| 1. |
- Kehoe, Laura, et al.
(författare)
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Make EU trade with Brazil sustainable
- 2019
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Ingår i: Science. - : American Association for the Advancement of Science (AAAS). - 0036-8075 .- 1095-9203. ; 364:6438, s. 341-
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 2. |
- Alt Murphy, Margit, 1970, et al.
(författare)
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Kinematic analysis using 3D motion capture of drinking task in people with and without upper-extremity impairments
- 2018
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Ingår i: Journal of Visualized Experiments. - : MyJove Corporation. - 1940-087X. ; :133
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Tidskriftsartikel (refereegranskat)abstract
- Kinematic analysis is a powerful method for objective assessment of upper extremity movements in a three-dimensional (3D) space. Three-dimensional motion capture with an optoelectronic camera system is considered as golden standard for kinematic movement analysis and is increasingly used as outcome measure to evaluate the movement performance and quality after an injury or disease involving upper extremity movements. This article describes a standardized protocol for kinematic analysis of drinking task applied in individuals with upper extremity impairments after stroke. The drinking task incorporates reaching, grasping and lifting a cup from a table to take a drink, placing the cup back, and moving the hand back to the edge of the table. The sitting position is standardized to the individual's body size and the task is performed in a comfortable self-paced speed and compensatory movements are not constrained. The intention is to keep the task natural and close to a real-life situation to improve the ecological validity of the protocol. A 5-camera motion capture system is used to gather 3D coordinate positions from 9 retroreflective markers positioned on anatomical landmarks of the arm, trunk, and face. A simple single marker placement is used to ensure the feasibility of the protocol in clinical settings. Custom-made Matlab software provides automated and fast analyses of movement data. Temporal kinematics of movement time, velocity, peak velocity, time of peak velocity, and smoothness (number of movement units) along with spatial angular kinematics of shoulder and elbow joint as well as trunk movements are calculated. The drinking task is a valid assessment for individuals with moderate and mild upper extremity impairment. The construct, discriminative and concurrent validity along with responsiveness (sensitivity to change) of the kinematic variables obtained from the drinking task have been established. © 2018 Journal of Visualized Experiments.
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| 3. |
- Kristersson, Therese, et al.
(författare)
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Evaluation of a short assessment for upper extremity activity capacity early after stroke.
- 2019
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Ingår i: Journal of rehabilitation medicine. - : Medical Journals Sweden AB. - 1651-2081 .- 1650-1977. ; 51:4, s. 257-263
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Tidskriftsartikel (refereegranskat)abstract
- To explore the concurrent validity, responsiveness, and floor- and ceiling-effects of the 2 items of Action Research Arm Test (ARAT-2) in comparison with the original ARAT and the Fugl-Meyer Assessment for Upper Extremity (FMA-UE) during the first 4 weeks post-stroke.A prospective longitudinal cohort study.A non-selected cohort of 117 adults with first-ever stroke and impaired upper extremity function.The activity capacity and motor function was assessed with ARAT and FMA-UE at 3 days, 10 days and 4 weeks post-stroke.Correlation between ARAT-2 and the other assessment scales was high (r=0.920.97) and ARAT-2 showed statistically significant changes between all time-points (effect size, r=0.310.48). The effect sizes for the change in ARAT and FMA-UE varied from 0.44 to 0.53. ARAT-2, similarly to ARAT, showed a floor effect at all time-points. The ceiling effect was reached earlier using ARAT-2 than with ARAT and FMA-UE.ARAT-2 appears to be valid and a responsive short assessment for upper extremity activity capacity, and suitable for use in the acute stage after stroke. However, when the highest score has been reached, the assessment needs to be complemented with other instruments.
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| 4. |
- Mühr, Oscar, 1989, et al.
(författare)
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Long-term outcome after reperfusion-treated stroke.
- 2017
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977. ; 49:4, s. 316-321
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Tidskriftsartikel (refereegranskat)abstract
- To explore motor function, health-related quality of life and impact on activities of daily living 5 and 6 years after reperfusion treatment in patients with stroke.A total of 75 patients with first-time stroke received either thrombectomy or thrombolytic treatment at the Sahlgrenska University Hospital in Gothenburg during an 18-month period in 2009-2010. Follow-up involved questionnaires and clinical examinations, 5 and 6 years post-stroke. The results were compared with an individually matched reference group.At follow-up 54 persons with reperfusion-treated stroke were alive, of whom 31 (57%) answered the questionnaires and 16 agreed to a clinical examination. The Stroke Impact Scale showed impact in several areas, with the emotion domain being the most affected. The reperfusion-treated group reported significantly better strength and hand function compared with the reference group. Of those clinically examined, 44% were dependent in activities of daily living and 38% had cognitive impairment.Long-term outcome after reperfusion treatment is relatively good, with treated individuals having better strength and hand function compared with a reference group. However, emotional and cognitive problems persist and need to be addressed.
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| 5. |
- Olsson, Ola A., et al.
(författare)
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Early prediction of physical activity level 1 year after stroke: A longitudinal cohort study
- 2017
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Ingår i: Bmj Open. - : BMJ. - 2044-6055. ; 7:8
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Tidskriftsartikel (refereegranskat)abstract
- Objective To investigate which variables present prior and early after stroke may have an impact on the level of physical activity (PA) 1 year poststroke. Design Prospective longitudinal cohort and logistic regression analysis. Setting Stroke Unit at Sahlgrenska University Hospital, Gothenburg, Sweden. Participants 117 individuals as part of the Stroke Arm Longitudinal Study (SALGOT) admitted to the stroke unit during a period of 18 months were consecutively recruited. The inclusion criteria were: First-time stroke, impaired upper extremity function, admitted to the stroke unit within 3 days since onset, local residency and ≥18 years old. The exclusion criteria were: Upper extremity condition or severe multi-impairment prior to stroke, short life expectancy and non-Swedish speaking. 77 participants followed up at 1 year poststroke were included in the analysis. Primary outcome PA level 1 year after stroke was assessed using a 6-level Saltin-Grimby Scale, which was first dichotomised into mostly inactive or mostly active and second into low or moderate/high level of PA. Results Being mostly inactive 1 year after stroke could be predicted by age at stroke onset (OR 1.07, 95% CI 1.00 to 1.13, p=0.041), functional dependency at discharge (OR 7.01, 95% CI 1.73 to 28.43, p=0.006) and prestroke PA (OR 7.46, 95% CI 1.51 to 36.82, p=0.014). Having a low level of PA 1 year after stroke could be predicted by age at stroke onset (OR 1.13, 95% CI 1.06 to 1.21, p<0.001) and functional dependency at discharge (OR 3.62, 95% CI 1.09 to 12.04, p=0.036). Conclusions Previous low level of PA, older age and functional dependency all provided value in predicting low PA 1 year after stroke. These results indicate that age and simple clinical evaluations early after stroke may be useful to help clinicians identify persons at risk of being insufficiently active after stroke. Further research is needed to clarify if these findings may apply to the large population of stroke survivors. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017.
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| 6. |
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| 7. |
- Opheim, Arve, 1962, et al.
(författare)
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Is upper-limb sensorimotor function or spasticity the best predictor for spasticity one year poststroke?
- 2015
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Ingår i: World Conference in Physical Therapy, Singapore; 05/2015.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- ABSTRACT: Background: Clinical assessments of body functions are an important part of physiotherapy practice poststroke. These assessments are used to plan treatments, and may be used to indicate future function. Upper limb spasticity has been found to be associated with poorer motor function and muscle strength, pain and higher dependence in daily life. Therefore, the identification of patients at risk of developing spasticity may be important. Whether sensorimotor function or spasticity during the first month is the better predictor for spasticity after 1 year is unknown. Purpose: The aim was to investigate whether sensorimotor function or spasticity assessed 4 weeks poststroke was the better predictor for spasticity after 1year. Methods: One hundred and seventeen patients in Gothenburg, Sweden, with first ever stroke and impaired upper-limb function on day 3 was included in this study. The clinical assessments were made 4 weeks and 1 year poststroke. Sensorimotor function was assessed with Fugl-Meyer Upper Extremity scale (FMA-UE), and higher score indicate better function (0-66). Spasticity in elbow flexors and extensors, wrist flexors and extensors, was assessed with the modified Ashworth Scale (MAS), with higher score indicating more spasticity (0-5). The MAS score was dichotomized into: 0=no spasticity and ≥1=spasticity present, and spasticity in any of these muscle groups was regarded as spasticity present. Univariate and multivariate logistic regression analysis was used to analyze the predictors, and odds ratio and 95% were calculated. Results: In univariate analysis, both FMA-UE and MAS were significantly associated with spasticity at one year poststroke. I the multivariate analysis, only FMA-UE (OR 0.91, 95%CI: 0.88-0.95) and age (OR 0.94, 95% CI: 0.89-0.99), was significant predictors for spasticity at 1 year post stroke. Conclusion(s): When both MAS and FMA-UE was analyzed together and controlled for in a multivariate regression analysis, only FMA-UE was significantly associated with spasticity after 1 year. Better sensorimotor function was associated with reduced OR for spasticity. Also, higher age had reduced OR for spasticity. This may imply that upper limb spasticity at 4 weeks poststroke may still be an “unstable” impairment, and not yet manifest. Therefore, sensorimotor function seems to be a better predictor than spasticity 4 weeks after for spasticity one year poststroke. Implications: Poorer sensorimotor function was associated with long-term spasticity and therefore important to assess in the first month poststroke. Assessment of spasticity within the first month to predict long-term spasticity poststroke may be limited. Keywords: Stroke, spasticity, sensorimotor function, clinical assessment scales.
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| 8. |
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| 9. |
- Palstam, Annie, 1981, et al.
(författare)
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Work-related predictors for return to work after stroke.
- 2019
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Ingår i: Acta neurologica Scandinavica. - : Hindawi Limited. - 1600-0404 .- 0001-6314. ; 139:4, s. 382-388
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Tidskriftsartikel (refereegranskat)abstract
- Disability due to stroke imposes a large burden on individuals, and on society, in terms of impaired work ability and sick leave. The reported return to work (RTW) rate after stroke varies globally and is influenced by a range of different aspects. The aim of this study was to investigate the influence of work-related factors on time to RTW after stroke, and possible differences between the sexes.Data from 204 persons with first-time stroke in the years 2009-2010 in Gothenburg, Sweden, who were of working age and had worked prior to their stroke, were analysed. Disease-related characteristics were retrieved from medical records, and work-related- and socio-economic data were collected up to 6years post-stroke from Statistics Sweden and the Swedish Social Insurance Agency. Cox regression was used to analyse predictors for time to RTW.We identified qualified occupation and large organizational size as work-related predictors for shorter time to RTW after stroke. Being male predicted a faster and higher frequency of RTW. Qualified occupation predicted shorter time to RTW in men but not in women. For women, the only predictor for RTW was physical dependency at discharge.Type of work and organizational size are work-related factors of importance for RTW after stroke. Work-related factors were important for RTW in men, but not in women. Reasons for differences between men and women in work-related factors that influence RTW need to be further investigated to better understand how to support women in the RTW process.
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| 10. |
- Persson, Hanna C, 1979, et al.
(författare)
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A cohort study investigating a simple, early assessment to predict upper extremity function after stroke - a part of the SALGOT study
- 2015
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Ingår i: Bmc Neurology. - : Springer Science and Business Media LLC. - 1471-2377. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- Background: For early prediction of upper extremity function, there is a need for short clinical measurements suitable for acute settings. Previous studies demonstrate correct prediction of function, but have ether included a complex assessment procedure or have an outcome that does not automatically correspond to motor function required to be useful in daily activity. The purpose of this study was to investigate whether a sub-set of items from the Action Research Arm Test (ARAT) at 3 days and 1 month post-stroke could predict the level of upper extremity motor function required for a drinking task at three later stages during the first year post-stroke. Methods: The level of motor function required for a drinking task was identified with the Fugl-Meyer Assessment for Upper Extremity (FMA-UE). A structured process was used to select ARAT items not requiring special equipment and to find a cut-off level of the items' sum score. The early prognostic values of the selected items, aimed to determine the level of motor function required for a drinking task at 10 days and 1 and 12 months, were investigated in a cohort of 112 patients. The patients had a first time stroke and impaired upper extremity function at day 3 after stroke onset, were >= 18 years and received care in a stroke unit. Results: Two items, "Pour water from glass to glass" and "Place hand on top of head", called ARAT-2, met the requirements to predict upper extremity motor function. ARAT-2 is a sum score (0-6) with a cut-off at 2 points, where >2 is considered an improvement. At the different time points, the sensitivity varied between 98 % and 100 %, specificity between 73 % and 94 %. Correctly classified patients varied between 81 % and 96 %. Conclusions: Using ARAT-2, 3 days post-stroke could predict the level of motor function (assessed with FMA-UE) required for a drinking task during the first year after a stroke. ARAT-2 demonstrates high predictive values, is easily performed and has the potential to be clinically feasible.
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| 11. |
- Persson, Hanna C, 1979, et al.
(författare)
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A cross sectional study of upper extremity strength ten days after a stroke; relationship between patient-reported and objective measures
- 2015
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Ingår i: Bmc Neurology. - : Springer Science and Business Media LLC. - 1471-2377. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- Background: Reduced upper extremity function early after a stroke is common, and a combination of strength capacity and patient-reported measures contribute to setting realistic goals. The validity of the patient's perception of upper extremity strength in relation to objective strength assessments early after a stroke needs to be clarified. The objective was to investigate the relationship between perceived upper extremity strength and measured hand strength at ten days post-stroke. Methods: This study of 99 patients with reduced upper extremity function at 3 days post stroke, were consecutively included from a stroke unit to the Stroke Arm Longitudinal Study at the University of Gothenburg, (the SALGOT-study). The correlations between two questions from the Stroke Impact Scale (SIS 1a and 1b), and a dynamometer measure of hand strength values (percentage of normative values) were investigated. In order to explain differences between the two types of measurements, the accordance between perceived strength in a dichotomized SIS and objective measures was explored. In SIS 1a and 1b, 1-3 points correspond to reduced strength (<80 % or normative strength values). In SIS 1a and 1b, 4-5 points correspond to normal strength (>= 80 % of normative strength values). Results: The correlation between the measured strength values and perceived arm strength was rho 0.82 (p = < 0.001) and with perceived grip strength rho 0.87 (p = < 0.001). Using the dichotomized SIS and the 80 % cut-off correctly classified arm strength in 81 % and grip strength in 84 % of the patients, with a sensitivity of 0.86-0.87, a specificity of 0.62-0.77, positive predicted values of 0.87-0.91 and negative predicated values of 0.64-0.67. Discussion: The discrepancy between assessed strength capacity and self-perceived strength highlights the importanceof including self-perceived assessments early after stroke, in order to increase knowledge of a patient'sawareness of functioning or lack thereof. Conclusions: Ten days after stroke in patients without severe cognitive disabilities, this study suggests that despite high correlations between measures, an objective assessment of arm and hand strength does not always reflect the patient's perspective. A combination of self-reported and objective strength assessment is requested to enhance in setting of realistic goals early after stroke.
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| 12. |
- Persson, Hanna C, 1979, et al.
(författare)
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Consequences and coping strategies six years after a subarachnoid hemorrhage - A qualitative study
- 2017
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Ingår i: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 12:8
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Tidskriftsartikel (refereegranskat)abstract
- Background After a subarachnoid haemorrhage (SAH), continuing impairment is common and may impact the person's life. There is a lack of knowledge regarding long-term consequences experienced. To explore experiences of the care and rehabilitation as well as the consequences and strategies used to cope with everyday life six years post SAH. An explorative interview study with a qualitative design. Individual interviews, with open ended questions, using an interview guide were performed with sixteen participants (mean age 63, 8 men, 8 women) six years post SAH. Data was analyzed according to a descriptive thematic analysis, and themes were discovered inductively. Two major themes from the analysis, both including four sub-themes, were identified; these themes were consequences of the SAH and coping strategies. Participants were grateful to have survived the SAH and most were satisfied with their acute medical care. If discharged directly from the neurosurgical unit participants can feel abandoned. In contrast, participants who were referred to a rehabilitation clinic felt supported and informed. Cognitive problems, such as impaired memory and mental fatigue, were reported as still present six years post SAH. Coping strategies were; receiving support from family, society, employers, or technical equipment. At work, talking to colleagues and to taking breaks were common. Participants described hiding their symptoms from employers and friends, as well as trying to continue doing tasks in the same manner as prior to the SAH. If this was not possible, some refrained from doing these tasks. They went through a mourning process, fear, and worries. Participants reported several long-term consequences which impacted on their daily lives post SAH, and different coping strategies were used to cope with these problems. Participants reported lack of awareness regarding the consequences of SAH and stressed the importance of structured multidisciplinary follow-ups, which mostly is missing.
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| 13. |
- Persson, Hanna C, 1979, et al.
(författare)
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Differences in recovery of upper extremity functioning after ischemic and hemorrhagic stroke – part of the SALGOT study.
- 2016
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Ingår i: 2nd European Stroke Organisation Conference, 10-12 May, 2016, Barcelona, Spain.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background It is unclear if and how the type of stroke influences the recovery of motor function after stroke. The purpose was to assess if there are differences in extent of change in upper extremity motor function and activity capacity, in persons with ischemic versus hemorrhagic stroke during the first year post stroke. Methods 117 persons with stroke (ischemic n=98, hemorrhagic n=19) and reduced upper extremity function 3 days after onset were consecutively included to the Stroke Arm Longitudinal Study at the University of Gothenburg (SALGOT) from a stroke unit. Upper extremity motor function and activity capacity were assessed at 6 time points during the first year; age and initial stroke severity were recorded. Possible differences between groups in extent of change over time of upper extremity motor function and activity capacity were analyzed with the Mixed models repeated measurements. Results Significant improvements were present in function and activity in both groups within the first month (p= 0.001). Higher age and more severe stroke had a negative impact on recovery in both groups. Larger improvements of function and activity were seen in persons with hemorrhagic stroke, both from 3 days to 3 - and 12 months, and from 1 month to 3 months. Both groups reached similar level of function and activity at 3 months post stroke. Conclusions Poor initial motor function or activity capacity could mislead expertise and exclude persons with hemorrhagic stroke from further intensive rehabilitation.
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| 14. |
- Persson, Hanna C, 1979, et al.
(författare)
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Life situation 5years after subarachnoid haemorrhage
- 2018
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Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314. ; 137:1, s. 99-104
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesSubarachnoid haemorrhage (SAH) has high mortality and morbidity among survivors. SAH mainly affects young people and may result in long-term disabilities such as decreased Health-related Quality of Life (HRQoL), mental health and cognitive function. The aim of this study was to investigate the life situation 5years after a SAH including physical/emotional status, participation and HRQoL. Materials & MethodsIn this cross-sectional descriptive study, a mail survey was sent to all persons treated at a neurosurgery unit in Gothenburg, Sweden, for non-traumatic SAH in 2009-2010, approximately 5years post-SAH. The survey included questions regarding HRQoL; EuroQol 5-Dimensions (EQ-5D), the impact of the SAH; Stroke Impact Scale (SIS), Occupational Gaps Questionnaire and participation in society; Impact of Participation and Autonomy (IPA). ResultsForty-two 5year survivors were sent the survey, of whom 26 (62%) responded (59years old, range 33-85). The participants had generally low HRQoL and scored low in the domain of anxiety and depression. Many reported problems with emotions, fatigue, memory and executive function, but few problems with physical condition. However, nearly all participants reported to have an acceptable level of participation and 64% were independent in their daily life. ConclusionsIn this 5-year follow-up after SAH, the participants reported to have a greater number of hidden disabilities compared to physical problems, whereas most had acceptable participation in society. A yearly follow-up after a SAH could be suggested aiming to improving the cognitive and mental health.
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| 15. |
- Persson, Hanna C, 1979, et al.
(författare)
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Motor function in ischemic and hemorrhagic stroke during the first year
- 2015
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Ingår i: the World Confederation for Physical Therapy Congress 2015.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: Few studies have investigated motor function in the upper extremity in both ischemic or hemorrhagic stroke. Different recovery patterns in upper extremity motor function have clinically been described, but there is a lack of research. Purpose: To investigate differences in recovery of upper extremity motor function after ischemic or hemorrhagic stroke during the first year after a stroke. Methods: From the Stroke Arm Longitudinal Study at the Gothenburg University study, 45 people fulfilled eight assessment occasions during twelve months after a first ever stroke. People who had first ever stroke and reduced upper extremity function at day three post stroke were included in the study. Upper extremity motor function was investigated with the Fugl-Meyer Assessment for Upper Extremity (FMA-UE) at day 3, day 10, at 3, 4 and 6 weeks and at 3, 6 and 12 months. Descriptive statistics was used to present data, to compare differences between ischemic or hemorrhagic stroke, subgroup analyses were performed at every occasion using the Mann-Whitney U-tests. Results: Of 45 people, 33 had ischemic stroke, and twelve had hemorrhagic stroke. There was a crossover in mean level of upper extremity motor function, with lower level of function in people with hemorrhagic stroke compared to ischemic stroke from day three to one month. In one month to one year, the mean level of upper extremity function was higher for people with hemorrhagic stroke. No statistically significant differences in upper extremity motor function between the two groups were seen at any of the eight assessments during the first year after stroke. Conclusion(s): No significant differences were seen in upper extremity motor function between hemorrhage and ischemic stroke. On average those with hemorrhagic stroke seemed to have lower level of upper extremity motor function from day three to one month post stroke, but thereafter have a higher level compared to ischemic stroke. Implications: Based on this study, the implication could be that the rehabilitation of upper extremity motor function during the first year after a stroke, should not be changed due to if the patient have ischemic or hemorrhagic stroke, but should be individual based.
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| 16. |
- Persson, Hanna C, 1979, et al.
(författare)
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Motor function recovery in patients with ischemic versus hemorrhagic stroke during the first year
- 2015
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Ingår i: Nordic Stroke 2015. 18th Nordic Congress on Cerebrovascular Diseases. 26-28 August 2015, Malmö, Sweden.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background and purpose Few studies have investigated the recovery of motor function in the upper extremity according to the sub types ischemic and hemorrhagic stroke. Different recovery patterns in upper extremity motor function have clinically been described, but there is a lack of research. The purpose of the present study was to investigate possible differences in the recovery of upper extremity motor function in patients with ischemic versus intracerebral hemorrhagic stroke during the first year after a stroke. Materials and methods Patients with a first ever stroke and impaired upper extremity function 3 days after onset were consecutively included in the Stroke Arm Longitudinal Study at the Gothenburg University study during 2009-2011. Upper extremity function was investigated with the Fugl-Meyer Assessment for Upper Extremity (FMA-UE) at 3 and 10 days and at 1, 3, 6 and 12 months, age and initial stroke severity were assessed day 1. To compare changes over time in ischemic and hemorrhagic stroke, the Mixed model repeated measurement was used. A p-value <0.05 at was considered statistically significant. Results Of 117 patients, 98 had ischemic (mean 70 years), and 19 had hemorrhagic stroke (mean 62 years). A wide spread in upper extremity motor function recovery was seen. Statistically significant differences over the first year between ischemic and hemorrhagic stroke (interaction of type of stroke and time since onset, p= 0.001 at 3, 10 days and 1 month) were seen, where patients with ischemic stroke started at a higher FMA-UE level but at 3 months the two groups had approximately same level of motor function. Initial stroke severity and age had a significant impact on the recovery pattern. Conclusion Patients with ischemic stroke has during the first 3 months higher motor function and recover faster compared to hemorrhagic stroke. Thereafter no significant difference was seen. The type of stroke (ischemic or hemorrhagic) is of most relevance for the recovery process in the sub-acute phase, but still, the wide-ranging individual changes emphasizes the importance of individually based rehabilitation. Further studied are needed to confirm these results.
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| 17. |
- Persson, Hanna C, 1979, et al.
(författare)
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Symptoms and consequences of subarachnoid haemorrhage after 7years.
- 2019
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Ingår i: Acta neurologica Scandinavica. - : Hindawi Limited. - 1600-0404 .- 0001-6314. ; 140:6, s. 429-434
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Tidskriftsartikel (refereegranskat)abstract
- Short-term follow-up studies after a subarachnoid haemorrhage (SAH) have shown impaired cognition, fatigue, depression and anxiety, but less is known regarding long-term consequences. The aim of this study was to investigate health outcomes in persons 7years after SAH.This is a descriptive cohort follow-up study of persons with non-traumatic SAH treated at Sahlgrenska University Hospital, Gothenburg, Sweden. The follow-up was conducted 7years post-treatment and included home visits using forms and questionnaires about health outcomes; the Barthel Index (BI), modified Rankin Scale (mRS), National Institutes of Health Stroke Scale (NIHSS), Hospital Anxiety and Depression Scale (HADS), Montreal Cognitive Assessment (MoCA) and Multidimensional Fatigue Inventory (MFI).Seven years post-SAH, 33 persons fulfilled the inclusion criteria, of whom 18 (55%) participated (median age 63years). Cognitive impairment was present in 11 participants, assessed with the MoCA, where the item of delayed recall was most difficult. The majority (n=16) were independent in activities of daily living (ADL), and few (n=3) had physical symptoms according to the NIHSS. However, three participants were free from disability according to the mRS. Nearly, half of the participants had symptoms of anxiety (n=8). Three had symptoms of depression and more than half experienced fatigue.The physical function and independency in ADL is high among long-term SAH survivors. Despite this, only a few were completely free from disability, and the main problems 7years after SAH were cognitive impairment and anxiety.
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| 18. |
- Persson, Hanna C, 1979, et al.
(författare)
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Transport mobility 5years after stroke in an urban setting.
- 2018
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Ingår i: Topics in stroke rehabilitation. - : Informa UK Limited. - 1945-5119 .- 1074-9357. ; 25:3, s. 180-185
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Tidskriftsartikel (refereegranskat)abstract
- Background People after stroke may have residual problems with mobility that can affect their independence and mode of transport. However, there is limited knowledge about transport mobility several years after stroke. Objective The objective was to survey the outdoor mobility and transportation in an urban setting five years post-stroke. Method This cross-sectional study was based on a mail survey focusing on long-term consequences after stroke. The survey comprises a set of self-evaluated questionnaires and was sent to 457 persons, of whom 281 responded (61.5%). From the survey, items regarding transportation and mobility were selected and analyzed. Results A high level of mobility function was reported with regard to outdoor mobility and different modes of transport. However, one-fifth still reported problems with outdoor mobility and mode of transport. Some perceived barriers were reported, predominantly mobility aspects such as transfer to/from, and getting on/off specific transportation mode/s. The respondents reported some communication problems and cognitive impairments, but these were not reported as prominent barriers when using public transport. A total of 67% were active drivers and were more often men (p=0.002), younger (p≤0.001), and were less dependent at discharge from the acute hospital (p≤0.001). Conclusions Five years post-stroke, mobility problems were the dominant barrier reported when using transport modes. Individualized transport training is needed during rehabilitation to increase possibility to participate. Infrastructure and transportation planning should focus on older, women, and people with impairments to be able to facilitate the use of public transport and mobility.
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| 19. |
- Persson, Hanna C, 1979
(författare)
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Upper extremity functioning during the first year after stroke
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to investigate upper extremity functioning during the first year after stroke from different perspectives. Methods. All patients with first ever stroke, admitted to a stroke unit within 72 hours after stroke incidence were included during a period of 18 months. The prevalence of impaired upper extremity function was investigated within 72 hours. Differences in change over time in functioning (function and activity) between patients with ischemic and hemorrhagic stroke were explored. The possibility of a simple early assessment to predict the level of upper extremity motor function required for a drinking task was investigated, as well as the relationship between patient-perceived and assessed strength capacity. The studies are a part of the SALGOT-study (The Stroke Arm Longitudinal Study at the University of Gothenburg). Main results. Of patients admitted to a stroke unit, 48% had impaired upper extremity function within 72 hours after stroke onset. In patients with impaired upper extremity function initially, those with hemorrhagic stroke had a larger improvement from 1 to 3 months in their function and activity compared to patients with ischemic stroke. Patients with hemorrhagic and ischemic stroke improved function and activity to a similar level 3 months and thereafter. Two items from the Action Research Arm Test (ARAT) used at 3 days post stroke could accurately predict the level of motor function required for a drinking task at three later time points during the first year post stroke. Assessed grip strength capacity and perceived strength at 10 days post stroke correlated highly, but some patients rated their strength differently compared to the assessment of strength capacity. Conclusions and clinical implications. Fewer patients than previously described had impaired upper extremity function early after stroke which is of importance in planning of care and rehabilitation. In patients with impaired upper extremity function, larger improvements of function and activity were seen after 1 month in those patients with hemorrhagic stroke compared to ischemic, but both stroke types reached a similar level at 3 months post stroke. These results together with the finding that early prediction of function is possible, and that a combination of patient-reported and objective strength assessment early after stroke may be valuable in planning of care, rehabilitation and goal setting, and therefore improve the overall rehabilitation process.
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| 20. |
- Persson, Hanna C, 1979, et al.
(författare)
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Upper extremity recovery after ischaemic and haemorrhagic stroke: Part of the SALGOT study
- 2016
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Ingår i: European Stroke Journal. - : SAGE Publications. - 2396-9873 .- 2396-9881. ; 1:4, s. 310-19
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Tidskriftsartikel (refereegranskat)abstract
- Introduction The purpose was to explore if there are differences in extent of change in upper extremity motor function and activity capacity, in persons with ischaemic versus haemorrhagic stroke, during the first year post stroke. Patients and methods One hundred seventeen persons with stroke (ischaemic n=98, haemorrhagic n=19) and reduced upper extremity function 3 days after onset were consecutively included to the Stroke Arm Longitudinal Study at the University of Gothenburg (SALGOT) from a stroke unit. Upper extremity motor function (Fugl-Meyer Assessment Scale for Upper Extremity (FMA-UE)) and activity capacity (Action Research Arm Test (ARAT)) were assessed at 6 assessments during the first year; age and initial stroke severity were recorded. Differences between groups in extent of change over time of upper extremity motor function and activity capacity were analysed with mixed models repeated measurements method. Results Significant improvements were found in function and activity in both groups within the first month (p=0.001). Higher age and more severe stroke had a negative impact on recovery in both groups. Larger improvements of function and activity were seen in haemorrhagic stroke compared to ischaemic, both from 3 days to 3- and 12 months, and from 1 month to 3 months. Both groups reached similar levels of function and activity at 3 months post stroke. Conclusion Although persons with haemorrhagic stroke had initially lower scores than those with ischaemic stroke, they had a larger improvement within the first 3 months, and thereafter both groups had similar function and activity.
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| 21. |
- Skoglund, Erik, et al.
(författare)
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SELF-PERCEIVED IMPACT OF STROKE: A LONGITUDINAL COMPARISON BETWEEN ONE AND FIVE YEARS POST-STROKE
- 2019
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977. ; 51:9, s. 660-664
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate different aspects of self-perceived impact of stroke 1 and 5 years after stroke onset, with a focus on self-perceived participation. Design: Longitudinal cohort study. Participants: Forty-five persons diagnosed with first-time stroke included in the Stroke Arm Longitudinal study at University of Gothenburg (SALGOT). Methods: Participants responded to the Stroke Impact Scale, the Impact on Participation and Autonomy and the European Quality of Life 5 dimensions at 1 year and 5 years post-stroke. Wilcoxon signed-rank test was used to check for differences in changes over time between groups. Results: In general, the perceived consequences of stroke were more severe after 5 years compared with at 1 year. Strength, emotion and participation were the areas most affected, along with restrictions in social life and autonomy indoors. Global disability (mRS) was moderately correlated with quality of life. Conclusion: The perceived impact of stroke becomes more prominent with time, even for persons with mild-to-moderate stroke. This study highlights the need for long-term support for persons with stroke.
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| 22. |
- Snickars, Jenny, 1986, et al.
(författare)
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Early clinical predictors of motor function in the upper extremity one month post-stroke.
- 2017
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Ingår i: Journal of rehabilitation medicine. - : Medical Journals Sweden AB. - 1651-2081 .- 1650-1977. ; 49:3, s. 216-222
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Tidskriftsartikel (refereegranskat)abstract
- To investigate factors within 3 days post-stroke that could predict severe impairment in motor function in the upper extremity at one month post-stroke.This cross-sectional study included 104 patients with first-ever stroke and impaired motor function in the upper extremity. Initial impairment in motor function, demographic data, type of stroke and stroke risk factors were chosen as possible predictors. Severe impairment in motor function was defined as ≤ 31p according to the Fugl-Meyer Assessment for Upper Extremity (FMA-UE). Logistic regression was used to predict severe impairment in motor function at one month post-stroke.Three possible prediction models were found, comprising stroke severity combined with grip strength and sex, finger extension or shoulder abduction. Models including grip strength or finger extension gave the most accurate predictions, with overall predictive ability 90.4% (95% confidence interval (95% CI) 0.847-0.961) and sensitivity 92.9% (95% CI 0.851-1.0) and 90.5% (95% CI 0.816-0.979), respectively.Within 3 days post-stroke, severe impairment in motor function in the upper extremity at one month can be predicted using assessment of stroke severity in combination with grip strength, finger extension or shoulder abduction. This may facilitate early planning of rehabilitation for patients with impaired upper extremity in the stroke unit.
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| 23. |
- Svensson, Joel, et al.
(författare)
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Occupational gaps 5years after stroke.
- 2019
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Ingår i: Brain and behavior. - : Wiley. - 2162-3279. ; 9:3
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Tidskriftsartikel (refereegranskat)abstract
- To investigate the incidence and number of occupational gaps 5years after stroke and find possible predictors and explanatory factors for increased number of experienced gaps.The participants were diagnosed with first-time stroke in Gothenburg during 2009-2010. Medical records from their hospital stay were used to obtain baseline data. The Occupational Gaps Questionnaire and the Swedish stroke registers follow-up questionnaire were sent out. Data from the Occupational Gaps Questionnaire were used as a dependent variable and baseline data and questions from the stroke registry were used as independent variables in logistic regression.Five years poststroke, 49.5% experienced a higher number of occupational gaps compared to a healthy reference population. Predictors for an increased number of gaps were higher age at stroke onset and a higher degree of functional dependency. Explanatory factors for an increased number of gaps in the study population were higher age at follow-up and feelings of depression.Older age at the time of stroke and functional dependency can predict an increased number of occupational gaps. Older age and feelings of depression are connected to an increased number of occupational gaps. Individuals at risk should be provided with additional interventions to reduce participation restrictions.
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| 24. |
- ten Brink, Hanna, et al.
(författare)
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Do intraspecific or interspecific interactions determine responses to predators feeding on a shared size-structured prey community?
- 2015
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Ingår i: Journal of Animal Ecology. - : Wiley. - 0021-8790 .- 1365-2656. ; 84:2, s. 414-426
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Tidskriftsartikel (refereegranskat)abstract
- 1. Coexistence of predators that share the same prey is common. This is still the case in size-structured predator communities where predators consume prey species of different sizes (interspecific prey responses) or consume different size classes of the same species of prey (intraspecific prey responses). A mechanism has recently been proposed to explain coexistence between predators that differ in size but share the same prey species, emergent facilitation, which is dependent on strong intraspecific responses from one or more prey species. Under emergent facilitation, predators can depend on each other for invasion, persistence or success in a size-structured prey community. Experimental evidence for intraspecific size-structured responses in prey populations remains rare, and further questions remain about direct interactions between predators that could prevent or limit any positive effects between predators [e.g. intraguild predation (IGP)]. Here, we provide a community-wide experiment on emergent facilitation including natural predators. We investigate both the direct interactions between two predators that differ in body size (fish vs. invertebrate predator), and the indirect interaction between them via their shared prey community (zooplankton). Our evidence supports the most likely expectation of interactions between differently sized predators that IGP rates are high, and interspecific interactions in the shared prey community dominate the response to predation (i.e. predator-mediated competition). The question of whether emergent facilitation occurs frequently in nature requires more empirical and theoretical attention, specifically to address the likelihood that its pre-conditions may co-occur with high rates of IGP.
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| 25. |
- Thrane, Gyrd, et al.
(författare)
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Kinematic upper extremity performance in people with near or fully recovered sensorimotor function after stroke.
- 2019
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Ingår i: Physiotherapy Theory and Practice. - : Informa UK Limited. - 1532-5040 .- 0959-3985. ; 35:9, s. 822-832
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Tidskriftsartikel (refereegranskat)abstract
- Clinical scales for upper extremity motor function may not capture improvement among higher functioning people with stroke.To describe upper extremity kinematics in people with stroke who score within the upper 10% of the Fugl-Meyer Assessment (FMA-UE) and explore the ceiling effects of the FMA-UE.A cross-sectional study design was used.People with stroke were included from the Stroke Arm Longitudinal Study at University of Gothenburg together with 30 healthy controls. The first analysis included participants who achieved FMA-UE score > 60 within the first year of stroke (assessed at 3days, 2weeks, 4weeks, 3months, or 12 months post stroke). The second analysis included participants with submaximal FMA-UE (60-65 points, n=24) or maximal FMA-UE score (66 points, n=21) at 3 months post stroke.The kinematic analysis of a standardized drinking task included movement time, velocity and strategy, joint angles of the elbow, and shoulder and trunk displacement.The high FMA-UE stroke group showed deficits in seven of eight kinematic variables. The submaximal FMA-UE stroke group was slower, had lower tangential and angular peak velocity, and used more trunk displacement than the controls. In addition, the maximal FMA-UE stroke group showed larger trunk displacement and arm abduction during drinking and lower peak angular velocity of the elbow.Participants with near or fully recovered sensorimotor function after stroke still show deficits in movement kinematics; however, the FMA-UE may not be able to detect these impairments.
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| 26. |
- Törnbom, Karin, 1982, et al.
(författare)
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Self-Assessed Physical, Cognitive, and Emotional Impact of Stroke at 1 Month: The Importance of Stroke Severity and Participation
- 2017
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Ingår i: Journal of Stroke & Cerebrovascular Diseases. - : Elsevier BV. - 1052-3057. ; 26:1, s. 57-63
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Tidskriftsartikel (refereegranskat)abstract
- Objectives The aims of this study were to describe the self-assessed physical, emotional, and cognitive impact of stroke and to investigate associations with participation and stroke severity in early stage (1 month) poststroke. Methods Participants (n=104, mean age=68) with reduced upper extremity function assessed at day 3 were included from a Swedish stroke unit. Participants were evaluated with The National Institutes of Health Stroke Scale at arrival, median 7.9 (0-24). The cohort was assessed for their perceived impact of stroke with the Stroke Impact Scale at 1 month poststroke. Results The perceptions of emotional health, communication skills, and ability to remember were perceived as quite good, with a mean score of 83-86. However, nearly 60% reported limitations in participation. This group also evaluated their physical function to be significantly lower compared to participants who did not report limitations in participation. Conclusions One month poststroke, a lower score on self-assessed physical function was associated with both a perceived restriction in participation and a more severe stroke. The association of physical function and perceived participation at 1 month poststroke needs to be taken into account when planning the early rehabilitation.
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| 27. |
- Törnbom, Karin, 1982, et al.
(författare)
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The impact of physical functioning on participation in the first year post-stroke
- 2017
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Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314. ; 135:6, s. 649-655
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Tidskriftsartikel (refereegranskat)abstract
- Studies have investigated predictors of participation and showed that fewer depressive symptoms, physical independence, and age could predict the level of participation after stroke. Association between self-assessed functions and perceived levels of participation over time is not yet known. The aim of this study was to investigate perceptions of participation and how this related to background characteristics and self-assessed rehabilitation outcomes, at 1, 6, and 12 months post-stroke.
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| 28. |
- Vikholmen, K, et al.
(författare)
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Stroke treated at a neurosurgical ward: a cohort study.
- 2015
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Ingår i: Acta neurologica Scandinavica. - : Hindawi Limited. - 1600-0404 .- 0001-6314. ; 132:5, s. 329-336
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Tidskriftsartikel (refereegranskat)abstract
- Little is known about the long-term recovery of patients treated with neurosurgery after stroke. This study aimed to explore the recovery of patients with first-time stroke treated in a neurosurgical ward, including their function, the presence of disability and life situation at admission, discharge and 4years later.
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| 29. |
- Wesali, Sahar, 1982, et al.
(författare)
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Improved survival after non-traumatic subarachnoid haemorrhage with structured care pathways and modern intensive care.
- 2015
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Ingår i: Clinical neurology and neurosurgery. - : Elsevier BV. - 1872-6968 .- 0303-8467. ; 138, s. 52-58
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Tidskriftsartikel (refereegranskat)abstract
- Patients with subarachnoid haemorrhage (SAH) often require multidisciplinary management and their treatment is difficult to standardize. The aim was to describe baseline characteristics, care pathways and discharge status in an unselected group of patients with first ever non-traumatic SAH, and to examine whether their care pathways and outcomes vary.
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| 30. |
- Westerlind, Emma, 1992, et al.
(författare)
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Return to Work after a Stroke in Working Age Persons; A Six-Year Follow Up.
- 2017
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Ingår i: PloS one. - : Public Library of Science (PLoS). - 1932-6203. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- Stroke is one of the most common and resource intensive diseases for society. Stroke in the working age population is increasing in different parts of the world. An incomplete return to work (RTW) after sick leave post stroke entails negative consequences for the affected person and an economical burden for society. The aim of this study was to explore the RTW rate and factors associated with RTW in a six-year follow up post stroke.Data from 174 persons 63 years or younger, with first ever stroke in 2009-2010 in Gothenburg were analyzed. Baseline characteristics were collected through medical records and the Swedish Health Insurance Office provided information on sick leave up to 6 years post stroke. Time-to-event was presented and cox regression as well as logistic regression were used to analyze risk factors for no-RTW.The RTW rate was 74.7%, at the end of follow up. Participants continued to RTW until just over 3 years post stroke. Dependency at discharge (in the modified Rankin Scale) and sick leave prior to the stroke were significant risk factors for no-RTW after 1 year with odds ratio 4.595 and 3.585, respectively. The same factors were significant in time-to-event within six years post stroke with hazard ratio 2.651 and 1.929, respectively.RTW after a stroke is incomplete, however RTW is possible over a longer period of time than previously thought. More severe disability at discharge from hospital and sick leave prior to the stroke were shown to be risk factors for no-RTW. This knowledge can contribute to more individualized vocational rehabilitation.
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| 31. |
- Westerlind, Emma, 1992, et al.
(författare)
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Very early cognitive screening and return to work after stroke
- 2019
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Ingår i: Topics in Stroke Rehabilitation. - : Informa UK Limited. - 1074-9357 .- 1945-5119. ; 26:8, s. 602-607
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Tidskriftsartikel (refereegranskat)abstract
- Background: Stroke is a common cause of long-term disability worldwide, and an increasing number of persons affected by stroke are of working age. In addition to physical impairments, a majority of patients reportedly suffer cognitive impairments after stroke. Reduced cognitive function may hinder poststroke return to work (RTW); however, most studies of this relationship have assessed cognitive function months after the stroke. Objectives: The current study aims to investigate the degree of post-stroke RTW, and whether very early cognitive function screening can predict RTW after a stroke. Methods: This study included 145 persons treated for stroke at 18-63 years of age at a large university hospital in Sweden between 2011 and 2016. Data were retrieved from the GOTVED database. Within 36-48 h after hospital admission, cognitive function was screened using the Montreal Cognitive Assessment (MoCA). Full and partial RTW were assessed based on the Swedish Social Insurance Agency's register. Logistic regression was performed to analyze the potential predictors of RTW at 6 months and 18 months. Results: Neither global cognitive function nor executive function at 36-48 h after stroke predicted any degree of RTW at 6 or 18 months. Male sex, lower stroke severity, and not being on sick leave prior to stroke were significant predictors of RTW. Conclusions: Screening for cognitive impairments at 36-48-h post stroke is apparently too early for predicting RTW, and thus cannot be the sole basis for discharge planning after stroke. Additional research is needed to further analyze cognitive function early after stroke and RTW.
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| 32. |
- Westerlind, Emma, 1992, et al.
(författare)
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Working capacity after a subarachnoid haemorrhage: A six-year follow-up.
- 2017
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Ingår i: Journal of rehabilitation medicine. - : Medical Journals Sweden AB. - 1651-2081 .- 1650-1977. ; 49:9, s. 738-743
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Tidskriftsartikel (refereegranskat)abstract
- Subarachnoid haemorrhage can lead to long-term disabilities. It is a major health issue for the patient and can affect work capacity. The aim of this study was to investigate working capacity after subarachnoid haemorrhage from a long-term perspective, using data from national sick leave records. In addition, factors associated with working capacity were analysed.A retrospective cohort study.A consecutive total sample of 38 working-age participants with first-ever subarachnoid haemorrhage was included. Working capacity of the 30 participants not on early retirement prior to the subarachnoid haemorrhage was analysed.Working capacity was defined as no longer being registered on sick leave or early retirement in the Social Insurance Agency and not being age retired or deceased.Regain of working capacity continued until 2.5 years post-subarachnoid haemorrhage and 73% of the participants were deemed to have working capacity. Functional independence at discharge from hospital, and higher responsiveness at admittance were the main factors associated with an earlier regain of working capacity.Nearly three-quarters of subjects were deemed to have working capacity within 2.5 years post-subarachnoid haemorrhage with a non-self-reported outcome. This information will help to individualize rehabilitation for affected persons.
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