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| 2. |
- Gutierrez, Elena M, 1973-, et al.
(author)
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Kinetics of compensatory gait in persons with myelomeningocele
- 2005
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In: Gait & Posture. - : Elsevier BV. - 0966-6362 .- 1879-2219. ; 21:1, s. 12-23
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Journal article (peer-reviewed)abstract
- This study investigated the kinetic strategy and compensatory mechanisms during self-ambulatory gait in children with lumbo-sacral myelomeningocele. Thirty-one children with mid-lumbar to low-sacral myelomeningocele who walked without aids and 21 control children were evaluated by three-dimensional gait analysis. Joint moments in all planes at the hip and knee and sagittal moments at the ankle, as well as joint power and work done at all three joints, were analyzed. Joint moment capacity lost due to plantarflexor and dorsiflexor weakness was provided instead by orthotic support, but other joints were loaded more to compensate for the weakness at the ankles and restricted ankle motion. Subjects with total plantarflexor and dorsiflexor paresis and strength in the hip abductors had more knee extensor loading due to plantarflexor weakness and dorsiflexion angle of the orthotic, ankle joint. The subjects with orthoses also generated more power at the hip to supplement the power generation lost to plantarflexor weakness and fixed ankles. The most determinant muscle whose paresis changes gait kinetics was the hip abductor. Hip abductor weakness resulted in a characteristic pattern where the hips displayed an eccentric adduction moment, mediating energy transfer into the lower limbs, and the hips replaced the knees as power absorbers in early stance. Joint moment, power and work analyses complement a kinematic analysis to provide a complete picture of how children who have muscle paresis recruit stronger muscle groups to compensate for weaker ones.
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| 3. |
- Murans, Girts, et al.
(author)
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Kinematic and kinetic analysis of static sitting of patients with neuropathic spine deformity
- 2011
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In: Gait & Posture. - : Elsevier BV. - 0966-6362 .- 1879-2219. ; 34:4, s. 533-538
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Journal article (peer-reviewed)abstract
- Wheelchair dependent children with neuropathic and neuromuscular diseases have up to 90% risk for progressive spine deformities. An unbalanced sitting can induce progression of spinal and pelvic deformities. Many current clinical assessment methods of sitting of such patients are semi-quantitative, or questionnaire-based. A 3D movement analysis offers quantitative and objective biomechanical analysis of sitting. The aim was to validate a method to describe quiet sitting and differences between patients and controls as well as to apply the methodology for pre- and post-operative comparison. The analysis was performed on 14 patients and 10 controls. Four patients were retested after spine surgery. Seat load asymmetry was up to 30% in the patient group comparing to maximum 7% in the control group. The asymmetric position of Ground Reaction Force vector between left and right sides was significant. Plumb line of cervical 7th vertebra over sacral 1st was different only in rotation. The location of Common Center of Pressure relative to inter-trochanteric midpoint was more anterior in controls than in patients. Pelvic inclination in patients was smaller, the obliquity and rotation was similar. There were no significant differences between patients and controls of the thorax position. Results with more changes in the seat-loading domain in comparison with posture indicate good postural control compensation of spinal deformity induced disequilibrium despite neuromuscular disease in the background. The comparison of the pelvic obliquity data from kinematics and X-ray showed good correlation. The four patients tested postoperatively improved after surgery.
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| 4. |
- Robinson, Yohan, 1977-
(author)
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Spinal fractures related to ankylosing spondylitis : Epidemiology, clinical outcome and biomechanics
- 2017
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Doctoral thesis (other academic/artistic)abstract
- Background: Spinal fractures related to ankylosing spondylitis (AS) are often associated with serious complications. Therefore, knowledge of the incidence, best treatment, outcome, and prevention would assist in improving current guidelines.Objectives: This thesis aims at (1) analysing the complications and mortality of surgical treatment, (2) mapping the incidence and treatment modalities for these patients in Sweden, as well as (3) investigating the putative preventive effect of biological disease modifying anti-rheumatic drug (bDMARD) therapy on spinal fractures related to AS.Methods: Merged multiple national registries were used to identify predictors of mortality and spinal fractures in patients with AS. Beyond that a finite element model (FEM) was designed to simulating a cervicothoracic fracture related to AS.Results and Conclusions: During the last two decades an increase of the incidence of vertebral fractures in patients with AS was observed. With the introduction of bDMARD treatment of AS was revolutionised and quality of life and function improved. It seems that the improved quality of life and function in these patients does not correlate with a reduced fracture risk. Still, for the first time a beneficial effect of bDMARD with regard to spinal fracture occurrence was provided. The risk of spinal fractures was not reduced, but the debut of a spinal fracture was delayed with bDMARD. Since for this study the observation interval was only a decade, a future follow-up should revisit the effect of bDMARD on spinal fractures related to AS.Furthermore, it was shown that posterior stabilisation is an effective method for restoring stability without the necessity of additional external fixation. Most likely the early rehabilitation reduced pulmonary complications, which in turn reduced early mortality of these fractures. The FEM could be used to identify the most appropriate implant configuration, since no well-established cadaver models exist.Clinical Trial Registration: ClinicalTrials.gov, Identifier NCT02840695.
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| 5. |
- Saraste, Helena, et al.
(author)
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3D analysis of spine and chest wall form and mobility. Application of a new method to evaluate treatment outcome in pediatric spine deformities
- 2012
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Conference paper (other academic/artistic)abstract
- SummaryA new optical scanning method is applyed for a static and dynamic analysis of thorax and spine deformities in brace and surgically treated scoliosis patients to capture intervention dependent changes over time. The costs and additional information captured by the method is analysed.IntroductionTo evaluate the intervention dependent changes in spine and chest wall deformities, such as mobility of thorax, volume, symmetry of growth, and possible growth distorting factors are poorly known and should be studied. In patients with neuropathic spine deformities, the seat loading is of importance to enhance balanced sitting and preventing pressure problems. Quantitative methods to be used for over time comparisons need to be further developed.In adolescents the decision to treat a spine deformity is mainly based on radiographic findings, whereas many patients are more interested in how their body configuration deviates from the normality. There is a need to implement and evaluate a method for this purpose. In brace treated children and adolescents, a non-radiation producing examination is to prefer for repeated follow-up controls.MethodsA consequtive series of children with spine deformity, who are enrolled in the treatment protocol, are invited to take part in the tests. In surgery group, tests are performed before and 3 months after surgery aimed to correct the spine and/or thorax deformity. In brace treatment and follow-up groups tests are made at the same time points as x-rays. The static and dynamic recordings are performed by and optic scanenr Artec 3D (Artec Group, San Diego, CA), and the sitting load distribution measurements with a sensor mat (Clin-seat Type 5315 by Tekscan, Boston, Massachusetts, USA). 60 children/year in brace treatment, 40 in surgery, and 50 in the follow-up group are estimated to be included. These methods´ costs and benefits as well as their added value for the clinical decision making will be evaluated after 2-3 years.ResultsA feasibility test shows that clinically small enough differences can be recorded and numerically expressed and analysed. An application on a consecutive, clinical patient group will be carried on.ConclusionThe optical scanning method by Artec, allows a static and dynamic capturing of respiratoryassociated thorax movements and the changes of a spine deformity over time. The new method will be applied in a consecutive series of patients.
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| 6. |
- Schell, Elisabet, et al.
(author)
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Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up.
- 2008
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In: J Occup Environ Med. - 1536-5948 .- 1076-2752. ; 50:6, s. 667-76
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Journal article (other academic/artistic)abstract
- Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up.Schell E, Theorell T, Hasson D, Arnetz B, Saraste H.Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, S-171 77 Sweden. e.schell@telia.comOBJECTIVE: To evaluate the influence of a web-based stress management program on neck-shoulder-back pain and perceived pain-relatedness to stress in a prospective and controlled study. METHODS: Study points were baseline, after 6 months intervention and at 12 months follow-up on 226 news media employees in two study groups and one control group. RESULTS: Between groups no significant differences were found at any study point. Within groups, the study group with less intensive program improved in pain-relatedness to stress at follow-up. Between baseline and after intervention, the group with more intensive program showed decreased low back pain, and the control group showed less pain-relatedness to stress. Within group differences varied according to pain localization and were inconsistent. CONCLUSION: Present web-based stress management program did not influence neck-shoulder-back pain or perceived pain-relatedness to stress in stress-intensive occupations.
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| 7. |
- Schell, Elisabet, et al.
(author)
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Stress biomarkers' associations to pain in the neck, shoulder and back in healthy media workers : 12-month prospective follow-up.
- 2008
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In: Eur Spine J. - : Springer Science and Business Media LLC. - 1432-0932 .- 0940-6719. ; 17:3, s. 393-405
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Journal article (other academic/artistic)abstract
- Stress biomarkers' associations to pain in the neck, shoulder and back in healthy media workers: 12-month prospective follow-up.Schell E, Theorell T, Hasson D, Arnetz B, Saraste H.Department of Molecular Medicine and Surgery, Karolinska Institutet, 17177 Stockholm, Sweden. e.schell@telia.comPhysiological and psychological mechanisms have been proposed to link stress and musculoskeletal pain (MSP), and a number of stress biomarkers in patients with chronic pain have shown to be associated with stress-related disorders as well as health and recovery. The aim was to study if similar results might be found in a working population, in stress and computer intensive occupations with mild/moderate pain in neck, shoulder and back. The questions were if there are: (1) associations between self rated neck, shoulder and back pain (VAS) on one hand and stress-related (catabolic), recovery related (anabolic) variables, cardiovascular/lifestyle factors and immune markers on the other hand. (2) associations between long term changes in pain and stress marker values (6 month period). (3) predictive values in stress biomarkers for pain (12 month period) A study group with 121 media workers, 67 males (average 45 years) and 53 females (average 43 years), at three news departments of a media company was recruited. Pain occurrence and pain level in neck, shoulder, upper and low back were self-rated at three times with a 6-month interval towards the last month. Stress biomarker sampling was performed, at the same intervals. An additional similar questionnaire with momentary ratings focusing on "at present" i.e. within the same hour as stress biomarker sampling was performed. There were no changes in medicine intake or computer working hours during the 12 month study period. The total pain level and prevalence of pain decreased between baseline and 12 months follow-up. The rate of participation was 95%. Cross-sectional analyses on differences in stress biomarkers in groups of "no pain" and "pain" showed less beneficial stress biomarker levels (P < 0.05) in the "pain" group after age and gender adjustments in: S-DHEA-S and P-endothelin, S-insulin and P-fibrinogen. Analyses of each gender separately, adjusted for age, revealed in males differences in S-insulin, saliva cortisol 3, and P-endothelin. Furthermore, tendencies were seen in BMI, P-fibrinogen, and S-testosterone. In the female "pain" group a less beneficial P-BNP level was found. Longitudinal analysis of changes in pain levels and stress biomarkers within an interval of 6 months showed beneficial changes in the following stress markers: P-NPY, S-albumin, S-growth hormone and S-HDL when pain decreased, and vice versa when pain increased. Linear regression analyses showed statistically significant predicting values at the initial test instance for pain 12 months later in lower S-DHEA-S and S-albumin and higher B-HbA1c and P-fibrinogen. In stepwise regression and after age and gender adjustments, the associations with S-DHEA-S remained statistically significant. The present study shows that individuals in working life with a high level of regenerative/anabolic activity have less pain than other subjects, and that decreased regenerative/anabolic activity is associated with increasing pain. The levels of NPY, albumin, GH and HDL increased when pain decreased and vice versa. Low DHEA-S predicted pain 12 months later. These findings might contribute to increased knowledge about strategies to prevent further progression of neck/shoulder/back pain in persons who are "not yet in chronic pain".
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| 8. |
- Schell, Elisabet, et al.
(author)
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Workplace aesthetics : Impact of environments upon employee health?
- 2011
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In: Work. - 1051-9815 .- 1875-9270. ; 39:3, s. 203-213
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Journal article (peer-reviewed)abstract
- Associations between self-reported need for aesthetic improvements in the workplace and the need for ergonomic improvement and health factors were investigated to determine the possible impact of aesthetic needs on job performance. The need for aesthetic improvements were compared with the need for ergonomic improvements. All employees at a Swedish broadcasting company were invited to participate in this cross sectional study. Of those who fulfilled the inclusion criteria the participation rate was 74% (1961/2641). Demographic data was obtained from company files and pre-validated questionnaire was used for data collections from the participants. additional questions on needs for improvement were developed, tested for repeatability, and demonstrated to be within acceptable limits. Differences between "high rank" and "low rank" aesthetic needs and ergonomic needs were correlated to set ups of demographic, work environmental and organisational and health variables.The perceived needs for aesthetic and ergonomic improvements showed significantly different distributions (>0.001). Aesthetic needs were more frequently reported than ergonomic needs. There was no significant gender related difference in response distribution of aesthetic or ergonomic needs, whereas differences between occupational groups were shown (0.006 and 0.003). "High rank" needs for aesthetic improvement were associated to psychologically demanding work, negative work stress, sleep disturbances, problems at work, musculoskeletal pain and lower age. Gender and physical training did not differ between "high and low rank" responders regarding neither aesthetic nor ergonomic needs. Sick leave was stronger related to ergonomics. The independently tested associations with aesthetic needs were similar to, but fewer than those for ergonomic needs with regard to the variable set ups. Sixteen studied factors out of 24, showed significant difference between "high and low rank" aesthetic needs, and 21/24 of ergonomic needs, independently tested. The study results show a relation between work place aesthetics and health and well-being. Future work health promotion and prevention may benefit from the inclusion of an assessment of workplace aesthetics.
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