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  • 1.
    Elgh, Eva
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Hu, Xiaolei
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Dynamic Trajectory of Long-Term Cognitive Improvement Up to 10 Years in Young Community-Dwelling Stroke Survivors: A Cohort Study2019In: Frontiers in Neurology, ISSN 1664-2295, E-ISSN 1664-2295, Vol. 10, article id 97Article in journal (Refereed)
    Abstract [en]

    Background and objective: The trajectories of long-term and domain-specific cognitive alterations over a decade after stroke are largely unknown. This study aims to investigate the dynamic alterations of domain-specific cognitive performance among young stroke survivors over 10 years after their first stroke.

    Methods: A prospective cohort study was carried out on 38 young stroke survivors (aged 18-65 at stroke onset) living in the community at 10 years after their first stroke. The cognitive outcomes were assessed repeatedly at 1 week, 7 months, and 10 years after their first stroke on the sub-domains: process speed (Symbol search and Coding from WAIS, TMT-A), visual attention (Bells test), visuospatial function (Block design from WAIS, RCFT), executive function (TMT-B, verbal fluency), verbal function [Letter fluency (FAS) from D-KEFS and CD], working memory (Digit Span from WAIS), immediate memory (RCFT and CD), and delayed memory (RCFT and CD). Global cognition was evaluated with Mini mental state examination at the two later time-points.

    Results: We found a delayed significant improvement of working memory with total recovery 10 years after participants' stroke. Visuospatial function recovered already at 7 months and remained stable at 10-year follow-up. Process speed demonstrated a significant decrease at 10 years compared to 7 months after stroke onset, a decrease which could be compensated by enhancements of other cognitive domains. No further deterioration was found in verbal function, immediate-, and delayed memory, and executive function during 10-year follow-up. Global cognition improved by on average two points between 7 months and 10 years. Education level and fatigue showed low to moderate positive correlations with cognitive improvements.

    Conclusions: The concordance of cognitive improvements between domain-specific and global cognitions strongly suggest that some young stroke survivors do improve their cognitive outcome over a 10-year period following their first stroke. This finding fills a gap of knowledge with respect to the dynamic trajectory of post-stroke cognition, with important implications in clinical practice.

  • 2.
    Ertzgaard, Per
    et al.
    Linköping University.
    Hu, Xiaolei
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Levi, Richard
    Linköping University.
    Förslag på kursämnen för rehabiliteringsmedicin: Socialstyrelsen2014Report (Other (popular science, discussion, etc.))
  • 3.
    Hellström, Thomas
    et al.
    Umeå University, Faculty of Science and Technology, Department of Computing Science. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. University Hospital of Northern Sweden, Umeå, Sweden.
    Lindahl, Olof
    Umeå University, Faculty of Medicine, Department of Radiation Sciences. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. University Hospital of Northern Sweden, Umeå, Sweden.
    Bäcklund, Tomas
    Umeå University, Faculty of Medicine, Department of Radiation Sciences. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. University Hospital of Northern Sweden, Umeå, Sweden.
    Karlsson, Marcus
    Umeå University, Faculty of Medicine, Department of Radiation Sciences. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. University Hospital of Northern Sweden, Umeå, Sweden.
    Hohnloser, Peter
    Umeå University, Faculty of Science and Technology, Department of Computing Science. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. University Hospital of Northern Sweden, Umeå, Sweden.
    Bråndal, Anna
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. University Hospital of Northern Sweden, Umeå, Sweden.
    Hu, Xiaolei
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. University Hospital of Northern Sweden, Umeå, Sweden; Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Sweden.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. University Hospital of Northern Sweden, Umeå, Sweden.
    An intelligent rollator for mobility impaired persons, especially stroke patients2016In: Journal of Medical Engineering & Technology, ISSN 0309-1902, E-ISSN 1464-522X, Vol. 40, no 5, p. 270-279Article in journal (Refereed)
    Abstract [en]

    An intelligent rollator (IRO) was developed that aims at obstacle detection and guidance to avoid collisions and accidental falls. The IRO is a retrofit four-wheeled rollator with an embedded computer, two solenoid brakes, rotation sensors on the wheels and IR-distance sensors. The value reported by each distance sensor was compared in the computer to a nominal distance. Deviations indicated a present obstacle and caused activation of one of the brakes in order to influence the direction of motion to avoid the obstacle. The IRO was tested by seven healthy subjects with simulated restricted and blurred sight and five stroke subjects on a standardised indoor track with obstacles. All tested subjects walked faster with intelligence deactivated. Three out of five stroke patients experienced more detected obstacles with intelligence activated. This suggests enhanced safety during walking with IRO. Further studies are required to explore the full value of the IRO.

  • 4.
    Hu, Xiao-Lei
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Apoptotic and necrotic cell death after photothrombotic ring stroke: characterization of a stroke model and its morphological and molecular consequences2003Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Cerebral ischemic cell death is a major cause of disability and death among stroke patients. The brain cell demise can occur through apoptosis or necrosis or as a continuum of both. This study aimed at establishing a dual setup of a photothrombotic ring stroke model and exploring its morphological and molecular consequences.

        Photothrombotic ring stroke was induced in adult male Wistar rats by a ring shaped laser irradiation beam (514.5nm, outer diameter 5mm, thickness 0.35 mm) for 120 seconds focused on the exposed intact skull bone with simultaneous intravenous infusion of the photosensitizer erythrosin B (17 mg/kg). By using otherwise identical experimental conditions, high intensity irradiation (1.94 W/cm2) resulted in consistent lack of reperfusion in the region at risk whereas low intensity irradiation (0.90 W/cm2) induced late spontaneous reperfusion. The morphological appearance of apoptotic and necrotic cells was demonstrated by H&E, TUNEL and Hoechst stainings under light microscopy, immunohistochemistry and electron microscopy. This was further confirmed by gel electrophoresis showing DNA laddering that coexisted with DNA smear. Cell counts revealed that apoptotic cells appeared earlier (at 24 h) and remained as long as the necrotic cells, that is up to 72 hours after ischemic onset in regions with severe CBF reduction. After low intensity irradiation, we observed early and widespread increased expression of the anti-apoptotic protein bcl-w and a prolonged elevation of Bcl-2 with unchanged pro-apoptotic Bax in mitochondria. In contrast, decreased bcl-w and Bcl-2 with scattered Bax remained after high intensity irradiation. Correspondingly, the release of the pro-apoptotic factor Smac/DIABLO from the mitochondria to the cytosol was more persistent in high- compared with low-intensity irradiation.   

        Apoptotic and necrotic cell death coexisted in the same regions at the same time after photothrombotic ring stroke induced by low- or high-intensity irradiation, where spontaneous morphological recovery or pannecrosis were evident in the region at risk. The ratios between Bcl-w, Bcl-2 and Bax may direct the translocation of Smac/DIABLO from the mitochondria to the cytosol and thereby influence cell death or survival after focal cerebral ischemia.

  • 5.
    Hu, Xiaolei
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Bedömning och handläggning av kognitiv nedsättning efter stroke2016Conference paper (Refereed)
  • 6.
    Hu, Xiaolei
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Evidensbaserade interventioner för nedre extremitet efter stroke2016Conference paper (Refereed)
  • 7.
    Hu, Xiao-Lei
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Bergström, Sven-Anders
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Brink, Mikael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Rönnbäck, Annica
    Karolinska Institute, Dept NVS, KI-Alzheimer Disease Research Center, KASPAC, Novum, SE-141 57 Huddinge, Sweden.
    Dahlqvist, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Enriched environment increases spinophilin mRNA expression and spinophilin immunoreactive dendritic spines in hippocampus and cortex2010In: Neuroscience Letters, ISSN 0304-3940, E-ISSN 1872-7972, Vol. 476, no 2, p. 79-83Article in journal (Refereed)
    Abstract [en]

    Housing rodents in an enriched environment (EE) induces structural and functional plasticity in the adult brain, including increased dendritic sprouting and number of dendritic spines. However, the molecular mechanisms behind EE-induced brain plasticity remain largely unknown. Circadian rhythm plays an important role in memory processing but the neurobiological mechanisms of how circadian rhythm affects memory and brain plasticity remain controversial. In the current study, we studied the expression of spinophilin, a protein highly enriched in dendritic spines and involved in spine morphology and synaptic plasticity, to examine the effects of EE and circadian rhythm in rats housed in EE for different periods of time. Spinophilin mRNA expression was studied by in situ hybridization and the density of spinophilin immunoreactive puncta was quantified after immunohistochemical staining. Compared to rats living in a deprived environment (DE), we found a transient increase in the density of spinophilin immunoreactive puncta in hippocampus and cortex after 1 week of EE housing and persistent elevations of spinophilin mRNA expression during 1-4 weeks of environmental enrichment. Increased spinophilin expression was found during the light phase of the diurnal cycle, but not the dark phase. Thus, enriched housing altered the diurnal variation in spinophilin mRNA expression, suggesting that circadian modulation is likely to be important for experience dependent plasticity. The current results suggest a possible role for spinophilin in neuronal plasticity induced by environmental enrichment, but further studies are needed to establish a cause-effect relation.

  • 8.
    Hu, XiaoLei
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Brännström, Thomas
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Gu, Weigang
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    A photothrombotic ring stroke model in rats with or without late spontaneous reperfusion in the region at risk1999In: Brain Research, ISSN 0006-8993, E-ISSN 1872-6240, Vol. 849, no 1-2, p. 175-186Article in journal (Refereed)
    Abstract [en]

    This study aimed at developing a dual setup of the photothrombotic ring stroke model with or without late spontaneous reperfusion in the region at risk and to explore the morphological consequences. The exposed crania of adult male Wistar rats were subjected to a ring-shaped laser-irradiation beam (o.d. 5.0 mm, 0.35 mm thick) for 2 min simultaneously with intravenous erythrosin B (17 mg/kg) infusion. Transcardial carbon-black perfusion revealed that a laser intensity of 0.90 W/cm(2) resulted in late, that is, starting at 72 h, spontaneous reperfusion, whereas the lowest laser intensity that produced lack of reperfusion at 7 days post-irradiation was 1.84 W/cm(2). Laser-Doppler flowmetry showed prompt cortical cerebral blood flow (cCBF) reduction both in the ring lesion and region at risk (12% and 25% of control values) after high-intensity irradiation; these reduced flow values were more rapid and pronounced than in the low-intensity irradiation setup as previously shown. The high- compared with low-intensity irradiation setup produced more frequent occurrence of thrombi in the ring-lesion region and a larger ischemic cortical lesion with a more rapid pace of ischemic cellular changes in the ring-lesion region and the region at risk. The region at risk transformed into pannecrosis in the high-intensity, but recovered morphologically in the low-intensity irradiation setup. This dual photothrombotic setup with or without spontaneous reperfusion enables the study of events related to ischemic cell survival or death in an anatomically predefined region at risk.

  • 9.
    Hu, Xiaolei
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Heyn, Patricia C.
    Schwartz, Jaclyn
    Roberts, Pamela
    What is mild stroke?2017In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 98, no 11, p. 2347-2349Article, review/survey (Refereed)
  • 10.
    Hu, Xiaolei
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Heyn, Patricia C.
    Schwartz, Jaclyn
    Roberts, Pamela
    What Is Mild Stroke?2017In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 98, no 11, p. 2347-2349Article in journal (Refereed)
  • 11.
    Hu, XiaoLei
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Johansson, Inga-Maj
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology.
    Brännström, Thomas
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Olsson, Tommy
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Long-lasting neuronal apoptotic cell death in regions with severe ischemia after photothrombotic ring stroke in rats2002In: Acta Neuropathologica, ISSN 0001-6322, E-ISSN 1432-0533, Vol. 104, no 5, p. 462-70Article in journal (Refereed)
    Abstract [en]

    Apoptotic and necrotic cell death may act in concert in focal cerebral ischemia. This study explored the temporal and spatial pattern of apoptosis and necrosis in a novel photothrombotic ring stroke model with or without spontaneous reperfusion. Adult male Wistar rats were subjected to a ring-shaped laser irradiation beam simultaneously with intravenous erythrosin B infusion. The presence and attributes of apoptosis and necrosis in the anatomically well-defined cortical region at risk and ring-lesion region were verified under light microscopy with TUNEL, Hoechst 33342, and hematoxylin and eosin staining. Cells exhibiting apoptotic morphology with chromatin condensation and apoptotic bodies and necrotic ghost appearance were observed. The occurrence of apoptosis and necrosis in the ischemic regions was confirmed by electron microscopy and gel electrophoresis, in which DNA isolated from the lesion area revealed both a ladder and a smear. Double staining with TUNEL and the cell markers NeuN, glial fibrillary acidic protein, and ED-1 revealed that the majority of apoptotic cells were of neuronal origin. Cells exhibiting pyknosis/eosinophilia, apoptosis, or ghost appearance were quantified by stereological means. In subregions with severe ischemia, the peak appearance of apoptotic cells started earlier, i.e., at 24 h, than the peak of necrotic cells, and the high concentration of the apoptotic cells remained as long as that of necrotic cells, i.e., until 72 h post-ischemia. The ratio of apoptotic to necrotic cells was approximately 1:2. Therefore, apoptosis may be an important contributor to neuronal cell death in brain regions with severely reduced blood flow after thrombo-embolic stroke.

  • 12.
    Hu, Xiao-Lei
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Olsson, Tommy
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Johansson, Inga-Maj
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Brännström, Thomas
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology. Umeå Stroke Centre, Umeå University Hospita.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Dynamic changes of the anti- and pro-apoptotic proteins Bcl-w, Bcl-2, and Bax with Smac/Diablo mitochondrial release after photothrombotic ring stroke in rats2004In: European Journal of Neuroscience, ISSN 0953-816X, E-ISSN 1460-9568, Vol. 20, no 5, p. 1177-1188Article in journal (Refereed)
    Abstract [en]

    The anti‐apoptotic proteins Bcl‐w and Bcl‐2 and the pro‐apoptotic protein Bax may mediate cell death or survival via regulation of the mitochondria including second mitochondria‐derived activator of caspase (Smac)/direct inhibitor of apoptosis protein (IAP)‐binding protein with low pI (DIABLO) release. This study aimed to explore alterations in Bcl‐w, Bcl‐2, and Bax and the relationship between these proteins and Smac/DIABLO by means of in situ hybridization, immunohistochemical (IHC) staining, and Western blots after low‐ and high‐intensity photothrombotic ring stroke. At 4 h after low‐intensity irradiation, we found widespread bcl‐w overexpression on both the mRNA and protein levels in the bilateral cortex except the ring lesion region and in subcortical regions. A prolonged elevation of Bcl‐2 with relatively unchanged Bax in the mitochondrial fraction was demonstrated from 4 to 72 h. These upregulated anti‐apoptotic proteins combined with little Smac/DIABLO release might be associated with increased cell survival and thereby remarkable morphological recovery after low‐intensity irradiation. After high‐intensity irradiation, we observed decreased bcl‐w and bcl‐2 mRNA with increased Bcl‐2 protein in the cytosolic fraction, whereas the Bax protein remained in scattered ischaemic cells in the ring lesion and the region at risk that corresponded with release of Smac/DIABLO from mitochondria to the cytosol at 1–24 h. These changes might be related to the massive cell death observed after high‐intensity irradiation. Taken together, the balance and the location of anti‐apoptotic proteins vs. pro‐apoptotic proteins could be associated with the translocation of Smac/DIABLO from the mitochondria to the cytosol and therefore closely related to cell death or survival after focal cerebral ischaemia.

  • 13.
    Hu, Xiao-Lei
    et al.
    Neurorehab, Neuro-Huvud-Hals Centrum / Norrlands Universitetssjukhus.
    Stibrant Sunnerhagen, Katharina
    Stroke, rehabilitering2018Other (Refereed)
  • 14.
    Hu, Xiao-Lei
    et al.
    Neurorehab, Neuro-Huvud-Hals Centrum / Norrlands Universitetssjukhus.
    Stibrant Sunnerhagen, Katharina
    Stroke, rehabilitering2018Other (Refereed)
  • 15.
    Hu, Xiaolei
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Brännström, Thomas
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Watson, Brant D.
    Cerebrovascular Disease Research Center, Departments of Neurology and Biomedical Engineering, University of Miami, Miami, FL 33101, USA.
    Gu, WeiGang
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Progressive and reproducible focal cortical ischemia with or without late spontaneous reperfusion generated by a ring-shaped, laser-driven photothrombotic lesion in rats2001In: Brain Research Protocols, ISSN 1385-299X, E-ISSN 1872-809X, Vol. 7, no 1, p. 76-85Article in journal (Refereed)
    Abstract [en]

    Clinical stroke is mostly of thromboembolic origin, in which the magnitude of brain damage resulting from arterial occlusions depends on the degree and duration of the concomitant ischemia. To facilitate more controllable and reproducible study of stroke-related pathophysiological mechanisms, a photothrombotic ring stroke model was initially developed in adult rats. The ring interior zone comprises an anatomically well confined cortical region-at-risk which is gradually encroached by progressive hypoperfusion, thus mimicking the situation (albeit in inverse fashion) of an ischemic penumbra or stroke-in-evolution. Modification of this model using a thinner ring irradiation beam resulted in late spontaneous reperfusion in the cortical region-at-risk and a remarkable morphological tissue recovery in this ostensibly critically injured region. On the other hand, doubling the thin irradiating beam intensity facilitates a complementary situation in which lack of reperfusion in the region-at-risk after stroke induction leads to tissue pannecrosis. The dual photothrombotic ring stroke model, effectuated either with or without reperfusion and thereby tissue recovery or pannecrosis, may be well suited for the study of events related to postischemic survival or cell death in the penumbra region. To popularize the photothrombotic ring stroke model, we present a detailed protocol of how this model is induced in either version as well as protocols for transcardial carbon black perfusion and laser-Doppler flowmetry experiments.

  • 16.
    Hu, Xiao-Lei
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. Neurocentrum, NUS.
    Wester, Per
    Stibrant Sunnerhagen, Katharina
    Rehabilitering efter stroke - Socialstyrelsens strokeriktlinjer medför nya utmaningar2018In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, no 51-52, article id FDIXArticle in journal (Refereed)
    Abstract [en]

    Stroke rehabilitation has often been based on tradition instead of evidence-based methods in the clinical practice. The recently updated Swedish national stroke guidelines have emphasized the amount of evidence-based stroke rehabilitation that is expected to be implemented in clinical practice. The most important recommendations in regarding stroke rehabilitation are the early support discharge, a structured follow-up at the subacute stage for identifying unmet rehabilitation needs and high intensity task-specific training from early to chronic phases.  Meanwhile, we have to use the resource in a most cost-effective ways, such as a newly developed Rehab-Compass, group education for patients and caregivers ("stroke school") and sufficient number of employees of different occupational groups including rehab-assistants, to provide stroke survivors more evidence-based rehabilitation. These inputs will not only improve quality of stroke care but also save the medical and community resource in the near future.

  • 17. Kim, Sonya
    et al.
    Mortera, Marianne
    Hoffecker, Lilian
    Herrold, Amy
    King, Laurie
    Terhorst, Lauren
    Hu, Xiaolei
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Shilpa, Krishnan
    Machtinger, Joseph
    Heyn, Patricia
    An Umbrella Review of Systematic Reviews of Pharmacological Treatments Post-TBI2017In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 98, no 10, p. 142-Article in journal (Refereed)
  • 18. Kim, Sonya
    et al.
    Mortera, Marianne
    Hu, Xiao-Lei
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Krishnan, Shilpa
    Hoffecker, Lilian
    Herrold, Amy
    Terhorst, Lauren
    King, Laurie
    Machtinger, Joseph
    Zumsteg, Jennifer M.
    Negm, Ahmed
    Heyn, Patricia
    Overview of pharmacological interventions after traumatic brain injuries: impact on selected outcomes2019In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 33, no 4, p. 442-455Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to conduct an overview of systematic reviews (SRs) to appraise the published evidence related to pharmacological interventions after traumatic brain injury (TBI). Searches were conducted with Medline, Embase, PsycINFO, Web of Science, PubMed. 780 retrieved SRs underwent a two-level screening to determine inclusion. Data extracted included participant characteristics, TBI severity, study design, pharmacological interventions, and outcomes. SRs were assessed for methodological quality by using the AMSTAR measurement tool. After removing duplicates, 166/780 SRs published between 1990-2017 were reviewed, 62 of which met inclusion criteria. More than 90 drugs and 22 substance-classes were extracted. Most medications were administered during the acute stage. Mild TBI was included in 3% of the SRs. Physiological outcomes comprised 45% of the SRs, primarily mortality. Activities of daily living (ADLs) outcomes constituted 22% of the SRs followed by cognition (13%) and psychological/behavioral outcomes (13%). Only 7% of the SRs assessed adverse events. Inconsistencies in definitions, methods, and heterogeneity of instruments used to measure treatment response were noted. Only a third of the SRs had high methodological quality. Most SRs had heterogeneous TBI samples, outcomes, or methodologies making it difficult to synthesize findings into recommended guidelines. This study demonstrated a need for adequately powered and rigorous randomized clinical trials (RCTs) to provide generalizable evidence on the effectiveness of pharmacologic interventions for TBI. PROSPERO Registration: CRD42015017355.

  • 19.
    Magaard, Gustaf
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine. Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Levi, Richard
    Lindvall, Peter
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience.
    Gustafsson, Emma
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Nazemroaya Sedeh, Arzhang
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Lönnqvist, Malin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Berggren, Stina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Nyman, Kristin
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience.
    Hu, Xiao-Lei
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Neurocentrum, NUS.
    Identifying unmet rehabilitation needs in patients after stroke with a graphic rehab-compassTM2018In: Journal of Stroke & Cerebrovascular Diseases, ISSN 1052-3057, E-ISSN 1532-8511, Vol. 27, no 11, p. 3224-3235Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Unmet rehabilitation needs are common among stroke survivors. We aimed to evaluate whether a comprehensive graphic "Rehab-Compass," a novel combination of structured patient-reported outcome measures, was feasible and useful in facilitating a capture of patients' rehabilitation needs in clinical practice.

    METHODS: A new graphic overview of broad unmet rehabilitation needs covers deficits in functioning, daily activity, participation, and quality of life. It was constructed by using 5 patient-oriented, well-validated, and reliable existing instruments with converted data into a 0 (worst outcome) to 100 (best outcome) scale but unchanged in terms of variable properties. Satisfaction of the Rehab-CompassTM was studied by a qualitative interview of 9 patients with stroke and 3 clinicians. Practical feasibility and capacity of the instrument were evaluated in a cross-sectionalstudy with 48 patients at 5-month follow-ups after subarachnoid hemorrhage.

    RESULTS: The Rehab-CompassTM identified and graphically visualized a panoramic view of the multidimensional needs over time which was completed before clinical consultation. The Rehab-CompassTM appeared to be feasible and time-efficientin clinical use. The interviews of both patients and clinicians showed high satisfaction when using the Rehab-CompassTM graph. In the studied stroke patients, the Rehab-CompassTM identified memory and processing information, fatigue, mood, and pain after subarachnoid hemorrhage as the most common problems.

    CONCLUSIONS: The graphic Rehab-CompassTM seems to be a feasible, useful, and time-saving tool for identification of unmet rehabilitation needs among stroke survivors in clinical practice. Further research is needed to make the Rehab-CompassTM more concise and evaluate the instrument among different stroke subgroups.

  • 20. Schwartz, Jaclyn
    et al.
    Thomas, Lauren
    Belagaje, Samir
    Hu, Xiao-Lei
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Salinas, Paige
    Terrill, Alexandra
    STROKE HOT TOPICS: Addressing Mental Health in Stroke Rehabilitation2018Conference paper (Refereed)
    Abstract [en]

    After the stroke, as many as 70% of people will find that they have also developed a mental health condition, such as depression, fatigue, and anxiety. Unfortunately, mental health is not commonly addressed as part of the typical rehabilitation for people with stroke. In this hot topic session, we will discuss the benefits and barriers to addressing mental health as part of stroke rehabilitation with an interdisciplinary panel of experts. Attendees with leave with evidence-based, client-centered, recovery-oriented strategies to help them evaluate and treat mental health in people with stroke.

    Learning Objectives:

    • Describe common mental health concerns in patients with stroke
    • Understand the benefits and barriers for addressing mental health as part of regular stroke rehabilitation
    • Describe best-practices to improve the mental health of persons with stroke
  • 21. Sood, Pallavi
    et al.
    Kletzel, Sandra L.
    Krishnan, Shilpa
    Devos, Hannes
    Negm, Ahmed
    Hoffecker, Lilian
    Machtinger, Joseph
    Hu, Xiao-Lei
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Neurocentrum, NUS.
    Heyn, Patricia C.
    Nonimmersive Brain Gaming for Older Adults With Cognitive Impairment: A Scoping Review2019In: The Gerontologist, ISSN 0016-9013, E-ISSN 1758-5341Article in journal (Refereed)
    Abstract [en]

    Background: Technological advances have allowed a variety of computerized cognitive training tools to be engineered in ways that are fun and entertaining yet challenging at a level that can maintain motivation and engagement. This revolution has created an opportunity for gerontological scientists to evaluate brain gaming approaches to improve cognitive and everyday function. The purpose of this scoping review is to provide a critical overview of the existing literature on nonimmersive, electronic brain gaming interventions in older adults with mild cognitive impairment or dementia.

    Research Design and Methods: Systematic search was conducted using 7 electronic databases from inception through July 2017. A comprehensive 2-level eligibility process was used to identify studies for inclusion based on PRISMA guidelines.

    Results: Seventeen studies met eligibility criteria. Majority of the studies were randomized controlled trials (n = 13) and incorporated an active control (n = 9). Intervention doses ranged from 4 to 24 weeks in duration with an average of 8.4 (±5.1 standard deviation [SD]) weeks. Session durations ranged from 30 to 100 min with an average of 54 (±25 SD) minutes. Nearly half of studies included a follow-up, ranging from 3 months to 5 years (n = 8). For most studies, brain gaming improved at least one cognitive outcome (n = 12); only one study reported improvement in activities of daily living.

    Discussion and Implications: This scoping review conveys the breadth of an emerging research field, which will help guide future research to develop standards and recommendations for brain gaming interventions which are currently lacking.

  • 22.
    Vuagnat, Hubert
    et al.
    Geneva university Hospitals woundcare centre, Generva, Swiss.
    Zaslaer, Nathan
    Concussion Care Centre of Virginia, Ltd. Virginia, USA.
    Nguyen, Vu
    Carolinas Rehabilitation Charlotte, North Carolina, USA.
    Hu, Xiaolei
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Symposium Sexuality and neurorehabilitation2016Conference paper (Refereed)
    Abstract [en]

    Body of abstract:

    As ancient as our origins, human sexuality and sexual health are typically important components of a fulfilled life.  The aim of the rehabilitation process should ideally be to permit the individual to attain independence, self-determination and full inclusion and participation in all aspects of life.  Sexuality can be adversely impacted by neurological disease and therefore must be addressed in the context of interdisciplinary neurorehabilitation and community transition.  Often times, the rehabilitation process inadequately addresses sexuality and/or sexual health concerns due to sociocultural mores and taboos, lack of training and education, and/or propensities to assume other will address this topic which many professionals, patients and families may find uncomfortable to discuss.  With a team of international specialists, this symposium’s aim will be to facilitate introspection regarding the topics of sexuality and sexual health in the neurorehabilitation process, as well as promote better practice on this topic through three main objectives.

     

     

    Human sexuality and sexual health are typically important components of a fulfilled life. They can be negatively impacted by neurological disease. As the aim of the rehabilitation process should ideally be to permit the individual to attain independence, self-determination and full inclusion and participation in all aspects of life, sexuality should therefore be addressed in the context of interdisciplinary neurorehabilitation and community transition. Due to sociocultural mores and taboos, lack of training and education this process is often inadequately addressed. The symposium will address this topic to facilitate introspection regarding the topics of sexuality and sexual health in the neurorehabilitation process and promote better practice on this topic.

     

    Learning Objectives

     

    1. Assessing the need for sexuality and sexual health intervention through interdisciplinary assessment across the rehabilitation continuum
    2. Exploring the neuroanatomy and associated impairments in sexual function following brain injury/insult
    3. Addressing current knowledge on patient’s assessment, treatment and management
    4. Pointing out deficiencies in sexual health and sexuality education for patients with neurodisabilities in acute and community-based rehabilitation and long term care settings

     

     

    Hubert Vuagnat, MD                              12 min.                   Sexuality: a need during and after rehabilitation

    Nathan Zasler, MD 12 min.                   Neuroanatomy and associated impairments in sexual function following brain                                                                                                                      injury/insult.

    Vu Nguyen, MD       12 min.                   Sexuality alteration in common neurological diseases

    Xiaolei Hu, MD, Ph.D                              12 min.                   Basic patient assessment with knowledge on current management

    All, roundtable         12 min.                   Addressing the deficiencies in everyday life, long term care settings and the lack                                                                                                              of training regarding sexuality

    Public                                                         15 min                    Questions and answers

     

    Symposium developed in collaboration with: Caron Gan, RN, RMFT and Alexander Moreno, PhD (who will not be able to attend)

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