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  • 1. Giné-Garriga, Maria
    et al.
    Sandlund, Marlene
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Dall, Philippa M.
    Chastin, Sebastien F. M.
    Pérez, Susana
    Skelton, Dawn A.
    A co-created intervention with care home residents and university students following a service-learning methodology to reduce sedentary behaviour: The GET READY project protocol2018In: Journal of Frailty, Sarcopenia and Falls, ISSN 2459-4148, Vol. 3, no 3, p. 132-137Article in journal (Refereed)
    Abstract [en]

    Background: There is a growing demand for long-term care settings. Care-home residents are a vulnerable group with high levels of physical dependency and cognitive impairment. Long-term care facilities need to adapt and offer more effective and sustainable interventions to address older residents’ complex physical and mental health needs. Despite the increasing emphasis on patient and public involvement, marginalised groups such as care-home residents, can be overlooked when including people in the research process. The GET READY project aims to integrate servicelearning methodology into Physical Therapy and Sport Sciences University degrees by offering students individual service opportunities with residential care homes, in order to co-create the best suited intervention with researchers, older adults of both genders (end-users) in care homes, health professionals, caregivers, relatives and policy makers. Methods: Stage 1 will integrate a service-learning methodology within a Physical Therapy module in Glasgow and Sport Sciences module in Barcelona, design two workshops for care home residents and one workshop for staff members, relatives and policy makers and conduct a co-creation procedure. Stage 2 will assess the feasibility, safety and preliminary effects of the co-created intervention in a group of 60 care home residents, within a two-armed pragmatic randomized clinical trial. ClinicalTrials.gov Identifier: NCT03505385.

  • 2. Giné-Garriga, Maria
    et al.
    Sandlund, Marlene
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Dall, Philippa M.
    Chastin, Sebastien F. M.
    Pérez, Susana
    Skelton, Dawn A.
    A Novel Approach to Reduce Sedentary Behaviour in Care Home Residents: The GET READY Study Utilising Service-Learning and Co-Creation2019In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, no 3, article id 418Article in journal (Refereed)
    Abstract [en]

    The GET READY study aimed to integrate service-learning methodology into University degrees by offering students individual service opportunities with residential care homes, to co-create the best suited intervention to reduce the sedentary behaviour (SB) of residents throughout the day, with researchers, end-users, care staff, family members and policymakers. Eight workshops with care home residents and four workshops with care staff, relatives and policymakers, led by undergraduate students, were audiotaped, transcribed verbatim and analysed with inductive thematic analysis to understand views and preferences for sustainable strategies to reduce SB and increase movement of residents. Perspectives about SB and movement in care homes highlighted four subthemes. Assets for decreasing SB included three subthemes, and suggestions and strategies encapsulated four subthemes. There is a need to include end-users in decision making, and involve care staff and relatives in enhancing strategies to reduce SB among residents if we want sustainable changes in behaviour. A change in the culture at a policymaker and care staff's level could provide opportunities to open care homes to the community with regular activities outside the care home premises, and offer household chores and opportunities to give residents a role in maintaining their home environment.

  • 3.
    Guerrero, Esteban
    et al.
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Nieves, Juan Carlos
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Sandlund, Marlene
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Activity qualifiers in an argumentation framework as instruments for agents when evaluating human activity2016In: Advances in Practical Applications of Scalable Multi-agent Systems. The PAAMS Collection: 14th International Conference, PAAMS 2016, Sevilla, Spain, June 1-3, 2016, Proceedings / [ed] Yves Demazeau, Takayuki Ito, Javier Bajo, Maria José Escalona, Springer, 2016, Vol. 9662, p. 133-144Conference paper (Other academic)
    Abstract [en]

    Theoretical frameworks have been developed for enabling software agents to evaluate simple activities such as walking and sitting. However, such frameworks typically do not include methods for how practically dealing with uncertain sensor information. We developed an argument-based method for evaluating complex goal-based activities by adapting two qualifiers: Performance and Capacity defined in the health domain. The first one evaluates what a person does, and the second one how "well" or "bad" an activity is executed. Our aim is to deal with uncertainty and inconsistent information; generate consistent hypotheses about the activity execution; and resemble an expert therapist judgment, where an initial hypothesis assessment can be retracted under new evidence. We conducted a pilot test in order to evaluate our approach using a Physiotherapy assessment test as a goal-based activity. Results show that skeptic argumentation semantics are may be useful for discriminating individuals without physical issues by considering Performance and Capacity; conversely, credulous semantics may be suitable for obtaining information in the evaluation of activity, which an intelligent agent may use for providing personalized assistance in an ambient assisted living environment.

  • 4.
    Guerrero, Esteban
    et al.
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Nieves, Juan Carlos
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Sandlund, Marlene
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Activity qualifiers using an argument-based construction2018In: Knowledge and Information Systems, ISSN 0219-1377, E-ISSN 0219-3116, Vol. 54, no 3, p. 633-658Article in journal (Refereed)
    Abstract [en]

    Based on an argumentation theory approach, we present a novel method for evaluating complex goal-based activities by generalizing a notion of qualifier defined in the health domain. Three instances of the general qualifier are proposed: Performance, Actuation and Capacity; the first one evaluates what a person does, the second how an individual follows an action plan, and the third one how "well" or "bad" an activity is executed. Qualifiers are intended to be used by autonomous systems for evaluating human activity. We exemplify our approach using a health domain assessment protocol. Main results of this test show a partial correlation between ambiguities assessed by experts and our argument-based approach; and a multi-dimensional perspective how an activity is executed when a combined evaluation of qualifiers is used. This last outcome was interesting for some therapists consulted. Results also show differences between values of qualifiers using different argumentation semantics; two scenarios were proposed by therapist for using different semantics: preliminary activity screening and time-span follow-up evaluation.

  • 5.
    Larsson, Gunilla
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Swedish National Rett Center, Frösön, Sweden.
    Julu, Peter O. O.
    Engerström, Ingegerd Witt
    Sandlund, Marlene
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Lindström, Britta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Walking on treadmill with Rett syndrome: effects on the autonomic nervous system2018In: Research in Developmental Disabilities, ISSN 0891-4222, E-ISSN 1873-3379, Vol. 83, p. 99-107Article in journal (Refereed)
    Abstract [en]

    People with Rett syndrome have deficient central autonomic control, which may interfere with walking. We have limited knowledge regarding the effects of exertion during physical activity in Rett syndrome. The aim was to investigate the autonomic responses during walking on a treadmill in Rett syndrome. Twenty-six females, 12 with Rett syndrome and 14 healthy females were included. All individuals started on the treadmill by standing still, followed by walking slowly with progressive speed until reaching maximum individual speed, which they kept for 6 min. Heart rate (HR), systolic (SBP), diastolic (DBP), mean arterial blood pressures (MAP), cardiac vagal tone (CVT), cardiac sensitivity to baroreflex (CSB), transcutaneous partial pressures of oxygen (pO2), carbon dioxide (pCO2), and breathing movements were recorded simultaneously and continuously. Autonomic responses were assessed by MAP, CSB and CVT during walking at 3 and 6 min. The changes in CSB and CVT in people with Rett syndrome compared to controls indicated more arousal, but only when the treadmill was started; as they continued walking, the arousal dropped to control level. People with Rett syndrome exhibited little changes in pCO2 whereas the controls showed increased values during walking. This suggests poor aerobic respiration in people with Rett syndrome during walking. Five people with Rett syndrome had Valsalva type of breathing at rest, three of those had normal breathing while walking on the treadmill while the remaining two started but soon stopped the Valsalva breathing during the walk. Our results show that individuals with Rett syndrome can walk for up to 6 min at their own maximum sustainable speed on a treadmill. Energy production may be low during walking in Rett syndrome, which could cause early tiredness. A treadmill can be used in people with Rett syndrome, but must be introduced slowly and should be individually tailored. We propose that walking promotes regular breathing in Rett syndrome.

  • 6.
    Larsson, Gunilla
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Swedish Rett Center, Jämtland County Council, Östersund, Sweden.
    Julu, Peter O.O.
    Breakspear Medical Group, Hertfordshire, UnitedKingdom.
    Witt Engerström, Ingegerd
    RettCenter, Jämtland CountyCouncil, Östersund, Sweden.
    Sandlund, Marlene
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lindström, Britta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Normal reactions to orthostatic stress in Rett syndrome2013In: Research in Developmental Disabilities, ISSN 0891-4222, E-ISSN 1873-3379, Vol. 34, no 6, p. 1897-1905Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate orthostatic reactions in females with Rett syndrome (RTT), and also whether the severity of the syndrome had an impact on autonomic reactions. Based on signs of impaired function of the central autonomic system found in RTT, it could be suspected that orthostatic reactions were affected. The orthostatic reactions in 21 females with RTT and 14 normally developed femalesmatched by age were investigated when they rose from a sitting position, and during standing for 3 min. Reactions of the heart, the blood pressure and the time for recovery of systolic blood pressure, were studied in real time, heartbeat by heartbeat, simultaneously. There was no difference between participants with RTT and the normally developed controls regarding general orthostatic reactions (heart rate, systolic and diastolic blood pressure, and mean arterial pressure) when getting up from a sitting position, and when standing erect for 3min. In the specific immediate response by the heart to standing up, the 30:15 ratio, significantly lower values were found for females with RTT. In the RTT group, the maximum fall of systolic blood pressure showed a tendency to a larger decrease, and the initial decrease in systolic blood pressure was significantly faster. The time for recovery of systolic blood pressure from standing erect did not differ between groups. At baseline the females with RTT had significantly lower systolic blood pressure and a tendency to a higher heart rate. The results do not indicate any autonomic limitations for people with RTT in getting up from a sitting position and standing. The participants with RTT had normal orthostatic reactions indicated by the heart and blood pressure responses when standing erect for 3 min. A faster initial drop in systolic blood pressure in people with RTT was notable.

  • 7. Leask, Calum F.
    et al.
    Sandlund, Marlene
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Skelton, Dawn A.
    Chastin, Sebastien F. M.
    Co-creating a tailored public health intervention to reduce older adults' sedentary behaviour2017In: Health Education Journal, ISSN 0017-8969, E-ISSN 1748-8176, Vol. 76, no 5, p. 595-608Article in journal (Refereed)
    Abstract [en]

    Objective: The increasing health care costs associated with an ageing population and chronic disease burden are largely attributable to modifiable lifestyle factors that are complex and vary between individuals and settings. Traditional approaches to promoting healthy lifestyles have so far had limited success. Recently, co-creating public health interventions with end-users has been advocated to provide more effective and sustainable solutions. The aim of this study was to document and evaluate the co-creation of a public health intervention to reduce sedentary behaviour in older adults.

    Design: Community-dwelling older adults (N = 11, mean age = 74 years) and academic researchers attended 10 interactive co-creation workshops together.

    Setting: Workshops took place on university campus and the co-creators completed fieldwork tasks outside the workshops.

    Method: Workshops were informed by the Participatory and Appreciative Action and Reflection methodology. Data were collected using field notes, video recording and worksheet tasks. Analysis was conducted using a qualitative content analysis approach.

    Results: The co-creators developed a tailored intervention delivered through a mode congruent with older adults’ lives. Key elements of the intervention included (1) education on sedentary behaviour, (2) resources to interrupt sedentary behaviour, (3) self-monitoring, (4) action planning and (5) evaluating the benefits of interrupting sedentary behaviour.

    Conclusion: Co-creation is a feasible approach to develop public health interventions; however, it is limited by the lack of a systematic framework to guide the process. Future work should aim to develop principles and recommendations to ensure co-creation can be conducted in a more scientific and reproducible way. The effectiveness and scalability of the intervention should be assessed.

  • 8. Leask, Calum F.
    et al.
    Sandlund, Marlene
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Skelton, Dawn A.
    Tulle, Emmanuelle
    Chastin, Sebastien F. M.
    Modifying Older Adults' Daily Sedentary Behaviour Using an Asset-based Solution: Views from Older Adults2016In: AIMS public health, ISSN 2327-8994, Vol. 3, no 3, p. 542-554Article in journal (Refereed)
    Abstract [en]

    Objective: There is a growing public health focus on the promotion of successful and active ageing. Interventions to reduce sedentary behaviour (SB) in older adults are feasible and are improved by tailoring to individuals' context and circumstances. SB is ubiquitous; therefore part of the tailoring process is to ensure individuals' daily sedentary routine can be modified. The aim of this study was to understand the views of older adults and identify important considerations when creating a solution to modify daily sedentary patterns. Method: This was a qualitative research study. Fifteen older adult volunteers (mean age = 78 years) participated in 1 of 4 focus groups to identify solutions to modify daily sedentary routine. Two researchers conducted the focus groups whilst a third took detailed fieldnotes on a flipchart to member check the findings. Data were recorded and analysed thematically. Results: Participants wanted a solution with a range of options which could be tailored to individual needs and circumstances. The strategy suggested was to use the activities of daily routine and reasons why individuals already naturally interrupting their SB, collectively framed as assets. These assets were categorised into 5 sub-themes: physical assets (eg. standing up to reduce stiffness); psychological assets (eg. standing up to reduce feelings of guilt); interpersonal assets (eg. standing up to answer the phone); knowledge assets (eg. standing up due to knowing the benefits of breaking SB) and activities of daily living assets (eg. standing up to get a drink). Conclusion: This study provides important considerations from older adults' perspectives to modify their daily sedentary patterns. The assets identified by participants could be used to co-create a tailored intervention with older adults to reduce SB, which may increase effectiveness and adherence.

  • 9. Leask, Calum F.
    et al.
    Skelton, Dawn A.
    Sandlund, Marlene
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Chastin, Sebastien F. M.
    Co-Creating a Tailored Intervention to Reduce Sedentary Behaviour in Older Adults2016In: Journal of Aging and Physical Activity, ISSN 1063-8652, E-ISSN 1543-267X, Vol. 24, p. 92-92Article in journal (Other academic)
  • 10.
    Lindgren, Helena
    et al.
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Pohl, Petra
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Sandlund, Marlene
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    End users transforming experiences into formal information and process models for personalised health interventions2014In: Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365, Vol. 205, p. 378-382Article in journal (Refereed)
    Abstract [en]

    Five physiotherapists organised a user-centric design process of a knowledge-based support system for promoting exercise and preventing falls. The process integrated focus group studies with 17 older adults and prototyping. The transformation of informal medical and rehabilitation expertise and older adults' experiences into formal information and process models during the development was studied. As tool they used ACKTUS, a development platform for knowledge-based applications. The process became agile and incremental, partly due to the diversity of expectations and preferences among both older adults and physiotherapists, and the participatory approach to design and development. In addition, there was a need to develop the knowledge content alongside with the formal models and their presentations, which allowed the participants to test hands-on and evaluate the ideas, content and design. The resulting application is modular, extendable, flexible and adaptable to the individual end user. Moreover, the physiotherapists are able to modify the information and process models, and in this way further develop the application. The main constraint was found to be the lack of support for the initial phase of concept modelling, which lead to a redesigned user interface and functionality of ACKTUS.

  • 11.
    Pettersson, Beatrice
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Wiklund, Maria
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Janols, Rebecka
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy. Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Skelton, Dawn A.
    Sandlund, Marlene
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    "Managing pieces of a personal puzzle': Older people's experiences of self-management falls prevention exercise guided by a digital program or a booklet2019In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 19, article id 43Article in journal (Refereed)
    Abstract [en]

    Background: Exercise is effective in order to prevent falls in community-dwelling older people. Self-management programs have the potential to increase access and reduce costs related to exercise-based fall prevention. However, information regarding older people's views of participating in such programs is needed to support implementation. The aim of this study was to explore older people's experiences of a self-management fall prevention exercise routine guided either by a digital program (web-based or mobile) or a paper booklet.

    Methods: This qualitative study was part of a feasibility study exploring two completely self-managed exercise interventions in which the participants tailored their own program, guided either by a digital program or a paper booklet. Individual face-to-face semi-structured interviews were conducted with a purposeful sample of 28 participants (18 women), mean age 76yrs. Qualitative content analysis was used to analyse the data.

    Results: Self-managing and self-tailoring these exercise programs was experienced as Managing pieces of a personal puzzle'. To independently being able to create a program and manage exercise was described in the categories Finding my own level' and Programming it into my life'. The participants experienced the flexibility and independence provided by completely self-managed exercise as positive and constructive although it required discipline. Furthermore, different needs and preferences when managing their exercise were described, as well as varying sources of motivation for doing the exercise, as highlighted in the category Defining my source of motivation'. The category Evolving my acquired knowledge' captures the participants' views of building their competence and strategies for maintenance of the exercise. It describes a combined process of learning the program and developing reflection, which was more clearly articulated by participants using the digital program.

    Conclusions: This study provides new knowledge regarding experiences, preferences and motivations of older people to engage in home-based self-managed fall prevention exercise. They expressed both a capability and willingness to independently manage their exercise. A digital program seems to have strengthened the feeling of support while creating their own exercise program and tailoring it to their preferences and circumstances, which might therefore create better opportunities for adoption and adherence in the long term.

  • 12.
    Pohl, Petra
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Sandlund, Marlene
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Ahlgren, Christina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Bergvall-Kårebom, Birgitta
    Luleå universitet.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Melander Wikman, Anita
    Luleå universitet.
    Fall risk awareness and safety precautions taken by older community-dwelling women and men: a qualitative study using focus group discussions2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 3, article id e0119630Article in journal (Refereed)
    Abstract [en]

    Introduction Daily life requires frequent estimations of the risk of falling and the ability to avoid a fall. The objective of this study was to explore older women's and men's understanding of fall risk and their experiences with safety precautions taken to prevent falls.

    Methods A qualitative study with focus group discussions was conducted. Eighteen community-dwelling people [10 women and 8 men] with and without a history of falls were purposively recruited. Participants were divided into two groups, and each group met four times. A participatory and appreciative action and reflection approach was used to guide the discussions. All discussions were audio recorded and transcribed verbatim. Data were analysed by qualitative content analysis, and categories were determined inductively.

    Findings Three categories describing the process of becoming aware of fall risks in everyday life were identified: 1] Facing various feelings, 2] Recognizing one's fall risk, and 3] Taking precautions. Each category comprised several subcategories. The comprehensive theme derived from the categories was "Safety precautions through fall risk awareness". Three strategies of ignoring [continuing a risky activity], gaining insight [realizing the danger in a certain situation], and anticipating [thinking ahead and acting in advance] were related to all choices of actions and could fluctuate in the same person in different contexts.

    Conclusions The fall risk awareness process might be initiated for various reasons and can involve different feelings and precautions as well as different strategies. This finding highlights that there are many possible channels to reach older people with information about fall risk and fall prevention, including the media and their peers. The findings offer a deeper understanding of older peoples' conceptualizations about fall risk awareness and make an important contribution to the development and implementation of fall prevention programmes.

  • 13.
    Sandlund, Marlene
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Motion interactive games for children with motor disorders: motivation, physical activity, and motor control2011Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    As motion interactive games have become more widespread the interest in using these games in rehabilitation of children with motor disorders has increased among both clinical professionals and the families of these children. The general aim of this thesis was to evaluate the feasibility of using interactive games in rehabilitation of children to promote motivation for practice, physical activity, and motor control. A systematic review of published intervention studies was conducted to obtain an overview of existing research and the current levels of evidence for using interactive games in motor rehabilitation of children. Sixteen studies met the inclusion criteria, out of these three were randomized controlled trials while half were case series or case reports. Thirteen studies presented positive findings, which indicated a promising potential. However, more convincing research is needed.

    Commercially available motion interactive games have only been used in a few studies on motor control, and in none of these home based practice was provided. Moreover, no earlier studies have evaluated if these games may increase motivation for training and daily physical activity among children with disabilities. To address these issues a feasibility intervention including 15 children in the ages 6-16 years and with mild to moderate cerebral palsy was conducted. Each child was provided with a Sony PlayStation2â and the EyeToyâ games in Play3, and was recommended to practice with the provided games for at least 20 minutes/day during four weeks. The intervention was evaluated with gaming diaries, physical activity monitors (SenseWear Armband), interviews with the parents, and the clinical motor tests Movement Assessment Battery for Children-2 (mABC-2), Bruininks-Oseretsky Test of Motor Proficiency subtest 5:6, and the 1 Minute Walk Test. In addition, 3D motion analysis was used to evaluate effects on quality of goal-directed arm movements towards virtual and real objects, respectively.

    Motivation for practice and compliance of training were high, although declining somewhat during the course of the four weeks. The children’s physical activity increased significantly during the intervention. However, four children were excluded from this analysis due to lack of complete data from the physical activity monitors. According to mABC-2 the children’s motor performance improved, but there were both floor and ceiling effects, indicating a low sensibility of this test. The two additional motor tests showed only non-significant progress. Results from the 3D motion analysis suggest that the children improved movement precision when playing the games, movement smoothness when reaching for real objects, and used a more economic reaching strategy with less trunk involvement. In the interviews the parents expressed the view that motion interactive games promote positive experiences of physical training and add elements of social interaction to the training. They also experienced less urge to take on a coaching role. The training provided by the games was considered unspecific and there was a desire for individualized games to better address the unique rehabilitative need of each child.

    In conclusion, it is feasible to use motion interactive games in home rehabilitation for children with cerebral palsy to promote short term motivation for practice and general physical training. Specific effects on motor control need to be further explored and there is also a need for reliable tests that are adequate and sensitive enough to capture changes in movement control. In future development of interactive games for rehabilitation purposes, it is a challenge to preserve the motivational and social features of games while at the same time optimizing an individualized physical training.

  • 14.
    Sandlund, Marlene
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Dock, Katarina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Häger, Charlotte K
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lindh Waterworth, Eva
    Umeå University, Faculty of Social Sciences, Department of Informatics.
    Motion interactive video games in home training for children with cerebral palsy: parents' perceptions2012In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 34, no 11, p. 925-933Article in journal (Refereed)
    Abstract [en]

    Purpose: To explore parents' perceptions of using low-cost motion interactive video games as home training for their children with mild/moderate cerebral palsy.

    Method: Semi-structured interviews were carried out with parents from 15 families after participation in an intervention where motion interactive games were used daily in home training for their child. A qualitative content analysis approach was applied.

    Results: The parents' perception of the training was very positive. They expressed the view that motion interactive video games may promote positive experiences of physical training in rehabilitation, where the social aspects of gaming were especially valued. Further, the parents experienced less need to take on coaching while gaming stimulated independent training. However, there was a desire for more controlled and individualized games to better challenge the specific rehabilitative need of each child.

    Conclusions: Low-cost motion interactive games may provide increased motivation and social interaction to home training and promote independent training with reduced coaching efforts for the parents. In future designs of interactive games for rehabilitation purposes, it is important to preserve the motivational and social features of games while optimizing the individualized physical exercise.

  • 15.
    Sandlund, Marlene
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Domellöf, Erik
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Grip, Helena
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Rönnqvist, Louise
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Effect of practice with motion interactive video games on goal-directed arm movements in children with cerebral palsy: a kinematic evaluationManuscript (preprint) (Other academic)
    Abstract [en]

    Objective: The aim of the present study was to evaluate the quality of goal-directed arm movements in children with cerebral palsy after four weeks of daily practice with motion interactive games, and to explore and compare the applicability of various kinematic parameters in a virtual context compared to a situation with real objects.

    Methods: Fifteen children with CP, 6-16 years, practiced with the EyeToyâ for PlayStation2â in their homes during four weeks. Before and after the intervention kinematics and kinetics were captured with a five camera motion analysis system (Proreflex, Qualisys AB, Gothenburg, Sweden) and a force plate. The children performed arm movements towards both virtual and real targets.

    Results: The children used a more economic reaching strategy with shorter Centre of pressure paths, improved Movement precision, and reduced variability in Maximal shoulder angles during play after practice. Transfer of improved motor control to goal-directed arm movements towards real targets was also indicated by increased Movement smoothness, and while reaching with the non-dominant side, reduced Centre of pressure paths path. The spatiotemporal characteristics proved complex to interpret in terms of improved motor control.

    Conclusions: When taking the constraints of the tasks into account the relevant kinematic parameters explored support the conclusion that practice with motion interactive games resulted in an improved motor control. The results of this study illuminate the importance of considering both the nature of the task and the context in which movements are performed when selecting and interpreting kinematic parameters.

  • 16.
    Sandlund, Marlene
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Domellöf, Erik
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Grip, Helena
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Rönnqvist, Louise
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Häger, Charlotte K.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Training of goal directed arm movements with motion interactive video games in children with cerebral palsy: a kinematic evaluation2014In: Developmental Neurorehabilitation, ISSN 1751-8423, E-ISSN 1751-8431, Vol. 17, no 5, p. 318-326Article in journal (Refereed)
    Abstract [en]

    Objective: The main aim of this study was to evaluate the quality of goal-directed arm movements in 15 children with cerebral palsy (CP) following four weeks of home-based training with motion interactive video games. A further aim was to investigate the applicability and characteristics of kinematic parameters in a virtual context in comparison to a physical context.

    Method: Kinematics and kinetics were captured while the children performed arm movements directed towards both virtual and physical targets.

    Results: The children’s movement precision improved, their centre of pressure paths decreased, as did the variability in maximal shoulder angles when reaching for virtual objects. Transfer to a situation with physical targets was mainly indicated by increased movement smoothness.

    Conclusion: Training with motion interactive games seems to improve arm motor control in children with CP. The results highlight the importance of considering both the context and the task itself when investigating kinematic parameters.

  • 17.
    Sandlund, Marlene
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Grip, Helena
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Domellöf, Erik
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Rönnqvist, Louise
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Low-cost motion interactive video games in home training for children with cerebral palsy: A kinematic evaluation2011In: 2011 International Conference on Virtual Rehabilitation, ICVR / [ed] Daniel Thalmann, IEEE conference proceedings, 2011Conference paper (Refereed)
    Abstract [en]

    3D motion analysis was applied to assess goal-directed arm movements in 15 children with cerebral palsy (CP) before and after four weeks of home training with low-cost motion interactive video games. The results indicated that the children improved movement precision when playing the virtual games, improved movement smoothness when reaching for real targets, and reduced the involvement of the trunk especially when reaching with the non-dominant side. © 2011 IEEE.

  • 18.
    Sandlund, Marlene
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Hoshi, Kei
    Umeå University, Faculty of Social Sciences, Department of Informatics.
    Lindh Waterworth, Eva
    Umeå University, Faculty of Social Sciences, Department of Informatics.
    Häger-Ross, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    A conceptual framework for design of interactive computer play in rehabilitation of children with sensorimotor disorders2009In: Physical Therapy Reviews, ISSN 1083-3196, E-ISSN 1743-288X, Vol. 14, no 5, p. 348-354Article in journal (Refereed)
  • 19.
    Sandlund, Marlene
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Lindgren, Helena
    Umeå University.
    Pohl, Petra
    Umeå University.
    Melander-Wikman, Anita
    Bergvall-Kåreborn, Birgitta
    Lundin-Olsson, Lillemor
    Umeå University.
    Towards a Mobile Exercise Application to Prevent Falls: a Participatory Design Process2015In: Technology, Rehabilitation and Empowerment of People with Special Needs / [ed] Lena Pareto, Paul M Sharkey, Joav Merrick, Nova Science Publishers, Inc., 2015, p. 157-168Chapter in book (Refereed)
    Abstract [en]

    The digitalization of society is spreading around the world and technology has become part of many people’s daily lives. It acts as a means of communication, work, education and leisure. For populations with special needs (people with some kind of disability or disorder) technology can play an essential role in their rehabilitation and treatment. It also empowers the individuals themselves. The aim of this multi-disciplinary research for decades has been to explore, develop and evaluate innovative technology to aid people with disabilities through virtual reality and associated machinery. The field engages researchers from health sectors, areas of engineering and schools of education to collaborate in order to take on a holistic approach to meet these challenges.

  • 20.
    Sandlund, Marlene
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Lindgren, Helena
    Umeå University.
    Pohl, Petra
    Umeå University.
    Melander-Wikman, Anita
    Bergvall-Kåreborn, Birgitta
    Lundin-Olsson, Lillemor
    Umeå University.
    Towards a Mobile Exercise Application to Prevent Falls: a Participatory Design Process2016In: International Journal of Child Health and Human Development, ISSN 1939-5965, Vol. 9, no 3, p. 389-398Article in journal (Refereed)
    Abstract [en]

    In this cross-disciplinary project senior citizens and researchers participated in the collaborative design and development of a mobile exercise application to prevent falls. The methods Form-IT and Participatory and Appreciative Action and Reflection were applied in a series of workshops, facilitating the creation of new knowledge and a socio-technical platform for an end-user development process. The participation of the older adults was key to understanding the broad range of preferences and motivational aspects. The outcomes emerged into prototypes, which were composed using the ACKTUS platform for end-user development, resulting in a dynamic application, easily adaptable to future needs and studies.

  • 21.
    Sandlund, Marlene
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lindh Waterworth, Eva
    Umeå University, Faculty of Social Sciences, Department of Informatics.
    McDonough, Suzanne
    Häger-Ross, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Interactive games in motor rehabilitation for children with sensor motor disorders2007In: 2007 virtual rehabilitation, New York: IEEE conference proceedings, 2007, p. 78-78Conference paper (Refereed)
    Abstract [en]

    Interactive computer environments may be a good way to make motor practice more fun and motivating for children with sensorimotor disorders. However, appropriate computer environments that could be used for this purpose need to be systematically tested in rehabilitation settings in order to evaluate their impact on motor aspects as well as on motivation and activity levels. This abstract describes pilot data from an ongoing intervention study involving children diagnosed with cerebral palsy. The interactive environment used is the Sony's EyeToy system for PlayStation2. The intervention is evaluated through interviews as well as with activity monitoring and motor assessments, including 3D motion analysis. Here we will report pilot data based on the interviews.

  • 22.
    Sandlund, Marlene
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    McDonough, Suzanne
    Häger-Ross, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Interactive computer play in rehabilitation of children with sensorimotor disorders: a systematic review2009In: Developmental medicine and child neurology, ISSN 1469-8749, Vol. 51, no 3, p. 173-179Article in journal (Refereed)
    Abstract [en]

    The aim of this review was to examine systematically the evidence for the application of interactive computer play in the rehabilitation of children with sensorimotor disorders. A literature search of 11 electronic databases was conducted to identify articles published between January 1995 and May 2008. The review was restricted to reports of intervention studies evaluating the impact of interactive computer play on motor rehabilitation in children. For each study the quality of the methods and the strength of the evidence were assessed by two independent reviewers using the guidelines of the American Academy for Cerebral Palsy and Developmental Medicine. A total of 74 articles were identified, of which 16 met the inclusion criteria. Three studies were randomized controlled trials (RCTs) and half were case series or case reports. Areas investigated were movement quality, spatial orientation and mobility, and motivational aspects. Thirteen studies presented positive findings. Two of the three RCTs investigating movement quality and one level III study examining spatial orientation showed no significant improvements. Interactive computer play is a potentially promising tool for the motor rehabilitation of children but the level of evidence is too limited to assess its value fully. Further and more convincing research is needed.

  • 23.
    Sandlund, Marlene
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Pohl, Petra
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Ahlgren, Christina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Skelton, Dawn A.
    Melander-Wikman, Anita
    Bergvall-Kareborn, Birgitta
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Gender Perspective on Older People's Exercise Preferences and Motivators in the Context of Falls Prevention: A Qualitative Study2018In: BioMed Research International, ISSN 2314-6133, E-ISSN 2314-6141, article id 6865156Article in journal (Refereed)
    Abstract [en]

    Background: Several factors have previously been identified to positively influence the uptake and adherence for fall prevention exercise programmes. There is, however, a lack of studies investigating if men and women differ in their views and preferences for fall prevention exercises.

    Aim: To explore exercise preferences and motivators of older community-dwelling women and men in the context of falls prevention from a gender perspective.

    Methods: Workshops including multistage focus group discussions were conducted with 18 older community-dwelling people with and without history of falls. Participants were purposively selected and divided into two groups. Each group met on six occasions over a period of five months. Participatory and Appreciative Action and Reflection methodology was used to guide the discussions. A qualitative content analysis approach was used in the analysis.

    Results: Older participants had many diverse preferences and confirmed that individually tailored exercise, in terms of mode, intensity, challenge, and social context, is important. Moreover, important factors for exercise adherence and maintenance included the experience of individual confirmation; different spirit lifters to increase enjoyment; and personal tricks to maintain exercise routines. The individual differences within genders were more diverse than the differences between women and men.

    Conclusion: Exercise interventions to prevent falls should be individually tailored, based on the specific needs and preferences of the older participant, and do not appear to require gender specific approaches. To increase adherence, intrinsic motivation for exercise may be encouraged by competence enhancing confirmations, energizing spirit lifters, and practical tips for exercise maintenance. The study provides an awareness about women's and men's preferences for fall prevention exercises, and this information could be used as guidance in designing inclusive exercise interventions.

  • 24.
    Sandlund, Marlene
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Pohl, Petra
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Ahlgren, christina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Skelton, Dawn
    Glasgow Caledonian University.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Gender Perspective on Older People’s Preferences for Exercises in the Context of Falls Prevention: A qualitative studyManuscript (preprint) (Other academic)
    Abstract [en]

    The aim with this study was to explore the preferences of community-dwelling older women and men regarding exercise characteristics in the context of preventing falls. Multistage focus group discussions were conducted with 18 older community-dwelling people with or without a history of falls. Participants were purposively sampled, and divided into two groups. Each group met six times. Participatory and Appreciative Action and Reflection methodology was used to guide the discussions. A qualitative content analysis approach was used in the analysis. Six categories emerged from the analysis. Two categories were related to motives and barriers for uptake, and four categories were related to adherence and maintenance: exercise characteristics; confirmation; spirit lifters and maintenance tricks. Small differences and many similarities in what women and men perceived as motivating factors in an exercise situation were displayed. To conclude, older people have many diverse preferences regarding exercise in the context of preventing falls, and the individual differences within genders seem to be greater than the differences between men and women. Exercise interventions to prevent falls should be individually tailored based on the specific needs and preferences of the older participant. In order to encourage internalization and intrinsic motivation for exercises, autonomy-supportive approaches may be applied and accompanied by competence strengthening confirmations, energizing spirit lifters and practical tips for exercise maintenance

  • 25.
    Sandlund, Marlene
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Skelton, Dawn A.
    Pohl, Petra
    Ahlgren, Christina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Melander-Wikman, Anita
    Lundin-Olsson, Lillemor
    Gender perspectives on views and preferences of older people on exercise to prevent falls: a systematic mixed studies review2017In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 17, article id 58Article in journal (Refereed)
    Abstract [en]

    Background: To offer fall prevention exercise programs that attract older people of both sexes there is a need to understand both women's and men's views and preferences regarding these programs. This paper aims to systematically review the literature to explore any underlying gender perspectives or gender interpretations on older people's views or preferences regarding uptake and adherence to exercise to prevent falls. Methods: A review of the literature was carried out using a convergent qualitative design based on systematic searches of seven electronic databases (PubMed, CINAHL, Amed, PsycINFO, Scopus, PEDro, and OTseeker). Two investigators identified eligible studies. Each included article was read by at least two authors independently to extract data into tables. Views and preferences reported were coded and summarized in themes of facilitators and barriers using a thematic analysis approach. Results: Nine hundred and nine unique studies were identified. Twenty five studies met the criteria for inclusion. Only five of these contained a gender analysis of men's and women's views on fall prevention exercises. The results suggests that both women and men see women as more receptive to and in more need of fall prevention messages. The synthesis from all 25 studies identified six themes illustrating facilitators and six themes describing barriers for older people either starting or adhering to fall prevention exercise. The facilitators were: support from professionals or family; social interaction; perceived benefits; a supportive exercise context; feelings of commitment; and having fun. Barriers were: practical issues; concerns about exercise; unawareness; reduced health status; lack of support; and lack of interest. Considerably more women than men were included in the studies. Conclusion: Although there is plenty of information on the facilitators and barriers to falls prevention exercise in older people, there is a distinct lack of studies investigating differences or similarities in older women's and men's views regarding fall prevention exercise. In order to ensure that fall prevention exercise is appealing to both sexes and that the inclusion of both men and women are encouraged, more research is needed to find out whether gender differences exists and whether practitioners need to offer a range of opportunities and support strategies to attract both women and men to falls prevention exercise.

  • 26.
    Sandlund, Marlene
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Waterworth, Eva
    Umeå University, Faculty of Social Sciences, Department of Informatics.
    Häger-Ross, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Using motion interactive games to promote physical activity and enhance motor performance in children with cerebral palsy2011In: Developmental Neurorehabilitation, ISSN 1751-8423, E-ISSN 1751-8431, Vol. 14, no 1, p. 15-21Article in journal (Refereed)
    Abstract [en]

    Objective: To explore the feasibility of using low-cost motion interactive games as a home-based intervention for children with cerebral palsy (CP).

    Methods: Fourteen children with CP, 6–16 years old, practiced with the EyeToy for PlayStation2® in their homes during 4 weeks. Outcome measures were physical activity monitors, Movement Assessment Battery for Children-2 (mABC-2), Bruininks-Oseretsky Test of Motor Proficiency (sub-test 5 : 6), 1 Minute Walk Test and gaming diaries.

    Results: Motivation for practice and compliance of training were high. The children's physical activity increased during the intervention and activity monitors were feasible to use, although data loss may be a concern. According to mABC-2 the children's motor performance improved, but there were both floor and ceiling effects. The two additional motor tests showed only non-significant progress.

    Conclusion: It is highly feasible to use motion interactive games in home rehabilitation for children with CP. Specific motor effects need to be further explored.

1 - 26 of 26
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