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  • 1.
    Ambrosio, Fabrisia
    et al.
    Department of Physical Medicine and Rehabilitation, University of Pittsburgh.
    Kadi, Fawzi
    Lexell, Jan
    Fitzgerald, F.K.
    Boninger, Michael
    Huard, Johnny
    The effect of muscle loading on skeletal muscle regenerative potential: an update of current research findings relating to aging and neuromuscular pathology2009Inngår i: American Journal of Physical Medicine & Rehabilitation, ISSN 0894-9115, E-ISSN 1537-7385, Vol. 88, nr 2, s. 145-155Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Skeletal muscle is a dynamic tissue with a remarkable ability to continuously respond to environmental stimuli. Among its adaptive responses is the widely investigated ability of skeletal muscle to regenerate after loading or injury or both. Although significant basic science efforts have been dedicated to better understand the underlying mechanism controlling skeletal muscle regeneration, there has been relatively little impact in the clinical approaches used to treat skeletal muscle injuries and wasting. The purpose of this review article is to provide an overview of the basic biology of satellite cell function in response to muscle loading and to relate these findings in the context of aging and neuromuscular pathology for the rehabilitation medicine specialist.

  • 2.
    Blauwet, Cheri A.
    et al.
    Medical Committee, International Paralympic Committee, Bonn, Germany; and Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Derman, Wayne
    Medical Committee, International Paralympic Committee, Bonn, Germany; Institute for Sport and Exercise Medicine, Division of Orthopaedics, Stellenbosch University, South Africa; and International Olympic Committee (IOC) Research Centre, South Africa.
    Idrisova, Guzel
    Medical Committee, International Paralympic Committee, Bonn, Germany; and Lesgaft National State University of Physical Education, Sport and Health, St. Petersburg, Russia; National Paralympic Committee of Russia, Moscow, Russia.
    Kissick, James
    Medical Committee, International Paralympic Committee, Bonn, Germany; and Department of Family Medicine, University of Ottawa, Ottawa, Canada; Carleton University Sport Medicine Clinic, Ottawa, Canada.
    Stomphorst, Jaap
    Medical Committee, International Paralympic Committee, Bonn, Germany; and Sports Medicine Department, Isala Klinieken, Zwolle, The Netherlands.
    Wosornu, Yetsa Tuakli
    Medical Committee, International Paralympic Committee, Bonn, Germany; and Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
    Vliet, Peter van der
    Medical Committee and Medical and Scientific Department, International Paralympic Committee, Bonn.
    Webborn, Nick
    Medical Committee, International Paralympic Committee, Bonn, Germany; and School of Sport and Service Management, University of Brighton, East Sussex, United Kingdom.
    The Road to Rio: Medical and Scientific Perspectives on the 2016 Paralympic Games2016Inngår i: PM&R, ISSN 1934-1482, E-ISSN 1934-1563, Vol. 8, nr 8, s. 798-801Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In August and September of this year, the world will turn its attention to Rio de Janeiro, Brazil, for the 2016 Summer Olympic and Paralympic Games. Of interest to physiatrists, the Paralympic Games will take place from September 7 to 18, with an estimated total of 4 billion viewers. In the United States, for the first time in history, the Summer Games will be broadcast over a total of 66 hours on NBCUniversal. The Paralympic Games represent the pinnacle of elite sport for athletes with disabilities while also changing perceptions around the importance of grassroots sport and physical activity opportunities for the disability community more broadly.It is no secret that the planning and preparation for the Rio Games has brought with it a number of challenges—the Zika virus, water quality, construction delays, and the oft-tenuous state of the Brazilian political system, to name a few. In some respects, these challenges are important as they stimulate discourse about the future of the Olympic and Paralympic Movement. In Paralympic sport, some of our current and most salient challenges are rooted in principles of sports medicine and science, as outlined herein. Because it is imperative to uphold the highest standards of athlete health and safety at the Games, this presents an unparalleled opportunity for the voice of physiatrists to come to the fore. As experts in disability and functional performance, neurologic and musculoskeletal rehabilitation, and sports medicine, we uniquely are suited to make an important and timely impact on Paralympic sport. Here, we provide a snapshot of what to watch out for in Rio.

  • 3.
    Brogårdh, Christina
    et al.
    Lund University Hospital, Skåne University Hospital, Lund, Institutionen för hälsa, vård och samhälle, Lunds universitet, Department of Health Sciences, Lund University, Department of Rehabilitation Medicine, Skåne University Hospital.
    Flansbjer, Ulla-Britt
    Lunds universitet, Lund University, Department of Rehabilitation Medicine, Skåne University Hospital.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Determinants of falls and fear of falling in ambulatory persons with late effects of polio2017Inngår i: PM&R, ISSN 1934-1482, E-ISSN 1934-1563, Vol. 9, nr 5, s. 455-463Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BackgroundFalls and fear of falling (FOF) are common in persons with late effects of polio but there is limited knowledge of associated factors.ObjectiveTo determine how knee muscle strength, dynamic balance and gait performance (adjusted for gender, age and BMI) are associated with falls and FOF in persons with late effects of polio.DesignA cross-sectional study.SettingA university hospital outpatient clinic.ParticipantsEighty-one ambulatory persons with verified late effects of polio (43 men; mean age 67 years).Main Outcome MeasurementsNumber of falls the past year, Falls Efficacy Scale –International (FES-I) to assess FOF, a Biodex dynamometer to measure knee muscle strength, the Timed Up and Go (TUG) test to assess dynamic balance and the Six Minute Walk test (6MWT) to assess gait performance. Univariate and multivariate logistic regression analyses were used for falls (categorical data) and linear regression analyses for FOF (continuous data) as dependent variables.ResultsFifty-nine % reported at least one fall during the past year and 79% experienced FOF. Reduced knee muscle strength in the more affected limb and gait performance were determinants of falls. An increase of 10 Nm in knee flexor and knee extensor strength reduced the OR between 0.70 and 0.83 (P=.01), and an increase of 100 meter in 6MWT reduced the OR to 0.41 (P=.001). All factors were determinants of FOF; reduced knee muscle strength in the more and less affected limbs explained 17% to 25% of the variance in FOF, dynamic balance 30% and gait performance 41%. Gender, age and BMI only marginally influenced the results.ConclusionsReduced gait performance, knee muscle strength and dynamic balance are to a varying degree determinants of falls and FOF in ambulatory persons with late effects of polio. Future studies need to evaluate if rehabilitation programs targeting these factors can reduce falls and FOF in this population. 

  • 4.
    Brogårdh, Christina
    et al.
    Lund University Hospital, Skåne University Hospital, Lund, Institutionen för hälsa, vård och samhälle, Lunds universitet, Department of Health Sciences, Lund University, Department of Rehabilitation Medicine, Skåne University Hospital.
    Flansbjer, Ulla-Britt
    Lunds universitet, Lund University, Department of Rehabilitation Medicine, Skåne University Hospital, Department of Health Sciences, Lund University.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Muscle Weakness and Perceived Disability of Upper Limbs in Persons With Late Effects of Polio2016Inngår i: PM&R, ISSN 1934-1482, E-ISSN 1934-1563, Vol. 8, nr 9, s. 825-832Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Muscle weakness in one or both upper limbs is common in persons with previous polio, but there is very limited knowledge how it influences daily life. Objective: To assess muscle weakness and self-perceived disability of the upper limbs in persons with late effects of polio and evaluate their association. Design: Cross-sectional study. Settings: University hospital outpatient clinic. Participants: Twenty-eight persons (mean age 67, SD 16 years) with late effects of polio in their upper limbs. Main Outcome Measures: A fixed dynamometer (Biodex System 3 PRO dynamometer (Biodex Medical Systems Inc., Shirley, NY) was used to measure isometric shoulder abduction and elbow flexion, as well as isokinetic concentric elbow flexion and extension. A hand-held dynamometer (Grippit, Hägersten, Sweden) was used to measure isometric grip strength. The Disabilities of Arm, Shoulder and Hand (DASH) questionnaire was used to assess self-perceived disability of the upper limbs. The relationships between the measures were analyzed with the Spearman rank correlation coefficients (rho). Results: The participants were 20%-31% weaker in their more-affected upper limb compared with their less-affected limb. The DASH score was on average 33.5 (SD 18.6), indicating a mild-to-moderate disability of their upper limbs. Changing a lightbulb overhead, carrying a heavy object, and performing recreational activities that required muscle force with the arms were perceived as most difficult. The correlations (rho) between the muscle strength measurements and DASH scores ranged from -0.46 (95% confidence interval [95% CI] -0.10 to -0.71) to -0.61 (95% CI -0.31 to -0.80) for the more affected upper limb, and from -0.54 (95% CI -0.21 to -0.76) to -0.68 (95% CI -0.41 to -0.84) for the less affected upper limb (P < .05-.01). Conclusions: Persons with previous polio and muscle weakness in their upper limbs perceive difficulties to use their arms in daily life, especially when performing activities above their head and strenuous household or leisure activities. The fair-to-moderate correlations of muscle strength with self-perceived disability imply that the weakness can only partially explain the perceived disabilities of arm, shoulder and hand. Other factors are therefore important to consider in the rehabilitation of persons with late effects of polio and upper limb disability. © 2016 American Academy of Physical Medicine and Rehabilitation.

  • 5.
    Brogårdh, Christina
    et al.
    Skåne University Hospital, Lund.
    Flansbjer, Ulla-Britt
    Lund University.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Medicinsk vetenskap.
    No effects of whole-body vibration training on muscle strength and gait performance in persons with late effects of polio: a pilot study2010Inngår i: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 91, nr 9, s. 1474-1477Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    ObjectiveTo evaluate the feasibility and possible effects of whole-body vibration (WBV) training on muscle strength and gait performance in people with late effects of polio.DesignA case-controlled pilot study with assessments before and after training.SettingA university hospital rehabilitation department.ParticipantsPeople (N=5; 3 men, 2 women; mean age, 64±6.7y; range, 55-71y) with clinically and electrophysiologically verified late effects of polio.InterventionsAll participants underwent 10 sessions of supervised WBV training (standing with knees flexed 40°-55° up to 60 seconds per repetition and 10 repetitions per session twice weekly for 5 weeks).Main Outcome MeasuresIsokinetic and isometric knee muscle strength (dynamometer), and gait performance (Timed Up & Go, Comfortable Gait Speed, Fast Gait Speed, and six-minute walk tests).ResultsAll participants completed the 5 weeks of WBV training, with no discernible discomfort. No significant changes in knee muscle strength or gait performance were found after the WBV training period.ConclusionsThis pilot study did not show any significant improvements in knee muscle strength and gait performance following a standard protocol of WBV training. Thus, the results do not lend support to WBV training for people with late effects of polio.

  • 6.
    Brogårdh, Christina
    et al.
    Department of Health Sciences, Lund University.
    flansbjer, Ulla-Britt
    Department of Health Sciences, Lund University.
    Lexell, Jan
    Self-reported walking ability in persons with chronic stroke and the relationship with gait performance tests2012Inngår i: PM&R, ISSN 1934-1482, E-ISSN 1934-1563, Vol. 4, nr 10, s. 734-738Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To assess self-reported walking ability in individuals with chronic stroke and to determine the relationship with gait performance tests. Design: Descriptive analysis of a convenience sample. Setting: A university hospital rehabilitation medicine clinic. Participants: Fifty ambulatory community-dwelling poststroke individuals (mean age, 64 years [range, 44-74 years] and mean time since stroke onset 42 months [range, 6-101 months]). Main Outcome Measures: The Walking Impact Scale (the Walk-12) to assess self-reported walking ability, and the Timed "Up & Go" test, 10-m Comfortable Gait Speed and Fast Gait Speed tests, and 6-Minute Walk Test to assess gait performance. Results: A majority of the participants (94%) reported limitations in their walking ability. The most common limitations were related to standing or walking, walking speed and distance, effort, and gait quality aspects. The ability to run was reported as most affected, whereas the need for support indoors or outdoors was least affected. Significant correlations (. P < .01) were found between the Walk-12 and the 4 gait performance tests (ρ = -0.60 to 0.60). Conclusions: Persons with chronic stroke perceive limitations in their walking ability. The relationship between the Walk-12 and the 4 gait performance tests indicates that self-reports and quantitative assessments are associated. Because the Walk-12 reflects broader dimensions than the gait performance tests, it can be a complementary tool when walking ability in persons with chronic stroke is evaluated.

  • 7.
    Brogårdh, Christina
    et al.
    Umeå University, Rehabilitation Medicine, Department of Community Medicine and Rehabilitation.
    Flansbjer, Ulla-Britt
    Department of Rehabilitation, Lund University Hospital, Sweden.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Medicinsk vetenskap.
    What is the long term benefit of constraint induced movement therapy?: a 4-year follow-up2009Inngår i: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 23, nr 5, s. 418-423Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To evaluate the long-term benefits of constraint-induced movement therapy in chronic stroke.Design: A four-year follow-up after constraint-induced group therapy assessing arm and hand function and self-reported daily hand use.Subjects: Fourteen post-stroke individuals (six women and eight men; mean age 59.6 ± 12.7 years, range 23-75 years) with mild to moderate impairments of hand function.Outcome measures: The Sollerman hand function test and the Motor Activity Log test.Results: Four years after constraint-induced group therapy the participants had maintained their hand function, as measured by the Sollerman hand function test. The self-reported use and quality of movements of the more affected hand, as measured by the Motor Activity Log test, had decreased compared to post-treatment and three months follow-up (P < 0.01), but was still significantly higher than pre-treatment (P < 0.05).Conclusion: There seems to be a long-term benefit of constraint-induced group therapy. Hand function was maintained over time and daily hand use had increased compared to pre-treatment. To provide guidelines about the clinical use of constraint-induced movement therapy further, larger and controlled studies are needed.

  • 8.
    Brogårdh, Christina
    et al.
    Lund University Hospital.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Medicinsk vetenskap.
    A 1-year follow-up after shortened constraint-induced movement therapy with and without mitt poststroke2010Inngår i: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 91, nr 3, s. 460-464Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    ObjectiveTo explore the long-term benefits of shortened constraint-induced movement therapy (CIMT) in the subacute phase poststroke.DesignA 1-year follow-up after shortened CIMT (3h training/d for 2wk) where the participants had been randomized to a mitt group or a nonmitt group.SettingA university hospital rehabilitation department.ParticipantsPoststroke patients (N=20, 15 men, 5 women; mean age 58.8y; on average 14.8mo poststroke) with mild to moderate impairments of hand function.InterventionsNot applicable.Main Outcome MeasuresThe Sollerman hand function test, the modified Motor Assessment Scale, and the Motor Activity Log test. Assessments were made by blinded observers.ResultsOne year after shortened CIMT, participants within both the mitt group and the nonmitt group showed statistically significant improvements in arm and hand motor performance and on self-reported motor ability compared with before and after treatment. No significant differences between the groups were found in any measure at any time.ConclusionsShortened CIMT seems to be beneficial up to 1 year after training, but the restraint may not enhance upper motor function. To determine which components of CIMT are most effective, larger randomized studies are needed.

  • 9.
    Brogårdh, Christina
    et al.
    Department of Rehabilitation Medicine, Skåne University Hospital.
    Lexell, Jan
    Effects of cardiorespiratory fitness and muscle-resistance training after stroke2012Inngår i: PM&R, ISSN 1934-1482, E-ISSN 1934-1563, Vol. 4, nr 11, s. 901-907Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Stroke is a leading cause of long-term disability. The physical and cognitive impairments after an ischemic or hemorrhagic stroke often lead to activity limitations and participation restrictions. Many persons after stroke have a sedentary lifestyle, are physically inactive, and have a low fitness level. Physical fitness training is known to be beneficial for persons with a number of comorbid conditions or risk factors for stroke. Although exercise and physical activity are considered valuable, the evidence of their benefits after stroke is still insufficient. In this review, we summarize published randomized controlled trials regarding the effects of cardiorespiratory fitness and muscle-resistance training after stroke on physical function, activity, participation, life satisfaction, and mood. We discuss various barriers that can impede the ability to perform exercise, and the importance of reducing these barriers to increase physical fitness levels after the completion of usual stroke rehabilitation, thereby enhancing leisure, well-being, and participation in society

  • 10.
    Brogårdh, Christina
    et al.
    Department of Health Sciences, Lund University.
    Lexell, Jan
    Lundgren-Nilsson, Åsa
    Rehabilitation Medicine, Sahlgrenska Academy at Göteborg University.
    Construct Validity of a New Rating Scale for Self-Reported Impairments in Persons With Late Effects of Polio2013Inngår i: PM&R, ISSN 1934-1482, E-ISSN 1934-1563Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To evaluate the construct validity of a new rating scale for self-reported impairments in persons with late effects of polio. Design: Psychometric analysis of data on self-perceived impairments in persons with prior polio. Participants: Two hundred and seventy-three persons with prior polio (119 men and 154 women; mean age, 63.5 years). Method: Rasch analysis of a 13-item rating scale with 5 response categories, in which the participants rated how much they have been bothered by various post-polio-related impairments during the past 2 weeks. Results: The initial analysis showed disordered categories, misfit with some of the items, multidimensionality, and local dependency. After adjustment of the categories, which resulted in a 4-category rating scale, fit to the model was achieved, but the scale still showed signs of multidimensionality. Analyses of local dependency revealed correlations among some of the items, which resulted in a 5 testlet solution, which gave fit to the model and unidimensionality. Conclusion: After adjustment of the categories and local dependency, this new rating scale, Self-Reported Impairments in Persons With Late Effects of Polio, can be considered as unidimensional. The good psychometric properties implies that the Self-Reported Impairments in Persons With Late Effects of Polio scale could be a useful rating scale that would increase our understanding of the impairments that persons with late effects of polio can experience. With further refinements, this scale may assist in the planning and evaluation of appropriate rehabilitation interventions.

  • 11.
    Brogårdh, Christina
    et al.
    Department of Health Sciences, Lund University.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Sjödahl Hammarlund, Catharina
    Department of Health Sciences, Lund University.
    Experiences of falls and strategies to manage the consequences of falls in persons with late effects of polio: a qualitative study2017Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 49, nr 8, s. 652-658Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE:

    To explore how persons with late effects of polio experience falls and what strategies they use to manage the consequences of falls.

    DESIGN:

    A qualitative study with face-to-face interviews. Data were analysed by systematic text condensation.

    PARTICIPANTS:

    Fourteen ambulatory persons (7 women; mean age 70 years) with late effects of polio.

    RESULTS:

    Analysis resulted in one main theme, "Everyday life is a challenge to avoid the consequences of falls", and 3 categories with 7 subcategories. Participants perceived that falls were unpredictable and could occur anywhere. Even slightly uneven surfaces could cause a fall, and increased impairments following late effects of polio led to reduced movement control and an inability to adjust balance quickly. Physical injuries were described after the falls, as well as emotional and psychological reactions, such as embarrassment, frustration and fear of falling. Assistive devices, careful planning and strategic thinking were strategies to prevent falls, together with adaptation and social comparisons to mitigate the emotional reactions.

    CONCLUSION:

    Experiences of falls greatly affect persons with late effects of polio in daily life. To reduce falls and fall-related consequences both problem-focused and emotion-focused strategies are used. In order to increase daily functioning, these findings should be included in a multifaceted falls management programme.

  • 12.
    Derman, Wayne
    et al.
    Institute of Sport and Exercise Medicine, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University. International Olympic Committee (IOC) Research Centre.
    Runciman, Phoebe
    Institute of Sport and Exercise Medicine, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University. International Olympic Committee (IOC) Research Centre.
    Schwellnus, Martin
    International Olympic Committee (IOC) Research Centre. Sport, Exercise Medicine and Lifestyle Institute (SEMLI) and Section Sports Medicine, Faculty of Health Sciences, University of Pretoria.
    Jordaan, Esme
    Biostatistics Unit, Medical Research Council, Parow.
    Blauwet, Cheri
    Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Women's Hospital, Harvard Medical School, Boston, USA.
    Webborn, Nick
    Centre for Sport and Exercise Science and Medicine (SESAME), University of Brighton, Eastbourne.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering. Department of Health Sciences, Lund University, Sweden. Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Sweden.
    Van de Vliet, Peter
    Medical and Scientific Department, International Paralympic Committee, Bonn.
    Tuakli-Wosornu, Yetsa
    Yale School of Public Health, Department of Chronic Disease and Epidemiology, Department of Orthopaedics and Rehabilitation, Yale University, Connecticut, USA.
    Kissick, James
    Carleton University Sport Medicine Clinic, Department of Family Medicine, Ottawa, Canada.
    Stomphorst, Jaap
    Department of Sport Medicine, Isala Klinieken, Zwolle.
    High precompetition injury rate dominates the injury profile at the Rio 2016 Summer Paralympic Games: a prospective cohort study of 51 198 athlete days2018Inngår i: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 52, nr 1, s. 24-31Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES:

    To describe the incidence of injury in the precompetition and competition periods of the Rio 2016 Summer Paralympic Games.

    METHODS:

    A total of 3657 athletes from 78 countries, representing 83.4% of all athletes at the Games, were monitored on the web-based injury and illness surveillance system over 51 198 athlete days during the Rio 2016 Summer Paralympic Games. Injury data were obtained daily from teams with their own medical support.

    RESULTS:

    A total of 510 injuries were reported during the 14-day Games period, with an injury incidence rate (IR) of 10.0 injuries per 1000 athlete days (12.1% of all athletes surveyed). The highest IRs were reported for football 5-a-side (22.5), judo (15.5) and football 7-a-side (15.3) compared with other sports (p<0.05). Precompetition injuries were significantly higher than in the competition period (risk ratio: 1.40, p<0.05), and acute traumatic injuries were the most common injuries at the Games (IR of 5.5). The shoulder was the most common anatomical area affected by injury (IR of 1.8).

    CONCLUSION:

    The data from this study indicate that (1) IRs were lower than those reported for the London 2012 Summer Paralympic Games, (2) the sports of football 5-a-side, judo and football 7-a-side were independent risk factors for injury, (3) precompetition injuries had a higher IR than competition period injuries, (4) injuries to the shoulder were the most common. These results would allow for comparative data to be collected at future editions of the Games and can be used to inform injury prevention programmes.

  • 13.
    Derman, Wayne
    et al.
    Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Institute of Sport and Exercise Medicine, Stellenbosch University. International Olympic Committee (IOC) Research Centre.
    Schwellnus, Martin P.
    International Olympic Committee (IOC) Research Centre. Sport, Exercise Medicine and Lifestyle Institute (SEMLI) and Section Sports Medicine, Faculty of Health Sciences, University of Pretoria.
    Jordaan, Esme
    Biostatistics Unit, Medical Research Council of South Africa, Cape Town. Statistics and Population Studies Department, University of the Western Cape.
    Runciman, Phoebe
    Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Institute of Sport and Exercise Medicine, Stellenbosch University. International Olympic Committee (IOC) Research Centre.
    Blauwet, Cheri
    Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Women's Hospital, Harvard Medical School, Boston.
    Webborn, Nick
    Centre for Sport and Exercise Science and Medicine (SESAME), University of Brighton, Eastbourne.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering. Department of Health Sciences, Lund University. Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Sweden.
    Van de Vliet, Peter
    Medical and Scientific Department, International Paralympic Committee, Bonn.
    Tuakli-Wosornu, Yetsa
    Yale School of Public Health, Department of Chronic Disease and Epidemiology, Department of Orthopaedics and Rehabilitation, Yale University, Connecticut.
    Kissick, James
    Carleton University Sport Medicine Clinic, Department of Family Medicine, Ottawa, Canada.
    Stomphorst, Jaap
    Department of Sport Medicine, Isala Klinieken, Zwolle.
    Sport, sex and age increase risk of illness at the Rio 2016 Summer Paralympic Games: a prospective cohort study of 51 198 athlete days2018Inngår i: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 52, nr 1, s. 17-23Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE:

    To describe the epidemiology of illness at the Rio 2016 Summer Paralympic Games.

    METHODS:

    A total of 3657 athletes from 78 countries, representing 83.5% of all athletes at the Games, were monitored on the web-based injury and illness surveillance system (WEB-IISS) over 51 198 athlete days during the Rio 2016 Summer Paralympic Games. Illness data were obtained daily from teams with their own medical support through the WEB-IISS electronic data capturing systems.

    RESULTS:

    The total number of illnesses was 511, with an illness incidence rate (IR) of 10.0 per 1000 athlete days (12.4%). The highest IRs were reported for wheelchair fencing (14.9), para swimming (12.6) and wheelchair basketball (12.5) (p<0.05). Female athletes and older athletes (35-75 years) were also at higher risk of illness (both p<0.01). Illnesses in the respiratory, skin and subcutaneous and digestive systems were the most common (IRs of 3.3, 1.8 and 1.3, respectively).

    CONCLUSION:

    (1) The rate of illness was lower than that reported for the London 2012 Summer Paralympic Games; (2) the sports with the highest risk were wheelchair fencing, para swimming and wheelchair basketball; (3) female and older athletes (35-75 years) were at increased risk of illness; and (4) the respiratory system, skin and subcutaneous system and digestive system were most affected by illness. These results allow for comparison at future Games.

  • 14.
    Downham, David
    et al.
    Department of Physical Medicine, Umeå University.
    Lexell, Jan
    Sjöström, Michael
    Department of Neurology, Umeå university.
    The co-dispersion index for the measurement of fiber type distribution pattern1984Inngår i: Muscle and Nerve, ISSN 0148-639X, E-ISSN 1097-4598, Vol. 7, nr 9, s. 751-752Artikkel i tidsskrift (Fagfellevurdert)
  • 15.
    Downham, David
    et al.
    Department of Statistics & Computational Mathematics, University of Liverpool.
    Taylor, B.C.
    Department of Statistics & Computational Mathematics, University of Liverpool.
    Lexell, Jan
    Sjöström, Michael
    Department of Neurology, Umeå university.
    Distribution of different fibre types in human skeletal muscles: a method for the detection of neurogenic disorders1987Inngår i: IMA journal of mathematics applied in medicine and biology, ISSN 0265-0746, E-ISSN 1471-6879, Vol. 4, nr 1, s. 81-91Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Human skeletal muscles are composed of two distinguishable types of fibres, which in healthy muscles appear to be randomly arranged. Large groups of one fibre type are commonly regarded as evidence of a neuropathological process affecting the peripheral nerves or the nerve cells in the spinal cord. An objective method that detects non-random arrangements as a sign of a neurogenic disorder, particularly in its early stages, could improve diagnosis. The randomness, or otherwise, of the fibre type arrangement is here considered in terms of the numbers of fibres surrounded entirely by others of the same type (enclosed fibres). The distribution of the number of enclosed fibres is studied for a free-sampling model using Monte Carlo methods. The negative binomial distribution is shown to fit closely, where the parameters can be expressed in terms of the number of fibres and the fibre type proportion in a sample area. This result permits the calculation of significance levels for a sample area and the combination of information in several sample areas. Finally, the method is applied to whole cross-sections of 24 male human autopsied muscles.

  • 16.
    Downham, David Y.
    et al.
    University of Liverpool.
    Holmbäck, Anna Maria
    Lund University.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Medicinsk vetenskap.
    Reliability of measurements in medical research and clinical practice2005Inngår i: Multidisciplinary Approaches to Theory in Medicine, Amsterdam: Elsevier, 2005, s. 147-163Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 17.
    Edman, Anne-Christine
    et al.
    Departments of Anatomy and Neurology, University of Umeå.
    Lexell, Jan
    Sjöström, Michael
    Departments of Anatomy and Neurology, University of Umeå.
    Squire, John M.
    Biophysics Section, Blackett Laboratory, Imperial College, London.
    Structural diversity in muscle fibres of chicken breast1988Inngår i: Cell and Tissue Research, ISSN 0302-766X, E-ISSN 1432-0878, Vol. 251, nr 2, s. 281-289Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    hicken breast muscle is usually considered to be a relatively homogeneous white muscle and has therefore been widely used for studies of muscle proteins. In a previous study, however, we have found different M-region structures in different fibres from this muscle. Because of this result, we have now carried out a combined histochemical and ultrastructural survey of this muscle. In particular, we have made use of large transverse cryo-sections that include most of the muscle cross-section. Although the white region is fairly homogeneous in fibre content according to normal histochemical criteria (mATPase), we have found that there is a gradation of fibre structure across the muscle. The bulk of the muscle stains conventionally for Type-II fibres according to mATPase tests (the "white" part) but, in the small "red" part of the muscle, there are also Type-I fibres together with the Type-II fibres. Superimposed on this division into Type-I and Type-II fibres are variations in fibre size, oxidative and glycolytic staining properties, and variations of Z-band width and M-band structure; there is no strict correlation among any of these parameters. The apparently uniform staining across most of the muscle when tested for myofibrillar ATPase may be a misleading indicator of fibre properties.

  • 18.
    Ekstrand, Elisabeth
    et al.
    Department of Health Sciences, Lund University.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Brogårdh, Christina
    Lund University Hospital, Skåne University Hospital, Lund, Institutionen för hälsa, vård och samhälle, Lunds universitet, Department of Health Sciences, Lund University, Department of Rehabilitation Medicine, Skåne University Hospital.
    Grip strength is a representative measure of muscle weakness in the upper extremity after stroke2016Inngår i: Topics in Stroke Rehabilitation, ISSN 1074-9357, E-ISSN 1945-5119, Vol. 23, nr 6, s. 400-405Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Muscle weakness is the most common impairment in the upper extremity after stroke, leading to a reduced ability to use the arm and the hand in daily activities. Grip strength is easier to measure than precise, but more time-consuming, isokinetic and isometric arm muscle strength measurements. It would therefore be advantageous in a clinical setting if grip strength could be used as a proxy for muscle strength in the entire upper extremity. OBJECTIVE: To investigate the association between grip strength and isometric and isokinetic arm muscle strength in persons with chronic stroke. METHODS: Forty-five persons with mild-to-moderate paresis in the upper extremity, at least 6 months post-stroke participated. Isometric grip strength was measured with a computerized grip dynamometer and arm strength (isometric shoulder abduction and elbow flexion as well as isokinetic elbow extension and flexion) with an isokinetic dynamometer. Pearson's correlation coefficient was used to determine the association between the muscle strength measurements. RESULTS: There were significant correlations (p < .0001) between grip strength and all arm strength measurements in both the more affected (r = 0.77-0.82) and the less affected upper extremity (r = 0.65-0.82). CONCLUSION: This cross-sectional study showed that grip strength is strongly associated with muscle strength in the arm in persons in the chronic phase after stroke. As grip strength is easy to measure and less time-consuming than arm muscle strength measurements, this implies that grip strength can be a representative measure of muscle weakness of the entire upper extremity in the chronic phase after stroke.

  • 19.
    Ekstrand, Elisabeth
    et al.
    Department of Health Sciences, Lund University.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Brogårdh, Christina
    Lund University Hospital, Skåne University Hospital, Lund, Institutionen för hälsa, vård och samhälle, Lunds universitet, Department of Health Sciences, Lund University, Department of Rehabilitation Medicine, Skåne University Hospital.
    Test-Retest Reliability and Convergent Validity of Three Manual Dexterity Measures in Persons With Chronic Stroke2016Inngår i: PM&R, ISSN 1934-1482, E-ISSN 1934-1563, Vol. 8, nr 10, s. 935-943Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Decreased manual dexterity is common in persons after stroke. Different measures are used to assess manual dexterity, but a lack of knowledge exists about their reliability and how they are related. Objective: To evaluate the test-retest reliability and convergent validity of 3 manual dexterity measures after stroke. Design: A test-retest design. Setting: University Hospital. Participants: Forty-five persons (mean age 65 years) with mild-to-moderate impairments in the upper extremity at least 6 months after stroke. Main Outcome Measures: Manual dexterity was assessed on 2 occasions, 1 week apart using the Box and Block Test (BBT), the Nine-Hole Peg Test (NHPT), and the modified Sollerman Hand Function Test (mSHFT). The reliability of the BBT and NHPT was evaluated with the intraclass correlation coefficient together with systematic and random measurement errors. Reliability of the mSHFT was evaluated with the Kappa coefficient and the Svensson rank-invariant method (percent agreement and systematic and random disagreements). Convergent validity of the total scores was evaluated with the Spearman rank correlation coefficients (rho). Results: The intraclass correlation coefficient for the BBT and the NHPT ranged from 0.83 to 0.99. Significant systematic measurement errors were found for both tests and hands. The Kappa coefficient for the total sum score of the mSHFT was 0.95 for the more affected hand and 0.59 for the less affected hand. One of the 3 items showed systematic disagreements for both hands. The convergent validity (rho) for the more affected hand ranged from 0.41 (BBT versus mSHFT) to -0.68 (NHPT versus mSHFT). Conclusion: The test-retest reliability of the BBT, NHPT and mSHFT was high but all measures showed learning effects. The relationships between the 3 measures indicate that they partly complement one another. The BBT may be preferred for persons with moderate impairments of the upper extremity and the NHPT and the mSHFT for persons with milder impairments. As the mSHFT has the advantage of reflecting activities in daily life it may be a suitable alternative to the NHPT.

  • 20.
    Ekstrand, Elisabeth
    et al.
    Department of Health Sciences, Lund University.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering. Department of Health Sciences, Lund University.
    Brogårdh, Christina
    Department of Health Sciences, Lund University.
    Test-retest reliability of the life satisfaction questionnaire lisat-11 and association between items in individuals with chronic stroke2018Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 50, nr 8, s. 713-718Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To evaluate the test-retest reliability of the Life Satisfaction Questionnaire (LiSat-11) and the association between items in individuals with chronic stroke. Design: Test-retest design. Subjects: Forty-five individuals (mean age 65 years) with mild to moderate disability at least 6 months post-stroke. Methods: LiSat-11, which includes 1 global item "Life as a whole" and 10 domain-specific items, was rated on 2 occasions, one week apart. Test-retest reliability was evaluated by kappa statistics, the percent agreement (PA) and the Svensson rank-invariant method. The association between items was evaluated with the Spearman's rank correlation coefficient (rho). Results: The kappa coefficients showed good to excellent agreement (0.59-0.97) and the PA <= 1 point was high (> 89%) for all items. According to the Svensson method, a small systematic disagreement was found for "Partner relationship". The other items showed no systematic or random disagreements. All domain-specific items, except one ("Sexual life") were significantly correlated with "Life as a whole" (rhos 0.29-0.80). Conclusion: LiSat-11 is considered reliable and can be recommended for assessing life satisfaction after stroke. The association between items indicates that LiSat-11 measures various aspects that can impact on an individual's life satisfaction.

  • 21.
    Ekstrand, Elisabeth
    et al.
    Department of Health Sciences, Lund University.
    Rylander, L.
    Division of Occupational and Environmental Medicine, Lund University.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Brogårdh, Christina
    Lund University Hospital, Skåne University Hospital, Lund, Institutionen för hälsa, vård och samhälle, Lunds universitet, Department of Health Sciences, Lund University, Department of Rehabilitation Medicine, Skåne University Hospital.
    Perceived ability to perform daily hand activities after stroke and associated factors: a cross-sectional study2016Inngår i: BMC Neurology, ISSN 1471-2377, E-ISSN 1471-2377, Vol. 16, nr 1, artikkel-id 208Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND:

    Despite that disability of the upper extremity is common after stroke, there is limited knowledge how it influences self-perceived ability to perform daily hand activities. The aim of this study was to describe which daily hand activities that persons with mild to moderate impairments of the upper extremity after stroke perceive difficult to perform and to evaluate how several potential factors are associated with the self-perceived performance.

    METHODS:

    Seventy-five persons (72 % male) with mild to moderate impairments of the upper extremity after stroke (4 to 116 months) participated. Self-perceived ability to perform daily hand activities was rated with the ABILHAND Questionnaire. The perceived ability to perform daily hand activities and the potentially associated factors (age, gender, social and vocational situation, affected hand, upper extremity pain, spasticity, grip strength, somatosensation of the hand, manual dexterity, perceived participation and life satisfaction) were evaluated by linear regression models.

    RESULTS:

    The activities that were perceived difficult or impossible for a majority of the participants were bimanual tasks that required fine manual dexterity of the more affected hand. The factor that had the strongest association with perceived ability to perform daily hand activities was dexterity (p < 0.001), which together with perceived participation (p = 0.002) explained 48 % of the variance in the final multivariate model.

    CONCLUSION:

    Persons with mild to moderate impairments of the upper extremity after stroke perceive that bimanual activities requiring fine manual dexterity are the most difficult to perform. Dexterity and perceived participation are factors specifically important to consider in the rehabilitation of the upper extremity after stroke in order to improve the ability to use the hands in daily life.

  • 22.
    Fagher, Kristina
    et al.
    Rehabilitation Medicine Research Group, Department of Health Sciences, Lund University.
    Jacobsson, Jenny
    Athletics Research Center, Department of Medical and Health Sciences, Linköping University.
    Dahlström, Örjan
    Athletics Research Center, Department of Medical and Health Sciences, Linkoping University.
    Timpka, Toomas
    Athletics Research Center, Department of Medical and Health Sciences, Linkoping University.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering. Rehabilitation Medicine Research Group, Department of Health Sciences, Lund University, Lund; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital.
    An eHealth Application of Self-Reported Sports-Related Injuries and Illnesses in Paralympic Sport: Pilot Feasibility and Usability Study2017Inngår i: JMIR Human Factors, ISSN 2292-9495, Vol. 4, nr 4, artikkel-id 30Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Sport participation is associated with a risk of sports-related injuries and illnesses, and Paralympic athletes’ additional medical issues can be a challenge to health care providers and medical staff. However, few prospective studies have assessed sports-related injuries and illnesses in Paralympic sport (SRIIPS) over time. Advances in mobile phone technology and networking systems offer novel opportunities to develop innovative eHealth applications for collection of athletes’ self-reports. Using eHealth applications for collection of self-reported SRIIPS is an unexplored area, and before initiation of full-scale research of SRIIPS, the feasibility and usability of such an approach needs to be ascertained.

    Objective: The aim of this study was to perform a 4-week pilot study and (1) evaluate the monitoring feasibility and system usability of a novel eHealth application for self-reported SRIIPS and (2) report preliminary data on SRIIPS.

    Methods: An eHealth application for routine collection of data from athletes was developed and adapted to Paralympic athletes. A 4-week pilot study was performed where Paralympic athletes (n=28) were asked to weekly self-report sport exposure, training load, general well-being, pain, sleep, anxiety, and possible SRIIPS. The data collection was followed by a poststudy use assessment survey. Quantitative data related to the system use (eg, completed self-reports, missing responses, and errors) were analyzed using descriptive statistics. The qualitative feasibility and usability data provided by the athletes were condensed and categorized using thematic analysis methods.

    Results: The weekly response rate was 95%. The athletes were of the opinion that the eHealth application was usable and feasible but stated that it was not fully adapted to Paralympic athletes and their impairments. For example, it was difficult to understand how a new injury or illness should be identified when the impairment was involved. More survey items related to the impairments were requested, as the athletes perceived that injuries and illnesses often occurred because of the impairment. Options for description of multifactorial incidents including an injury, an illness, and the impairment were also insufficient. Few technical issues were encountered, but athletes with visual impairment reported usability difficulties with the speech synthesizer. An incidence rate of 1.8 injuries and 1.7 illnesses per 100 hours of athlete exposure were recorded. The weekly pain prevalence was 56% and the impairment contributed to 20% of the reported incidents.

    Conclusions: The novel eHealth-based application for self-reported SRIIPS developed and tested in this pilot study was generally feasible and usable. With some adaptation to accommodate Paralympic athletes’ prerequisites and improved technical support for athletes with visual impairment, this application can be recommended for use in prospective studies of SRIIPS.

  • 23.
    Fagher, Kristina
    et al.
    Department of Health Sciences, Lund University, Sweden.
    Jacobsson, Jenny
    Linköpings universitet, Avdelningen för samhällsmedicin.
    Timpka, Toomas
    Linköpings universitet, Institutionen för medicin och hälsa.
    Dahlström, Örjan
    Linköpings universitet, Handikappvetenskap.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Erratum to: The sports-related injuries and illnesses in paralympic sport study (SRIIPSS): a study protocol for a prospective longitudinal study2016Inngår i: BMC Sports Science, Medicine and Rehabilitation, ISSN 2052-1847, Vol. 8, nr 1, artikkel-id 30Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    This corrects the article DOI: 10.1186/s13102-016-0053-x

  • 24.
    Fagher, Kristina
    et al.
    Department of Health Sciences, Lund University, Sweden.
    Jacobsson, Jenny
    Linköpings universitet, Avdelningen för samhällsmedicin.
    Timpka, Toomas
    Linköpings universitet, Institutionen för medicin och hälsa.
    Dahlström, Örjan
    Linköpings universitet, Handikappvetenskap.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    The sports-related injuries and illnesses in paralympic sport study (SRIIPSS): a study protocol for a prospective longitudinal study2016Inngår i: BMC Sports Science, Medicine and Rehabilitation, ISSN 2052-1847, Vol. 8, nr 1, artikkel-id 28Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND:

    Paralympic sport provides sporting opportunities for athletes with a disability, with the Paralympic Games as the main event. Participation in sport is, however, associated with a significant risk for sustaining injuries and illnesses. Our knowledge of sports-related injuries and illnesses in Paralympic sport is very limited and there are no large-scale epidemiological cohort studies. The purpose here is to present a protocol for a prospective longitudinal study: The Sports-Related Injuries and Illnesses in Paralympic Sport Study (SRIIPSS).

    METHODS/DESIGN:

    An argument-based method for investigation of design problems was used to structure the study protocol. The primary requirement of the protocol is to allow prospective studies over time and include exposure to both training and competition. To reflect the complexity of Paralympic sport with athletes' pre-existing impairments, use of assistive equipment, pain and other and medical issues, it is required that the data collection system is specifically adapted to Paralympic sport. To allow the collection of data, at the same time as there is limited access to coaches and medical personnel, it is advantageous that data can be collected online directly from the athletes. Based on this a self-report athlete monitoring system will be developed, where the athletes can enter data weekly via their mobile phones or lap-tops. Data will be collected from around 100 Swedish Paralympic athletes for approximately 1 year, which will allow us to i) prospectively estimate the annual incidence of sports-related injuries and illnesses and ii) explore risk factors and mechanisms for sustaining sports-related injuries and illnesses based on athlete exposure and training loads.

    DISCUSSION:

    For effective implementation of injury and illness prevention measures, comprehensive epidemiological knowledge is required. This study will be the first prospective longitudinal self-report study of sports-related injuries and illnesses in Paralympic sport over a longer period of time. The results will eventually contribute to the development of evidence-based preventive measures specifically adapted to Paralympic sport in order to provide safe and healthy sport participation. Thereby, the project will be of relevance for Paralympic athletes at all levels and to the Paralympic Movement.

  • 25.
    Flansbjer, Ulla-Britt
    et al.
    Department of Clinical Sciences, Division of Rehabilitation Medicine, Lund university.
    Lexell, Jan
    Reliability of Gait Performance Tests in Individuals With Late Effects of Polio2010Inngår i: PM&R, ISSN 1934-1482, E-ISSN 1934-1563, Vol. 2, nr 2, s. 125-131, 167Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    To assess the reliability of 4 gait performance tests in individuals with late effects of polio. DESIGN: An intrarater (between occasions) test-retest reliability study. SETTINGS: University hospital. PARTICIPANTS: Thirty men and women (mean age 63 +/- 6.4 years) with clinically and electrophysiologically verified late effects of polio. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: The Timed "Up & Go" test, the Comfortable and the Fast Gait Speed tests, and the 6-Minute Walk test were assessed 7 days apart. Reliability was evaluated with the intraclass correlation coefficient (ICC(2,1)), the mean difference between the test sessions (d), and the 95% confidence intervals for d, the standard error of measurement (SEM and SEM%), the smallest real difference (SRD and SRD%) and the Bland & Altman graphs. RESULTS: Test-retest agreements were high (ICC(2,1) 0.82-0.97) and measurement errors generally small. The standard error of measurement (SEM%), representing the smallest change that indicates a real (clinical) improvement for a group of individuals, was small (4%-7%). The smallest real difference (SRD%), representing the smallest change that indicates a real (clinical) improvement for a single individual also was small (12%-21%). CONCLUSION: These commonly used gait performance tests are highly reliable and can be recommended to evaluate improvements in various aspects of gait performance in groups of individuals as well as single individuals with late effects of polio.

  • 26.
    Flansbjer, Ulla-Britt
    et al.
    Department of Rehabilitation Medicine, Skåne University Hospital.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Medicinsk vetenskap.
    Reliability of knee extensor and flexor muscle strength measurements in persons with late effects of polio2010Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 42, nr 6, s. 588-592Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To assess the reliability of knee extensor and flexor muscle strength measurements in persons with late effects of polio. Design: A test-retest reliability study. Subjects: Thirty men and women (mean age 63 (standard deviation 6.4) years) with verified late effects of polio. Methods: Knee extensor and flexor muscle strength in both lower limbs were measured twice 7 days apart using a Biodex dynamometer (isokinetic concentric contractions at 60°/sec and isometric contractions with knee flexion angle 90º) and a Leg Extension/Curl Rehab exercise machine with pneumatic resistance (HUR) (isotonic contractions). Reliability was assessed with the intraclass correlation coefficient (ICC1,1), the mean difference between the test sessions (đ) together with the 95% confidence intervals for đ, the standard error of measurement (SEM and SEM%), the smallest real difference (SRD and SRD%) and Bland-Altman graphs. Results: Test-retest agreements were high, (ICC1,1 0.93-0.99) and measurement errors generally small. The SEM% was 4-14% and the SRD% 11-39%, with the highest values for the isokinetic measurements. Conclusion: Knee muscle strength can be measured reliably and can be used to detect real changes after an intervention for a group of persons with late effects of polio, whereas the values may be too high for single individuals or to detect smaller short-term changes over time for a group of individuals.

  • 27.
    Flansbjer, Ulla-Britt
    et al.
    Department of Rehabilitation Medicine, Skåne University Hospital.
    Lexell, Jan
    Reproducibility of ankle dorsiflexor muscle strength measurements in individuals with post-polio syndrome2011Inngår i: Isokinetics and exercise science, ISSN 0959-3020, E-ISSN 1878-5913, Vol. 19, nr 1, s. 55-61Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this study was to assess the reproducibility of isokinetic and isometric ankle dorsiflexor strength measurements in individuals with post-polio syndrome (PPS). Thirty-one men and women (mean age 63 ± 7.0 years) with verified PPS, participated in an intra-rater test-retest reproducibility study. Strength of the ankle dorsiflexor muscles in both lower limbs were measured twice, seven days apart, with a Biodex dynamometer (isokinetic concentric; 30°/s and isometric; ankle plantar flexion angle 10°). Reproducibility was evaluated with the intraclass correlation coefficient (ICC2,1), the mean difference between the test sessions (d̄) and the 95% confidence intervals for , the standard error of measurement (SEM, 95% SEM and SEM%) and Bland & Altman graphs. All 31 individuals completed the measurements in the less affected lower limb, but only 14 in the more affected lower limb due to severe weakness and/or joint stiffness. The analysis was therefore based on data from the two lower limbs separately. The test-retest agreements were high, (ICC2,1 0.85 to 0.94) and measurement errors generally small, and there was no discernible difference between the less and more affected lower limbs. The mean isokinetic and isometric peak torque (Nm) for the two lower limbs from the two test sessions ranged from 22.7 to 25.8. The SEM, which represents the limit for the smallest change that indicates a real change for a group of individuals, ranged from 2.51 to 3.74 Nm. In conclusion, isokinetic and isometric muscle strength measurements of the ankle dorsiflexor muscles in individuals with PPS are reproducible and can be used to detect changes over time or after an intervention for groups of individuals.

  • 28.
    Flansbjer, Ulla-Britt
    et al.
    Department of Health Sciences, Lund University, Lund, Sweden.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering. Department of Health Sciences, Lund University, Lund, Sweden; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden; .
    Brogårdh, Christina
    Department of Health Sciences, Lund University, Lund, Sweden; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden.
    Predictors of changes in gait performance over four years in persons with late effects of polio2017Inngår i: NeuroRehabilitation (Reading, MA), ISSN 1053-8135, E-ISSN 1878-6448, Vol. 41, nr 2, s. 403-411Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND:

    Reduced gait performance is common in persons with late effects of polio.

    OBJECTIVE:

    To identify predictors of change in gait performance over four years in persons with late effects of polio.

    METHODS:

    Gait performance was assessed annually in 51 ambulatory persons (mean age 64 years, SD 6) by the Timed “Up & Go” (TUG), Comfortable and Fast Gait Speed (CGS, FGS), and 6-Minute Walk Test (6MWT). Isokinetic knee extensor and flexor muscle strength was measured with a Biodex dynamometer. Mixed Linear Models were used to analyze changes in gait performance and to identify any predictors of change among the covariates gender, age, body mass index, time with new symptoms, baseline reduction in gait performance and knee muscle strength.

    RESULTS:

    There were significant linear effects over time (reduction per year) for three gait performance tests; CGS (0.8%; p < 0.05), FGS (1.7%; p < 0.001), and 6MWT (0.7%; p < 0.05) with significant random effects for all tests. The strongest predictor of a change in gait performance was the individual variations in the knee flexor strength (p < 0.001).

    CONCLUSION:

    The small gradual reduction in gait performance over time in persons with late effects of polio is primarily determined by the individual variations in the knee flexor strength.

  • 29.
    Flansbjer, Ulla-Britt
    et al.
    Department of Rehabilitation, Lund University Hospital, Sweden.
    Miller, Michael
    Lund University, Department of Health Sciences, Divison of Physiotherapy.
    Dowham, David
    University of Liverpool, Department of mathematical sciences.
    Lexell, Jan
    Progressive resistance training after stroke: effects on muscle strength, muscle tone, gait performance and perceived participation2008Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 40, nr 1, s. 42-8Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To evaluate the effects of progressive resistance training on muscle strength, muscle tone, gait performance and perceived participation after stroke. DESIGN: A randomized controlled trial. SUBJECTS: Twenty-four subjects (mean age 61 years (standard deviation 5)) 6-48 months post-stroke. METHODS: The training group (n = 15) participated in supervised progressive resistance training of the knee muscles (80% of maximum) twice weekly for 10 weeks, and the control group (n = 9) continued their usual daily activities. Both groups were assessed before and after the intervention and at follow-up after 5 months. Muscle strength was evaluated dynamically and isokinetically (60 degrees /sec) and muscle tone by the Modified Ashworth Scale. Gait performance was evaluated by Timed "Up & Go", Fast Gait Speed and 6-Minute Walk tests, and perceived participation by Stroke Impact Scale. RESULTS: Muscle strength increased significantly after progressive resistance training with no increase in muscle tone and improvements were maintained at follow-up. Both groups improved in gait performance, but at follow-up only Timed "Up & Go" and perceived participation were significantly better for the training group. CONCLUSIONS: Progressive resistance training is an effective intervention to improve muscle strength in chronic stroke. There appear to be long-term benefits, but further studies are needed to clarify the effects, specifically of progressive resistance training on gait performance and participation.

  • 30.
    Henriksson-Larsén, K.
    et al.
    Department of Neurology, Umeå university.
    Lexell, Jan
    Sjöström, Michael
    Department of Neurology, Umeå university.
    Distribution of different fibre types in human skeletal muscles: I. Method for the preparation and analysis of cross-sections of whole tibialis anterior1983Inngår i: The Histochemical Journal, ISSN 0018-2214, E-ISSN 1573-6865, Vol. 15, nr 2, s. 167-78Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this study was to examine whether small biopsy specimens are representative of the whole human skeletal muscle or whether the different fibre types are unevenly distributed at different depths of the muscle. Ten micrometre thick cross-sections of whole human tibialis anterior were prepared using LKB PMV Cryo-Microtomes with a stroke length of 160 to 480 mm and the sections were stained for myofibrillar ATPase according to a modified procedure. The total and relative number of different fibres (Types 1 and 2) was determined in every 9th mm2 of the section. The data obtained were analysed by means of a computer program, which allowed assessment of bivariate data in the form of contour plots. The total number of fibres varied greatly between individuals (from 96 000 to 162 000; five individuals). The relative number of different fibres varied systematically in all individuals as a function of depth in the muscle. There was a gradual, often dramatic, relative increase in Type 2 fibre occurrence from the surface of the muscle (about 10--25%) towards the deeper regions (30--50%), the maximum being approximately along a line slightly posterior to the middle of the muscle. Additionally, superficial peaks were seen in places. In conclusion, the fibre type distribution in the tibialis anterior is not random. These results point to the importance of defining biopsy depth

  • 31.
    Holmbäck, Anna Maria
    et al.
    Lund University, Department of Health Sciences, Division of Physical Therapy.
    Lexell, Jan
    Reproducibility of isokinetic ankle dorsiflexor strength and fatigue measurements in healthy older subjects2007Inngår i: Isokinetics and exercise science, ISSN 0959-3020, E-ISSN 1878-5913, Vol. 15, nr 4, s. 263-270Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this study was to determine the test-retest (two occasions seven days part) reproducibility of isokinetic (Biodex) concentric (CON) and eccentric (ECC) ankle dorsiflexor strength and fatigue measurements in older subjects using several statistical methods. Thirty healthy men (n=15) and women (n=15) aged between 70 and 85 years participated in the study. To determine the reproducibility of strength measurements, the 30 individuals performed three maximal CON and ECC contractions at 30°/s and 90°/s. The intraclass correlation coefficient (ICC_{2.1}) for CON and ECC strength measurements was high and ranged from 0.94 to 0.98. Bland & Altman graphs and analyses indicted no systematic bias. The standard error of measurement (SEM), representing the smallest change that indicates a real improvement (or deterioration) for a group of individuals, was small (< 2.3 Nm). The smallest real difference (SRD), representing the smallest detectable change that indicates a real improvement (or deterioration) for a single subject, was also small ('error bands' from -7.2 Nm to 5.6 Nm). A high correlation (Pearson's r > 0.94) between CON peak torque at 30°/s and 90°/s, as well as ECC peak torque at 30°/s and 90°/s, suggested that any of these two velocities could be used as a reference. To determine the reproducibility of fatigue measurements, 28 of the 30 individuals performed 50 maximal CON contractions at 60°/s. Reproducibility of the loss in work (work fatigue) and the relative loss in peak torque, comparing the first three to the last three contractions (3-3), was determined and the ICC was 0.71 and 0.60, respectively. In addition, the SEM was small (< 8.4%) and the 'error bands' to define the SRD for a single subject were also small (from -23.5% to 24.5%). In conclusion, these values indicate small measurement errors and thus provide a clinically acceptable basis for testing ankle dorsiflexion strength and fatigue of the dominant side in healthy older people.

  • 32.
    Isaksson, Gunilla
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Josefsson, Staffan
    Neurotec Department, Division of Occupational Therapy, Karolinska Institute, Huddinge.
    Lexell, Jan
    Skär, Lisa
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    To regain participation in occupations through human encounters: narratives from women with spinal cord injury2007Inngår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 29, nr 22, s. 1679-1688Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose. To gain an understanding of how women with spinal cord injury (SCI) experienced human encounters in occupations and how these influenced their participation. Method. The data were collected through two or three in-depth interviews with 13 women (age 25 - 61 years) with SCI. Data analysis was carried out by using a paradigmatic analysis of narrative data, followed by an interpretation based on a narrative theory. Results. The results showed a complexity where the women's experiences and acting in human encounters changed over time. In these human encounters the women struggled with conflicts, supported other persons that were insecure and revaluated their apprehension about persons in their social network. These multidimensional human encounters thereby enabled them to regain participation in occupations. Conclusions. This shows that human encounters are important for persons with disabilities so they can restructure their occupational identity and their needs for participation in occupations. The study also showed that the use of narratives as a tool within rehabilitation could lead to an increased understanding of the subjective changes that occur over time for a person with a disability

  • 33.
    Isaksson, Gunilla
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Josephsson, Staffan
    Karolinska institute, Neurobiology Care Sciences and Society, Division of Occupational Therapy.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Medicinsk vetenskap.
    Skär, Lisa
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Men's experiences of giving and taking social support after their wife's spinal cord injury2008Inngår i: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 15, nr 4, s. 236-246Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this study was to gain an understanding of how men living with women with spinal cord injury (SCI) experienced and acted when they were giving and taking social support to and from their wives and other persons in their social network. Another aim was to give some possible explanations of the complex process of change that they went through. Data were collected through in-depth interviews with four men and field notes. To describe the men's subjective experiences and the process of change, a narrative approach inspired by Polkinghorne was used. The analyses resulted in one story that included the four men's experiences and action. The story showed that when the men went through a process of change, they used and needed both emotional and practical support to handle their new life situation. Furthermore, the men's experiences and action against social support changed over time. This indicated that, through narratives from spouses, professionals within rehabilitation could understand the process of change they went through after their partner's sudden injury, and support them to find strategies to handle their changed life situation. To give some possible explanations for the men's experiences and action during the process of change, the findings are discussed in relation to theories concerning adaptation and coping

  • 34.
    Isaksson, Gunilla
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Josephsson, Staffan
    Karolinska institutet, Sektionen för arbetsterapi.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap.
    Skär, Lisa
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    To regain participation in occupations through human encounters: narratives from women with spinal cord injury2008Konferansepaper (Annet vitenskapelig)
  • 35.
    Isaksson, Gunilla
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Lexell, Jan
    Skär, Lisa
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Social support provides motivation and ability to participate in occupation2007Inngår i: OTJR (Thorofare, N.J.), ISSN 1539-4492, E-ISSN 1938-2383, Vol. 27, nr 1, s. 23-30Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In this study, a qualitative perspective of how 13 women (aged 25 to 61 years) with spinal cord injury perceive the importance of social support for their participation in occupation is presented. The data were collected through repeated in-depth interviews and field notes, and the analysis used a grounded theory approach. The women needed both emotional and practical support, which was important in a time perspective and motivated them to participate in occupation. The women needed to receive support soon after the injury, but after a period of time they needed to give and receive support in a reciprocal fashion. Social support is therefore an effective rehabilitation strategy that can motivate people with disabilities to participate in meaningful occupation. The importance of social support for a person's motivation and ability to participate in occupation expands our knowledge of the relationship between individuals, their social environment, and occupation.

  • 36.
    Isaksson, Gunilla
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Skär, Lisa
    Josephsson, Staffan
    Institutionen Neurotec, Sektionen för arbetsterapi, Karolinska institutet.
    Projekt: Det sociala nätverkets betydelse för delaktighet i dagliga aktiviteter - Erfarenheter från kvinnor med ryggmärgsskada och deras män2010Annet (Annet (populærvitenskap, debatt, mm))
    Abstract [sv]

    Projektets övergripande syfte  Syftet med detta projekt var att få en fördjupad kunskap om och förståelse för upplevelsen av den sociala miljöns betydelse för delaktighet i dagliga aktiviteter hos kvinnor med en ryggmärgsskada och deras män samt om upplevelsen förändrades över tid.   Kort beskrivning av projektet  Projektet fokuserar på betydelsen av det sociala nätverket och dess relation till aktivitet och hälsa inom rehabilitering och arbetsterapi. Utgångspunkten var att det behövs en ökad kunskap om hur personer med funktionshinder upplever betydelsen av socialt stöd från det sociala nätverket eftersom en framgångsrik rehabilitering förutsätter att en person med funktionshinder upplever socialt stöd från det sociala nätverket. Målgruppen för att belysa detta har i projektet varit kvinnor som drabbats av en ryggmärgsskada, då de ofta får omfattande funktionshinder med förändrade vanor vid aktivitetsutförande samt förändrade relationer i deras sociala nätverk. Vidare för att kunskap om kvinnor med ryggmärgsskada är begränsad. I projektet har även män som var sammanboende med kvinnor med en ryggmärgsskada ingått. Metodologiskt har projektet en kvalitativ inriktning där deltagarna intervjuats om deras upplevelser av det sociala nätverkets betydelse för delaktighet i vardagen från strax före skadan fram till idag. Resultaten visar att över tid utvecklades ett förändrat samspel mellan kvinnorna och deras sociala nätverk som influerade deras delaktighet i dagliga aktiviteter. Resultatet påvisade även betydelsen av berättelser för att fånga dynamiken och komplexiteten i den förändringsprocess som både kvinnorna och männen som var sammanboende med dem gick igenom. Vidare hur klient-centrerad praxis som inkluderar även anhöriga kan utveckla en djupare förståelse för dynamiken och samspelet mellan personen, aktiviteter och socialt samspel.  Detta forskningsprojekt kan därför tillföra arbetsterapeuter, men även annan personal inom rehabilitering, en ökad kunskap om den sociala miljöns betydelse för utförandet av aktiviteter i det dagliga livet. 

  • 37.
    Isaksson, Gunilla
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Skär, Lisa
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Lexell, Jan
    Women's perception of changes in the social network after a spinal cord injury2005Inngår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 27, nr 17, s. 1013-1021Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: To describe how women with a spinal cord injury (SCI) perceived changes in the social network, and how these changes affected their ability to participate in occupation. METHOD: Thirteen women, aged 25 to 61 years, with a SCI were interviewed twice. The interviews focused on their ability to participate in occupation, their relations with individuals within the social network, and changes in the social network following the SCI. The analysis was carried out using qualitative content analysis. RESULTS: The women described an emotional need for social support after the SCI to participate in occupation. This was a new experience that required time to adapt to. The women also described a need for practical social support from the social network members to manage meaningful occupation. After the SCI, the women had developed new habits through close cooperation with members in the social network. The women felt that they had become more responsible for the development of their relations. Many relations had improved after the SCI, while some had decreased. The women had also developed new relations with other persons with disabilities. CONCLUSIONS: The women perceived substantial changes in the social network following the SCI, which in several ways affected their ability to participate in occupation. To adapt to their new life situation, the women gradually developed different strategies. The results point out the need to identify persons in the social network that women with SCI develop relations with, and integrate them in the rehabilitation process.

  • 38.
    Jacobsson, Lars
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Life satisfaction after traumatic brain injury: comparison of ratings with the Life Satisfaction Questionnaire (LiSat-11) and the Satisfaction With Life Scale (SWLS)2016Inngår i: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 14, nr 1, artikkel-id 10Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background An optimal life satisfaction (LS) is considered an important long-term outcome after a traumatic brain injury (TBI). It is, however, not clear to what extent a single instrument captures all aspects of LS, and different instruments may be needed to comprehensively describe LS. The aim of this study was to compare self-ratings of life satisfaction after a TBI with two commonly used instruments. Methods Life Satisfaction Questionnaire (LiSat-11), comprising eleven items and Satisfaction With Life Scale (SWLS), comprising five items, were administered to 67 individuals (51 men and 16 women). Secondary analysis of data collected as part of a survey of individuals with TBI 6 to 15 years post TBI. Results Item 1 in LiSat-11 (‘Life as a whole’) and the total SWLS score was strongly correlated (Spearman’s rho = 0.66; p < 0.001). The total score in SWLS had the strongest correlation with items in LiSat-11. All items in LiSat-11, except ‘Family life’ and ‘Partner relationship’, were moderately to strongly correlated with items in SWLS. The item ‘Partner relationship’ in LiSat-11 did not correlate with any of the items in SWLS or the total score. The item ‘If I could live my life over, I would change nothing’ in SWLS had the weakest correlations with items in LiSat-11. Items ‘Vocation’ and ‘Leisure’ in LISat-11 were most strongly correlated with items in SWLS, whereas the item ‘ADL’ in LiSat-11 was more weakly correlated with items in SWLS. Conclusions The strength of the relationships implies that the two instruments assess similar but not identical aspects of LS and therefore complement each other when it is rated.

  • 39.
    Jacobsson, Lars
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Medicinsk vetenskap.
    Westerberg, Mats
    Luleå tekniska universitet, Institutionen för ekonomi, teknik och samhälle, Innovation och Design.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Medicinsk vetenskap.
    Demographics, injury characteristics and outcome of traumatic brain injuries in northern Sweden2007Inngår i: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 116, nr 5, s. 300-306Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives - To describe demographics, injury characteristics and outcome of traumatic brain injury (TBI) in northern Sweden over 10 years. Material and methods - Data were retrospectively collected on those individuals ( n = 332) in Norrbotten, northern Sweden, with a TBI who had been transferred for neurosurgical care from 1992 to 2001. Results - A majority were older men with a mild TBI and an acute or chronic subdural hematoma following a fall. Younger individuals were fewer but had more often a severe TBI from a traffic accident. Most individuals received post-acute care and brain injury rehabilitation. A majority had a moderate or severe disability, but many were discharged back home with no major changes in their physical or social environment. Conclusions - Our data confirm the relationship between age, cause of injury, injury severity and outcome in relation to TBI and underscore the need for prevention as well as the importance of TBI as a cause of long-term disability

  • 40.
    Jacobsson, Lars
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Medicinsk vetenskap.
    Westerberg, Mats
    Luleå tekniska universitet, Institutionen för ekonomi, teknik och samhälle, Innovation och Design.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Medicinsk vetenskap.
    Health related quality of life and life satisfaction 6 to 15 yearsafter traumatic brain injuries in northern Sweden2010Inngår i: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 24, nr 9, s. 1075-1086Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To describe health-related quality-of-life (HRQoL) and life satisfaction many years after a traumatic brain injury (TBI) and assess possible associations with variables related to the time of injury and follow-up and the individuals' self-appraisal of the impact of the TBI. Method: Sixty-seven individuals (18-65 years), on average 10 years post-injury, were interviewed. Data on HRQoL, using the SF-36 questionnaire, were compared with a Swedish age-and sex-matched reference sample, and life satisfaction, using the Satisfaction With Life Scale (SWLS), were compared with a nationwide Swedish sample of students. The participant's self-appraisal of the TBI was assessed with two supplementary questions. Data were analysed with hierarchical multiple regression analyses.Results: HRQoL as well as life satisfaction were lower compared with the reference samples. From the regression analyses, the individuals' own appraisal of the impact of the TBI and whether they were vocationally productive or not were strongly associated with their current physical health and life satisfaction.Conclusion: These results confirm the importance of TBI as a cause of long-term disability and the impact of the injury on the individuals' self-perceived values of health, quality-of-life and life satisfaction

  • 41.
    Jacobsson, Lars
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Westerberg, Mats
    Luleå tekniska universitet, Institutionen för ekonomi, teknik och samhälle, Innovation och Design.
    Malec, J.
    Rehabilitation Hospital of Indiana and Indiana University School of Medicine.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap.
    Sense of coherence and disability and the relationship with life satisfaction 6 to 15 years after traumatic brain injuries in northern Sweden2011Inngår i: Neuropsychological rehabilitation (Print), ISSN 0960-2011, E-ISSN 1464-0694, Vol. 23, nr 1, s. 383-400Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The objective of the study was to assess sense of coherence (SOC) many years after traumatic brain injury (TBI) and explore the relationship between SOC and self-rated life satisfaction (LS) as well as measures of functioning and disability, sex, age at injury, injury severity and time post-injury. Sixty-six individuals (aged 18-65 years) who were 6-15 years post-injury were interviewed. Data on SOC (SOC-13 item scale), measures of functioning and disability (Mayo-Portland Adaptability Inventory, MPAI-4), LS (Satisfaction with Life Scale, SWLS), and sex, age at injury, injury severity and time post-injury were analysed with hierarchical multiple regression analyses. The results showed that SOC in the study group did not differ from the general population and was strongly associated with LS. Regression analyses revealed that emotional factors, social participation, SOC, and time since injury, were more influential than sex, age at injury, and injury severity in explaining LS. It was concluded that SOC in this group of individuals with TBI who were many years post-injury was similar to nondisabled individuals. SOC, together with emotional factors, social participation and injury-related factors, were determinants of LS. These results confirm that LS after TBI is a complex phenomenon dependent on several factors that are important targets for rehabilitation professionals.

  • 42.
    Jacobsson, Lars
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap.
    Westerberg, Mats
    Luleå tekniska universitet, Institutionen för ekonomi, teknik och samhälle, Innovation och Design.
    Söderberg, Siv
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Lexell, Jan
    Functioning and disability 6-15 years after traumatic brain injuries in northern Sweden2009Inngår i: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 120, nr 6, s. 389-395Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives - To assess long-term functioning and disability after traumatic brain injury (TBI). Material and methods - Individuals (n = 88) in Norrbotten, northern Sweden, who had been transferred for neurosurgical care were assessed with internationally established TBI outcome measures 6-15 years post-injury. Results - There was an improvement in overall outcome from discharge from inpatient rehabilitation to follow-up. Many individuals had a high degree of motor and cognitive functioning, which enabled them to live independently in their own home without assistance, but there remained a disability related to community reintegration and social participation. This affected their productivity and to some degree their marital stability. The remaining disability and reduced productivity were related to the age at injury and the injury severity. Conclusions Our data showed that individuals with a TBI can achieve and maintain a high degree of functioning many years after the injury. Increasing age and a greater injury severity contributed to their long-term disability.

  • 43.
    Jonasson, Stina B.
    et al.
    Department of Health Sciences, Lund University.
    Nilsson, Maria H.
    Department of Health Sciences, Lund University.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Psychometric properties of the original and short versions of the Falls Efficacy Scale-International (FES-I) in people with Parkinson’s disease2017Inngår i: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 15, nr 1, artikkel-id 116Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Fear of falling is common in people with Parkinson’s disease (PD) and is associated with an increased risk for future falls, activity limitations and a reduced quality of life. The Falls Efficacy Scale-International (FES-I) assesses fear of falling conceptualized as concerns about falling. The original FES-I has good psychometric properties in people with PD, but whether this applies also for the short version of FES-I remains to be shown.

    The aim of the present study was to evaluate the psychometric properties of the short FES-I and to compare these with the original FES-I in the same sample of people with PD. The investigated psychometric properties included known groups validity, data completeness, scaling assumptions, targeting and reliability.

    Methods

    A postal survey, which included the original, full-length FES-I, was distributed to 174 people with PD. Responders received a second survey after two weeks. From these data, short FES-I total scores were calculated by extracting the items that are included in the short version of the scale.

    Results

    Median age and PD duration of the 101 responders (43% women) were 73 and 5 years, respectively. The original as well as the short FES-I scores were able to discriminate (p < 0.001) between groups with and without fear of falling, activity avoidance, falls, near falls, and with various self-rated PD severity, respectively. Both versions of FES-I had a high level of data completeness (0.7 to 0.9% missing item responses). Scaling assumptions were acceptable for the original as well as the short FES-I. While the short FES-I had 19% floor effect, the original version was better targeted. Both versions were reliable and obtained high values for internal consistency (Cronbach’s alpha >0.8) and test-retest reliability (Intraclass Correlation Coefficient > 0.9).

    Conclusions

    Both the original and short FES-I revealed generally good psychometric properties in people with PD, although the original scale was better targeted. Due to the higher floor effect in the short FES-I, the present findings favors using the original, full-length FES-I in longitudinal follow-ups, intervention studies and clinical practice when addressing concerns about falling.

  • 44.
    Jonasson, Stina B.
    et al.
    Department of Health Sciences, Lund University.
    Nilsson, Maria H.
    Department of Health Sciences, Lund University.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering. Department of Health Sciences, Lund University, .
    Carlsson, Gunilla
    Department of Health Sciences, Lund University.
    Experiences of fear of falling in persons with Parkinson’s disease: a qualitative study2018Inngår i: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 18, nr 1, artikkel-id 44Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Fear of falling is common among persons with Parkinson’s disease and is negatively associated with quality of life. However a lack of in-depth understanding of fear of falling as a phenomenon persists. This qualitative study aimed to explore the experiences of fear of falling in persons with Parkinson’s disease.

    Methods

    Individual interviews were performed with twelve persons with Parkinson’s disease (median age 70 years, median Parkinson duration 9 years, 50% women). The interviews were semi-structured and followed a study-specific interview guide. The transcribed interviews were analyzed using qualitative content analysis.

    Results

    Fear of falling was experienced as a disturbing factor in everyday life. It generated a feeling of vulnerability and made daily activities and everyday environments seem potentially hazardous. Persons also missed performing previous activities. The fear of falling was a varying experience, fueled by an awareness of falls and near falls, Parkinson-related symptoms and disabilities, and by others in their environment. The persons adopted different strategies to handle their fear of falling. Activities were adapted, avoided, performed with help, or carried out despite their fear of falling.

    Conclusions

    The experiences of fear of falling were complex, multifaceted and varied over time and in relation to different activities and environments. This indicates that interventions targeting fear of falling need to be individually tailored for persons with Parkinson’s disease and should focus on several aspects, such as Parkinson-related symptoms and disabilities, activities and environmental factors. This study provides new information that increases the understanding of fear of falling, which has implications for researchers as well as clinicians working with persons with Parkinson’s disease and fear of falling.

  • 45. Jumisko, Eija
    et al.
    Lexell, Jan
    Söderberg, Siv
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Att leva med en medelsvår eller svår traumatisk hjärnskada2005Konferansepaper (Annet vitenskapelig)
  • 46. Jumisko, Eija
    et al.
    Lexell, Jan
    Söderberg, Siv
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Living with a traumatic brain injury as narrated by people with moderate or severe traumatic brain injury2004Inngår i: Workgroup of European nurse researchers. Biennial conference (12 : Lisboa : 2004), WENR , 2004, s. 87-Konferansepaper (Annet vitenskapelig)
  • 47.
    Jumisko, Eija
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Medicinsk vetenskap.
    Söderberg, Siv
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Living with moderate or severe traumatic brain injury: the meaning of family members' experiences2007Inngår i: Journal of Family Nursing, ISSN 1074-8407, E-ISSN 1552-549X, Vol. 13, nr 3, s. 353-69Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Traumatic brain injury (TBI) has long-lasting consequences not only for the individual with the injury but also for family members. The aim of this study is to elucidate the meaning of family members' experiences of living with an individual with moderate or severe TBI. The data have been collected by means of qualitative research interviews with 8 family member participants. A phenomenological hermeneutic interpretation (Ricouer, 1976) of the data reveal that family members struggle with their own suffering while showing compassion for the injured person. Their willingness to assume care for the injured person is derived from their feeling of natural love and the ethical demand to be responsible for the other. Hope and natural love from close relatives, the afflicted person, and other family members give the family members strength. It is important that professionals pay more attention to the suffering of close relatives

  • 48. Jumisko, Eija
    et al.
    Lexell, Jan
    Söderberg, Siv
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    The experiences of treatment from other people as narrated by people with moderate or severe traumatic brain injury and their close relatives2007Inngår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 29, nr 19, s. 1535-1543Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose. The aim of this study was to describe the treatment from other people as experienced by people with moderate or severe traumatic brain injury (TBI) and their close relatives. Method. Twelve people with moderate or severe TBI and eight of their close relatives were interviewed. The interviews were analysed using thematic content analysis. Results. The results were described by the means of two themes: being excluded and missing confirmation. People with TBI and their close relatives had experiences of being avoided, being ruled by the authorities, being met with distrustfulness and being misjudged. They also searched for answers and longed for the right kind of help. People who listened to them, believed them and tried to understand and help them were appreciated. Conclusions. This study showed a lack of treatment which promotes well-being of the people with TBI and their close relatives. They experienced bad treatment also from authorities. Therefore, we emphasize that authorities should continuously reflect on how to make their practice a place which promotes dignity. Treatment of people with TBI and close relatives may be improved by increased knowledge about TBI, living with it and being a close relative to a person with TBI. This is a challenge to health care and rehabilitation professionals

  • 49.
    Jumisko, Eija
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Medicinsk vetenskap.
    Söderberg, Siv
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    The meaning of feeling well in people with moderate or severe traumatic brain injury2009Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 18, nr 16, s. 2273-2281Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim. The aim of this study was to elucidate the meaning of feeling well for people with moderate or severe traumatic brain injury.Background. Considerable attention has been given to research consequences, quality of life and satisfaction with life in people with traumatic brain injury. Most studies reveal negative aspects of living with traumatic brain injury. Knowledge that provides an understanding of the meaning of feeling well for people with a traumatic brain injury entails the possibility that they could receive support to feel well, despite their injury.Design. This study used a qualitative research approach, as the aim was to elucidate meaning.Methods. Data were collected through qualitative research interviews with two women and six men with moderate or severe traumatic brain injury who had lived with the injury for between 7-15 years. A phenomenological hermeneutic method was used to interpret the data.Results. The meaning of feeling well for people with moderate or severe traumatic brain injury was that the initially unfamiliar life with traumatic brain injury became familiar. This included finding strength, regaining control over everyday life, being close to someone and being good enough. People with traumatic brain injury felt well when they became reconciled with the circumstances of their life and created a new entity in that life, in which their complete health had been lost.Relevance to clinical practice. This study helps professionals to enhance their understanding and awareness of the possibilities for people with moderate or severe traumatic brain injury to feel well. The study showed that people with traumatic brain injury needed a lot of strength to achieve this. Professionals can help them to feel well by getting to know them and thus find ways to support the person's feeling of wellbeing.

  • 50.
    Jumisko, Eija
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Lexell, Jan
    Söderberg, Siv
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    The meaning of living with traumatic brain injury in people with moderate or severe traumatic brain injury2005Inngår i: Journal of Neuroscience Nursing, ISSN 0888-0395, E-ISSN 1945-2810, Vol. 37, nr 1, s. 42-50Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    A traumatic brain injury (TBI) extensively affects the injured person's daily life. Research based on the perspectives of people with TBI can increase understanding of the challenges they face and the possibility of supporting them in managing their lives. The aim of this study was to elucidate the meaning of living with TBI as narrated by the people with moderate or severe TBI. The data were collected by means of qualitative research interviews with 12 participants who had lived with TBI for 4-13 years. A phenomenological hermeneutic method was used to interpret the transcribed interviews. The study showed that people with TBI had lost their way and struggled to achieve a new normalcy. Losing one's way included experiences of waking up to unknown, missing relationships and experiencing the body as an enemy. Participants' struggles to attain a new normalcy included searching for an explanation, recovering the self, wishing to be met with respect, and finding a new way of living. Living with TBI seems to mean living with a perpetually altered body that changed the whole life and caused deep suffering, where feelings of shame and dignity competed with each other. Participants seem to be quite alone in their suffering and need more support from healthcare professionals.

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