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- Langhammer, Birgitta, et al.
(författare)
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Bobath : et tolkningsdilemma for fysioterapeuter i neurologisk rehabilitering: en litteraturgjennomgang : Bobath konsept eller metode? : et tolkings dilemma i neurologisk rehabilitering blant fysioterapeuter.
- 2010
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Ingår i: Fysioterapeuten. - 0016-3384. ; 77:6, s. 2-11
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Tidskriftsartikel (refereegranskat)abstract
- Bakgrunn/hensikt: Det er rettet kritikk mot Langhammer og Stanghelles fortolkning og bruk av Bobathmetoden. Dette inspirerte til å se nærmere på de ulike tolkninger av Bobathmetoden/konseptet. Metode: En litteraturstudie ble gjort i MEDLINE og BIBSYS på definisjon av Bobathmetoden/konseptet. I tillegg ble det gjennomført håndsøk på samme nøkkelord i bøker og fagartikler rundt tema. Resultat: Det ble funnet seks ulike tolkninger av Bobathmetoden: 1) Bobaths bok, 2) Langhammer og Stanghelles tolkning i hovedfagsoppgave og artikkel, 3) Lennons undersøkelse blant Bobathterapeuter, 4) Raines undersøkelse blant Bobathinstruktører, 5) Gjelsvik og Hæstads tolkning i fagkronikk og 6) Gjelsviks og IBITAs beskrivelse av samme metode. Tre av disse beskrivelsene (Raine, Hæstad og Gjelsvik og Gjelsvik og IBITA) avviker til en viss grad fra Bobaths egen beskrivelse og Langhammer og Stanghelles. Forskjellen mellom de tre førstnevnte og beskrivelsene til Bobath, Langhammer og Stanghelle ligger i forklaringsmodellen; refleks-hierarkisk versus systemteoretisk. Behandlingsprinsippene synes å være de samme i alle beskrivelser: sensorisk stimulering, fasilitering av bevegelse i håndtering (handling), demping (inhibering) av spastisitet, begrensning av assosierte reaksjoner og stereotype bevegelser. Oppsummering: Det er liten grunn til å hevde at det er vesentlige forskjeller mellom de seks tolkninger av Bobathmetoden. Langhammer og Stanghelles tolkning av Bobathmetoden skiller seg lite fra Bobaths egen beskrivelse av metoden, noe som tilsier at metodikken i undersøkelsene til Langhammer og Stanghelle synes å være adekvat.
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| 3. |
- 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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| 4. |
- Opheim, Arve, 1962, et al.
(författare)
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Spasticitet i övre extremitet under det första året efter stroke: del av SALGOT- studien.
- 2013
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Ingår i: Sjukgymnastikdagarna. Oktober 2013, Göteborg..
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- BAKGRUND/SYFTE Syftet med studien var att beskriva förekomst av spasticitet, sensomotorisk funktion, smärta och rörelseomfång (ROM) i övre extremitet under första året efter stroke. METODER Konsekutivt inkluderades 117 patienter från Göteborgsområdet, med förstagångs stroke och nedsatt arm och handfunktion tre dagar efter insjuknade. Patienterna bedömdes vid sex tillfällen under det första året: 3, 10 dagar, 4 veckor, 3, 6 och 12 månader efter stroke. Spasticitet i övre extremitet bedömdes med Modifierad Ashworth Skala (MAS), sensomotorisk funktion, smärta vid passiv rörelse och ROM med Fugl-Meyer skala (FMA), Subgruppsanalyser genomfördes. RESULTAT/DISKUSSION Förekomst av spasticitet vid dag 3 var 25% och vid ett år 46%.. Graden av spasticitet ökade över tid bland de som visade spasticitet vid tidigare mättillfällen.Sensomotorisk funktion bedömt med FMA förbättrades fram till 3 månader efter stroke på gruppnivå, men inte därefter. Förekomst av smärta under studieperioden ökade från 20% till 45%. Minskat ROM bedömdes hos 40% vid dag 3 och vecka 4, och ökade till 55% vid 3, 6, 12 månader efter stroke. De med spasticitet hade signifikant lägre poäng på FMA, och högre poäng smärta. KONKLUSSION Spasticitet i övre extremitet är vanligt efter stroke och kan vara associerat med sämre sensomotorisks funktion och ökad smärta. I tillägg till funktionell träning, indikerar denna studie att smärta och spasticitet bör beaktas (behandlas) hos patienter med förstagångsstroke. Smärta och nedsatt rörelseomfång är viktiga aspekter att beakta hos personer med spasticitet efter Denna studie indikerar att smärta och spasticitet bör behandlas (beaktas) i tillägg till funktionell träning.
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| 7. |
- Opheim, Arve, 1962, et al.
(författare)
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What comes first, spasticity, reduced range of motion or pain in patients after stroke?
- 2013
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Ingår i: Journal of Rehabilitation Medicine. Presented at the 3rd Baltic and North Sea Conference on Physical & Rehabilitation Medicine, the 118th Congress of the German Society for Physical Medicine & Rehabilitation, and the annual Congress for the Austrian Society for Physical Medicine & Rehabilitation. September 2013, Hannover, Germany. - : Medical Journals Sweden AB. - 1650-1977. ; 45
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction Pain, reduced range of motion (ROM) and reduced motor function has been found to be associated with spasticity in persons with stroke, but the developments of these impairments over time are less known. The aim of the study was to describe the development of spasticity, pain, ROM, sensibility and sensory motor function in persons with first stroke during the first year after stroke. Method 117 patients with first ever stroke was recruited for the study. No selections apart from reduced arm function on day 3 were made. The patients were assessed six times during the first year, at day 3, 10, week 4, month 3, 6 and 12. Upper limb spasticity was assessed with the modified Ashworth scale (MAS), and a MAS score ≥ 1 was regarded as presence of spasticity. Sensory motor function was assessed with the Fugl-Meyer Upper-Extremity scale (FM-UE). The presence of pain, reduced sensibility and range of motion (ROM) was regarded if lower than maximum scores on the non-motor domains of the FM-UE. Results The proportion of persons with spasticity increased from 0.25 at day 3 to 0.44 at week 4 and was stable up to 12 months. Sensory motor function improved from 28 (SD 25) at day 3 to 47 (SD 23) at 3 months and was stable up to 12 months. The proportion of persons with reduced ROM was 0.45 at day 3, was stable up to 3 months and increased at 6 and 12 months, 0.55 and 0.61, respectively. The proportion of patients with reduced sensibility decreased from 0.55 at day 3 to 0.36 at 12 months. Discussion Pain, spasticity and sensory motor function seemed to develop in about parallel the first 3 months. The proportion of persons with pain continued to increase during the first year. The proportion of patients with reduced ROM was unchanged during the first three months, but increased at 6 and 12 months. Based on this, reduced upper limb ROM seems secondary to pain and spasticity.
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| 8. |
- 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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| 9. |
- 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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| 10. |
- 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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