study design: A descriptive design was used of a reflective process of problem solving among individuals working together to improve the process of translating.Setting: Sweden.Objectives: The aim of this study was to describe a modified process for translation and validation of the International Spinal Cord Injury (SCI) Quality of Life (QoL) and Activity and Participation (A&P) Basic Data Sets from English into Swedish.Methods: The process of translation followed the Executive Committee for the International SCI Standards and Data Sets (ECSCI) recommendations. The initial translation was performed by translators. Experts in SCI were then assembled to scrutinize the translations and to reach a consensus for defining a final version.Results: The whole process was time consuming. To save time in future translations, the start-up planning is of great importance. To identify appropriate participants with knowledge and interest to be part of the project is crucial. In addition, the consensus meetings, when scrutinizing the translated International SCI Data Sets, should be well prepared and structured. We identified a few steps that could make the process more efficient.Conclusions: By adding a few steps as well as defining the role of a project coordinator, we believe that future translations of the International SCI Data Sets for non-English-speaking countries could be facilitated.
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