| 1. |
- Persson, Carina Ulla, 1970, et al.
(author)
-
Responsiveness of a modified version of the postural assessment scale for stroke patients and longitudinal change in postural control after stroke- Postural Stroke Study in Gothenburg (POSTGOT) -
- 2013
-
In: Journal of neuroengineering and rehabilitation. - : Springer Science and Business Media LLC. - 1743-0003. ; 10:1
-
Journal article (peer-reviewed)abstract
- ABSTRACT: BACKGROUND: Responsiveness data certify that a change in a measurement output represents a real change, not a measurement error or biological variability. The objective was to evaluate the responsiveness of the modified version of the Postural Assessment Scale for Stroke Patients (SwePASS) in patients with a first event of stroke. An additional aim was to estimate the change in postural control during the first 12 months after stroke onset. METHODS: The SwePASS assessments were conducted during the first week and 3, 6 and 12 months after stroke in 90 patients. Svensson's method, Relative Position (RP), Relative Concentration (RC) and Relative Rank Variance (RV), were used to estimate the scale's responsiveness and the patients' change in postural control over time. RESULTS: From the first week to 3 months after stroke, the patients improved in terms of postural control with 2 to 12 times larger systematic changes in Relative Position (RP), for which 9 items and the total score showed a significant responsiveness to change when compared to the interrater reliability measurement error of the SwePASS reported in a previous study. When SwePASS was used to assess change in postural control between the first week and 3 months, 74% of the patients received higher scores while 10% received lower scores, RP 0.31 (95% CI 0.219-0.402). The corresponding figures between 3 and 6 and between 6 and 12 months were 37% and 16%, RP 0.09 (95% CI 0.030-0.152), and 18% and 26%, RP -0.07 (95% CI -0.134- (-0.010)), respectively. CONCLUSIONS: The SwePASS is responsive to change. Postural control evaluated using the SwePASS showed an improvement during the first 6 months after stroke. The measurement property, in the form of responsiveness, shows that the SwePASS scoring method can be considered for use in rehabilitation when assessing postural control in patients after stroke, especially during the first 3 months.
|
|
| 2. |
- Persson, Carina Ulla, 1970, et al.
(author)
-
Timed Up & Go as a measure for longitudinal change in mobility after stroke - Postural Stroke Study in Gothenburg (POSTGOT)
- 2014
-
In: Journal of NeuroEngineering and Rehabilitation. - : Springer Science and Business Media LLC. - 1743-0003. ; 11:83
-
Journal article (peer-reviewed)abstract
- Abstract Background A frequently used clinical test to assess mobility after stroke is the Timed Up & Go. Knowledge regarding whether or not the Timed Up & Go is able to detect change over time in patients with stroke, whether improvements in mobility exist after the first three months and whether or not longitudinal change in mobility after stroke depend on the patients’ age, is limited or unclear. The objectives were to investigate the distribution-based responsiveness of the Timed Up & Go (TUG) during the first three months after a first event of stroke, to measure the longitudinal change in TUG time during the first year after stroke and to establish whether recovery in TUG time differs between different age groups. Methods Ninety-one patients with first-ever stroke were assessed using the Timed Up & Go at the 1st week and at 3, 6 and 12 months after stroke. The non-parametric sign-test, the parametric t-test and a mixed model approach to linear regression for repeated measurements (Proc mixed) were used for the statistical analyses. Results The median TUG time was reduced from 17 to 12 seconds (p < 0.001) between the 1st week and 3 months. No further improvement was seen between 3 and 12 months after stroke. In a mixed model approach to linear regression, there was a significant age difference. Patients at age 80 and above tended to deteriorate in terms of TUG time between 3 and 12 months after stroke, while patients < 80 years did not (p = 0.011 for the interaction between age group and time). Conclusion The Timed Up & Go demonstrates ability to detect change in mobility over time in patients with stroke. A significant improvement in TUG time from the 1st week to 3 months after stroke was found, as expected, but thereafter no statistically significant change was detected. After 3 months, patients ≥80 years tended to deteriorate in terms of TUG time, while the younger patients did not.
|
|
| 3. |
|
|
| 4. |
- Alt Murphy, Margit, 1970, et al.
(author)
-
SALGOT - Stroke Arm Longitudinal study at the University of Gothenburg, prospective cohort study protocol.
- 2011
-
In: BMC neurology. - : Springer Science and Business Media LLC. - 1471-2377. ; 11
-
Journal article (peer-reviewed)abstract
- BACKGROUND: Recovery patterns of upper extremity motor function have been described in several longitudinal studies, but most of these studies have had selected samples, short follow up times or insufficient outcomes on motor function. The general understanding is that improvements in upper extremity occur mainly during the first month after the stroke incident and little if any, significant recovery can be gained after 3-6 months. The purpose of this study is to describe the recovery of upper extremity function longitudinally in a non-selected sample initially admitted to a stroke unit with first ever stroke, living in Gothenburg urban area. METHODS/DESIGN: A sample of 120 participants with a first-ever stroke and impaired upper extremity function will be consecutively included from an acute stroke unit and followed longitudinally for one year. Assessments are performed at eight occasions: at day 3 and 10, week 3, 4 and 6, month 3, 6 and 12 after onset of stroke. The primary clinical outcome measures are Action Research Arm Test and Fugl-Meyer Assessment for Upper Extremity. As additional measures, two new computer based objective methods with kinematic analysis of arm movements are used. The ABILHAND questionnaire of manual ability, Stroke Impact Scale, grip strength, spasticity, pain, passive range of motion and cognitive function will be assessed as well. At one year follow up, two patient reported outcomes, Impact on Participation and Autonomy and EuroQol Quality of Life Scale, will be added to cover the status of participation and aspects of health related quality of life. DISCUSSION: This study comprises a non-selected population with first ever stroke and impaired arm function. Measurements are performed both using traditional clinical assessments as well as computer based measurement systems providing objective kinematic data. The ICF classification of functioning, disability and health is used as framework for the selection of assessment measures. The study design with several repeated measurements on motor function will give us more confident information about the recovery patterns after stroke. This knowledge is essential both for optimizing rehabilitation planning as well as providing important information to the patient about the recovery perspectives. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01115348.
|
|
| 5. |
- Björkdahl, Ann, 1959, et al.
(author)
-
Effect of very early supported discharge versus usual care on activi-ties of daily living ability after mild stroke: a randomized controlled trial.
- 2023
-
In: Journal of rehabilitation medicine. - 1651-2081. ; 55
-
Journal article (peer-reviewed)abstract
- To examine the ability to perform basic and instrumental activities of daily life after very early supported discharge vs usual discharge and referral routine during the first year after mild stroke.A secondary analysis of data from the Gothenburg Very Early Supported Discharge randomized controlled trial. Patients: A total of 104 patients (56% men; mean (standard deviation) age 75 (11) years) who had experienced a first stroke classified as mild.The primary outcome was the Activities of Daily Living Taxonomy score. Stroke Impact Scale (activities of daily living, and mobility) scores was a secondary measure. Patients were randomized to either very early supported discharge with 4 weeks of home rehabilitation provided by a multidisciplinary stroke team, or a control group discharged according to usual routine (referral to primary care when needed). Assessments were performed at discharge, 4 weeks post-discharge, and 3 and 12 months post-stroke.Instrumental activities of the Activities of Daily Living Taxonomy scores (the lower the better) in the very early supported discharge and control groups were median 4 and 6 (p=0.039) at 4 weeks post-discharge and 3 and 4.5 (p=0.013 at 3 months post-stroke, respectively. Stroke Impact Scale (Mobility) median scores (the higher the better) in the very early supported discharge and control groups at 3 months were 97 and 86 (p=0.040), respectively. There were no group differences in the 2 outcomes at 12 months post-stroke.Compared with usual discharge routine, team-based rehabilitation during the first month at home is beneficial for instrumental activity in the subacute phase, in patients with mild stroke. One year post-stroke both groups show equal results.
|
|
| 6. |
- Chen, Eric, et al.
(author)
-
Levels of physical activity in acute stroke patients treated at a stroke unit: A prospective, observational study.
- 2020
-
In: Journal of rehabilitation medicine. - : Medical Journals Sweden AB. - 1651-2081 .- 1650-1977. ; 52:4
-
Journal article (peer-reviewed)abstract
- A prospective, observational study to describe levels of physical activity in patients with stroke on day 2 and day 5 or 6 after admission to a comprehensive stroke unit in Sweden.The study was performed at the stroke unit at Sahlgrenska University Hospital during a period of 4 months between 2017 and 2018. Consecutive patients with stroke were observed for 1 min every 10 min while the multidisciplinary team was at work. The level of physical activity, location and the people present were noted at each time-point.A total of 46 patients were observed on day 2, of whom 29 were observed a second time on day 5 or 6. Patients were in bed half of the time and engaged in upright activity for less than 10% of day 2. Patients spent 73% of day 2 in the bedroom and 56% of this day alone. Over time, there was a significant shift of 10% from "in bed" activity to "sitting" (p§lt;0.001).Patients are physically inactive, alone and in their rooms for a majority of the time during the first days at a comprehensive stroke unit. There is some increase in physical activity during the first week after admission.
|
|
| 7. |
- Danielsson, Anna, 1957, et al.
(author)
-
Comparison of energy cost of walking with and without a carbon composite ankle foot orthosis in stroke subjects
- 2010
-
In: 13th ISPO World Congress, 10-15 May 2010, Leipzig, Germany.
-
Conference paper (peer-reviewed)abstract
- 13th ISPO World Congress Poster [3009] Abstract [207] | Topic: Orthotics Author: Danielsson, Anna (Göteborg SE) Dr. University of Gothenburg, Institute of Neuroscience and Physiology - Clinical Neuroscience and Rehabilitation Title: Comparison of Energy Cost of Walking with and without a Carbon Composite Ankle Foot Orthosis in Stroke Subjects Coauthors: Sunnerhagen KS, Willén C Summary: Oxygen cost, gait speed and perceived exertion was measured in 10 subjects with stroke walking with and without a carbon composite ankle foot orthosis. Walking with ankle foot orthosis was statistically less energy demanding and the speed somewhat higher compared to unbraced walking. Introduction: The opinions on effects of AFOs on functional outcome after stroke are inconsistent and the clinical significance of changes reported has been questioned. The improved walking velocity with an AFO as compared to unbraced walking seen in some studies may involve a reduction in energy cost. To our knowledge, only two studies report reduced energy cost with the use of an AFO. The aim was to measure and compare the energy expenditure and walking speed with and without a carbon composite AFO in stroke subjects. Methods: Ten persons with prior stroke, habituated to a carbon composite AFO were included. First the self-selected speeds on a tredmill without (speed I) and with (speed II) the AFO were determined in randomised order. The energy expenditure and heart rate were estimated with a stationary, computerized system for breath-by-breath analysis. Two measurements of energy expenditure were carried out with and without the AFO in randomized order at speed I. A third measurement was made with the AFO at speed II. Each trial lasted for five minutes. The measurements were repeated in reversed order once within one week. The energy cost per minute was divided by walking speed for estimation of energy cost per distance. Data was analysed with Wilcoxons sign rank test. Results: The mean self-selected walking speed was 20% higher (p = 0.027) with the ankle foot orthosis than without. Walking at speed I with an AFO was 4% less energy demanding (VO2 mL•kg-1•min-1) (p=0.028) than walking without AFO at the same speed. The energy cost (VO2 mL•kg-1•m-1) at speed I was also significantly lower with the AFO (p = 0.037) than without. Heart rate or perceived exertion did not differ between the two conditions. There was no significant difference in energy expenditure (VO2 mL•kg-1•min-1) between walking at speed I without AFO and speed II with AFO. However, the energy cost (VO2 mL•kg-1•m-1), was 12% lower (p=0.024) with the AFO. Heart rate and perceived exertion showed no difference between the two conditions. Conclusion: A carbon composite ankle foot orthosis may decrease energy demands and increase walking speed after stroke. The differences in energy cost seen in this study were small and not clinically significant whereas an increase in walking speed might have some impact on walking capacity. Further studies on the effects of an AFO on walking ability after stroke are wanted. References: Franceschini M, Massucci M, Ferrari L, Agosti M, Paroli C. Effects of an ankle-foot orthosis on spatiotemporal parameters and energy cost of hemiparetic gait. Clin Rehabil 2003;17(4):368-72. Corcoran PJ, Jebsen RH, Brengelmann GL, Simons BC. Effects of plastic and metal leg braces on speed and energy cost of hemiparetic ambulation. Arch Phys Med Rehabil 1970;51(2):69-77. de Wit DC, Buurke JH, Nijlant JM, Ijzerman MJ, Hermens HJ. The effect of an ankle-foot orthosis on walking ability in chronic stroke patients: a randomized controlled trial. Clin Rehabil 2004;18(5):550-7 Leung J, Moseley A. Impact of ankle-foot orthoses on gait and leg muscle activity in adults with hemiplegia: systematic literature review. Physiotherapy 2003;89(1):39-55. Danielsson A, Sunnerhagen KS. Energy expenditure in stroke subjects walking with a carbon composite ankle foot orthosis. J Rehabil Med 2004;36:165-8.
|
|
| 8. |
|
|
| 9. |
- Danielsson, Anna, 1957, et al.
(author)
-
Energy cost during walking - a comparison of two measurement methods
- 2005
-
In: European Stroke Conference, Bologna, Italy 25-28 may 2005.
-
Conference paper (peer-reviewed)abstract
- Background and purpose Many persons with stroke walk slowly with increased energy cost. Efficient gait is an important rehabilitation goal. Measurement of energy cost adds valuable information to gait analysis in evaluation of exercise, orthoses and walking aids. Direct measurement of oxygen uptake (VO2) is golden standard, but clinically practicable methods are needed. Physiological Cost Index (PCI)1 is a clinical method based on the relation between VO2 and heart rate. The reliability and validity of PCI in stroke patients has not been investigated. The aim was to compare energy cost measured by VO2 with PCI-value, in persons with stroke and healthy reference persons. Methods 20 persons with stroke and hemiparesis and 16 healthy, reference persons 30-63 years of age were included. Individual, self-selected walking speed on a treadmill was determined. VO2 was measured by breath-by-breath analysis and heart rate by electrocardiography at rest and during 5 minutes of walking on the treadmill at the predetermined self-selected speed. Mean values from two sessions were used. PCI was calculated as the heart rate difference between rest and walking, divided by gait speed. Spearman’s rank correlation between VO2 and PCI was calculated. Results Gait speed on the treadmill was 0,48 and 1,01 m/s, in the stroke and reference group respectively. VO2 was 9,1 and 11,4 ml/kg/min, with an energy cost of 0,41 and 0,19 ml/kg/m, in the stroke and reference group respectively. PCI was 0,76 and 0,30 heartbeats/m, in the stroke and reference group respectively. The correlation coefficient between VO2/m and PCI was ρ = 0,70 for the stroke group and ρ = 0,83 for the reference group. Conclusion Both VO2 and PCI were increased in the stroke group compared to the healthy reference group. VO2 and PCI were correlated in both groups. The stroke group had a large variability, why measurement of VO2 is recommended for research purposes. PCI needs further investigation before conclusions about the applicability for stroke patients can be drawn. 1 MacGregor J. The evaluation of patient performance using long-term ambulatory monitoring technique in the domiciliary environment. Physiotherapy 1981;67(2):30-33.
|
|
| 10. |
- Danielsson, Anna, 1957, et al.
(author)
-
Energy cost,walking habits and physical activity late after stroke
- 2008
-
In: Neurorehabilitation & Neural repair. ; 22:5
-
Conference paper (peer-reviewed)abstract
- Background: The aim was to investigate if walking energy cost and walking distance late after stroke were influenced by the physical environment, walking habits, physical activity or perceived difficulties. Methods: Included were 31 subjects with a mean age of 59.7 years and time since stroke 7-10 years. Heart rate and distance were measured during in- and outdoor walking for 6 minutes. The energy cost was assessed by the Physiological Cost Index (PCI). Assessments were made by the Physical Activity Scale for the Elderly, Stroke Impact Scale and a questionnaire on walking habits. Data were analyzed with linear regression. Results: Walking speeds and distances were reduced and the PCI was elevated compared to reference values. There were no differences between in- and outdoor walking. Sex, body mass index and perceived difficulty explained 24% of the variation in PCI (not statistically significant). Body mass index, physical activity level and perceived difficulty explained 48% of the variation in walking distance (p <0.05). Conclusions: Late after stroke, perceived difficulties may influence walking distance and energy cost. In this study the impact of the physical environment was not significant. The level of physical activity was associated with walking distance. Assessment of physical activity may be of importance after stroke and support should be given to increase physical activity when needed.
|
|
| 11. |
|
|
| 12. |
- Danielsson, Anna, 1957, et al.
(author)
-
Energy expenditure in stroke subjects walking with a carbon composite ankle foot orthosis.
- 2004
-
In: Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977. ; 36:4, s. 165-8
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: To measure walking speed and energy cost in patients with prior stroke with and without a carbon composite ankle foot orthosis. DESIGN: Within-group comparisons of 2 walking conditions. PARTICIPANTS: Convenience sample of 10 hemiparetic patients with a stroke at least 6 months earlier (average age 52 years) habituated to a carbon composite ankle foot orthosis. METHODS: Subjects walked on a treadmill at self-selected speed both with and without ankle foot orthosis for 5 minutes on each occasion. Energy expenditure was measured by breath-by-breath analysis and electrocardiography. Main outcome measures were walking speed, oxygen consumption, heart rate and energy cost per metre. RESULTS: Walking speed: without ankle foot orthosis 0.27 (SEM +/- 0.03) m/s, with 0.34 (+/- 0.06) m/s, difference 20%. Oxygen consumption: without ankle foot orthosis 8.6 (+/- 0.4) ml/kg/min, with 8.8 (+/- 0.5) ml/kg/min. Energy cost: without ankle foot orthosis 0.58 (+/- 0.07) ml/kg/m, with 0.51 (+/- 0.06) ml/kg/m, difference 12%. CONCLUSION: Use of a carbon composite ankle foot orthosis in patients with stroke may increase speed and decrease energy cost during walking.
|
|
| 13. |
- Danielsson, Anna, 1957, et al.
(author)
-
Is walking endurance associated with activity and participation late after stroke?
- 2011
-
In: Disability and rehabilitation. - : Informa UK Limited. - 1464-5165 .- 0963-8288. ; 33:21–22, s. 2053-2057
-
Journal article (peer-reviewed)abstract
- Purpose.After stroke, impaired walking ability may affect activity and participation. The aim was to investigate whether self-reported activity and participation were associated with walking endurance late after stroke. Method.A non-randomised sample of 31 persons with a mean age of 59.7 years and time since stroke of 7-10 years was studied. Walking endurance was measured by the 6-minute walk test (6MWT). Self-reported activity and participation were measured by the Physical Activity Scale for the Elderly and the Stroke Impact Scale. Relationships were analysed with linear regression. Results.A regression model including activities of daily living and 6MWT explained 44%, mobility and 6MWT explained 25% and a model including physical activity level and 6MWT explained 21% of the variation in activity. Regarding participation, the explanatory level of the model of participation and 6MWT was 30%. Conclusions.Walking distance several years after stroke was partly associated with self-reported difficulties in activity and participation.
|
|
| 14. |
- Danielsson, Anna, 1957, et al.
(author)
-
Measurement of energy cost by the physiological cost index in walking after stroke.
- 2007
-
In: Archives of physical medicine and rehabilitation. - : Elsevier BV. - 0003-9993. ; 88:10, s. 1298-303
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: To compare the Physiological Cost Index (PCI) with direct measurement of oxygen consumption (Vo(2)) as an estimate of energy cost in persons with stroke and healthy subjects. DESIGN: Test-retest on separate days. A comparison of 2 methods of measurement. Measurements with and without an orthosis. SETTING: A university hospital. PARTICIPANTS: A convenience sample of 20 persons with hemiparesis more than 6 months after stroke and 16 healthy subjects, ages 30 to 63 years. INTERVENTIONS: Five minutes of treadmill walking at self-selected speeds while recording Vo(2) levels and heart rates. Additional data was recorded for 11 of the stroke subjects with and without an ankle-foot orthosis. MAIN OUTCOME MEASURES: Vo(2) and the PCI. RESULTS: No significant differences were found in the PCI or Vo(2) between test and retest. Both PCI and Vo(2) per distance were higher for the stroke subjects compared with healthy subjects. PCI showed a larger dispersion than Vo(2) between test and retest. The regression analysis for PCI showed that the model including age, sex, group assignment, and Vo(2) could explain 53% of the variation. The PCI did not show a significant difference in walking with or without an orthosis, whereas Vo(2) differed significantly. CONCLUSIONS: The PCI showed limited reliability and validity as a measure of energy cost after stroke due to the extensive variability between test and retest.
|
|
| 15. |
- Danielsson, Anna, 1957, et al.
(author)
-
Oxygen consumption during treadmill walking with and without body weight support in patients with hemiparesis after stroke and in healthy subjects
- 2000
-
In: Archives of Physical Medicine and Rehabilitation. - 0003-9993 .- 1532-821X. ; 81, s. 953-7
-
Journal article (peer-reviewed)abstract
- Objective: To compare oxygen consumption during walking with body weight support (BWS) with oxygen consumption during unsupported treadmill walking. Design: Patient and reference group. Comparisons between two walking conditions within each group. Setting: Research laboratory of a university hospital. Participants: Nonrandom convenience sample of 9 hemiparetic and 9 healthy subjects, mean age of 56 and 57 years, respectively. Interventions: The subjects walked on a treadmill with 0% and 30% BWS at their self-selected and maximum walking speeds. The trials were performed twice. Main Outcome Measures: Ventilatory oxygen uptake (VO2) and heart rate were measured by computerized breath-by-breath analysis and electrocardiography. Results: VO2 was lower during walking with 30% BWS than during unsupported walking. At self-selected speed the Wilcoxon's signed rank p values were <.01 for both patients and reference group; at maximum velocity, p values were p <.02 for the patients and p <.05 for the reference group. Patients' heart rates were lower when they walked with 30% BWS than at 0% BWS, at both self-selected and maximum walking speeds (p <.05 and p <.02, respectively). Conclusions: The 30% body weight supported condition requires less oxygen consumption than full weight bearing. Treadmill training with BWS can be tolerated by patients with cardiovascular problems.
|
|
| 16. |
- Danielsson, Anna, 1957, et al.
(author)
-
Perception of walking and walking capacity late after stroke
- 2009
-
In: 5th World Congress of the International Society of Physical and Rehabilitation Medicine June 13-17 2009, Istanbul, Turkey.
-
Conference paper (peer-reviewed)abstract
- OBJECTIVE: The aim was to investigate the perception of walking ability and compare this to actual walking capacity. MATERIALS-METHODS: Persons who had completed a stroke rehabilitation programme 7-10 years previously were invited to participate. The Modified Rankin Scale was used for classification; Stroke Impact Scale and a Walking Habit Score were used in an interview on walking difficulties and walking habits, respectively. The Six-Minute Walk test (6MW) and the leg section of the Fugl-Meyer Sensorimotor Assessment (FMA, maximum score 34)) were performed in subjects who were able to come to the clinic. The relationships between variables were analysed with Spearman’s Rank correlation (rs) and gamma coefficients. RESULTS: Twelve woman and 24 men with a mean age of 60 years were included. Median time since stroke onset was 9 years.The Modified Rankin Scale scored median 3 (2-4). Three of the subjects used a wheelchair for transport, 19 used a walking aid and 9 wore an ankle foot orthosis. The clinical tests were performed in 31 subjects, their FMA score was median 29 and their mean 6MW distance was 344 m. Seventy percent perceived walking difficulties, 85% answered that they could walk unassisted in the near surroundings and 65% reported that they walked 500m. The 6MW distance was highly associated with the FMA motor score; rs 0.80 (p<0.001). The correlation between 6MW and perceived difficulties was rs 0.65 (p<0.001). There was a moderate correlation, gamma coefficient 0.60 (p<0.01), between 6MW and reported ability to walk 500m. CONCLUSION: The walking capacity may be reduced and stroke subjects perceive walking problems even many years after stroke onset. Persons well adapted to their situation seem to have an adequate opinion on their capacity. The findings support that self-reports on walking ability may be sufficient at follow-up after stroke
|
|
| 17. |
- Danielsson, Anna, 1957, et al.
(author)
-
Physical activity, ambulation, and motor impairment late after stroke.
- 2012
-
In: Stroke research and treatment. - : Hindawi Limited. - 2042-0056 .- 2090-8105. ; 2012
-
Journal article (peer-reviewed)abstract
- Objective. To assess walking capacity and physical activity using clinical measures and to explore their relationships with motor impairment late after stroke. Subjects. A nonrandomised sample of 22 men and 9 women with a mean age of 60 years, 7-10 years after stroke. Methods. Fugl-Meyer Assessment, maximum walking speed, 6min walk test, perceived exertion, and heart rate were measured, and the Physiological Cost Index was calculated. Physical activity was reported using The Physical Activity Scale for the Elderly. Results. Mean (SD) 6min walking distance was 352 (±136)m, and Physiological Cost Index was 0.60 (±0.41). Self-reported physical activity was 70% of the reference. Motor impairment correlated with walking capacity but not with the physical activity level. Conclusion. It may be essential to enhance physical activity even late after stroke since in fairly young subjects both walking capacity and the physical activity level were lower than the reference.
|
|
| 18. |
- Danielsson, Anna, 1957, et al.
(author)
-
Physical activity and walking speed after stroke compared to control values
- 2012
-
In: Neurorehabilitation and neural repair. - : SAGE Publications. - 1545-9683 .- 1552-6844. ; 26:6, s. 695-804
-
Conference paper (peer-reviewed)abstract
- Background and Aims: Persons with stroke are often less physically active than healthy and it can be hypothesized that activity increases over time and that walking speed is important. The aim was to describe the physical activity level using a questionnaire, compare with normative data and examine relationships between physical activity level, time since stroke and walking speed. Methods: A convenience sample of 70 persons (48 men, 22 woman) with a mean age of 60 (SD 6.8) was examined at a mean of 6 (SD 3) years after first event of stroke. A population based sample of 141 persons (70 men, 71 women) between 40 and 79 years of age from the same geographical area, divided into four cohorts, served as controls. The Physical Activity Scale for the Elderly (PASE) (1) was used to estimate the self-reported physical activity level. The self-selected walking speed was measured on a 30 m track and in stroke persons motor function in the affected leg was assessed according to Fugl-Meyer (maximum score 34). Results: The mean PASE score in the stroke group was 119 (SD 74), corresponding to 72% (SD 31) of the control score. There was no correlation between PASE and time since stroke. The median Fugl-Meyer score was 29 (range 11-34). The mean self-selected walking speed in the stroke group was 1.01 (SD 0.42) m/s which corresponded to 73% of the controls’. In a regression model, the self-selected walking speed could explain the variation in the PASE to 24% (p 0.001) and 6% (p 0.002), in the stroke and control groups, respectively. Conclusions: Persons with stroke reported lower physical activity than controls several years after stroke. Self-selected walking speed could partially explain physical activity level in persons with stroke but not in controls.
|
|
| 19. |
|
|
| 20. |
|
|
| 21. |
- Danielsson, Anna, 1957, et al.
(author)
-
PREVALENCE OF ANXIETY WITHIN THE FIRST YEAR AFTER STROKE: A SYSTEMATIC REVIEW AND METAANALYSIS
- 2018
-
In: European stroke journal. Vol. 3 Issue 1_suppl.. - : SAGE Publications. - 2396-9873 .- 2396-9881.
-
Conference paper (peer-reviewed)abstract
- Background and Aims: Anxiety is associated with decreased quality of life and depression, but gets less attention than other psychological consequences after stroke. The aim was to estimate prevalence of anxiety in the first year after stroke. Method: Searches in EMBASE, MEDLINE, PsycINFO, Cochrane Library, Amed and CINAHL were conducted in May 2015 and April 2017. Included were studies of populations with a hemorrhagic or ischemic stroke or transient ischemic attack, anxiety categorized on a rating scale during the first year after stroke. Two reviewers independently screened and included studies and assessed quality using a checklist. Studies using the Hospital Anxiety and Depression Scale – Anxiety (n 31) were included in a meta- analysis using the random effects model. Heterogeneity was assessed using the Q-test and I2 was used to estimate heterogeneity. Results: Of 4453 titles screened, 37 studies were included comprising 13756 participants with mean ages from 52 to 79 years, assessed within 2 weeks to 1 year after stroke. Most studies were of medium quality. The pooled prevalence of anxiety within the first year was 29.3% [(95% CI 24.8 – 33.8), (I2¼97%, p<0.00001)] which is higher than previously shown. Frequency 0-2 weeks post stroke was 34.8% (95% CI 24.9 – 44.6%), 2 weeks -3 months 23.2 (95% CI 16.3–30.1%) and 3 -12 months 35.6% (95% CI 17.7–54.3. Conclusion: One third of the stroke population may have an anxiety disorder and the prevalence seems to increase, why routine screening may be worth considering in order to provide appropriate interventions.
|
|
| 22. |
- Danielsson, Anna, 1957, et al.
(author)
-
Reliability and validity of the physiological cost index compared with oxygen consumption for estimation of energy cost after stroke
- 2007
-
In: 4th World Congress of the International Society of Physical and Rehabilitation Medicine, June 10-14, 2007, Seoul, Korea.
-
Conference paper (peer-reviewed)abstract
- The energy cost of walking is often increased after stroke, which might restrict participation in daily activities. Effects of walking aids or orthoses on the energy cost need to be evaluated. Oxygen consumption (VO2) is the standard for measurement of energy cost is, but in clinical practise methods must be simple. The Physiological Cost Index (PCI) based on heart rate and walking speed gives an estimate of energy cost. The reliability and validity of PCI for persons with stroke has not been documented. The aim was to investigate the test retest reliability and validity of PCI in comparison with VO2, in persons with stroke and healthy persons. A convenience sample of 20 persons with hemiparesis > 6 months after stroke and 16 healthy persons were included. VO2 and heart rate were registered during five minutes of treadmill walking at the self-selected speed. Measurements were repeated within one week. Eleven of the stroke participants were measured with and without an ankle foot orthosis. PCI showed a larger dispersion than VO2 of differences between test and retest. Changes in PCI of 74% and 53% in the stroke and healthy groups respectively, were necessary for a “true” difference on retest, compared to 22% and 21% respectively for VO2. The regression analysis for PCI showed that the model including age, sex, group assignment and VO2 could explain 53 % of the variation. PCI did not show any difference between walking with or without an orthosis, whereas VO2 differed significantly. In persons with stroke as well as healthy persons, energy cost measured by the Physiological Cost Index showed limited reliability and validity compared to measurement of oxygen consumption. The Physiological Cost Index might be used as a rough estimate on the individual level, but for study purposes measurement of oxygen consumption seems more accurate.
|
|
| 23. |
- Danielsson, Anna, 1957, et al.
(author)
-
Self-perceived mobility in the first year after mild stroke – a comparison between Very Early Supported Discharge and ordinary discharge routine
- 2022
-
In: 12th World Congress for Neurorehabilitation, Wien, 14-17 dec 2022.
-
Conference paper (other academic/artistic)abstract
- Background: People with mild stroke mostly present with good basic but may experience difficulties with complex ADL activities. Knowledge about effects of common rehabilitation interventions after mild stroke is scarce. Objective: To investigate perceived mobility after Very Early Supported Discharge (VESD) compared to standard discharge. Methods: At an inpatient stroke unit 140 participants (39% women) were included day 2 post stroke. Inclusion criteria: stroke according to WHO criteria, age >18 years, living ≤30 min from the hospital, NIHSS score 0-16, Barthel Index score 50-100 and Montreal Cognitive Assessment <26 if BI=100. Exclusion criteria: life expectancy <1 year, non-communicating in Swedish prior stroke. Patients were randomised to VESD delivered at home by occupational therapist, physiotherapist and nurse from the stroke unit, for 4 weeks or to a control group discharged according to standard routine. VESD was focused on individual goals in personal care, transfers, household and leisure activities. The control group received standard rehabilitation as needed. The Mobility domain (0-100) of the Stroke Impact Scale (SIS) was administered 5 days after onset, 3 and 12 months after discharge. Results: Participants’ mean age was 74 (SD 11) year and NIHSS score median 2 (min-max 0-11). Mean (SD) SIS Mobility was 71.2 (22,7) and 73.6 (23.6) at baseline, in the VESD and control groups respectively. At the 3-month follow up SIS mobility score was significantly higher in the VESD group, 89.6 (15.0) compared to the controls’ 80.9 (21.3), p 0.027. There was no group difference at 12 months after discharge with 85.0 (18.1) and 86.6 (16.8), respectively. We conclude that stroke specialised team rehabilitation at home in the subacute phase may be beneficial for both basic and more demanding mobility situations in the first months, in people with mild stroke.
|
|
| 24. |
- Danielsson, Anna, 1957, et al.
(author)
-
Self-perceived mobility in the first year after stroke in relation to observer based clinical measures
- 2020
-
In: WFNR & SOFMER congress 7–11 October 2020.
-
Conference paper (other academic/artistic)abstract
- Questions: To what extent do people with stroke experience mobility difficulties during the first year after onset? Is self-perceived mobility associated with perceived strength and clinical measures of mobility? Methods: At an inpatient stroke unit 140 participants were recruited. Inclusion criteria were confirmed stroke according to WHO criteria, > 18 years of age, living within 30 min from the hospital, day 2 NIHSS score 0-16, Barthel Index (BI) score 50-100 and MOCA index <26 if BI=100. Exclusion criteria were life expectancy < 1 year and inability to communicate in Swedish prior stroke. Stroke Impact Scale (SIS 3.0) domains for strength and mobility (score 0-100) and Timed Up and Go (TUG, s) at 1 week, 3 months and 1 year after onset were analysed with addition of the motor domain of Fugl-Meyer Assessment (FMA, score 0-100) at week 1 and 1 year. Standard linear regression was carried out with SIS mobility as dependent and SIS strength, TUG and FMA as independent variables. Results: Participants’ mean age was 74 (SD 11) years, 39% were women. Their initial motor function on FMA scored 90. SIS mobility score was 73 (SD 23) at 1 week, 85 (SD 19) at 3 months and 86 (SD 17) at 1 year. At 1 week 28% of the variation in SIS mobility was explained by a model including SIS strength, FMA and TUG with significant contribution from TUG only. At 3 months 40% of the variation in SIS mobility was explained by significant contribution from SIS strength and TUG. At 1 year post stroke, 56% of the variation in perceived mobility was explained by significant contribution from TUG and SIS strength, but not from FMA. Addition of sex and age did not change the explanatory values of the models. Conclusion: People with mildly impaired motor function experienced mobility difficulties that decreased, but still persisted one year after stroke. The pure measure of motor function was not related to self-perceived mobility. Perceived mobility was significantly associated with clinical mobility measures and self-perceived extremity strength. The results highlight the importance of including patient reported outcomes in rehabilitation.
|
|
| 25. |
|
|
